Form FHWA TIM-5 FHWA TIM-5 Demographic Survey

National Traffic Incident Management (TIM) Responder Training Program

L32C TIM Trng PCAT Demographic Questions - 012215 Final Draft

Demographic Survey

OMB: 2125-0650

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This collection of information is voluntary and will be used to validate the effectiveness of, and assess the value of the National Traffic Incident Management (TIM) Responder Training Program. Public reporting burden is estimated to average 15 minutes 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. Please note that 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. The OMB control number for this collection is 2125-XXXX. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: Information Collection Clearance Officer, Michael Howell, [email protected], 202 366-5707, Federal Highway Administration, 1200 New Jersey Avenue, SE, E66-233, Washington, DC 20590.

L32C Interdisciplinary TIM Training Post-Course Assessment Tool

Demographic Questions

It is anticipated that some variation of the demographic questions will be used for all four assessment levels and that some attendee information may be marked as optional.

Attendee Information

  1. Name

  2. Agency

  3. City, State

  4. Discipline

    • Law Enforcement

    • Fire/Rescue

    • Towing and Recovery

    • Emergency Medical Services (EMS)

    • DOT/Transportation

    • Other

  1. Work E-mail

  2. Work Phone Number

Training Information

  1. Location (City, State)

  2. Date(s)

  3. Type of Training

    • Train-the-Trainer (TtT) Session

    • Responder Training Session

  1. Length of Course

    • 10+ Hours

    • 8 Hours

    • 4 Hours

    • 3 Hours

    • 2 Hours

    • 1 Hour

    • Other

FHWA TIM-5 01/22/15 2

File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorKatherine Belmore
File Modified0000-00-00
File Created2021-01-24

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