\documentclass[11 pt,a4paper]{report}
\usepackage[utf8]{inputenc}
\usepackage[T1]{fontenc}

%
% QUESTIONNAIRE
\usepackage[survey]{automultiplechoice}
\AMCtext{message}{}
\AMCtext{draft}{}
%
%
% START DOCUMENT
\begin{document}
%
% START QUESTIONNAIRE
\begin{Questionnaires}{1}
\parindent0pt
%
% ---------------------------
% Question 1
% question text
\textbf{Question 1: Does the shop in which you work belong to a capitalist or to a limited company?}
%
\vskip5mm

% select oval answer boxes
\AMCboxStyle{shape=oval}
%
% single-choice format 
\begin{variable-single}{capitalist}{99}
	\begin{values}
		\answer{Capitalist \dotfill}{0,3}{vallab-sc}{checkbox-sc}\scoring{b=3}
		\answer{Limited company \dotfill}{0,2}{vallab-sc}{checkbox-sc}\scoring{b=2}
		\answer{Don’t know \dotfill}{0,1}{vallab-sc}{checkbox-sc}\scoring{b=1}
	\end{values}
\end{variable-single} 

\vskip10mm

% ---------------------------
% Question 2
% question text
\textbf{Question 2: What is the youngest age at which children are taken on?}
%
\vskip5mm
%
% single-choice format horizontal
\begin{variable-single}{children}{99}
	% connected answer boxes
	\draw[dotted]
		(.2,-.8) -- (9,-.8);
	% answer options
	\begin{values}
		\answer{< 13 \\ years}{0,0}{vallab-sc, font=\footnotesize, align=center, text width=10mm}{checkbox-sc, below=of lab\thecsvrow}\scoring{b=7}
		\answer{13 \\ years}{1.25,0}{vallab-sc, font=\footnotesize, align=center, text width=10mm}{checkbox-sc, below=of lab\thecsvrow}\scoring{b=6}
		\answer{14 \\ years}{2.5,0}{vallab-sc, font=\footnotesize, align=center, text width=10mm}{checkbox-sc, below=of lab\thecsvrow}\scoring{b=5}
		\answer{15 \\ years}{3.75,0}{vallab-sc, font=\footnotesize, align=center, text width=10mm}{checkbox-sc, below=of lab\thecsvrow}\scoring{b=4}
		\answer{16 \\ years}{5,0}{vallab-sc, font=\footnotesize, align=center, text width=10mm}{checkbox-sc, below=of lab\thecsvrow}\scoring{b=3}		
		\answer{> 16 \\ years}{6.25,0}{vallab-sc, font=\footnotesize, align=center, text width=10mm}{checkbox-sc, below=of lab\thecsvrow}\scoring{b=2}				
		\answer{Don't \\ know}{9,0}{vallab-sc, font=\footnotesize, align=center, text width=10mm}{checkbox-sc, below=of lab\thecsvrow}\scoring{b=1}						
	\end{values}
\end{variable-single} 

\vskip10mm

% ---------------------------
% Question 3
% question text
\textbf{Question 3: Is the shop in a town or in a village?}
%
\vskip5mm
%
% single-choice format with filter instructions
\begin{variable-single}{local}{99}
	% answer options
	\begin{values}
		\answer{Town \dotfill}{0,1}{vallab-sc}{checkbox-sc}\scoring{b=2}
		\answer{Village \dotfill}{0,0}{vallab-sc}{checkbox-sc}\scoring{b=1}
	\end{values}
	% filter instructions
	\node[minimum width=25mm, font=\footnotesize] at (5.75,1) {Go on with question 5};
	\node[minimum width=25mm, font=\footnotesize] at (5.75,0) {Go on with question 4};
	% arrows
	\draw[->] (2.75,1) -- (4,1);
	\draw[->] (2.75,0) -- (4,0);
\end{variable-single} 

\vskip10mm

% ---------------------------
% Question 4
% question text
\textbf{Question 4: If your shop is in the country, is there sufficient work in the factory for your existence, or are you obliged to combine it with agricultural labor?}
%
\vskip5mm
%
% single-choice format
\begin{variable-single}{existence}{99}
	% answer options
	\begin{values}
		\answer{Sufficient work in the factory \dotfill}{0,1}{vallab-sc, text width=6.5cm}{checkbox-sc}\scoring{b=2}
		\answer{Combine it with agricultural labor \dotfill}{0,0}{vallab-sc, text width=6.5cm}{checkbox-sc}\scoring{b=1}
	\end{values}
\end{variable-single} 

\vskip10mm

% ---------------------------
% Question 5
% question text
\textbf{Question 5: Are safety measures to prevent accidents applied to the engine, transmission and machinery?} \textit{Please select all that apply!}
%
\vskip5mm
%
\AMCboxStyle{shape=square}
%
% multiple-choice format
\foreach \label [count=\num from 1] in {engine, transmission, machinery}{
	\begin{variable-multi}{safety\num}{\label \dotfill}{varlab-mc}{99}
		\begin{values}
			\answer{}{2.5,0}{vallab-mc}{checkbox-mc}\scoring{b=1}
		\end{values}
	\end{variable-multi}
}

\pagebreak 

% ---------------------------
% Question 6
% 
% reset question counter
\setcounter{AMCquestionaff}{6}
%
% question text
\textbf{Question 6: How satisfied are you with the hygienic conditions in the workshop regarding the following aspects?} \textit{Please select one answer for each row!}
%
\vskip5mm
%
% matrix/grid format
%
% first row with scale
\begin{variable-multi}{hyg1}{Size of the room space \dotfill}{varlab-mc}{99}
	\begin{values}
		% connected answer boxes
		\draw[double, thick] (2.5,0) -- (11,0);
		% answer options
		\answer{Very satisfied}{2.1,0}{vallab-mc, font=\small}{checkbox-mc,xshift=5mm}\scoring{b=1}
		\answer{Somewhat satisfied}{4.2,0}{vallab-mc, font=\small}{checkbox-mc,xshift=5mm}\scoring{b=2}		 
		\answer{Somewhat dissatisfied}{6.3,0}{vallab-mc, font=\small}{checkbox-mc,xshift=5mm}\scoring{b=3}		
		\answer{Very dissatisfied}{8.4,0}{vallab-mc, font=\small}{checkbox-mc,xshift=5mm}\scoring{b=4}
		\answer{Don't know}{10.5,0}{vallab-mc, font=\small}{checkbox-mc,xshift=5mm}\scoring{b=5}				
	\end{values}
\end{variable-multi}
%
% remaining rows
%
\foreach {\label} [count=\num from 2] in {
	Ventilation,
	Temperature,
	Plastering,
	Lavatories,
	General cleanliness,
	Noise of Machinery,
	Metallic Dust,
	Dampness		
}{
	\begin{variable-multi}{hyg\num}{\label \dotfill}{varlab-mc}{99}
	\begin{values}
		% connected answer boxes
		\draw[double, thick] (2.5,0) -- (11,0);
		% answer options
		\answer{}{2.1,0}{vallab-mc, font=\small}{checkbox-mc,xshift=5mm}\scoring{b=1}
		\answer{}{4.2,0}{vallab-mc, font=\small}{checkbox-mc,xshift=5mm}\scoring{b=2}		 
		\answer{}{6.3,0}{vallab-mc, font=\small}{checkbox-mc,xshift=5mm}\scoring{b=3}		
		\answer{}{8.4,0}{vallab-mc, font=\small}{checkbox-mc,xshift=5mm}\scoring{b=4}
		\answer{}{10.5,0}{vallab-mc, font=\small}{checkbox-mc,xshift=5mm}\scoring{b=5}				
	\end{values}
	\end{variable-multi}
}

% END QUESTIONNAIRE
\end{Questionnaires}
% END DOCUMENT
\end{document}
