Fatigue Training Evaluation Survey

ID_________ Training Evaluation Survey Date_________

Form Approved

OMB No. 0920-xxxx

Exp. Date XX/XX/XXXX

CDC estimates the average public reporting burden for this collection of information as 15 minutes per response, including the time for reviewing instructions, searching existing data/information sources, gathering and maintaining the data/information needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to response 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).

Section 1. Please rate the training and give your honest opinion.

On a scale from 1 to 5, where 1 indicates strongly agree, and 5 indicates strongly disagree, please give the number which indicates how much you agree or disagree with each statement.

	1 Strongly disagree	2	3 Neutral	4	5 Strongly agree
I liked this training overall.
This training told me something new.
This training motivated me to do something to improve my sleep.
This training said something important to me.
The messages did not apply to me or my driving situation.

Next questions ask how you feel about NIOSH (National Institute for Occupational Safety and Health) as the source of this information.

	Yes	No	Do not know/not sure	Refuse to respond
Have you heard of NIOSH before taking this training?
Is NIOSH a good source of information?
Does NIOSH seem trustworthy?

Was there any content in the training that was difficult to understand? If yes, which sections_______________________________________________________________________________________________________________________________________________

What part of the training did you dislike the most?____________________________________

Is there additional content on the topic of sleep, shift work, and long work hours that you would like to have seen? If yes, please enter the topics here. ______________________________________________________________________________________________________________________________________________________

What could improve this training? _________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Section 2. Please tell us what barriers may prevent you from using the information in the NIOSH shift work and long hours training for drivers for hire. Please select the number that corresponds with your opinion.

	1 Not a barrier at all	2 Minimal barrier	3 Neutral	4 Strong barrier	5 Very strong barrier
The cost in sleep aids (like blackout curtains, white noise machines, coffee)	1	2	3	4	5
The cost for seeing a healthcare provider about a possible sleep disorder	1	2	3	4	5
Being able to control my work schedule and hours	1	2	3	4	5
The time needed to set up my sleep environment	1	2	3	4	5
The ability to do the recommended techniques (like	1	2	3	4	5
Getting support from persons I live with	1	2	3	4	5
Getting support from family and friends I don’t live with	1	2	3	4	5
Getting support from the company I drive for	1	2	3	4	5
My competing personal priorities	1	2	3	4	5
Other__________________ (Please specify)	1	2	3	4	5

Section 3. Influencers in your life. Now we would like to ask you about who might influence you to use or not use information from the NIOSH shift work and long hours taxi drivers training. Please select the number that corresponds with your opinion.

Based on your knowledge and experience with these persons below, how likely is it that the following would like you to use the information from the training program.	Extremely Unlikely	Somewhat unlikely	Neither Likely or Unlikely	Somewhat likely	Extremely Likely
The company I drive for	1	2	3	4	5
Other taxi drivers	1	2	3	4	5
Taxi driver associations	1	2	3	4	5
Passengers	1	2	3	4	5
Spouse, partner, girlfriend, or boyfriend	1	2	3	4	5
Parents	1	2	3	4	5
Children	1	2	3	4	5
Family, friends, or people I know who have worked night or rotating shifts or long hours	1	2	3	4	5
The public	1	2	3	4	5
SFMTA and law enforcement
Other, Please specify_________________	1	2	3	4	5

Is there anything else you would like to tell us about the training? _________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Section 4. Changes in sleep health behaviors. Please tell us about changes in your behavior after taking the training.

Has your life improved at all since you took the NIOSH training for shift work and long work hours for taxi drivers?

• Yes, my worklife has improved because I took the NIOSH training for shift work and long work hours for taxi drivers

• No, my worklife has not improved because I took the NIOSH training for shift work and long work hours for taxi drivers

Please explain: ______________________________________________________________

Have you noticed any changes in your behavior since you took the NIOSH training for shift work and long work hours for taxi drivers?

• Yes, I have changed my behavior as a result of the training

• No, I have not changed my behavior as a result of the training

If yes, please select all the ways in which you have changed your behavior:

• I try to get more sleep

• I take more naps than I used to

• I have improved my sleeping environment

• I adjust the times I use caffeine now

• I adjust the amount of caffeine I use now

• I pay more attention to my level of fatigue

• I am less likely to drive while drowsy

• I am more likely to balance driving additional hours with my need for sleep

• I use relaxation techniques

• I educated my family and the important people in my life so they understand my needs due to my work hours

• I went to or plan to go to a sleep disorder specialist or my healthcare provider for help with sleep symptoms

• Other

Please explain: __________________________________