example survey form page 1 (facsimile only – do not...
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![Page 1: Example Survey Form Page 1 (Facsimile Only – Do Not Use)dmna.ny.gov/r3sp/risk_reduction/URI_Example_Survey.pdf43. By your own standards, do you consider yourself to have been physically](https://reader034.vdocuments.site/reader034/viewer/2022050602/5fa96176c756a0349476fcc1/html5/thumbnails/1.jpg)
Example Survey Form Page 1 (Facsimile Only – Do Not Use)
Page A-1
![Page 2: Example Survey Form Page 1 (Facsimile Only – Do Not Use)dmna.ny.gov/r3sp/risk_reduction/URI_Example_Survey.pdf43. By your own standards, do you consider yourself to have been physically](https://reader034.vdocuments.site/reader034/viewer/2022050602/5fa96176c756a0349476fcc1/html5/thumbnails/2.jpg)
Example Survey Form Page 2 (Facsimile Only – Do Not Use)
Page A-2
![Page 3: Example Survey Form Page 1 (Facsimile Only – Do Not Use)dmna.ny.gov/r3sp/risk_reduction/URI_Example_Survey.pdf43. By your own standards, do you consider yourself to have been physically](https://reader034.vdocuments.site/reader034/viewer/2022050602/5fa96176c756a0349476fcc1/html5/thumbnails/3.jpg)
Example Survey Form Page 3 (Facsimile Only – Do Not Use)
Page A-3
![Page 4: Example Survey Form Page 1 (Facsimile Only – Do Not Use)dmna.ny.gov/r3sp/risk_reduction/URI_Example_Survey.pdf43. By your own standards, do you consider yourself to have been physically](https://reader034.vdocuments.site/reader034/viewer/2022050602/5fa96176c756a0349476fcc1/html5/thumbnails/4.jpg)
Example Survey Form Page 4 (Facsimile Only – Do Not Use)
Page A-4