Campaign Partner Feedback Form Mockup

Safe + Sound Campaign Partner Survey

OMB Control Number XXXX-XXXX
Expiration date X/XX/XXXX
PAPERWORK REDUCTION ACT
Public reporting burden for this voluntary collection of information is estimated to average 10 minutes per response, including time for reviewing
instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of
information. OSHA will use this information to evaluate partnership participation in OSHA's Safe + Sound Week. Persons are not required to
respond to the collection of information unless it displays a current valid OMB control number. If you have any comments about this estimate or
any other aspects of this data collection, including suggestions for reducing this burden, please send them to [email protected] or to US
Department of Labor, OSHA Directorate of Standards and Guidance N-3609, 200 Constitution Avenue, NW, Washington, DC 20210.

* 1. Name of Organization

2. Rate your partnership experience and available resources.
Strongly
Disagree

Disagree

Neutral

Agree

Strongly Agree

N/A

Strongly Agree

N/A

Partnering for the Safe +
Sound Campaign was a
positive experience for
my organization.
Comments

3. Rate your partnership experience and available resources.
Strongly
Disagree
The partner resources
provided were helpful in
communicating with my
members/stakeholders.
Comments

Disagree

Neutral

Agree

4. If you worked with OSHA to develop a safety information sheet for your

membership/stakeholders, please respond to the following question.
Strongly
Disagree

Disagree

Neutral

Agree

Strongly Agree

N/A

The process to develop
the safety information
sheet was a positive
experience for my
organization.
Comments

5. If you worked with OSHA to develop a safety information sheet for your

membership/stakeholders, please respond to the following question.
Strongly
Disagree
The information fact sheet
was a valuable resource
for my
membership/stakeholders.
Comments

Disagree

Neutral

Agree

Strongly Agree

N/A

6. What communication channels did you utilize to share information about and encourage

participation in the Safe + Sound Campaign? (Select all that apply).
Twitter
LinkedIn
Facebook
Blog Post
Email/Listserv
eNewsletter/Newsletter
Print Media
Calendar of Events
Website Announcement
Presentation
Press Release
Other
Comments

7. Do you have any metrics about the number of members/stakeholders that were reached

with these communications?

8. What Campaign events or resources did you find to be of most interest to your

stakeholders? (Select all that apply).
Safe + Sound Week
Live webinars
Pre-recorded/on-demand webinars
Materials developed in collaboration with your organization
Monthly communications updates
Local events
Other
Comments

9. Tell us about your Safe + Sound Campaign experience. What did you do? Please

describe any successes or outcomes you have seen.

10. What would improve your partnership experience in the future? Please be as specific

as possible (e.g., specific resources or materials, communications with OSHA, NSC,
NIOSH, ASSE, AIHA, CPWR, VPPPA).

11. Are you interested in sharing more about your experience?
(If yes, OSHA will contact you for further discussion).
Yes
No