Attachment C7 – Mine Rescue participants: Pre-Training Questionnaire
	 OMB
	No. 0920-xxxx Exp.
	Date xx/xx/20xx 
	
	
	
	6. Which of the following training materials and methods does
	your mine use for your mine rescue team training? (check all that
	apply) Lectures Written
		materials Videos Self-guided
		interactive computer programs Demonstrations Hands-on
		training exercises Group
		exercises (e.g., games, problem solving) Classroom
		simulations (e.g., virtual reality) Worksite
		simulations Narrative
		story telling 
	4. How often does your mine hold safety meetings (e.g.,
	“toolbox talks”)? (check one) Less than once
		a month Once a month Once every 2
		weeks Once a week Several times
		a week Daily Several times
		a day 
	3. How many years of experience do you have… As a
	miner?				______ At your
	mine?				______ In your current
	job?			______ On a mine rescue
	team?		______ 
	2. Gender:   □
	Male     □
	Female 
	1. Age_______ 
 
 
 
 
		
		
	
	
	
	5. Do you have training or experience with any of the
	following? (check all that apply) Volunteer fire
		fighting Professional
		fire fighting Military
		emergency response EMT/Paramedic Mine fire
		brigade Mine rescue
		team Mine
		responsible person Work assigned
		in a real emergency as a mine rescue team member Other
		emergency response  related training/experience: 
	 
		
	
	7. How often does your mine rescue team train? 
	 (check one) Once a month Once every 2
		weeks Once a week More than once
		a week 
		
	
	9. Of all the team members training with you today, how many
	do you interact with AT LEAST once a month outside of work and/or
	mine rescue team training? None Maybe 1 or 2 About half Most All 
		
	8. Have you ever experienced a virtual reality environment
	before today? 	□
	No     □ Yes 
| Place an “X” in the appropriate box. 
 | Strongly Disagree | Disagree | Neither | Agree | Strongly Agree | 
| 10. Even though mine emergencies are rare, I need to be as prepared as I can. | 
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| 11. It is important to be prepared for a mine emergency. | 
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| 12. It is important to put in extra effort toward improving my mine’s ability to respond to an emergency. | 
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	Public reporting burden of
	this collection of information is estimated to average 3 minutes per
	response, including the time for reviewing and completing 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). 
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			 On average, how often do your team’s members… | Not at all | Once in a while | Sometimes | Fairly often | Frequently or always | 
| 13. See each other at work? | 
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| 14. See each other outside of work or training? | 
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| 15. Spend at least part of your training time cross-training in each other’s team roles? | 
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| How often do you… | 
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| 16. Play video games? (e.g., computer, Xbox, Playstation) | 
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| 17. Spend time on the computer? (e.g., work, internet, games) | 
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| Place an “X” in the appropriate box. Rate your confidence in the following areas, from “0” (Completely Unconfident) to “100” (Completely Confident) | Completely Unconfident | 
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				 | Completely Confident | |||||
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| How confident are you that your team could, if required, do the following right now in a real mine emergency? | ||||||||||||
| 18. Make quick and effective decisions. | 0 | 10 | 20 | 30 | 40 | 50 | 60 | 70 | 80 | 90 | 100 | |
| 19. Agree on solutions to difficult problems encountered. | 0 | 10 | 20 | 30 | 40 | 50 | 60 | 70 | 80 | 90 | 100 | |
| 20. Readapt team strategy in response to unexpected changes in the environment. | 0 | 10 | 20 | 30 | 40 | 50 | 60 | 70 | 80 | 90 | 100 | |
| 21. Assist with each other’s responsibilities. | 0 | 10 | 20 | 30 | 40 | 50 | 60 | 70 | 80 | 90 | 100 | |
| 22. Maintain clear and efficient communication. | 0 | 10 | 20 | 30 | 40 | 50 | 60 | 70 | 80 | 90 | 100 | |
| 23. Monitor each other’s work to catch mistakes and provide feedback. | 0 | 10 | 20 | 30 | 40 | 50 | 60 | 70 | 80 | 90 | 100 | |
| 24. Maintain a level of trust and confidence in each other. | 0 | 10 | 20 | 30 | 40 | 50 | 60 | 70 | 80 | 90 | 100 | |
| 25. Maintain a shared understanding of each other’s responsibilities. | 0 | 10 | 20 | 30 | 40 | 50 | 60 | 70 | 80 | 90 | 100 | |
| 26. Maintain coordination in performing the tasks at hand. | 0 | 10 | 20 | 30 | 40 | 50 | 60 | 70 | 80 | 90 | 100 | |
| 27. Consider teammate input before making an action. | 0 | 10 | 20 | 30 | 40 | 50 | 60 | 70 | 80 | 90 | 100 | |
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| How confident are you that your team captain could, if required, do the following right now in a real mine emergency? | ||||||||||||
| 28. Be decisive yet flexible | 0 | 10 | 20 | 30 | 40 | 50 | 60 | 70 | 80 | 90 | 100 | |
| 29. Be open to input from others | 0 | 10 | 20 | 30 | 40 | 50 | 60 | 70 | 80 | 90 | 100 | |
| 30. Have a calming influence on the group | 0 | 10 | 20 | 30 | 40 | 50 | 60 | 70 | 80 | 90 | 100 | |
| 31. Make logical decisions | 0 | 10 | 20 | 30 | 40 | 50 | 60 | 70 | 80 | 90 | 100 | |
| 32. Know the kinds of decisions that would need to be made | 0 | 10 | 20 | 30 | 40 | 50 | 60 | 70 | 80 | 90 | 100 | |
| 33. Know what to do to get the team out safely | 0 | 10 | 20 | 30 | 40 | 50 | 60 | 70 | 80 | 90 | 100 | |
| 34. Know what to do to get trapped/injured miners out safely | 0 | 10 | 20 | 30 | 40 | 50 | 60 | 70 | 80 | 90 | 100 | |
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| In the upcoming simulation, how confident are you that your team can work the problem… | ||||||||||||
| 35. better than your previous mine rescue competition | 0 | 10 | 20 | 30 | 40 | 50 | 60 | 70 | 80 | 90 | 100 | |
| 36. almost perfect with reasonable time | 0 | 10 | 20 | 30 | 40 | 50 | 60 | 70 | 80 | 90 | 100 | |
| 37. perfectly with record time | 0 | 10 | 20 | 30 | 40 | 50 | 60 | 70 | 80 | 90 | 100 | |
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| How confident are you that your team could complete the following right now without any mistakes? | ||||||||||||
| 38. A mine rescue competition problem | 0 | 10 | 20 | 30 | 40 | 50 | 60 | 70 | 80 | 90 | 100 | |
| 39. A mine rescue problem in a virtual environment | 0 | 10 | 20 | 30 | 40 | 50 | 60 | 70 | 80 | 90 | 100 | |
| 40. Work assigned at a real emergency | 0 | 10 | 20 | 30 | 40 | 50 | 60 | 70 | 80 | 90 | 100 | |
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| Place an “X” in the appropriate box. | Completely Unconfident | 
				 | Completely Confident | |||||||||
| Rate your confidence in the following areas, from “0” (Completely Unconfident) to “100” (Completely Confident) | 0 | 10 | 20 | 30 | 40 | 50 | 60 | 70 | 80 | 90 | 100 | |
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| How confident are you that you could correctly demonstrate or explain the following to a new mine rescue team member? | ||||||||||||
| 41. Paths the team would use to explore a mine. | 0 | 10 | 20 | 30 | 40 | 50 | 60 | 70 | 80 | 90 | 100 | |
| 42. Rules of a mine rescue competition | 0 | 10 | 20 | 30 | 40 | 50 | 60 | 70 | 80 | 90 | 100 | |
| 43. How to identify an explosive atmosphere with a gas meter | 0 | 10 | 20 | 30 | 40 | 50 | 60 | 70 | 80 | 90 | 100 | |
| 44. Mine map symbols | 0 | 10 | 20 | 30 | 40 | 50 | 60 | 70 | 80 | 90 | 100 | |
| 45. Setting roof supports | 0 | 10 | 20 | 30 | 40 | 50 | 60 | 70 | 80 | 90 | 100 | |
| 46. Roof testing | 0 | 10 | 20 | 30 | 40 | 50 | 60 | 70 | 80 | 90 | 100 | |
| 47. Reestablishing ventilation | 0 | 10 | 20 | 30 | 40 | 50 | 60 | 70 | 80 | 90 | 100 | |
| 48. Actions would be penalized in a competition | 0 | 10 | 20 | 30 | 40 | 50 | 60 | 70 | 80 | 90 | 100 | |
	
| Place an “X” in the appropriate box. Think about the mine where you work. Rate how much you agree or disagree with each statement below. | Strongly Disagree | Disagree | Neither | Agree | Strongly Agree | 
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| Mine management: | 
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| 49. does a good job of emphasizing emergency preparedness. | 
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| 50. makes decisions that increase the likelihood of a successful response. | 
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| 51. prepares for how to handle emergencies before they happen. | 
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| My mine rescue team: | 
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| 52. is given the support and resources we need to prepare for an emergency. | 
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| 53. is encouraged to improve our emergency response skills and abilities. | 
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| 54. is provided extra training opportunities for interested team members | 
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| Our mine rescue training: | 
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| 55. is usually realistic and “hands-on”. | 
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| 56. Includes practice using the equipment we would use in a real emergency. | 
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| 57. has opportunities for constructive feedback from instructors. | 
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| 58. does a good job of preparing us for a real emergency. | 
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| At my mine: | 
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| 59. Production is stopped if there is even a minor chance that an emergency could happen. | 
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| 60. Mine emergencies are thoroughly investigated no matter what delay it may cause. | 
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| 61. Preventing a potential emergency is more important than meeting a production goal. | 
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| In my work crew: | 
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| 62. We regularly talk about the decisions and issues that would come up during a mine emergency. | 
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| 63. I would probably be made fun of or ridiculed if I asked questions about our emergency preparedness procedures. | 
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| 64. We remind each other of the need to be prepared for mine emergencies. | 
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	Page 
	
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document | 
| Author | CDC User | 
| File Modified | 0000-00-00 | 
| File Created | 2021-01-29 |