Final Followback Survey Report for Site-visits

NIOSH Health Hazard Evaluation Survey: Final Report
This survey asks your thoughts about the health hazard evaluation NIOSH recently completed
concerning your workplace.
Please fill in circles completely like this:

1.

2.

Have any changes been made at the workplace based
on the NIOSH recommendations?

O Yes
O No
O I don’t know

Do you think NIOSH helped make things better at
the workplace?

O Yes
O No
O No changes were needed

NIOSH Health Hazard Evaluation Survey: Final Report
Did you read the final report?

O Yes
O No

8.

Do you think the final report is helpful?

O
O
O
O
O

9.

Did the NIOSH response change your thinking about
the workplace concerns?

O Yes
O No

7.

Yes, definitely
Yes, probably
Probably not
Definitely not
I don’t know

10. Please explain your answer

3.

4.

If “Yes” to Question 2, please describe the positive
changes.

After the site visit(s), did NIOSH keep you well
O Yes
informed about the health hazard evaluation progress?
O No

5.

Did NIOSH issue the final report in a reasonable
amount of time?

O Yes
O No
O I don’t know

6.

Did the employer post the final report so employees
could see it?

O Yes
O No
O I don’t know

11. Which best describes what you think NIOSH found?

O NIOSH found a health hazard
O NIOSH did not find a health hazard
O NIOSH did not decide whether there was
a health hazard
O The NIOSH findings were not clear to me
O I don’t know

12. Overall, do you agree with the NIOSH findings?

O Yes
O No
O I’m not sure

13. Overall, do you think the NIOSH recommendations
address the workplace concerns well?

O Yes
O No
O I don’t know

14. Overall, do you think the NIOSH recommendations
are practical?

O Yes
O No
O I don’t know

NIOSH Health Hazard Evaluation Survey: Final Report
15. What do you think about the health hazard
evaluation?

O
O
O
O

16. If you were concerned about a possible workplace
health hazard in the future, would you request a
NIOSH health hazard evaluation?

O Yes
O No

It was Excellent
It was Good
It was Fair
It was Poor

17. Please tell us more of your thoughts about the health hazard evaluation.

Form Approved
OMB No.: 0920-0260
Expiration Date:

Followback Survey
Final Report
The National Institute for Occupational Safety and Health (NIOSH) surveys people
involved with its health hazard evaluations. We want to learn your thoughts about
the evaluation and the report.

18. Will you be part of decision making related to
the NIOSH recommendations?

O Yes; I have final authority
O Yes; I provide input
O No

19. Are you still associated with the workplace
that NIOSH evaluated?

O Yes
O No

Please make any corrections to this label.

4/29/2014
Administrative area
FOLLOWBACK SURVEY FORM 2B
375

Your responses will be kept securely according to federal laws. Our reports include
only summary information and will not identify you. About one year from now, we
will send you the last survey, which asks about our recommendations.
Thank you for completing this survey

Please mail the completed survey to NIOSH in the enclosed postage paid envelope.
Call Barbara Jenkins at 513-458-7132 if you have any questions about the survey.

Public reporting burden of this collection of information is estimated to average 15 minutes per response, including the time for
reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing 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 Reports Clearance Officer, 1600 Clifton Road
NE, MS E-11, Atlanta, Georgia 30333; ATTN: PRA (0920-0260).