Name |
Phone/Room number |
Outcome: See Code Below |
Notes |
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Outcome:
E: eligible and completed questionnaire
NE: not eligible
DEC: eligible but declined non-response questionnaire,
NR: eligible and took non-response questionnaire
MIA: cannot find or left site.
NOTE: UPON COMPLETION OF SURVEY ADMINISTRATION AT LOCATION, DESTROY THIS SHEET
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | Retzer, Kyla D. (CDC/NIOSH/WSD) |
| File Modified | 0000-00-00 |
| File Created | 2021-01-22 |