Survey Questionnaire for OSHA Challenge Administrators

Form Approved
OMB No. 1225-0088
Exp. Date: 10/31/2020
Survey Questionnaire for OSHA Challenge
1.
o
o
o
o
o
o
o

Are you a current OSHA Challenge Administrator? Yes/No
If No: Why are you no longer an Administrator? (Select all that apply)
Lack of time to recruit participants
No interest by companies/employers in my area
No longer fit with our organization’s strategic goals
All of our participants dropped out/didn’t complete Program
No longer have budget to cover time & expenses
Took too much time to work with participants
Other (must complete why)

2.
O
O
O
O

Why were you interested in becoming an Administrator in the first place?
(Select all that apply).
Fit in with our organization’s mission/strategic goals
Were recruited to become an Administrator to assist OSHA
As a VPP site we want to mentor other sites
Other (must complete why)

3.

Would you consider becoming an Administrator again? Yes/No

4.
O
O
O
O
O

On average, how much time did you spend with each Challenge Participant?
1-2 hours per week
1-2 hours per month
1-2 hours per quarter
1-2 hours per 6 months
Other (must complete why)

5.

As an administrator for you organization, are you performing these duties in
a full or part time capacity?

6.

Based on your experience, how many participants should each Coordinator
be expected to mentor at a time?
1-2
2-4
4-6
6-8
8-10
10+

O
O
O
O
O
O

Paperwork Reduction Act Notice
Public reporting for this collection of information is voluntary and is estimated to average 45 minutes 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. Persons are not required to respond to the collection of information unless it
displays a currently valid Office of Management and Budget (OMB) control number. If you have any comments regarding this
estimate or any other aspect of this information collection, including suggestions for reducing this burden, please send them to
OSHA Office of the Chief Information Office 200 Constitution Avenue, N.W., Washington, D.C. 20210.

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O
O
O
O
O
O

How many participants have/did you help to enter the Program?
0-5
6-10
11-15
16-20
21-25
25+

8
O
O
O
O
O

What support would you find helpful in being an Administrator? (Select all
that apply)
Orientation/Training
Quarterly Administrator Phone Conferences
Face-to-Face Meetings
Working with local OSHA VPP Coordinator
Other (must complete what is needed)

9.

What other resources do you need? (Open Ended Question)

10

Would you be willing to discuss your answers, if needed? (Optional)Yes/No
Contact Information: Name, Organization, Email, Phone

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