Memo 2

Appendix B

Form Approved

OMB #0920-0

Expiration Date: _________

OCCUPATIONAL SAFETY AND HEALTH INFORMATION NEEDS AND USES BY TRADE ASSOCIATIONS AND LABOR UNIONS WITHIN

EIGHT INDUSTRIAL SECTORS

Interviewer Name:

Computer Log Number:

Date:

Name of Association or Union:

Address:

Phone No.:

Fax No.:

Guidelines for Interviewers

A. First contact with Association or Union:

Hello, Is this ____________________________ (Name of association or union)? My name is ____________________________ (Name of Interviewer). I work for the Oak Ridge Institute for Science and Education (ORISE). We are working with the National Institute for Occupational Safety and Health or NIOSH (as it is commonly known) which is part of the Centers for Disease Control and Prevention. We are interested in obtaining information about the workplace (worker) safety and health resources you use in your association/union and/or disseminate to your members.

(1) Could I speak with ______________ (contact name from Association Unlimited Database)?

(1a) No ______________ ( Interviewer: If no one in this position go to (2))

(1b) Person no longer the contact ______________

(1c) New contact name ______________ (Interviewer: If available go to Section B)

(1d) If not available get date/time to call back __________

(Interviewer: Say thank you and I will call back at the suggested time and date)

(1e) Yes ____ (Interviewer: If person available go to Section B)

(1f) If person not available get the Name _________________________ and

(1g) get date/time to return call _______________________

(Interviewer: Say thank you and I will call back at the suggested time and date)

Public reporting burden of this collection of information is estimated to average 15 minutes per response. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Reports Clearance Officer; 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-XXXX).

(2) I am trying to reach the person who is responsible for handling the workplace (worker) safety and health issues for the members of your organization. Could I speak to the safety manager, or executive director?

(2a) No ______ (Interviewer: Go to (3))

(2b) Yes ________ (Interviewer: If person available go to Section B)

(2c) If person not available get the name _________________and

(2d) date/time to return call __________

(Interviewer: Say thank you and I will call back at the suggested time and date)

3. Is there anyone you could suggest I speak to who deals with the workplace (worker) safety and health issues of your members? (Suggest- the regulatory person, membership person, or marketing person or someone else)

(3a) No __________ (Interviewer: If the person still says there is no one to speak to thank person and say good-bye. Secretaries are not eligible to answer the survey.)

(3b) Yes __________ (Interviewer: If person available go to Section B)

(3c) If yes, but person not available get name ____________

(3d) date and time to call back __________

(Interviewer: Say thank you and I will call back at the suggested time and date)

B. When responsible person is reached:

Hello, _________ (Name of person to be interviewed), my name is ______________ (Name of interviewer). I work for the Oak Ridge Institute for Science and Education (ORISE). We are working with the National Institute for Occupational Safety and Health or NIOSH (as it is commonly known) which is part of the Centers for Disease Control and Prevention. I am calling today on behalf of NIOSH to learn about the workplace (worker) safety and health issues of your members. Also, I would like to know about the workplace (worker) safety and health resources you use or send to members of your association (union). Participation in the survey is voluntary and you are free to skip any questions or stop participating at any time. Would you have a few minutes to answer some questions for me or may I call back later?

(1) No ____ (Interviewer: Ask if you can call back, if refused ask questions in Blue Box in Appendix B1 below)

Non-Response Form

1. Before we say good-bye, may I ask you just two questions so that we can compare associations (unions) that do and do not take part in the survey?

1) No ____ (Interviewer: Thank person and say good-bye)

(2) Yes ____ (Interviewer: Go to question 2)

2. Does your association (union) distribute workplace (worker) safety and health information to your members?

(1) No ____ (Interviewer: Go to question 3) (2) Yes ____ (Interviewer: Go to question 3)

3. On a scale of 1-5, with 5 being very important and 1 being not at all important, how important are workplace (worker) safety and health issues to your association (union).

2 3 4 5

Thank you for taking the time to answer these questions. Have a great day.

(Interviewer: Thank person and say good-bye)

(2) Call back ____ (Interviewer: Get date, time and phone number) _______________________

Thank you. I will call you back at ________ (time and date)

(Interviewer: Say thank you and I will call back at the suggested time and date)

(3) Yes _______

Beginning of Survey Questions

General Information

Interviewer: First, I would like to thank you for taking your valuable time to participate in this NIOSH survey. To start our interview I’d like to ask you about your job at your association (union)?

4. What is your job title? ____________________________________________ (Interviewer: Go to question 5)

5. How many years have you worked in your current position? ____________

(Interviewer: Go to question 6a)

6a. Are workplace (worker) safety and health issues part of your job responsibilities?

(1) No ____ (Interviewer: Go to question 7)

(2) Yes ____ (Interviewer: Go to question 6b)

6b. In an average week, what percentage of your time is spent on workplace (worker) safety and health issues?

(1) < 10 % of the time ____

(2) 10% - 50% of the time ____

(3) >50% of the time ___

(Interviewer: Go to question 7)

Interviewer: Next let’s talk about your association (union).

7. How many members belong to your association (union)? _______________ (interviewer: Go to question 8)

8. On a scale of 1-5, with 5 being very important and 1 being not at all important, how important are workplace (worker) safety and health issues to your association (union)?

1 2 3 4 5

(Interviewer: Go to question 9)

9. In your opinion, what are the 3 most important workplace (worker) safety and health issues for your members?

(1) ______________________________________________________________________________

(2) ______________________________________________________________________________

(3) ______________________________________________________________________________

(Interviewer: Go to question 10a)

Communication

Interviewer: Now, I would like to ask about the communication materials your association (union) provides to its members.

10a. Does your association (union) have a website?

(1) No ____ (Interviewer: Go to question 11)

(2) Yes ____ (Interviewer: Go to part 2a below)

(2a) What is the address of your Website ___________________________________ (Interviewer: Go to question 10b)

(3) Don’t Know ____ (Interviewer: Go to question 11)

10b. Does your website include any workplace (worker) safety and health information?

(1) No ____ (Interviewer: Go to question 11)

(2) Yes ____ (Interviewer: Go to part 10c)

(3) Don’t Know ____ (Interviewer: Go to question 11)

10c. Does your website include any workplace (worker) safety and health information in languages other than English?

(1) No ____ (Interviewer: Go to question 11)

(2) Yes ____ (Interviewer: Go to part 2a below)

(2a) If yes, please specify language(s) ________________________

__________________________ ________________________ (Interviewer: Go to 11)

(3) Don’t Know ____ (Interviewer: Go to question 11)

Interviewer: For the next set of questions, I am going to ask if you distribute information to your members in the following ways and then I will ask how frequently workplace (worker) safety and health information is included in the communication.

11. Do you provide your members any of the following forms of communication?

1a. Email Notices: No ____ Don’t Know ____ Yes ____

1b. If yes, how often does your association (union) include workplace (worker) safety and health information?

Never ____ Sometimes ____ Often ____

2a Magazine: No ____ Don’t Know ____ Yes ____

2b. If yes, how often does your association (union) include workplace (worker) safety and health information?

Never ____ Sometimes ____ Often ____

3a Newsletter: No ____ Don’t Know ____ Yes ____

3b. If yes, how often does your association (union) include workplace (worker) safety and health information?

Never ____ Sometimes ____ Often ____

4a Technical Journal: No ____ Don’t Know ____ Yes ____

4b. If yes, how often does your association (union) include workplace (worker) safety and health information?

Never ____ Sometimes ____ Often ____

5a Other: No ____ Don’t Know ____ Yes ____

5b. If yes, please specify _________________________________

(Interviewer: If yes to part 2a, 3a, 4a, or 5a of question 11, go to question 12; otherwise go to question 13a)

12. Would you be willing to send us a recent copy of your technical journal, magazine or newsletter if we send you a self-addressed stamped envelope? (NIOSH will supply envelope.)

(1) No ____ (Interviewer: Go to question 13a)

(2) Yes ____ (Interviewer: Go to part 2a)

(2a) Address to send self-addressed stamped envelope

Name_______________________________

Street ______________________________

City ________________________________

State (Drop down) ____________________ Zip ___________

(Interviewer: Go to question 13a)

13a. Does your association (union) provide any workplace (worker) safety and health training courses?

(1) No ____ (Interviewer: Go to question 14a)

(2) Yes ____ (Interviewer: Go to question 13b)

(3) Don’t Know ____ (Interviewer: Go to question 14a)

13b. Are any of the workplace (worker) safety and health training courses provided in languages other than English?

(1) No ____ (Interviewer: Go to question 13c)

(2) Yes ____ (Interviewer: Go to part 2a)

(2a) If yes, please specify language(s) used for training courses ________________________ ___________________________

________________________ (Interviewer: Go to question 13c)

(3) Don’t Know ____ (Interviewer: Go to question 13c)

13c. Which workplace (worker) safety and health training courses does your association (union) provide?

Training Course

Yes No Don’t

Topic Know

(1) Electrical safety ____ ____ ____

(2) Emergency preparedness ____ ____ ____

(3) Equipment safety ____ ____ ____

(4) Ergonomics ____ ____ ____

(5) Exposure to hazardous substances ____ ____ ____

(6) Explosives ____ ____ ____

(7) Hearing loss/noise ____ ____ ____

(8) Job stress management ____ ____ ____

(9) Lifting safety ____ ____ ____

(10) Musculoskeletal disorders ____ ____ ____

(11) Occupational diseases

(Asthma, Latex allergy, etc) ____ ____ ____

(12) OSHA regulations ____ ____ ____

(13) Personal protective equipment ____ ____ ____

(14) Respirators ____ ____ ____

(15) Slips, trips and falls ____ ____ ____

(16) Health and safety programs ____ ____ ____

(17) Special worker populations’ ____ ____ ____

(18) Violence in the workplace ____ ____ ____

(19) Other, please specify below

____________________________ ____ ____ ____

(20) Other, please specify below

____________________________ ____ ____ ____

(Interviewer: Go to question 14a)

14a. Not including materials available through a formal training course, does your association (union) provide any other workplace (worker) safety and health information or training materials?

(1) No ____ (Interviewer: Go to question 15a)

(2) Yes ____ (Interviewer: Go to question 14b)

(3) Don’t Know ____ (Interviewer: Go to question 15a)

14b. Is any of this workplace (worker) safety and health information provided in languages other than English?

(1) No ____ (Interviewer: Go to question 14c)

(2) Yes ____ (Interviewer: Go to question 2a)

(2a) If yes, please specify language used for training materials _______________________ ________________________

_______________________ ________________________ (Go to question 14c)

(3) Don’t Know ____ (Interviewer: Go to question 14c)

14c. Are any of the following types of workplace (worker) safety and health materials offered to your members? (Interviewer: For each resource listed below record one answer from the three choices provided.)

Don’t

Resources No Yes Know

(1) Brochures ____ ____ ____

(2) Fact sheets ____ ____ ____

(3) Safety manuals ____ ____ ____

(4) Tool box talks ____ ____ ____

(5) Videos ____ ____ ____

(6) Other ____ ____ ____

(6a) If yes, please specify _______________________________________________

(Interviewer: Go to question 15a)

15a. Does your association (union) sponsor a conference(s)?

(1) No ____ (Interviewer: Go to question 16)

(2) Yes ____ (Interviewer: Go to question 15b)

(3) Don’t Know ____ (Interviewer: Go to question 16)

15b. Are workplace (worker) safety and health TRAINING COURSES provided at your conference(s)?

(1) No ____

(2) Yes ____

(3) Don’t Know ____

(Interviewer: Go to question 15c)

15c. Do the sessions at your conference(s) ever include any workplace (worker) safety and health presentations?

(1) No ____

(2) Yes ____

(3) Don’t Know ____

(Interviewer: Go to question 16)

16. When you have needed workplace (worker) safety and health information in the past, which of the following sources have you used? (Interviewer: For each source listed below record one answer from the three choices provided.)

Yes NO Don’t Source Know

(1a) Commercial publication ____ ____ _____

(1b) Please specify name_______________________

(2a) Government agency ____ ____ ____

(2b) Please specify name_______________________

(3a) Industrial hygiene association ____ ____ ____

(3b) Please specify name_______________________

(4a) Insurance or loss control company ____ ____ ____

(4b) Please specify name_______________________

(5a) (Another) Professional association ____ ____ ____ (Another: If association being interviewed is a professional association)

(5b) Please specify name _______________________

(6a) Public health agency ____ ____ ____

(6b) Please specify name_______________________

(7a) (Another) Business association ____ ____ ____

(Another: If a business association is being interviewed)

(7b) Please specify name ________________________

(8a) (Another) Labor Union ____ ____ ____

(Another: If a union is being interviewed)

(8b) Please specify name________________________

(9a) University or other academic institution ____ ____ ____

(9b) Please specify name________________________

(10a) Other sources that we have not mentioned? ____ ____ ____

(10b) Please specify name________________________

(Interviewer: Go to question 17)

17. Does your association (union) have any unmet needs in the area of workplace (worker) safety and health?

(1) No ____ (Interviewer: Go to question 18a)

(2) Yes ____ (Interviewer: Go to part 2a)

(2a) What are the unmet needs? ___________________________________________ __________________________­­­­­­­­____­_______________________ ____________ (Interviewer: Go to question 18a)

(3) Don’t Know ____ (Interviewer: Go to question 18)

Knowledge of the National Institute for Occupational Safety and Health (NIOSH)

Interviewer: In this last section, I’d like to ask you a few questions about the National Institute for Occupational Safety and Health or NIOSH.

18. Prior to this survey had you ever heard of the National Institute for Occupational Safety and Health or NIOSH as it is also known?

(1) No ____ (Interviewer: Go to question 25a)

(2) Yes ____ (Interviewer: Go to question 19)

19. I am going to read you a list of statements about NIOSH. Please tell me if you agree or disagree with the following statements.

Agree Disagree Don’t

Know

19a. NIOSH is an institute that makes regulations ______ ______ ______

19b. NIOSH is an institute that makes recommendations _____ ______ _______

19c. NIOSH is part of the Occupational Safety and

Health Administration (OSHA) ______ ______ _______

19d. NIOSH is a research institute ______ ______ _______

(Interviewer: Go to question 20)

20. Please tell me how much you agree or disagree with the following statements? (Interviewer: For each statement listed below record one answer from the five choices provided.)

Strongly Neither Agree Strongly

Statements Agree Agree nor Disagree Disagree Disagree

20a. NIOSH is a credible source

for obtaining workplace safety

and health information. ______ ______ _______ _______ _______

20b. NIOSH is an important

resource for the workplace

safety and health community. ______ ______ _______ ______ _______

(Interviewer: Go to question 21a

21a Have you ever used the NIOSH Website? (www.cdc.gov/niosh)

(1) No ____ (Interviewer: Go to question 21a)

(2) Yes ____ (Interview: Go to question 20b)

(3) Don’t Know ____ (Interviewer: Go to question 21a)

21b. Please indicate how strongly you agree or disagree with each of the following statements about the NIOSH Website? (Interviewer: For each statement listed below record one answer from the five choices provided.)

Strongly Neither Agree Strongly

Statements Agree Agree nor Disagree Disagree Disagree

The NIOSH Website has (is):

(1) easy to read information _____ _____ ______ ______ _____

(2) high-quality information _____ _____ ______ ______ _____

(3) out-of-date information _____ _____ ______ ______ _____

(4) difficult to navigate _____ _____ ______ ______ _____

(5) a good OS&H resource _____ _____ ______ ______ _____

(Interviewer: Go to question 22a)

22a. Have you ever used or referred to a NIOSH publication?

(1) No ____ (Interviewer: Go to Question 23)

(2) Yes _____ (Interviewer: Go to question 22b)

(3) Don’t Know ____ (Interviewer: Go to question 23)

22b. Please indicate how strongly you agree or disagree with each of the following statements about NIOSH publications. (Interviewer: For each statement listed below record one answer from the five choices provided.)

Statements Strongly Neither Agree Strongly

Agree Agree nor Disagree Disagree Disagree

NIOSH publications:

(1) are clearly written ______ ______ _______ ______ ______

(2) are too technical ______ ______ _______ ______ ______

(3) are readily available ______ ______ _______ ______ ______

(4) are impartial ______ ______ _______ ______ ______

(5) provide impractical

recommendations ______ ______ _______ _______ ______

(Interviewer: Go to question 23)

23. Have you ever called the NIOSH 800 Number? (1-800-356-4674)

(1) No ____

(2) Yes ____

(3) Don’t Know ____

(Interviewer: Go to question 24)

24. Have you ever used a NIOSH multimedia product (CD-ROM, DVD, Video, etc.)?

(1) No ____ (Interviewer: Go to question 25a)

(2) Yes ____ (Interviewer: Go to part 2a below)

(2a) Please specify which multimedia product(s) you have used:

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

(Interviewer: Go to question 25a)

(3) Don’t Know ____ (Interviewer: Go to question 25a)

25a. Would your association (union) be interested in receiving a NIOSH article about workplace (worker) safety and health that you could distribute to your members?

(1) No ____ (Interviewer: Go to question 26a)

(2) Yes ____ (Interviewer: Go to question 25b)

(3) Don’t Know ____ (Interviewer: Go to question 26a)

25b. Would your association (union) like to receive the article as a paper copy or in an electronic format or both?

1. Print ____ (Interviewer: If participant provided address in question 12, do not ask again.)

Address: ____________________________

____________________________

____________________________

(2) Electronic ____

Email address ___________________________

(3) Both ___

(Interviewer: Go to question 25c)

25c. How would your organization distribute this article to your members?

(Interviewer: For each of the communication forms listed below record one answer from the three choices provided.)

Communication Forms No Yes Don’t

Know

(1) Conference ____ _____ ____

(2) Email ____ _____ ____

(3) Magazine ____ _____ ____

(4) Newsletter ____ _____ ____

(5) Technical journal ____ _____ ____

(6) Website ____ _____ ____

(7) Other ­­­____ _____ ____

(7a) Please specify _______________________________________________

(Interviewer: Go to question 26a)

26a. Would your association (union) be interested in having NIOSH contact your organization in the future about partnering on a workplace (worker) safety and health issue? (Interviewer: If asked “what do I have to do” answer “the level of involvement is your own choice”.

(1) No ____ (Interviewer: Go to question 27)

(2) Yes ____ (Interviewer: Go to question 26b)

(3) Don’t Know ____ (Interviewer: Go to question 27)

26b. If you are interested in partnering with NIOSH, is there a specific workplace safety and health issue of interest to your association? (This may be different from the answers provided in question 10.) ____________________________________________________________________

____________________________________________________________________

____________________________________________________________________

____________________________________________________________________

(Interviewer: Go to question 27)

27. Is there anything that we have not discussed about workplace (worker) safety and health relevant to your association (union) that you would like to mention?

____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

(Interviewer: Go to Close and Thank You Section)

Close and Thank You Section:

Interviewer: We would like to thank you for participating in this survey. We very much appreciate the time you have given us. The information you have provided is very important to the successful outcome of this study.

If you have any questions about this survey please contact:

Andrea Okun, Dr. P.H.

Deputy Director

Education and Information Division

Telephone: (513) 533-8302

E-Mail [email protected]

.