READI Revised SURVEY

(Air Force)

A. Please rate your level of competency according to the following scale
  1. I need theory, demonstration & supervised practice
  2. I would need review & supervised practice
  3. I would need some review & little supervision
  4. I would need review only
  5. I would need no review or supervision
Please select the circle to indicate your response
  1. Not Competent
  2. Minimally Competent
  3. Moderately Competent
  4. Highly Competent
  5. Totally Competent
1.
1 2 3 4 5
2.
1 2 3 4 5
3.
1 2 3 4 5
4.
1 2 3 4 5
5.
1 2 3 4 5
6.
1 2 3 4 5
7.
1 2 3 4 5
8.
1 2 3 4 5
9.
1 2 3 4 5
10.
1 2 3 4 5
11.
1 2 3 4 5
12.
1 2 3 4 5
13.
1 2 3 4 5
14.
1 2 3 4 5
15.
1 2 3 4 5
16.
1 2 3 4 5
17.
1 2 3 4 5
18.
1 2 3 4 5
19.
1 2 3 4 5
20.
1 2 3 4 5
21.
1 2 3 4 5
22.
1 2 3 4 5
23.
1 2 3 4 5
24.
1 2 3 4 5
25.
1 2 3 4 5
B. For the following, please indicate your level of agreement according to this scale by indicating the circle for your response
  1. Totally Disagree
  2. Minimally Agree
  3. Moderately Agree
  4. Highly Agree
  5. Totally Agree
26.
1 2 3 4 5
27.
1 2 3 4 5
28.
1 2 3 4 5
29.
1 2 3 4 5
30.
1 2 3 4 5
31.
1 2 3 4 5
32.
1 2 34 5
33.
1 2 3 4 5
34.
1 2 3 4 5
35.
1 2 3 4 5
36.
1 2 3 4 5
37.
1 2 3 4 5
38.
1 2 3 4 5
39.
1 2 3 4 5
40.
1 2 3 4 5
PART 2 - Demographics

Please select from the drop down box the answer most applicable to yourself or enter the information as indicated. This information is very important for our research and is anonymous. No names are used.

Yes No

Male Female

9. Do you have the following triage experiences and education?


Yes No

Yes No

Yes No Not sure

Yes No Not Applicable

Yes No Not Applicable

  • Tobacco
  • Alcohol
  • Physical Exercise
  • Reading
  • Relaxation/Meditation Techniques
  • Music
  • Talking with Friends
  • Religious Faith
  • Eating
  • Sleeping
  • Other (please specify below)

Thank you very much for completing this questionnaire.