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1) Gender<\/b><\/font><\/td><\/tr>
<\/td><\/td><\/tr>
<\/td>Male<\/font><\/td><\/tr>
<\/td>Female<\/font><\/td><\/tr>
 <\/td> <\/td><\/tr>
2) Age<\/b><\/font><\/td><\/tr>
 <\/td> <\/td><\/tr>
3) Household income (per year)<\/b><\/font><\/td><\/tr>
 <\/td> <\/td><\/tr>
4) Years in woodworking<\/b><\/font><\/td><\/tr>
 <\/td> <\/td><\/tr>
5) What type of woodworker do you consider yourself?<\/b><\/font><\/td><\/tr>
<\/td><\/td><\/tr>
<\/td>Hobbyist<\/font><\/td><\/tr>
<\/td>Professional<\/font><\/td><\/tr>
 <\/td> <\/td><\/tr>
6) How often do you do woodworking?<\/b><\/font><\/td><\/tr>
<\/td><\/td><\/tr>
<\/td>Daily<\/font><\/td><\/tr>
<\/td>Once or twice per week<\/font><\/td><\/tr>
<\/td>Once or twice per month<\/font><\/td><\/tr>
<\/td>Rarely<\/font><\/td><\/tr>
 <\/td> <\/td><\/tr>
7) Is your woodworking shop\/space<\/b><\/font><\/td><\/tr>
<\/td><\/td><\/tr>
<\/td>Dedicated<\/font><\/td><\/tr>
<\/td>Shared (dual use, garage, basement)<\/font><\/td><\/tr>
 <\/td> <\/td><\/tr>
8) Have you ever had a woodworking accident that caused some form of injury?<\/b><\/font><\/td><\/tr>
<\/td><\/td><\/tr>
<\/td>Yes<\/font><\/td><\/tr>
<\/td>No<\/font><\/td><\/tr>
 <\/td> <\/td><\/tr>
9) How would you describe the injury?<\/b><\/font><\/td><\/tr>
 <\/td> <\/td><\/tr>
10) What level of medical care did you require?<\/b><\/font><\/td><\/tr>
 <\/td> <\/td><\/tr>
11) What was the total dollar cost of the accident, including medical, time off of work, repair to tools etc.<\/b><\/font><\/td><\/tr>
 <\/td> <\/td><\/tr>
12) On what machine\/tool did the injury occur?<\/b><\/font><\/td><\/tr>
 <\/td> <\/td><\/tr>
13) Was this a new (to you) machine or tool?<\/b><\/font><\/td><\/tr>
<\/td><\/td><\/tr>
<\/td>Yes<\/font><\/td><\/tr>
<\/td>No<\/font><\/td><\/tr>
<\/td>No injury<\/font><\/td><\/tr>
 <\/td> <\/td><\/tr>
14) How did the injury occur?<\/b><\/font><\/td><\/tr>
 <\/td> <\/td><\/tr>
15) Did the machine or tool have the factory supplied safety equipment in place?<\/b><\/font><\/td><\/tr>
<\/td><\/td><\/tr>
<\/td>Yes<\/font><\/td><\/tr>
<\/td>No<\/font><\/td><\/tr>
<\/td>No Injury<\/font><\/td><\/tr>
 <\/td> <\/td><\/tr>
16) Were you using a push stick, push pad or push handle at the time of the injury?<\/b><\/font><\/td><\/tr>
<\/td><\/td><\/tr>
<\/td>Yes<\/font><\/td><\/tr>
<\/td>No<\/font><\/td><\/tr>
<\/td>No Injury<\/font><\/td><\/tr>
 <\/td> <\/td><\/tr>
17) Were you distracted by something in the shop in the moments leading up to the injury?<\/b><\/font><\/td><\/tr>
<\/td><\/td><\/tr>
<\/td>Yes<\/font><\/td><\/tr>
<\/td>No<\/font><\/td><\/tr>
<\/td>No Injury<\/font><\/td><\/tr>
 <\/td> <\/td><\/tr>
18) Do you feel that your own complacency contributed to the accident?<\/b><\/font><\/td><\/tr>
<\/td><\/td><\/tr>
<\/td>Yes<\/font><\/td><\/tr>
<\/td>No<\/font><\/td><\/tr>
<\/td>No Injury<\/font><\/td><\/tr>
 <\/td> <\/td><\/tr>
19) Do you feel a design problem in the tool itself directly contributed to the accident?<\/b><\/font><\/td><\/tr>
<\/td><\/td><\/tr>
<\/td>Yes<\/font><\/td><\/tr>
<\/td>No<\/font><\/td><\/tr>
<\/td>No Injury<\/font><\/td><\/tr>
 <\/td> <\/td><\/tr>
20) Do you feel the injury was your own fault?<\/b><\/font><\/td><\/tr>
<\/td><\/td><\/tr>
<\/td>Yes<\/font><\/td><\/tr>
<\/td>No<\/font><\/td><\/tr>
<\/td>No Injury<\/font><\/td><\/tr>
 <\/td> <\/td><\/tr>
21) Had you previously performed the proceedure during which the injury occured and done it without incident?<\/b><\/font><\/td><\/tr>
<\/td><\/td><\/tr>
<\/td>Yes<\/font><\/td><\/tr>
<\/td>No<\/font><\/td><\/tr>
<\/td>No Injury<\/font><\/td><\/tr>
 <\/td> <\/td><\/tr>
22) Have you altered the way you perfom this or similar proccedures since the accident?<\/b><\/font><\/td><\/tr>
<\/td><\/td><\/tr>
<\/td>Yes<\/font><\/td><\/tr>
<\/td>No<\/font><\/td><\/tr>
<\/td>No Injury<\/font><\/td><\/tr>
 <\/td> <\/td><\/tr>
23) Have you added safety equipment to your shop since the injury?<\/b><\/font><\/td><\/tr>
<\/td><\/td><\/tr>
<\/td>Yes<\/font><\/td><\/tr>
<\/td>No<\/font><\/td><\/tr>
<\/td>No Injury<\/font><\/td><\/tr>
 <\/td> <\/td><\/tr>
24) Have you re-installed factory safety equipment since the injury?<\/b><\/font><\/td><\/tr>
<\/td>Yes<\/font><\/td><\/tr>
<\/td>No<\/font><\/td><\/tr>
<\/td>No Injury<\/font><\/td><\/tr>
 <\/td> <\/td><\/tr>
Your Comments :<\/font>