Form 092-20BY AttachmentK_LSH_RespondentScreeningForm

Respondent Screening Form

1) Are you 18 years of age or older?

• Yes

• No

2) Are you currently a L/SH truck driver?

• Yes

• No

3) Are you employed Full-Time as a L/SH truck driver?

• Yes

• No

4) Please state the company in which you are employed Full-Time as a L/SH truck driver

Company name:______________________

5) For how long have you been employed Full-Time as a L/SH truck driver? (inclusion = at least 6 months)

Tenure as employed FT L/SH truck driver:______________________