Attachment C4 – Mine Escape participants: Post-Training Questionnaire
	 Form
	Approved 
	 OMB
	No. 0920-xxxx Exp.
	Date xx/xx/20xx 
	
	
	
	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). 
| 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 | |||||
| 0 | 10 | 20 | 30 | 40 | 50 | 60 | 70 | 80 | 90 | 100 | ||
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| How confident are you that your simulation team could, if required, do the following right now in a real mine emergency? | ||||||||||||
| 4. Make quick and effective decisions. | 0 | 10 | 20 | 30 | 40 | 50 | 60 | 70 | 80 | 90 | 100 | |
| 5. Agree on solutions to difficult problems encountered. | 0 | 10 | 20 | 30 | 40 | 50 | 60 | 70 | 80 | 90 | 100 | |
| 6. Readapt team strategy in response to unexpected changes in the environment. | 0 | 10 | 20 | 30 | 40 | 50 | 60 | 70 | 80 | 90 | 100 | |
| 7. Assist with each other’s responsibilities. | 0 | 10 | 20 | 30 | 40 | 50 | 60 | 70 | 80 | 90 | 100 | |
| 8. Maintain clear and efficient communication. | 0 | 10 | 20 | 30 | 40 | 50 | 60 | 70 | 80 | 90 | 100 | |
| 9. Monitor each other’s work to catch mistakes and provide feedback. | 0 | 10 | 20 | 30 | 40 | 50 | 60 | 70 | 80 | 90 | 100 | |
| 10. Maintain a level of trust and confidence in each other. | 0 | 10 | 20 | 30 | 40 | 50 | 60 | 70 | 80 | 90 | 100 | |
| 11. Maintain a shared understanding of each other’s responsibilities. | 0 | 10 | 20 | 30 | 40 | 50 | 60 | 70 | 80 | 90 | 100 | |
| 12. Maintain coordination in performing the tasks at hand. | 0 | 10 | 20 | 30 | 40 | 50 | 60 | 70 | 80 | 90 | 100 | |
| 13. Consider teammate input before making an action. | 0 | 10 | 20 | 30 | 40 | 50 | 60 | 70 | 80 | 90 | 100 | |
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				 If you worked a different mine escape scenario in the VR simulator right now, how confident are you that your simulation team could work the problem… | ||||||||||||
| 14. better than in your previous mine evacuation training. | 0 | 10 | 20 | 30 | 40 | 50 | 60 | 70 | 80 | 90 | 100 | |
| 15. almost perfect with reasonable time. | 0 | 10 | 20 | 30 | 40 | 50 | 60 | 70 | 80 | 90 | 100 | |
| 16. 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 simulation team could complete the following right now without any mistakes? | ||||||||||||
| 17. A mine evacuation scenario. | 0 | 10 | 20 | 30 | 40 | 50 | 60 | 70 | 80 | 90 | 100 | |
| 18. A mine evacuation scenario in a virtual environment. | 0 | 10 | 20 | 30 | 40 | 50 | 60 | 70 | 80 | 90 | 100 | |
| 19. Evacuating from a real emergency. | 0 | 10 | 20 | 30 | 40 | 50 | 60 | 70 | 80 | 90 | 100 | |
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| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document | 
| Author | CDC User | 
| File Modified | 0000-00-00 | 
| File Created | 2021-01-29 |