Putting the Fragments Together (Sociological/Psychological Questionnaire)

PROPERTY OF B.O.I.S.D. (BOARD OF INVESTIGATION OF THE SUDDEN DEPARTURE)

**PLEASE NOTE: THIS IS A PRELIMINARY DRAFT TO BE APPROVED BY THE BIPARTISAN RESEARCH GROUP, B.O.I.S.D.,  APPOINTED BY THE GOVERNMENT OF THE UNITED STATES OF AMERICA. DO NOT ALTER OR DAMAGE.**

DETAILS OF THE DEPARTED

NAME:

DATE OF BIRTH:

SEX:

RACE:

GENDER IDENTITY:

OCCUPATION:

QUESTIONNAIRE

EMPLOYEE, please note that you are only to circle ONE answer for each question. This will help determine the most accurate data for our research. When a WRITTEN answer is required, print legibly and to the specifications of the interviewee. Thank you.

RELIGION

1. To your knowledge, was the Departed religious?

YES NO

2. Which faith/belief most accurately represents their beliefs?

CHRISTIANITY JUDAISM ISLAM HINDUISM AGNOSTIC ATHEIST

BUDDHISM FOLK RELIGION OTHER: _______________

3. To your knowledge, did the Departed regularly attend religious services?

4. If yes, how regularly?

DAILY WEEKLY MONTHLY BIANNUALLY ANNUALLY

5. To your knowledge, was the Departed an extremist in regards to religion?

YES NO

POLITICAL/ECONOMIC

1. Which political party did the Departed most commonly identify with?

DEMOCRAT REPUBLICAN    INDEPENDENT SOCIALIST NO PREFERENCE

2. Did the Departed vote our current President into office?

YES NO

3. What is the most accurate description of the Departed’s political beliefs? Be brief but comprehensive.

4. What is the Departed’s last known financial status? Be brief but comprehensive.

5. Did the Departed have one or more of the following:

401K PLAN    PENSION    IRA      403B PLAN    SEP PLAN   SARSEP PLAN  

ESOP       PROFIT-SHARING PLAN 457 PLAN MONEY PURCHASE PLAN

6. Was the Departed invested in the stock market?

YES         NO

7. Was the Departed invested in any venture, business, company, corporation, etc.?

YES         NO

8. Was the Departed in any sort of debt?

YES         NO

9. Did the Departed support President Obama’s OBAMACARE plan?

YES         NO

10. Did the Departed complete and pay for local and federal taxes each calendar year?

YES         NO

HEALTH

1. Did the Departed have any allergies?

YES        NO

2. Did the Departed have any previously existing medical condition(s)?

YES        NO

3. If yes, please briefly describe their condition:

4. Did the Departed have any issues with mental health?

YES      NO

5. If yes, please briefly describe their condition:

6. Did the Departed ever display any suicidal tendencies?

YES           NO

7. Was the Departed ever hospitalized for longer than a week?

YES      NO

8. If yes, please briefly describe the situation:

9. Was the Departed in any way physically or mentally impaired?

YES       NO

10. If yes, please briefly describe their condition:

SOCIAL

1. Was the Departed in a long term, monogomous relationship?

YES        NO

2. Was the Departed socially healthy?

YES        NO

3. Where did the Departed go to be social? Be brief but comprehensive.

4. Was the Departed a social drinker?

YES NO

5. Did the Departed maintain social connections in the workplace?

YES                NO

6. Please list the top five social outings the Departed most enjoyed:

a.

b.

c.

d.

e.

7. Did the Departed maintain an appreciation for the arts (theatre, music, artwork, dance, etc.?)

YES NO

8. Was the Departed ever in an unhealthy relationship?

YES            NO

9. Was the Departed ever bullied or intimidated socially?

YES NO

10. Did the Departed enjoy their social life?

YES            NO

**TO BE CONTINUED AND EDITED. PLEASE DO NOT REMOVE FROM THE OFFICES OF B.O.I.S.D.**