APPENDIX 1

INJURY PREVENTION NEEDS ASSESSMENT QUESTIONNAIRE

1. What are the significant injury problems in your region?

Unintentional (accidents)

__ automobile/snowmobile
__ fire/all-terrain vehicles
__ drownings/boats
__ firearms/household accidents
__ poisoning/schoolyard accidents
__ school bus

Intentional (violence)

__ partner abuse/alcohol-related
__ child abuse (physical)/drug-related
__ child abuse (sexual)/homicides
__ elder abuse/other domestic violence

Self-inflicted (suicide and self-injury)

__ poisonings/overdoses/alcohol
__ solvent sniffing (gas/glue)/drugs
__ firearms

 

2. In what areas are there currently injury prevention programs in place in your region?

Unintentional (accidents)

__ automobile/snowmobile
__ fire/all-terrain vehicles
__ drownings/boats
__ firearms/household accidents
__ poisoning/schoolyard accidents
__ school bus

Intentional (violence)

__ partner abuse/alcohol-related
__ child abuse (physical)/drug-related
__ child abuse (sexual)/homicides
__ elder abuse/other domestic violence

Self-inflicted (suicide and self-injury)

__ poisonings/overdoses alcohol
__ solvent sniffing (gas/glue) drugs
__ firearms

 

3. In which areas have injury prevention programs been successful in the past?

Unintentional (accidents)

__ automobile/snowmobile
__ fire/all-terrain vehicles
__ drownings/boats
__ firearms/household accidents
__ poisoning/schoolyard accidents
__ school bus

Intentional (violence)

__ partner abuse/alcohol-related
__ child abuse (physical)/drug-related
__ child abuse (sexual)/homicides
__ elder abuse/other domestic violence

Self-inflicted (suicide and self-injury)

__ poisonings/overdoses drugs
__ solvent sniffing (gas/glue) alcohol
__ firearms

 

4. In which areas of injury prevention would you like to see programs developed in your region?

Unintentional (accidents)

__ automobile/snowmobile
__ fire/all-terrain vehicles
__ drownings/boats
__ firearms/household accidents
__ poisoning/schoolyard accidents
__ school bus

Intentional (violence)

__ partner abuse/alcohol-related
__ child abuse (physical)/drug-related
__ child abuse (sexual)/homicides
__ elder abuse/other domestic violence

Self-inflicted (suicide and self-injury)

__ poisonings/overdoses
__ solvent sniffing (gas/glue)
__ drugs
__ alcohol
__ firearms

 

5. What role does alcohol play as a contributor to injuries?
__ a very important role
__ a somewhat important role
__ a minor role

 

6. What hampers the creation of injury prevention programs in your region?
__ lack of funding
__ lack of technical support
__ lack of community interest
__ lack of community awareness
__ lack of awareness by CHRs

 

7. What types of training do CHRs require in the area of injury prevention?
__ information on existing programs
__ information on how to access programs
__ better proposal writing skills
__ information on how to get their communities motivated

 

8. What method of training do you think would be most effective in promoting injury prevention?
__ conferences open workshops/local coalitions
__ academic courses/train-the-trainer workshops

 

9. What do you think is the best method for giving out injury prevention information in your region?
__ posters/videos
__ manuals/audio tapes
__ flyers/films
__ booklets

 

10. Would you like to see injury prevention programs targeted at:
__ school children
__ teenagers
__ young adults
__ adults
__ elders

 

11. In your opinion, an injury control officer for your region would be:
__ very useful
__ somewhat useful
__ not very useful

 

12. CHRs are now doing:
__ not enough in the area of injury prevention
__ about the right amount in the area of injury prevention
__ more than is necessary in the area of injury prevention

---