APPENDIX C.2b – CROPS Observer Test
Form Approved
OMB No. 0920-09CO
Exp. Date xx/xx/20xx
CROPS Observer Test1
Name _______________________________________
How was the CROPS to install on the tractor? (place a check mark next to your answer)
easy _____ somewhat easy _____ somewhat hard _____ hard_____
Did it appear the directions for installing the CROPS on the tractor was:
easy _____ somewhat easy _____ somewhat hard _____ hard_____
What was the level of physical effort required for installing the CROPS?
easy _____ somewhat easy _____ somewhat hard _____ hard_____
In regard to the amount of time it took to install the CROPS, was it:
too much _____ about right _____ too little _____
Are you glad you decided to observe the CROPS demonstration?
Yes ____ No _____
If you have a tractor without a ROPS or were to purchase one without a ROPS, would you be interested in retrofitting it in the future?
Yes _____ No _____
Are you aware that tractors account for the largest single identifiable source of occupational deaths in farming? Yes _____ No _____
How important do you believe it is to have roll over protection on your tractor(s)? (circle your answer)
“not at all important” “not very important” “important” “very important”
Why do you believe roll over protection is (your answer above)? _______________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
In the following question we would like you to rate the statements given on a scale of 1 to 10. For example, Installing a roll-over protective structure on my unprotected tractor is…. Bad farm practice/good farm practice, 1 being bad, 10 being good
Installing a roll-over protective structure on at least one of my unprotected tractors is…
bad farm practice 1 2 3 4 5 6 7 8 9 10 good farm practice
not cost effective 1 2 3 4 5 6 7 8 9 10 very cost effective
inconvenient 1 2 3 4 5 6 7 8 9 10 convenient
unnecessary 1 2 3 4 5 6 7 8 9 10 necessary
irresponsible 1 2 3 4 5 6 7 8 9 10 responsible
Please indicate how you feel about the following statements, circling your desired response
It is less likely that anyone on my farm would be killed or hurt in a tractor roll-over, when compared to other farms.
Strongly Disagree Disagree Agree Strongly Agree
Most people who are important to me think that I should retrofit at least one of my unprotected tractors.
Strongly Disagree Disagree Agree Strongly Agree
It is expected of me that I retrofit at least one of my unprotected tractors.
Strongly Disagree Disagree Agree Strongly Agree
I feel pressured to retrofit at least one of my unprotected tractors.
Strongly Disagree Disagree Agree Strongly Agree
If I have a ROPS/CROPS on my tractor, I will wear my seatbelt whenever I am on the tractor.
Strongly Disagree Disagree Agree Strongly Agree
Thank you for your participation in our study to help make farming safer.
1 Public reporting burden of this collection of information is estimated to average 15 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 Information Collection Review Office, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-09CO).
File Type | application/msword |
File Title | APPENDIX C |
Author | dlh6 |
Last Modified By | tfs4 |
File Modified | 2010-01-25 |
File Created | 2010-01-25 |