CRUISING HEALTH QUESTIONAIRE (III)

Instructions:

1. This cruising health questionnaire is anonymous and confidential (your personal information will not be identified or shared), and should be filled in by the person with the illnes or injury.

2. The survey should be for any past cruise, the present cruise or portion of that cruise. Day or weekend cruises should be included as well as more prolonged cruises.

3. The survey is organized by illness or injury, and one should choose the approriate illness or injury entity in the respective category.

4. There are check boxes or a list of choices in each category, please select the box(es) or response(s) that are relevant to you.

5. If you have had multiple injuries or illnesses on any cruises, complete a separate survey for each injury or illness. To record each different illness or injury requires submittion of a new survey for each incidence.

6. There can be multiple treatments for each injury or illness: more than one treatment is common for a given illness or injury.

7. The questionnaire should be filled out any time there is a new illness or injury since a prior survey response.

8. The questionnaire may be filled out multiple times, but do not repeat entries of any prior reporting occurrences unless they have returned (recurred.)

9. After completing this survey, if a new illness or injury occurs on this cruise or another cruise, a new form should be filled in at the time of the subsequent occurrence.

10. The data will be kept anonymously (de-identified) at the Medical University of South Carolina in Charleston and become a database for preparing publications for healthier future cruises. No individual will know who did or did not participate in the survey. Results of the survey will be released after four years of surveying.