Appendix F_090910

APPENDIX F

PRE-INTERVIEW LETTER FOR POTENTIAL SUBJECTS

style=" top: 1.38in; left: 3.75in" U.S. CONSUMER PRODUCT SAFETY COMMISSION

WASHINGTON, DC 20207

October 27, 2008

«Title». «FirstName» «LastName»

«Address1»

«Address2»

«City», «State» «PostalCode» Re: «Taskno»

Dear «Title». «LastName»:

As part of an ongoing research program, all work-related injuries and illnesses seen in the Emergency Department at «HospName» are reported to the Consumer Product Safety Commission (CPSC). These data are collected without the patient’s name, address, or phone number and are used solely for statistical purposes.

At this time, the CPSC in cooperation with the Centers for Disease Control and Prevention (CDC) and the National Highway Traffic Safety Administration (NHTSA), is doing an in-depth research study of injuries and illnesses to people who perform emergency medical services. The goal is to collect information about injuries and illnesses to people who perform emergency medical services. This information will help us to understand how to prevent these injuries and illnesses. CPSC records show that on «Treatment date» you were treated in the Emergency Department at «HospName» for an injury or illness sustained while working. We would like to follow-up with you for more information regarding your injury or illness. All follow-up is being done by telephone. You may receive a telephone call asking questions about the circumstances of the injury or illness, the injury or illness outcome, and other related issues. If you agree to participate in this telephone survey, it should take about 20 minutes to answer the questions.

Your participation would be greatly appreciated because your answers will represent other workers who have suffered a similar injury. However, your participation is voluntary and you may end your participation in this study at any time without penalty or loss of benefits to which you are otherwise entitled. There is no compensation or direct benefit to you for participating in this study.

Your name and phone number will be kept only by the CPSC for no more than 60 days. This information will then be destroyed. These personal identifiers will not be stored on the dataset given to the CDC and the NHTSA.

Your answers to the questions in this study will be kept private to the extent allowed by law. Your name will not be available to the CDC and NHTSA researchers. Other facts that might point to you indirectly will not be shown in any report or published paper. The information you give us will be a part of the CDC Privacy Act System. It may be released to private contractors assisting CDC with this study or collaborating researchers who plan to conduct further research.

This study is voluntary. You may decline to answer specific questions or withdraw from the study at any time.

The only known risk to taking part in this study is the loss of privacy that may lead to mental grief. Injury or harm from this project is unlikely, but if it results, medical care is not provided. If you are injured through the negligence of a CPSC contracted telephone interviewer, you would file a claim against the contractor. If an injury or harm should occur to you as the result of your participation in the study, you should contact Audrey Reichard, CDC project officer at the National Institute for Occupational Safety and Health (NIOSH), at (304)285-6019. You may also contact Cheryl Estill, Chair CDC/NIOSH Human Subjects Research Board, at (513)533-8591.

Data collected for this study are done so under the authority described in the Occupational Safety and Health Act of 1970. If you have questions about this research, contact Audrey Reichard, CDC/NIOSH project officer, at (304)285-6019. If you have questions about your rights as a member of this study, contact Cheryl Estill, Chair CDC/NIOSH Human Subjects Research Board, at (513)533-8591.

If you would prefer that you not be contacted by CPSC for this study, please leave a message at (800) 638-8095, extension 1462, within 10 days of receipt of this letter. Be sure to leave your name and the reference number found at the top of this letter.

Thank you for your time.

Respectfully,

Tom Schroeder

Statistician

Division of Hazard and Injury Data Systems