Your voluntary, anonymous answers to the following questions will be used to support an injury prevention effort.

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* 1. Unit/Flexible Resource:

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* 2. Age:

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* 3. Gender:

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* 4. Please provide the following.

  Feet Inches
Height:

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* 5. How long have you done this kind of work?

  Years Months
Years, months:

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* 6. How long have you been at this hospital?

  Years Months
Years, months:

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* 7. What time of day do you usually start work?

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* 8. What is the usual length of your shift?

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* 9. On average, how many hours do you work per week?

 
Hours:

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