NG911 Focus Group Questionnaire 2

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Introduction

ASL Video Referring People to ASL Questionnaire

This questionnaire is available with American Sign Language. If you would like to complete this questionnaire using ASL, please use this link: 911 Emergency Services Questionnaire in ASL

The best way to contact 911 is by phone. This may not always work. There are times when we cannot talk. We may have talking problems. There are times when it is not safe to talk. We may be robbed. We want to change this with Next Generation 911 (NG911). This will give us more ways to talk to 911. We will be able to use voice, text, and video to chat. This will let us get help safe and fast.  

 

Please answer the questions below. It will help us see if you are a good fit for the focus groups we have coming up to discuss this subject. The questionnaire should only take a few minutes. 

 

Do you want to do it over the phone? If you do, please email us. Our email address is rd.info@neilsquire.ca. We will set a time up to ask you the questions. 

 

Principal Investigator:

Dr. Gary Birch 
Executive Director
Neil Squire Society 
Head of Research and Development 
Email: garyb@neilsquire.ca 
 

What if I don't understand something?

The questions may have words you do not understand. If you would like, the research staff will read it with you. You can arrange to have the staff help you complete the questions by emailing rd.info@neilsquire.ca.

You are free to ask questions at any time – before, during, or after you complete the questions.

Please ask as many questions as you would like before you decide if you want to be considered for the study. If you decide to complete the questions, it should be because you really want to volunteer.

 

Questionnaire Procedures 

The questions will take about 15 minutes to answer. 

 

Study Team

This study is being conducted by a research team led by Dr. Gary Birch. If you have any questions or need help in completing the questions, please email our project team at: rd.info@neilsquire.ca.  

 

Risks and Benefits of Participation

There are no known or suspected risks associated with answering the questions.   

 

Confidentiality

We respect your privacy and are committed to protecting the personal information that we collect from you. We will: 

  •  only collect the information required   
  • give you access to your own records and, if requested, make copies of them at a reasonable cost 
  • ask your permission to share your information if required for other purposes unless we must provide it for legal reasons 
  • keep your information safe 
  • keep accurate records. 

 

Consent

Answering the questions is entirely voluntary. You may refuse to answer or withdraw at any time. There will be no penalty if you choose not to complete the questions or if you start to answer and then change your mind.  

By answering the questions below and clicking the SUBMIT button you indicate that you have understood the information above and agree to participate.  

If you have any concerns or complaints about your rights as a research participant and/or your experiences while completing this questionnaire, contact Dr. Gary Birch at garyb@neilsquire.ca.

 

Contact Information

Please provide the following contact information.

 

Mobility-Related Conditions

If you cannot freely move your fingers, hands or arms please answer these questions. 

Hearing-Related Conditions

If you have difficulty hearing, please answer these questions.

 

Vision-Related Conditions

If you have difficulty seeing, please answer these questions. 

 

Cognitive or Intellectual Disability-Related Conditions

If you have difficulty concentrating, remembering or following instructions please answer these questions. 

 

Everyone, please answer the following questions.

Technical Use:

Emergency Services Use 

Other Question