Surveys 2014 November I Introductory Survey

Introductory Survey

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Questions marked with an * are required Exit Survey

* Participant #: (last 4 digits of office phone)       * What is your age range? -- Select --18-2425-2930-3435-3940-4445-4950-5455-5960-6465-6970+     * Todays date: -- 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 -- Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec -- 2024     * Department: * Job Title:     * What are your job tasks? Check all that apply   Keyboarding   Phone calls   Filing   Teaching   Composing text at computer   Data entry   Email   Other       * How long do you work at any time before taking a break? * Describe what you do during your breaks:     * Do you have any discomforts such as (strains, aches or pains) caused by work?   Yes   No     * Is there ergonomic information related to your work station at work you would like to know about? * Is there ergonomic information related to your activities outside of work you would like to know about?       * When did you first notice your discomfort? * What kind of treatment did you receive?     * Have you had to seek medical attention because of your discomfort?   Yes, but no relief   Yes, Some relief   No need   Not yet not bad enough   Not yet due to finances   Other       * Is there ergonomic information related to your work station at work you would like to know about?     * Is there ergonomic information related to your activities outside of work you would like to know about?     * On a pain scale of 0 being no pain and 5 being extreme pain) how would you rate your discomfort right now? (Aches, pains, discomforts, strains)   0 No Pain   1 Minimal Pain   2 Mild Pain   3 Moderate Pain   4 Severe Pain   5 Extreme Pain     * What word(s) would you use to describe the pain/discomfort?