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| Please add questions to this page that can be used for a survey regarding a study sleep deprivation related accidents of health care professionals.
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| Please use this check mark to add options to your question. ❑
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| ==Questions==
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| *What kind of health care professional are you?
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| ❑Intern
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| ❑Resident
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| ❑Attending
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| ❑RN
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| ❑Tech
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| ❑Administrative position
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| *Which specialty do you belong to?
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| ❑Internal Medicine
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| State subspecialty : ______
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| ❑Surgery
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| ❑Radiology
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| ❑Anesthesia
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| ❑FM
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| *Do you drive?
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| *How long is your commute?
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| *Have you ever been in a near accident?
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| *Have you ever been in an accident after your shift?
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| *How many hours do you sleep?
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| What healthcare role do you have in the hospital setting? | | What healthcare role do you have in the hospital setting? |
| Intern | | Intern |
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| Other healthcare professionals | | Other healthcare professionals |
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| How do you go back home after duty hours? | | How do you go back home after duty hours |
| Drive | | Drive |
| Commute | | Commute |
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| What is the duration of your maximum shift? | | What is the duration of your maximum shift? |
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| Have you ever felt drowsy/fatigued after the shift?
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| Yes
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| No
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| Have you ever felt drowsy while driving after the shift?
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| Yes
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| No
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| Have you ever had an accident while driving after the shift?
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| Yes
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| No
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| What was the extent of damage to you in that accident?
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| Minor
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| Moderate
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| Severe
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| What was the extent of damage to the health of other persons involved in the accident?
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| Minor
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| Moderate
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| Severe
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| What was the extent of damage to the vehicle you were driving?
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| Minor
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| Moderate
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| Severe
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| What was the extent of damage to other vehicles involved in the accident?
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| Minor
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| Moderate
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| Severe
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Revision as of 16:50, 4 August 2017
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?