Community Towbar Safety Survey
Subject: Injuries caused by unprotected towbars

Injuries can be caused by towbars protruding from vehicles at home, shopping centres, work places, car and caravan parks etc. With the public's best interest, health and well-being in mind, we ask if you could fill out the following survey and submit it to us.

1. Have you ever hit your leg on a towbar?
Yes No

If yes, please answer the following questions. Otherwise please skip all questions up to and including seven, then fill out your name and the following entries.
Once Several Times Many times

2. Did accidents involving a towbar, happen at:
Home Work Car Park Shopping centre
Sporting venue Caravan park Street curb side
Other

3. How did the accident(s) happen?

4. Did any injury require medical attention?
Yes No

5. Did the accident cause further injury to other parts of the body such as:
Head Shoulders Elbows Chest
Back Knees
Other

6. Did the injury cause any loss in work, school or recreation hours?
Yes No
If yes, how many hours?

7. Has the accident left any permanent scare or injury?
Yes No

We value your comments and suggestions please:

Your details will be kept private and will not be given to any third party. You will not recieve any junk E-mail from us.

Name(optional):
Post/Zipcode:
Gender: Male Female
Age: 1-15 16-30 31-45 46-60 61+


Research Survey compiled and sponsored solely by

BODYSAFE PRODUCTS

Contact Details

Postage:
Bodysafe Products
1066 Dunolly Rd.
Victoria 3472
AUSTRALIA

Phone/Fax:
+061 03 5469 7202
(AUSTRALIA)

Email:
info@bodysafe.com.au



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