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Evaluation Form
Please take a few minutes to help us evaluate this NIOSH guide by printing and mailing this form, once completed.
Thank you.
ATTN: JIM COLLINS PHD
NIOSH DIVISION OF SAFETY RESEARCH
MS 1900
1095 WILLOWDALE RD
MORGANTOWN WV 26505-9989
1. Are you involved in the operation of a nursing or personal care home, or in the lifting or movement of nursing home
residents?
__ yes
__ no
1.a. If yes, check the item(s) below that best describes your involvement:
__ A nursing or personal care home owner
__ A nursing or personal care home administrator
__ A manager of nursing services
__ An occupational safety and health specialist
__ A physician
__ A physical therapist
__ A nurse, aide, or orderly
__ Other, please specify: ______________________________________________________
1.b. If no, please describe your role or interest in the issue of safe resident lifting in nursing and personal care homes:___________________________________________________
If you answered no proceed to question 3
2. Which of the following best describes the resident lifting program in your facility?
__ The facility has no resident lifting program
__ The facility has a safe resident lifting program that includes (check all that apply):
__ A written resident lifting policy, procedures
__ The use of mechanical lifting devices
__ Staff training in use of mechanical lifting devices
__ Other components (specify:)______________________________________________________
3. How did you read this guide?
__ Cover to cover
__ Selected sections only (please specify all that apply):
__ Introduction
__ The Challenge of Lifting Residents in Nursing Homes
__ Benefits, Cost, and Effectiveness of a Safe Resident Lifting Program
__ Frequently Asked Questions
__ Conclusion
__ More Information
__ References
__ Did not read
Was the information used (check all that apply)?
__ To pass along to/inform someone else
__ For communicating to managers or staff
__ To obtain further information on this issue
__ To review/evaluate current facility policies and programs
__ To change current facility policies and programs:
(specify:) _________________________________________________________
__ To implement the following activities or components of a resident lifting program:
__ Develop and communicate a written policy
__ Invest in portable (not ceiling mounted) mechanical lifting devices
__ Invest in ceiling mounted mechanical lifting devices
__ Train staff in the use of mechanical lifting devices
__ To implement a comprehensive resident lifting program based upon the guide
__ The information was not used
Other Concerns: _________________________________________________________
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(32 pages, 4.17MB)