0920-1441 Construction_Demolition Robot Experience Questionnaire

Form Approved

OMB No. 0920-1441

Exp. Date 09/30/2027

Attachment B

Construction/Demolition Robot Experience Questionnaire

1. Prior experience in the construction industry

1. Have you worked previously in the construction industry?

YES | NO

2. How many years?

3. What tasks did you perform? (Please check all that apply)

☐ Site preparation	☐ Installation of windows	☐ Insulation
☐ Site Work	☐ Concrete slabs	☐ Roofing
☐ Foundation work	☐ Plumbing	☐ Equipment Operator
☐ Framing	☐ Electric	Other_______________________

2. Prior experience operating an excavating machine

1. Do you have experience operating an excavating machine?

YES | NO

2. How long have you used or worked with excavating machines?

______________ years

3. Prior experience with demolition robots

1. Do you have experience operating a demolition robot?

YES | NO

2. How long have you used or worked with demolition robots?

______________ years

3. What type of structures did you demolish using these robots? (Please check all that apply)

☐ Residential buildings

☐ Commercial buildings

☐ Highway/exterior structures

4. Characteristic of the demolition robot remote control: (Please check all that apply)

☐ Cabled remote control

☐ Wireless remote control

3. Prior Experience with video games:

   1. Have you ever played video games?

YES | NO

2. If yes, when was the last time you played a video game?

_______________________________________

3. Which system did you use? (Please check all that apply)

☐ XBOX	☐ PlayStation	☐ Nintendo
Other_________________

Public reporting burden of this collection of information is estimated to average 10 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. 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 Reports Clearance Officer; 1600 Clifton Road NE, MS H21-8, Atlanta, Georgia 30333 ATTN: PRA (0920-1441).