Running head: SURVEY PAPER� � PAGE \* MERGEFORMAT �1� �� SURVEY PAPER� � PAGE \* MERGEFORMAT �6� ��
Survey Paper
Sanjeet K. Singh
RES/341
January 7, 2011
John Sankovic
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Survey Paper
Workman's Compensation Survey
Your Age: _______
Your Sex: ___Male ___Female
Your Race/Ethnicity: ___ Asian ___ Pacific Islander ___ Black/African American ___ American Indian/Alaska Native ___ White (Not Hispanic or Latino) ___ Hispanic or Latino (All Races) ___ Unknown
Do you feel your workman's compensation rights were fully explained to you?
Yes or No ______
Do you feel you may lose your job because of your work related injury?
Yes or No ______
Is temporary disability an option that is worth considering in lieu of Workman's Compensation Benefits?
Yes or No ______
Do you feel the information provided in the Workman's Compensation Booklet was useful to you?
Yes or No ______
Please answer the following questions in order of how important they are to you.
You can answer by marking agree, strongly agree, do not agree, strongly disagree or do not know.
Having a lawyer represent you in a Workman's Compensation case is important?
___Agree | ___Strongly agree | ___Do not agree | ___Strongly disagree | ___Do not know |
Claiming a work related injury will cause me to lose my job or position with the company?
___Agree | ___Strongly agree | ___Do not agree | ___Strongly disagree | ___Do not know |
Do feel filing you have been discriminated against because of your Workman's Compensation claim?
___Agree | ___Strongly agree | ___Do not agree | ___Strongly disagree | ___Do not know |
Do you believe you should be able to go to the medical provider of your choice while going through the Workman's Compensation process?
___Agree | ___Strongly agree | ___Do not agree | ___Strongly disagree | ___Do not know |
Your medical injury could have been avoided if you were provided with better knowledge...