Moderators Guide Handout - Form A

Typical Riding Gear (Form A)

For each item, indicate whether you: never, rarely, sometimes, usually or always wear it. The pictures are examples only.

Example	Item	Use Mark your response with an “X”
If you wear a helmet, circle the type that best reflects the one you use.	Helmet	Never
		Rarely
		Sometimes
		Usually
		Always
	If you wear a helmet, is it DOT certified? (circle your response) YES NO DON’T KNOW
	Leather jacket	Never
		Rarely
		Sometimes
		Usually
		Always
	Armored/protective jacket	Never
		Rarely
		Sometimes
		Usually
		Always
	Riding gloves	Never
		Rarely
		Sometimes
		Usually
		Always
	Riding boots	Never
		Rarely
		Sometimes
		Usually
		Always

Example	Item	Use Mark your response with an “X”
	Leather pants	Never
		Rarely
		Sometimes
		Usually
		Always
	Chaps	Never
		Rarely
		Sometimes
		Usually
		Always
	Leather vest	Never
		Rarely
		Sometimes
		Usually
		Always
	Armored vest	Never
		Rarely
		Sometimes
		Usually
		Always
	Rain gear	Never
		Rarely
		Sometimes
		Usually
		Always
	High visibility gear	Never
		Rarely
		Sometimes
		Usually
		Always

Example	Item	Use Mark your response with an “X”
	Denim jacket /vest	Never
		Rarely
		Sometimes
		Usually
		Always
	Denim pants	Never
		Rarely
		Sometimes
		Usually
		Always
	Eye protection	Never
		Rarely
		Sometimes
		Usually
		Always

OTHER (Specify) ________________________________________________________________________

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