Tobacco-free Retailers Survey

We would appreciate it if you could complete the Tobacco-free Retailer Survey with the retailer. The information in this survey will form part of a national database that will help provide robust evidence for future research.

Having a centralised database of all tobacco-free retailers will provide an overview of the number and type of tobacco-free retailers throughout the country and their reasons for making this decision.

The survey can also help you gather information to support possible media opportunities.

When you have completed the Tobacco-free Retailer Survey, please scan and email to or enter detail directly into survey form below.



Tobacco-free Retailers information
Retailers survey
Type of retailer
What was the main reason you decided to stop selling tobacco?
To what extent do you agree with the following statement: 'I would recommend other retailers to consider stopping selling tobacco'?
Do you agree to be contacted at a later date to discuss your experience of not selling tobacco?
Would you be interested in joining an internet group for retailers who have stopped selling tobacco?
Would you be willing for a photo of your shop to be taken for publicity purposes?
Media coverage (if any)
Do you agree to have your shop listed on the tobacco-free retailer website? (business name and address)