Download Thank you for attending the workshop coordinated by Farmsafe WA

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
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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 ________________________________
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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: __________________________________________________________
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