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Screener Survey (OSHA)

OMB Number: 1225-0093 
Exp. Date: 2/29/2024

Burden Statement
All responses to this survey are voluntary. The OMB Control Number for this survey is No. 1225-0093 (expires 02/29/2024), with an estimated burden time of 15 minutes. Please send comments about this survey to Madeline Martinez at Martinez.Madeline.M@dol.gov”


Please complete this screener survey for participants in OSHA’s Focus Group on the Experience of Special Government Employees (SGEs) in the Voluntary Protection Programs

1. Name:
2. Email:
3.Please select type of employee (select all that apply)
4.How many years have you been in safety/health (please enter a number between 0-50):
5.Please select type of specialization (select all that apply) 
6.Please select type of employer:
7.Please select all the VPP activities that you’re responsible for at your worksite:
8.What qualifying activities outside of your VPP worksite have you participated on in the past 3 years (please select all that apply):
9.How many SGE activities have you participated on in the past 3 years (please enter a number between 0 and 20):
10.Are you interested in participating in a virtual SGE Focus Group Interview to describe your experience as an SGE? Saying yes now is not a commitment on your part. You are free to change your mind on participation.
Current Progress,
0 of 10 answered