Federal Aviation Administration Sponsored Safety Seminar

DRAFT

F

OMB No. 2120-0568: Expires 10/31/2010

ederal Aviation Administration Sponsored

Safety Seminar Program

PLEASE USE A BLUE OR BLACK PEN TO FILL IN THE BUBBLE FOR THE

RESPONSE THAT BEST REPRESENTS YOUR ANSWER.

1. During the last 2 years, how many FAA- sponsored Safety Seminars did you attend?

• None

• 1-2

• 3-4

• 5 or more

2. Overall, how satisfied are you with the information you have received from FAA-sponsored Safety Seminars?

• Does not apply; I have not attended any FAA-sponsored seminars.

• Very satisfied

• Satisfied

• Neither satisfied nor dissatisfied

• Dissatisfied

• Very dissatisfied

3. If you have not attended any FAA-sponsored Safety Seminars in the last 2 years, what is your MAIN reason for not attending?

MARK ONLY ONE.

• Does not apply; I have attended a seminar in the last 2 years.

• Location is not convenient

• Scheduled class time is not convenient

• Material is not relevant to me

• Instructors are not knowledgeable

• I do not like the training format (e.g. lecture)

• I receive my safety training from my employer

• Some other reason

4. Which of the following best describes your current level in the WINGS Program?

• I am not familiar with the WINGS Program.

• I am aware of the WINGS program but I have not participated.

• Current level is between 1 – 3

• Current level is between 4 – 6

• Current level is between 7 – 9

• Current level is 10 or higher

5. How much do you agree or disagree with the following statements?

Strongly disagree
D isagree
N either agree nor disagree
A gree
S trongly agree
P articipation in the WINGS Program makes pilots safer aviators.	O	O	O	O	O
I have applied information I received in Safety Seminars to my own flying experiences.	O	O	O	O	O
Information presented in FAA-sponsored Safety Seminars increases safety awareness.	O	O	O	O	O
Information I received in an FAA-sponsored Safety Seminar helped me to avoid an accident.	O	O	O	O	O

6. The BEST way to get new safety information would be through:

MARK ONLY ONE

• Newsletters or articles by regular mail

• E-mail

• CD-ROM

• Videotapes

• Audio cassettes

• Attending Safety Seminars with a speaker

• Reviewing interactive websites

7. Which of the following best describes your computer access? MARK ALL THAT APPLY.

• I have access to a computer at home.

• I have access to the Internet at home

• I have a high-speed Internet connection (e.g. DSL or cable connection) at home

• I have access to e-mail at home

• I have access to a computer at work

• I have access to the Internet at work

• I have a high-speed Internet connection at work

• I have access to e-mail at work

8. Which of the following list of potential seminar topics would be of most interest to you.

MARK ALL THAT APPLY.

• Aerodynamics

• Aircraft Icing

• Aircraft Maintenance

• Aircraft Maintenance-Preventative

• Aircraft Performance/Density Attitude

• Aircraft Record Keeping

• Airspace

• ATC Communications

• Balloons

• Controlled Flight Into Terrain

• Crash Survival (Land)

• Crash Survival (Water)

• Crew Resource Management

• Currency-Skills Proficiency

• Decision Making

• Flight Planning

• Fuel Management

• Gliders

• Human Factors

• Mountain Flying

• Multi-Engine Airplanes

• Rotorcraft

• Runway Safety

• Single Pilot/IFR Flying

• Stall Spin

• Take Off And Landings

• Towered Airport Operations

• Visual Flight Rules (VFR)

• Wake Turbulence

• Weather

• Specialty Seminars (e.g. Seaplanes, Agricultural Flying)

• Event Operations (e.g. Oshkosh, Sun & Fun)

• Other (Please Specify:____________

__________________________________

__________________________________

__________________________________)

9. Is piloting an aircraft your main source of income?

• No

• Yes

10. Do you own or co-own an aircraft?

• No

• Yes

11. Which of the following pilot certificates do you hold? MARK ALL THAT APPLY.

• Student

• Recreational

• Private

• Commercial

• Airline Transport

12. Which of the following ratings are on your pilot’s certificate? MARK ALL THAT APPLY.

• Airplane

• Rotorcraft

• Lighter than Air

• Glider

13. Which of the following certifications do you hold? MARK ALL THAT APPLY.

• Designated Pilot Examiner

• Certified Flight Instructor

• Safety Counselor

• Ground Instructor

• Pilot Proficiency Examiner

• Check Airman

• None of the above

14. For which kind of operator(s) do you fly? MARK ALL THAT APPLY.

• Do not apply; I am not employed as a pilot.

• Flight School

• Air Taxi

• Corporate

• Regional

• Major Commercial Airline

• Other

15. How many hours have you flown . . .

During your career		In the last 12 months
O	Under 100 hrs	O	None
O	101 to 500	O	1 to 10
O	501 to 1,000	O	11 to 50
O	1,001 to 3,000	O	51 to 150
O	3,001 to 10,000	O	151 to 300
O	Over 10,000 hrs	O	Over 300 hrs

16. What is your current age?

• Under 21

• 21 – 29

• 30 – 39

• 40 – 49

• 50 – 59

• 60 or more

Paperwork Reduction Act Statement: This voluntary collection of information is authorized by Executive Order #12862. We estimate that it will take approximately 10 minutes to complete the survey. According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The OMB control number associated with this collection is 2120-0568. Comments concerning the accuracy of this burden and suggestions for reducing the burden should be directed to the FAA at: 800 Independence Ave. SW, Washington, DC, 20691., Attn:: Information Collection Clearance Officer, AES-200.