Nurse Letter of Introduction

Appendix F

Nurse Survey Introduction Letter

U.S. Department of Health and Human Services

Centers for Disease Control and Prevention

National Institute for Occupational Safety and Health

The National Institute for Occupational Safety and Health (NIOSH) is a part of the United States

Public Health Service and an institute within the Centers for Disease Control and Prevention

(CDC). NIOSH is concerned with workplace health and safety. The purpose of this research

study is to examine healthcare facility compliance with the New Jersey Violence Prevention

New Jersey Violence Prevention in Health Care Facilities Act and to evaluate the effectiveness

of the regulations in reducing assault injuries to workers. This questionnaire is about your work history as it relates to incidents of workplace violence. We are interested in obtaining feedback from those who HAVE and those who HAVE NOT experienced violence while on the job. Although participation is entirely voluntary, NIOSH feels it is important for you to complete the survey in order for the study to be successful.

All personal information that you provide NIOSH will be kept in a secure manner in accordance

with the Privacy Act of 1974 (Public Law 93-579). The information you provide NIOSH

will be used for statistical and research purposes and will be summarized so that no individual

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

“BY COMPLETING THIS QUESTIONNAIRE, YOU INDICATE

YOUR CONSENT TO PARTICIPATE IN THIS STUDY.”

Thank you for your participation.

If you have any questions about the survey, you may contact the NIOSH project officer, Marilyn Ridenour at 1(800) XXX-XXXX.

National Institute for Occupational Safety and Health

1095 Willowdale Road, Morgantown, West Virginia 26505