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pdfAppendix K:
Oil Spill Work History Form
Page 1 of 4
Oil Spill Work History Form Instructions
During the telephone interview, we will ask you about your experience in the oil spill clean-up
effort. To prepare for the interview, you may find it helpful to complete the attached Oil Spill Work
History form. Please keep the form where it can be easily found when we call you.
Record all of the clean-up jobs that you held, including jobs that did not involve contact with oil or
dispersants.
Start with your first clean-up job after April 20, 2010 and continue up to your most recent job.
Complete as many rows as necessary. There are spaces to record jobs on both sides of the form.
Record additional jobs on a blank piece of paper, if necessary.
We will not ask you to return the form. You may discard the form after you complete all of your
study activities.
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Oil Spill Work History
Job Title
Location of Work
Work
Work
Start Date
End Date
Page 3 of 4
Tasks Performed
Type of Protective
Equipment Used
Oil Spill Work History
Job Title
Location of Work
Start Date
End Date
Page 4 of 4
Tasks performed
Type of Protective
Equipment Used
| File Type | application/pdf |
| Author | Richard Kwok |
| File Modified | 2011-01-14 |
| File Created | 2011-01-14 |