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* 1. Name

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* 2. Agency or Organization

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* 3. Primary County that you work in

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* 4. Email Address

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* 5. Training Date/Time

Date
Time

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* 6. City of Training Location

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* 7. How many years have you been working traffic scenes?

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* 8. Have you previously participated in any traffic incident management training?

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* 9. When arriving at a traffic incident on a major highway, do you believe measures are in place to secure the safety of the scene?

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* 10. How would you describe your overall level of personal safety when working traffic incidents on major highways?

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* 11. How would you rank your knowledge of scene safety principles when responding to a traffic incident on a major highway?

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* 12. When at the scene of a traffic incident on a major highway, does the incident commander respond to your safety concerns?

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* 13. Have you ever been injured or witnessed another responder being injured at the scene of a traffic incident?

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* 14. Have you ever had a near-miss or injury at the scene of a traffic incident?

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