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HSR Course Participant Data Collection Form
Participant data collection
1) Full Name
Internal ID
External ID
Question Type
Basic - Text
2) Contact Email
Internal ID
External ID
Question Type
Basic - Text
3)Contact Phone
Internal ID
External ID
Question Type
Basic - Text
4) Occupation
Internal ID
External ID
Question Type
Basic - Text
5) Please tick the category, which best describes the industry of your employer.
Accommodation and food services
Agriculture, forestry and fishing
Arts and recreational services
Construction
Education and training
Electricity, gas, water and waste services
Financial and insurance services
Health care and social assistance
Information media and telecommunications
Manufacturing
Mining – Onshore
Professional, scientific and technical services
Public administration and safety
Administrative and support services
Other services
Rental, hiring and real estate services
Retail trade
Transport, postal and warehousing
Wholesale trade
NOPSEMA
Seafarers
Internal ID
External ID
Question Type
Basic - Radio buttons
6) Please tick the occupational category in which you work.
Managers and Administrators
Including School Principals, Directors, Mine Managers, Farm, Managers, Managing, Supervisors, Commissioned Police Officers, Chief Executives, Trade Union Secretaries
Professionals
Including Chemists, Teachers, Architects, Accountants, Engineers, Geologists, Metallurgists,
Journalists, Actors, Librarians, Public Relations Officers, Registered Nurses
Para-Professionals
Including Technicians, Police Officers, Ships Captains, Welfare Officers, Safety Inspectors, Prison Officers
Tradespersons
Including Fitters, Welders, Tilers, Hairdressers, Chefs, Tailors, Mechanics, Gardeners, Apprentices
Clerks
Including Typist, Secretaries, Messengers, Computer Operators, Bookkeepers, Telephonists, Teachers Aids, Law Clerks
Salespersons and Personal Service Workers
Including Travel Agents, Enrolled Nurses, Dental Nurses, Waiters, Insurance Brokers, Sales Representatives, Tellers, Cashiers, Beauty Therapists
Plant and Machine Operators
Including Bus Drivers, Forklift Drivers, Crane Operators, Press Operators, Processing Machine Operators, Treatment Plant Operators, Mining Equipment Operators
Labourers and Related Workers
Including Trades Assistants, Factory Hands and Cleaners, Farm Hands, Meat Packers, Process Workers, Scaffolders, Riggers, Security Officers, Fishing Workers, Deckhands, Labourers, Miners
Other / not stated
Internal ID
External ID
Question Type
Basic - Radio buttons
7) Where do you usually work (in your current job)?
Metropolitan Area
Non-Metropolitan Area (regional WA)
Internal ID
External ID
Question Type
Basic - Radio buttons
8) Please tick your age group
15-19
20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65+
Internal ID
External ID
Question Type
Basic - Radio buttons
9) Your gender
Female
Male
Non-binary
Prefer not to disclose
Internal ID
External ID
Question Type
Basic - Radio buttons
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