Survey JAN Employer Interview

EMPLOYER OMB Control no. 1225-0059

Changes marked in Red below

Section II. Outreach

1. How did you know to contact the Job Accommodation Network?

(ALL THAT APPLY); [Interviewers FIELD CODE into the following categories]

a. Used JAN service before

b. Previous user of JAN service (specify if another employer)

c. JAN Website

d. Other website (not JAN website)

e. Internet search

f. Referral from:

Organization (list) ________________________

Government Agency (list) __________________

Company

DOL Call Center

EARN

JAN self employment service

g. Friend/co-worker/word of mouth

h. Personal contact with JAN staff member

i. Rehabilitation professional

j. Medical professional

k. Educational institution

l. Union

m. Legal professional

n. Newspaper/magazine/book/professional journal article

o. Television (report or advertisement)

p. Listed in a directory

q. I&R Service

r. Conference

s. JAN Publication or Brochure

t. JAN presentation

u. Used JAN self-employment service before

v. Previous user of JAN self-employment service

w. JAN self-employment Website

x. JAN self-employment Publication or Brochure

y. Other (please specify): _____________________________________________________

Section III. ACCOMMODATION OUTCOME

"The following questions explore the outcomes of your consultation with JAN."

Ask only if Purpose of Call = WORK ACCOMMODATION

Else Go To Section IV

W1. Was the accommodation you discussed with the JAN consultant about

a. a job applicant [application, interview]

b. hiring a new employee [already have job offer, maybe just started or hasn't yet started]

c. retaining an employee [retention of a current employee]

d. promoting a current employee

f. other (explain: _________________________________________________)

f DK

g. RF

DATA ENTRY ONLY (INTERVIEWER: CIRCLE IF APPLICABLE)

e. involving more than one employee

W3. How many years has the employee been with your company? ____ . _

W4. What is the wage (by hour or annually) for this employee’s job

a. by hour _______ and

how many hours does this employee work on average per week _________

OR

b. Annually_______________

IF DK, THEN, Does this job usually pay

a. less than $10,000 per year

b. $10,000 - $20,000

c. $20,001 - $50,000

d. $50,001 - $100,000

e. More than $100,000

f. DK

g. RF

[If queried, interviewer may say "Because JAN is a service funded by the federal government, it is important for JAN to establish that they reach a wide range of individuals."]

W5. What is the employee's highest level of education?

a. Did not complete high school

b. High school certificate (not high school diploma)

c. High school diploma or GED (code this if participant says "graduated from high school")

d. Associates degree (2 year degree)

e. Graduated from college (4 year degree)

f. Degree from graduate/professional school (e.g., MA, MBA, PhD, MD, JD)

g. DK

h. RF

W6. What is the employee's gender?

[Interviewers ask even if it seems evident]

[If queried, interviewer may say "Because JAN is a service funded by the federal government, it is important for JAN to establish that they reach a wide range of individuals.]

a. Male

b. Female

c. DK

d. RF

W7. What is the employee's race or ethnicity? (CHOOSE ALL THAT APPLY?)

Race

a. American Indian or Alaska Native

b. Asian

c. Black or African American

d. Native Hawaiian or Other Pacific Islander

e. White

f. Other

Ethnicity

g. Hispanic or Latino

h. Not Hispanic or Latino

i. DK

j. RF

W8. What is the employee's age?

a. less than 18

b. 18 - 25

c. 26 - 35

d. 36 - 45

e. 46 - 55

f. 56 - 65

g. 66 and over

h. DK

i. RF

9. a. Approximately how many employees are in the company? ____________

If DK, then ask: How many employees are in your facility? ______________

OR in your division? _____________

b. Of these _____ employees, how many are individuals that your company considers to have a disability? _____ % OR ___________ number

10a. Who makes the decision whether the company will provide an accommodation? (mark all that apply)

1. Human Resources or Personnel department

b. Legal department

c. Managers

d. Employee's supervisor

e. Other: _______________________________________

10. After your interaction with JAN, was an accommodation made? (Choose one of a-h)

a. Yes or No?

2. Implementation Pending (DECISION TO ACCOMMODATE MADE, BUT IMPLEMENTATION PENDING (EXPLAIN/Why?) __________

c. Decision pending (explain/Why?) _____________________________________________

d. No (Please explain why an accommodation was not made.) [Interviewer to query for reason for rejecting the accommodation.] ____________________________

e. other (e.g., employee resigned) _______________________________________________ Please tell me briefly about that. _____________________________________

f. DK

g. RF

h. N/A

DATA ENTRY ONLY – IF ACCOMMODATION WAS NOT IMPLEMENTED, WHAT WAS THE REASON? (INTERVIEWER: CIRCLE REASON)

1. Implementation pending (if 10 = b)

2. Decision pending (if 10 = c)

3. Determined not required by ADA/other law (rejected)

4. Determined not possible to accommodate (rejected)

5. Determined not needed by employee (other)

6. Accommodation implemented before contacting JAN (other)

7. Accommodation rejected before contacting JAN (other)

8. Other reason (for rejection or other)

11. Did this accommodation solution that (was made, is pending implementation, the decision is pending on, was rejected) include: [Repeat as necessary as preface to each item in table.]

	Yes		No	Rejected	Pending	DK	RF	Other
	Made	Waiting
Buying a product or piece of equipment (like software, or a tool)? What specific products or pieces of equipment?	Has that accommodation been made?	Are you still waiting on implementation?
Modifying a product or piece of equipment (like software, or a tool) Please describe how the product or equipment was or will be modified?
Modifying the worksite (like a ramp, lighting or mirrors) Please describe the modifications to the worksite
Changes to a work schedule (such as flex time, shift change, part time) Please describe the changes to the work schedule [Light duty = work schedule change if same job, reassignment of changed job title]
Moving the employee to another job (or reassignment) What type of work was the employee doing before reassignment and what type does or is he going to do after reassignment.
	Yes		No	Rejected	Pending	DK	RF	Other
	Made	Waiting
Changes in workplace policy What workplace policies were modified?
Formal or Company Education of co-workers Please describe how the company was/is going to educate co-workers
h. Providing an interpreter, reader, job coach or personal attendant services? Which services were provided
i. Providing information in an alternative format (e.g., large print, taped text, Braille, etc.) What alternative formats were provided?
j. Working from home or telework What arrangements were made (# of hours in # hours/wk)
k. Are there accommodation solutions that we have not talked about? IF YES, Please specify
DATA ENTRY ONLY (INTERVIEWER: RECORD IF APPLICABLE) l. Moved the employee to another location

[IF ANY PARTS OF Q11 = MADE, then Continue, ELSE SKIP TO Question 14]

12. On a scale of 1 – 5, how effective was the accommodation, with 1 being (not effective at all) and 5 being (extremely effective)?

1 2 3 4 5 8 = DK 9 = RF

not effective at all extremely effective

13. Please describe why the accommodation was or was not effective?

[IF ANY PARTS Q11 = MADE OR PENDING IMPLEMENTATION, CONTINUE;

ELSE SKIP to Section IV]

14. Approximately how much did the accommodation cost (or is expected to cost)?

[For Each Cost Designate Whether Actual or Predicted Cost]

a. one-time cost _$____________OR

b. annually _$_____________

DK = 888,888 RF = 999,999

[IF Q14 = 0, THEN SKIP TO Q18]

15. Who helped (or will help) pay for the accommodation? (All the Apply)

a. Employer

b. Employee

c. Rehabilitation Services

d. Insurance Company

e. Other

If "Employer", ask:

15a. What was the source of funding for this accommodation?

a. Departmental funds

b. Human Resources funds

c. Company general funds

e. Other: ___________________________________________

DATA ENTRY ONLY (INTERVIEWER: CIRCLE IF APPLICABLE)

d. Specific accommodation-related funds

15b. Who has the authority to authorize expenditure for accommodations?

a. Local managers/supervisors

b. Human Resources representatives

c. Corporate/General Management

e. Other: ___________________________________________

[IF ONLY ONE ANSWER, SKIP TO QUESTION 17]

16. How much did (or will) each pay? (PERCENT OR $ AMOUNT)

a. Employer

b. Employee

c. Rehabilitation Services

d. Insurance Company

e. Other

17. How much of the $_(insert amount from question 14)__ cost was beyond what you would have paid for an employee in the same position who did not have a disability? "For example, an employer might purchase a computer monitor for all of his employees, but an employee may need a large screen rather than a regular monitor as an accommodation. The cost difference between the large screen monitor and the regular monitor would be the amount that we are asking about."

$_____________ [must be $ amount and not a percentage.]

DK = 888,888

RF = 999,999

DK 888,888, RF 999,999

18. What benefits did your company derive from providing this accommodation or do you expect to derive?

19. I will read a list of direct benefits that your company may have received from providing this accommodation. Please answer yes or no to the following:

Removed question about whether each of below was derived or just expected.

a. The accommodation allowed the company to hire a qualified employee Yes No DK RF

b. The accommodation allowed company to retain a qualified employee Yes No DK RF

c. The accommodation allowed company to promote a qualified employee Yes No DK RF

d. The accommodation eliminated the cost of training a new employee Yes No DK RF

e. The accommodation saved workers’ compensation or other insurance costs Yes No DK RF

f. The accommodation increased the accommodated worker's productivity Yes No DK RF

g The accommodation increased the accommodated worker's attendance Yes No DK RF

h. Increased diversity of the company Yes No DK RF

h. Other ______________________________________________________

20. Removed

21. Were there any or do you expect any indirect costs for the accommodation (Indirect costs are those not directly related to providing the accommodation such as lost time because of training, supervisor's time, loss of production, etc.)?

1. YES

2. NO [SKIP TO 22.]

8. DK [SKIP TO 22.]

9. RF [SKIP TO 22.]

22. I will read a list of indirect benefits that your company may have received from providing this accommodation. Please answer yes or now to the following:

Removed question about whether each of below was derived or just expected.

a. The accommodation increased overall company productivity Yes No DK RF

b. The accommodation increased overall company attendance Yes No DK RF

c. The accommodation increased overall company morale Yes No DK RF

d. The accommodation increased workplace safety Yes No DK RF

e. The accommodation increased customer base Yes No DK RF

f. The accommodation increased profitability Yes No DK RF

g. The accommodation improved interactions with co-workers Yes No DK RF

h. The accommodation improved interactions with customers Yes No DK RF

i. Other indirect benefits? _________________________________________________________

23. Removed

Section IV. Legislative Outcomes

ASK ONLY IF LEGISLATIVE INFORMATION WAS PROVIDED

Purpose of Call Code = WORK, EDUCATION OR PUBLIC LEGISLATION;

ELSE GO To Section V.

Legislation Information:

The next few questions ask about how you used the information about ADA or other laws that you received from JAN.

1. Did the information help you to understand the ADA or another law?

a. YES

2. NO

3. DK

4. RF

Word change in question 2. (last word in sentence - decision changed to change)

2. Was the information used to argue for or make a policy change?

Explanation of policy decision removed.

a. YES

2. NO (SKIP TO Next Section)

3. DK (SKIP TO Next Section)

4. RF (SKIP TO Next Section)

3. What was the outcome of that policy decision?

a. the policy was changed

b. the policy was not changed

c. the decision about whether to change the policy is still pending

d. other. (Explain) _____________________________________

i. DK

j. RF

DATA ENTRY ONLY (INTERVIEWER: CIRCLE ONE)

1 – Policy changed (if 3 = a)

2 – Policy not changed (if 3 = b)

3 – Decision still pending (if 3 = c)

4 – Confirm/validate/interpret existing policy (other)

5 – Accommodation decision made (other) –

6 – Other (anything else identified in “other”)

Section V. JAN Web site

A. User Satisfaction - Ease of Use

1. Have you visited the JAN website within the last year? [If queried, "JAN website is at: http://www.jan.wvu.edu/]

1. YES [GO TO Q2]

2. NO

3. DK

4. RF

1. Have you ever visited the JAN website?

1. YES

2. NO [SKIP TO SECTION VI]

3. DK [SKIP TO SECTION VI]

4. RF [SKIP TO SECTION VI]

2. On a scale of 1 to 5 with 1 being difficult and 5 being easy, how was the website to navigate?

1 2 3 4 5 8 = DK 9 = RF

(difficult) (easy)

[If response = "1", query "So, the website was difficult for you to navigate?"]

3. On the same scale, how was it for you to obtain the information that you needed from the website?

1 2 3 4 5 8 = DK 9 = RF

(difficult) (easy)

[If response = "1", query "So, it was difficult for you to get the information that you needed from the website?"]

4. What did you hope to find on the Website? ________________________________________

5. Did you find it? Yes ____ No _____

IF NO, Please tell me more about that.___________________________________

Section VI. General User Satisfaction

The last few questions are more general. Please tell me...

1. On a scale from 1 to 5, with 1 being difficult to use and 5 as easy, how easy or difficult was it to contact JAN?

1 2 3 4 5 8. DK 9. RF

(difficult) (easy)

[If response = "1", query "So, it was difficult for you to contact JAN?"]

2. On a scale of 1 to 5 with 1 being “not courteously” and 5 being “courteously,” how were you treated by the receptionist at JAN?

1 2 3 4 5 8 = DK 9 = RF

(not courteously) (courteously)

[If response = "1", query " "So, the JAN receptionist was not courteous?"]

Spontaneous Comments: ____________________________________________________________

3. On that same scale, how were you treated by the consultant at JAN?

1 2 3 4 5 8 = DK 9 = RF

(not courteously) (courteously)

[If response = "1", query "So, the JAN consultant was not courteous?"]

Spontaneous Comments: ____________________________________________________________

4. On a scale from 1to 5, with 1 being "not understand" and 5 being "understood" , how well did the consultant understand your needs?

1 2 3 4 5 8 = DK 9 = RF

(not understand) (understood)

[If response = "1", query "So, the consultant did not understand your needs?"]

Spontaneous Comments: ____________________________________________________________

5. On a scale from 1 to 5, with 1 being “did not meet my needs at all” and 5 being “met my needs exceptionally well”, how well did the information that you received meet your needs?

1 2 3 4 5 8. DK 9. RF

(not at all) (exceptionally well)

[If response = "1", query "So, the information you received did not meet your needs at all?]

6. How could the services you received have better met your needs?

7. Where would you get the type of information that JAN provides if JAN did not exist?

8. Would you use the service again, if you needed information?

a. Yes b. No 8 = DK 9 = RF

9. Have you referred other people to JAN?

a. Yes

b. No

10. On a scale from 1 to 5, with 1 being "very unlikely to refer" and 5 being "very likely to refer", how likely would you be to refer other people to JAN?

1 2 3 4 5 8. DK 9. RF

Very unlikely Very likely

11. We would appreciate any comments or suggestions that you may have about JAN.

Thank you for your participation.

Employer 13