Attachment 7: EHS-Net Listeria Retail Deli Study-Worker Recruiting Screener and Informed Consent
Public
reporting burden for this collection of information is estimated to
average 3 minutes per response, including the time for
reviewing instructions, searching existing data sources, gathering
and maintaining the data needed, and completing and reviewing the
collection of information. An agency may not conduct or sponsor,
and a person is not required to respond to, a collection of
information unless it displays a currently valid OMB control number.
Send comments regarding this burden estimate or any other aspect of
this collection of information, including suggestions for reducing
this burden, to: CDC/ATSDR Information Collection Review Office, MS
D-74; 1600 Clifton Road NE, Atlanta, Ga. 30333; ATTN: PRA
(0920-0792)
Let me give you a little background on why I am here. I am working with __________________ (health department) on a research project. Your retail deli was chosen at random to be in this project, and your manager said that it would be okay for you to talk to me for a few minutes. However, your participation is voluntary—you do not have to talk to me if you do not want to- I will not tell your manager. If you do talk with me, I will not tell your manager anything that you say.
Would you be willing to talk to me for about 10 minutes about what you do at work and some of the deli’s policies and practices?
No Okay, thanks for your time. (End interview)
Yes Great, thanks.
I am going to ask you some questions, and if any of the questions make you uncomfortable you can choose not to answer them. The information we collect today will be combined with information from other retail delis in various states. Your name and your establishment’s name will not be linked in any way to the information we collect, nor will they be included in any reports.
The information you provide will be valuable in helping us understand the difficult issues that retail delis face so we ask you to be as open and honest as possible.
Do you have any questions?
If you have any questions at a later time or would like a summary of the study’s findings, you can contact: (Local Contact Name). (If have card) My information is on this card. We expect to have all of the data summarized in about12 months.
File Type | application/msword |
File Title | INFORMED CONSENT |
Author | uzk4 |
Last Modified By | Williams, Denita (CDC/ONDIEH/NCEH) (CTR) |
File Modified | 2012-08-13 |
File Created | 2012-08-13 |