Field TA Survey

COVID-19 Response Worker Safety and Health Site Visit Follow-Up Survey
Form Approved
OMB No. 0920-0953
Exp. Date 8/31/2021

The survey is for recipients of technical assistance on worker safety and health from CDC/NIOSH as part of the CDC COVID-19
response. We want to know your thoughts about our site visits so we can improve our technical assistance for the COVID-19 response
and future responses.
The survey is voluntary and will take about 12 minutes. The information you provide will be used for program improvement purposes
only, will not be shared in any way that would identify you or your organization. NIOSH will keep information you provide private and
secure to the extent permitted by law.

Public reporting burden of this collection of information is estimated to average 12 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 Reports Clearance Officer; 1600 Clifton
Road NE, MS D-74, Atlanta, Georgia 30333 ATTN: PRA (0920-0953)

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COVID-19 Response Worker Safety and Health Site Visit Follow-Up Survey
Site Visit
1. At the end of the site visit, did CDC/NIOSH give a good summary of what they did?
Yes
No
I don't know

2. What did you think about the site visit?
Excellent
Good
Fair
Poor

3. Please tell us more of your thoughts about the site visit.

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COVID-19 Response Worker Safety and Health Site Visit Follow-Up Survey
Technical Assistance
4. Please rate your agreement with the following statements.
Strongly agree

Agree

Disagree

Strongly disagree

The technical assistance
provided by CDC/NIOSH
was helpful.
I understood the
recommendations from
CDC/NIOSH.
I trusted the information
provided by the
CDC/NIOSH field team.

5. Overall, how would you describe the quality of the technical assistance you received?
Excellent
Good
Fair
Poor

6. Please tell us more of your thoughts about the technical assistance provided by CDC/NIOSH.

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COVID-19 Response Worker Safety and Health Site Visit Follow-Up Survey
Memo
7. Did you receive a memo from CDC/NIOSH after the site visit?
Yes
No
I don't know

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COVID-19 Response Worker Safety and Health Site Visit Follow-Up Survey
8. Did CDC/NIOSH issue the memo in a reasonable amount of time?
Yes
No
I don't know

9. Overall, how would you describe the quality of the memo you received?
Excellent
Good
Fair
Poor

10. Please tell us more of your thoughts about the memo.

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COVID-19 Response Worker Safety and Health Site Visit Follow-Up Survey
Workplace Changes
11. Did the CDC/NIOSH technical assistance change employer or employee thinking about the workplace
concerns?
Yes
No
I don't know

12. Please explain.

13. Did the CDC/NIOSH technical assistance change employer or employee behaviors about workplace
health and safety?
Yes
No
I don't know

14. Please explain.

15. How many recommendations were implemented?
All/nearly all

None

Most

I don't know

A few

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16. Why weren’t recommendations implemented? Check all that apply.
Too expensive

Inconvenient or uncomfortable for workers

Too time-consuming

I don't know

Too complicated
Other (please specify)

17. Please provide details about actions taken and not taken regarding the CDC/NIOSH recommendations.

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COVID-19 Response Worker Safety and Health Site Visit Follow-Up Survey
Wrap-up
18. Do you think CDC/NIOSH helped make things better at the workplace(s)?
Yes
No
Nothing needed to change

19. If yes, please describe positive changes

20. When did CDC/NIOSH provide technical assistance?
January-March 2020
April-June 2020
July-September 2020
October-December 2020
January-March 2021
April-June 2021

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