Appendix A Screening Questions

Cognitive and Psychological Research

Appendix A - Screening Questions

ORS Incumbent Survey Development Test

OMB: 1220-0141

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Appendix A: Screening Questions


  1. Are you currently employed either part-time or full-time?

    • Yes

    • No



  1. (If Yes to Q1) What is your current job title?




  1. (If Yes to Q1, and not obvious from Q2) Do you work in one of the following occupations?


  • Nursing Assistant

  • Childcare Worker

  • Truck driver (Long-haul)

  • Security Guard

  • Bank Teller

  • DOES NOT WORK IN THE TARGET JOBS (Stop)


  1. (If eligible for study) How long have you worked as a [fill with occupation from Q3] for your current employer?


  • Less than a year

  • 1 – 2 years

  • 3 – 5 years

  • 6 – 10 years

  • More than 10 years


  1. (If eligible for study) What is the highest level of education you have achieved, or the highest grade you have completed?


  • Less than HS

  • HS diploma or equivalent

  • Some college but no degree

  • BA or BS

  • Post Graduate (MA/MS, PhD, MD)

  • Other, specify


  1. (If Yes to Q1) How old are you?






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