Consent

Attachment F_Consent to Participate.docx

Ready CDC

Consent

OMB: 0920-1022

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Consent to Participate


The Learning Office within CDC’s Office of Public Health Preparedness and Response has personally invited you to participate in "Ready CDC," an educational intervention aimed at improving the personal preparedness of the CDC workforce. Thank you for taking the time to learn about this research study and determine whether you would like to participate.



What is the purpose of this study?
The purpose of this study is to assess whether our designed intervention changes any (and/or your family’s) behaviors associated with preparedness for a disaster or emergency.



How long will you need me?
The intervention includes one, in-person, 60-minute workshop on November 18 from 11:00 AM - 12:00 PM at CDC's Roybal Campus in Atlanta. Subject matter experts in preparedness will be available for 30 minutes afterward for optional questions and discussion. Before and after the workshop, you will be asked to complete a pre and follow-up surveys that will take no longer than 20 minutes each (20 minutes for the pre-workshop survey and 10 minutes for the follow-up survey).



What do you want me to do if I decide to be in this study?
If you decide to be in this study, you will be asked to participate in one, in-person training workshop related to personal preparedness. This workshop will include learning about personal preparedness from local, subject matter experts, starting or refining a family disaster plan, and discussion with local experts and classmates. You will also be asked to complete a brief evaluation after the workshop.



Are there any risks to me if I decide to be in this study?
Risks from participating in this research study are unlikely. All questions in the assessments include an option to not disclose information, if you so choose. However, if you have experienced an emergency/disaster, there may be some distress that could occur if the content discussed in the training workshops triggers negative emotions.



Are there any benefits from being in this study?
There are many benefits from participating in this study. You and your family may be better prepared to handle an emergency or disaster situation because you have accurate, localized information. If you and your family are better prepared, CDC may benefit from you being more willing to help on behalf of your Agency during an event. Your community may also benefit from you and your family being better prepared in that you are likely to need less help from responders and can potentially assist neighbors or friends.



Will the information I give you be kept private?
Yes, the information we collect over the course of the study will be kept private and confidential. All results will be reported in the aggregate; no individual results will be accessible to anyone other than the primary investigators on this project. You will be assigned an identification number so that results of your assessment will not be linked to your name.



Who should I contact if I have questions about this study?
If you have questions about this study, contact Victoria Harp at [email protected] or 404.639.4929. She is the study coordinator for this project.



Who should I call if I have a question about my rights as a research volunteer?
If you have any questions about your rights as a participant in this study, please contact CDC/ATSDR’s Acting Deputy Associate Director for Science at 1-800-584-8814. Leave a message with your name, phone number, and refer to CDC protocol #6472, and someone will call you back.



Do I have to be in this study?
Participation is completely voluntary.





By signing and dating this form, you agree to be in the study.





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