1. Name
   
     
2. Today’s date
   
   

3. Age: <15 15-19 20-29   30-39 40-49 50-59 60-69 70+
   
   

4. Sex: M F
   
   

5. Are you a member of the Washington Kayak Club? Yes No   
   
   
6. May we contact you to clarify answers, or with future surveys (not to many, honest)?
   Yes   No 
   
   
7. Have you ever had a diagnosis of, or been treated for, presumed giardia infection?  
   Yes   No
   If yes, do you feel the infection was due to your paddling activities? 
   Yes  No
   
   
8. What percent of boating days are spent in each of the following type of boats?
   kayak    C-1   C-2   Open Canoe   Other
   
   
9. How many days each year do you paddle each of the following?  
   River running  Slalom  Creeking  Other
   Play/Rodeo (Much time spent in holes)   
   
   
10. How many years have you whitewater paddled (at least five days in each year)?    
    <2   2-4   5-7   8-10   11-13   14-16   >16
    
    
11. What percent of your boating days are on rivers of the following difficulty?      
    Give a percent for each; the total should equal 100%
    2-2+   3   3+   4   4+   5 and up   Ocean surf 
    
    
12. Do you use a helmet-attached face guard? Yes No  
    What percent of the time?  
    How long have you used a face guard? 
    Has the guard protected you from injury? Yes No                                       
     
    
    Canoers please skip to question 17!
    
    
13. Do you use a bent shaft paddle? Yes   No   If yes answer the following:
     How long have you used a bent shaft paddle?
     Did you have wrist/forearm problems prior to using the bent shaft paddle? 
    Yes   No                  
    Did you change the feather angle of your paddle at the same time? 
    Yes   No           
     Did you continue to have wrist problems after switching to bent shaft? 
    Yes  No
    
    
14. How many degrees is your paddle feathered?
    0  45   60   80   Other
    Have you decreased your feather due to wrist or forearm problems? 
    Yes   No
    If yes, did this eliminate your wrist/ forearm problem? Yes  No
    
    
15. Have you been injured hiking to or from the river, during a portage, or scouting?  
    Yes   No
    
    
16. Do you get blisters on your hands or feet from paddling? Yes   No   If yes where?
    
    Have the blisters ever incapacitated you, or kept you from paddling? 
    Yes  No
    Do you wear paddling gloves? Yes   No
    
    
17. Have you ever had acute injuries due to paddling?    
     Acute Injury:  An injury resulting suddenly from a particular accident 
    or episode.  Examples are, shoulder dislocations, fractures, lacerations, 
    contusions, concussions, sprains, etc.
    
    If so, check yes after the appropriate body part, and answer the questions following..

Shoulder/Upper Arm Yes   No
    Did you ever see a medical practitioner? Yes   No
    Did you ever have surgery for the injury ? Yes   No
    Were you hospitalized overnight for this injury? Yes No
    How long did this injury affect your paddling?
    Have you also injured this area doing other activities? Yes  No
    Details of injury.
   

Elbow/Lower Arm Yes   No
    Did you ever see a medical practitioner? Yes   No

    Did you ever have surgery for the injury? Yes   No
    Were you hospitalized overnight for this injury? Yes No

    How long did this injury affect your paddling?
    Have you also injured this area doing other activities? Yes   No
    Details of injury            

   


Wrist/Hand Yes  No

    Did you ever see a medical practitioner? Yes   No

    Did you ever have surgery for this injury? Yes   No
    Were you hospitalized overnight for the injury? Yes No

    How long did this injury affect your paddling?

    Have you also injured this area doing other activities? Yes   No
    Details of injury.    

   

  Head/Face/Neck Yes  No
    Did you ever see a medical practitioner? Yes   No
    Did you ever have surgery for this injury? Yes   No
    Were you hospitalized overnight for the injury? Yes No
    How long did this injury affect your paddling?
    Have you also injured this area doing other activities? Yes  No
    Details of injury    

   

Back/Chest/Hip Yes  No
    Did you ever see a medical practitioner? Yes   No
    Did you ever have surgery for this injury? Yes   No
    Were you hospitalized overnight for the injury? Yes No
    How long did this injury affect your paddling?
    Have you also injured this area doing other activities? Yes   No
    Details of injury

   

Knee/Leg Yes  No
    Did you ever see a medical practitioner? Yes  No
    Did you ever have surgery for this injury? Yes   No
    Were you hospitalized overnight for the injury? Yes No
    How long did this injury affect your paddling?
    Have you also injured this area doing other activities? Yes   No
    Details of injury    

   

Ankle/Foot Yes   No
    Did you ever see a medical practitioner? Yes  No
    Did you ever have surgery for this injury? Yes  No
    Were you hospitalized overnight for the injury? Yes No
    How long did this injury affect your paddling?
    Have you also injured this area doing other activities? Yes   No
    Details of injury

   

If so, check yes after the appropriate body part, and answer the questions following.

 Shoulder/Upper Arm Yes   No
    Did you ever see a medical practitioner? Yes   No
    Did you ever have surgery for this injury? Yes   No
    How long did this injury affect your paddling?
    Have you also injured this area doing other activities? Yes  No
    Has this injury recurred due to paddling? Yes No

    Details of injury.
   

Elbow/Lower Arm Yes   No
    Did you ever see a medical practitioner? Yes   No

    Did you ever have surgery for this injury? Yes   No

    How long did this injury affect your paddling?
    Have you also injured this area doing other activities? Yes   No
    Has this injury recurred due to paddling? Yes No
    Details of injury.
   

Wrist/Hand Yes  No

    Did you ever see a medical practitioner? Yes   No

    Did you ever have surgery for this injury? Yes   No

    How long did this injury affect your paddling?

    Have you also injured this area doing other activities? Yes   No
    Has this injury recurred due to paddling? Yes No
    Details of injury.    

   

  Head/Face/Neck Yes  No
    Did you ever see a medical practitioner? Yes   No
    Did you ever have surgery for this injury? Yes   No
    How long did this injury affect your paddling?
    Have you also injured this area doing other activities? Yes  No
    Has this injury recurred due to paddling? Yes No
    Details of injury.    

   

Back/Chest/Hip Yes  No
    Did you ever see a medical practitioner? Yes   No
    Did you ever have surgery for this injury? Yes   No
    How long did this injury affect your paddling?
    Have you also injured this area doing other activities? Yes   No
    Has this injury recurred due to paddling? Yes No
    Details of injury.

   

Knee/Leg Yes  No
    Did you ever see a medical practitioner? Yes  No
    Did you ever have surgery for this injury? Yes   No
    How long did this injury affect your paddling?
    Have you also injured this area doing other activities? Yes   No
    Has this injury recurred due to paddling? Yes No
    Details of injury.

   

Ankle/Foot Yes   No
    Did you ever see a medical practitioner? Yes  No
    Did you ever have surgery for this injury? Yes  No
    How long did this injury affect your paddling?
    Have you also injured this area doing other activities? Yes   No

    Has this injury recurred due to paddling? Yes No
    Details of injury.   

   

 

Thank you for taking the time to complete this survey!!!  

 

If you would like your name entered into the drawing, we need some form of contact.  E-mail is sufficient, or phone.  All personal information is kept confidential. 

 

    Address:    
                    
                    

    Phone(s):   

    Email: