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.

* 1. What is your age?

* 2. What is your Gender?

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

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

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

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

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

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

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

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

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

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

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

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

* 14. Are you legally blind?

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

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

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

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

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

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

  Yes No
Plentiful supply of clean water
Emergency drench shower

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

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

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

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

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

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

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

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

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

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