Article Number 04AAPI01-05
QUESTIONNAIRE PREPARED BY:
DATE:
SITE LOCATION:
CONTACT FOR SITE:
CONTACT INFORMATION:
Name of Interviewee:
Phone / Fax / Mobile:
Phone / Fax / Mobile:
Address:
1.What is the relationship of the witness to the site?
(Occupant, owner, etc.)
2.Occupation or profession:
3.Education Level:
Less than high school ?
GED or high school ?
Some college ?
College graduate (BA / BS / AA-Certificate)
Degree: _____
Some graduate studies Field of study: _____
Masters Degree:
Post Graduate Studies: Field of study:
Doctorate:
4.Sex: Male Female
5.Age:
6.What is your religion/faith base:
7.Were you taking any prescription or recreational drugs at the time of the
occurrence: Y N
8.Were you alone at the time of the occurrence: Y N
If no, who was with you:
9.What was the time and date of the occurrence:
10.What was the location of the occurrence:
11.How long have you occupied this location:
ADDITIONAL NOTES:
1.Age of site:
2.How many previous owners:
3.History of site: (tragedies, deaths, previous complaints):
4.Type of site: (Rural/Open land/Burial site/Cemetary/ Industrial building/Barn/Single Family Home/ Town home/Apartment/Other-please explain)
5.How many occupants at the site:
Names, ages and sexes of all residents:
Name: Age: Sex:
Name: Age: Sex:
Name: Age: Sex:
Name: Age: Sex:
Name: Age: Sex:
6.How long have you occupied the site:
7.How many rooms in the site:
8.Has there been any recent remodeling:
9.Any occupants on medication:
10.Any occupants using illegal drugs:
11.Any occupants drink alcohol heavily:
12.Any occupants interested in the occult: (Ouija, séances, psychics,
spells)
13.Any occupants currently seeing a psychiatrist:
14.Have any religious clergy been consulted:
15.Has the location been blessed:
16.Has there been any media involvement:
17.Have there been any other witnesses besides the occupants:
18.Have there been any odors: (perfumes, flowers, sulfur, excrement)
19.Have there been any sounds: (footsteps, knocks, banging)
20.Have there been any voices: (whispering, yelling, crying, speaking)
21.Has there been any movement of objects:
22.Has there been any levitations:
23.Have there been any uncommon cold or hot spots:
24.Have there been any problems with electrical appliances: (TV, lights, kitchen appliances, doorbells)
25.Have there been any problems with plumbing: (leaks, flooding, sinks, toilet bowls)
26.Any occupants having nightmares or trouble sleeping:
27.Have there been any physical attacks:
28.Are pets affected:
29.When was the first occurrence of the phenomena:
30.Describe what happened:
31.What was the witnesses reaction during the phenomena:
32.How long was the duration of the phenomena:
33.Who first witnessed the phenomena:
34.Were there any other witnesses: Y N
Name Relationship Contact Information
35.What time was the first occurrence of the phenomena:
36.How often does the phenomena occur:
37.Do the occupants feel the phenomena is threatening: Y N
38.What do the occupants believe is happening: (is it supernatural)
39.Do all of the occupants agree on what is happening or do they think it’s nonsense:
SIGNATURE OF INTERVIEWEE: DATE:
SIGNATURE OF INTERVIEWER: DATE:
American Association of Paranormal Investigators
INTERVIEWIEE’S ACCOUNT:
INTERVIEWER’S NOTES AND IMPRESSIONS:
TEAM ASSESSMENT AND FINDINGS:
RESEARCH AND HISTORY:
