Attachment C2 – Mine Escape participants: Pre-Training Questionnaire
Form
Approved OMB
No. xxxx-0975 Exp.
Date xx/xx/201x
2. Gender: □
Male □
Female
1. Age_______
4. 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
3. How many years of experience do you have… As a
miner? ______ At your
mine? ______ In your current
job? ______
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 Evacuating a
mine due to a mine emergency Other
emergency response related training/experience:
6. Have you ever experienced a virtual reality environment
before today? □
No □ Yes
7. 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
8. Of all the people training with you today, how many do you
interact with AT LEAST once a month outside of work and/or training? None Maybe 1 or 2 About half Most All
Place an “X” in the appropriate box.
On average, how often do the people in your VR team… |
Not at all |
Once in a while |
Sometimes |
Fairly often |
Frequently or always |
9. See each other at work? |
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10. See each other outside of work or training? |
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How often do you… |
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11. Play video games? (e.g., computer, Xbox, Playstation) |
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12. Spend time on the computer? (e.g., work, internet, games) |
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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
(0920-0975).
Place an “X” in the appropriate box. |
Strongly Disagree |
Disagree |
Neither |
Agree |
Strongly Agree |
13. Even though mine emergencies are rare, I need to be as prepared as I can. |
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14. It is important to be prepared for a mine emergency. |
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15. It is important to put in extra effort toward improving my mine’s ability to respond to an emergency. |
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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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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? |
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16. Make quick and effective decisions. |
0 |
10 |
20 |
30 |
40 |
50 |
60 |
70 |
80 |
90 |
100 |
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17. Agree on solutions to difficult problems encountered. |
0 |
10 |
20 |
30 |
40 |
50 |
60 |
70 |
80 |
90 |
100 |
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18. Readapt team strategy in response to unexpected changes in the environment. |
0 |
10 |
20 |
30 |
40 |
50 |
60 |
70 |
80 |
90 |
100 |
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19. Assist with each other’s responsibilities. |
0 |
10 |
20 |
30 |
40 |
50 |
60 |
70 |
80 |
90 |
100 |
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20. Maintain clear and efficient communication. |
0 |
10 |
20 |
30 |
40 |
50 |
60 |
70 |
80 |
90 |
100 |
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21. Monitor each other’s work to catch mistakes and provide feedback. |
0 |
10 |
20 |
30 |
40 |
50 |
60 |
70 |
80 |
90 |
100 |
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22. Maintain a level of trust and confidence in each other. |
0 |
10 |
20 |
30 |
40 |
50 |
60 |
70 |
80 |
90 |
100 |
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23. Maintain a shared understanding of each other’s responsibilities. |
0 |
10 |
20 |
30 |
40 |
50 |
60 |
70 |
80 |
90 |
100 |
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24. Maintain coordination in performing the tasks at hand. |
0 |
10 |
20 |
30 |
40 |
50 |
60 |
70 |
80 |
90 |
100 |
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25. Consider teammate input before making an action. |
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 simulation team can evacuate from the mine… |
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26. better than in your previous mine evacuation training |
0 |
10 |
20 |
30 |
40 |
50 |
60 |
70 |
80 |
90 |
100 |
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27. almost perfect with reasonable time |
0 |
10 |
20 |
30 |
40 |
50 |
60 |
70 |
80 |
90 |
100 |
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28. 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? |
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29. A mine evacuation scenario |
0 |
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60 |
70 |
80 |
90 |
100 |
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30. A mine evacuation scenario in a virtual environment |
0 |
10 |
20 |
30 |
40 |
50 |
60 |
70 |
80 |
90 |
100 |
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31. Evacuating from a real emergency |
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? |
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32. Properly don a SCSR |
0 |
10 |
20 |
30 |
40 |
50 |
60 |
70 |
80 |
90 |
100 |
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33. Use a fire extinguisher |
0 |
10 |
20 |
30 |
40 |
50 |
60 |
70 |
80 |
90 |
100 |
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34. Explain where the escape routes are located |
0 |
10 |
20 |
30 |
40 |
50 |
60 |
70 |
80 |
90 |
100 |
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35. Explain the chain of command for reporting a mine emergency |
0 |
10 |
20 |
30 |
40 |
50 |
60 |
70 |
80 |
90 |
100 |
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36. Explain your mine’s emergency response plan |
0 |
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20 |
30 |
40 |
50 |
60 |
70 |
80 |
90 |
100 |
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37. Explain your own role in the mine’s emergency response plan |
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20 |
30 |
40 |
50 |
60 |
70 |
80 |
90 |
100 |
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38. Explain where to report in the event of a mine emergency |
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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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39. does a good job of emphasizing emergency preparedness. |
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40. makes decisions that increase the likelihood of a successful response. |
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41. prepares for how to handle emergencies before they happen. |
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My work crew: |
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42. is given the support and resources we need to prepare for an emergency. |
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43. is encouraged to improve our emergency response skills and abilities. |
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44. is provided extra training opportunities for interested crew members. |
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Our mine emergency training: |
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45. is usually realistic and “hands-on”. |
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46. Includes practice using the equipment we would use in a real emergency. |
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47. has opportunities for constructive feedback from instructors. |
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48. does a good job of preparing us for a real emergency. |
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At my mine: |
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49. Production is stopped if there is even a minor chance that an emergency could happen. |
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50. Mine emergencies are thoroughly investigated no matter what delay it may cause. |
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51. Preventing a potential emergency is more important than meeting a production goal. |
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In my work crew: |
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52. We regularly talk about the decisions and issues that would come up during a mine emergency. |
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53. I would probably be made fun of or ridiculed if I asked questions about our emergency preparedness procedures. |
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54. We remind each other of the need to be prepared for mine emergencies. |
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File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
Author | CDC User |
File Modified | 0000-00-00 |
File Created | 2021-01-27 |