Sowing Wellbeing in Every Field
All information provided will remain anonymous when reported.
Surveyor Name
Please Select
Self Completion
Laura
Surveyor 1
Surveyor 2
Surveyor 3
Surveyor 4
Which of the following best describes your gender?
*
Female
Male
Non Binary
Prefer Not To Say
Your Age
*
Under 18 years
18-24 years
25-44 years
45-64 years
65 years and over
Your Primary Location
*
Please Select
Carlow
Cavan
Clare
Cork
Donegal
Dublin
Galway
Kerry
Kildare
Kilkenny
Laois
Leitrim
Limerick
Longford
Louth
Mayo
Meath
Monaghan
Offaly
Roscommon
Sligo
Tipperary
Waterford
Westmeath
Wexford
Wicklow
Other
Select option which is most relevant.
If you selected 'other' please specify.
As part of this campaign, we are sharing stories related to the topics below. Please select the topics which are of most relevance to you or highlight other areas you'd like to learn more about.
*
Quad Safety
Livestock Safety
Heart & Blood Pressure Health
Weight Management
Mental Health
Farm Machinery Safety
Other
Would you consider yourself to be a farmer / producer of agri-food products?
*
Yes
No
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What is your farm enterprise? Please tick all boxes that apply to you.
*
Beef
Dairy
Equine
Horticulture
Pig
Poultry
Sheep
Tillage
Other
Do you usually carry your phone with you while working on the farm or working with livestock?
*
Never
Rarely
Sometimes
Often
Always
Have you ever been involved in an accident associated with a quad?
*
Yes
No
Would you classify the accident as a major or minor accident?
Major accident
Minor accident
Did you raise or report the accident to family, friends, or the relevant authorities?
Yes
No
Do you own or regularly use a quad?
*
Yes
No
Do you own a quad helmet?
Yes
No
Do you wear the helmet when using a quad?
Never
Rarely
Sometimes
Often
Always
Have you participated in a quad safety course?
*
Yes
No
Are you aware of the legal age limit to drive a quad?
*
Over 14 years old
Over 16 years old
Over 18 years old
Over 21 years old
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Next
Are you aware of the legal age limit to drive a light quad on a farm?
*
Yes - the legal age limit is over 14 years old
Yes - the legal age limit is over 16 years old
Yes - the legal age limit is over 18 years old
Yes - the legal age limit is over 21 years old
No, I am not aware of the legal age limit
Are you aware of the symptoms associated with high blood pressure?
*
Yes
No
Have you had your blood pressure checked by a medical professional?
Please Select
Yes
No
High blood pressure may present in a number of ways. If you have any doubts or concerns, make sure to get your blood pressure checked.
Which, if any, of these do you think could be signs of sepsis?
Fast breathing
Confusion or disorientation
High or very low temperature
Slurred speech
Cold, clammy skin
I don't know
How often would you seek a general check-up from your Doctor or GP?
*
Never
Rarely - e.g. Every 3-5 years
Sometimes - e.g. Every 2 years
Often - e.g. Once a year
Always - e.g Every 6 months or more frequently
Would you seek immediate medical attention for an injury or accident?
*
Yes, I would seek medical attention immediately
No, I would wait
Have you ever had an injury or accident that you never got medical attention for?
*
Yes
No
Do you have any hesitations in seeking medical advice or getting check ups for an injury or accident?
*
Please provide your email if you would like to be entered into a draw to win a prize worth €1000.
Confirmation Email
example@example.com
Would you like to hear more from Agri Aware regarding additional programmes and events.
Yes
No
Would you seek medical attention straight away for an injury or accident?
No
Yes
How often would you seek a general check-up from your Doctor or GP?
Never
Every two years
Once a year
Twice or more a year
Are you aware of the symptoms associated with high blood pressure?
No
Yes
Are you aware of the symptoms of sepsis?
No
Yes
Have you ever had an injury, accident or illness that you never got medical attention for?
No
Yes
What is your hesitation, if any, to seek medical advice or get checked up for the injury, accident or illness?
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