Mine Worker Survey - Paper Version

Attachment C

Mine Worker Survey

Form Approved
OMB No. 0920-xxxx
Exp. Date xx/xx/20xx

Mine Worker Survey - The purpose of these questions is to try to understand what you
think has the biggest impact on health and safety at this operation. Please think about
a typical work week when responding.

• Mark your answers directly on the answer sheet by filling in the box.

• Return your survey and answer sheet to us when you are done.

To protect your identity:

• Your supervisors will not see your individual responses.

• These forms will not be made available to any management personnel.

• We will combine the data from everyone into larger groups to describe the results.

Strongly Disagree	Disagree	Somewhat Disagree	Somewhat Agree	Agree	Strongly Agree
1	2	3	4	5	6

Please mark the number below each statement or question that best describes your opinion using the following scale.

When I’m at work I…								Strongly Strongly Disagree Agree
go out of my way to address potential hazards.								1				2		3				4				5			6
voluntarily carry out tasks that help improve workplace health/safety (H/S).								1				2		3				4				5			6
make suggestions to improve how H/S is handled.								1				2		3				4				5			6
try new things to improve workplace H/S.								1				2		3				4				5			6
try to solve problems in ways that reduce H/S risks.								1				2		3				4				5			6
don’t take risks that could result in an accident.								1				2		3				4				5			6
use all necessary H/S equipment to do my job.								1				2		3				4				5			6
use the correct H/S procedures for carrying out my job.								1				2		3				4				5			6
always report all health/safety-related incidents.								1				2		3				4				5			6
When doing my job...								Strongly Strongly Disagree Agree
I can pretty much achieve whatever I set out to achieve.								1				2		3				4				5			6
I can do something if I am unhappy about a decision that affects me.								1				2		3				4				5			6
I can stay healthy/safe if I take the right actions.								1				2		3				4				5			6
most of the problems that I experience are completely ‘out of my hands.’								1				2		3				4				5			6
I am always thorough.								1				2		3				4				5			6
I can be somewhat careless with my work tasks.								1				2		3				4				5			6
I am a reliable worker.								1				2		3				4				5			6
I work until my task is finished. I know when to seek help during a difficult task.								1				2		3				4				5			6
I do not take risks with my safety/ health.								1				2		3				4				5			6
I take risks regularly.								1				2		3				4				5			6
safety comes first.								1				2		3				4				5			6
I like not knowing what is going to happen.								1				2		3				4				5			6
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 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-xxxx).
As far as day to day work…								Strongly Strongly Disagree Agree
H/S rules and procedures are sometimes ignored.								1				2		3				4				5			6
it doesn’t matter how the work is done as long as there are no accidents.								1				2		3				4				5			6
I often have impossible production pressures.								1				2		3				4				5			6
My supervisor…								Strongly Strongly Disagree Agree
tries to help me do my job as safely as possible.								1				2		3				4				5			6
helps me if I have a health/safety (H/S) problem at work.								1				2		3				4				5			6
doesn’t notice if I do my job safely.								1				2		3				4				5			6
reminds me to follow H/S work rules.								1				2		3				4				5			6
closely monitors my H/S work practices.								1				2		3				4				5			6
takes action if I don’t follow H/S work practices.								1				2		3				4				5			6
clearly explains health/safety (H/S) rules to me.								1				2		3				4				5			6
regularly informs me of work hazards specific to my job.								1				2		3				4				5			6
encourages communication about H/S problems.								1				2		3				4				5			6
I am satisfied with my supervisor.								1				2		3				4				5			6
Everyone in my work crew…								Strongly Strongly Disagree Agree
has confidence in each other to work safely.								1				2		3				4				5			6
helps each other with H/S problems at work.								1				2		3				4				5			6
informs each other about potential work place H/S hazards.								1				2		3				4				5			6
When it comes to the health and safety rules and procedures in place at this operation…								Strongly Strongly Disagree Agree
they are used the same for all employees.								1				2		3				4				5			6
I can question the rules and procedures that influence my work.								1				2		3				4				5			6
my supervisor makes sure that our concerns are heard before making any new rules or procedures.								1				2		3				4				5			6
I am involved in improving H/S rules and procedures.								1				2		3				4				5			6
I know how to…								Strongly Strongly Disagree Agree
use health/safety (H/S) equipment to follow standard work procedures.								1				2		3				4				5			6
maintain or improve workplace H/S.								1				2		3				4				5			6
reduce the risk of safety accidents and health incidents at my job.								1				2		3				4				5			6
It is important to…								Strongly Strongly Disagree Agree
maintain work place H/S at all times.								1				2		3				4				5			6
reduce the risk of work place safety accidents and health incidents.								1				2		3				4				5			6
maintain or improve my personal H/S.								1				2		3				4				5			6
When it comes to health and safety training…								Strongly Strongly Disagree Agree
the organization provides enough training for me to do my job.								1				2		3				4				5			6
it helps me to do my job as healthy/safely as I can.								1				2		3				4				5			6
it is not a priority here.								1				2		3				4				5			6
In general I think that…								Strongly Strongly Disagree Agree
tried and tested ways of doing things are usually the best.								1				2		3				4				5			6
there is no need to change things unless there is a problem.								1				2		3				4				5			6
I can handle any changes that come along. changes in my work routine keeps my job interesting.								1				2		3				4				5			6
Over the last 6 months on your job how often were you…								Never		Once					Two times			Three times			Four times				+ Five times
Involved in a near miss?								1		2				3				4				5			6
Injured requiring first aid treatment?								1		2				3				4				5			6
Injured requiring medical treatment beyond first aid?								1		2				3				4				5			6
Injured severe enough that it resulted in lost time from work?								1		2				3				4				5			6
Demographic Items (circle or check item)
Age	18-24		25–34				35–44			45–54						55–64				65–74						75 +
Are you:	Male				Female
Are you:	Hourly				Salary
Time in current job:	0–3 mths				3–6 mths				6–12 mths								1-5 yrs						5 + yrs
Time in mining industry:	0–3 mths				3–6 mths				6–12 mths								1-5 yrs						5 + yrs
Time with current company:	0–3 mths				3–6 mths				6–12 mths								1-5 yrs						5 + yrs
Work group:	Production				Maintenance				Safety								Engineering						Other
Average work start time:	6 am – 9:59 am	10 am – 1:59 am				2pm – 5:59 am					6 pm-9:59pm						10 pm – 1:59 am						2 am- 5:59 am
Work schedule:	Start at the same time every day								Rotate between different starting times
Family mining history:	First generation miner								Multi-generation miner
Education level:	Less than high school				High school				Associate Degree/ Trade certificate								Bachelor’s degree						Master’s degree
Marital status:	Married/Domestic partnership				Divorced				Widowed								Separated						Single, never been married
Children:	Yes				No
Children in these ranges:	Less than 5 years old				5 through 12 years old				13 through 17 years old								18 or older
In general, drowsiness at work:	Extremely tired			Tired				Somewhat tired					Somewhat awake						Wake					Wide awake

Thank you for your participation in this survey.