Chemical Eye Injury Survey

CNIB (Canadian National Institute for the Blind) is conducting this survey in order to gain a better understanding of the incidence and nature of laboratory eye injuries in Canada. It is hoped that the information gained will help inform an awareness campaign and advocacy in order to minimize vision loss from chemical accidents in the laboratory. Your participation in this survey is entirely voluntary and anonymous. The data from your responses will be amalgamated with that of all other participants and will only be reported as a total.

CNIB and the Chemical Institute of Canada want to thank you for your participation in this important survey.

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* 1. What is your age?

20-29

30-39

40-49

50-59

60-69

70+

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* 2. What is your Gender?

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* 3. What is the highest level of education you have attained?

High School

Bachelor’s degree

Master's degree

Ph.D

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* 4. Do you now, or have you ever worked in a chemical laboratory or any laboratory where hazardous chemicals are used?

Yes

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* 5. If the answer to this question is “Yes”, how long did you work for?

1 – 5 years

5 – 10 years

10 – 20 years

More than 20 years

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* 6. During the time you worked in a chemical laboratory, did you ever have an eye injury that required medical attention?

Yes, once only?

Yes, more than once?

If the answer to question 6 is “Yes”, answer questions 7-16
If the answer to question 6 is “No”, proceed to question 17

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* 7. When did your eye injury(ies) occur?

1960 – 1969

1970 – 1979

1980 – 1989

1990 – 1999

2000 – 2012

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* 8. Which of the following best describes your chemical accident?

I splashed chemicals in my eye

A neighbor splashed chemicals in my eye

Chemicals entered my eye as the result of an explosion.

My eye(s) was/were damaged as the result of a chemical fire.

Other (specify)

Other (please specify)

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* 9. Have you ever had an eye injury in the chemical laboratory that did not result from chemicals entering your eye?

Yes

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* 10. If “Yes”, which of the following was it a result of (check all that apply):

A flying object or glass

Inadvertent exposure to radiation

Other, describe:

Other (please specify)

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* 11. Which of the following best describes the outcome of your injury? (if more than one, report on your most severe injury).

I experienced no pain and the injury had no effect on my vision.

My vision was affected for 3 – 5 days. I needed medication and/or my eye was patched.

My vision was affected for more than 1 week. I needed medication and/or my eye was patched for more than 1 week.

My vision was affected for more than 2 weeks. I needed medication and/or my eye was patched for more than 2 weeks.

My vision was affected permanently.

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* 12. Did the accident affect one eye or both?

One eye

Both eyes

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* 13. Did the accident permanently affect your vision in:

One eye

Both eyes

My vision was not affected permanently

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* 14. Are you legally blind?

Yes

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* 15. Which of the following best describes any eye protection you used at the time of your accident (you may check more than one)?

I was not wearing any eye protection.

I was only wearing my regular prescription eye glasses

I was wearing safety glasses or safety prescription glasses

I was wearing safety eye goggles

I was using a face shield

The reaction was being conducted in a fume hood with no safety shield.

The reaction was being conducted in a fume hood with the safety shield in place.

Other (specify)

Other (please specify)

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* 16. At the time of your injury had you received safety training in the previous year that covered eye safety?

Yes

I don't recall

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* 17. If you are currently working in a chemical laboratory, when last did you receive safety training that included eye safety?

Within the past year

Within the past 5 years

5 – 10 years ago

More than 10 years ago

Never

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* 18. Did this training cover the wearing of eye protection and how to handle a splash in the eye once it occurred?

Eye protection only

How to handle a splash

Both

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* 19. Is there an eyewash station in your current laboratory?

Yes

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* 20. Is there an emergency drench shower or plentiful supply of clean water in your current laboratory?

	Yes	No
Plentiful supply of clean water	Plentiful supply of clean water Yes	Plentiful supply of clean water No
Emergency drench shower	Emergency drench shower Yes	Emergency drench shower No

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* 21. Are the eyewash station and shower checked annually or more often to see if they are functioning?

Yes

Don't know

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* 22. When you are in the chemical laboratory today, which of the following best describes your wearing of eye protection?

I wear safety glasses all the time that I am in the laboratory

I wear safety glasses less than one week per month when I am in the laboratory

I never wear safety glasses in the laboratory

I wear safety goggles only when working with chemicals

I wear safety goggles whenever I am in the laboratory

I use a face shield only when conducting a chemical reaction

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* 23. Have you received instruction on how to use a fire extinguisher?

Yes

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* 24. Thinking back over your laboratory career, did anyone in your laboratory experience an eye injury?

Yes

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* 25. If yes, when did this (these) occur?

1960 – 1969

1970 – 1979

1980 – 1989

1990 – 1999

2000 – 2012

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* 26. How frequently do you have your eyes examined by an eye doctor?

Every year or more often

Every 2 years

Every 5 years

Less than every 5 years

I have never had an eye examination by an eye doctor

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* 27. If you are currently working in a laboratory, is there a policy in place regarding the wearing of eye protection?

Yes

No - proceed to question 29

I am not currently working in a laboratory - proceed to end of survey

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* 28. If Yes to 27, what is the general wording of the policy?

Eye protection must be worn at all times while in the laboratory

Eye protection must be worn at all times when conducting laboratory experiments with chemicals

Other:

Other (please specify)

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* 29. If “no” to 27 above…if a policy were posted, would it change your current use of eye protection

Some of the time

All of the time

None of the time

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* 30. Is there an eye safety manual present in the laboratory that deals with all issues related to eye safety?

Yes

I am not aware of one