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You may find it easier to fill out this survey by copying the following text file to your computer, rather than using this HTML formatted copy of the survey. To use the text survey, click on text copy of survey and when the survey displays on your screen, use the File menu and then the Save As command in your web browser to copy this survey to disk. Fill in the survey and mail to bella@mindspring.com.
Dear Fellow Ham,
The following questionnaire will be used as part of my master's thesis in Psychology that deals with amateur radio operators who have participated in emergency communications. As a ham operator for over 25 years, I feel this part of our hobby is certainly worthy of further study, and I appreciate your help in furthering this research.
Please note that in the final compilation of information, no names or callsigns will be used; your confidentiality will be assured.
73,
Bella Romain, N4ILQ
285 Timber Ridge Trail
Carrollton, GA 30117-8884
(770) 834-5674
FAX (770) 830-9481
bella@mindspring.com
Callsign:________________
Age: ________ Sex: Male ________ Female ________
How long have you been an amateur radio operator? ___________ Years
Class of license (check one)
Novice ____ Tech ____ Tech Plus ____ General ____ Advanced ____ Extra Class ____
Do you belong to any amateur radio emergency group:
ARES ____ MARS ____ RACES ____ OTHER ____________________________
What other public service/emergency organizations are you active with (if any):
_____________________________________________________________________
Do you hold any office or position that deals with emergency communications:
(Please list title or position) _______________________________________________
Have you taken any affiliated courses dealing with response in an emergency?
(Examples: Red Cross Disaster Training Courses, CPR, First Aid, First Responder Training, etc.)
Please list: ________________________________________________________________
_________________________________________________________________________
Occupation: _______________________________________________________________
Do you basically work alone or in a group: _______________________________________
Hobbies in addition to amateur radio: ___________________________________________
_________________________________________________________________________
How would you describe your physical characteristics:
_____ I would say that my weight is basically in proportion to my height
_____ I am somewhat heavier in weight than is average for my height
_____ I am somewhat lighter in weight than is average for my height
What do you consider your overall physical fitness to be:
____ Poor ____ Fair ____ Average ____ Above Average ____ Outstanding
Annual income range:
_____ Less than $10,000 _____ Between $10,000 - $20,000
_____ Between $20,000 - $30,000 _____ Between $30,000 - $40,000
_____ Between $40,000 - $50,000 _____ Over $50,000
PART II: EMERGENCY COMMUNICATIONS EXPERIENCES
Please check all types of emergencies in which you have participated in providing emergency
communications:
____ Tornadoes ____ Hurricanes ____ Severe Storms ____ Earthquakes ____ Flooding
____ Power Outages ____ Automobile Accidents ____ Bombings
____ Hazardous Materials Spills ____ Other (please specify) __________________________
Where were you when you participated in providing emergency communications (you may
indicate more than one location if you participated during several emergencies):
____ At the site of the disaster. Please indicate: ____ Mobile ____ On foot
____ At home at my ham radio station
____ At club station
____ At work. Please indicate: ____ At station at work site ____ Portable on foot
____ At other emergency communications station. Please specify (example: hospital,
Red Cross Shelter, EMA Office, etc.) ___________________________________
How would you describe your own motivations for participating in emergency communications?
Please recall a situation or time when you were providing emergency communications. Please
indicate briefly what you were thinking or feeling during that time:
On a scale of 1 to 5, how would you rate your level of personal comfort during that time you
provided emergency communications? 1 = very uncomfortable, up to 5 = very comfortable.
Comfort level: _____
On a scale of 1 to 5, how would you rate your level of personal safety during that time?
1 = in great physical danger, up to 5 = very safe.
Personal safety level: _____
Please indicate if you would be willing to discuss your experience in-depth in an interview:
_____ Yes _____ No, thank you.
If yes, how can you be contacted:
__________________________________________________________________________
Thank you very much for participating in this survey. This research would not be possible without
your help. Please feel free to pass along a copy of this questionnaire to any ham who also might
be interested. If you have any additional comments, please list them below:
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