Mine Worker Focus Group Worksheet

Attachment E

Mine Worker Focus Group Worksheet

Form Approved

OMB No. 0920-xxxx

Exp. Date xx/xx/20xx

Mine Worker Focus Group Worksheet

Participant Number: _______/ Date: _______

Job Type: ______________________________

1) In what ways does your job increase your exposure to respirable dust?

2) What have you been doing recently to try and reduce your exposure to respirable dust?

3) How can you help minimize respirable dust emitted?

5. What can you do to help other individuals perform their jobs in a way to help minimize the respirable dust emitted?

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).

Please mark the number below each statement or question that best describes your opinion using the following scale.

Strongly Disagree	Disagree	Somewhat Disagree	Somewhat Agree	Agree	Strongly Agree
1	2	3	4	5	6

	Strongly Strongly Disagree Agree
Changing my behavior is not possible given my job.	1	2	3	4	5	6
I have little control over my respirable dust exposure.	1	2	3	4	5	6
If I change my behaviors I will reduce my chance of getting CWP.	1	2	3	4	5	6
I feel healthier when my respirable dust is below the allowable limit.	1	2	3	4	5	6

I had conversations this week with co-workers about my CPDM readings.	Yes	No
I had conversations this week with my supervisor about my CPDM readings.	Yes	No

If applicable, list what you discussed this week related to your CPDM.