Occupational Exposure Banding Survey

Form Approved

OMB No. 0920-0953

Exp. Date xx/xx/20xx

Your industry sector:___________________________________________________________________________

1. By which of the following organizations are you currently employed?

• Academic institution

• Union

• Professional or trade association

• Private business

• Government

• Other (please specify) ______________________________

2. Which of the following best describes your role?

• Environmental health and safety technician

• Industrial hygienist

• Safety manager

• Toxicologist

• Risk assessor/risk manager

• Other (please specify) ______________________________

3. Which of the following best describes your work experience?

• <5 years

• 5 – 15 years

• 16 – 25 years

• 26+ years

4. Do you have any professional certifications? Check all that apply.

• Certified Industrial Hygienist (CIH)

• Certified Safety Professional (CSP)

• Diplomate of the American Board of Toxicology (DABT)

• Certified Hazardous Materials Manager (CHMM)

• Other (please specify) ______________________________

5. Before today’s presentation, how familiar were you with the concept of Occupational Exposure Banding?

• Not at all familiar

• Not very familiar

• Somewhat familiar

• Familiar

• Very familiar

• Not at all familiar

• Not very familiar

• Somewhat familiar

• Familiar

• Very familiar

6. How useful to you is the Occupational Exposure Banding (OEB) process?

• Not at all useful

• Not very useful

• Somewhat useful

• Useful

• Very useful

7. How likely are you to use the OEB e-Tool?

• Not at all likely

• Not very likely

• Somewhat likely

• Likely

• Very likely

Public reporting burden of this collection of information is estimated to average 10 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. 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 (0920-0953).

• Not at all likely

• Not very likely

• Somewhat likely

• Likely

• Very likely

8. Where do you go to find new occupational safety and health (OSH) information? Check all that apply.

• Government agencies

• Trade associations

• Employer

• Professional associations

• Union

• Insurance companies

• Other (please specify) ______________________________

9. How do you like to receive OSH information? Check all that apply.

• Email

• Website posting

• Newsletter

• Social Media

• Conferences

• Employer sponsored training

• Third party sponsored training

• Pre-shift safety brief

• Other (please specify) ______________________________

10. Please rate today’s presentation in terms of its useful in your professional role:

• Not at all useful

• Not very useful

• Somewhat useful

• Useful

• Very Useful

11. Please provide any additional feedback you may have about the presentation, OEB process, or OEB e-tool.