Non-Respondent Follow-up Interview

Attachment L

Non-Respondent Follow-Up Interview

Form Approved

OMB No. 0920-0949

Exp. date xx/xx/xxxx

Hello,

This is <name of research coordinator> calling from the University of Texas: School of Public Health about Project BLISS – a project to help Ohio wholesale and retail trade companies to reduce workers' compensation losses. Your company chose not to participate.

We need your help to better understand why Ohio wholesale and retail companies choose not to participate. Using a short 3-minute interview to compare firm size, sector, and other demographic information we are determining whether there are differences between companies who participated and didn’t.

We expect project results to help guide companies in adopting best practices for managing occupational safety and health and improving workers compensation outcomes. We are hoping your company will be part of this effort.

Do you agree to participate in this 3-minute interview?

IF NO

That’s ok, I appreciate you taking the time to speak to me.

IF YES THEN PROCEED TO NEXT PAGE

Public reporting burden of this collection of information is estimated to average1 hours 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 D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-0949).

Verbal Consent:

READ TO RESPONDENT

We would like to invite you to participate in a project being conducted by the University of Texas School of Public Health (UTSPH). The project is sponsored by the National Institute for Occupational Safety and Health (NIOSH) and the Ohio Bureau of Workers’ Compensation (OBWC).

The project’s purpose is to identify safety and health practices that reduce workers’ compensation claims and costs for Ohio wholesale and retail trade companies. Identifying safety and health practices associated with reduced claims and costs allows employers to better manage safety and health for improved outcomes. If you agree to participate:

• You will be asked to complete a 3 minute interview about you and your company’s demographic information

• Individual interviews will not be shared with OBWC.

• There is little anticipated risk to you from completing the interview. Your name and your company’s name will not be disclosed in any UTSPH, NIOSH or OBWC reports. Data will be treated in a secure manner and will be protected to the extent provided by law.

Your participation is voluntary and you may withdraw at any time without consequence to you or your company.

The new information gained is expected to improve our understanding of the safety and health practices that best prevent injuries and illnesses. There are no immediate direct benefits to you personally from participating.

If you have questions about this study, contact David Gimeno at the University of Texas School of Public Health (UTSPH). If you have questions about your rights as a member of this study, contact UT Compliance Hotline at 1-888-472-9868, www.uthouston.edu/compliance/reporting-issues/hotline.htm, or NIOSH at 513-533-8222, [email protected].

If you agree to participate we will proceed with the 3 minute interview

Principle Investigator Contact Information:

David Gimeno, Ph.D. UTSPH 7411 John Smith Drive, Suite 1120 San Antonio, TX 78229 210-562-5500 [email protected]

First I would like to get some information about your job and organization.

1. What is your job title? ___________________________________________

2. Please describe your main job duties and tasks: _______________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________.

3. Are you the key person responsible for safety & health at your organization?

 Yes

 No

 Other (please specify) ____________________________________________

________________________________________________________________

________________________________________________________________

4. Approximately how many employees are employed at your firm?

 < 20 employees

 20-99 employees

 100-999 employees

 1000 employees

5. Is your organization unionized?

Yes

No

Don’t know

Other (please specify) ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

6. Could you please tell us why you chose not to participate in the ” Best Practice Safety & Health Project” during the survey period?

It is of no value to the organization

It requires too much of my time

We have a policy in place to never participate in research

Leadership would say “No”

Other reason (please specify)_____________________________________________

7. How could we encourage you to participate in future surveys?

____________________________________________________________________________________________________________________________________________

____________________________________________________________________________________________________________________________________________

____________________________________________________________________________________________________________________________________________

Finally, I would like to quickly get some background information about you.

8. Are you…

Male Female

9. What is your birthdate? __________/ __________

MONTH YEAR

Thank you for taking the time to answer these questions.