Control Group, Initial Call (screening plus questionnaire)

Form Approved

OMB No. 0920-XXXX

Exp. Date: _______

Control Group, Initial Call

Control Group, Initial Call Script

Hello, my name is YY and I am calling to invite your company to participate in a research study to help develop health and safety material for the wood pallet industry. We are the National Institute for Occupational Safety and Health or NIOSH, which is part of the Centers for Disease Control and Prevention. NIOSH is not OSHA. The Institute primarily conducts research, is not regulatory and cannot fine you--we are located in the Department of Health and Human Services and not the Department of Labor. We are in partnership with the National Wood Pallet and Container Association to develop educational materials to help improve safety and health in the pallet manufacturing businesses.

Screening Question:

Are you the person in charge of making safety and health changes at your business? ____yes _____ no

If yes, are you the:­­­­­­­­­­­ Owner

Safety and health manager

Other (what) ___________________________________

If no, then can you please tell me who that person is?

Name: ___________________________________­

Phone Number: _____________________________

Get in touch with that person and start again.

______________________________________________________________________________________

Public reporting burden of this collection of information is estimated to average 3-12 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: OMB# (0920-XXXX).

I would like to ask just a few questions now about occupational safety and health at your business. In about 5 months I will call you back to see what you think about occupational safety and health then. After that call, I will send you a free copy of our NIOSH educational/informational manual and 13 posters, which you can keep. Your participation is voluntary and your responses will be protected by the Federal Privacy Act; data will be treated in a secure manner unless otherwise compelled by law. There are no consequences to not participating in this study. Besides getting a free copy of NIOSH educational materials and helping us to develop a program to reduce injuries in the wood pallet industry, there are no benefits from participating in this study. We will only be asking questions about safety and health and not personal questions but a risk of your participation might involve the accidental disclosure of your responses to people who are not members of our research team. These risks will be minimized by the replacement of your name with a numeric code accessible only to NIOSH employees or its contractors.

Respondent agrees to participate, Yes/No, if no why? ______________

What is your name?­­­­­­­­­­­­­­­­­­­­____________Study Id#:__________________________________

I am required to tell you that this is an OMB approved data collection and the OMB number for this project is 0920-XXXX. NIOSH operates under authority of part 20(a)(1) of the Occupational Safety and Health Act (29.U.S.C. 669), which allows us to conduct research. Feel free to contact the project officer, Robert Malkin, at 513-533-8375 if you have any questions about the study.

I’ll ask you a few safety and health questions now. [If now is a bad time, but they want to participate, arrange a call back time that is good for them.]

1. How long have you been working in the pallet manufacturing or recycling industry? _________

2. Does your business:

a. make new pallets only

b. recycle pallets

c. both ____________________________

Ask only if they say they recycle pallets or both:

2a. What percent of your company’s time is spent recycling pallets __________%

2b.What else does your business do? _______________________________________

3. How many people work at your business in the pallet shop? _______

4. How many of your workers speak some language other than English as their main language? __________

4a.What other languages? __________

__________

__________

5. Do you pay your employees hourly or by the piece? ___­_­_

6. What business organizations are you a member of, such as the National Wood Pallet and Container Association or Chamber of Commerce? _______________________________________

________________________________________

7. On a scale of 1 to 4, please tell me how valuable it is to have a safety and health program with 1 being the least valuable and 4 being the most valuable.

8. Do you have a safety and health program at your business now that consists of a written program that discusses prevention and control of hazards, scheduled safety meetings with the employees, and contains safety and health instructions for employees?

Yes___ No ___

If yes, ask

8A. How often does the safety and health program meet?

Suggestions for interviewer

a. Daily quick talks __________# of minutes

b. Weekly toolbox talks __________# of minutes

c. Monthly meetings__________# of minutes

d. Once a year meetings

e. Other (please specify) _____________________________________

If no then ask:

8B. Do you have meetings for your employees just to discuss health and safety issues and not have a written Safety &Health program? ­­ Yes___ No_____

9. Who conducts the safety and health talks with the employees? _______________ (suggestions for interviewer)

a. Owner or manager of the company

b. Safety and health professional I hire

c. Senior worker

d. My insurer or workers’ compensation rep

e. Equipment or manufacturers’ rep

f. Other; Who_______________

10. Where do you get most of your safety and health information? ___________________

(suggestions for interviewers)

a. from tool and material suppliers

b. from insurance companies or workers’ compensation safety materials

c. I received it from friends or colleagues

d. I learned about it at conventions or workshops

e. I created it myself

f. other. Please describe _____________________________

11. What safety and health information do you give new employees? _______________ (Suggestions for interviewer)

a. nothing

b. I have someone show them how things work

c. a special program for new employees

Find out what it entails-is it run by the owner, another employee, contractor. Does it have a written curriculum?)

d. the same program as other employees-find out what that is

12. Has your company had any on the-job-injuries in the last year?

Yes___ No ___

If yes:

a. how many?

b. what was the nature of the injury?

13. Which of the following statements best describes your feelings today regarding starting a safety and health program?

a. I haven’t thought about it at all.

b. I am thinking about starting a new safety and health program in the next 6 months.

c. I am preparing to put a new safety and health program in place in the next 30 days.

d. I have already started a new safety and health program within the past 6 months.

e. My safety and health program is fine and I do not feel the need to change.

Interviewer-- if the respondent answered positively to either statements b, c or d then ask one of the following questions.

If yes to statement b, then ask:

What prompted you to think about a new safety and health program? __________________________________________________________

____________________________________________________________

If yes to statement c, then ask:

Why are you intending to put a new program in place? ____________________________________________________________ Please briefly describe what your new program may include. __________________________________________________________

If yes to statement d, then ask:

Briefly describe what you’ve started. ____________________________________________________________

What prompted you to make those changes? ___________________________________________________________

___________________________________________________________

14. What types of safety equipment are your employees required to use and where are they required to use them? ________________________________

Suggestions for interviewer

a. hearing protection devices (earplugs) when using nail guns

b. hearing protection devices when using saws or other noisy tools

c. safety lenses

15. Do you have a hearing conservation program at your business? ___________

If yes, ask if you:

monitor noise levels at your business? ___________

test the hearing of your employees? ___________­­­­__

16. Approximately what percent of the saws at your company are equipped with local exhaust ventilation? ___________%

For interviewer, local exhaust ventilation is an exhaust pipe located next to the saw blade to remove the sawdust.

17. Have you changed anything to control carbon monoxide emissions in the past year? __________

Suggestions for interviewer

a. bought an electric forklift

b. improved ventilation

c. limited the idling time of forklifts

d. installed catalytic converters

Finally, I’d like your opinion about these statements. Please say whether you

1 = disagree a lot
2 = disagree a little
3= agree a little

4= agree a lot

1.	A safety and health program will decrease injury in my business.
2	A safety and health program will cost too much money.
3.	A safety and health program will lower my workers’ compensation costs.
4.	Good safety practices will increase productivity at my business.
5.	The cost of production will decrease as a result of safety education.
6.	Safety and health education will make my employees more aware of properly using saws and forklifts.
7.	Safety and health knowledge will improve relations with my employees.
8.	Safety and health education will result in more workers’ compensation claims.
9.	Safety and health education will make employees more dissatisfied with their job.

Is there anything else that we haven’t asked that you might like to share with me?

Thank you for your time. NIOSH will contact you in about 5 months to ask you about your occupational safety and health program.