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Noise Injury Prevention & Management Post Workshop Questionnaire 2011 Thank you for attending the workshop coordinated by Farmsafe WA in collaboration with the Ear Science Institute and Lions Hearing. Your participation and input in this pilot project is invaluable to us. Your feedback will be used as recommendations for future workshops and the further development of this project, and all information is kept confidential within Farmsafe WA Alliance. Please complete and return this form via email [email protected] or fax: 9359 3468 by the 15th of April 2011. Alternatively you can post this form to: Regards Alisa Lim Farmsafe WA Alliance PO Box 118 Forrestfield WA 6058 Project Officer Farmsafe WA Alliance YOUR DETAILS Q1. Gender: Male Q2. Age: 10-21 Female 22-31 32-41 42-51 51-65 66+ Q3. Are you An employer An employee Farm contractor Self-employed Other _________________________________________________________ Q4. Please indicate which workshop you attended: Northam (7th March) Quairading (8th March) Beverley (7th March) Corrigin (8th March) EAR HEALTH KNOWLEDGE Q5. Since attending Farmsafe WA’s workshop do you: Have a better understanding of how your ears function? Yes No Somewhat Have a better knowledge of the symptoms of hearing loss? Yes No Somewhat Have a better understanding of Noise Induced Hearing Loss (NIHL)? Yes No Somewhat Have a better understanding of the implications of impaired hearing? Yes No Somewhat Know who to contact for a hearing test or information in your area? Yes No Supported by NOISE EXPOSURE AND HEARING PROTECTION Q6. Since attending Farmsafe WA’s workshop are you: More aware of loud noises around you? Yes No Somewhat More likely to reduce the time you spend exposed to loud noise? Yes No Somewhat More likely to use Personal Hearing Protection? Yes Somewhat No (Go to Q8) Q7. If yes, which type of Personal Hearing Protection are you more likely to use? Ear Plugs Ear Muffs Ear Muffs and Plugs together Q8. Since the workshop, do you have a clearer understanding of decibel (dB) levels of various noises? Yes No Somewhat NOISE RESPONSIBILITIES Q9. Since the workshop, are you more aware of your legislative responsibilities in regards to noise exposure? Yes No CURRENT PROGRAMS AND RESOURCE MATERIAL Q10. Are you aware of any of the following resources or programs? (Please tick all that apply) TelScreen program, where your hearing is tested over the phone? The Assistive Listening Devices (ADL’s) program? Cheers for Ears program? Noise Induced Hearing Loss (NIHL) pamphlet? Rural Noise Injury Factsheet? Ear Infections pamphlet? Q11. Have you used any of these projects/resources? Yes, please specify which _________________________________ No (Go to Q13) Q12. Did you find the program/resource useful? Yes No THE WORKSHOP Q13. Where did you hear about the workshop? Radio Local newspaper Countryman TV Other ________________________________ Supported by Q14. Did you find the workshop informative? Yes No Q15. What was the most useful aspect of the workshop? Please tick all that apply Presentation by Audiologist Show bag content Information on the available audio equipment and services Hearing tests by the Lions Hearing Bus Other (Please specify):___________________________ Q16. What was the least useful aspect of the workshop? Please specify __________________________________________________________ Q17. Was the workshop relevant to you? Yes No Somewhat Q18. Do you have any recommendations on how the workshop could be improved? ___________________________________________________________________________ ___________________________________________________________________________ Q19. Would you recommend this workshop to others? Yes No If you have had a near miss story due to impaired hearing, please share your story. ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ Thank you for providing us with this feedback. If you would like to know more or would like information sent to you please contact us via email [email protected] or call on 9359 4118. I would like to know more about: This program’s outcome Farmsafe WA Membership The resources specified in the questionnaire Please specify which _______________ To be included on the Farmsafe WA database for free information and newsletters Legislative Responsibilities & Code of Practise Financial assistance for travel and hearing service voucher Other __________________________________________________ Name: _________________________________________________________________ Address: _______________________________________________________________ Phone: ________________________________ Fax: ____________________________ Email address: __________________________________________________________ Supported by