Note to Reviewer - Household Survey of Injuries and Illnesses

Note to Reviewer - HSOII Cognitive Testing.docx

Cognitive and Psychological Research

Note to Reviewer - Household Survey of Injuries and Illnesses

OMB: 1220-0141

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March 31, 2016

NOTE TO THE REVIEWER OF:

OMB CLEARANCE 1220-0141

“Cognitive and Psychological Research”

FROM:

Polly Phipps and Robin Kaplan

Office of Survey Methods Research

SUBJECT:

Submission of Materials for the Household Survey of Injuries and Illnesses

Please accept the enclosed materials for approval under the OMB clearance package 1220-0141 “Cognitive and Psychological Research.” In accordance with our agreement with OMB, we are submitting a brief description of the study.

The total estimated respondent burden for this study is 165 hours.

If there are any questions regarding this project, please contact Polly Phipps at 202-691-7513.



  1. Introduction

The purpose of this memorandum is to inform you that the Bureau of Labor Statistics (BLS) plans to conduct cognitive interviews for Designing a Household Survey of Injury and Illness (HSOII) under the generic clearance of survey improvement projects (OMB #1220-0141).


The objectives of the cognitive interviews are to evaluate the HSOII survey questions for correct interpretation and to assess the ability of respondents to accurately answer the survey questions. The results of this research will be used to refine the HSOII questionnaire items and item order.


Background

The Survey of Occupational Injuries and Illnesses (SOII) is an annual survey of over

230,000 establishments used to generate estimates of non-fatal workplace injuries and illnesses that occur during the survey year. Existing research points to an underestimate of injuries and illnesses attributed to a variety of factors including an employer/employee incentive to underreport these occurrences. A potential solution is to contact workers directly through a household survey. Such a survey would be expected to produce estimates that are not “filtered” by establishment-level reporting involved in the SOII. Ideally, a household survey would sample from the universe of all workers, including those who work as independent contractors. It should also allow BLS to produce annual calendar year estimates of injuries and illnesses by employment relationship (contractor vs. employee), sector (private, government), and broad industry and occupational groups. BLS intends to conduct a series of cognitive interviews between March and September 2016 to develop and test an HSOII instrument.


Purpose

The purpose is to develop a survey design and questionnaire on non-fatal occupational injuries and illnesses that covers the population of workers and allows BLS to estimate injuries and illnesses by employment relationship, broad industry, and occupation at the national level.


A series of cognitive interviews will be conducted to test and fine-tune wording and question ordering revisions to the existing instrument. The cognitive interviews will enable the research team to identify problems with items, the organization and order of the instrument, revealing potential sources of response error in the HSOII that the research team will draw on to inform their design efforts.


The cognitive interviews will assess issues such as:

  • Respondent understanding of terms in the survey, such as illness and injury

  • Respondent confidence in responses

  • Recall techniques when answering factual questions, such as when an injury or illness occurred and what happened

  • Suitability of response options

  • Ease of answering questions

  • Issues with sensitive questions

  • Consistency of answers within the questionnaire and in comparison to the expected range of answers


  1. Methodology

General approach

The cognitive interviews will be conducted by staff with training and experience in cognitive interviewing. The research team anticipates completing up to three rounds of cognitive interviews with 30 respondents per round for a maximum total of 90 cognitive interviews. Interviewing in rounds will allow the team to evaluate the effectiveness of a set of proposed instrument changes in one round, revise the instrument as needed, and test the revisions in the next round. The interviews will be audio-recorded if respondent consent is granted.


A full set of materials for use in conducting interviews are attached to this OMB clearance package. These materials include: sample flyer, Frequently Asked Questions, eligibility screener, cognitive interview protocol, and participant consent form.


Recruitment

Sampling. The study will be conducted in the Chicago and Bethesda areas. NORC at the University of Chicago (NORC) will use a non-probability sample of 90 participants for this research. Respondents will be adults who have experienced a workplace injury or illness in the past 12 months and adults who work in occupations that place them at higher risk of experiencing workplace injuries and illnesses. In addition, some respondents will be from the general population of workers, who may not have experienced a workplace injury or illness. For testing of proxy response, described further below, the proxy respondent will be an adult from the household of a recruited respondent.


Method for recruiting. NORC will obtain participants through a variety of channels. Flyers (see Attachment 1) will be distributed through neighborhoods, community centers, public libraries, supermarkets, and shopping malls. The flyer will also be posted online on Craigslist and other social media sites (Twitter, Facebook, etc.).


Additional recruitment avenues to explore are American Job Centers (One-Stop Career Centers)1, which provide assistance to those seeking employment. These centers may be helpful in providing outreach to recently or newly employed individuals who would be willing to be interviewed. In addition, the Outreach Training Program2, which provides basic safety and health information and education for employers and employees, will be approached to help with reaching individuals whose occupations increase their likelihood of experiencing a workplace injury or illness. In addition, we will contact trade unions in Chicago to distribute information. We will provide copies of the recruitment flyer to these centers for them to make available to interested individuals.


Other sites of interest are community colleges and not-for-profit organizations focused on human services offering vocational training. Also, temporary work agencies and associations in alliance with the Occupational Safety & Health Administration can be approached for recruiting. These institutions will be contacted by email and telephone to inform them of the study. We will gain cooperation and provide flyers for these organizations to distribute and post.


As an additional method of recruiting, we will ask respondents who have agreed to participate in the study to pass on study information to others they know. To assure that we recruit individuals in occupations in which workers have a higher risk of experiencing workplace injury and illness, we will ask respondents to recruit others in the same occupation.


Recruitment materials will direct individuals interested in participating in an interview to contact NORC (via telephone or email, to be determined). A trained NORC staff member will explain the study and the cognitive interview process, answer any questions the respondent may have, and screen the respondent. The Frequently Asked Questions are presented in Attachment 2; the recruitment script and screener and are presented in Attachment 3.


Interviews

We anticipate that the first round of interviews will be conducted face-to-face with respondents in laboratory cognitive interviews. Recruited respondents who are completing in-person laboratory cognitive interviews will come to NORC’s offices in either downtown Chicago or the University of Chicago campus, to NORC’s Bethesda office. An in-person interview allows the interviewer to observe both verbal and nonverbal cues in assessing how the instrument is working. Later interview rounds will include some telephone interviews as well.


Interviewers will follow a cognitive interview protocol in which the interviewer asks probing questions throughout the survey to examine question comprehension, recall of information, judgment processes, and sensitivity of questions. The protocol is included in Attachment 4. Analysis of the cognitive interview data, revision of the questions, and updating of the cognitive interview protocol will be ongoing throughout data collection. Since this research involves pretesting of a questionnaire, we expect that modifications to the questionnaire will be made throughout the course of the study. The goals of the testing and overall design of the study will remain the same. However, findings from earlier interviews will be used to improve the survey instrument to be tested in later interviews.


Prior to participating in the study, respondents will first be informed of their rights and the study confidentiality. The interviewer will address the respondent’s questions and concerns and then participants will sign the consent form (Attachment 5). At the end of the interview respondents will receive compensation of $40.



  1. Participants

Sample characteristics

There are several characteristics of respondents that are of specific interest in the sample recruitment for this study. Individuals who respond to the recruitment flyer will be screened (Attachment 3) to ensure that a broad range of respondent characteristics in terms of gender, age, education level, race and ethnicity, and occupation are included in the sample. Respondents will also be asked about whether they have experienced a workplace injury or illness to ensure that respondents who have experienced a workplace injury or illness are included in the sample. All respondents will be 18 years of age or older.


Potential respondents who are in professions in which workers have a high likelihood of experiencing a workplace injury or illness (such as individuals who work in construction, food service, manufacturing, and health care), and individuals who indicate that they have experienced a workplace injury or illness, will be the focus of recruitment efforts. However, some respondents from the more general population of workers or who have not experienced a workplace injury or illness will also be invited to participate to ensure that the questionnaire works well with a variety of respondents. In addition, some respondents participating in pairs interviews, described below, will be adult members of a recruited respondent’s household.


Proxy reporting

An individual who is knowledgeable about the household, or knowledge about the work history and injuries/illnesses of other household members could potentially serve as respondent or proxy. In developing initial plans for respondent recruitment, we will conduct interviews that include both proxy and self-reporting. As the survey design develops, the recruitment plans will be adapted according to decisions made concerning the use of proxy respondents. To test the accuracy of proxy reports, we will interview two adult members from the same household. We will attempt to recruit up to 20 pairs of respondents so that self and proxy reports may be compared. Each member of the respondent pair will receive the $40 compensation for study participation.





  1. Burden Hours

Respondent burden includes time spent on the following:

  1. Responding to the flyer

  2. Screening process and collection of background information

  3. Appointment scheduling and confirmation

  4. Interview


The total estimated burden associated with this study is 165 hours


Activity

Number of Respondents

Average Time (minutes)

Total Burden

(minutes)

Telephone inquiry: Estimate that 300 individuals will respond to the flyer and receive information about the study

300

5

1500

Screening and collection of background information: Estimate that 200 individuals will decide to be screened for participation

200

10

2000

Appointment scheduling and confirmation: Estimate that 100 individuals will be scheduled for an interview and receive confirmation phone call or email

100

10

1000

Interview: 90 individuals will be interviewed

90

60

5400

Total burden

9,900 minutes

(165 hours)




  1. Data Confidentiality

Cognitive interview respondents will be informed of confidentiality verbally and through the consent form (Attachment 5). The consent form indicates that the purpose of the study is to improve a BLS survey, that participation is voluntary, and that responses will be used for statistical purposes only. Respondents will also be informed that the interview will be audio-recorded or that someone may observe the interview. To protect respondent confidentiality, respondents will be assigned a unique identifier. Although quotes may be used in the final reports, quotes will not be attributed to a name and no respondent will be identifiable based on any quotes used. The signed consent forms will be kept separately from the interview files in a locked cabinet for the duration of the study and will be destroyed after the final report is completed.



  1. Attachments

1: Sample flyer

2. Frequently Asked Questions

3: Eligibility Screener

4: Cognitive Interview Protocol

5: Participant Consent Form





Appendix

Attachment 1: Recruitment Materials: Flyer

Shape2

EARN $40 BY COMPLETING AN INTERVIEW!

  • Have you had an on-the-job injury in the last year?


  • Have you had an illness related to your job in the last year?


  • Do you do any of the following kinds of work?

    • Construction

    • Food service

    • Health care

    • Cleaning and maintenance

    • Manufacturing

    • Stocking, loading, moving


If you said YES to any of these questions, we want you to take part in an interview on workplace injuries and illnesses!


The interview will last no more than 60 minutes and can be completed at NORC’s offices in downtown Chicago or the University of Chicago campus [OR Bethesda] during regular business hours.


If you are interested, please contact NAME at:


[email protected]

312-XXX-XXXX












































Attachment 2: Frequently Asked Questions


What is the study about?

This study is being conducted on behalf of the Bureau of Labor Statistics to try to learn how many people experience workplace injuries or illnesses each year.


Who is the Bureau of Labor Statistics (BLS)?

The Bureau of Labor Statistics (BLS) is the principal fact-finding agency for the Federal Government in the broad field of labor economics and statistics. The BLS is an independent national statistical agency that collects, processes, analyzes, and disseminates essential statistical data to the American public, the U.S. Congress, other Federal agencies, State and local governments, business, and labor. Learn more at www.bls.gov.


Who is NORC?

NORC is a not-for-profit social science research organization affiliated with the University of Chicago. NORC is conducting this study on behalf of the Bureau of Labor Statistics (BLS). You can learn more about NORC at its website, www.norc.org, or by contacting the Study Director, Dr. Lisa Lee at [email protected] or calling xxx-xxx-xxxx.


Do I have to participate?

Participation is voluntary. You may choose whether or not you want to be in this study. If you decide to be in the study, you may choose to skip any question you do not want to answer or stop participating at any time.


How much will I be paid?

You will be given $40 for participating in the study.


How long will the study take?

The interview will take less than 60 minutes.


Why should I participate?

Your input on how the questionnaire is working will help improve the data BLS collects. By participating in this study you can help make sure that the BLS collects the most complete and accurate data possible on workplace injury and illness in the United States, information that is used to inform policies designed to keep employees safe


Who do I contact if I have questions about my rights as a respondent?

If you have any questions regarding your rights as a study participant, you may call the NORC IRB Manager, toll-free, at 866-309-0542.


How is my privacy protected?

Your answers will always be kept private, and none of the information that you provide will be used for any purpose other than research. Your name or any information that could identify you will never be used.


Attachment 3: Recruitment Script and Screener Questions


Hello. My name is [NAME] and I work for NORC at the University of Chicago. I am calling you about your interest in the Worker Study. Is this a good time to talk? I would like to tell you about the study and you can let me know if you are still interested.


NORC is conducting this study for the Bureau of Labor Statistics (BLS) under OMB number 1220-0141 in an effort to try to improve the way that information on work-related injuries and illnesses is collected. We are helping to develop a survey for workers like yourself to ask about the injuries and illnesses related to your job that you may have experienced. For this study, you will come to NORC’s offices for an interview. The interview will include questions on the type of work you do, whether you have had a work-related injury or illness, and details about any injury or illness you may have experienced. The interview will take about one hour and you will be paid $40 in compensation.


Your answers will always be kept private, and none of the information that we collect about you will be used for any purpose other than research. BLS will not receive your name or any other identifying information about you. Also, your participation is completely voluntary and you may choose to skip any questions the interviewer asks or stop participating at any time. We will first ask some questions which will take approximately 10 minutes to determine if you are eligible to participate.


Would you like to participate?



  • [IF YES] Great. I am going to ask you a few background questions to confirm your eligibility. Then we can schedule an appointment time for you. GO TO SCREENER QUESTIONS


  • [IF NO] That's okay. We appreciate your call. But for research purposes, we would like to know why you choose not to participate. Thank you. NOTE TO RECRUITER: IF POTENTIAL RESPONDENT DECIDES AFTER HEARING ABOUT THE STUDY THAT HE/SHE DOES NOT WANT TO PARTICIPATE, ASK WHY NOT AND OFFER TO ANSWER QUESTIONS. RECORD THE RESPONDENT’S REASONS FOR NOT PARTICIPATING BELOW:





Eligibility Screener

  1. Since [DATE], did you do ANY work for pay or profit?

    1. YES

    2. NO


  1. How many jobs have you had since [DATE]?



_____ jobs



  1. What type of work do you do [did you do] at each job?: [RECORD VERBATIM AND CODE]

    1. Office, professional, business, or management staff

    2. Healthcare

    3. Delivery or driving

    4. Sales

    5. Food service

    6. Product assembly, product manufacture

    7. Cleaning, maintenance of building, grounds

    8. Repair, installation or service of machines, equipment

    9. Material handling (e.g., stocking, loading/unloading, moving, etc.)

    10. Construction

    11. Farming

    12. Other:____________________


  1. Since [DATE], have you experienced any injuries or illnesses related to any job you had?

    1. YES Please describe this incident.

    2. NO



Now I would like to ask you about other adult members of your household, that is, persons ages 18 and older who live with you.


  1. Since [DATE], has any adult member of your household done any work at all for which they were paid? [RECORD NAMES]



[ASK Q6 THROUGH Q8 FOR EACH HOUSEHOLD MEMBER.]



  1. How many jobs has [NAME] had since [DATE]?



_____ jobs





  1. What type of work does/did [NAME] do? [RECORD VERBATIM AND CODE]

    1. Office, professional, business, or management staff

    2. Healthcare

    3. Delivery or driving

    4. Sales

    5. Food service

    6. Product assembly, product manufacture

    7. Cleaning, maintenance of building, grounds

    8. Repair, installation or service of machines, equipment

    9. Material handling (e.g., stocking, loading/unloading, moving, etc.)

    10. Construction

    11. Farming

    12. Other:____________________



  1. Since [DATE], did [NAME] experience any injuries or illnesses related to any job he/she had?




  1. [IF INTERVIEW TO BE CONDUCTED IN PERSON] Would you and [OTHER ADULT HOUSEHOLD MEMBER NAME] be able to come in person to our offices in downtown Chicago/Bethesda to complete an interview?

    1. YES, DOWNTOWN OFFICE

    2. YES, HYDE PARK OFFICE

    3. YES, BETHESDA OFFICE

    4. NOFIND OUT WHERE RESPONDENT WOULD LIKE TO BE INTERVIEWED; WE WILL DETERMINE IF TRAVEL ARRANGEMENTS CAN BE MADE; CONTINUE SCREENING.


  1. RESPONDENT GENDER. ASK IF UNSURE.

    1. MALE

    2. FEMALE


  1. How old are you?

_______ years


  1. What is the highest degree or level of school you have completed?

      1. NO SCHOOLING COMPLETED

      2. NURSERY SCHOOL TO 8TH GRADE

      3. 9TH-12TH GRADE, NO DIPLOMA

      4. HIGH SCHOOL GRADUATE (HIGH SCHOOL DIPLOMA OR THE EQUIVALENT)

      5. VOCATIONAL/TECHNICAL/BUSINESS/TRADE SCHOOL CERTIFICATE OR DIPLOMA (BEYOND THE HIGH SCHOOL LEVEL)

      6. SOME COLLEGE, BUT NO DEGREE

      7. ASSOCIATE DEGREE

      8. BACHELOR'S DEGREE

      9. MASTER'S, PROFESSIONAL OR DOCTORATE DEGREE

      10. DON’T KNOW

      11. REFUSED


  1. Are you of Hispanic, Latino, or Spanish origin?

      1. YES

      2. NO


  1. What is your race? Please choose one or more.

      1. American Indian or Alaska Native

      2. Asian

      3. Black or African American

      4. Native Hawaiian or other Pacific Islander

      5. White

      6. DON’T KNOW

      7. REFUSED



IF RESPONDENT IS ELIGIBLE


  • OK, it looks like you are eligible to participate in the study. SCHEDULE APPOINTMENT


We would like to audio-record the interview so that we may review our conversation as we prepare a summary of our findings. Is this OK with you? [NOTE TO RECRUITER: THIS QUESTION IS NOT MEANT TO ASK FOR CONSENT. RESPONDENTS WILL BE ASKED AGAIN ABOUT RECORDING DURING THE CONSENT PROCESS. THEY WILL HAVE THE OPPORTUNITY TO DECIDE NOT BE RECORDED AND STILL PARTICIPATE IN THE INTERVIEW. WE PREFER TO RECRUIT RESPONDENTS WHO ARE LIKELY TO CONSENT TO RECORDING.]

  1. YES

  2. NO


  • Ok, let’s schedule an appointment for you [and NAME] to come in for the interview.

  • COLLECT CONTACT INFORMATION AND SCHEDULE APPOINTMENT. IF PAIRS INTERVIEW, WHEN CALLING/EMAILING TO REMIND RESPONDENT OF APPOINTMENT, CONFIRM THAT OTHER ADULT HAS AGREED TO COME AND KNOWS OF APPOINTMENT.


If RESPONDENT IS NOT ELIGIBLE


  • I’m sorry that right now we have enough people who have similar characteristics as you. Could I put your name on the waiting list and call you if a slot opens up?

  1. YES

  2. NO



Attachment 4: Cognitive Interview Protocol


HOUSEHOLD SURVEY OF OCCUPATIONAL INJURIES AND ILLNESSES

DRAFT cognitive interview protocol



MATERIALS NEEDED FOR INTERVIEW

    • INTERVIEWER PROTOCOL BOOKLET (THIS BOOKLET)

    • CONSENT FORM (TWO COPIES)

    • $40 CASH IN ENVELOPE

    • PAYMENT RECEIPT

    • FULLY CHARGED DIGITAL RECORDER AND EXTRA BATTERIES

    • NOTE PAPER, PENS AND PENCILS


STEP 1: INFORMED CONSENT

PROVIDE RESPONDENT WITH A COPY OF THE INFORMED CONSENT FORM. ASK THE RESPONDENT TO READ THE FORM, ANSWER ANY QUESTIONS, AND HAVE THE RESPONDENT SIGN THE FORM. LEAVE A SEPARATE COPY OF THE FORM WITH THE RESPONDENT.


  • SIGNED CONSENT FORM COLLECTED

  • COPY OF CONSENT FORM GIVEN TO RESPONDENT


  • IF THE RESPONDENT HAS CONSENTED TO RECORDING, START THE RECORDER.


STEP 2: COMPLETION OF THE QUESTIONNAIRE

BEGIN QUESTIONNAIRE.


Interviewer probe bank (use as appropriate):

  • “How did you come up with that answer?”

  • “Can you tell me in your own words what you think the question is asking?”

  • “Can you tell me more about that?”


If you pick up on a visual cue that suggests an issue or confusion:

  • “Tell me what you are thinking.”

  • What does the word [term] in this question mean to you?

  • You said [answer]. Can you tell me more about that?


If R is uncertain and asking for confirmation:

  • There is not a right or wrong answer for this question. I am interested in hearing your thoughts on what the question is asking.



INTERVIEWER: If this interview is with a proxy respondent, please modify language accordingly. For example, instead of asking “Did you do ANY work for pay or profit?” ask “Did [your husband/wife/brother/he/she] do ANY work for pay or profit?”


Survey Introduction


This survey is about work-related injuries and illnesses that you may have experienced. I would like to ask you questions about your work history and about the injuries and illnesses you may have had that are related to your job. The information that you provide in this survey is confidential. Your name and your answers to the questions will not be shared with anyone outside of NORC, the survey organization conducting this survey. I would be happy to answer any questions you may have about the survey. [ANSWER RESPONDENT QUESTIONS.] Let’s begin.


Screener


  1. Since [DATE: ONE YEAR AGO FROM TODAY], did you do ANY work for pay or profit?

    1. Yes ELIGIBLE, CONTINUE

    2. No NOT ELIGIBLE, END INTERVIEW

    3. DK

    4. REF


Any injury

  1. Since [DATE: ONE YEAR AGO FROM TODAY], have you experienced any injuries or illnesses related to any job you had?

    1. Yes COLLECT BRIEF DESCRIPTION, CONFIRM WORK-RELATED

    2. No

    3. DK

    4. REF


  1. Since [DATE: ONE YEAR AGO FROM TODAY], have you experienced an injury or illness, related to any job you had, that caused you to…

  1. Lose consciousness? 1) YES 2) NO 3)DK 4)REF

  2. Be unable to work for a day or more? 1) YES 2) NO 3)DK 4)REF

  3. Restrict your work activities? 1) YES 2) NO 3)DK 4)REF

  4. Transfer jobs? 1) YES 2) NO 3)DK 4)REF

  5. Get medical treatment other than first aid? 1) YES 2) NO 3)DK 4)REF


IF YES, COLLECT BRIEF DESCRIPTION AND CONFIRM WORK-RELATED.


  1. Since [DATE: ONE YEAR AGO FROM TODAY], have you experienced any of the following injuries related to any job you had? CUES:

    1. Sprains, strains or tears

    2. Soreness or pain

    3. Bruises or contusions

    4. Cuts, lacerations or punctures

    5. Broken bones

    6. Injury to muscles or joints

    7. Open wounds

    8. Burns

    9. Carpal tunnel syndrome

    10. Any other injury?

    1. YES COLLECT BRIEF DESCRIPTION, CONFIRM WORK-RELATED

    2. NO

    3. DK

    4. REF


  1. Since [DATE: ONE YEAR AGO FROM TODAY], have you experienced any of the following illnesses, related to any job you had? CUES:

    1. Skin disorders

    2. Respiratory conditions

    3. Poisonings,

    4. Hearing loss

    5. A disease or infection

    6. Cancer

    7. Any other illness?

  1. YES COLLECT BRIEF DESCRIPTION, CONFIRM WORK-RELATED

  2. NO

  3. DK

  4. REF



IF R HAS NOT REPORTED ANY INJURIES OR ILLNESSES ASK ABOUT INJURIES/ILLNESSES EVER EXPERIENCED. ELSE GO TO Q7.]


  1. Have you EVER experienced any injuries or illnesses related to any job you had?


  1. YES COLLECT BRIEF DESCRIPTION, CONFIRM WORK-RELATED

  2. NO GO TO PROBES AT END OF SCREENER SECTION THEN SKIP TO DEMOGRAPHICS

  3. DK GO TO PROBES AT END OF SCREENER SECTION THEN SKIP TO DEMOGRAPHICS

  4. REF GO TO PROBES AT END OF SCREENER SECTION THEN SKIP TO DEMOGRAPHICS



  1. [IF YES TO ANY INJURIES OR ILLNESSES] How many total times [since [DATE: ONE YEAR AGO FROM TODAY], did you experience/have you ever experienced] an injury or illness related to any job you had? [THIS WILL CREATE THE LOOPS.] ________TIMES


  1. [FOR EACH INJURY/ILLNESS] In what month and year did this injury/illness occur?


MONTH/YEAR

ENTER MM/YYYY

DK

REF


INTERVIEWER: CONFIRM NUMBER OF INCIDENTS AND BRIEF DESCRIPTION OF EACH. IF INJURY/ILLNESS EXPERIENCED WITHIN PAST YEAR, RESPONDENT WILL REPORT ON THOSE. OTHERWISE, IF NO INJURY/ILLNESS WITHIN PAST YEAR, RESPONDENT WILL REPORT ON INJURIES/ILLNESSES EVER EXPERIENCED.


Probes:

Screener

  • I started off by telling you that this survey is about work-related injuries and illnesses, or injuries and illnesses related to your job. In your own words, what would be a work-related injury or illness? Can you give me some examples of some things that would count as work-related injuries and illnesses? What would not count?

  • I asked you this question: “Since [DATE: ONE YEAR AGO FROM TODAY], have you experienced any injuries or illnesses related to any job you had?” In your own words, what is this question asking?

  • Tell me about the kind of work you do. Did you ever get hurt or sick because of the work you do? Tell me about that.

  • I asked you about whether you ever experienced any injury or illness, related to any job you had, that caused you to get medical treatment other than first aid. What does “first aid” mean to you? What kind of treatment counts as first aid? What kind of treatment doesn’t count?

  • Have you ever experienced a work-related injury or illness? Tell me about that.

  • The questions gave some examples of injuries and illnesses [LIST FROM Q4 AND Q5]. Tell me what you think of this list. Which ones have you heard of? Which ones had you not heard of?

  • How easy or hard was it to remember when the injury/illness happened? Can you tell me more about that? How did you figure out when the injury/illness happened?


Notes to interviewer:

The goal of the screener section is to enumerate all instances of work-related injuries and illnesses that occurred during the reference period. What issues do respondents have in reporting these incidents? Do they understand the types of injuries and illnesses to report? Can they accurately report only those that are work-related? How do they determine the boundary of the reference period and determine whether an incident occurred within the RP?



IF NO INCIDENTS OF WORK-RELATED INJURIES AND ILLNESSES, GO TO DEMOGRAPHICS SECTION.


Injury or Illness

[FOR FIRST INJURY/ILLNESS START AT Q10]

[FOR SECOND AND FOLLOWING INJURY/ILLNESS START AT Q9]


  1. [FOR SECOND/THIRD/ETC. LOOPS] How is this injury/illness related to the other injury/illness you mentioned? Is this related to [the other/another] injury/illness you already mentioned or is it a different injury/illness?

    1. RELATED TO THE OTHER/ANOTHER INJURY/ILLNESS [GO TO NEXT LOOOP]

    2. THIS IS A DIFFERENT INJURY/ILLNESS [CONTINUE]

    3. DK

    4. REF


  1. [FOR EACH LOOP] What happened? How did the injury or illness occur? [For example: “When ladder slipped on wet floor, I fell 20 feet”; “I was sprayed with chlorine when gasket broke during replacement”; “I developed soreness in wrist over time.”] [OPEN ENDED]



  1. [FOR EACH LOOP] What were you doing just before the incident occurred? Describe the activity as well as the tools, equipment, or material you were using. Be specific. [Examples: “climbing a ladder while carrying roofing materials”; “spraying chlorine from hand sprayer”; “daily computer key-entry.”]


a. DESCRIBE THE ACTIVITY.


DK

REF


b. DESCRIBE THE TOOLS, EQUIPMENT, OR MATERIAL THAT YOU WERE USING.] [OPEN ENDED]


DK
REF


  1. [FOR EACH LOOP] What object or substance directly harmed you? [Examples: “concrete floor”; “chlorine”; “radial arm saw.”]

          1. FLOORS, WALKWAYS, GROUND SURFACES

          2. VEHICLES

          3. WORKER MOTION OR POSITION

          4. CONTAINERS

          5. PARTS AND MATERIALS

          6. OTHER _______________

          7. NOT APPLICABLE

          8. DK

          9. REF


Body part/type of injury

  1. [FOR EACH LOOP] [INTERVIEWER NOTE: R should be more specific than “hurt,” “pain,” or “sore.” For example: “strained back”; “chemical burn, hand”; “carpal tunnel syndrome.”]


    1. How did this injury or illness happen?

  1. OVEREXERTION AND BODILY REACTION WHILE LIFTING, PULLING, ETC., OR PERFORMING A REPETITIVE MOTION

  2. FALLS, SLIPS OR TRIPS, FALLS ON THE SAME LEVEL

  3. CONTACT WITH OBJECTS OR EQUIPMENT, STRUCK BY OBJECT OR EQUIPMENT

  4. INJURY CAUSED BY ANOTHER PERSON OR AN ANIMAL

  5. INCIDENT RELATED TO A CAR, TRAIN, AIRPLANE OR OTHER FORM OF TRANSPORTATION

  6. EXPOSURE TO SOMETHING HARMFUL, SUCH AS ELECTRICITY, RADIATION, HEAT OR COLD, A NEEDLE OR SHARP OBJECT

  7. OTHER ____________________

  8. DK

  9. REF


    1. What part of your body was affected?

  1. ARM

  2. WRIST

  3. SHOULDER

  4. FINGERS

  5. HANDS

  6. HEAD

  7. KNEE

  8. ANKLE

  9. FOOT

  10. TOE

  11. BACK LOCATIONS (THORACIC, LUMBAR, SACRAL, COCCYGEAL)

  12. ENTIRE BODY

  13. LUNGS

  14. OTHER ORGANS

  15. OTHER ________________________

  16. DK

  17. REF


    1. How was it affected? What type of injury or illness affected your [PART OF BODY]?

  1. SPRAINS, STRAINS, TEARS

  2. SORENESS, PAIN

  3. BRUISES, CONTUSIONS

  4. FRACTURES

  5. CUTS, LACERATIONS, PUNCTURES

  6. BROKEN BONE

  7. INJURY TO MUSCLES OR JOINTS

  8. STRAINS OR SPRAINS

  9. OPEN WOUNDS, CUTS, BRUISES OR BURNS

  10. PAIN

  11. CARPAL TUNNEL SYNDROME

  12. SKIN DISORDERS

  13. RESPIRATORY CONDITIONS

  14. POISONINGS

  15. HEARING LOSS

  16. A DISEASE OR INFECTION

  17. AN ILLNESS SUCH AS CANCER

  18. ANY OTHER INJURY OR ILLNESS?

  19. DK

  20. REF




Probes:

Date of injury/illness

  • You said that the injury/illness happened in [Q8 MONTY/YEAR]. Tell me how you remembered the month and year this injury/illness occurred. How sure are you about that date?


Notes to interviewer:

How certain is the R of the month/year of the injury/illness? How did R determine when the incident happened?


Probes:

Characteristics of incident

  • Tell me more about what happened.

  • [READ QUESTION] Can you tell me in your own words what you think this question is asking?

  • [IF R DOES NOT INDICATE HOW INJURY/ILLNESS IS WORK-RELATED] Tell me more about how this injury/illness was related to your job. Where were you when this happened? What were you doing? What caused the injury/illness? Tell me more about the injury/illness.


Notes to interviewer:

Questions 10 through 13 are intended to capture (event or exposure, source of the injury/illness, part of body affected, and nature of the injury/illness). Do the questions elicit the information needed? Are the response options adequate to capture the information Rs give? Use general probing to elicit more information about the incident. (For example, if R says “I cut myself” ask: What part of your body was injured? What did you get cut with? What were you doing at the time?


Medical attention

  1. [FOR EACH LOOP] Was the injury/illness serious enough that a medical professional was consulted?

    1. Yes What type of medical professional did you see? (specify)___ ___________________

    2. No

    3. DK

    4. REF


  1. [FOR EACH LOOP]Did you get medical advice, treatment, or follow-up care for this injury/illness from…?


Yes

No

Not needed

DK/REF

An emergency vehicle, such as an ambulance or fire truck





An emergency room





A doctor’s office or other health clinic

Please include on site offices or clinics at your place of employment





A phone call to a doctor, nurse, or other health care professional





Any place else? Specify







  1. [FOR EACH LOOP] Were you in the hospital?

    1. YES How many nights were you in the hospital? _______ nights

    2. NO

    3. DK

    4. REF


  1. Did you receive a medical diagnosis from your healthcare professional?

    1. YES What was your medical diagnosis?

    2. NO

    3. DK

    4. REF



Effect on work

  1. [FOR EACH LOOP] Did you report this injury/illness to your employer?

  1. YES [SKIP TO Q20]

  2. NO

  3. DK

  4. REF


  1. [FOR EACH LOOP] IF NO TO REPORTING TO EMPLOYER: Why did you not report this injury/illness to your employer?

    1. Avoid being laid off YES NO DK REF

    2. Avoid loss of wages YES NO DK REF

    3. Avoid loss of promotion or advancement YES NO DK REF

    4. Avoid job transfer or restriction YES NO DK REF

    5. Employer would not recognize the injury/illness as

work-related YES NO DK REF

    1. Employer wants to keep injury and illness rates low YES NO DK REF

    2. Realized the injury/illness was work-related after

leaving the job YES NO DK REF

    1. Other (specify) YES NO DK REF



  1. [FOR EACH LOOP] Did the injury/illness cause you to…?

YES

NO

NOT NEEDED

DK/REF

a. Be unable to work the next day, whether or not you were actually scheduled to work? [ASK FOLLOW-UP QUESTION]





b. Work at your regular job less than your usual number of hours?





c. Work at your regular job, but be unable to perform all of the normal duties of the job?





d. Be assigned to another job on a temporary basis?





e. Be transferred?





f. Receive temporary disability benefits?





g. Quit your job?





h. Be laid off?





i. Be fired?





j. Change occupations?





k. Lose any wages?





l. OTHER (SPECIFY)






IF NO WORK DAYS MISSED, GO THROUGH PROBES THEN SKIP TO INTRO TO Q23.



Probes:

Medical attention (tailor probes based on whether R reported receiving medical attention)

  • Can you tell me in your own words what you think this question is asking?

  • Who do you think of as a medical professional? Who would you include or not include? [IF NEEDED ASK IF THESE WOULD COUNT: medical doctor, nurse, physician’s assistant, chiropractor, paramedic]

  • Did you go to a doctor, nurse, or other health care provider after [INCIDENT]? Did you go to the hospital or did paramedics come?

  • Is/Was there a medical clinic at your place of employment? Did you see anyone at that clinic?

  • Did you speak to a doctor, nurse, or another health care provider by phone after the incident?

  • Tell me more about the medical care you received after the injury/illness happened.

  • I asked you about whether you received a medical diagnosis. What does the term “medical diagnosis” mean to you? How do you get a medical diagnosis? Who gives you a medical diagnosis? Does a medical diagnosis have to come from a doctor or other health care professional?

Temporary disability

  • I asked about whether you received temporary disability benefits. Have you heard of temporary disability benefits? Can you tell me what this term means?


Notes to interviewer:

Does the R consider all potential sources of medical attention? Does R provide a complete report of medical care received, including both immediate and follow-up care?




Probes:

Effect on work


  • [IF YES TO MORE THAN ONE ITEM IN Q19] Tell me more about the reasons why you did not tell your employer about this injury/illness. Which was the main reason for not telling your employer?

  • IF YES TO ANY ITEM IN Q20: Tell me more about [TEXT FILL]. [E.g., Tell me more about your normal job duties. What duties were you unable to perform? OR Tell me more about why you quit your job? When did you quit? How was that related to your injury/illness?]

  • What does the term [TEXT FILL] mean to you? Can you give me an example? [E.g., What does it mean to you to be assigned to another job on a temporary basis? What does it mean to you to be transferred?]

  • What kind of effect did the injury/illness have on your work schedule? Job duties? Ability to work? Ability to keep your job? The pay you received?


Notes to interviewer:

Observe for signs of acquiescence bias in Q19. Are Rs saying “yes” because a reason sounds plausible or because it was a reason why R did not report an injury/illness? Ask for more detail and main reasons. How did R determine an answer to each item in Q19? Probe to explore understanding of terms, ability to accurately report on consequences of the injury/illness.




  1. [FOR EACH LOOP] IF YES ON MISSING DAYS OF WORK: How many calendar days, or days in a row, were you not able to work? This may include both the days you were scheduled to work and days you were not scheduled.

____DAYS

DK

REF


  1. [FOR EACH LOOP] How many days after the injury/illness were you able to start work again?

  1. _____DAYS AFTER THE INJURY/ILLNESS

  2. STILL OFF PAID WORK

  3. EXPECTS NEVER TO DO PAID WORK AGAIN

  4. BACK TO WORK SAME DAY

  5. DK

  6. REF




Probes:

Calendar days missed

  • How did you figure out the number of days you were not able to work?

  • Walk me through the timeline of when you were injured and when you got back to work.

  • I asked you [REPEAT QUESTION AND ITALICIZED INSTRUCTION ON CALENDAR DAYS NOT ABLE TO WORK]. Can you tell me in your own words what you think this question is asking? Can you think of a simpler way to ask this question? What does the term “calendar day” mean to you?

  • You said you missed XX calendar days of work. How did you figure that out?

  • Did your doctor or another medical professional recommend that you take days off from work? How many days off did they recommend?


Notes to interviewer:

Is R able to distinguish between work shifts vs. calendar days of work missed? Does R correctly report calendar days missed? How does R determine the days missed?


If reported no days missed in Q20, confirm that R is thinking of calendar days, not work shifts.



Workers’ compensation


Workers’ compensation is insurance that provides you with your lost wages and medical care when you become injured or ill due to your job. The next questions are about income you may have received from workers’ compensation.


  1. [FOR EACH LOOP] Has anyone filed a workers’ compensation claim for this injury/illness?

  1. YES

  2. NO [SKIP TO Q25]

  3. DK

  4. REF


  1. Who filed the workers’ compensation claim?

    1. EMPLOYER

    2. EMPLOYEE

    3. FAMILY MEMBER OF EMPLOYEE

    4. OTHER SPECIFY

    5. DK

    6. REF


GO TO SKIP INSTRUCTION BEFORE Q26.


  1. [FOR EACH LOOP] IF NO ON QUESTION ABOUT WORKERS’ COMPENSATION: What was the main reason you or your employer did not file a workers’ compensation claim for this injury/illness?

          1. Not eligible (did not meet waiting period)

          2. Employer refused

          3. Did not inform employer

          4. Worker unaware of workers’ compensation coverage

          5. Other reason, please specify

          6. DK

          7. REF


SKIP INSTRUCTION: IF YES TO Q20—MISSED DAYS OF WORK, GO TO Q26. ELSE IF WORKERS’ COMPENSATION CLAIM FILED (i.e., Q23=YES) SKIP TO Q27. ELSE GO TO PROBES AT END OF SECTION THEN SKIP TO Q28.


  1. IF R MISSED DAYS OF WORK FOLLOWING THE INJURY/ILLNESS: MARK YES OR NO FOR EACH QUESTION

YES

NO

NOT NEEDED

DK/REF

Workers compensation is insurance that provides you with your lost wages and medical care when you become injured or ill due to your job. Did you receive workers’ compensation?





Being kept on salary means that, after an injury or illness, your employer continued to pay the wages and other compensation you were receiving when the injury or illness occurred. Were you kept on salary?





Short-term or temporary disability benefits provide you with a portion of your income if you are temporarily unable to work due to a medical condition. Did you receive short term (temporary) disability?





Did you use sick leave, annual leave, or personal time off?





Did you take leave without pay?





Other-specify _____________






Definitions:

Workers compensation is insurance that provides you with your lost wages and medical care when you become injured or ill due to your job.

Being kept on salary means that, after an injury or illness, your employer continued to pay the wages and other compensation you were receiving when the injury or illness occurred.

Short-term or temporary disability benefits provide you with a portion of your income if you are temporarily unable to work due to a medical condition.



SKIP INSTRUCTION: IF WORKERS’ COMPENSATION CLAIM FILED (i.e., Q23=YES), GO TO Q27. ELSE GO TO PROBES AT END OF SECTION AND THEN SKIP TO Q28.



  1. [FOR EACH LOOP] IF FILED A WORKERS’ COMPENSATION CLAIM: Is there an open claim pending for this injury/illness?

  1. YES

  2. NO

  3. DK

  4. REF



Probes:

Workers’ compensation

  • ASK PROBES TAILORED TO THE REASONS R REPORTS ON WHY NO WC CLAIM WAS FILED BY EMPLOYER. EXAMPLES: Tell me more about the reasons why your employer did not file a workers’ compensation claim for this injury/illness? What did your employer say? Why did the employer refuse? How sure are you about whether or not your employer filed a claim?

  • Can you tell me what it means to file a workers’ compensation claim? Tell me what you know about that process.

  • Have you heard of [TEXT FILL]? Please tell me in your own words what you think [TEXT FILL] means: workers’ compensation, kept on salary, short-term or temporary disability, sick leave/annual leave/personal time off, leave without pay.


Notes to interviewer:

Do Rs know what workers’ compensation is? Do they know whether a WC form was filed? Are the terms in Q26 familiar to Rs and are the definitions helpful?






Occupation and Industry at Time of Injury or Illness



[FOR EACH LOOP] Thinking about the time of the injury/illness [TEXT FILL DESCRIPTION].

  1. Were you employed full-time or part-time?

    1. Full-time

    2. Part-time

    3. DK

    4. REF


  1. In a typical week, how many hours did you work? ______hours

IF NECESSARY: Was it greater than or equal to 35 hours per week?

DK
REF



Probes:

Hours worked

  • Do you work the same number of hours per week, or not? How did you determine how many hours per week you typically work?


Notes to interviewer:

Does R have any difficulty recalling FT vs. PT work? How do Rs with irregular work schedules, seasonal employment, etc., answer the question? Does the number of hours per week typically worked accord with report of FT/PT status?


  1. At the time of the injury/illness, were you …?

  1. An employee of a private for-profit company or business, or of an individual, for wages, salary, or commissions?

  2. An employee of a private not-for-profit, tax-exempt, or charitable organization?

  3. A local government employee (city, county, etc.)?

  4. A state government employee?

  5. A federal government employee?

  6. Self-employed in own not incorporated business, professional practice, or farm?

  7. Self-employed in own incorporated business, professional practice, or farm?

  8. Working without pay in family business or farm?

  9. DK
    REF


  1. For whom did you work? [OPEN ENDED]

DK

REF


  1. What kind of business or industry was this? [OPEN ENDED]

DK

REF


  1. Was this business or organization mainly manufacturing, retail trade, wholesale trade, or something else?

    1. Manufacturing

    2. Retail trade

    3. Wholesale trade

    4. Something else

    5. DK

    6. REF


  1. What did they make or do where you worked? [OPEN ENDED]

DK

REF


  1. In what state were you employed at this job?

DK

REF


  1. What kind of work did you do? (For example: registered nurse, personnel manager, supervisor of order department, secretary, accountant) [OPEN ENDED]

DK

REF


  1. What were your most important activities or duties? (For example: patient care, directing hiring policies, supervising order clerks, typing and filing, reconciling financial records) [OPEN ENDED]

DK

REF


  1. At this job, were you a member of a union or covered by a collective bargaining agreement?

  1. YES

  2. NO

  3. DK
    REF


  1. About how many workers were employed by [TEXT FILL EMPLOYER NAME]?

    1. 1 to 10 workers

    2. 11 to 49 workers

    3. 50 to 249 workers

    4. 250 to 999 workers

    5. 1000 or more workers

    6. DK

    7. REF


Probes:

Employment characteristics for job at time of injury/illness

  • Q38 (union): Have you heard of unions? Have you heard of a collective bargaining agreement? Tell me what those words mean to you.

  • Q38: Tell me how you decided on your answer. Tell me about the collective bargaining agreement. What union do/did you belong to?

  • Q39 ON HOW MANY WORKERS: Tellme how you figured out your answer to this question. Walk me through how you figured out that answer. How certain are you of your answer?


Notes to interviewer:

Observe respondent ability to understand and respond to questions about employment at time of the injury/illness. Probe as needed to explore an issues with response. Are respondents able to accurately report answers for Q38 and Q39?



IF R HAS ADDITIONAL INJURIES/ILLNESSES TO REPORT, GO BACK TO Q9. ELSE GO TO Q40.



Demographic Characteristics


Race/ethnicity

  1. Are you Spanish, Hispanic, or Latino?

  1. YES

  2. NO

  3. DK

  4. REF


  1. [I am going to read you a list of five race categories.] Please choose one or more races that you consider yourself to be:

  1. White

  2. Black or African American

  3. American Indian or Alaska Native

  4. Asian

  5. Native Hawaiian or Other Pacific Islander

  6. Other ________

  7. DK

  8. REF

Age

  1. What is your date of birth? Enter MM/DD/YYYY

DK

REF


  1. As of last week, that would make you approximately (AGE) years old. Is that correct?


[IF NECCESARY] Even though you don’t know your exact birthdate, what is your best guess as to how old you were on your last birthday?

______ years

DK

REF


Marital Type

  1. Are you now married, widowed, divorced, separated or never married?

    1. MARRIED - SPOUSE PRESENT

    2. MARRIED - SPOUSE ABSENT

    3. WIDOWED

    4. DIVORCED

    5. SEPARATED

    6. NEVER MARRIED

    7. DK

    8. REF


Gender

  1. Are you male or female?

  1. MALE

  2. FEMALE

Education

  1. What is the highest level of school you have completed or the highest degree you have received?

  1. Less than 1st grade

  2. 1st, 2nd, 3rd or 4th grade

  3. 5th or 6th grade

  4. 7th or 8th grade

  5. 9th grade or 10th grade

  6. 11th grade

  7. 12th grade NO DIPLOMA

  8. High school graduate - high school diploma or the equivalent (For example: GED)

  9. Some college but no degree

  10. Associate degree in college - Occupational/vocational program

  11. Associate degree in college -- Academic program

  12. Bachelor's degree (For example: BA, AB, BS)

  13. Master's degree (For example: MA, MS, MEng, MEd, MSW, MBA)

  14. Professional School Degree (For example: MD,DDS,DVM,LLB,JD)

  15. Doctorate degree (For example: PhD, EdD)



Current Industry and Occupation


The next questions are about your current job. If you have more than one job, please tell me about the job at which you usually work the most hours. If you work the same number of hours at two jobs, please tell me about the job where you were employed the longest.


  1. What is your current employment status? Are you currently employed full-time, part-time, or are you not employed?

  1. FULL-TIME

  2. PART-TIME

  3. NOT CURRENTLY EMPLOYED [SKIP TO END OF SURVEY]

  4. DK

  5. REF


  1. [IF CURRENTLY EMPLOYED] Is this job the same job with the same employer that you have already told me about?

    1. Same job with same employer [FOLLOW SKIP BELOW]

    2. Different job, same employer [SKIP TO Q49]

    3. Different employer [SKIP TO Q49]

    4. DK

    5. REF


  1. [IF YES AND ONLY ONE LOOP FOR INJURY/ILLNESS THEN SKIP TO END OF SURVEY. ELSE IF YES AND MORE THAN ONE REPORTED INJURY/ILLNESS AND EMPLOYER ASK:] Which job and employer is that?


  1. Currently, in a typical week, how many hours do you work? ______hours

IF NECESSARY: Was it greater than or equal to 35 hours per week?

DK

REF


  1. Are you …?

  1. An employee of a private for-profit company or business, or of an individual, for wages, salary, or commissions?

  2. An employee of a private not-for-profit, tax-exempt, or charitable organization?

  3. A local government employee (city, county, etc.)?

  4. A state government employee?

  5. A federal government employee?

  6. Self-employed in own not incorporated business, professional practice, or farm?

  7. Self-employed in own incorporated business, professional practice, or farm?

  8. Working without pay in family business or farm?

  9. DK

  10. REF


  1. For whom do you work? [OPEN ENDED]

DK

REF


  1. What kind of business or industry is this? [OPEN ENDED]

DK

REF


  1. Is this business or organization mainly manufacturing, retail trade, wholesale trade, or something else?

  1. Manufacturing

  2. Retail trade

  3. Wholesale trade

  4. Something else, specify:

  5. DK

  6. REF


  1. What do they make or do where you work? [OPEN ENDED]

DK

REF


  1. What kind of work do you do? (For example: registered nurse, personnel manager, supervisor of order department, secretary, accountant) [OPEN ENDED]

DK

REF


  1. What are your most important activities or duties? (For example: patient care, directing hiring policies, supervising order clerks, typing and filing, reconciling financial records) [OPEN ENDED]

DK

REF


Probes:

Employment characteristics for current job

  • Use general probes as needed to investigate issues with these questions.

  • Is the job you reported your only job or do you have more than one job?

  • [REREAD THE ITALICIZED INSTRUCTION ON WHICH JOB TO REPORT ON]. In your own words, what do you think this instruction means?


Notes to interviewer:

These questions are the same as for the job at time of the incident. Continue to observe for issues to explore.

Does R notice that this set of questions is about the current job? If R has more than one job, did R report on the correct one?


How do Q47 and Q48 function for determining that the current and former job are the same?



Debriefing questions for self-interview:


Recall and reference period

  • How easy or difficult was it for you to answer questions about injuries/illnesses that occurred over the last year?

  • How sure are you that the injury/illness you told me about happened in the last year?

  • Were there any questions that were particularly difficult to answer? Tell me more about that?

  • If I asked you about injuries/illnesses that happened during the past year, how easy or hard would it be to answer the questions I asked you?

  • When you signed up to do the survey, you may have seen a flyer or someone from NORC ask you about injuries and illnesses related to work that you may have had. Did you think about those injuries/illnesses you had, or did you do anything to get ready for the interview before you came? Tell me about that.

  • Imagine that you didn’t know ahead of time that this survey was going to be about work-related injuries and illnesses. If someone called you or came to your door, and asked you whether you had ever had a work-related injury or illness, do you think you would have remembered? How hard would these questions in the survey be, if you didn’t know in advance what the survey was about?

Sensitivity

  • Were you worried/Would you be worried about telling your employer about an injury/illness? Was it/Would it be hard for you to tell your employer? Tell me more about that.

  • Were you worried/Would you be worried about telling the government about an injury/illness? Why? Tell me more about that.

  • Were you worried/Would you be worried about telling anyone else about a work-related injury/illness? Tell me more about that.


Review of selected items

  • I’d like to ask you a little more about [QUESTION]. You said [FILL]. In your own words, what do you think that question was asking? How did you decide on your answer?


General debriefing

  • What are your suggestions on how to improve the survey?

  • What questions were the most difficult for you to answer?

  • What questions were the easiest to answer?


Notes to interviewer:

Is reporting work-related injuries and illnesses to the employer a sensitive issue? Why or why not? Is telling others outside the workplace about these incidents sensitive? Why or why not?


What questions are the most and least difficult for Rs to answer? What answers are they uncertain about? Do they have suggestions for improving the survey?


Return to any questions that need further exploration.




Debriefing questions for proxy respondents:


Proxy

  • What is your relationship to [RESPONDENT NAME]?

  • How much would you say you know about R’s job?

  • How familiar would you say you are with R’s work-related injury/illness? Are you aware of the medical treatment he/she received when the injury/illness occurred? Are you aware of how this affected R’s job? How did you learn about R’s injury/illness? Who in your household besides R would be the best person to answer the kinds of questions I asked?

  • What questions were the hardest for you to answer for R? Why? How much would you say you know about [QUESTION TOPIC]? How easy/hard is it to remember the information the question asked about? Tell me more.

  • What questions were the easiest for you to answer for R? Why? How much would you say you know about [QUESTION TOPIC]? How easy/hard is it to remember the information the question asked about? Tell me more.


Sensitivity

  • Were you worried/Would you be worried about telling anyone else about R’s work-related injury/illness? Tell me more about that.


Review of selected items

  • I’d like to ask you a little more about [QUESTION]. You said [FILL]. In your own words, what do you think that question was asking? How did you decide on your answer?


General debriefing

  • What are your suggestions on how to improve the survey?

  • What questions were the most difficult for you to answer?

  • What questions were the easiest to answer?


Notes to interviewer:

Is proxy reporting of work-related injuries and illnesses a sensitive issue? Why or why not?


What questions are the most and least difficult for Rs to answer? What answers are they uncertain about? Do they have suggestions for improving the survey?


Return to any questions that need further exploration.




Debriefing questions for those with no injury/illness to report:


Terms

How familiar are you with the following terms? Please tell in your own words what these terms mean to you?


Workers’ compensation, etc.

  • Worker’s compensation

  • Temporary disability

  • Short-term disability

  • Being kept on salary

  • Sick leave

  • Annual leave

  • Personal time off


Medical professional/calendar days/work shifts

ASK R: In the last year, have you had any injury or illness that was serious enough that a medical professional was consulted? Please include any injury whether or not it was work-related.

  • Who do you think of as a medical professional? Who would you include or not include? [IF NEEDED ASK IF THESE WOULD COUNT: medical doctor, nurse, physician’s assistant, chiropractor, paramedic]

  • When you became injured or ill, how many calendar days were you unable to do your usual activities?

  • Did you miss any work shifts? How many?

  • You said you were not able to do your usual activities for XX calendar days. How did you figure that out?

  • You said you missed XX work shifts. How did you figure that out?


Unions/collective bargaining agreement

  • Have you heard of unions? Have you heard of a collective bargaining agreement? Tell me what those words mean to you.

  • Q39 (how many workers): Tell me how you figured out your answer to this question. Walk me through how you figured out that answer. How certain are you of your answer?


Understanding of terms

  • Have you heard of the term “calendar days”? What does that term mean to you? What about the term “work shift”? What does that term mean to you? How are these terms the same? Different?

  • Who do you think of as a medical professional? Who would you include or not include? [IF NEEDED ASK IF THESE WOULD COUNT: medical doctor, nurse, physician’s assistant, chiropractor, paramedic]

  • Now I’d like to ask you about the term “medical diagnosis.” What does the term “medical diagnosis” mean to you? How do you get a medical diagnosis? Who gives you a medical diagnosis? Does a medical diagnosis have to come from a doctor or other health care professional?


STEP 3: END OF INTERVIEW


Thank you for taking part in this survey.


  • STOP THE RECORDER.


RECRUITMENT QUESTION:

We are looking for additional respondents like you who would be interested in helping with the study. Do you know anyone who had a work-related injury or illness who might be interested in participating? If yes, would you mind if we gave you a flyer about the study and send you an email about the study that you could forward to them?


INTERVIEWER: ANSWER ANY RESPONDENT QUESTIONS.


This concludes the interview. I would be happy to answer any questions that you have. Thank you for your help with this study.


  • PAY THE RESPONDENT AND OBTAIN SIGNATURE ON RECEIPT.



MATERIALS TO TAKE AWAY FROM INTERVIEW

      • INTERVIEWER PROTOCOL BOOKLET (THIS BOOKLET)

      • SIGNED CONSENT FORM

      • SIGNED PAYMENT RECEIPT

      • DIGITAL RECORDER AND BATTERIES

      • NOTE PAPER, PENS, PENCILS







Attachment 5: Participant Consent Form


CONSENT FORM


The Bureau of Labor Statistics (BLS) is conducting research to increase the quality of BLS surveys. This study is intended to suggest ways to improve the procedures the BLS uses to collect survey data.


The BLS, its employees, agents, and partner statistical agencies, will use the information you provide for statistical purposes only and will hold the information in confidence to the full extent permitted by law. In accordance with the Confidential Information Protection and Statistical Efficiency Act of 2002 (Title 5 of Public Law 107-347) and other applicable Federal laws, your responses will not be disclosed in identifiable form without your informed consent. The Privacy Act notice on the back of this form describes the conditions under which information related to this study will be used by BLS employees and agents.


During this research you may be audio and/or videotaped, or you may be observed. If you do not wish to be taped, you still may participate in this research.


We estimate it will take you an average of [enter #] minutes to participate in this research (ranging from [enter #] minutes to [enter #] minutes).


Your participation in this research project is voluntary, and you have the right to stop at any time. If you agree to participate, please sign below.


Persons are not required to respond to the collection of information unless it displays a currently valid OMB control number. The OMB control number is 1220-0141 and expires April 30, 2018.


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I have read and understand the statements above. I consent to participate in this study.



___________________________________ ___________________________

Participant's signature Date



___________________________________

Participant's printed name



___________________________________

Researcher's signature




44


File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorEdgar, Jennifer - BLS
File Modified0000-00-00
File Created2021-01-27
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