National Survey of the Mining Population Questionnaire

F orm Approved

OMB NO. xxxx-xxxx

Exp. Date mm/dd/yyyy

NIOSH Draft 10 (8/9/2006)

National Survey of the Mining Population

Questionnaire

Centers for Disease Control and Prevention

National Institute for Occupational Safety and Health

P ittsburgh Research Laboratory

P.O. Box 18070

Pittsburgh, Pennsylvania 15236

Public reporting burden of this collection of information is estimated to average 120 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. 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 E-11, Atlanta, Georgia 30333; ATTN: PRA (0920-xxxx).

QUESTIONNAIRE OVERVIEW

This questionnaire contains five parts:

Mine Questions	Pages 1-13
Employee Selection Instructions	Page 14
Employee Questions Instructions	Pages 15-16
Employee Questions	Pages 17-18
Final Questions and Comments	Pages 19-20

Items of Special Importance:

1. All responses you give should be for the specific Mine ID shown on the label above. Some items in the questionnaire are for a specific one-week period which we call the REPORTING WEEK, also shown on the label above.

2. You have the option of completing either this survey questionnaire booklet or an Internet web-based survey questionnaire. The contents of both versions of the survey questionnaire are the same. Instructions to access the web-based questionnaire (www.miningsurvey.org) are attached to the cover letter included in the survey mailing.

3. If you have a question regarding your REPORTING WEEK, how to access the web-based questionnaire, or if you need assistance in completing any of the items, please call 1-888-814-4707. This is the toll-free number for Westat, the survey contractor.

4. Use the Comments section (Item F8 on Page 20) to explain any responses or situations unique to your mine.

MINE QUESTIONS

TRAINING

The first series of questions asks about miner training. This includes both annual miner refresher training and new miner training.

1. In the past 12 months, did this mining operation use its employees to conduct:

		Yes	No
a.	annual miner refresher training?		
b.	training for newly hired inexperienced miners?		
c.	training for newly hired experienced miners?		

2. In the past 12 months, did this mining operation use an outside trainer to conduct annual miner refresher training?

 Yes  Go to Question M3

 No  Go to Question M4

(next page)

3. [IF YES TO Question M2]: What type of outside trainer did you use? [Please check ALL that apply.]

• Contract trainer

• State grantee

• Other (Please specify):

_____________________________

_____________________________

4. In the past 12 months, did this mining operation use an outside trainer to conduct training for newly hired inexperienced miners?

 Yes  Go to Question M5

 No  Go to Question M6

5. [IF YES TO Question M4]: What type of outside trainer did you use? [Please check ALL that apply.]

• Contract trainer

• State grantee

• Other (Please specify):

_____________________________

_____________________________

6. In the past 12 months, did this mining operation use an outside trainer to conduct training for newly hired experienced miners?

 Yes  Go to Question M7

 No  Go to Question M8

M7. [IF YES TO Question M6]: What type of outside trainer did you use? [Please check ALL that apply.]

• Contract trainer

• State grantee

• Other (Please specify):

_____________________________

_____________________________

M8. How frequently are periodic safety meetings (e.g., “toolbox talks”), for employees engaged in mining operations, conducted at this mine? [Please check one.]

• Less than once a year

• Annually

• Less than once a month

• Once a month

• Once every 2 weeks

• Once a week

• Several times a week

• Daily

M9. When conducting employee safety training and retraining, which of the following training materials and methods are used as part of your training program? [Please check ALL that apply.]

• Lectures

• Written materials

• Videos

• Self-guided interactive computer programs

• Demonstrations

• Hands-on training exercises

• Group exercises (role playing, games, problem solving, etc.)

• Classroom simulations (e.g., virtual reality)

• Worksite simulations

• Narrative story telling

• Other (Please specify):

_______________________________

_______________________________

The next series of questions asks about the use of languages other than English.

M10. Approximately what percentage of employees currently working at the mine use a language other than English to communicate?

_________________%

M11. Does this mining operation currently provide training materials, signs, or other written materials in a language other than English?

 Yes  Go to Question M12

 No  Go to Question M14

12. [IF YES TO Question M11]: What language(s) is/are provided? [Please check ALL that apply.]

• Spanish

• Other (Please specify):

_______________________________

_______________________________

12. Would it be helpful to have training materials, signs, or written materials in any other languages, in addition to those already provided by your mining operation?

 Yes  Go to Question M15

 No  Go to Work Schedules

Section (next page)

12. Would it be helpful to have training materials, signs, or other written materials in language(s) other than English?

 Yes  Go to Question M15

 No  Go to Work Schedules

Section (next page)

12. [IF YES TO Question M13 or M14]: Which languages? [Please check ALL that apply.]

• Spanish

• Other (Please specify):

_____________________________

_____________________________

The next series of questions asks about how the mine schedules work for the following types of mine operator employees:

• Production Workers are ‘face workers’ and others who work extracting coal/ore/stone.

• Production Support Workers are those who aid and maintain production (e.g., by cleaning or moving belts, maintaining ventilation, delivering supplies, repairing equipment, etc. Office workers are also counted here).

• Preparation Plant/Mill Workers are those who operate or perform support activities in a preparation plant or mill.

We suggest, for this section and the next, that you first respond to all questions in Column A for Production Workers, and then go back to complete them in Column B for Production Support Workers, followed by the Column C items for Preparation Plant/Mill Workers, if applicable to this mine.

WORK SCHEDULES		A. Production Workers	B. Production Support Workers	C. Preparation Plant/ Mill Workers
M16.a. On average, how many days per week are these workers scheduled to work?		|__| Scheduled days per week	|__| Scheduled days per week	 CHECK if this mine does not have any Preparation Plant/Mill Workers and leave this column blank. If Box Is NOT CHECKED, continue with this column. |__| Scheduled days per week
	b. On average, how many hours per day are these workers scheduled to work?	|__|__| Scheduled hours per day	|__|__| Scheduled hours per day	|__|__| Scheduled hours per day

WORK SCHEDULES		A. Production Workers	B. Production Support Workers	C. Preparation Plant/ Mill Workers
M16.c. During the REPORTING WEEK (see Page 1 label), what was the average number of hours per week these workers actually worked (including overtime)?		|__|__| Actual work hours during REPORTING WEEK	|__|__| Actual work hours during REPORTING WEEK	 CHECK if this mine does not have any Preparation Plant/Mill Workers and leave this column blank. If Box Is NOT CHECKED, continue with this column. |__|__| Actual work hours during REPORTING WEEK
	d. Do work crews generally change shifts at the active mining site (e.g., the face or long wall - also known as a ‘hot seat” change)?	 Yes  No	 Yes  No	QUESTIONS M16.d & e. NOT APPLICABLE FOR PREPARATION PLANT MILL WORKERS GO TO SHIFT WORK SECTION (Next Page)
	e. On average, how much time per shift do workers spend traveling to and from the active mining site on-shift (while being paid)?	|__| |__|__| Hours Minutes round trip, per shift GO TO COLUMN B	|__| |__|__| Hours Minutes round trip, per shift GO TO COLUMN C

For the next series of questions, assume that the:

• Day shift begins in the morning hours (e.g., 6 a.m., 7 a.m., or 8 a.m.)

• Afternoon shift begins in the afternoon hours (e.g., 2 p.m. or 3 p.m.)

• Night or Midnight shift begins in the late evening hours (e.g., 11 p.m. or 12 a.m.)

SHIFT WORK	A. Production Workers	B. Production Support Workers	C. Preparation Plant/ Mill Workers
M17. Typically how many shifts per day does the mine operate for these workers?	|__| Shifts per day	|__| Shifts per day	 CHECK if this mine does not have any Preparation Plant/Mill Workers and leave this column blank. If Box is NOT CHECKED continue with this column. |__| Shifts per day
M18. Do they work rotating shifts?	 Yes GO TO QUESTION M19  No  GO TO QUESTION M21 (Next Page)	 Yes GO TO QUESTION M19  No  GO TO QUESTION M21 (Next Page)	 Yes GO TO QUESTION M19  No  GO TO QUESTION M21 (Next Page)
M19. [IF YES TO QUESTION M18]: How frequently do these workers change their assigned shift?	 Weekly  Twice a Month  Monthly  Other (specify): _________________ _________________	 Weekly  Twice a Month  Monthly  Other (specify): _________________ _________________	 Weekly  Twice a Month  Monthly  Other (specify): _________________ _________________
M20. Do they rotate shifts clockwise or counterclockwise? Note that Clockwise is day→afternoon→night Counterclockwise is night→afternoon→day	 Clockwise  Counterclockwise  Other (specify): _________________ _________________	 Clockwise  Counterclockwise  Other (specify): _________________ _________________	 Clockwise  Counterclockwise  Other (specify): _________________ _________________
SHIFT WORK	A. Production Workers	B. Production Support Workers	C. Preparation Plant/Mill Workers
M21. Are there any regularly scheduled unique work shifts that do not fit into the previous descriptions (e.g., a shift of three 12-hour days on Friday, Saturday, and Sunday, known as an “alternative work schedule” or “Weekend Warrior” shift)?	 Yes GO TO QUESTION M22  No  GO TO COLUMN B	 Yes GO TO QUESTION M22  No  GO TO COLUMN C	 CHECK if this mine does not have any Preparation Plant/Mill Workers and leave this column blank. If Box is NOT CHECKED continue with this column.  Yes GO TO QUESTION M22  No  GO TO NEXT PAGE
M22. [IF YES TO QUESTION M21]: Please either: a. describe this shift. If you need additional space, use the ‘comments’ section (Item F7) on Page 20; or: b . send us an example of your mine’s shift schedule(s) and check the appropriate box(es).	_________________ _________________ _________________ _________________ _________________ _________________ _________________ _________________ _________________ _________________  Schedule enclosed	__________________ __________________ __________________ __________________ __________________ __________________ __________________ __________________ __________________ __________________  Schedule enclosed	___________________ ___________________ ___________________ ___________________ ___________________ ___________________ ___________________ ___________________ ___________________ ___________________  Schedule enclosed

The next series of questions asks about the mine’s use of independent contractor employees for various activities. Take special note of these two definitions:

• Independent contractor means “any person, partnership, corporation, firm, association, subsidiary of a corporation, or other organization that contracts to perform services or construction of a mine.”

• REPORTING WEEK is the specific 7-day period shown on the label on Page 1. The number of independent contractors you report should be for that week only.

M23. In the REPORTING WEEK, did this mining operation use independent contractor employees to do . . .	M24. How many independent contractor employees did you use for this activity during the REPORTING WEEK?	M25. How many total hours did independent contractor employees work in this activity during the REPORTING WEEK?
a. Mine development, including shaft and slope sinking, or “driving a decline”?  Yes  No	a. ________________ # of Contractor employees	a. _________________ Contractor hours
b. Construction or reconstruction of mine facilities, including building or rebuilding preparation plants and mining equipment, maintenance, and building additions to existing facilities?  Yes  No	b. ________________ # of Contractor employees	b. _________________ Contractor hours

M23. In the REPORTING WEEK, did this mining operation use independent contractor employees to do . . .	M24. How many independent contractor employees did you use for this activity during the REPORTING WEEK?	M25. How many total hours did independent contractor employees work in this activity during the REPORTING WEEK?
c. Demolition of mine facilities?  Yes  No	c. ________________ # of Contractor employees	c. _________________ Contractor hours
d. Construction of dams?  Yes  No	d. ________________ # of Contractor employees	d. _________________ Contractor hours
e. Excavation or earthmoving activities involving mobile equipment?  Yes  No	e. ________________ # of Contractor employees	e. _________________ Contractor hours
f. Equipment installation, such as crushers and mills?  Yes  No	f. ________________ # of Contractor employees	f. _________________ Contractor hours

M23. In the REPORTING WEEK, did this mining operation use independent contractor employees to do . . .	M24. How many independent contractor employees did you use for this activity during the REPORTING WEEK?	M25. How many total hours did independent contractor employees work in this activity during the REPORTING WEEK?
g. Equipment service or repair of equipment on mine property for a period exceeding 5 consecutive days at a particular mine?  Yes  No	g. ________________ # of Contractor employees	g. _________________ Contractor hours
h. Material handling such as hauling of coal, ore, or refuse within mine property? (Only include material handling conducted primarily on mine property.)  Yes  No	h. ________________ # of Contractor employees	h. _________________ Contractor hours
i. Drilling and blasting?  Yes  No	i. ________________ # of Contractor employees	i. _________________ Contractor hours

M23. In the REPORTING WEEK, did this mining operation use independent contractor employees to do. . .	M24. How many independent contractor employees did you use for this activity during the REPORTING WEEK?	M25. How many total hours did independent contractor employees work in this activity during the REPORTING WEEK?
j. Production support work (belt moves, building stoppings, installing roof support, moving a longwall, relocating a large piece of mining equipment (including dismantling and reassembly), surveying, engineering work, etc.)?  Yes  No	j. ________________ # of Contractor employees	j. _________________ Contractor hours
k. Mineral extraction?  Yes  No	k. ________________ # of Contractor employees	k. _________________ Contractor hours
l. Any other types of work?  Yes  No  GO TO NEXT PAGE	l. ________________ # of Contractor employees	l. _________________ Contractor hours
Please describe this activity: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________

M26. Which of the following types of communication devices and systems does this mine currently use? [Please check ALL that apply.]

• Dedicated telephones

• Mine page phones

• Trolley phones

• Shaft or hoist phones

• Cell phones

• Voice Over Internet Protocol (VOIP) phones

• Handheld two-way radios

• Wireless paging devices

• Leaky feeder communications system (not running a PED)

• Personal emergency device (PED) cap lamp/pager

• Through-the-Earth (TTE) technology (other than a PED,

e.g., Flexalert or TeleMag)

• Inductive coupled radios

• Ethernet

• TRACKER Tagging System

• Longwall face communication systems

• None of the above

• Other (Please specify):

_______________________________

_______________________________

M27. Which of the following personal locators, trackers, or other devices does this mine currently use to make miners more visible and to support escape in limited visibility situations? [Please check ALL that apply.]

• Electronic or computerized tagging or tracking systems/devices

• Tag boards (check-in/check-out)

• Reflective vests/clothing

• Chemical light sticks

• Lighted vests

• Laser lights/pointers

• Strobe lights

• None of the above

• Other (Please specify):

_______________________________

_______________________________

M28. Which of the following methods does this mine use for emergency incident early warning systems for miners? [Please check ALL that apply.]

• Stench gas

• Audible systems

• Visual systems (lights)

• Pager phones

• Telephones

• Messengers

• Electronic personal communication

systems (e.g., PED)

• None of the above

• Other (Please specify):

_______________________________

_______________________________

M29. Does this mine have its own mine rescue team?

 Yes  [IF YES] How many individual members are assigned to the mine’s rescue team?

_____________________

TOTAL

 No  [IF NO] Go to NOTE box in next column

M30. How frequently is team training conducted for the members of the mine rescue team? [Please check one.]

• Less than once a year

• Annually

• Less than once a month

• Once a month

• Once every 2 weeks

• Once a week

• Some other time interval (Please specify):

_______________________________

_______________________________

NOTE – The next two questions (M31 and M32) apply only to underground mines. Surface mine respondents should skip to the next section (Employee Selection Instructions).

M31. Which of the following types of emergency equipment or emergency supplies does this mine currently rely on for miner safety? [Please check ALL that apply.]

• Belt-worn self-contained-self- rescuers (SCSRs)

• Cached self-contained-self- rescuers (SCSRs)

• Filter self-rescuers (FSRs) (e.g., W65)

• Stationary emergency refuge chambers

• Mobile emergency refuge chambers

• Sealing materials

• Cached water/food supplies

• First aid kits

• Defibrillator

• None of the above

• Other (Please specify):

_______________________________

_______________________________

M32. Which of the following types of escapeway aids does this mine use? [Please check ALL that apply.]

• Lifelines

• Directional lifelines

• Signage

• Colored reflectors

• Lighting

• Strobe lights

• None of the above

• Other (Please specify):

________________________________

___________________________________

EMPLOYEE SELECTION INSTRUCTIONS

The Employee Questions ask you to report the demographic characteristics of a sample of your employees. This page contains instructions for selecting the sample of employees to include in the Employee Questions. (Please DO NOT include independent contractor employees in this part of the questionnaire, and DO NOT include any mine employee who was not at work during the REPORTING WEEK.)

Step 1. Print or copy a list from your files of the names and job titles of all mine employees who worked during the REPORTING WEEK (see label above) for the mining operation associated with the Mine ID (see label above). (Hourly and salaried employees can be combined, or listed separately, on the REPORTING WEEK list.)

Step 2. Sequentially number the salaried and hourly employees on your list, starting with the first name on the top of the list, e.g., 1, 2, 3, … This number will be the employee sequence number. [NOTE: The sequential numbering may be done by computer.]

Step 3. Record the total number of employees who worked during the REPORTING WEEK.

_______ = TOTAL NUMBER WHO WORKED DURING REPORTING WEEK

If this total number is. . .

... equal to 0, [not applicable] Go to Page 19.

... fewer than 30, [all are to be included] Please circle every one of the numbers you have recorded in Step 2, and Go to next page.

... 30 or more, [select a sample] Continue with Step 4

Step 4. Quarterly reports indicate that this mine employs the Estimated Number of Employees shown in the label above. Does the number of employees recorded in Step 3 fall within the range of Estimated Number of Employees shown in the label above?

 Yes  Continue with Step 5.

 No  If estimated number (based on MSHA records) is incorrect, please call

1-888-814-4707 for assistance. This is the toll-free number for Westat, the survey contractor.

Step 5. In these next steps, you will circle the employee sequence numbers for employees to be selected for the survey. To do this, you will use the Start With Number and Take Every Number printed on the label above.

Step 6. First, circle the employee sequence number that matches the Start With Number on the label above. This is the first employee selected for the survey.

Step 7. Next, start counting the employee sequence numbers, beginning with the sequence number after the one just circled. Count until you reach the Take Every Number listed on the label above. Circle that employee sequence number. This is the next selection.

Step 8. Repeat Step 7 until you come to the end of your employee list.

EXAMPLE: If total employees = 49, Start With Number = 2, and Take Every Number = 3, then you would circle the following employee sequence numbers: 2, 5, 8, 11, 14, 17, 20, 23, 26, 29, 32, 35, 38, 41, 44, 47.

Step 9. Refer to the detailed instructions on the next page and record the sequence numbers you have circled in the first column of the Employee Questions.

This section provides you with an item-by-item explanation for the Employee Questions. Please read these instructions carefully before completing the fold-out answer form on Page 17, or Employee Question screens on web version.

E1. Employee sequence number

This is the circled number from your employee roster list.

• If there are fewer than 30 employees who worked during the REPORTING WEEK at your mine, all employees are included in the survey. Write each circled number on a separate line and provide the information corresponding to that employee.

• If there are 30 or more employees who worked during the REPORTING WEEK at your mine, according to Steps 5-9 of the selection instructions, you have circled and recorded the sequence numbers of the employees being sampled. For example, if John Doe is fifth on your list, and he is selected to be included in the employee survey, then write “5” as the employee sequence number, and provide the information corresponding to that employee.

E2. Employee’s regular job title

Regular job title means the title that specifies the employee’s current position in the mine structure (e.g., manager). This information may be in an employee’s personnel file or in the payroll system.

E3. Months or years of experience in this job

Experience in this job title means the number of months or years that this employee has had his or her current job title. Report months only for those employees with less than 1 year of experience.

• Months (MM) Column: If the employee has been in the current job title less than a year at this mine, please record the number of months in the month’s column. Round partial months up if one- half or more.

• Years (YY) Column: If the employee has been in the current job title 1 year or more, please record number of years in the year’s column. Round partial years up if one-half or more.

E4. Months or years of experience in this mine

Experience in this mine means the number of months or years that this employee has been working at this mine, from the time that the mine hired him or her. Report months only for those employees with less than 1 year of experience.

• Months (MM) Column: If the employee has worked for the mine less than a year, please record the number of months in the month’s column. Round partial months up if one-half or more.

• Years (YY) Column: If the employee has worked for the mine 1 year or more, please record number of years in the year’s column. Round partial years up if one-half or more.

E5. Months or years of total mining experience

Total mining experience means the number of months or years that an employee has been employed in the mining industry overall. Please include years spent at other mining companies and at other ranks or job titles. Report months only for those employees with less than 1 year of experience.

• Months (MM) Column: If the employee has worked in the mining industry less than a year, please record the number of months in the month’s column. Round partial months up if one-half or more.

• Years (YY) Column: If the employee has worked in the mining industry 1 year or more, please record number of years in the year’s column. Round partial years up if one-half or more.

E6. Number of hours worked during the REPORTING WEEK

Number of hours worked means the number of hours for which the employee was paid conducting mining business during the REPORTING WEEK. The REPORTING WEEK is indicated on the label at the top of Page 1 or Page 14.

• Do not include vacation time, sick time, medical leave, or other time spent on non-work activities.

This information may be found in the employee’s time reporting records.

E7. Employee’s primary work location

Primary work location means the location where this employee worked the most hours in the REPORTING WEEK.

• Check ONLY one location.

Location categories (listed on the answer form/screen) are adapted from MSHA's Quarterly Mine Employment and Coal Production Report (MSHA Form 7000-2) with the exception that the following operational subunits have been combined into one work location: Auger, Culm Bank or Refuse Pile. This information may be found in the same employee work records that are used as source data to compile the MSHA quarterly report.

E8. Gender

Please specify by checking if the employee is male (M) or female (F). This information may be found in the employee’s personnel file.

E9. Hispanic or Latino

Please specify ethnicity by checking whether or not the employee is Hispanic or Latino. Note that an additional question on the employee’s race follows in the next question.

This information may be found in the employee’s personnel file.

E10. Race

Please specify the employee’s race by checking one or more categories.

E11. Year of birth

Please record the employee’s year (YY) of birth. Use two digits for year (e.g., 1980 is “80”).

This information may be found in the employee’s personnel file.

E12. Highest level of education completed

Please check one category for highest level of education completed. This means the last grade that the employee completed.

This information is most likely included in the employee’s personnel file.

Employee Questions

E1.

E2.

E3.

E4.

E5.

E6.

E7.

E8.

E9.

E10.

E11.

E12.

Employee Sequence Number (from employee roster list)

Months OR Years of Experience

EMPLOYEE'S PRIMARY WORK LOCATION Where He/She Worked the Most Hours in the REPORTING WEEK (Check ONLY One)

Gender

Hispanic or Latino

Race (Check One or More)

Year of Birth

Highest Level of Education Completed (Check ONLY One)

In this Job Title

In this Mine

Total Mining

Employee's Regular Job Title

IF LESS THAN A YEAR, Enter Number of Months

IF ONE YEAR OR MORE, Enter Number of Years

IF LESS THAN A YEAR, Enter Number of Months

IF ONE YEAR OR MORE, Enter Number of Years

IF LESS THAN A YEAR, Enter Number of Months

IF ONE YEAR OR MORE, Enter Number of Years

Number of Hours Worked during the REPORTING WEEK

Underground Mine: Underground

Underground Mine: Surface Shops, Yards, etc.

Surface Mine (including associated shops and yards): Strip, Open Pit, or Quarry

Surface Mine (including associated shops and yards): Auger, Culm Bank or Refuse Pile (Coal Mine Only)

Surface Mine (including associated shops and yards): Dredge

Surface Mine (including associated shops and yards): Other Surface Mining (Metal/ Nonmetal only)

Independent Shops or Yards

Mill Operations, Preparation Plants, or Breakers (include associated shops and yards)

Office (professional and clerical employees at the mine or plant working in an office)

M

F

Yes

No

American Indian or Alaska Native

Asian

Black or African American

Native Hawaiian or Other Pacific Islander

White

19YY

Less than 9th grade

9th-12th grade (no diploma)

HS Graduate or Equivalent (GED)

Some College, Associate Degree, or Technical School

Bachelor's Degree or beyond

MM

YY

MM

YY

MM

YY

MM

YY

MM

YY

MM

YY

MM

YY

MM

YY

MM

YY

MM

YY

MM

YY

MM

YY

MM

YY

MM

YY

MM

YY

MM

YY

MM

YY

MM

YY

MM

YY

MM

YY

MM

YY

MM

YY

MM

YY

MM

YY

MM

YY

MM

YY

MM

YY

MM

YY

MM

YY

MM

YY

MM

YY

MM

YY

MM

YY

MM

YY

MM

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MM

YY

MM

YY

MM

YY

MM

YY

MM

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MM

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MM

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MM

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MM

YY

Employee Questions (continued)

E1.

E2.

E3.

E4.

E5.

E6.

E7.

E8.

E9.

E10.

E11.

E12.

Employee Sequence Number (from employee roster list)

Months OR Years of Experience

EMPLOYEE'S PRIMARY WORK LOCATION Where He/She Worked the Most Hours in the REPORTING WEEK (Check ONLY One)

Gender

Hispanic or Latino

Race (Check One or More)

Year of Birth

Highest Level of Education Completed (Check ONLY One)

In this Job Title

In this Mine

Total Mining

Employee's Regular Job Title

IF LESS THAN A YEAR, Enter Number of Months

IF ONE YEAR OR MORE, Enter Number of Years

IF LESS THAN A YEAR, Enter Number of Months

IF ONE YEAR OR MORE, Enter Number of Years

IF LESS THAN A YEAR, Enter Number of Months

IF ONE YEAR OR MORE, Enter Number of Years

Number of Hours Worked during the REPORTING WEEK

Underground Mine: Underground

Underground Mine: Surface Shops, Yards, etc.

Surface Mine (including associated shops and yards): Strip, Open Pit, or Quarry

Surface Mine (including associated shops and yards): Auger, Culm Bank or Refuse Pile (Coal Mine Only)

Surface Mine (including associated shops and yards): Dredge

Surface Mine (including associated shops and yards): Other Surface Mining (Metal/ Nonmetal only)

Independent Shops or Yards

Mill Operations, Preparation Plants, or Breakers (include associated shops and yards)

Office (professional and clerical employees at the mine or plant working in an office)

M

F

Yes

No

American Indian or Alaska Native

Asian

Black or African American

Native Hawaiian or Other Pacific Islander

White

19YY

Less than 9th grade

9th-12th grade (no diploma)

HS Graduate or Equivalent (GED)

Some College, Associate Degree, or Technical School

Bachelor's Degree or beyond

MM

YY

MM

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FINAL QUESTIONS AND COMMENTS

1. In the REPORTING WEEK, were there any events or circumstances that would make what you have reported unusual (e.g., severe weather conditions, trouble in production, a labor strike, etc.)?

 Yes  Go to Question F2

 No  Go to Question F3

2. [IF YES TO Question F1]: Please specify the unusual events:

3. What is today’s date? |__|__| |__|__| |__|__|__|__|

M M D D Y Y Y Y

4. Please make a copy of this completed questionnaire and your list of sampled employees (keep these on file for 60 days) in case we need to contact you for clarification.

5. Please provide the company representative to be contacted regarding the completion of the questionnaire:

Name: ________________________________________

Title: ________________________________________

Telephone: ( ) ______________________

6. Reminder: If you so indicated in question M22, please enclose an example of your mine schedule with your completed questionnaire.

7. Please mail this completed questionnaire in the provided business reply envelope to the survey contractor: Westat, Room TC-2074F, 1650 Research Boulevard, Rockville, MD 20850-3195.

Please record any comments on the next page.

F8. Do you have any comments, or is there any other information you can provide that may help us understand the answers you provided? (Please include question numbers for comments or explanations related to specific responses.)

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Thank you for your participation in this survey!

Delivering on the Nation's promise:

Safety and health at work for all people

through research and prevention

If you have any questions regarding the

National Survey of the Mining Population, please contact:

Linda J. McWilliams, Project Director

Surveillance and Statistics Team

CDC, NIOSH, Pittsburgh Research Laboratory

P.O. Box 18070, Bldg. 01

626 Cochrans Mill Road

Pittsburgh, PA 15236

Telephone:	(412) 386-6116
Fax:	(412) 386-6678
E-mail:	[email protected]
http://www.cdc.gov/niosh/mining/statistics/survey.htm