Name: | Country: | ||
---|---|---|---|
Please describe your practical massage experience. | |||
Name of Organaization | Duration | Your Role | Type of Massage |
(month / year) from / to / |
□ masseur □ instructor |
□ relaxation □ therapeutic
□ others( ) |
|
(month / year) from / to / |
□ masseur □ instructor |
□ relaxation □ therapeutic
□ others( ) |
|
Your present Organization | |||
Name of organization: | |||
Total number of staff members: | ( ) persons, | ||
including ( ) persons with visually impaired | |||
Are you visually impaired? | □Yes □No | ||
If your answer is “Yes”, please answer the following questions. | |||
1) Please describe your eye condition. a) □ totally blind low vision (eye sight : right eye ( ) left eye ( )
b) The cause of your visual impairment : ( ) |
|||
2) Usually you use; □printed materials □Braille materials | |||
3) For reading; | □You can read normal printed materials with your naked eye. | ||
□You can read normal printed materials with magnifying glass/lens. | |||
□You can read large print letters. | |||
□You can not read printed letters. | |||
4) Choose how you see in your daily life; | □You can ride a bicycle. | ||
□You can walk around an unfamiliar place without a white cane. | |||
□You need a white cane to walk. | |||
□You can walk alone in daylight, but need a white cane at night time. |
QUESTINNAIRE
