CROPS Demonstrators Post-test

APPENDIX C.1c – CROPS Demonstrators Post-test

Form Approved

OMB No. 0920-09CO

Exp. Date xx/xx/20xx

CROPS Demonstrator Post-test⁰

Name _______________________________________

Address _____________________________________

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City _________________________ zip code ________________

Are you aware that tractors account for the largest single identifiable source of occupational deaths in farming? Yes _____ No _____

How important do you believe it is to have roll over protection on your tractor(s)? (circle your answer)

“not at all important” “not very important” “important” “very important”

Why do you believe rollover protection is (your answer above)? _______________________

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In the following question we would like you to rate the statements given on a scale of 1 to 10 by circling a response number that corresponds to your belief/opinion. For example, Installing a roll-over protective structure on my unprotected tractor is…. Bad farm practice/good farm practice, 1 being bad, 10 being good, you should circle a number that is the closest to your belief/opinion.

Installing a roll-over protective structure on at least one of my unprotected tractors is…

bad farm practice 1 2 3 4 5 6 7 8 9 10 good farm practice

not cost effective 1 2 3 4 5 6 7 8 9 10 very cost effective

inconvenient 1 2 3 4 5 6 7 8 9 10 convenient

unnecessary 1 2 3 4 5 6 7 8 9 10 necessary

irresponsible 1 2 3 4 5 6 7 8 9 10 responsible

Please indicate how you feel about the following statements, circling your desired response

It is less likely that anyone on my farm would be killed or hurt in a tractor roll-over, when compared to other farms.

Strongly Disagree Disagree Agree Strongly Agree

Most people who are important to me think that I should retrofit at least one of my unprotected tractors.

Strongly Disagree Disagree Agree Strongly Agree

It is expected of me that I retrofit at least one of my unprotected tractors.

Strongly Disagree Disagree Agree Strongly Agree

I feel pressured to retrofit at least one of my unprotected tractors.

Strongly Disagree Disagree Agree Strongly Agree

If I have a ROPS/CROPS on my tractor, I will wear my seatbelt whenever I am on the tractor.

Strongly Disagree Disagree Agree Strongly Agree

Do you have children (18 or under) on the farm operating a tractor? Yes _____ No _____

What age(s)? ________________________________________________________

Are you glad you decided to participate in the CROPS demonstration?

Yes ____ No _____

If you have another tractor or get another tractor without a ROPS, would you be interested in retrofitting it in the future?

Yes _____ No _____

Could you tell us why you chose the answer you did?

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Have you had any problems with the CROPS you retrofitted to your tractor?

Yes _____ No _____

If you answered yes to the question above, please explain. _________________________

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Is there anything else you would like to tell us about the CROPS? __________________

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Thank you for your response. Please send the survey back in the enclosed, postage paid envelope sent with the survey.

0 Public reporting burden of this collection of information is estimated to average XX hours/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 Information Collection Review Office, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-XXXX).