Telephone Screener

Form approved

OMB No. 0920-0940

Expiration date: 06/30/2015

Task A

Appendix A: Focus Group Screener

Introduction: Hello, my name is __________ and I am calling on behalf of the National Institute for Occupational Safety and Health, also known as NIOSH. I want to assure you that this is not a sales call. NIOSH conducts health hazard evaluations at work sites across the United States.

We’re conducting a study about employee and employer reactions to the materials that NIOSH uses to explain their program and services. As an employer (or employee), we consider your input critical in helping improve these materials. Would you be interested in participating in a focus group, which would last two hours with about 7 other people? We would pay you $75 for your participation. We would also validate your parking at our facility. Finally, a light meal will be served during the focus group.

Would you be interested in participating?

• Yes (proceed to next paragraph)

• No – not interested (try and convince them how important their opinion is. If cannot be swayed, thank them for their time and end call)

(Q & A if needed) How do I know this is legitimate? Please call Stefanie Brown at NIOSH (513-222-2733) to confirm the sponsor of this focus group meeting.

I need to ask you a few questions now to make sure that you meet the criteria that NIOSH is looking for.

1. Have you participated in a focus group before? If so, was it:

• In the last 6 months (thank and terminate)

• Over 6 months ago

• Never

2. Do you read in the English language?

• No (thank and terminate)

• Yes

3. Are you a current employee or a current employer?

• Employee (recruit for groups 1 & 2) (CONTINUE TO Q4, THEN SKIP TO Q7)

• Employer (recruit for groups 3 & 4) (SKIP TO Q 6)

4. Do you belong to a union?

• No

• Yes (recruit at least one union official for each employee group, but no more than 2)

  • Are you a union official; that is someone who can speak for the union?

• No (skip to Q6)

• Yes

5. What is your union title? (get a mix of international and national union officials)

• International President

• Local President

• International Vice President

• Local Vice President

• International Director of Health and Safety

• Local Chief Steward

• Business Agent

• Other (specify)

6. What is your job title? (recruit a mix in each employer group)

• Owner/operator

• Plant manager/Office manager

• President

• Health and safety officer

• Chief Executive Officer (CEO)/Chief Financial officer (CFO)

• Other (specify)

7. What is the total number of employees where you work? Would you say:

• Less than 3

• 3-20

• 21-100

• 101-499

• 500 or more

8. Which of the following industries/agencies applies to your work? Would you say:

• Manufacturing

• Service sector (landscaping, housekeeping, and others)

• Health care and social services

9. Do you consider yourself to be someone who always, sometimes, rarely, or never enjoys speaking in a small group of people?

Always	[CONTINUE]
Sometimes	[CONTINUE]
Rarely	[HOLD]
Never	[THANK AND TERMINATE]

ARTICULATION QUESTION:

And now a quick question just for fun. If you could invite any person to dinner, living or deceased, who would it be and why? [RECORD VERBATIM RESPONSE]

 USE ARTICULATION QUESTION TO ASSESS RESPONDENTS ABILITY TO ARTICULATE AND TO BE CREATIVE. IF RESPONDENT SAYS THEY ‘DO NOT KNOW’, OR GIVES A SHORT RESPONSE WITHOUT ELABORATING, THANK and TERMINATE.

IF RESPONDENT HAS DIFFICULTY HEARING, IS HARD TO UNDERSTAND, OR YOU HAVE THE SLIGHTEST DOUBT AS TO HIS/HER ABILITY TO COMMUNICATE, THANK AND TERMINATE.

10. Generally, how concerned are you about hazards at your workplace? Would you say: (recruit a mix, with at least 5 a little, fairly, or very concerned)

• Not concerned at all

• A little concerned

• Fairly concerned

• Very concerned

11. Which of the following ranges includes your age? (recruit a mix of age levels in each group)

• 18-24

• 25-29

• 30-34

• 35-39

• 40-44

• 45-49

• 50-54

• 55-59

• 60-64

• 65 and older

12. Are you from a Hispanic, Latino, or Spanish speaking background? (recruit at least one in each group)

• No

• Yes

13. What race would you classify yourself as? (Choose all that apply. Recruit a mix in each group)

• Black/African American

• White/Caucasian

• American Indian or Alaska Native

• Asian

• Native Hawaiian or other Pacific Islander

ASK Q 14 ONLY FOR THE EMPLOYEE GROUP

14. Gender (try to recruit half male and half female in each group)

Standard Invitation: As I mentioned before, the focus group discussion will last two hours, refreshments will be served, and you will receive $75), plus validated parking if you park at our facility. Our facility is located on the bus and light rail lines to downtown Seattle.

The focus group will be held on:

• Group 1 – Employees – Wednesday, <date>, at PRR in downtown Seattle from 6:15-8:15 pm

• Group 2 – Employees – Thursday, <date>, at PRR in downtown Seattle from 6:15-8:15 pm

• Group 3 – Employers – Monday, <date>, at PRR in downtown Seattle from 6:15-8:15 pm

• Group 4 – Employers – Tuesday, <date>, at PRR in downtown Seattle from 6:15-8:15 pm

If you wear glasses please be sure to bring them with you.

Please also note that we cannot provide child care and children will not be allowed in the focus group.

Will you be able to join us?

• Yes (proceed to “address” paragraph at the end of this document)

• No – not interested after all (try and convince them how important their opinion is. Ask if we can contact them if the date or time of the focus group changes. If cannot be swayed, thank them for their time and end call)

Contact Info

So that we can send you directions and a letter to confirm your participation, may I please have (or, confirm) your name and address? We will use your name and address only to schedule the focus group. After your focus group is completed, we will destroy this personal information.

Name: (VERIFY CORRECT SPELLING)

Address: ____________________________________________________________

City: ___________________ State: ____ Zip: ____________________

Telephone: ______________________

Email: _____________________________

We will call you the day before the focus group to remind you about the group. Is it ok to call you at this number or is there a better phone number to reach you?

• YES, OK TO CALL THIS NUMBER

• NO, CALL DIFFERENT NUMBER -- > RECORD NUMBER BELOW

NUMBER TO CALL TO REMIND:____________________________

Thank you for agreeing to participate. We look forward to seeing you.

Public reporting burden of this collection of information is estimated to average 10 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 Reports Clearance Officer, 1600 Clifton Road NE, MS E-11, Atlanta, Georgia 30333; ATTN: PRA (0920-0940).