Write Intervention + Survey about Fire Safety [Examples provided]

1.

Very Unlikely

Unlikely

Likely

Very Likely

How likely are you to watch/supervise the child you care for with a lifeguard on duty?

VU

UL

L

VL

How likely is it that the child you care for would drown, if he or she does not learn how to swim?

VU

UL

UL

VL

How likely are you to take the child you care for swimming at a place with no lifeguard on duty?

VU

UL

UL

VL

How likely is it that the child you care for would get hurt or injured with a lifeguard on duty?

VU

UL

UL

VL

How likely is it that the child you care for would drown if left unsupervised, near or in the water?

VU

UL

UL

VL

2.

Very Unlikely

Unlikely

Likely

Very Likely

Without my supervision, the child I care for could drown when near or in the water.

VU

UL

L

VL

Without swim lessons, the child I care for could drown when near or in the water.

VU

UL

L

VL

Without a lifeguard on duty, the child I care for could drown when near or in the water.

VU

UL

L

VL

A non-swimmer may slip under the water unnoticed and drown in a matter of seconds.

VU

UL

L

VL

If someone was drowning and I did not call for help, the person could die.

VU

UL

L

VL

3.

Strongly Disagree

Disagree

Agree

Strongly Agree

I would feel good about myself if I was able to help someone who was drowning.

SD

D

A

SA

I would feel relieved if the child I care for knew how to swim.

SD

D

A

SA

I would feel reassured if there was a lifeguard on duty at the place we go swimming.

SD

D

A

SA

I would feel better if I knew how to rescue someone who was drowning.

SD

D

A

SA

I would feel better if I knew how to prevent the child I care for from drowningdowning.

SD

D

A

SA

4.

Strongly Disagree

Disagree

Agree

Strongly Agree

Not knowing what to do during a water related emergency could result in a drowningdowning.

SD

D

A

SA

Not having a lifeguard on duty could result in a drowning.

SD

D

A

SA

Not having a supervised place to practice swimming could result in a drowning.

SD

D

A

SA

Not receiving swim lessons could result in a drowning.

SD

D

A

SA

Not having access to rescue equipment could result in a drowning.

SD

D

A

SA

5.

Strongly Disagree

Disagree

Agree

Strongly Agree

I am confident that I can prevent the child I care for from drowningdowning.

SD

D

A

SA

I am confident the child I care for can swim.

SD

D

A

SA

I am confident that I can adequately watch/ supervise the child I care for in and around the water.

SD

D

A

SA

I am confident that I can enroll or reenroll the child I care for into swim lessons.

SD

D

A

SA

I am confident that if I saw someone drowning, I would know what to do.

SD

D

A

SA

6.

True

False

Unsure

Lakes are safer to swim in than pools.

T

F

U

To help someone who is drowning you should dive into the water to rescue them.

T

F

U

For children ages 4 and under, most drowning fatalities occur at or near the home.

T

F

U

Drowning is responsible for 1 in 4 deaths among children.

T

F

U

Infants should be within arm’s reach at all times when near or around the water.

T

F

U

7.

Yes

No

I received prevention information in person.

Y

N

I received prevention information in the mail.

Y

N

I received prevention information on my cell phone.

Y

N

I received prevention information via email.

Y

N

I received prevention information via Facebook.

Y

N

8.

Very Unlikely

Unlikely

Likely

Very Likely

I plan to reenroll the child I care for in swim lessons.

VU

UL

L

VL

I will only take the child I care for to swim at facilities that have a lifeguard on duty.

VU

UL

L

VL

I will closely watch the child I care for when near or around the water.

VU

UL

L

VL

I will help if I see someone drowning downing.

VU

UL

L

VL

I will not jeopardize my own safety trying to help someone else.

VU

UL

L

VL