Attachment C3 – Mine Escape participants: Post-Simulation Questionnaire
	 OMB
	No. 0920-xxxx Exp.
	Date xx/xx/20xx 
	
	
1. For each item below, rate how well your team did in each of the following areas by placing an “X” in the appropriate box.
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				 | Poor | Below Average | Average | Above Average | Excellent | 
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2. Think about the simulation you just completed and place an “X” in the appropriate box.
| a) The mental demands were: | |||||||||||
| Very Low | 
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						 | Very High | 
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						 b) The physical demands of the exercise were: | |||||||||||
| Very Low | 
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						 | Very High | 
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						 c) The level of stress I experienced was: | |||||||||||
| Very Low | 
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						 | Very High | 
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						 d) The time pressure I felt was: | |||||||||||
| Very Low | 
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						 | Very High | 
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						 e) The level of frustration I experienced was: | |||||||||||
| Very Low | 
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						 | Very High | 
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						 f) The amount of effort needed to complete the task was: | |||||||||||
| Very Low | 
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						 | Very High | 
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						 g) The level of eye strain I experienced was: | |||||||||||
| Very Low | 
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						 | Very High | 
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						 h) The level of strain I experienced from standing during the simulation was: | |||||||||||
| Very Low | 
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						 | Very High | 
	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). 
3. Answer the following questions about the simulation by placing an “X” in the appropriate box.
| a) How natural did moving through the virtual mine seem? | ||||||||
| Not Natural | 
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				 | Very Natural | 
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				 b) How much did your experience in the virtual simulation seem consistent with your real-world experiences in an actual mine? | ||||||||
| Not Consistent | 
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				 | Very Consistent | 
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				 c) How natural were your interactions with the environment (e.g., opening doors, taking gas readings)? | ||||||||
| Not Natural | 
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				 | Very Natural | 
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				 d) Were you involved in the exercise to the extent that you lost track of time? | ||||||||
| No – I did not lose track of time at all | 
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				 | Yes – I completely lost track of time | 
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				 e) How responsive was the simulation to actions that you performed with the air mouse? | ||||||||
| Not at all responsive | 
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				 | Very responsive | 
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				 f) How engaged were you in the virtual reality experience? | ||||||||
| Not at all engaged | 
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				 | Very engaged | 
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				 g) How immersed did you feel in the virtual environment? | ||||||||
| Not at all immersed | 
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				 | Very immersed | 
4. On a scale from 1 to 10, rate how difficult or easy it was for you, by the end of the simulation, to do the following.
| Place an “X” in the appropriate box. | Very Difficult | 
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				 | Very Easy | ||
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5. Rate how much you agree or disagree that the words and phrases below describe the simulation you just completed.
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				 | Strongly Disagree | Disagree | Neither | Agree | Strongly Agree | 
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6. Are you able to see stereoscopic 3D images?  Yes  No
7. Rate how much, if at all, you experienced the symptoms below as a result of the VR simulation.
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			 | None | Slight | Moderate | Severe | 
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8. How often do you get motion sickness in the following situations?
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			 | Never | Once in a while | Sometimes | Frequently | Always | 
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9. How much, if any, motion sickness did you experience during the following events in the VR simulation?
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			 | None | Slight | Moderate | Severe | 
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10. Did you enjoy participating in this VR simulation?  Yes  No
	Page 
	
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document | 
| Author | CDC User | 
| File Modified | 0000-00-00 | 
| File Created | 2021-01-29 |