QID Quality Control Worksheet - VCUS

NATIONAL
AGRICULTURAL
STATISTICS
SERVICE
U.S. Department of Agriculture
Rm 5829, South Building
1400 Independence Avenue, S.W.
Washington, D.C. 20250-2000
1-800-727-9540
Fax: 202-690-2090
E-mail: [email protected]

TELEPHONE QUALITY
CONTROL WORKSHEET

Form Approved
OMB Number 0535-0218
Approval Expires XX/XX/XXXX
Project code 136

for
2014 VEGETABLE CHEMICAL USE SURVEY

State: _________________________________________________

Farm, Ranch, or
Operation Name: __________________________________________

Version:

Operator’s name: __________________________________________

ID/POID: ______________________________________________

Address: __________________________________________________

Enumerator: __________________________________________
Interview Date & Time: ________________________________
Survey Respondent: __________________________________
Current Respondent: __________________________________

__________________________________________________

Telephone: ________________________________________________
Operator/Mgr

Spouse

Accountant/

Partner

Other

Partner

Other

Bookkeeper
Operator/Mgr

Spouse

Accountant/

Bookkeeper

INTRODUCTION:
[Introduce yourself, and ask for the survey respondent. Rephrase in your own words.]
Recently you should have been contacted by one of our interviewers, Mr./Ms.
,
for the Vegetable Chemical Use Survey. This telephone call is part of our survey quality assurance measures
to verify that personal contact was actually made with you for that purpose. Your response is voluntary and not required
by law, but your cooperation will be appreciated. Facts about your farm/ranch will be kept confidential.

1. During the past few days, do you recall an interview with Mr./Ms.
obtaining information about your farming or ranching operation?

, for the purpose of

YES - [Go to item 3.]
NO - [Go to item 2.]
DON'T REMEMBER - [Go to item 2.]
2. During the past few days, did any other person from the
Agricultural Statistics Service,
NASS, or USDA, interview you to obtain information about your farm or ranch?
YES - [Go to item 3.]
NO - [Conclude interview.]
DON'T REMEMBER - [Conclude interview.]
3. Did the person conducting the interview ask you to verify the spelling of your name, address
and the operation name?
YES
NO
DON'T REMEMBER
[Continue on back.]

-2-

4. Now I need to verify items that are critical to our survey procedures.

a. Total acres of all vegetables (Section A, item 4)

Reported

Verified

_______________________

_______________________

None, Positive

None, Positive

b. Chemical applications to target vegetables

5. Did Mr./Ms.

conduct the interview in a knowledgeable and professional manner?

YES
NO – Explain: ____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________

6. Do you have any additional comments you would like to make concerning our survey contact?
______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________

This concludes the interview. Thank you for your help.

Signature:___________________________________________________

Date:____________________________________________________