Script for Industrial Hygiene Samples

Attachment I Form Approved

No. 0920-xxxx

Exp. Date xx/xx/20xx

Script for collection of industrial hygiene samples

Hello, my name is ___________________________. I’m with the National Institute for Occupational Safety and Health or NIOSH.

We would like for you to participate in the industrial hygiene sampling that we will be conducting at Umicore this week on [days/dates].

Your participation is important to answer questions about the health effects of indium-tin oxide production and to ensure your workplace is as safe as possible. Your participation is voluntary.

You will be asked to wear two samplers. These samplers measure the amount of dust and indium in the air from your breathing zone.

The first sampler measures respirable dust, including indium and tin, in the air.

The second sampler is a continuous direct-reading instrument that measures real-time dust in the air.

We will ask that you wear the devices during your entire workday for two days.

If you wish to receive a copy of your personal air sampling results by mail, please complete the contact information form on the next page.

We will provide a summary of the results (without workers’ names) to Umicore managers and employees in our report.

Public reporting burden of this collection of information is estimated to average 5 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing 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 Information Collection Review Office, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-xxxx).