Infrared Camera Health & Safety Survey by RAFT (Rank and File Together)
Answer confidential questions about any eye, skin, or driving-distraction effects you associate with in-cab infrared camera systems.
Full name
*
First Name
Last Name
Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Union local number
Active union member?
Yes
No
Retired
Job title
Eye & vision effects (check all that apply)
Eye irritation
Dry eyes
Watery eyes
Tired eyes
Blurred vision
Vision loss
Headaches
Feels like excessive screen time
Feels like allergy season
None
Other
Skin effects (check all that apply)
Skin irritation
Skin rashes/eczema
Skin cancer (present or removed)
Skin discoloration/blotching
None
Other
Camera distractions while driving (check all that apply)
Visible red light or glow from camera
Glare or reflection on windshield at night
Camera placement blocking view
Feeling watched causing distraction
None
Other
Have you sought medical treatment for a condition you associate with the camera?
Yes
No
If yes, please describe (confidential)
Additional comments
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