Sandbox:survey

Please add questions to this page that can be used for a survey regarding a study sleep deprivation related accidents of health care professionals. Please use this check mark to add options to your question. ❑

Questions

• What kind of health care professional are you?

❑Intern ❑Resident ❑Attending ❑RN ❑Tech ❑Administrative position ❑ ❑ ❑

• Which specialty do you belong to?

❑Internal Medicine State subspecialty : ______ ❑Surgery ❑Radiology ❑Anesthesia ❑FM

• Do you drive?

• How long is your commute?

• Have you ever been in a near accident?

• Have you ever been in an accident after your shift?

• How many hours do you sleep?

What healthcare role do you have in the hospital setting? ❑Intern ❑Resident ❑Fellow ❑Attending ❑Other healthcare professionals

How do you go back home after duty hours? ❑Drive ❑Commute ❑Walk

How many hours a week do you work?

What is the duration of your maximum shift?

Have you ever felt drowsy/fatigued after the shift? ❑Yes ❑No

Have you ever felt drowsy while driving after the shift? ❑Yes ❑No

Have you ever had an accident while driving after the shift? ❑Yes ❑No

How long was the shift after which you had an accident/near accident/drowsiness while driving?

What was the extent of damage to you in that accident? ❑Minor ❑Moderate ❑Severe

What was the extent of damage to the health of other persons involved in the accident? ❑Minor ❑Moderate ❑Severe

What was the extent of damage to the vehicle you were driving? ❑Minor ❑Moderate ❑Severe

What was the extent of damage to other vehicles involved in the accident? ❑Minor ❑Moderate ❑Severe

What was the extent of damage to the property involved in the accident? ❑Minor ❑Moderate ❑Severe