Sector Council Member Questionnaire - Word

Appendix D

Sector Council Member Questionnaire

Form Approved

OMB No. 0920-xxxx

Exp. Date xx/xx/20xx

INTRODUCTION: You’ve been selected to participate in this brief survey about your experiences as a member of a National Occupational Research Agenda (NORA) sector council during the second decade of the NORA (April 2006 to present).

It should take you about 15 minutes to complete the questionnaire. Your responses are voluntary and you can discontinue participation in this questionnaire at any time. You will be able to save your answers and return to the questionnaire at a later time for completion or to change your responses until the survey period ends.

If you served on multiple sector councils, please answer the following questions for the council in which you were the most active.

Section 1. Background

First, we will ask you some questions about the organization that you represent and your level of involvement on the Sector Council.

1. What sector council did you serve on during the second decade of NORA? If you served on more than one sector council, please select the one council in which you were the most active.

a) Agriculture, Forestry and Fishing

b) Construction

c) Healthcare and Social Assistance

d) Manufacturing

e) Mining

f) Oil and Gas Extraction

g) Public Safety

h) Services

i) Transportation, Warehousing and Utilities

j) Wholesale and Retail Trade

1a. How many years did you serve on this sector council?
Enter a whole number between 1 and 9 _____

1.2. What is/was your primary role on the sector council?

a. Council Leader: Co-Chair, Program Manager, Program Coordinator, or Assistant Coordinator

b. Council Member

c. Uncertain

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 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).

1.3. Please select the type of organization you represented during your tenure on the council. (Please select only one.)

a. NIOSH

b. Other federal, state, or local government agency

c. Labor/union

d. Industry/corporation

e. Academia

f. Other research organization

g. OSH professional association

h. Other (Please Describe) _____________________________

Demographics (Leveraging of Funds)

1.4. We would like to know about the different types of resources that were contributed to support the work of the sector council. The work of the council may have included meetings, development of council products (agendas, fact sheets, and white papers) and other council activities (presentations, building partnerships, holding conferences).

Thinking about your participation on the council, please indicate whether you or your organization contributed the following resources.

Please estimate the number of resources contributed as an annual average:

1. On average, how many days did you contribute to council activities each year?
   

1. 0

2. 1-3 per year

3. 4-6 per year

4. 7-9 per year

5. 10-12 per year

6. 13 or more per year

Please estimate the dollar value of resources contributed as an annual average.

2. On average, how much direct financial support was contributed each year by you or your organization? Examples of direct financial support include the cost of travel, conference calls, meeting space and materials.

1. $0

2. $1-$1000 per year

3. $1001-$5000 per year

4. Above $5000 per year
   
   
   

Please estimate the number or dollar value of resources contributed as an annual average.

3. If you or your organization contributed other types of resources for direct council activities, please describe up to three types and estimate the number or dollar value contributed on average each year.

Resource 1 (Describe): ____________________
Number or Dollar Value of Average Annual Contribution: ______

Resource 2 (Describe): ____________________
Number or Dollar Value of Average Annual Contribution: ______

Resource 3 (Describe): ____________________
Number or Dollar Value of Average Annual Contribution: ______

Section 2. Council Effectiveness

The sector council mission is to develop a strategic plan for occupational safety and health research for the nation and promote adoption of improved workplace practices. In this section, we will ask questions about your satisfaction with different aspects of sector council activities and products related to that mission. Please rate your level of satisfaction in each of the areas below using the following scale:

2.1 Overall how satisfied are you with the effectiveness of the sector council?

(1) Very Dissatisfied (2) Dissatisfied (3) Neutral (4) Satisfied (5) Very Satisfied

2.1a. What were the most effective aspects of the sector council? (Check all that apply)

a. Developing research agenda and goals

b. Stakeholder involvement

c. Development of informational products

d. Communication of council priorities to sector stakeholders

e. Meeting sector needs

f. Productivity of council meetings

g. None

h. Other (please explain) _________________

2.1b. What were the least effective aspects of the sector council? (Check all that apply)

a. Developing research agenda and goals

b. Stakeholder involvement

c. Development of informational products

d. Communication of council priorities to sector stakeholders

e. Meeting sector needs

f. Productivity of council meetings

g. None

h. Other (please explain) _________________

2.2. Thinking about the role of the sector council leadership (council co-chairs, program manager, coordinator and assistant coordinator) to facilitate council activities, please rate how satisfied you are with the following:

a. Leadership’s ability to clearly articulate a vision for the council

(1) Very Dissatisfied (2) Dissatisfied (3) Neutral (4) Satisfied (5) Very Satisfied

b. Inclusion of appropriate stakeholders/partners on the sector council

(1) Very Dissatisfied (2) Dissatisfied (3) Neutral (4) Satisfied (5) Very Satisfied

c. Effectiveness of sector council meetings

(1) Very Dissatisfied (2) Dissatisfied (3) Neutral (4) Satisfied (5) Very Satisfied

d. Effectiveness of leadership’s communication with council members

(1) Very Dissatisfied (2) Dissatisfied (3) Neutral (4) Satisfied (5) Very Satisfied

Section 3. Impact

In this section, we will ask questions about how sector council activities made a difference in the sector.

3.1. Did the council research agenda address the most pressing needs of the sector? Yes/No/Uncertain

3.2. Did the council research agenda result in improved workplace health and safety? Yes/No/Uncertain

3.3. Did the work of the council lead to adoption of improved workplace practices in the sector? Yes/No/Uncertain

3.4. We are interested in examples of successful council activities that made a difference in the sector. Please use the space below to describe up to three activities and how they made a difference.

Example 1.

Example 2.

Example 3.

Section 4. The Next Decade of NORA

We are interested in suggestions that will help inform the third decade of NORA. This section will ask questions about how this decade was structured and seek recommendations for the next decade.

4.1. Was the sector based structure an effective way to organize the second decade of NORA?
Yes/No/ Uncertain

4.2. Do you have any recommendations for how to structure the next decade of NORA? Please describe.

Thank you for your time.
We appreciate your participation in NORA.

Your responses are very important to the review of the second decade of NORA in preparation for the next decade.