Beginning of School Year Questionnaire Beginning of School Year Questionnaire If you are human, leave this field blank. Please complete this test prior to completing the educational program. These questions gather your impression about your students’ experience utilizing protective eyewear. School Name * Teacher Name * How necessary is protective eyewear for youth learning and working in your classroom, even if they do not wear prescription glasses? * Not necessary at all Not very necessary Unsure Somewhat necessary Very necessary Please answer the following statements about protective eyewear. Please choose whether the statement is true or false. Protective goggles are not necessary for students wearing eye glasses. * True False Eyeglasses provide ample protection against eye injuries. * True False Students wearing eyeglasses while working are at an increased risk for eye injury as compared to those children who do not wear glasses. * True False Protective goggles cause students to not be able to see very well. * True False Protective goggles should have a polycarbonate lens. * True False Please indicate whether you agree or disagree with the following statements. My students (or their parents) know how to find protective eyewear to purchase. * Agree Disagree Eye injuries are a serious risk for vocational students. * Agree Disagree All students working in vocational programs should wear protective eyewear. * Agree Disagree How many students in your class CURRENTLY wear protective eyewear? * None Few Some Many All How many potential eye injuries do you estimate occurred last school year? * 0 1-5 6-10 Play Hard. Don't Blink is funded by a grant awarded by the Ohio Department of Health, Bureau of Maternal and Child Health Save Our Sight Fund. For more information about the Save Our Sight Fund and how you can help promote good eye health and safety for children in Ohio, visit: www.saveoursight.ohio.gov. Submit
