Phase II PFD Evaluation Form

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Attachment 8: Phase 2 Form

FD Evaluation Form Form Approved

OMB No: 0000-0000

Exp Date: 00/00/0000

Public reporting burden of this collection of information is estimated to average 20 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Reports Clearance Officer; 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (XXXX-XXXX)

Instructions for Respondents

Thank you for assisting us in this PFD evaluation. This form has been provided as a tool to rate comfort, satisfaction, and opinions about the PFD you have been given. You should complete this form at two times during the evaluation period - after one day of wear, and after one month of wear. Only you should wear the PFD and complete the form. All answers are completely confidential. The information you provide will not be identified with you in any manner.

Please answer the questions as accurately as possible. Place a check mark in the box or fill in the blank where appropriate. If you don’t know the answer, simply write DK for “don’t know” and go to the next question.

Purpose of study:

• The purpose of this study is to evaluate a variety of modern PFDs with commercial fishermen to discover the features and qualities that they like and dislike.

• Findings from the PFD evaluations will help PFD manufacturers design PFDs that better meet the needs of the fishing industry.

• The PFD evaluations will also supply information to fishermen about which types of PFDs worked best.

• This study has the potential to greatly benefit the fishing industry. It will provide information to fishermen that may encourage them to wear PFDs while they work.

Participation is voluntary, responses will not be used in enforcement actions against you, and the survey results will be made available to industry, safety organizations, federal agencies, and other interested parties in a summary format only - without any personal identifiers.

Thank you for participating and helping us gather this information!

WE APPRECIATE YOUR HELP!

ABOUT YOUR PFD

1. What is the brand of your PFD?  Mustang

 Stearns

 Stormy Seas

2. What is the style of your PFD?  Inflatable Suspenders

 Inflatable Belt Pack

 Foam Core Vest

3. For every ten times you were out on deck, please estimate the number of times you wore the PFD.

1 2 3 4 5 6 7 8 9 10

YOUR PFD RATINGS

4. How much does the weight of the PFD bother you?

 Very Much  Somewhat  Very Little  Not at All

5. How much does the tightness of the PFD bother you?

 Very Much  Somewhat  Very Little  Not at All

6. How much does the PFD constrict or limit your motion?

 Very Much  Somewhat  Very Little  Not at All

7. How much discomfort does the PFD cause by rubbing or chafing your skin?

 Very Much  Somewhat  Very Little  None

8. How much does the bulkiness of the PFD bother you?

 Very Much  Somewhat  Very Little  Not at All

9. IF SUMMER, how much discomfort do you feel from the hotness of the PFD?

 Very Much  Some  Very Little  None

10. IF WINTER, how much comfort do you feel from the warmth the PFD provides?

 Very Much  Some  Very Little  None

11. How much padding/protection does the PFD provide?

 Very Much  Some  Very Little  None

12. How often does the PFD get snagged by gear?

 Very Often  Occasionally  Rarely  Not at All

13. How much does the PFD interfere with your work?

 Very Much  Somewhat  Very Little  Not at All

14. Please rate the ease of donning the PFD

 Very Difficult

 Somewhat Difficult

 Fairly Easy

 Extremely Easy

15. All things considered, how satisfied are you with the wearability of the PFD you tested?

 Extremely Satisfied

 Fairly Satisfied

 Somewhat Satisfied

 Somewhat Dissatisfied

 Fairly Dissatisfied

 Extremely Dissatisfied

16. On a scale of one to ten, how comfortable was the PFD you tested? (1 is the least comfortable and 10

is the most comfortable)

1 2 3 4 5 6 7 8 9 10

17. How difficult or easy was it to keep the PFD clean?

 Very Difficult

 Somewhat Difficult

 Fairly Easy

 Extremely Easy

18. Have you fallen overboard during this fishing season?

 Yes

 No

18A. IF YES, were you wearing your PFD when you fell overboard?

 Yes

 No

19. Please list any changes to the PFD that would make it better suited for use by commercial fishermen:

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20. Please describe what the ultimate PFD for Commercial Fishermen would be like:

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