SOII Recontact Survey

Attachment B

SOII Follow-back survey

OSHA Form 300 request script

Thank you for your participation in our follow-back survey. To conclude, we are requesting the most up to date copy of your [OSHA Form 300/other recordkeeping form] used track your establishment’s injuries and illnesses in 2013. With receipt of this form, we can verify that our data accurately reflect what you have recorded.

After making a copy of your [Log of Work-Related Injuries and Illnesses (OSHA Form 300) or other form], if you could, please fax, mail, or e-mail this copy to us. The BLS 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 and other applicable Federal laws, your responses will not be disclosed in identifiable form without your consent.

INSTUCTIONS FOR SENDING FORMS

• WILL FAX  READ BLOCK A

• WILL EMAIL  READ BLOCK B

• WILL MAIL  READ BLOCK C

• REFUSED  READ BLOCK D

BLOCK A

Please fax your copies to (301) 251-xxxx. Please mark the attachment to the attention of [YOUR NAME].

As a participant in a BLS statistical survey, you should be aware that use of electronic transmittal methods in reporting data involves certain inherent risks to the confidentiality of those data.  Further, you should be aware that responsible electronic transmittal practices employed by the BLS cannot completely eliminate those risks.  The BLS is committed to the responsible treatment of the data you report and will take appropriate steps within our ability to protect the confidentiality of those data.

Thank you for helping us collect accurate information and for helping in the effort to make America’s work places safer and healthier. [END INTERVIEW]

BLOCK B

You may scan your copies and e-mail them as attachments to [email protected]. Please indicate on the subject line “SOII STUDY”.

As a participant in a BLS statistical survey, you should be aware that use of electronic transmittal methods in reporting data involves certain inherent risks to the confidentiality of those data. Further, you should be aware that responsible electronic transmittal practices employed by the BLS cannot completely eliminate those risks. The BLS is committed to the responsible treatment of the data you report and will take appropriate steps within our ability to protect the confidentiality of those data.

Thank you for helping us collect accurate information and for helping in the effort to make America’s work places safer and healthier. [END INTERVIEW]

BLOCK C

You may mail your copies to:

Westat, Inc.

1600 Research Blvd

Rockville, MD 20850

Thank you for helping us collect accurate information and for helping in the effort to make America’s work places safer and healthier. [END INTERVIEW]

BLOCK D

Thank you for helping us collect accurate information and for helping in the effort to make America’s work places safer and healthier. [END INTERVIEW]