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Pages 58-77

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From page 58...
... 58 A P P E N D I X A Survey Questionnaire
From page 59...
... Survey Questionnaire 59   Email to Potential Participants From: Gabriel B Dadi, Ph.D., PE To: Members of AASHTO Standing Committee on Maintenance Members and North American Association of Transportation Safety & Health Officials (NAATSHO)
From page 60...
... 60 Use of Safety Management Systems in Managing Highway Maintenance Worker Safety SMS Survey Questionnaire NCHRP Synthesis 52-09: "Use of Safety Management Systems in Managing Highway Maintenance Worker Safety" Dear Department of Transportation Representative, The Transportation Research Board (TRB) , through the National Cooperative Highway Research Program (NCHRP)
From page 61...
... Survey Questionnaire 61   (1) Please enter the following information: Name: Title: Email: Phone Number: (2)
From page 62...
... 62 Use of Safety Management Systems in Managing Highway Maintenance Worker Safety Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina
From page 63...
... Survey Questionnaire 63   South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming (3) What division do you work for within your agency?
From page 64...
... 64 Use of Safety Management Systems in Managing Highway Maintenance Worker Safety (5) For the purpose of this survey, safety management systems (SMSs)
From page 65...
... Survey Questionnaire 65   The contents of the SMS Executive management support for safety and the SMS Goals for the SMS Roles and responsibilities for data entry Roles and responsibilities for data management Roles and responsibilities for corrective actions To my knowledge, no policy manual documents SMSs Other - Write In: (9) Which of the following components, elements, or characteristics of an SMS are in your system?
From page 66...
... 66 Use of Safety Management Systems in Managing Highway Maintenance Worker Safety Single point of access (i.e. one log-in portal)
From page 67...
... Survey Questionnaire 67   Maintenance Worker Maintenance Superintendent/Supervisor or equivalent Safety Coordinator/Safety Manager or equivalent Safety Executive or equivalent Maintenance Engineer/Manager or equivalent Other - Write In: (14) How does your DOT retain the safety data?
From page 68...
... 68 Use of Safety Management Systems in Managing Highway Maintenance Worker Safety Once per day A few times per week Once per week Once per month After an incident occurs Other - Write In: (17) How often is the SMS accessed by those responsible to manage safety with its information?
From page 69...
... Survey Questionnaire 69   Information is collected as a requirement. The information is not used for any action.
From page 70...
... 70 Use of Safety Management Systems in Managing Highway Maintenance Worker Safety (21) Considering the costs and benefits of the SMS, what level of future use is planned in your agency?
From page 71...
... Survey Questionnaire 71   Non-SMS Safety Management Questions (24) What is included in the written language of your DOT's policy manual(s)
From page 72...
... 72 Use of Safety Management Systems in Managing Highway Maintenance Worker Safety (26) What maintenance worker safety information do you collect data on?
From page 73...
... Survey Questionnaire 73   Safety Executive or equivalent Maintenance Engineer/Manager or equivalent Other - Write In: (29) How does your DOT retain the data?
From page 74...
... 74 Use of Safety Management Systems in Managing Highway Maintenance Worker Safety Once per month After an incident occurs Other - Write In: (32) How often is maintenance worker safety information accessed by those responsible to manage safety?
From page 75...
... Survey Questionnaire 75   (34) What benefit(s)
From page 76...
... 76 Use of Safety Management Systems in Managing Highway Maintenance Worker Safety Will expand procedures Will continue current procedures Will reduce/limit current procedures due to lack of value Will reduce/limit current procedures due to lack of funding (37) Who is responsible for following up on safety actions from the maintenance worker safety information?
From page 77...
... Survey Questionnaire 77   correspondence to determine stakeholders who should participate in the case study, a phone interview approximately one hour in length, with minor follow-up to finalize case details, and a review of the case study prior to submission. Yes No Thank you for taking our survey.

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