Form 0920-0544 CSI Survey Shortl Intermediary Version

Attachment 3c -Short Survey, Intermediary Version

Form Approved

OMB No. 0920-0544

Exp. Date xx/xx/20xx

Welcome to the National Institute for Occupational Safety and Health (NIOSH)

Customer Satisfaction Survey.

If respondent initially declined to participate in the survey:

That’s okay—we know you’re busy.

But before you go, would you still be willing to answer a few questions?

They’ll take you less than 5 minutes.

YES NO

If YES is clicked, user is taken to the Short-version Survey.

If NO is clicked, user is shown this message:

Thank you for your time. For downloads of NIOSH’s most popular products and programs, click on these links:

• NIOSH Pocket Guide to Chemical Hazards: http://www.cdc.gov/niosh/npg/mobilepocketguide.html?s_cid=3ni7d2mnpg07112016

• NIOSH Ladder Safety Mobile Application: http://www.cdc.gov/niosh/topics/falls/mobileapp.html

• NIOSH Manual of Analytical Methods: http://www.cdc.gov/niosh/docs/2003-154/

• NIOSH Applications Manual for the Revised NIOSH Lifting Equation: http://www.cdc.gov/niosh/docs/94-110/pdfs/94-110.pdf

CDC estimates the average public reporting burden for this collection of information as 5 minutes per response, including the time for reviewing instructions, searching existing data/information sources, gathering and maintaining the data/information needed, and completing and reviewing 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 (0920-0544).

Customer Satisfaction Survey—Short

Intermediary Version

1. What type of organization do you work for?

___Company/business

___ Professional organization*

___ University/college*

___ Labor organization*

___ Industry or trade association*

___ Federal, state, or local government agency*

___ Other _____________________________

___ None of the above

[* Response coded as “intermediary”. Respondent will be shown intermediary version of the survey from here on.]

2. How often does your organization use the following to provide members with workplace (worker) safety and health information? Do any of these use NIOSH information? Please choose “N/A” (i.e., “not applicable”) if your organization does not have that channel.

Does your organization

How often? use NIOSH material?

Website Never ____ Sometimes ____ Often ____ N/A ____ Yes ___ No ___

Email notices Never ____ Sometimes ____ Often ____ N/A ____ Yes ___ No ___

Social media Never ____ Sometimes ____ Often ____ N/A ____ Yes ___ No ___

Newsletter Never ____ Sometimes ____ Often ____ N/A ____ Yes ___ No ___

Magazine Never ____ Sometimes ____ Often ____ N/A ____ Yes ___ No ___

Technical journal Never ____ Sometimes ____ Often ____ N/A ____ Yes ___ No ___

Conferences Never ____ Sometimes ____ Often ____ N/A ____ Yes ___ No ___

Training courses Never ____ Sometimes ____ Often ____ N/A ____ Yes ___ No ___

3. Does your organization provide members with any workplace (worker) safety and health information in languages other than English?

No _____ [If No or Don’t know, skip to Question #4.]

Yes _____ If yes, please specify language(s) ______________________________

Don’t know _____

In what formats does your organization provide information in languages other English?

Website ___ Emails ___ Social media ___ Newsletters ___

Other _________________________________________________________________

4. Please indicate how often you have done each of the following during the past 12 months based on information from one or more NIOSH publications and/or products (Please select one response per item.):

As a result of NIOSH publications and/or products, I have in the last 12 months:	Frequently >10 Times	Occasionally 3–10 Times	Rarely <3 Times	Never 0 Times	Not Applicable

a. Recommended a safety or health program for adoption by member organizations.

b. Recommended adoption of a technology or approach to improve health or safety practices

c. Used guidance and/or recommendations from NIOSH.

d. Seen greater knowledge of workplace (worker) health and safety issues in general.

e. Seen greater knowledge of workplace (worker) health and safety issues specific to my industry.

f. Seen improvement of safety practices within my organization.

g. Seen the improvement of the health and well-being of my organization’s members.

5. Please indicate your level of agreement with each of the statements below about NIOSH publications and products in general.

STATEMENTS		Strongly Agree	Agree	Neither Agree nor Disagree	Disagree	Strongly Disagree
	NIOSH publications contain current, up-to-date information.
	NIOSH publications are unbiased.
	NIOSH publications are written at the appropriate technical level.
	NIOSH publications are written in language that is clear.
	NIOSH publications provide useful and practical recommendations and guidance that are readily usable.
	The length of NIOSH publications is appropriate for coverage of the topic. NIOSH publications are delivered in a timely manner. It is easy to repackage NIOSH information and disseminate it according to my organization’s needs. i. The use of NIOSH products is perceived positively by my organization’s members. j. My organization is better able to meet the needs of its members with the use of NIOSH materials. k. NIOSH publications and resources are based on evidence and sound science.

6. Please indicate your level of agreement with each of the statements below about NIOSH as a source of OSH information.

STATEMENTS

Strongly Agree

Agree

Neither Agree nor Disagree

Disagree

Strongly Disagree

a. NIOSH is a credible source for obtaining

OSH information.

b. NIOSH is an important resource for the

OSH community.

c. Information from NIOSH is valuable to

my organization.

d. Members of my organization view open

and active partnerships with NIOSH

positively.

f. NIOSH is known for its commitment to

scientific and professional integrity.

g. NIOSH is known for its commitment to

transparency in the release of

information, policy statements, and

recommendations.

THANK YOU FOR COMPLETING THE QUESTIONNAIRE!

Your help is greatly appreciated. Further information about the NIOSH outreach initiatives can be found at the following links:

• National Institute for Occupational Safety & Health (NIOSH): http://www.cdc.gov/niosh

• NIOSH Newsroom: http://www.cdc.gov/niosh/newsroom/

• National Occupational Research Agenda (NORA): http://www.cdc.gov/niosh/nora

• Research to Practice (r2p): http://www.cdc.gov/niosh/r2p

• NIOSH Science Blog: http://blogs.cdc.gov/niosh-science-blog/

• Total Worker Health: http://www.cdc.gov/niosh/TWH/

• Prevention through Design (PtD): http://www.cdc.gov/niosh/topics/ptd