\documentclass[a4paper,10pt,BCOR10mm,oneside,headsepline]{scrartcl}
\usepackage[french]{babel}
\usepackage[utf8]{inputenc}
\usepackage{wasysym}% provides \ocircle and \Box
\usepackage{enumitem}% easy control of topsep and leftmargin for lists
\usepackage{color}% used for background color
\usepackage{forloop}% used for \Qrating and \Qlines
\usepackage{ifthen}% used for \Qitem and \QItem
\usepackage{typearea}
\areaset{17cm}{26cm}
\setlength{\topmargin}{-1cm}
\usepackage{scrpage2}
\pagestyle{scrheadings}
\ihead{Enquête sur la sécurité des données (fiche particulier)}
\ohead{\pagemark}
\chead{}
\cfoot{}

%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%
%% Beginning of questionnaire command definitions %%
%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%
%%
%% 2010, 2012 by Sven Hartenstein
%% mail@svenhartenstein.de
%% http~://www.svenhartenstein.de
%%
%% Please be warned that this is NOT a full-featured framework for
%% creating (all sorts of) questionnaires. Rather, it is a small
%% collection of LaTeX commands that I found useful when creating a
%% questionnaire. Feel free to copy and adjust any parts you like.
%% Most probably, you will want to change the commands, so that they
%% fit your taste.
%%
%% Also note that I am not a LaTeX expert! Things can very likely be
%% done much more elegant than I was able to. If you have suggestions
%% about what can be improved please send me an email. I intend to
%% add good tipps to my website and to name contributers of course.
%%
%% 10/2012~: Thanks to karathan for the suggestion to put \noindent
%% before \rule!

%% \Qq = Questionaire question. Oh, this is just too simple. It helps
%% making it easy to globally change the appearance of questions.
\newcommand{\Qq}[1]{\textbf{#1}}

%% \QO = Circle or box to be ticked. Used both by direct call and by
%% \Qrating and \Qlist.
\newcommand{\QO}{$\Box$}% or~: $\ocircle$

%% \Qrating = Automatically create a rating scale with NUM steps, like
%% this~: 0--0--0--0--0.
\newcounter{qr}
\newcommand{\Qrating}[1]{\QO\forloop{qr}{1}{\value{qr} < #1}{---\QO}}

%% \Qline = Again, this is very simple. It helps setting the line
%% thickness globally. Used both by direct call and by \Qlines.
\newcommand{\Qline}[1]{\noindent\rule{#1}{0.6pt}}

%% \Qlines = Insert NUM lines with width=\linewith. You can change the
%% \vskip value to adjust the spacing.
\newcounter{ql}
\newcommand{\Qlines}[1]{\forloop{ql}{0}{\value{ql}<#1}{\vskip0em\Qline{\linewidth}}}

%% \Qlist = This is an environment very similar to itemize but with
%% \QO in front of each list item. Useful for classical multiple
%% choice. Change leftmargin and topsep accourding to your taste.
\newenvironment{Qlist}{%
\renewcommand{\labelitemi}{\QO}
\begin{itemize}[leftmargin=1.5em,topsep=-.5em,label={\Square}]
}{%
\end{itemize}
}

%% \Qtab = A "tabulator simulation". The first argument is the
%% distance from the left margin. The second argument is content which
%% is indented within the current row.
\newlength{\qt}
\newcommand{\Qtab}[2]{
\setlength{\qt}{\linewidth}
\addtolength{\qt}{-#1}
\hfill\parbox[t]{\qt}{\raggedright #2}
}

%% \Qitem = Item with automatic numbering. The first optional argument
%% can be used to create sub-items like 2a, 2b, 2c, ... The item
%% number is increased if the first argument is omitted or equals 'a'.
%% You will have to adjust this if you prefer a different numbering
%% scheme. Adjust topsep and leftmargin as needed.
\newcounter{itemnummer}
\newcommand{\Qitem}[2][]{% #1 optional, #2 notwendig
\ifthenelse{\equal{#1}{}}{\stepcounter{itemnummer}}{}
\ifthenelse{\equal{#1}{a}}{\stepcounter{itemnummer}}{}
\begin{enumerate}[topsep=2pt,leftmargin=2.8em]
\item[\textbf{\arabic{itemnummer}#1.}] #2
\end{enumerate}
}

%% \QItem = Like \Qitem but with alternating background color. This
%% might be error prone as I hard-coded some lengths (-5.25pt and
%% -3pt)! I do not yet understand why I need them.
\definecolor{bgodd}{rgb}{0.8,0.8,0.8}
\definecolor{bgeven}{rgb}{0.9,0.9,0.9}
\newcounter{itemoddeven}
\newlength{\gb}
\newcommand{\QItem}[2][]{% #1 optional, #2 notwendig
\setlength{\gb}{\linewidth}
\addtolength{\gb}{-5.25pt}
\ifthenelse{\equal{\value{itemoddeven}}{0}}{%
\noindent\colorbox{bgeven}{\hskip-3pt\begin{minipage}{\gb}\Qitem[#1]{#2}\end{minipage}}%
\stepcounter{itemoddeven}%
}{%
\noindent\colorbox{bgodd}{\hskip-3pt\begin{minipage}{\gb}\Qitem[#1]{#2}\end{minipage}}%
\setcounter{itemoddeven}{0}%
}
}

%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%
%% End of questionnaire command definitions %%
%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%

\begin{document}

\begin{center}
\textbf{\huge Enquête sur la sécurité des données}
\end{center}\vskip1em

\Qitem{ \Qq{Êtes-vous inquiété.e par la collecte d'informations personnelles ou sensibles par les entreprises~?}


\Qtab{3cm}{Peu inquiété.e \Qrating{5}
Très inquiété.e}}


\Qitem{ \Qq{À quel point vous sentez-vous impliqué.e dans la protection de vos données~?} 

\Qtab{3cm}{Peu impliqué.e \Qrating{5}
Très impliqué.e}}


\Qitem{ \Qq{Utilisez-vous des outils numériques de protection de la vie privée~?}
\begin{Qlist}
\item Disques chiffrés
\item Systèmes d'exploitation open-source
\item VPN (réseau privé virtuel)
\item Cloud/Disque nuagique chiffré en ligne
\item Messagerie chiffrée (y compris PGP)
\item Autres~: \Qline{4cm}
\end{Qlist}
}

\Qitem{ \Qq{À quelles fins accepteriez-vous que vos données personnelles ou sensibles soient transmises à une tierce partie~?}
\begin{Qlist}
\item À des fins commerciales, dans le cadre~:
\begin{Qlist}
	\item de publicité ciblée
	\item de téléprospection
	\item d'études de marché (données anonymisées)
\end{Qlist}
\item À des fins juridiques, afin d'incriminer sur~:
\begin{Qlist}
	\item des délits
	\item des crimes
	\item des affaires de terrorisme
\end{Qlist}
\item À des fins scientifiques, dans le cadre de recherche en~:
\begin{Qlist}
	\item médecine
	\item sociologie
	\item économie
\end{Qlist}
\item À des fins politiques, afin de déterminer~:
\begin{Qlist}
	\item des statistiques anonymes sur votre alignement politique
	\item vos demandes et intérets
\end{Qlist}
\end{Qlist}
}

\Qitem{ \Qq{Que pensez-vous de l'état de la protection de vos données contre le vol~?} 

\Qtab{3cm}{Insuffisantes \Qrating{5}
Plus que suffisantes}}

\Qitem{ \Qq{Que pensez-vous de l'état de la protection de vos données contre la perte ou la destruction accidentelle~?} 

\Qtab{3cm}{Insuffisantes \Qrating{5}
Plus que suffisantes}}


\end{document}
