Appendix G - Information Letter

<Month> <Day>, <Year>

Dear Resident:

I am writing to ask for your help with a short survey about fire safety. This survey is being done in cooperation with the smoke alarm installation program being carried out by the <local_fd_name> fire department. The survey consists of questions about your use of smoke alarms (and other fire safety equipment), characteristics of your home, and your opinions and beliefs regarding fire safety.

This survey is part of an important study regarding fire safety being conducted on behalf of the Centers for Disease Control and Prevention (CDC). RTI International, a non-profit research organization, is working with a number of other organizations to conduct this study. Research partners include the Injury Prevention Research Program at the University of North Carolina (UNC) at Chapel Hill, the North Carolina Jaycee Burn Center, and the Injury Prevention Division of the North Carolina Department of Health and Human Services (DHHS).

Please be assured that both RTI International and all other research partners will follow procedures to protect your privacy.  The answers from all survey participants will be combined to produce reports for the CDC; no information about individual households will be reported at any time.

The survey will take about 15 minutes and is completely voluntary. You have the right to refuse to answer any and all of the questions in it. Choosing not to participate in this survey will not affect your eligibility to receive a smoke alarm today. We would also like to contact you again in about 6 months to conduct a short follow-up interview by telephone. At that time, we will ask you similar questions as well as your experience with the smoke alarms that will be installed today. This interview is expected to last about 15 minutes. To compensate you for your time and to thank you for participating, upon completion of the survey, you will receive a ten dollar gift.

If you have any questions about the study, please call the data collection manager (Mr. David Roe) toll-free at 1-800-334-8571, ext 3598.  If you have any questions about your rights as a study participant, please call RTI’s Office of Research Protection toll-free at 1-866-214-2043.

We would greatly appreciate your help with this important study. 

Sincerely,

<signature>

Jon Poehlman, Ph.D.

Director, Smoke Alarm Installation and Safety Education (SAIFE) Evaluation Project