Deepwater Horizon Responders-Web

Deepwater Horizon Response Worker Rostering Survey and Worker Health Survey

NIOSH_Survey_Disclosure_English

Deepwater Horizon Responders-Web

OMB: 0920-0857

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NIOSH is part of the Centers for Disease Control and Prevention (CDC)
in the Department of Health and Human Services. CDC/NIOSH is the federal agency that evaluates and makes recommendations for
the prevention of work-related injury and illness.

DATA USE AND DISCLOSURE
Why is NIOSH here at the site of the Gulf Oil Spill?
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We would like to monitor potential health effects workers involved in cleanup of an oil spill may experience so
we can help protect them in the future.
We have experts who routinely conduct these surveys of employees and employers.

Why is this evaluation being done?
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We know that workers may be potentially exposed to things in an oil spill cleanup: such as oils, volatile organic
compounds, polyaromatic hydrocarbons, diesel fumes, heat, noise, and heavy lifting.
We know that training will help provide information to workers about these exposures, and we are interested in
what training workers receive.
We want to gather information from workers involved in cleanup, so that after cleanup is over, we can see if
workers experienced any symptoms related to the oil spill work. Oil spill exposures may cause some workers to
experience symptoms like skin rash, throat irritation and cough, and back pain. We do not know if these symptoms
will occur or if they do, what will be the extent of these symptoms. We want to learn as much as we can in order to
reduce symptoms now and in the future.
Documenting symptoms in this incident may provide information that NIOSH can use to protect the health of
workers in this clean up and in future clean-up efforts.

Which employees does NIOSH want to evaluate?


NIOSH would like to evaluate ALL of the clean-up workers so that we can record any illness, injury, or stress
that is occurring.

Will your answers be private?
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What

Although the questionnaires will ask for personal information, it will only be used so that we can follow up with you,
but ONLY group data will be reported.
Participation in this survey is voluntary. You will decide whether you want to provide us with this information. You are
free to choose not to answer these questionnaires. It is up to you.
With your permission, NIOSH is allowed to collect and keep information about you, including your results from this
questionnaire, because of two laws passed by Congress. These laws are:
1. The Public Health Service Act (42 U.S.C 241)
2. The Occupational Safety and Health Act (29 U.S.C. 669)
If the information we are collecting is maintained and retrieved by personal identifiers, such as your name, it will
become part of the CDC record system, maintained under the federal Privacy Act, and we will protect it to the extent
allowed by law. We are requesting the last four digits of your Social Security Number so we can make sure to
differentiate you from others with similar names. Again you are free to choose not to provide this information.
You should know, however, that there are limited conditions under the Privacy Act when we could be authorized to
release this information to outside sources. These conditions under which we might release this information are listed on
Page 2 (the Privacy Act).

will be the result of this evaluation?


NIOSH will provide a final written report through CDC to BP, its contractors, the workers, and federal and state
government agencies. This report will not contain individual information and will be available to the public.

Contact: __Renée Funk, NIOSH, 404-498-GULF (4853), [email protected]__

Privacy Act
The Information you provide will become part of the CDC Privacy Act System, 09-20-0147, “Occupational
Health Epidemiological Studies and EEOICPA Program Records” and may be disclosed to


Appropriate state or local health departments to report communicable diseases;



A State Cancer Registry to report cases of cancer where the state has a legal reporting program providing
for confidentiality;

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Private contractors assisting NIOSH;

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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;

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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 prior written
consent.


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