Attachment 4:
Survey Tool

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR DISEASE CONTROL AND PREVENTION
NATIONAL INSTITUTE FOR OCCUPATIONAL SAFETY AND HEALTH

The National Institute for Occupational Safety and Health (NIOSH) is a part of the United States Public Health Service and an institute within the Centers for Disease Control and Prevention (CDC) that is concerned with workplace health and safety. The purpose of this research study is to measure the attitudes and beliefs of Iowa Law Enforcement Officers regarding seatbelt usage while in patrol cars.  Although participation is entirely voluntary, NIOSH feels it is important for you to complete the questionnaire in order for the study to be successful.  The information you provide NIOSH will be used for statistical and research purposes and will be summarized so that no individual is identified. The information you supply is voluntary and there is no penalty for not providing it.

“BY COMPLETING THIS QUESTIONNAIRE, YOU INDICATE
YOUR CONSENT TO PARTICIPATE IN THIS STUDY.”

Thank you for your participation. If you have any questions about the survey, you may contact the NIOSH project officer, Dr. Hope Tiesman at: 1(304) 285-6067
National Institute for Occupational Safety and Health
1095 Willowdale Road, Morgantown, West Virginia 26505-2888

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 Information Collection Review Office, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-09BL).

												    		                       Form Approved
											             OMB No. 0920-XXXX
										                  Expiration Date XX/XX/2011

Instructions: For most questions, simply check the box that best represents your answer.  Unless otherwise noted, you should select the one most appropriate response.  Use the line and box marked "Other" if the choices listed do not adequately represent your response.

Section 1. Information about Your Law Enforcement Position	

1.	What is your current rank or title? 	
	¡	Officer/Officer First Class	¡	Specialist	¡	Corporal	
	¡	Sergeant	¡	Lieutenant	¡	Captain	
	¡	Major	¡	Chief/Sheriff	¡	Other __________________	

2.	Where did you complete your most recent law enforcement certification? 	
	¡	Iowa Law Enforcement Academy		
	¡	Iowa State Patrol/DPS Academy		
	¡	Municipal or Agency Academy in Iowa	Which academy? ________________________	
	¡	Other academy	What state is the academy located in? ________	

3.	What division are you assigned to within your agency? If assigned to more than one division, select the one division where you spend the majority of your time.	
	¡	Patrol	¡	Tactical Operations (TOB)/Vice Unit	¡	Detective Bureau/Criminal Investigations Division (CID)	
	¡	Crime Prevention Unit	¡	Traffic Enforcement/Crash Investigation	¡	Administration	
	¡	Other ____________________	¡	Agency does not assign divisions	

4.	Are you currently certified as a peace officer by the state of Iowa? 	
	¡	Yes	¡	No	

5.	How many years have you been working in law enforcement? (Please round answer to nearest full year.)	__________	
/
6.	In an average week, how many shifts do you work? 	
	¡	1	¡	2	¡	3	
	¡	4	¡	5	¡	More than 5	

7.	What is the length of your regularly scheduled work shift?	
	¡	Less than 8 hours	
	¡	At least 8 hours but less than 10 hours	
	¡	At least 10 hours but less than 12 hours	
	¡	12 hours or more	

8.	In an average week, how many hours do you work (include regularly scheduled hours, overtime, etc)?	__________	

9.	What time does your regular shift begin? 	
	¡	Between midnight and 6:00 a.m. (0000 - 0600)	
	¡	After 6:00 a.m. and before 12:00 p.m. (0601 - 1200)	
	¡	After 12:00 p.m. and before 6:00 p.m. (1201- 1800)	
	¡	After 6:01 p.m. and before midnight (1801 - 2359)	

10.	How many sworn officers does your agency employ? 	
	¡	1-10	
	¡	11-20	
	¡	21-30	
	¡	31-50	
	¡	51-99	
	¡	100 or more	

11.	What type of agency do you currently work for? 	
	¡	City or Municipal Department	
	¡	County Sheriff's Department	
	¡	Iowa State Patrol (DPS)	
	¡	Auxiliary or Sheriff's Posse	
	¡	Other (Please describe)	______________________________	

12.	Which response best describes the type of community where you perform the majority of your law enforcement work? (Note: If you work for a Sheriff's Department or the Iowa State Patrol, please complete the special response category at the bottom of the list below. )	
	¡	Rural area (less than 1,000 people)		
	¡	Small town (1,000 to 10,000 people)		
	¡	Medium town (10,001 to 30,000 people)		
	¡	Large town (30,001 to 50,000 people)		
	¡	Mid-sized city (50,001 to 75,000 people)		
	¡	Suburb/Fringe of mid-sized city		
	¡	Large city (more than 75,000 people)		
	¡	Suburb/Fringe of large city		
	¡	Sheriff's Department Deputies	Estimated population of county where you serve  _____________	
	¡	Iowa State Patrol Officers	DPS Region Number _____________	

Section 2. Law Enforcement Training	

13.	Does your agency offer inservice training at least once per year?  	
	¡	Yes	
	¡	No (Skip to Question #21)	

14.	How often does inservice training occur? 	
	¡	Once per year	¡	Twice per year	¡	More than twice a year	
	¡	Don't know	

15.	Is at least part of your inservice training mandatory? 	
	¡	Yes	¡	No (Skip to Question #21)	¡	Don't know	

16.	How many hours of mandatory inservice training did you receive in the last 12 months? 	
	¡	1-8 hours	¡	9-16 hours	¡	17-24 hours	
	¡	25-32 hours	¡	33-40 hours	¡	More than 40 hours	
	¡	Don't know	

Considering the mandatory inservice training you have had in the last 12 months, please answer the following questions about the content that was covered.	

17.	What subjects does mandatory inservice training cover?  (Check all that apply.)	
	o	General officer safety	o	Firearms (including qualifications, FATS, combat courses, etc)	o	General driving (including safe driving, seatbelt use, etc)	
	o	Pursuit driving/PIT maneuvers	o	Emergency Vehicle Operations Course (EVOC)	o	Policy reviews and updates	
	o	Less-lethal methods (TASER, OC spray, etc)	o	Defensive tactics	o	First Aid	
	o	CPR	o	Legal issues (changes in state or federal laws, updates on recent court decisions that impact your practices, etc)	o	Ethics	
	o	Other topics ____________________

____________________
	o	Don't know	

18.	Which one of the topics included in your mandatory inservice training do you think is most important? 	
	¡	General officer safety	
	¡	Firearms (including qualifications, FATS, combat courses, etc)	
	¡	General driving (including safe driving, seatbelt use, etc)	
	¡	Pursuit driving/PIT maneuvers	
	¡	Emergency Vehicle Operations Course (EVOC)	
	¡	Policy reviews and updates	
	¡	Less-lethal methods (TASER, OC spray, etc)	
	¡	Defensive tactics	
	¡	First Aid/CPR	
	¡	Legal issues (changes in state or federal laws, updates on recent court decisions that impact your practices, etc)	
	¡	Ethics	
	¡	Other topic ______________________________________________________________________	

19.	How often does your mandatory inservice training include training focused on motor vehicle operations and safety?	
	¡	Once per year	¡	Twice per year	¡	More than twice a year	
	¡	Less than once a year (i.e. covered every other year or less)	¡	Don't know	

20.	Which elements of motor vehicle operations and safety are covered in mandatory inservice training? (Check all that apply.)	
	o	Emergency Vehicle Operations Course (EVOC) or similar course	
	o	Policies related to motor vehicle operations (pursuits, use of lights and sirens, maximum speed limits, etc)	
	o	Safety issues inside the vehicle (seatbelt use, loose articles in the car,etc)	
	o	Pursuits/PIT maneuvers	
	o	Driving course (i.e. skid cars, driving timed or scored courses, etc)	
	o	Safety at traffic stops or roadway scenes (vehicle positioning, etc)	
	o	Driving simulator	

21.	Please rate how strongly you agree or disagree with the following statements.	
		Strongly agree	Agree	Neither agree nor disagree	Disagree	Strongly disagree	
	The driver and motor vehicle operations training received at the law enforcement academy adequately prepares officers to safely function in the field. 	¡	¡	¡	¡	¡	
	Driver and motor vehicle operations training is a critical component of preparing officers to function safely in the field.	¡	¡	¡	¡	¡	
	Using a driving simulator as part of law enforcement training would help law enforcement officers be better prepared to drive safely on the job.	¡	¡	¡	¡	¡	
	The average recruit entering the law enforcement academy already possesses basic driving skills that would allow them to safely operate a law enforcement vehicle in emergency situations.	¡	¡	¡	¡	¡	

22.	What thoughts would you like to share about law enforcement officer motor vehicle training?  Consider elements that should or should not be included, recommendations for changes, etc.

	

Section 3. Motor Vehicle Operations & Safety Policies	

23.	Does your agency have a written motor vehicle operations policy, general order (G.O.), or standard operating procedure (S.O.P.)? 	
	¡	Yes	¡	No (Skip to Question #26)	¡	Don't know	

24.	Have you received formal training on this policy?	
	¡	Yes	¡	No	¡	Don't remember	

25.	If your agency has a written motor vehicle operations policy, G.O. , or S.O.P., does this policy 	
			Please offer your comments on the policy.	
		Yes	No	Don't know		
	Require use of a seatbelt for the driver	¡	¡	¡	

	
	Require use of a seatbelt for any front seat passenger	¡	¡	¡	

	
	Restrict maximum speeds when using lights and sirens (set maximum speed for all driving, maximum number of miles per hour over posted speed limit, etc)	¡	¡	¡		
	Establish procedures for monitoring driving speeds (use of tachometers, "black boxes", vehicle cameras that automatically record over a certain speed, etc)	¡	¡	¡		
	
Restrict the use of cell phones or other mobile devices (like a PDA or Blackberry) while driving

	¡	¡	¡	
______________________________	

Section 4. Officer Safety Practices and Perceptions	

26.	In the last twelve months, has there been a serious injury or death in your agency due to any of the following?  (Check all that apply.)	
	o	A motor vehicle crash (inside the vehicle at the of the crash)	
	o	Being struck by a vehicle while on the roadway or shoulder (outside the vehicle)	
	o	Gunshot wound	
	o	Assault (excluding gunshot wound)	
	o	Other cause _________________________________________________________________	
	o	No serious injuries or deaths have occurred in my agency in the last twelve months.	

27.	How likely do you believe it is that you will be seriously injured or killed while on the job	
		Very unlikely	Somewhat unlikely	Unlikely	Likely	Somewhat likely	Very likely	
	By being assaulted (excluding gunshot wounds)	¡	¡	¡	¡	¡	¡	
	By being shot	¡	¡	¡	¡	¡	¡	
	In a motor vehicle crash	¡	¡	¡	¡	¡	¡	
	Being struck on a roadway while outside the vehicle	¡	¡	¡	¡	¡	¡	

28.	How dangerous do you feel each of the following job-related activities are?	
		Not at all dangerous	Somewhat dangerous	Dangerous	Very dangerous	
	Driving under emergency conditions (i.e. lights and/or siren responses)	¡	¡	¡	¡	
	Driving during regular patrols/under non-emergent conditions	¡	¡	¡	¡	
	Making traffic or pedestrian stops on roadways	¡	¡	¡	¡	
	Working at crash scenes on roadways	¡	¡	¡	¡	
	Responding to domestic violence calls	¡	¡	¡	¡	
	Responding to scenes of known or suspected violence (excluding domestic violence)	¡	¡	¡	¡	

29.	
Look at the following list of safety practices and consider which are least or most important in maintaining officer safety.  Rank the top five safety practices from most important (#1) to least important (#5).	
	___	Consistently using safe driving practices	
	___	Wearing a seatbelt	
	___	Wearing a ballistic vest (Kevlar or other similar vest)	
	___	Understanding and following agency policy and procedure	
	___	Wearing reflective gear when on road scenes	
	___	Training regularly with firearms (including scenarios, range time, FATS, etc)	
	___	Maintaining good physical condition	
	___	Regularly practicing defensive tactics	
	___	Regular training in safe driving techniques (including pursuit training, defensive driving, EVOC, driving simulators, etc)	

        The following questions focus on on-duty use of motor vehicles and related topics.	
30.	What type of vehicle do you drive most frequently while working?	
	¡	4-door car	
	¡	2-door car	
	¡	Van or minivan	
	¡	Pickup truck	
	¡	Sport Utility Vehicle (SUV)	
	¡	Motorcycle	
	¡	Other ____________________________________________	

31.	On average, how many hours per week do you think you spend driving while at work?	_____	

32.	How often do you wear your seatbelt when driving while on-duty? 	
	¡	All of the time	
	¡	Most of the time	
	¡	Some of the time	
	¡	Rarely	
	¡	Never	

33.	While driving on-duty, do you wear your seatbelt	
	¡	more often than other officers in your agency.	
	¡	less often than other officers in your agency.	
	¡	about as often as other officers in your agency.	

34.	How often do you wear your seatbelt when riding as a front seat passenger while on-duty? 	
	¡	All of the time	
	¡	Most of the time	
	¡	Some of the time	
	¡	Rarely	
	¡	Never	
	¡	Do not ride with a partner/am not in front passenger's seat while on-duty	

35.	When responding to a call, at what point do you unbuckle your seatbelt?	
	¡	When you arrive on scene and the vehicle comes to a complete stop	
	¡	As you pull up to the scene (before the vehicle comes to a complete stop)	
	¡	When you are in the vicinity of the call (i.e. when you call out 10-60)	
	¡	When you are on your way to the call (i.e. half mile or more away from the scene)	
	¡	Other _________________________________________________________________	
	¡	Don't regularly wear a seatbelt

36.	For each situation listed, how likely are you to wear your seatbelt while driving on-duty?	
		Very likely	Somewhat likely	Neither likely nor unlikely	Somewhat unlikely	Very unlikely	
	When driving longer distances	¡	¡	¡	¡	¡	
	Inclement or bad weather	¡	¡	¡	¡	¡	
	Driving on the highway or interstate	¡	¡	¡	¡	¡	
	During lights and/or siren responses	¡	¡	¡	¡	¡	
	Low speed pursuit	¡	¡	¡	¡	¡	
	High speed pursuit	¡	¡	¡	¡	¡	
	When driving in heavy traffic	¡	¡	¡	¡	¡	
	When a ride-along or officer-in-training is in the vehicle	¡	¡	¡	¡	¡	

37.	How important are each of these factors in your decision to wear a seatbelt while driving on-duty?	
		Not at all important	Minimally important	Somewhat important	Important	Very important	
	Habit	¡	¡	¡	¡	¡	
	Risk of crash at high speed	¡	¡	¡	¡	¡	
	Risk of crash while driving long distances	¡	¡	¡	¡	¡	
	Setting a good example for others	¡	¡	¡	¡	¡	
	Agency policy	¡	¡	¡	¡	¡	

38.	When considering the decision to wear your seatbelt while driving on-duty, how important are each of these factors in that decision?	
		Not at all important	Minimally important	Important	Somewhat important	Very important	
	Only driving short distances	¡	¡	¡	¡	¡	
	In a hurry and don't want to take the time to put my seatbelt on	¡	¡	¡	¡	¡	
	Uncomfortable	¡	¡	¡	¡	¡	
	Takes more time to get out of the vehicle if my seatbelt is on 	¡	¡	¡	¡	¡	
	Hinders access to equipment (i.e. firearm, duty belt, radio, TASER, etc)	¡	¡	¡	¡	¡	
	Low risk of crash	¡	¡	¡	¡	¡	
	Seatbelt catches on equipment (i.e. firearm, TASER, duty belt, etc)	¡	¡	¡	¡	¡	

39.	

Do you believe there are barriers to consistent use of seatbelts while driving on-duty?	
	¡	Yes  (Proceed to Question #40.)	
	¡	No  (Skip to Question #41.)	

40.	Please rank the following barriers according to their impact on officers' decision to consistently wear a seatbelt while on-duty.  Rank the most significant barrier as #1, least significant as #5.	
	__	Seatbelt design makes it uncomfortable to wear while on-duty (i.e. puts pressure on duty belt, rubs my neck, etc)	
	__	Current seatbelt design makes it difficult to quickly and easily remove seatbelt when exiting the vehicle (i.e. catches on equipment like firearm, TASER, duty belt, etc)	
	__	Equipment locations within the vehicle (i.e. location of control panel, location of shotgun mount, location of MDC, etc) make it difficult to wear a seatbelt and easily/safely reach equipment	
	__	Types or amounts of equipment carried as part of the uniform interfere with seatbelt use (i.e. things carried on your person during a regular shift like firearm, mag holders, TASER, flashlight, ASP, SAP, etc)	
	__	Characteristics that cannot be altered (i.e. call volume, types of driving, type of vehicle, etc)	

41.	Which safety practices do you regularly use when performing traffic stops on different types of roadways? (Check all that apply for each type of roadway.)	
		Parking at an angle behind stopped vehicle	Parking offset behind stopped vehicle	Positioning to observe both occupants and roadway	Activating lights to indicate traffic should move over	Using a passenger-side (shoulder-side) approach	Wearing reflective gear to increase visibility	
	Residential street (speed limit up to 30 mph)	¡	¡	¡	¡	¡	¡	
	City street (speed limit 30-45 mph)	¡	¡	¡	¡	¡	¡	
	Highway (speed limit 55 mph)	¡	¡	¡	¡	¡	¡	
	Interstate (speed limit above 55 mph)	¡	¡	¡	¡	¡	¡	
	Rural roads (gravel, unpaved)	¡	¡	¡	¡	¡	¡	

Section 5. Occupational Motor Vehicle Crashes & Roadway Incidents	
42.	In the past three years, have you been involved in a motor vehicle crash while on-duty? 	
	¡	Yes   (Please complete the tables on the following pages for the most recent crash.)	
	¡	No  (Please proceed to Question #43.)	

If you answered "Yes" to Question #42, how many crashes have you been involved in during the last three years?	__________	

MVC Information	
	a.	What type of vehicle were you in at the time of the crash?	¡	2 door or 4 door car	¡	Van or minivan	¡	Pickup truck	¡	SUV	¡	Motorcycle	
	b.	Which best describes your restraint status and location at the time of the crash?	¡	Restrained driver	¡	Restrained
front seat passenger	¡	Restrained
back seat passenger	¡	Unrestrained driver	¡	Unrestrained front or back seat passenger	
	c.	Were you injured in the crash? 
 If so, please answer questions d, e, and f.  If not, please proceed to question g.	¡	Yes	¡	No							
	d.	If you were injured, did you receive medical treatment?	¡	Yes	¡	No							
	e.	If you were injured, did you miss days from work?	¡	Yes	¡	No							
	f.	If you were injured, did you or your agency file a workers' compensation claim?	¡	Yes	¡	No							
	g.	What type of collision was it?
	¡	Head on	¡	Broadside	¡	Rear end	¡	Single vehicle	¡	Rollover	
	h.	Which vehicle were you in?	¡	Striking vehicle	¡	Struck vehicle							
	i.	What time of day did the crash occur?	¡	0000-0600	¡	0601-1200	¡	1201-1800	¡	1801-2359			
	j.	What were the weather conditions at the time of the crash?	¡	Clear	¡	Overcast	¡	Raining	¡	Freezing rain	¡	Snow	
	k.	Did the crash occur during an emergency response?	¡	Yes	¡	No							
	l.	What was your approximate speed at the time of the crash?	¡	Less than 30 mph	¡	More than 30 but less than 50 mph	¡	More than 50 but less than 65 mph	¡	More than 65 mph		

Please provide a brief description of the crash you identified in the table, including circumstances of the crash, type and extent of injuries (if any), etc.

43.	In the past three years, have you been involved in any roadside incidents (i.e. struck by or nearly struck by a passing vehicle while outside your work vehicle)?	
	¡	Yes  (Please complete the table below for the most recent incident.)	
	¡	No  (Please proceed to Question #44.)	

Roadside Incident Information	
	a.	What type of scene were you at when the incident occurred?	¡	Traffic stop	¡	Disabled vehicle	¡	MVC	¡	Pedestrian stop	
	b.	Where were you located?	¡	Next to the involved vehicle	¡	On the shoulder	¡	On the roadway	¡	Next to your vehicle	
	c.	What were you struck by or nearly struck by?	¡	Oncoming traffic	¡	Opposing traffic	¡	Flying debris	¡	Involved vehicle	
	d.	Were you injured in the incident?	¡	Yes	¡	No					
	e.	Did you receive medical attention?	¡	Yes	¡	No					
	f.	Did you miss work or were you placed on restricted duty following the injury?	¡	Yes	¡	No					
	g.	Did you or your agency file a workers' compensation claim?	¡	Yes	¡	No					
	h.	What time of day did the incident occur?	¡	0000-0600	¡	0601-1200	¡	1201-1800	¡	1801-2359	
	i.	What were the weather conditions at the time of the incident?	¡	Clear	¡	Overcast	¡	Raining	¡	Freezing rain or snow	
	j.	What safety precautions did you take prior to the incident?	¡	Wearing reflective gear	¡	Parking your vehicle to block oncoming traffic	¡	Use of warning lights on vehicle	¡	Use of flares or other warning devices on the roadway	

Please describe a brief description of the roadside incident you identified in the table, including circumstances of the incident, type and extent of injuries (if any), etc.

Section 6. Personal Characteristics	

44.	What is your current age in years? 	_____	

45.	What is your gender? 	
	¡	Female	
	¡	Male	

46.	What is your highest level of education? 	
	¡	High school diploma or GED	
	¡	Some college completed, but no degree or certificate earned	
	¡	Technical or vocational certificate	
	¡	Associate's degree	
	¡	Bachelor's degree	
	¡	Master's degree	
	¡	Doctoral degree/Ph.D./J.D.	

47.	Are you in a committed relationship (i.e. married or in a long-term relationship)? 	
	¡	Yes	
	¡	No	

48.	Which best describes your race? 	
	¡	American Indian or Alaska Native	
	¡	Asian	
	¡	Black or African American	
	¡	Native Hawaiian or Other Pacific Islander	
	¡	White	
	¡	Hispanic or Latino	
	¡	Two or more races	

Thank you for taking the time to complete this survey.  We invite you to offer any comments you may have about officer safety issues and how officer safety can be improved.