1625-NEW Auxiliary Survey Draft 03202013

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OMB No. 1625-New

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EPARTMENT OF HOMELAND SECURITY

U.S. Coast Guard

District Five Auxiliary Safety Survey

An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a valid OMB control number.

The Coast Guard estimates that the average burden for this report is 10 minutes. You may submit any comments concerning the accuracy of this estimate or any suggestions for reducing the burden to: Commandant (CG-WWM-3), U.S. Coast Guard, Washington, D.C. 20593-0001 or Department of Homeland Security Desk Officer, Office of Management and Budget, Office of Information and Regulatory Affairs, Washington, D.C. 20503.

Privacy Act Notice

Authority: 33 U.S.C. §1226 authorizes the collection of this information.

Purpose: The Coast Guard will use this information to enhance the safety of USCG Auxiliarists operations. This safety survey will be limited to data collection that solicits strictly voluntary opinions and will not collect information which is required or regulated.

Routine Uses: The information will be used by and disclosed to Coast Guard personnel and Auxiliarists who need the information to assist in activities related to Coast Guard operations.

Disclosure: Furnishing this information is voluntary.

DEPARTMENT OF HOMELAND SECURITY

U.S. Coast Guard District Five

2014 Auxiliary Safety Survey

GERNERAL Auxiliary Audience—Purpose: Measure the Safety Culture.

Directions: Please answer the following statements with “Strongly Disagree”, “Disagree”, “Neutral”, “Agree”, “Strongly Agree”. Results are anonymous, and you may answer as few or as many questions as you would like. There will be opportunity for written comments at the end of the survey as well as contact information if you would like to discuss an issue or recommend a change to policy and procedure. The information will be used as a baseline to identify trends that need to be addressed in future training, policy or procedures to enhance “Just Safety Culture”.

“Just Safety Culture”:

A just culture refers to a way of safety thinking that promotes a questioning attitude, is resistant to

complacency, is committed to excellence, and fosters both personal accountability and unit self-

regulation.

AUXILIARY LEADERSHIP

Leaders set a good example for following the rules and meet the standards.

___ Strongly Disagree;___ Disagree;___ Neutral___ Agree ___ Strongly Agree

Leaders/supervisors encourage reporting safety concerns.

___ Strongly Disagree;___ Disagree;___ Neutral___ Agree ___ Strongly Agree

When a safety concern is identified, the leadership responds to eliminate or mitigate the hazard.

___ Strongly Disagree;___ Disagree;___ Neutral___ Agree ___ Strongly Agree

Safety conscious decision making is positively recognized by leadership.

___ Strongly Disagree;___ Disagree;___ Neutral___ Agree ___ Strongly Agree

Those who provide my mission tasking effectively apply Operational Risk Management “ORM” principles, and make prudent risk vs gain decisions.

___ Strongly Disagree;___ Disagree;___ Neutral___ Agree ___ Strongly Agree

OPERATIONS

Standards (SOP’s, COMDT policies, etc) are clearly defined for the job I do.

___ Strongly Disagree;___ Disagree;___ Neutral___ Agree ___ Strongly Agree

Crew members follow the rules and meet the safety standards.

___ Strongly Disagree;___ Disagree;___ Neutral___ Agree ___ Strongly Agree

I have adequate time to prepare for and brief my missions.

___ Strongly Disagree;___ Disagree;___ Neutral___ Agree ___ Strongly Agree

Adequate numbers of crew are assigned to the asset for the mission.

___ Strongly Disagree;___ Disagree;___ Neutral___ Agree ___ Strongly Agree

Unqualified crew members are frequently assigned to the mission.

___ Strongly Disagree;___ Disagree;___ Neutral___ Agree ___ Strongly Agree

All crew maintain a situational awareness for deteriorating conditions such as weather, illness or fatigue.

___ Strongly Disagree;___ Disagree;___ Neutral___ Agree ___ Strongly Agree

Crews are encouraged to submit and discuss facility maintenance concerns.

___ Strongly Disagree;___ Disagree;___ Neutral___ Agree ___ Strongly Agree

PERSONAL OPINION

Effective communication exists within my flotilla.

___ Strongly Disagree;___ Disagree;___ Neutral___ Agree ___ Strongly Agree

There are communications to keep me well-informed of important safety information.

___ Strongly Disagree;___ Disagree;___ Neutral___ Agree ___ Strongly Agree

My opinions are given consideration.

___ Strongly Disagree;___ Disagree;___ Neutral___ Agree ___ Strongly Agree

I feel supported and empowered to make operational decisions.

___ Strongly Disagree;___ Disagree;___ Neutral___ Agree ___ Strongly Agree

Individuals are comfortable reporting safety concerns, unsafe behaviors, or hazardous conditions.

___ Strongly Disagree;___ Disagree;___ Neutral___ Agree ___ Strongly Agree

I am able to perform my job without distractions or interference.

___ Strongly Disagree;___ Disagree;___ Neutral___ Agree ___ Strongly Agree

I have not been properly trained to use personal protective equipment (PPE).

___ Strongly Disagree;___ Disagree;___ Neutral___ Agree ___ Strongly Agree

Conflicts between individuals are impacting performance.

___ Strongly Disagree;___ Disagree;___ Neutral___ Agree ___ Strongly Agree

I have had a crew member that routinely presents a safety risk ? ____yes ____no.

If yes, check any condition that applies: __Hearing __Vision __Experience __Mobility __Cognitive Issues __Interpersonal Skills ___Other

USCG Auxiliary safety culture is effective.

___ Strongly Disagree;___ Disagree;___ Neutral___ Agree ___ Strongly Agree

The USCG perception of Auxiliary completed missions is a high quality standard of performance, proficiency, and professionalism.

___ Strongly Disagree;___ Disagree;___ Neutral___ Agree ___ Strongly Agree

Safety Posture All Participants: The next question is a very general question and requires some careful consideration.

If you choose “Increased”: Answer Section One

If you choose “Decreased”: Answer Section Two

If you choose “Remained the same”: Answer Section Three.

Over the past year I believe the mishap potential has: __Increased __ Decreased ­­__Remained the same __

Section One:

If you answered “Increased”, rate the importance from those most important as “1” to least important “10”.

__Lack of training

__Fatigue

__Failure to maintain facility

__Lack of Team Coordination (TCT) and/or Crew Resource Management (CRM)

__Lack supporting leadership

__Failure to adhere to existing policy and procedure

__Policy and procedure not adequate

__Lack of safety equipment

__Failure to maintain safety equipment

__Other

Section Two:

If you answered”Decreased”, to what would you attribute the success? Check all that apply and rate in order of importance from “1” being highest to “10” being lowest.

__Training

__Adequate rest

__Adequate maintenance

__Good Team Coordination (TCT) and/or Crew Resource Management (CRM)

__Supportive leadership

__Adherence to policy and procedure

__Proper safety equipment

__Proper maintenance of safety equipment

__ Other

Section Three:

If you answered “Remained the same”, how could the operation be improved? Check all that apply and rate the importance from “1” being the highest to “10” being the lowest.

__Training

__Duty time

__Maintenance

__Leadership

__Change in policy and procedure

__Safety equipment

__Maintenance of safety equipment

__Crew Good Team Coordination (TCT) and/or Crew Resource Management (CRM)

__Other

DEMOGRAPHIC INFORMATION

Please enter your:

Region: ___ 5NR ___ 5SR ___Coastal ___River ___ Lake ___ Bay

Age: ___17-30 ___31-45 ___46-60 ___ > 61 yrs

Years of Membership as an Auxiliarist: ___<5 ___6-10 ___11-15 ___ >16 yrs

Activity as a boat crew/coxswain member: ___Yes, ___ No

Activity as a member on air patrols: ___Yes ___ No

Please write a short answer to the following two questions:

What safety related area does your Aux unit excel?

If I could change one thing in my aux function to affect safety what would it be?

If you would like to personally discuss, report, or recommend a safety issue, please complete the following with your contact information and someone will get back to you as soon as possible:

Phone:

Email:

FAX:

Messages:

Thank you for your input; your contribution is making a difference!

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