Observers Informed Consent

APPENDIX F.2 - Informed Consent of CROPS Observers

Information for Informed Consent of CROPS Observers

(The following information will be orally read to the assembled group and the request made that if they have any questions to please ask.)

Your participation in the NIOSH/CDC research study called “Increasing CROPS by Farmers and Manufacturers” is completely voluntary. The head of this study, or project officer, is David Hard and can be reached at 304-285-6068 if you have any questions about the study. If you have any questions about your rights as a research participant, you may contact Cherie Estill, Chair NIOSH HSRB, 513-533-8591.

The reason for the study is to determine barriers to adoption, and approaches for encouraging farmers to retrofit their tractors with Cost-Effective Roll-Over Protective Structures (CROPS). Tractors are the single largest cause of occupational traumatic injury deaths of farmers each year, on average accounting for about 200 deaths/year or 1/3 of all occupational deaths to production agricultural workers each year. You will be given a survey and asked questions regarding your knowledge, attitudes and beliefs about roll over protective structures (ROPS) in general and about the cost-effective roll over protective structure (CROPS) you see here today.

The risk to you for participating in the research study is considered to be minimal and should not be greater than what you would routinely experience in your daily life and activities. The benefit of participation is for farmers as a whole, because if we can identify ways to get more CROPS/ROPS on tractors, this will help prevent the single largest identified cause of traumatic occupational injury deaths of farmers.

The information collected from you today will become part of the CDC record system and we will protect it to the extent allowed by law. However, there are conditions under the Privacy Act when we could be authorized to release this information to outside sources. The conditions under which we might release this information are listed on the posters here today.

You will decide whether you want to provide us with the information we’re requesting by completing the surveys today. We will mail you a similar survey in about a year to see if your opinions have changed. You are free to choose not to be in this study. It is up to you.

By completing the surveys, you are consenting to participate in this study.

The following information will be posted (2 places) for observers to see at the CROPS farm owner/operator demonstration sites on laminated poster board with size 72 font.

The Information you provide will become part of the CDC Privacy Act System, 09-20-0136 “Epidemiologic Studies and Surveillance of Disease Problems” and may be disclosed to

• Appropriate state or local heath departments to report communicable diseases;

• Private contractors assisting NIOSH;

• Collaborating researchers under certain circumstances to conduct further investigations;

• One or more potential sources of vital statistics to make determinations of death, health status or to find last known address;

• The Department of Justice or the Department of Labor in the event of litigation;

• Congressional offices assisting an individual in locating his or her records;

You may request an accounting of the disclosures made by NIOSH.

Except for these and other permissible disclosures authorized by the Privacy Act, or in limited circumstances required by the Freedom of Information Act, no other disclosures may be made without your written consent.