Don’t Fall For It! Preview Survey

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CPWR - The Center for Construction Research and Training

Summary Statement

Survey to use with workers in advance of showing the Don’t Fall for It! video to gauge their awareness and work practices.

CPWR - The Center for Construction Research and Training and the New Jersey State Building & Construction Trades Council are involved in a campaign to reduce falls on the job. Your candid responses to this survey will provide critical information for our campaign and help us expand this initiative in the future. Before answering the survey questions, please provide us with the following demographic information:

1. (Circle one):

    Apprentice
    Journeyman
    Foreman

2. Trade __________________Years in trade____ Age____

3. Race (circle one):

    White (non-Hispanic)
    Black
    Hispanic
    Other____________

4. Have you ever fallen from a ladder on the job? YES / NO

  1. If yes, how far did you fall? (circle one):
    • Less than 6 feet
      6 feet or more
  2. If yes, how much work did you miss? (circle one):
    • no time
      part of a day
      part of a week
      a full week
      over a week
      over a month

5. Last 4 digits of Social Security #_____ (for survey processing use only)


We would like to follow up with you in a few months to assess the value of our campaign information. Following up with you at home will be brief, but it will help us to make our campaign as effective as possible. Please be assured that your personal information is for contact purposes only. It will be kept confidential and will not be attached to your survey responses or demographic information.

Name _____________________
Phone (___)___________
Street Address ___________________________________________
City _________________________
State ____________
Zip _____________
Best time of day to reach you by phone (circle all that apply):

    morning
    afternoon
    evening

Thank you for your participation.

Don’t Fall for It! Survey #1

Section 1: When using a ladder BEFORE today, how often would you… (circle ONE):

1. Inspect the ladder for damage before using it?
    Always
    Sometimes
    Never
    Dont' know what this means
2. Clear away debris at the base and top before using it?
    Always
    Sometimes
    Never
    Dont' know what this means

3. Extend a straight ladder three feet above the working surface?
    Always
    Sometimes
    Never
    Dont' know what this means

4. Tie a straight ladder off at the bottom?

    Always
    Sometimes
    Never
    Dont' know what this means

5. Tie a straight ladder off at the top?

    Always
    Sometimes
    Never
    Dont' know what this means
6. Set a straight ladder at a 75-degree angle (4 to 1 ratio)?
    Always
    Sometimes
    Never
    Dont' know what this means

7. Use three-point climbing?

    Always
    Sometimes
    Never
    Dont' know what this means

8. Carry loads by hand up the ladder?

    Always
    Sometimes
    Never
    Dont' know what this means

9. Keep your body within the ladder rails at all times?

    Always
    Sometimes
    Never
    Dont' know what this means

10. Sit on a step?

    Always
    Sometimes
    Never
    Dont' know what this means

11. “Walk” the ladder while on it to change ladder position?

    Always
    Sometimes
    Never
    Dont' know what this means

12. Work less than 10 feet from power lines?

    Always
    Sometimes
    Never
    Dont' know what this means

13. Stand on the top step of a stepladder?

    Always
    Sometimes
    Never
    Dont' know what this means

14. Climb the back of a stepladder?

    Always
    Sometimes
    Never
    Dont' know what this means

15. Use an unopened stepladder like a straight ladder?

    Always
    Sometimes
    Never
    Dont' know what this means

Section 2: Please indicate whether you agree or disagree with each statement (circle ONE).

1. Very few deaths in construction are caused by falls from ladders.

    Disagree
    Agree
    Not Sure

2. Fall protection programs cover ladder safety.

    Disagree
    Agree
    Not Sure

3. If I fall on the job, it probably won’t change the way I live my life.

    Disagree
    Agree
    Not Sure

4. Inspecting a ladder before using it is critical to my safety.

    Disagree
    Agree
    Not Sure

5. I am unlikely to die or suffer a serious injury by falling only a few feet.

    Disagree
    Agree
    Not Sure

6. Before today, I was likely to report any ladder safety problem to my supervisor.

    Disagree
    Agree
    Not Sure

7. Falling on the job would have little economic impact on me or my family.

    Disagree
    Agree
    Not Sure

8. Workers' Compensation will not cover all the costs of a work-related injury.

    Disagree
    Agree
    Not Sure

9. An excellent estimate of proper ladder angle is to stand with your feet at the base and reach out; if your finger tips touch the ladder, the angle is good.

    Disagree
    Agree
    Not Sure

10. Most falls on the job result in lost time.

    Disagree
    Agree
    Not Sure

11. I would refuse to work on an unsafe ladder.

    Disagree
    Agree
    Not Sure

12. I could probably catch myself if I fall from a ladder.

    Disagree
    Agree
    Not Sure