Survey Instructions

Appendix J:

Survey Instructions

Instructions for Completing the

“Research to Inform the Prevention of Asthma in Health Care”

Study Survey

Thank you for agreeing to participate in the Research to Inform the Prevention of Asthma in Health Care survey. Your participation involves completion of a 30 minute survey either online or by phone. Please choose the method below for completing the survey that is easiest for you. You will only be able to complete the survey one time. You have the option of beginning the survey and complete it at a later time. However, you will not be able to go back and change answers to questions you have already completed. Completing the survey is voluntary and you may stop participation at any time.

If you have any questions or concerns about completing this survey please contact Michael Humann, Associate Service Fellow at the National Institute for Occupational Safety and Health (NIOSH) at 304-285-6193.

Instructions for Completing Survey Online:

1. Log on to the Centers for Disease Control and Prevention website at (web address to be determined).

2. Enter your study ID (<<ID Number>>) and click on the “Complete Survey” button.

3. Carefully read and follow all instructions before completing the survey.

When you have finished the survey identify the merchant you would prefer a gift card from and click on the “Submit” button.

Instructions for Completing Survey by Telephone:

1. Call into the SEIU 1199 Communications Center between the hours of __AM and __PM Monday – Friday toll free at <<telephone number>>

2. Tell the interviewer you would like to complete the “NIOSH Asthma in Health Care Survey”.

3. When asked, please provide your study ID (<<ID Number>>) to the interviewer.

4. To complete the survey follow the instruction from the interviewer.