Healthcare Workers Primary Hazard Module

Survey of Healthcare Workers' Health and Safety Practices

Documents and Forms

Document Name Document Type
Form 6 Healthcare Workers Primary Hazard Module Form and Instruction
3 Healthcare Workers Primary Hazard Module Attachment I2_Module A_FINAL_08042010.docx Form and Instruction
5 Antineoplastic Agents (Administer) Attachment I4_Module C_FINAL_8042010.docx Form and Instruction
4 Antineoplastic Agents (Compound) Attachment I3_Module B_FINAL_08042010.docx Form and Instruction
6 Chemical Sterilants Attachment I5_Module D_TC_72310.docx Form and Instruction
7 High Level Disinfectants Attachment I6_Module E_TC.docx Form and Instruction
8 Surgical Smoke Attachment I7_Module F_TC_72310.docx Form and Instruction
9 Anesthetic Gases Attachment I8_Module G_TC_72310.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Healthcare Workers Primary Hazard Module	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	6	Chemical Sterilants	Attachment I5_Module D_TC_72310.docx	Yes	Yes	Fillable Fileable
Form and Instruction	3	Healthcare Workers Primary Hazard Module	Attachment I2_Module A_FINAL_08042010.docx	Yes	Yes	Fillable Fileable
Form and Instruction	4	Antineoplastic Agents (Compound)	Attachment I3_Module B_FINAL_08042010.docx	Yes	Yes	Fillable Fileable
Form and Instruction	9	Anesthetic Gases	Attachment I8_Module G_TC_72310.docx	Yes	Yes	Fillable Fileable
Form and Instruction	8	Surgical Smoke	Attachment I7_Module F_TC_72310.docx	Yes	Yes	Fillable Fileable
Form and Instruction	7	High Level Disinfectants	Attachment I6_Module E_TC.docx	Yes	Yes	Fillable Fileable
Form and Instruction	5	Antineoplastic Agents (Administer)	Attachment I4_Module C_FINAL_8042010.docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 20,520	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	20,520	20,520
Annual IC Time Burden (Hours)	3,420	3,420
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.