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pdfAppendix E: Telephone Screener, Scripts, and Verbal Assent
If in-bound call,
Thank you for expressing an interest in this study. Before we begin, could you please provide the unique
ID indicated on the letter you received?
Insert unique ID _______
Just to make sure we are talking with the correct household, could you please share with us your address?
Check to see that the address matches the address we have on file
If unique ID and address don’t match
END SCREENER SCRIPT: Unfortunately [that is an incorrect ID and we are/ we need the unique ID
and are/ we are], unable to locate the address on file. Please call back when you have the correct unique
ID.
If address matches,
Hello, this is [NAME] calling for the U.S. Consumer Product Safety Commission from EurekaFacts, a
survey research company in Rockville, MD. We are conducting an important nationwide survey about
household fire and carbon monoxide safety.
May I speak with _________________?
[REPEAT IF A DIFFERENT PARTICIPANT COMES TO THE PHONE: Hello, this is [NAME] calling
for the U.S. Consumer Product Safety Commission from EurekaFacts, a survey research company in
Rockville, MD. We are conducting an important nationwide survey about household fire and carbon
monoxide safety.]
We are not selling anything. Your answers will help the U.S. Consumer Product Safety Commission
improve home safety and save lives. Your own experiences and thoughts on the topic are extremely
valuable to this effort.
We are interested in talking with people who live in households which do and do not have smoke
detectors and carbon monoxide detectors. By answering a few questions about your residence, we can
determine which type of interview you are eligible for. If you participate, you would receive a gift card
from a major credit card company in appreciation for your completion of the survey. Your input will
greatly help this research study.
I have just five brief questions to ask. It should only take two minutes of your time.
[If No] “Thank you very much for your time. Have a nice day/evening.”
[If Yes] “Great, thank you very much. Let’s begin….”
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GO TO QUESTION 1
If out-bound call
Hello, this is [NAME] calling for the U.S. Consumer Product Safety Commission from EurekaFacts, a
survey research company in Rockville, MD. We are conducting an important nationwide survey about
household fire and carbon monoxide safety.
May I speak with _________________?
If unavailable,
“Is there another person I can speak to who may be considered one of the heads of the
household?”
If not at the moment,
“When would be a convenient time to reach them?”
If participant rescheduled, please fill out the following information:
Date
Time
Contact information
____________
____________
____________
If refused,
“Thank you for taking the time to talk with me today. Have a great day/evening.”
If available, reintroduce yourself and company again,
We are not selling anything. Your answers will help the U.S. Consumer Product Safety Commission
improve home safety and save lives. Your own experiences and thoughts on the topic are extremely
valuable to this effort.
We are interested in talking with people who live in households which do and do not have smoke
detectors and carbon monoxide detectors. By answering a few questions about your residence, we can
determine which type of interview you are eligible for. If you participate, you would receive a gift card
from a major credit card company in appreciation for your completion of the survey. Your input will
greatly help this research study.
I have just five brief questions to ask. It should only take two minutes of your time.
[If No] “Thank you very much for your time. Have a nice day/evening.”
[If Yes] “Great, thank you very much. Let’s begin… .”
Screener
[Interviewer: Determine recruitment needs in advance. Record all responses. End screener at whatever
point the participant gives a response that confirms that their group has already been sampled adequately.
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End screener script: Based on the requirements of this study, we are not able to include you in the survey
at this time.]
NOTE: For each question on the screener and survey, only read the available response options if there are
instructions to do so. The instructions will appear at the end of the question usually as “(READ LIST).”
Otherwise, DO NOT read the possible response options to the respondent.
1. To make sure we are talking to a variety of people, what is your age? (Interviewer instruction: If
Refused, ask: Could you tell me, are you 18 years of age or older?
_____ years (INSERT VERBATIM RESPONSE)
a. Under 18 (Go to 1A)
b. Don’t Know (DON’T READ)
c. Refused (DON’T READ)
1A. Is there another person available we may speak with, who is 18 years or older and may be
considered one of the heads of the household?
a. Yes
b. No (Terminate)
END SCREENER SCRIPT: Thank you for speaking with us today. Based on the requirements of this
study, we are not able to include you in the survey at this time.
2. Are you one of the heads of the household?
a. Yes (Go to Q3)
b. No (Go to Q2A)
2A. [IF NO] Is there another person I may speak to who might be considered one of the heads of
the household?
a. Yes (Start from beginning)
b. Yes, but they are currently unavailable
c. No (Terminate)
If Q2A = 2
If a head of the household is unavailable: We would like to speak with one of the heads of the
household. What would be the best day and time to reach them?
If participant rescheduled, please fill out the following information:
Date
Time
Contact information
____________
____________
____________
If Q2 = 2 and Q2A = 3
END SCREENER SCRIPT : “Thank you for your time. Have a nice day.”
3. What type of residence do you live in? (READ LIST IF NECESSARY)
a. Single Family Detached Home
b. Single Family Attached Housing, such as a townhouse or row house
c. Apartment/Condominium
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d. Mobile/Other Manufactured Home
e. Trailer/RV
f. Other (Specify) (DON’T READ)____________________________________________
4. Do you have any smoke detectors in your home? When considering whether you do, please do not
include any uninhabited outbuildings or apartment hallways.
a. Yes
b. No (SKIP TO SCRIPT 2)
c. Don’t know (ASK RESPONDENT TO INSPECT, IF NO SKIP TO SCRIPT 2, ELSE CONTINUE)
Don’t know: “If you don’t mind, could you please take a quick look around your home to see if you
have a smoke detector?”
If needed:
•
•
Smoke detectors are typically installed on the ceilings or high on the walls of:
o Kitchens
o Bedrooms
o Hallways
They are housed in white plastic enclosures, usually shaped like a disk about 6 inches in diameter.
4A. Are any of your smoke detectors connected to a central alarm or security system that
notifies the police or fire department?
[If apartment/condominium: Only consider the smoke detectors in your unit. Are these
connected to a central alarm or security system that notifies the police or fire
department?]
[If needed: What we mean by this is if the smoke detector detected smoke, it would
automatically notify the police or fire department.]
a. Yes (SKIP TO SCRIPT 3)
b. No (SKIP TO SCRIPT 1)
c. Don’t know (GO TO Q4B)
4B. Thinking of all fire or smoke related incidents, has the police or fire department ever
arrived at your residence in response to a notification from a central alarm or security
system? (READ ALL OPTIONS BEFORE SELECTING A RESPONSE)
a. Yes (SKIP TO SCRIPT 3)
b. No (GO TO SCRIPT 1)
c. Never had a fire or smoke related incident (SKIP TO SCRIPT 3)
If Q4 = 2 SKIP TO SCRIPT 2
If Q4a = 1 OR Q4b = 1 or 3 SKIP TO SCRIPT 3
ELSE, GO TO SCRIPT 1
SCRIPT 3
QUALIFY FOR PHONE SURVEY- Group with Central Alarm
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Thank you for answering these questions. Since your smoke detector is attached to a central system, you
are not eligible for the in-home interview; you are, however, eligible for the shorter telephone interview
and will receive a $10 gift card from a major credit card company in appreciation fo completion of the
survey.
We are talking with residents about household fire and carbon monoxide safety. The interview lasts about
20 minutes, and will be completed over the phone. We will send you a $10 gift card from a major credit
card company in appreciation for completion of the survey.
Your responses to this survey will be kept completely confidential and your information will not be
shared with anyone other than the EurekaFacts research team. Any information provided to the U.S.
Consumer Product Safety Commission will be reported as group data with no identifying information.
The survey is very important and will help CPSC improve home safety and save lives.
Are you interested in participating?
[If No] “Thank you very much for your time. Have a nice day/ evening.”
[If Yes] “Okay.”
As I previously mentioned, this survey will take about 20 minutes to complete. Would you like to take the
survey now, or reschedule it for another time?
[If now] – CONTINUE To Assent Script
[If at a later time]
“When would be a convenient time for us to call back?”
If participant rescheduled, please fill out the following information:
Date
Time
Contact information
____________
____________
____________
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Verbal Assent Script
All information provided will remain confidential and will only be reported as group data with no
identifying information. Identifying information will be kept separately from the survey responses, and
your name will not be disclosed in any way. Instead, your responses will be marked with a random ID
number. All survey responses will be kept in a secure location. If any information is stored on the
computer, it will be password-protected. This conversation is not being recorded but notes will be taken.
Your participation does not involve any risks other than what you would encounter in daily life. By
participating, you will help researchers learn more about use and functionality of smoke detectors and
carbon monoxide detectors in households. The survey should take about 20 minutes to complete, and you
will receive a $10 gift card from a major credit card company in appreciation for completion of the
survey.
Your participation in this research study is completely voluntary. You do not have to respond to any
questions that you do not want to answer. You can withdraw at any time.
If you have questions regarding this study, you may contact Andrea Ton at [NUMBER] or [EMAIL
ADDRESS].
7b. Do you agree to participate in this survey?
a. Yes
b. No
[If No] “Thank you very much for your time. Have a nice day/ evening.”
[If Yes] “Great. Let’s begin.” GO TO Telephone Survey for Group With Smoke Detectors as Part of
Central Alarm [Appendix K].
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INCENTIVE VERIFICATION
Thank you so much for participating in this survey. Your answers will help CPSC with improving
household fire and CO safety across the U.S.
As appreciation for completing the survey, we would like to send you a $10 gift card from a major
credit company. Could you please provide your full name and mailing address?
Interviewer: Fill in the blank with the respondent’s name and address, and verify it. If
needed, assure the respondent of the confidentiality of the information provided.
Full Name:_________________________________
Street _________________________________
Apt/Suite/Other__________________
City_____________________
State____________
Zip/ Postal Code____________
You will receive your gift card in the mail in the next few weeks.
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Appendix F: Telephone Survey for Group With Smoke Detectors as Part of Central Alarm
TELEPHONE SURVEY FOR NATIONAL SMOKE AND CARBON MONOXIDE DETECTOR
SURVEY [WITH SMOKE DETECTOR AS PART OF CENTRAL ALARM]
Continuation of Script 3 from Appendix I above.
8. You had previously mentioned that you have one or more smoke detectors. Please tell me
to what extent do you believe your home is safe with your current smoke
detectors? Would you say... (READ LIST)
NOTE: Read the descriptors, but do not read the numbers.
Not at
all safe
(1)
9a.
Slightly Moderately
safe
safe
(2)
(3)
Mostly
safe
Very
safe
(4)
(5)
(DON’T (DON’T
READ) READ)
DK
RF
(8)
(9)
Do you have any carbon monoxide detectors in your home? When considering
whether you do, please do not include any uninhabited outbuildings or apartment
hallways. (DO NOT READ LIST)
Yes
No (SKIP TO Q10)
Don’t know (ASK TO INSPECT. IF YES CONTINUE, BUT IF NO TREAT AS
“NO” CO DETECTOR)
9b.
Are any of your carbon monoxide detectors connected to a central detector
or security system that notifies the police or fire department? (DO NOT
READ LIST)
[If needed: What we mean by this is if the carbon monoxide detector detected carbon monoxide,
it would automatically notify the police or fire department.]
Yes (SKIP TO Q9d)
No (SKIP TO Q9d)
Don’t Know (CONTINUE)
9c.
Thinking of all carbon monoxide related incidents, has the police or fire
department ever arrived at your residence in response to a notification from
a central alarm or security system? (READ ALL OPTIONS BEFORE
SELECTING A RESPONSE)
Yes
No
Never had a carbon monoxide related incident
IF 9b = 1 or 9c = 1 or 3, CONTINUE
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ELSE, SKIP TO 10
9d.
Please tell me to what extent do you believe your home is safe with your
current carbon monoxide detectors? Would you say... (READ LIST)
NOTE: Read the descriptors, but do not read the numbers.
Not at Slightly Moderately Mostly
all safe
safe
safe
safe
(1)
(2)
(3)
(4)
Very
safe
(5)
(DON’T (DON’T
READ) READ)
DK
(8)
RF
(9)
10.
Do you or another member of your household own or rent your home? (DO NOT
READ LIST)
Own
Rent
Don’t know
Refused
Other
11.
How long have you lived in this (apartment/ house)? Would that be… (READ LIST)
Less than 6 months
6 to 11 months
1 to 5 years
6 to 10 years
11 years or more
Don’t know (DON’T READ)
Refused (DON’T READ)
12.
Please tell me to the best of your knowledge, in what year was this (apartment/
house) built? Was it… (READ LIST)
2010 or later
Between 2000 and 2009
Between 1990 and 1999
Between 1980 and 1989
Before 1980
Don’t know (DON’T READ)
Refused (DON’T READ)
If Q3 = 1 or 2, CONTINUE
ELSE, SKIP TO 14
13a.
What type of fuel-burning appliances, if any, do you use in your home? By fuel
burning appliances, we mean appliances that use gas, propane, oil, wood, wood
pellets, coal, or kerosene. Do not include electric-powered appliances. (READ LIST,
SELECT ALL THAT APPLY)
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Gas powered generator
Furnace or boiler
Water heater
Charcoal grill
Gas Dryer
13b.
Does this residence have an attached garage unit? (DO NOT READ LIST)
Yes
No (SKIP TO Q14)
Don’t know (SKIP TO Q14)
Refused (SKIP TO Q14)
13c.
14.
Wood or pellet burning fireplace or stove
Kitchen applicances (e.g., stove, oven)
Other (Specify) ________________________
Do not own any fuel-burning appliances
Don’t know (DON’T READ)
Refused (DON’T READ)
For what purposes is the attached garage used? Would you say… (READ
LIST, SELECT ALL THAT APPLY)
Workshop/ workspace
Store tools or lawn/ sports equipment
Store vehicle(s) (e.g., motorcycle, car, SUV, van, etc.)
Fuel burning appliances (e.g., furnace, water heater, etc.)
Other (Specify:)___________________________
Don’t know (DON’T READ)
Refused (DON’T READ)
Do you know how to… (INSERT ITEM), or not?
Yes
No
(DON’T
READ)
Unsure
(DON’T
READ)
Refused
a. Install a smoke detector?
b. Maintain a smoke detector
in good working order?
FIRE HISTORY
15a.
In the past 12 months, have you had any accidental fires – that is unintended or
unwanted smoke or flames - in your home? Please include fires that were too small
to call the fire department. (DO NOT READ LIST)
Yes
No
Don’t know
Refused
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CO DETECTORS
16.
How would you know if high levels of carbon monoxide, or CO, were present in
your home? (DO NOT READ LIST, SELECT ALL THAT APPLY).
You can smell it
You can taste it
You can see it
You can feel it
Carbon monoxide detector
Other (Specify:)___________________________
Respondent does not believe there is a way to know if CO is present
Don’t know
Refused
17.
How much do you believe you know about carbon monoxide detectors (READ
LIST)
Nothing at all
A little
Some
A lot
Don’t know (DON’T READ)
Refused (DON’T READ)
18.
In the past 12 months, were you aware that any of your friends, relatives, neighbors,
or coworkers experienced… (INSERT ITEM)?
Yes
No
(DON’T
KNOW)
Unsure
(DONT
KNOW)
Refused
a. An accidental fire?
b. A carbon monoxide incident?
(e.g., effects of carbon
monoxide poisoning)
NO CO DETECTORS PRESENT
IF Q9a = 2 CONTINUE
ELSE, SKIP TO Q24a
If no CO detectors present, ask:
22. On a scale of 1 to 5, where 1 is Not at All Necessary, and 5 is Extremely
Necessary, how necessary do you feel it is to have a carbon monoxide detector
installed in your home?
1
2
3
4
5
DK
RF
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23. Can you tell me some of the reasons you don’t have a carbon monoxide detector
installed in your home?
(Open ended, Probe: Anything else?)
________________________________________________________________________
________________________________________________________________________
24a.
In the past 12 months, have you looked for any information about either fire or
carbon monoxide safety, or not? (DO NOT READ LIST)
Yes
No (SKIP to Q26)
Unsure
Refused
IF Q24a = 1, CONTINUE
ELSE, SKIP TO Q26
25a.
Where do you obtain information about fire safety? (READ LIST ONE AT A
TIME) (SELECT ALL THAT APPLY)
Sources of information
TV news or radio
Internet search engines like Google
Family or friends
Community or religious organizations
Social media like Facebook
Local fire department
Other (SPECIFY) DON’T READ)____________
None of these (DON’T READ)
Don’t know or remember (DON’T READ)
Refused (DON’T READ)
25b.
Fire safety
Where do you obtain information about carbon monoxide safety? (READ LIST
ONE AT A TIME) (SELECT ALL THAT APPLY)
Sources of information
Carbon
monoxide safety
TV news or radio
Internet search engines like Google
Family or friends
Community or religious organizations
Social media like Facebook
Local fire department
Other (SPECIFY) (DON’T READ)____________
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None of these (DON’T READ)
Don’t know or remember (DON’T READ)
Refused (DON’T READ)
26.
How often do you or any other member of the household cook at home using a stove
or oven? Does a member of this household cook… (READ LIST)
Never
Less than once a month
A few times per month
A few times per week
Or every day?
Don’t know (DON’T READ)
Refused (DON’T READ)
DEMOGRAPHICS
Great! To ensure that we interview a broad mix of residents, I have a few brief demographic
questions to ask about you and others within this household. It should only take a few minutes of
your time.
27.
How many people live or stay in your household? This can include:
• Anyone who is living or staying there for the last 2 months or longer
• Yourself, if you are living there for the last 2 months or longer
• Anyone else staying there who does not have another place to stay, even if they are
here for the last 2 months or less
Please do not include anyone who is living somewhere else for more than 2 months,
such as a college student living away or someone in the Armed Forces on deployment.
Enter number of people
28.
__________
Thinking of the individual(s) who live here, is there anyone …(INSERT ITEM)
Yes
No
(DON’T
READ)
Don’t
know
(DON’T
READ)
Refused
If yes,
how
many?
Under 5 years old?
5 - 17 years old?
18 – 64 years old?
65 years old or older?
20
29.
What is the highest level of education you have completed or the highest degree you
have received? (DO NOT READ LIST)
o Less than high school, no diploma
o High school diploma, or high school equivalent (GED)
o Trade or Vocational school degree
o Some college, no degree
o Associate’s degree
o Bachelor’s degree
o Master’s degree or higher
o Don’t know
o Refused
30.
Is anyone in the household of Hispanic or Latino origin or descent? (DO NOT
READ LIST)
o Yes
o No
o Don’t know
o Refused
31.
What is your race? (SELECT ALL THAT APPLY)
o White
o Black or African American
o Asian
o American Indian or Alaska Native
o Native Hawaiian or other pacific islander
o Some Other Race (Specify) (DON’T READ)_________________________
o Don’t know (DON’T READ)
o Refused (DON’T READ)
32.
Is anyone in the household deaf or hard of hearing? (DO NOT READ LIST)
o Yes
o No
o Don’t know
o Refused
33.
Does anyone in the household have a physical, mental, or other health condition that
has lasted 6 or more months which makes it difficult for them to carry out day to
day activities? (DO NOT READ LIST)
o Yes
o No
o Don’t know
o Refused
21
34.
Do any people in the home smoke any products such as cigarettes, cigars, hookahs
or pipes? Please do not include e-cigarettes or vaping devices. (DO NOT READ
LIST)
o Yes
o No
o Don’t know
o Refused
35.
In the last 12 months, what was your total household income from all sources,
before taxes? Just stop me when I get to the right category (READ LIST)
o Less than $15,000
o $15,000 to under $25,000
o $25,000 to under $35,000
o $35,000 to under $50,000
o $50,000 to under $75,000
o $75,000 to under $100,000
o $100,000 to under $150,000
o $150,000 to under $200,000
o $200,000 or more
o Don’t Know (DON’T READ)
o Refused (DON’T READ)
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INCENTIVE VERIFICATION
Thank you so much for participating in this survey. Your answers will help CPSC with improving
household fire and CO safety across the U.S.
As appreciation for completing the survey, we would like to send you a $10 gift card from a major
credit company. Could you please provide your full name and mailing address?
Interviewer: Fill in the blank with the respondent’s name and address, and verify it. If
needed, assure the respondent of the confidentiality of the information provided.
Full Name:_________________________________
Street _________________________________
Apt/Suite/Other__________________
City_____________________
State____________
Zip/ Postal Code____________
You will receive your participation gift card in the mail in the next few weeks.
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| File Type | application/pdf |
| File Modified | 0000-00-00 |
| File Created | 0000-00-00 |