Attachment 3b. Pilot Survey
Form Approved
OMB NO. 0920-xxxx
Expiration Date: xx/xx/20xx
NIOSH2018 - Aviation Safety – Pilots
Screening Question: Q00 Do you currently work for (Pipe in company name)?
Yes, I work for (Pipe in company name).
Yes, I work for (Pipe in company name) seasonally, occasionally, on-call, or when needed
No, I no longer work for (Pipe in company name).
Skip To: END of Survey if Do you currently work for (Pipe in company name)? = No, I no longer work for (Pipe in comp…)
Screening Question: Q00 Do you currently work as a pilot?
Yes, I work as a pilot.
No, I no longer work as a pilot.
Skip To: END of Survey if Do you currently work as a pilot? = No, I no longer work as a pilot.
Q0 INSERT CONSENT FORM HERE
I agree to participate in this study.
I do not agree to participate in this study.
Public reporting burden of this collection of information is estimated to average 25 mins 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 Information Collection Review Office, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-xxxx).
These first questions ask about your entire career as a pilot.
Q1 Over your entire career, how many years have you been a pilot? Please enter the number of months if less than 1 year.
Years: ___________________
Months: ___________________
Q2 Over your entire career, how many different companies have you worked for as a pilot?
Number of companies: ________________________________________________
If Over your entire career, how many different employers have you work for… # Employers > 1
Q2a Over how many years has that been?
Years: ________________________________________________
These questions are about your current job as a pilot.
Q3 Which of the following best describes your position as a pilot?
Captain
First officer
Other. Please specify: ________________________________________________
Q4 How long have you worked for your company?
Please enter the number of months if less than 1 year.
Years: ________________________________________________
Months: ________________________________________________
Q5 How long have you worked for your company as a pilot?
Please enter the number of months if less than 1 year.
Years: ________________________________________________
Months: ________________________________________________
Q6 In general, do you work as…
Please check all that apply.
A single pilot
A member of a multi-pilot crew
Something else. Please specify: ________________________________________________
Q7 Do you routinely perform tasks that are not in your job description?
Yes
No
I don’t know
Display This Question:
If Do you routinely perform tasks that are not in your job description? = Yes
Q7a What three tasks do you perform most often that are not in your job description?
Task 1: ________________________________________________
Task 2: ________________________________________________
Task 3: ________________________________________________
Q8 What pilot ratings and certificates do you hold?
Please
select all that apply.
Commercial
Instrument
Airline Transport
Helicopter
Flight Instructor
Single-engine land
Multi-engine land
Single-engine sea
Multi-engine sea
Other. Please specify: ________________________________________________
Q9 On your FAA pilot certificate, is your address in Alaska?
Yes
No
Q10 Please fill in the table below with the number of hours flown in Alaska and in all locations, including Alaska, for your total flight career and during the last 12 months.
*If you are using a mobile device, like a smart phone or tablet, please turn it sideways so you can see the full question. You may need to turn off your "screen lock" feature so the screen will turn.
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Alaska |
All locations (including Alaska) |
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Total Flight Career |
Last 12 Months |
Total Flight Career |
Last 12 Months |
Total paid flight hours |
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Instrument hours |
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Current employer hours |
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Q11 Thinking about the number of years you have flown in Alaska, has your work ever been seasonal?
Yes
No
Display This Question:
If Thinking about the number of years you have flown in Alaska, has your work ever been seasonal?= Yes
Q11a How many years was your work seasonal?
Years
Q12 Thinking about the number of years you have flown in Alaska, has your work ever been year-round?
Yes
No
Display This Question:
If Thinking about the number of years you have flown in Alaska, has your work ever been year-round? = Yes
Q12a How many years was your work year-round?
Years
These next questions are about your work schedule as a pilot.
Q13 Some people work a rotating schedule such as 2 weeks on and 2 weeks off. Do you currently work a rotating schedule?
Yes
No
Display This Question:
If Some people work a rotating schedule such as 2 weeks on and 2 weeks off. Do you currently work a rotating schedule? = Yes
Q13a Do you currently work...
1 week on and 1 week off
2 weeks on and 2 weeks off
3 weeks on and 1 weeks off
Other. Please specify: ________________________________________________
Q14 Is your work for your current employer seasonal or year-round?
Year-round
Mostly year-round
Seasonal
Mostly seasonal
Other. Please explain______
Q15 Please estimate what percent of your paid flight hours in YEAR occurred in each season.
Spring: _______
Summer: _______
Autumn: _______
Winter: _______
Total: ________
Q16 Does your work as a pilot have a peak season?
Yes
No
I don’t know
Display This Question:
If Does your work as a pilot have a peak season? = Yes
Q16a Have you worked during peak season as a pilot?
Yes
No
Display This Question:
If Does your work as a pilot have a peak season? = Yes AND Have you worked during peak season as a pilot? = Yes
Q17 During the peak season, what is your typical duty time each day?
Please enter your typical duty time in 24-hour clock format. That is, for 7:00 AM please enter 0700; for 1:00 PM please enter 1300.
From: ________________________________________________
To: ________________________________________________
Display This Question:
If Does your work as a pilot have a peak season? = Yes AND Have you worked during peak season as a pilot? = Yes
Q18 On the days you work during the peak season, how many flight hours per day do you typically log?
Flight hours per day: ________________________________________________
Display This Question:
If Does your work as a pilot have a peak season? = Yes AND Have you worked during peak season as a pilot? = Yes
Q19 During the peak season, how many days per week do you typically work?
Duty days per week: ________________________________________________
Display This Question:
If Does your work as a pilot have a peak season? = Yes AND Have you worked during peak season as a pilot? = Yes
Q20 During the peak season, do you typically work more than 40 hours per week?
Yes
No
Display This Question:
If During the peak season, do you typically work more than 40 hours per week? = Yes
Q20a During the peak season, about how many hours over 40 do you work per week?
Hours over 40 per week: _________________
Display This Question:
If Does your work as a pilot have a peak season? = No -OR- I don’t know OR Have you worked during peak season as a pilot? = No
Q17z What is your typical duty time each day?
Please enter your typical duty time in 24-hour clock format.
That is, for 7:00 AM please enter 0700; for 1:00 PM please enter
1300.
From: ________________________________________________
To: ________________________________________________
Display This Question:
If Does your work as a pilot have a peak season? = No -OR- I don’t know OR Have you worked during peak season as a pilot? = No
Q18z How many flight hours per day do you typically log?
Flight hours per day: ________________________________________________
Display This Question:
If Does your work as a pilot have a peak season? = No -OR- I don’t know OR Have you worked during peak season as a pilot? = No
Q19z How many days per week do you typically work?
Duty days per week: ________________________________________________
Display This Question:
If Does your work as a pilot have a peak season? = No -OR- I don’t know OR Have you worked during peak season as a pilot? = No
Q20z Do you generally work more than 40 hours per week?
Yes
No
Display This Question:
If Do you generally work more than 40 hours per week? = No
Q20az About how many hours over 40 do you work per week?
Hours over 40 per week: _________________
These next questions are about weather and decision-making in your job.
Q21 From the list of resources below, which ones do you use when
making decisions to launch flights?
Please select all that
apply.
Flight Service Station - in person
Flight Service - by telephone (1-800-WXBRIEF)
Alaska Aviation Weather Unit online – (weather.gov/aawu)
Aviation Weather Center online (aviationweather.gov)
Aviation applications (Aerovie, Foreflight, SkyVector, Garmin Pilot)
FIS-B Weather
Weather cameras
PIREPs
Other pilots who are en route or have flown in that area that day
Station manager, company personnel, or village agent at destination
Dispatchers, flight followers, or other company personnel
Unofficial weather observer
Other. Please specify: ________________________________________________
Q22 While working for your current employer, have you ever declined a flight due to poor visibility or other weather-related reasons?
Yes
No
Prefer not to answer
Display This Question:
If While working for your current employer, have you ever declined a flight due to poor visibility or other weather-related reasons?= Yes
Q22a Did the company support your decision?
Yes
No
Other. Please explain
Prefer not to answer
Q23 How often do you fly into weather that is different from what was predicted when you started your flight?
Daily
Weekly
Monthly
Less often than monthly
Never
Q24 How often do you have to decide whether to fly on a Visual Flight Rules (VFR) flight plan into unknown weather conditions that may deteriorate below VFR minimums?
Daily
Weekly
Monthly
Less often than monthly
Never
Q25 If you refuse to launch a flight due to marginal weather, how likely is it that your customers will fly with a different company?
Not at all likely
Somewhat likely
Very likely
I don’t know
Q26 Do you have standard procedures to follow if you unexpectedly fly into Instrument Meteorological Conditions (IMC)?
Yes
No
I don't know
Q27 How confident are you that you can safely fly under Visual Flight Rules (VFR) in the following conditions?
Whiteout conditions are when blowing snow, fog, or haze limit all visual references.
Flat light conditions are when an overcast limits visual cues, the features of the terrain, and make it hard to determine distance.
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Not confident |
Somewhat confident |
Very confident |
Whiteout conditions |
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Low visibility conditions |
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Flat light conditions |
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These next few questions ask about training and safety.
Q28 Please indicate if your current employer has provided you with training or check rides to help you deal with...
*If you are using a mobile device, like a smart phone or tablet, please turn it sideways so you can see the full question. You may need to turn off your "screen lock" feature so the screen will turn.
Whiteout conditions are when blowing snow, fog, or haze limit all visual references.
Flat light conditions are when an overcast limits visual cues, the features of the terrain, and make it hard to determine distance.
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Ground training |
Flight simulator |
Check rides |
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Yes |
No |
Yes |
No |
Yes |
No |
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Recovery from inadvertent flight into IMC |
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Whiteout conditions |
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Low visibility conditions |
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Flat light conditions |
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Q29 In your current job as a pilot, did your employer provide you with training, equipment, or information on any of the following safety topics?
*If you are using a mobile device, like a smart phone or tablet, please turn it sideways so you can see the full question. You may need to turn off your "screen lock" feature so the screen will turn.
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Training |
Equipment |
Information |
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Yes |
No |
Yes |
No |
Yes |
No |
Hazardous materials safety |
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Fire safety |
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Ramp safety |
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Office safety |
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Lifting safely |
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Forklift use |
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Fall from heights prevention |
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Yes |
No |
Yes |
No |
Yes |
No |
Fall from the same level prevention |
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Prevention of slips on ice |
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Personal protective equipment use |
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Exposure to pathogens or chemical contaminants |
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De-escalation of threats from customers, passengers, or co-workers |
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Other. Please specify: |
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Q30 In your opinion, what additional training might reduce injuries, prevent illnesses, and increase safety?
________________________________________________________________
________________________________________________________________
________________________________________________________________
Q31 While at work, about how often do you lift more than 50 pounds without equipment?
Daily
2-3 times a week
Once a week
Once a month
2-3 times a year
Never
Other. Please describe:
Q32 Is any of the following equipment available at work to assist
with moving heavy items?
Please select all that apply.
Forklift
Pallet jack
Mechanical lift
Other. Please describe: ________________________________________________
None of the above
Q33 Compared to non-piloting jobs, how safe is your pilot job?
Much safer than other jobs
Slightly safer than other jobs
As safe as other jobs
Slightly more dangerous than other jobs
Much more dangerous than other jobs
The following questions are about work-related exposures, illnesses, and injuries and measures to eliminate them at your job as a pilot.
Examples of exposures are workplace exposures to harmful substances, fumes, loud noises, and temperature extremes.
Examples of illnesses are skin diseases, respiratory disorders, and poisonings resulting from work exposures.
Examples of injuries are work-related cuts, fractures, sprains, hearing loss, and amputations.
These questions refer to a time when your body was damaged and required medical attention at the time of the event, or caused you to take time away from work, or required you to change how you did your job.
Q34 Exposures in the workplace may be to harmful substances, fumes, loud noises, or temperature extremes. In the past five years, have you had any exposures as a result of your work that required medical care, first aid, time off work, or changes in how you do your job?
Yes. Please explain:
No
Q35 Other than piloting the aircraft, which of your duties or tasks are most likely to make you ill?
________________________________________________________________
________________________________________________________________
________________________________________________________________
Q36 In the past five years, have you been made ill as a result of your work?
Yes. Please explain:
No
Q37 Other than piloting the aircraft, which of your duties or tasks are most likely to injure you?
________________________________________________________________
________________________________________________________________
________________________________________________________________
Q38 In the past five years, have you been injured as a result of your work?
Yes
No
Display This Question:
If In the past five years, have you been injured as a result of your work? = Yes
Q39 In the past five years, how many different times have you been injured at work?
Once
Twice
Three or more times
Display This Statement:
If In the past five years, how many different times have you been injured at work?!= Once
AND
If In the past five years, have you been injured as a result of your work? = Yes
Please think about your most serious injury when answering these next questions.
Display This Question:
If In the past five years, have you been injured as a result of your work? = Yes
Q40 How did your injury occur?
Lifting (picking up cargo, baggage, equipment, etc.)
Slip (on ice, wet or oily surfaces, etc.)
Trip (over objects, uncovered hoses or cables, etc.)
Fall
Pushing or pulling
Contact injury with object (aircraft wing, tug, etc.)
Assault or injury by another person
Other. Please specify: ________________________________________________
Display This Question:
If How did your injury occur? = Fall
AND
If In the past five years, have you been injured as a result of your work? = Yes
Q40a Was your fall while you were above ground level or at ground level?
Above ground level (on a ladder, aircraft wing, etc.)
At ground level
Display This Question:
If In the past five years, have you been injured as a result of your work? = Yes
Q41 How was your injury treated?
Please select all that apply.
Did not receive any treatment
Received first aid at work
Self-treatment at home after work
Went to medical or community clinic
Went to hospital or emergency room, but wasn't admitted to hospital
Hospitalized 1-3 days
Hospitalized 4-7 days
Hospitalized more than 7 days
Received outpatient long-term care including therapy (physical, occupational, massage, counseling, etc.)
Other. Please explain: ________________________________________________
Display This Question:
If In the past five years, have you been injured as a result of your work? = Yes
Q42 Due to your injury, did you miss any workdays?
Yes
No
I don’t remember
Prefer not to answer
Display This Question:
If Due to your injury, did you miss any workdays? = Yes
AND
If In the past five years, have you been injured as a result of your work? = Yes
Q42a Due to your injury, about how much time did you miss from work?
Days ________________________________________________
Weeks ________________________________________________
Months ________________________________________________
Years__________________________________________________
I don’t remember
Display This Question:
If In the past five years, have you been injured as a result of your work? = Yes
Q43 What part or parts of your body were
affected?
Please select all that apply.
Head
Neck
Upper limbs (shoulders, arms, hands, wrists)
Lower limbs (legs, knees, feet)
Other. Please explain: ________________________________________________
Display This Question:
If In the past five years, have you been injured as a result of your work? = Yes
Q44 At the time of your injury, about how long had you been at work that day?
Less than 1 hour
1 – 2 hours
3 – 5 hours
6 – 8 hours
More than 8 hours
I don’t remember
Q45 Did you file a worker's compensation claim for your injury?
Yes
No, I didn’t have coverage at the time
No, other reason
I don’t remember
Prefer not to answer
Display This Question:
If Did you file a worker's compensation claim for your injury? = No AND
If In the past five years, have you been injured as a result of your work? = Yes
Q45a Which of following best describes your reasons for not filing a worker's compensation claim?
Please select all that apply.
I didn't think the injury was bad enough, filing was unnecessary
I didn't know I could
I didn't know how
I didn’t want to hurt the company or my employer
I was worried it would make me look bad
I didn’t want to get a co-worker in trouble
Other. Please describe: ________________________________________________
Display This Question:
If In the past five years, have you been injured as a result of your work? = Yes
Q46 Did you report your injury to your employer?
Yes
No
I don’t remember
Prefer not to answer
Display This Question:
If In the past five years, have you been injured as a result of your work? = Yes
Q47 Do you think your injury could have been prevented?
Yes. What could have prevented it? ________________________________
No. Please explain: ________________________________________________
I don't know
Q48 Please indicate how much you agree or disagree with each of the following statements. Where I work…
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Where I work… |
Strongly Disagree |
Disagree |
Neither Disagree nor Agree |
Agree |
Strongly Agree |
the safety of workers is a high priority with management. |
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workers are discouraged from reporting safety issues. |
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there are no significant compromises or shortcuts taken when worker safety is at stake. |
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keeping aircraft in the air is more important than worker safety. |
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employees and management work together to ensure the safest possible working conditions. |
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management isn’t interested in safety issues. |
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Q49 What do you think contributes most to injuries in aviation in Alaska?
________________________________________________________________________________________________________________________________________________________________________________
Q50 If you could make changes, how would you make your job safer?
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Q51 Have you ever felt so tired at work that you forgot what you were doing, what you had done, or made a mistake?
Yes
No
I don’t remember
Prefer not to answer
Q52 During YEAR, about how often would you have liked to decline a flight because you were too tired, but you flew anyway?
Daily
Weekly
Monthly
Less often than monthly
Never
Prefer not to answer
Display This Question:
If During YEAR, about how often would you have liked to decline a flight because you were too tired, but you flew anyway? != Never OR Prefer not to answer
Q52a When you continued to work despite being tired, you did so because…
Please select all that apply.
Your employer expected you to get the job done
Passengers were waiting
You needed the money
You didn’t want to let your coworkers down
You didn't want to let your company down
Other. Please describe: ________________________________________________
Q53 In the list of equipment below, indicate how helpful you think each is in preventing aircraft crashes:
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Not helpful |
Somewhat helpful |
Very helpful |
Don't know |
Autopilot |
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ADS-B (Automatic Dependent Surveillance-Broadcast) |
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VOR (Very high frequency omni-directional range navigation equipment) |
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GPS (Global Positioning System) |
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NDB (Non-directional beacon) |
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Interactive map |
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TAWS (Terrain awareness and warning system) |
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TCAS (Traffic collision avoidance system) |
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Other. Please describe: |
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Q54 In the list of equipment below, indicate how helpful you think each is in surviving after a crash:
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Not helpful |
Somewhat helpful |
Very helpful |
Don't know |
Satellite phone |
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Cell phone |
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Personal Location Beacon |
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Satellite Tracking Device (Spidertracks, SPOT) |
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Survival kit |
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Other. Please describe: |
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The questions in the table below ask for your opinion about measures that might improve aviation safety throughout Alaska (not just at your company).
Q55 Please indicate how effective you think each measure would be in preventing aircraft crashes if widely applied in Alaska aviation.
Whiteout conditions are when blowing snow, fog, or haze limit all visual references.
Flat light conditions are when an overcast limits visual cues, the features of the terrain, and make it hard to determine distance.
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Not effective |
Somewhat effective |
Very effective |
Don't know |
Pilot training in meteorology |
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Pilot training in aeronautical decision-making |
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Pilot training in whiteout conditions |
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Pilot training in flat light conditions |
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Not effective |
Somewhat effective |
Very effective |
Don't know |
Pilot training in CFIT avoidance |
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Pilot training in regional hazards |
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Greater ability to refuse flights due to weather |
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Easing of time limit to move by-pass mail |
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Not effective |
Somewhat effective |
Very effective |
Don't know |
Changes in Medicare patient transport requirements |
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Improvement in infrastructure to allow more IFR flights |
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Improvements in company operational control structures |
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Q56 Thinking of the measures you just rated, if you had to choose only two as most useful, which would they be?
First choice: (Dropdown list of 11 measures in Q55 above)
Second choice: (Dropdown list of 11 measures in Q55 above)
Q57 If there are other measures that you believe might improve aviation safety in Alaska, but which weren’t listed in the two questions above, please list them below.
________________________________________________________________________________________________________________________________________________________________________________
Q58 What do you think contributes most to aviation accidents in Alaska?
________________________________________________________________________________________________________________________________________________________________________________
These final questions are about you.
Q59 What is the highest level of education you have completed?
Less than high school
Attended high school; didn't graduate
GED or equivalent
High school diploma
Attended college; no degree
Associate's degree
Bachelor's degree
Graduate or Professional degree
Q60 Are you male or female?
Male
Female
Prefer not to answer
Q61 How old are you?
Years: ________________________________________________
Prefer not to answer
Q62 What is your race?
Please select all that apply.
American Indian or Alaska Native
White
Black or African American
Native Hawaiian or Other Pacific Islander
Asian
Some other race. Please specify: ___________________________
Prefer not to answer
Q63 Please add any other comments about aviation safety in Alaska you think we should know.
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
Thank you for your help!
End of Survey
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
File Title | NIOSH2018 - Aviation Safety_Pilots |
Author | OConnor, Mary B. (CDC/NIOSH/WSD) |
File Modified | 0000-00-00 |
File Created | 2021-03-29 |