AgDARE - Agricultural Disability Awareness and Risk Education

Amputation - Narrative Simulation

Answer Sheet

Question A	Question B	Question C	Question D
T    F   1.	T    F   4.	T    F   8.	T    F   12.
T    F   2.	T    F   5.	T    F   9.	T    F   13.
T    F   3.	T    F   6.	T    F   10.	T    F   14.
	T    F   7.	T    F   11.	T    F   15.
			T    F   16.

Questionnaire

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1) Name of exercise: Jim In A Jam

2) Your age? ______

3) Your sex? ____ M ____ F

4) Do you work around farm jobs where machines with rotating parts (like PTOs, combines, mowing machines, or augers) are used?    ____ Yes ____ No

5) If "Yes" to item 4, about how many days a month do you work around jobs that use machines with rotating parts?    _______ days a month

6) a. Do you work on a farm? ____ Yes ____ No    b. Size of farm (acres) ______

7) Please note the condition of the shields on the machines with rotating parts that you are around.. (check only one item)

____ Good (all have working shields, no cracks or breaks)

____ Fair (have shields, but some may be cracked or broken)

____ Poor (some equipment may be missing shields)

8) Have you ever had an injury because of a machine with a rotating part?
____ Yes ____ No

9) Have you ever had a "close call" because of a machine with a rotating part?
____ Yes ____ No

10) Out of every ten times you work around a machine with rotating parts, how many times do you step over the rotating part?

Never   0   1   2   3   4   5   6   7   8   9   10   Always

Now think about the story you just finished. Circle the number that tells how much you agree or disagree with the following statements.

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Statement

Strongly Disagree

Strongly Agree

1)	I enjoyed working through the story.	1	2	3	4	5
2)	The activities described in this story are realistic.	1	2	3	4	5
3)	The written directions were easy to follow.	1	2	3	4	5
4)	The story was easy to read.	1	2	3	4	5
5)	The story took too long to complete.	1	2	3	4	5
6)	The story taught me new information about the relationship between injury and economics.	1	2	3	4	5
7)	Before working through this story, I had thought about the lifestyle changes from an injury caused from stepping over a PTO shaft.	1	2	3	4	5
8)	Working through this story helped to convince me not to take shortcuts while working.	1	2	3	4	5
9)	Working through this story has helped me to identify injury risks when using a PTO.	1	2	3	4	5
10)	Working through this story reminded me of ways I can prevent PTO injuries to myself and others.	1	2	3	4	5
11)	Until I read this story, I only thought about dying from an injury, not having a permanent disability.	1	2	3	4	5
12)	Working through the story will help me make better judgments about safety when doing farm work.	1	2	3	4	5
13)	What I learned in the story will help me to prevent injuries to myself and others.	1	2	3	4	5
14)	The questions and answers were easy to understand.	1	2	3	4	5
15)	The story has encouraged me to discuss with my family ways to make a farm safer.	1	2	3	4	5
16)	Working through the story has helped me to understand the impact an injury can have on my life.	1	2	3	4	5
17)	Working through the story has helped me to understand how an injury can affect farm and family finances.	1	2	3	4	5
18)	The pictures were easy to understand.	1	2	3	4	5

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