Appendix G: General Preference Questionnaire
Form Approved
OMB No. 0920-xxxx
Expires xx/xx/20xx
Date: ______________ Questionnaire: Preference ID# __________
General Preference Questionnaire
We would like it if you could complete this questionnaire about your information preference. On this questionnaire, you are being asked to answer questions about some of the information that may or may not be available to you during your work day. The questionnaire has four sections. There is no right or wrong answer to these questions; we are only interested in your opinions. Please try to answer the questions as completely and honestly as possible. You will be given specific instructions to use for each of the sections.
Section 1
Demographic Information
Please provide us with some information about yourself. Answer the questions to the best of your ability, rounding where necessary.
Age: _______ Years Gender (circle one): Male Female
Height: ________Feet ________Inches Weight: _______________ Pounds
Mining Experience
Current Job Title: _____________________________________________________________ |
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Other Job Titles: _____________________________________________________________ |
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Total # of Mines Worked:_______________________________________________________ |
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Years |
Months |
Experience in this Job Title |
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Experience at this Mine |
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Total Mining Experience |
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Public reporting burden of this collection of information is estimated to average 30 minutes or less 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 Reports Clearance Officer, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-XXXX).
Section 2
Current Information Availability
In this section, we are asking you about your current work experience. When you answer these questions, please think about how it is at the mine where you currently work. Answer the questions only based on that experience. The questions will be about six (6) specific types of information (gas levels, airflow, dust levels, your location in the mine, other’s location in the mine, and equipment location).
Gas Levels
How critical is it to you to know information about the gas levels?
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Not Critical Neutral Critical
How often are the gas levels checked or monitored in your underground work location?
(Please choose only one)
Continuously
A few times an hour
Hourly
Every shift
Every day
Every week
Never
I don’t care
Who currently has the ABILITY to check the gas levels at the mine where you work?
(Please choose only one)
Everyone
A few people on the crew (Specify: ___________________________)
One person on the crew (Specify: _____________________________)
Someone on the outside (Specify: _____________________________)
Other (Specify: _______________________________________)
No one
Who currently is RESPONSIBLE for monitoring the gas levels at the mine where you work?
(Please choose only one)
Everyone
A few people on the crew (Specify: __________________________)
One person on the crew (Specify: _____________________________)
Someone on the outside (Specify: _____________________________)
Other (Specify: ______________________________________)
No one
Do you currently know the gas levels in your underground work location at any time during your shift?
Yes
No
Airflow
How critical is it to you to know information about the airflow?
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6 |
7 |
Not Critical Neutral Critical
How often is the airflow checked or monitored in your underground work location?
(Please choose only one)
Continuously
A few times an hour
Hourly
Every shift
Every day
Every week
Never
I don’t care
Who currently has the ABILITY to check the airflow at the mine where you work?
(Please choose only one)
Everyone
A few people on the crew (Specify: ___________________________)
One person on the crew (Specify: _____________________________)
Someone on the outside (Specify: _____________________________)
Other (Specify: ______________________________________)
No one
Who currently is RESPONSIBLE for monitoring the airflow at the mine where you work?
(Please choose only one)
Everyone
A few people on the crew (Specify: __________________________)
One person on the crew (Specify: _____________________________)
Someone on the outside (Specify: _____________________________)
Other (Specify: ______________________________________)
No one
Do you currently know the airflow in your underground work location at any time during your shift?
Yes
No
Dust Levels
How critical is it to you to know information about the dust levels?
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2 |
3 |
4 |
5 |
6 |
7 |
Not Critical Neutral Critical
How
often are the dust
levels checked or
monitored in your underground work location?
(Please choose
only one)
Continuously
A few times an hour
Hourly
Every shift
Every day
Every week
Never
I don’t care
Who currently has the ABILITY to check the dust levels at the mine where you work?
(Please choose only one)
Everyone
A few people on the crew (Specify: ___________________________)
One person on the crew (Specify: _____________________________)
Someone on the outside (Specify: _____________________________)
Other (Specify: ______________________________________)
No one
Who currently is RESPONSIBLE for monitoring the dust levels at the mine where you work? (Please choose only one)
Everyone
A few people on the crew (Specify: __________________________)
One person on the crew (Specify: _____________________________)
Someone on the outside (Specify: _____________________________)
Other (Specify: ______________________________________)
No one
Do you currently know the dust levels in your underground work location at any time during your shift?
Yes
No
Your Location in the Mine
How critical is it to you to know information about your location in the mine?
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1 |
2 |
3 |
4 |
5 |
6 |
7 |
Not Critical Neutral Critical
How often is your location in the mine checked or monitored at the mine where you work? (Please choose only one)
Continuously
A few times an hour
Hourly
Every shift
Every day
Every week
Never
I don’t care
Who currently has the ABILITY to check your location in the mine at the mine where you work? (Please choose only one)
Everyone
A few people on the crew (Specify: ___________________________)
One person on the crew (Specify: _____________________________)
Someone on the outside (Specify: _____________________________)
Other (Specify: ______________________________________)
No one
Who currently is RESPONSIBLE for monitoring your location in the mine at the mine where you work? (Please choose only one)
Everyone
A few people on the crew (Specify: __________________________)
One person on the crew (Specify: _____________________________)
Someone on the outside (Specify: _____________________________)
Other (Specify: ______________________________________)
No one
Do you currently know your location in the mine at all times during your shift?
Yes
No
The Location of Other Miners in the Mine
How critical is it to you to know information about the location of other miners?
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7 |
Not Critical Neutral Critical
How often is the location of other miners checked or monitored at the mine where you work? (Please choose only one)
Continuously
A few times an hour
Hourly
Every shift
Every day
Every week
Never
I don’t care
Who currently has the ABILITY to check the location of other miners at the mine where you work? (Please choose only one)
Everyone
A few people on the crew (Specify: ___________________________)
One person on the crew (Specify: _____________________________)
Someone on the outside (Specify: _____________________________)
Other (Specify: ______________________________________)
No one
Who currently is RESPONSIBLE for monitoring the location of other miners at the mine where you work? (Please choose only one)
Everyone
A few people on the crew (Specify: __________________________)
One person on the crew (Specify: _____________________________)
Someone on the outside (Specify: _____________________________)
Other (Specify: ______________________________________)
No one
Do you currently know the location of other miners at all times during your shift?
Yes
No
Equipment Location
Equipment Location refers to all large pieces of equipment operating in the mine (Continuous Mining Machine, Shuttle Car(s), Scoop(s), etc.). This includes all the equipment, not just the equipment you use for your job unless otherwise specified.
How critical is it to you to know the location of the equipment you are directly working with?
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Not Critical Neutral Critical
How critical is it to you to know the location of the equipment you are NOT directly working with (i.e. Continuous Mining Machine on another section)?
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Not Critical Neutral Critical
How often is the location of equipment checked or monitored at the mine where you work? (Please choose only one)
Continuously
A few times an hour
Hourly
Every shift
Every day
Every week
Never
I don’t care
Who currently has the ABILITY to check the location of equipment at the mine where you work? (Please choose only one)
Everyone
A few people on the crew (Specify: ___________________________)
One person on the crew (Specify: _____________________________)
Someone on the outside (Specify: _____________________________)
Other (Specify: ______________________________________)
No one
Who currently is RESPONSIBLE for monitoring the location of equipment at the mine where you work? (Please choose only one)
Everyone
A few people on the crew (Specify: __________________________)
One person on the crew (Specify: _____________________________)
Someone on the outside (Specify: _____________________________)
Other (Specify: ______________________________________)
No one
Do you currently know the location of equipment that you are directly working with at all times during your shift?
Yes
No
Do you currently know the location of equipment that you are NOT directly working with at any time during your shift?
Yes
No
Section 3
Ideal World Information Availability
In this section, we are asking you to tell us about the best situation you could have. When you answer these questions, we would like you to think about how, in an ideal world, you would like it to be where you work and make your decisions based on that possible experience. The questions will be about six (6) specific types of information (gas levels, airflow, dust levels, your location in the mine, other’s location in the mine, and equipment location).
Gas Levels
Ideally, how often should the gas levels be checked or monitored in your underground work location? (Please choose only one)
Continuously
A few times an hour
Hourly
Every shift
Every day
Every week
Never
I don’t care
Ideally, who should have the ABILITY to check the gas levels at the mine where you work?
(Please choose only one)
Everyone
A few people on the crew (Specify: _____________________________)
One person on the crew (Specify: ______________________________)
Someone on the outside (Specify: ______________________________)
Other (Specify: ________________________________________)
No one
Ideally, who should be RESPONSIBLE for monitoring the gas levels at the mine where you work? (Please choose only one)
Everyone
A few people on the crew (Specify: _____________________________)
One person on the crew (Specify: ______________________________)
Someone on the outside (Specify: ______________________________)
Other (Specify: ________________________________________)
No one
Ideally, how should you be alerted if there is a problem with the gas levels at the mine where you work? (Select all that apply)
Light
Auditory Tone (alarm warning or sound)
Vibration
Displayed Message (similar to a text message)
Other (Specify: _______________________________________)
Airflow
Ideally, how often should the airflow be checked or monitored in your underground work location? (Please choose only one)
Continuously
A few times an hour
Hourly
Every shift
Every day
Every week
Never
I don’t care
Ideally, who should have the ABILITY to check the airflow at the mine where you work?
(Please choose only one)
Everyone
A few people on the crew (Specify: _____________________________)
One person on the crew (Specify: ______________________________)
Someone on the outside (Specify: ______________________________)
Other (Specify: ________________________________________)
No one
Ideally, who should be RESPONSIBLE for monitoring the airflow at the mine where you work? (Please choose only one)
Everyone
A few people on the crew (Specify: _____________________________)
One person on the crew (Specify: ______________________________)
Someone on the outside (Specify: ______________________________)
Other (Specify: ________________________________________)
No one
Ideally, how should you be alerted if there is a problem with the airflow at the mine where you work? (Select all that apply)
Light
Auditory Tone (alarm warning or sound)
Vibration
Displayed Message (similar to a text message)
Other (Specify: _______________________________________)
Dust Levels
Ideally, how often should the dust levels be checked or monitored in your underground work location? (Please choose only one)
Continuously
A few times an hour
Hourly
Every shift
Every day
Every week
Never
I don’t care
Ideally, who should have the ABILITY to check the dust levels at the mine where you work? (Please choose only one)
Everyone
A few people on the crew (Specify: _____________________________)
One person on the crew (Specify: ______________________________)
Someone on the outside (Specify: ______________________________)
Other (Specify: ________________________________________)
No one
Ideally, who should be RESPONSIBLE for monitoring the dust levels at the mine where you work? (Please choose only one)
Everyone
A few people on the crew (Specify: _____________________________)
One person on the crew (Specify: ______________________________)
Someone on the outside (Specify: ______________________________)
Other (Specify: ________________________________________)
No one
Ideally, how should you be alerted if there is a problem with the dust levels at the mine where you work? (Select all that apply)
Light
Auditory Tone (alarm warning or sound)
Vibration
Displayed Message (similar to a text message)
Other (Specify: _______________________________________)
Your Location in the Mine
Ideally, how often should your location in the mine be checked or monitored at the mine where you work? (Please choose only one)
Continuously
A few times an hour
Hourly
Every shift
Every day
Every week
Never
I don’t care
Ideally, who should have the ABILITY to check your location in the mine at the mine where you work? (Please choose only one)
Everyone
A few people on the crew (Specify: _____________________________)
One person on the crew (Specify: ______________________________)
Someone on the outside (Specify: ______________________________)
Other (Specify: ________________________________________)
No one
Ideally, who should be RESPONSIBLE for monitoring your location in the mine at the mine where you work? (Please choose only one)
Everyone
A few people on the crew (Specify: _____________________________)
One person on the crew (Specify: ______________________________)
Someone on the outside (Specify: ______________________________)
Other (Specify: ________________________________________)
No one
Ideally, how should you be alerted if there is a problem with your location in the mine at the mine where you work? (Select all that apply)
Light
Auditory Tone (alarm warning or sound)
Vibration
Displayed Message (similar to a text message)
Other (Specify: _______________________________________)
The Location of Other Miners in the Mine
Ideally, how often should the location of other miners be checked or monitored at the mine where you work? (Please choose only one)
Continuously
A few times an hour
Hourly
Every shift
Every day
Every week
Never
I don’t care
Ideally, who should have the ABILITY to check the location of other miners at the mine where you work? (Please choose only one)
Everyone
A few people on the crew (Specify: _____________________________)
One person on the crew (Specify: ______________________________)
Someone on the outside (Specify: ______________________________)
Other (Specify: ________________________________________)
No one
Ideally, who should be RESPONSIBLE for monitoring the location of other miners at the mine where you work? (Please choose only one)
Everyone
A few people on the crew (Specify: _____________________________)
One person on the crew (Specify: ______________________________)
Someone on the outside (Specify: ______________________________)
Other (Specify: ________________________________________)
No one
Ideally, how should you be alerted if there is a problem with the location of other miners at the mine where you work? (Select all that apply)
Light
Auditory Tone (alarm warning or sound)
Vibration
Displayed Message (similar to a text message)
Other (Specify: _______________________________________)
Equipment Location
Equipment Location refers to all large pieces of equipment operating in the mine (Continuous Mining Machine, Shuttle Car(s), Scoop(s), etc.). This includes all the equipment, not just the equipment you use for your job unless otherwise specified.
Ideally, how often should the location of equipment be checked or monitored at the mine where you work? (Please choose only one)
Continuously
A few times an hour
Hourly
Every shift
Every day
Every week
Never
I don’t care
Ideally, who should have the ABILITY to check the location of equipment at the mine where you work? (Please choose only one)
Everyone
A few people on the crew (Specify: _____________________________)
One person on the crew (Specify: ______________________________)
Someone on the outside (Specify: ______________________________)
Other (Specify: ________________________________________)
No one
Ideally, who should be RESPONSIBLE for monitoring the location of equipment at the mine where you work? (Please choose only one)
Everyone
A few people on the crew (Specify: _____________________________)
One person on the crew (Specify: ______________________________)
Someone on the outside (Specify: ______________________________)
Other (Specify: ________________________________________)
No one
Ideally, how should you be alerted if there is a problem with the location of equipment at the mine where you work? (Select all that apply)
Light
Auditory Tone (alarm warning or sound)
Vibration
Displayed Message (similar to a text message)
Other (Specify: _______________________________________)
Section 4
Vitals Preferences
In this section, we are asking you to tell us how you feel about your vital signs (for instance, your heart rate) being monitored while you work. Many people believe that having access to a person’s vital signs could help save lives. Heart Rate can be used to detect stress and fatigue on a daily basis and be used to help triage and monitor miners in an emergency situation. If vital signs were monitored on mine rescue workers, it could also help avoid sudden heart attack due to stress or overexertion. The next set of questions is related to your opinions about heart rate monitoring in the mining industry.
Do you think monitoring heart rate on a daily basis would be useful?
Yes
No
Why or why not?
Do you think monitoring heart rate during an emergency situation would be useful?
Yes
No
Why or why not?
Do you think that the benefits of wearing a heart rate monitor justify wearing it every day? Please consider the benefits both during an emergency and on a daily basis.
Yes
No
Why or why not?
Would you be willing to wear a heart rate monitor on a daily basis?
Yes
No
Why or why not?
Would you personally check or monitor your heart rate if that information was available?
Yes
No
Why or why not?
Would you allow other workers to monitor your heart rate?
Yes
No
Why or why not?
Would you check or monitor other workers heart rate if that information was available?
Yes
No
Why or why not?
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
Author | CDC User:bme |
File Modified | 0000-00-00 |
File Created | 2021-01-27 |