Attachment F Pre-interview Letter for Potential Subjects

PRE-INTERVIEW LETTER FOR POTENTIAL SUBJECTS

U.S. CONSUMER PRODUCT SAFETY COMMISSION

BETHESDA, MD 20814

October 27, 2008

«Title». «FirstName» «LastName»

«Address1»

«Address2»

«City», «State» «PostalCode» Re: «Taskno»

Dear «Title». «LastName»:

As part of an ongoing research program, all work-related injuries and illnesses seen in the Emergency Department at «HospName» are reported to the Consumer Product Safety Commission (CPSC). Using this information, the CPSC in cooperation with the Centers for Disease Control and Prevention (CDC) and the National Highway Traffic Safety Administration (NHTSA), is doing an in-depth research study of the injuries and illnesses to emergency medical services workers. The information collected will help to better understand how to prevent these injuries and illnesses.

CPSC records show that on «Treatment date» you were treated in the Emergency Department at «HospName» for an injury or illness sustained while working. We would like to follow-up with you for more information regarding your injury or illness. All follow-up interviews are being done by telephone. You may receive a telephone call asking questions about the circumstances of the injury or illness, the outcome, and other related issues. If you agree to participate in this telephone interview, it should take about 20 minutes to answer the questions.

Your participation would be greatly appreciated because your answers will represent other workers who have suffered a similar injury. However, your participation is voluntary and you may end your participation in this study at any time without penalty or loss of benefits to which you are otherwise entitled. There is no compensation or direct benefit to you for participating in this study.

If you would prefer that you not be contacted by CPSC for this study, please leave a message at (800) 638-8095, extension 7431, within 10 days of receipt of this letter. Be sure to leave your name and the reference number found at the top of this letter.

Your name and phone number are only used by the CPSC for this study.  Either when the interview is completed, you refuse to participate, or you cannot be reached within 30 days, this information will be destroyed. This personal information will not be stored on the dataset given to the CDC and the NHTSA.

Your answers to the questions in this study will be kept private to the extent allowed by law. Your name will not be available to the CDC and NHTSA researchers. Other facts that might point to you indirectly will not be shown in any report or published paper. The information you give us will be a part of the CDC Privacy Act System. It may be released to private contractors assisting CDC with this study or collaborating researchers who plan to conduct further research.

This study is voluntary. You may decline to answer specific questions or withdraw from the study at any time.

The only known risk to taking part in this study is the loss of privacy that may lead to mental grief. Injury or harm from this project is unlikely, but if it results, medical care is not provided. If you are injured through the negligence of a CPSC contracted telephone interviewer, you would file a claim against the contractor. If an injury or harm should occur to you as the result of your participation in the study, you should contact Audrey Reichard, CDC project officer at the National Institute for Occupational Safety and Health (NIOSH), at (304)285-6019. You may also contact Mark Toraason, Chair of the CDC/NIOSH Human Subjects Review Board, at (513) 533-8591.

Data are collected for this study under the authority described in the Occupational Safety and Health Act of 1970. If you have questions about this research, contact Audrey Reichard, CDC/NIOSH project officer, at (304)285-6019. If you have questions about your rights as a member of this study, contact Mark Toraason, Chair of the CDC/NIOSH Human Subjects Review Board, at (513) 533-8591.

Thank you for your time.

Respectfully,

Tom Schroeder

Statistician, Division Director

Division of Hazard and Injury Data Systems

U.S. Consumer Product Safety Commission