eLCOSH : Don’t Fall For It! Preview Survey

Don’t Fall For It! Preview Survey

(Part of Don't Fall For It!)

CPWR - The Center for Construction Research and Training

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CPWR - The Center for Construction Research and Training

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):

2. Trade __________________Years in trade____ Age____

3. Race (circle one):

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

If yes, how far did you fall? (circle one):

If yes, how much work did you miss? (circle one):

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):

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?

2. Clear away debris at the base and top before using it?

3. Extend a straight ladder three feet above the working surface?

4. Tie a straight ladder off at the bottom?

5. Tie a straight ladder off at the top?

6. Set a straight ladder at a 75-degree angle (4 to 1 ratio)?

7. Use three-point climbing?

8. Carry loads by hand up the ladder?

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

10. Sit on a step?

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

12. Work less than 10 feet from power lines?

13. Stand on the top step of a stepladder?

14. Climb the back of a stepladder?

15. Use an unopened stepladder like a straight ladder?

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.

2. Fall protection programs cover ladder safety.

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

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

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

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

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

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

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.

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

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

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

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