DATE
NAME
ADDRESS
CITY, STATE, ZIP
Dear NAME:
You are invited to take part in a study sponsored by the National Institute for Occupational Safety and Health (NIOSH), which 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 in Health Care Facilities Act and to evaluate the effectiveness of the regulations in reducing assault injuries to workers.
The enclosed 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. Please take a few moments to complete the survey and return it in the postage-paid envelope to Scantron, the organization helping us with this survey.
The information you provide NIOSH will be used for statistical and research purposes and will be summarized so that no individual is identified. The information you supply is voluntary and there is no penalty for not providing it. The risk of completing this survey is expected to be minimal, so you may choose to skip any question you don’t want to answer. Also, the information you provide will not be shared with anyone other than authorized research staff at NIOSH.
“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 BSN ([email protected]) at 1-304-285-5879, Monday through Friday, between 8:00 a.m. and 4:00 p.m. Eastern Standard Time. If you have any questions about your rights as a study participant, you may contact the NIOSH HSRB (IRB) Chair, Mark Toraason PhD ([email protected]) at 1-513-533-8207, Monday through Friday, between 8:00 a.m. and 4:00 p.m. Eastern Standard Time.
Sincerely,
Title
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | Centers for Disease Control & Prevention |
| File Modified | 0000-00-00 |
| File Created | 2021-01-30 |