Example of passenger questionnaire previously approved by OIRA

National Transportation Safety Board
Washington D.C. 20594

PASSENGER QUESTIONNAIRE
The mission of the National Transportation Safety Board is to prevent accidents and save lives in transportation. We are tasked with
investigating transportation accidents, determining their probable cause, and making recommendations to prevent them from
happening again. To accomplish our mission, the NTSB finds it helpful to contact the passengers onboard airplanes involved in
accidents and attempt to document their experiences. It is with this purpose in mind that we are asking you to complete this
questionnaire.
If you do not remember or do not feel comfortable answering any of the questions, please leave the question blank. The NTSB may
contact you for additional information, if it determines requesting more information from you would be helpful to the investigation.
Some questions at the end of this questionnaire request personal information, such as whether you consumed alcohol during
the accident flight or wear corrective lenses for eyesight. Please note the NTSB is not an agency charged with enforcing any
criminal or civil laws or related regulatory requirements. The NTSB’s use of your responses to the questions on this document
will be for the sole purpose of improving transportation safety.
The NTSB may make completed questionnaires available to the public in its public docket for this investigation, in accordance with
its obligation to release accident reports. However, the NTSB will redact all identifying information from each questionnaire prior to
such release.
Paperwork Reduction Act Statement - This information collection meets the requirements of 44 U.S.C. § 3507, as amended by
section 2 of the Paperwork Reduction Act of 1995. You do not need to answer these questions unless we display a valid Office of
Management and Budget control number. We estimate that it will take about 30 minutes to read the instructions and answer the
questions. Please return this questionnaire to Jason Fedok, NTSB Survival Factors Investigator, via email at
or via postal mail or carrier at 490 L’Enfant Plaza East, SW Washington D.C. 20594. In addition, you may send the
questionnaire via fax to
Please contact the NTSB via the email address provided above, or via telephone at
if you have any questions. Thank you for your assistance in this investigation.

Safety Briefing
1.

How were the preflight safety instructions presented? (Check all that apply)
Flight Attendant
Video
Audio

2.

How much of the preflight Safety Presentation did you watch?
All
75%
50%
25%
None
If All, go to question 4
3.

Indicate why you did not watch the whole presentation (check all that apply).
Seen it before
Obstructed view
Distracted by child
Distracted by other person
It’s basic knowledge
Listening to music/audio tapes
Reading
Sleeping
Too long
Other

4.

How well could you hear the presentation?
Heard every word
Some words difficult to hear

Most words difficult to hear

5.

Is English your primary language?
Yes
No
(if No, what is your primary language?

)

6.

Did the pre-flight safety presentation help during the evacuation?
Yes
No
Explain:

1

,

7.

Did anyone tell you listening to the pre-flight safety presentation was important?
Yes
No
Explain:

8.

When did you read the safety instruction card in the seatback in front of you?
Prior to flight
During pre-flight briefing
In-flight
Did not read
If you read the safety card skip to item 10
9.

Why did you not read the safety card?
Read it before
Could not find
Was not there
Not important
Other

Could not understand

10. Did the safety card information help you in the evacuation?
Yes
No
Explain:

11. If you believe any of the pre-flight presentation or safety card could have been more helpful, what suggestions would you make
for improving the presentation or safety card?

Brace Position
12. Were you instructed to brace for impact?
Yes
No
13. Did you brace for impact? (Describe position)

14. Why did you choose this position?
Flight attendant instruction
Looked at safety briefing card
Previous knowledge
Other, please

Copied people around me

Emergency Exits
15. When did you look for the emergency exit(s) closest to your seat?
During boarding
During the pre-flight briefing
After the preflight briefing but before the evacuation
During the evacuation
16. Where did you look for an exit? (Check all that apply)
In front of me
Behind me
Left of me
Right of me
17. Were you seated in an emergency exit row?
Yes
No If no skip to item 20
18. Did you receive any pre-flight instructions on your responsibilities in case of an evacuation?
Yes
No

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19. Did you receive a personal briefing by a flight attendant on your emergency exit responsibilities?
Yes
No
20. Did you read the instructions for operating the exit?
Yes
No
21. Did you open, or attempt to open, an exit yourself?
Yes
No If no, skip to item 24
22. What caused you to open the exit?
Flight attendant
P.A. announcement

Personal assessment

Other

23. Did you have any difficulties opening the exit?
Yes
No
Explain:

24. Did you use this exit?
Yes
No
25. When did you decide which exit to use?
Before the evacuation order was given
Other

As I left my seat

As I traveled down the aisle

26. For what reasons did you choose this exit? (Check all that apply)
I was called to the exit
I was directed by cabin staff
It was the only available exit
The other exit was blocked
I followed other passengers
It was the closest exit
Other
27. Were you directed away from a specific exit?
Yes
No
28. Were you directed toward a specific exit?
Yes
No
29. Did you follow these directions?
Yes
No
30. Did you pass a usable exit at the direction of a flight attendant?
Yes
No
31. Did you select an exit and then change your mind?
Yes
No
If yes, explain

32. If you used an over-wing exit, how did you get off the wing?
33. If you opened an over-wing exit, did you place the exit door inside the aircraft?
Yes
No
Not Applicable

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Carry-on Baggage
34. Did you have carry-on baggage (count purse, computers, backpack etc. each as one item)?
No
one bag
2 bags
3 bags
more than 3 bags
35. Did you have to gate check a bag you were planning to carry on?
Yes
No
36. Where did you store your:
Purse:
Under seat
Briefcase:
Under seat
Computer:
Under seat
Suitcase 1:
Under seat
Suitcase 2:
Under seat

Overhead bin
Overhead bin
Overhead bin
Overhead bin
Overhead bin

Closet
Closet
Closet
Closet
Closet

Not applicable
Not applicable
Not applicable
Not applicable
Not applicable

Other
Other
Other
Other
Other

37. Did you attempt to take any carry-on items with you during the evacuation?
Yes
No
If no, skip to item 40
38. What items did you need to take?
Medicines
Money/wallet/credit cards
Job related items
Sentimental items
39. Where were the items stored?
Under seat
Overhead bin

Car/House key
Other

Closet

Clothes

Camera

Computer

Other

40. What happened to any carry-on bags you took with you during the evacuation?
Taken by flight attendant
Placed in a seat
Returned to overhead bin
Dropped to floor
Carried into raft/out wing
Took with me onto rescue boat
Other
41. Did other passengers attempt to take carry-on items?
Yes
No
Don’t know
42. Did passengers retrieving carry-on luggage slow the evacuation?
Yes
No
Don’t know
43. Did passengers argue with flight attendants over retrieving carry-on luggage during the evacuation?
Yes
No
Don’t know

Passenger Behavior
44. Did you experience any delay in getting into the aisle?
Yes
No
If yes, describe

45. Did you climb over any seats during the evacuation?
Yes
No If yes, describe

46. Did you see anyone climb over the seats?
Yes
No

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47. Did you see any passengers pushing other passengers?
Yes
No
48. Did you get pushed?
Yes
No
49. Did you push anyone?
Yes
No
50. Were there any disputes among passengers during the evacuation?
Yes
No
Don’t know
51. Did you have to wait behind slow moving passengers (i.e. was the passenger in front of you moving slower than the line
to the exit)?
Yes
No
If yes, explain why they were moving slowly.

52. Did you consider another exit because of slow moving lines?
Yes
No
53. Were you traveling with anyone?
Yes
No If no skip to item 58
54. With whom were you traveling? (Check all that apply)
Spouse
Baby (Under 2 yrs.)
Young child (2-10 yr.)

Coworker

Friend

Other

55. If you were traveling with a child, was the child using a child safety seat?
Yes
No
56. Were you seated with your companion(s)?
Yes
No
57. Did you evacuate with your traveling companion(s)?
Yes
No
58. Did any of the following slow your movement during the evacuation? (Check all that apply)
Seat tray
Seatback in front of you
Galley
Bulkhead (Walls dividing cabin into sections)
Flight attendant seats
Galley items (Soda cans, carts)
Luggage fallen from overhead bins
Luggage passengers tried to take off plane
Footrest
Child Safety Seat
Shoes
Blankets
Headsets
Broken cabin interior
Overhead bins
Curtains
None of the above
Other
Please provide your opinion about the evacuation by indicating whether you agree or disagree with the following statements:
59. Other passengers in general were cooperative during the evacuation.
Strongly Disagree
Disagree
Neutral
Agree

Strongly Agree

60. My physical size assisted me in the evacuation.
Strongly Disagree
Disagree
Neutral

Agree

Strongly Agree

61. My physical condition assisted me in the evacuation.
Strongly Disagree
Disagree
Neutral

Agree

Strongly Agree

62. My age assisted me in the evacuation.
Strongly Disagree
Disagree

Agree

Strongly Agree

Neutral

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Seat Belt Usage
63. Was your seat belt fastened prior to the evacuation?
Yes, Very Tight
Yes, Moderately Tight
Yes, Loose

No

Can’t recall

64. Did you have any difficulties unfastening your seat belt?
Yes
No
65. Did unfastening your seat belt slow down your evacuation of the aircraft?
Yes
No
Seatbelt was not buckled

Communication
66. Who first informed you that an evacuation was necessary?
Pilot
Flight Attendant
Other Passenger
Personal Decision

Can’t recall

67. At the time, did you know why an evacuation was necessary?
Yes
No
68. Did the flight attendants give you any instructions just prior to the evacuation?
Yes
No
Not enough time
Can’t recall
69. Did the flight attendants go through the cabin prior to landing to prepare for the evacuation?
Yes
No
Not enough time
Can’t recall
70. Did you hear the flight attendants giving instructions during the evacuation?
Heard every word
Some words difficult to hear
Most words difficult to hear

Heard nothing

71. Describe the flight attendants’ instructions?

72. Did you remove your shoes during the evacuation?
Yes
No
If no skip to item 74
73. Why did you remove your shoes?
Flight attendant instructions
I thought I had to

Saw others removing shoes

74. How did the crew aid in your evacuation? (Check all that apply)
No aid
Indicated the exits in use
Shouted instructions
Assisted passengers from seat to aircraft exits
Opening exits

Directed passengers out exits
Other

75. Did the crew assign you any duties?
Yes
No
If yes, what were you asked to do and did you do the task.

Injury
76. Did you sustain any injuries prior to the evacuation?
Yes
No
If yes, describe the injuries, how they occurred and the effect they had on your evacuation

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Other

77. Did you sustain any injuries during the evacuation?
Yes
No
If yes, describe the injuries, how they occurred and the effect they had on your evacuation

78. Did you sustain any injuries after the evacuation?
Yes
No
If yes, describe the injuries and how they occurred

79. Describe the location of injuries suffered?
Wrist
Ankle
Leg
Arm
Back

Face

Head

Other

80. Description of injuries suffered? (Check all that apply)
Sprain
Fracture
Concussion
Broken Back
Dislocation
Burn
Abrasions (Lacerations & Bruises)
Smoke inhalation
Other

Strain

81.
Were you transported to a hospital? If yes, how and which
hospital?
82. Did you see any other injured passengers during or after the evacuation? Please describe their location/condition.

Your Location
The attached diagram on the last page shows the floor plan of the aircraft.
The doors are indicated by large arrows.
83. Seat Number
Please indicate the following locations on the diagram:
- If you know your exact seat position, place an “X” on that seat.
- If you are NOT SURE of your seat position place a question mark “?” on that seat.
- Position of other passengers and/or traveling companions.
- Show your route of escape (draw line from your seat to exit used).
- Indicate the empty seats in your vicinity by placing “E” on that seat.

Personal Information
84. Have you ever had to evacuate an aircraft before?
Yes
No
85. Age
86. Height
87. Weight
88. Gender
Male

Female
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89. Do you wear corrective lenses?
Yes
No
90. Were you wearing your corrective lenses during this flight?
Yes
No
91. Did you lose your corrective lenses during the event that caused the evacuation?
Yes
No
92. Had you consumed any alcohol in the 8 hours prior the evacuation?
Yes
No
93. Prior to departure, was your ability to evacuate affected by any of the following:
Difficulty seeing
Difficulty hearing
Difficulty walking or standing
Injury or recent surgery
Other
94. How often do you travel by air?
First flight
Less than 1 flight per year
More than 6 flights per year
95. Aviation Experience
Commercial Pilot
Private Pilot
Other

1 to 2 flights per year

Flight Attendant
None

3 to 6 flights per year

Aviation Mechanic

Final Thoughts
Thank you for completing the above items. The Safety Board welcomes any comments on what was helpful during the evacuation
and what improvements or changes to the design and operation of safety equipment you might suggest. Feel free to discuss items
such as the equipment used, instructions given, crew, passengers or any other area you think is important. Use additional paper if
needed.

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Asiana Airlines Flight 214
San Francisco, CA
July 6, 2013
Boeing 777-200ER

Directions:
The diagram above shows the passenger seats on the airplane. The front of the airplane is oriented to
the left. The arrows represent emergency exits. Please complete the items below:
1. On the diagram, please draw an “X” where you were seated, and then draw a line that shows the path
and the exit you used to evacuate the airplane. If you evacuated from a hole in the airplane, please
indicate that as well.
Example:

X

2. Write the seat where you were seated:
Example:

24D