Home
About
Our Team
Mission and Vision
Programs
Day at the Beach
Wounded Warrior
Adaptive Surfing Clinic
Adaptive Swim Clinic
Canoe Day
Fitness Videos
Talk Story Tuesday Videos
Media
Sponsors
Testimonials
2022 Annual Report
Get Involved
Donate
Online Training Manual
Participant
Volunteer
Events
Upcoming Events
Events Calendar
2023 Hawai’i Adaptive Surfing Championships
2022 HASC Competition Photos
2022 AASP World Title Results
News
Contact
Map
Donate
Shop
Home
About
Our Team
Mission and Vision
Programs
Day at the Beach
Wounded Warrior
Adaptive Surfing Clinic
Adaptive Swim Clinic
Canoe Day
Fitness Videos
Talk Story Tuesday Videos
Media
Sponsors
Testimonials
2022 Annual Report
Get Involved
Donate
Online Training Manual
Participant
Volunteer
Events
Upcoming Events
Events Calendar
2023 Hawai’i Adaptive Surfing Championships
2022 HASC Competition Photos
2022 AASP World Title Results
News
Contact
Map
Donate
Shop
Observation Questionnaire Swimming
Observation Questionnaire Swimming
Volunteer Name(s):
*
AccesSurfer Name:
*
Date of Most Recent Activity: (Referred to as: "Today" in fields below)
*
How long has the AccesSurfer been swimming with AccesSurf? month/year (if known)
How many times have you worked with the AccesSurfer? (estimate)
What type of equipment did the AccesSurfer use to swim? (Select all that apply)
Kick Board
Swim Fins
Leg Straps
Personal Flotation Device (Life Jacket)
None
Other
Other
1. Where did you and the AccesSurfer swim?
When they first joined AccesSurf:
White Plains Beach AccesSurf Day at the Beach
Other
Other
Today:
White Plains Beach AccesSurf Day at the Beach
Other
Other
2. How was the access to the water?
When they first joined AccesSurf:
Beginner
Intermediate
Advanced
Today:
Beginner
Intermediate
Advanced
3. How were the environmental conditions? (Water, wind, current, waves, crowds):
When they first joined AccesSurf:
Beginner
Intermediate
Advanced
Today:
Beginner
Intermediate
Advanced
4. What is the swimming style of the AccesSurfer?
When they first joined AccesSurf:
Floating with a Flotation Device
Floating without a Flotation Device
Doggy Paddle
Freestyle
Breast Stroke
Side Stroke
Butterfly Stroke
Back Stroke
Other
Other
Today:
Floating with a Flotation Device
Floating without a Flotation Device
Doggy Paddle
Freestyle
Breast Stroke
Side Stroke
Butterfly Stroke
Back Stroke
Other
Other
5. How much assistance in the water did the AccesSurfer need?
When they first joined AccesSurf:
Independent (swimming on their own with minimal assistance in the water)
Assisted (swimming on their own with instructor close by for assistance)
Dependent (swimming tandem with an instructor)
Today:
Independent (swimming on their own with minimal assistance in the water)
Assisted (swimming on their own with instructor close by for assistance)
Dependent (swimming tandem with an instructor)
6. How does the AccesSurfer access the water?
When they first joined AccesSurf:
Walking unassisted
Walking assisted
Crawling
Beach Wheel-Chair
Pool Chair Lift
Carried (fireman's, princess, backpack, etc.)
Other
Other
Today:
Walking unassisted
Walking assisted
Crawling
Beach Wheel-Chair
Pool Chair Lift
Carried (fireman's, princess, backpack, etc.)
Other
Other
Skill Level
Absolute Beginner
Advanced Beginner
Intermediate
Advanced Intermediate
Advanced
1
2
3
4
5
7. Technique:
When they first joined AccesSurf:
1
2
3
4
5
Today:
1
2
3
4
5
8. Strength:
When they first joined AccesSurf:
1
2
3
4
5
Today:
1
2
3
4
5
9. Speed:
When they first joined AccesSurf:
1
2
3
4
5
Today:
1
2
3
4
5
Comfort Level Scale
Very Uncomfortable
Uncomfortable
Neutral (OK, Alright)
Comfortable
Very Comfortable
1
2
3
4
5
10. How comfortable is the AccesSurfer talking to new people at AccesSurf?
When they first joined AccesSurf:
1
2
3
4
5
Today:
1
2
3
4
5
11. How comfortable is the AccesSurfer entering the water?
When they first joined AccesSurf:
1
2
3
4
5
Today:
1
2
3
4
5
12. How comfortable is the AccesSurfer in the water?
When they first joined AccesSurf:
1
2
3
4
5
Today:
1
2
3
4
5
13. How comfortable is the AccesSurfer when their face is submerged underwater?
When they first joined AccesSurf:
1
2
3
4
5
Today:
1
2
3
4
5
Level of Communication and Dependency
Totally Dependent
Max Assist
Min Assist
Verbal Assist
Self Direct
Totally Independent
1
2
3
4
5
6
14. How does the AccesSurfer prepare for swimming? (sun protection, hydration, equipment, meds, swim cap, googles, leg straps, fins, etc.)
When they first joined AccesSurf:
1
2
3
4
5
6
Today:
1
2
3
4
5
6
15. How does the AccesSurfer choose where to enter and swim in the water?
When they first joined AccesSurf:
1
2
3
4
5
6
Today:
1
2
3
4
5
6
16. How does the AccesSurfer swim in their desired style or stroke?
When they first joined AccesSurf:
1
2
3
4
5
6
Today:
1
2
3
4
5
6
17. How does the AccesSurfer move in the water? (smoothness, glide, etc.)
When they first joined AccesSurf:
1
2
3
4
5
6
Today:
1
2
3
4
5
6
18. How does the AccesSurfer coordinate and time their swimming and breathing?
When they first joined AccesSurf:
1
2
3
4
5
6
Today:
1
2
3
4
5
6
19. How does the AccesSurfer manage underwater situations?
When they first joined AccesSurf:
1
2
3
4
5
6
Today:
1
2
3
4
5
6
20. How does the AccesSurfer direct needs and wants to swim? (e.g. selection of waves, white water, lost equipment, etc.)
When they first joined AccesSurf:
1
2
3
4
5
6
Today:
1
2
3
4
5
6
Intensity Level
Low
Medium
High
1
2
3
21. What level of intensity was the swimming session?
When they first joined AccesSurf:
1
2
3
Today:
1
2
3
22. How long can the AccesSurfer endure a swimming session at the intensity stated in question #21?
When they first joined AccesSurf:
less than 20 minutes
20 minutes
30 minutes
40 minutes
50 minutes
1 hour
Today:
less than 20 minutes
20 minutes
30 minutes
40 minutes
50 minutes
1 hour
Community Integration Scale
Always Disagree
Sometimes Disagree
Neutral
Sometimes Agree
Always Agree
1
2
3
4
5
23. The AccesSurfer knows a number of people in AccesSurf to initiate a greeting and a receive a greeting in return.
When they first joined AccesSurf:
1
2
3
4
5
Today:
1
2
3
4
5
24. The AccesSurfer has developed a support system at AccesSurf events.
When they first joined AccesSurf:
1
2
3
4
5
Today:
1
2
3
4
5
25. The AccesSurfer is able to access new locations in the community.
When they first joined AccesSurf:
1
2
3
4
5
Today:
1
2
3
4
5
26. Does the AccesSurfer participate in water activities outside of AccesSurf events and how often?
When they first joined AccesSurf:
None
Only AccesSurf Events
Once a month
Twice a month
Once a week
More than once a week
Today:
None
Only AccesSurf Events
Once a month
Twice a month
Once a week
More than once a week
Do you recall any other changes/improvements you've observed since working with this AccesSurfer?
Comments:
Thank you very much!
If you are human, leave this field blank.
Submit
