Attachment G
Mine Specific Risk Tolerance Measure
Form Approved
OMB No. 0920-xxxx
Exp. Date xx/xx/20xx
Mine Specific Risk Tolerance Measure
Please indicate how comfortable you are with each of the following scenarios by putting a circle around the option you prefer. Please do not think too long before answering; usually your first inclination is also the best one.
Risk Scenario 1: Low Personal Risk
It is the end of the work shift. On the way out a worker notices a broken electrical conduit. It is not in his area of the work site. Reporting the problem will make him late getting home. He leaves without reporting what he saw.
If you did this, how comfortable would you be?
Very Comfortable Comfortable Uncomfortable Very Uncomfortable
Risk Scenario 2: Medium Personal Risk
It is Friday, the end of the work week. The person responsible for doing the preshift inspections is rushed for time. Today, he hurries through the pre-shift inspection in just a few minutes. Usually, the inspection takes much longer to complete thoroughly.
If you did this, how comfortable would you be?
Very Comfortable Comfortable Uncomfortable Very Uncomfortable
Risk Scenario 3: High Personal Risk
A worker is in the process of changing a screen and he drops a wrench onto the conveyor belt. Instead of locking out the conveyor belt first, he climbs onto the belt, picks up the wrench and continues working.
If you did this, how comfortable would you be?
Very Comfortable Comfortable Uncomfortable Very Uncomfortable
Public reporting burden of this collection of information is estimated to average 6 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).
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | Foley, Tamekia (CDC/NIOSH/OD) |
| File Modified | 0000-00-00 |
| File Created | 2021-01-24 |