Form 0920-1202 Nano Survey

Attachment 8

NIOSH Engineered Nanomaterials Survey

Form Approved

OMB No. 0920-1202

Exp. Date xx/xx/20xx

Thank you in advance for participating in this survey.

The National Institute for Occupational Safety and Health (NIOSH) is sponsoring the survey. The purpose is to learn about how companies in engineered nanomaterials industries are using research findings, guidance documents, and other information developed by NIOSH and how that information is influencing occupational safety and health. NIOSH is part of the Centers for Disease Control and Prevention (CDC), and is not a regulatory agency. Our mission is to eliminate work-related illnesses and injuries through a focused program of research and prevention. RTI International is conducting the survey on behalf of NIOSH. RTI is a private, not-for-profit research organization based in North Carolina.

The information gathered from this survey will be used by NIOSH to enhance our understanding of how our efforts are influencing occupational safety and health across a range of engineered nanomaterial-related businesses.

The survey is voluntary and should take no longer than 20 minutes to complete. The information we collect will be summarized in an internal document. We will not identify you or your [INSERT BASED ON CATEGORY: company/organization] in any documents or reports without your prior approval.

If you have questions about this survey, please do not hesitate to contact the RTI survey manager, Ryan Weber, at [insert toll free number] or our Help Desk at [insert Help Desk email].

This survey should be completed by the person in your [company/organization] who is the most knowledgeable about the safety and health programs at this location. This may be the environmental safety and health manager, for example, or a senior manager at this location.

LOCATION: ADD LOCATION

If there is someone else in your [company/organization] who would be a more knowledgeable respondent for this survey, please forward this survey to that individual. If more than one individual is needed to complete the survey, we ask that you work together to provide as much information as possible.

Public reporting burden of this collection of information is estimated to average 20 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 (0920-1202).

1. Does your [company/organization] develop, manufacture, use, handle, distribute, analyze, or provide services related to engineered nanomaterials?

For the purpose of this survey, the term “engineered nanomaterials” refers to a variety of purposefully engineered materials and structures that have at least one dimension that is in the order of 100 nanometers or less.

If you are not sure if the material is an engineered nanomaterial, you may need to consult with others (e.g., product manager, process engineer, purchasing agent, supplier or review product information (e.g., Safety Data Sheets).

(Check one.)

 Yes

 No  GO TO QUESTION 32, PAGE 11

 Don’t Know GO TO QUESTION 32, PAGE 11

2. Please indicate the commercial sector(s) where the engineered nanomaterials or the engineered nanomaterials-enabled products or services that your [company/organization] provides are intended to be used.

(Check all that apply.)

• Manufacturing the following products, specifically:

 Textiles or Apparel

 Wood, Paper, and/or Printing Products

 Petroleum or Coal Products (e.g., asphalt, petroleum refineries, lubricants, grease)

 Chemicals (e.g., petrochemical, dye and pigment, resin, paints, coatings, pesticides, fertilizer)

 Pharmaceuticals or Medicine (e.g., nanomaterial enabled medicines or therapeutics)

 Toiletry, Soap, or Cleaning Compounds (e.g., lotions, cosmetics, sunscreen, polishing)

 Plastics or Rubber Products (e.g., plastic containers, pipes, polymers)

 Nonmetallic Mineral Products (e.g., cement, concrete, clays, including carbon nanotubes and graphene)

 Metal or Fabricated Metal Products (e.g., nanoscale metals, forging, stamping, metal tools, metal parts)

 Manufacturing Machinery (e.g., for agriculture, construction, semiconductors, chemicals, metalworking)

 Electronic Products, Electrical, Electro-optical or Electromedical Equipment, and Components (e.g., batteries, semiconductors, integrated circuits, electronic sensors)

 Transportation Equipment (e.g., cars, trucks, boats, planes)

 Medical Equipment or Supplies (e.g., non-electrical equipment, such as surgical equipment)

 Agriculture, Forestry, Fishing, or Hunting (e.g., farming, crop production, animal production)

 Mining, Quarrying, or Oil and Gas Extraction

 Utilities (e.g., electric power [including solar], natural gas, water and sewage systems)

 Professional, Scientific, or Technical Services (e.g., R&D physical, engineering, life sciences, biotechnology)

 Waste Management and Remediation Services (e.g., land, site or building remediation)

 Other, please specify:

_________________________________________________________________________________

_________________________________________________________________________________

3. Your organization or [company/organization] may have multiple locations (i.e. worksite, building, facility, plant, etc.).

Please respond only about the location or locations for which you have knowledge of safety and health programs. Throughout the survey we refer to these sites as “your location(s).”

What is the total number of individuals (employees and contractors) who work at your location(s)?

(Check one.)

 1-10

 11-50

 51-250

 251-500

 501-1,000

 1,001-5,000

 More than 5,000

4. How many individuals have any contact with engineered nanomaterials at your location(s)? Include both employees and contractors with either regular or occasional contact with engineered nanomaterials.

Regular Contact – Include employees that regularly handle or use engineered nanomaterials as a matter of routine during the course of their average work day.

Occasional Contact – Include employees that may have infrequent, short contact with engineered nanomaterials over the course of an average work day (i.e., an employee that moves through a space where engineered nanomaterials are being handled or used such as maintenance or janitorial staff).

(Check one.)

 None

 1-10

 11-50

 51-250

 251-500

 501-1,000

 1,001-5,000

 More than 5,000

5. Which of the following describes how your [company/organization] handles or relates to engineered nanomaterials at this location(s)?

(Check all that apply.)

 Develop engineered nanomaterials

 Manufacture engineered nanomaterials

 Incorporate engineered nanomaterials into our products

 Develop applications or products that use engineered nanomaterials

 Repackage/distribute engineered nanomaterials

 Conduct laboratory scale-up of engineered nanomaterials

 Perform nanomaterials characterization

 Provide services using products containing engineered nanomaterials

 Conduct site visits to determine exposure to engineered nanomaterials

 Produce instruments for manufacturing, characterizing, and detection of engineered nanomaterials

 Dispose engineered nanomaterials

 Other, please specify:

__________________________________

__________________________________

6. In what physical forms are engineered nanomaterials handled at your location(s)?

(Check all that apply.)

 Solid, freely mobile (e.g., dry powder)

 Contained in an aerosol

 Suspended in a liquid (e.g. water, solvent)

 Suspended in a matrix (e.g. polymer, paste)

 Solid, embedded, bound, or fixed in a material or product

 Other, please specify:

__________________________________

__________________________________

7. On a typical day, what is the approximate quantity of engineered nanomaterials handled at your location(s)?

(Check one.)

 Less than a kilogram (2.2 pounds)

 More than a kilogram (2.2 pounds)

8. What are the different types of engineered nanomaterials at your location(s)?

(Check all that apply.)

 Nanoparticles, specifically:

 Silver nanoparticle

 Gold nanoparticle

 Other metallic nanoparticles, please specify:

__________________________________

__________________________________

 Titanium dioxide nanoparticle

 Zinc oxide nanoparticles

 Other metal-oxide nanoparticles, please specify:

__________________________________

__________________________________

 Ceramic nanoparticles, please specify:

__________________________________

__________________________________

 Quantum dots (i.e., semiconductor nanoparticles)

 Nanotubes, nanofibers, nanorods, or nanowires, specifically:

 Single-walled carbon nanotubes

 Multi-walled carbon nanotubes

 Carbon nanofibers

 Boron nitride nanofibers

 Semiconductor nanotubes or nanofibers

 Semiconductor nanorods or nanowires

 Other metallic nanorods or nanowires, please specify:

__________________________________

__________________________________

 Nanosheets, specifically:

 Graphene

 Boron-nitride nanosheets

 Other nanosheets, please specify:

__________________________________

__________________________________

 Nanofibrils cellulous

 Nanocystaline cellulous

 Nanoclays

 Dendrimer

 Polymers

 Other, please specify:

__________________________________

__________________________________

 Don’t know

9. Some government, non-profit, or for-profit organizations offer site visits or site consultations consisting of teams of experts that evaluate and provide recommendations regarding occupational safety and health practices.

Since 2005 have any of your location(s) hosted such a site visit or site consultation?

(Check one.)

 Yes

 No  GO TO QUESTION 13, PAGE 5

 Don’t Know  GO TO QUESTION 13, PAGE 5

10. Who conducted the site visit(s) or site consultation(s) at your location(s)?

(Check all that apply.)

 CDC/NIOSH

 Other government organization

 Private company/consultant

 Academic institution(s)

 Other, please specify:

__________________________________

__________________________________

11. Did the site visit(s) or site consultation(s) include feedback or recommendations for handling engineered nanomaterials?

(Check one.)

 Yes

 No  GO TO QUESTION 13, PAGE 5

 Don’t Know  GO TO QUESTION 13, PAGE 5

12. Was any of the feedback or recommendations for handling of engineered nanomaterials from the site visit(s) or site consultation(s) implemented?

(Check one.)

 Yes, all of them

 Yes, some of them

 No

13. Which of the following resources have you used to acquire information about how to safely handle engineered nanomaterials?

(Check all that apply.)

 Government publications/materials (Check all that apply.)

 NIOSH “Approaches to Safe Nanotechnology”

 NIOSH “General Safe Practices for Working with Engineered Nanomaterials in Research Laboratories”

 NIOSH “Current Strategies for Engineering Controls in Nanomaterial Production and Downstream Handling Processes”

 NIOSH “Occupational Exposure to Carbon Nanotubes and Nanofibers”

 NIOSH “Occupational Exposure to Titanium Dioxide”

 A professional development course or webinar taught by NIOSH instructors

 EPA “Control of Nanoscale Materials under the Toxic Substances Control Act”

 EPA disposal regulations

 OSHA Fact Sheet “Working Safely with Nanomaterials”

 NIST “New NIST Reference Material Provides a Silver Lining for NanoEHS Research“, 2015

 Federal, state, or local government publications, please specify:

_________________________________________________________________________________

_________________________________________________________________________________

 Industry, scientific, or professional meetings, conferences, or tradeshows. Please specify:

_________________________________________________________________________________

_________________________________________________________________________________

 Scientific articles, professional or industry publications. Please specify:

_________________________________________________________________________________

_________________________________________________________________________________

 International publications (e.g. Safe Work Australia). Please specify:

_________________________________________________________________________________

_________________________________________________________________________________

 Websites, blogs, and Internet search engines (e.g. Google, Bing)

 Informal discussions with professional contacts or peers

 Materials or publications developed by your company

 Product manufacturer information (e.g.: Safety Data Sheets (SDS) or Pre-manufacturing Notices (PMN))

 Other, please specify:

_________________________________________________________________________________

_________________________________________________________________________________

14. How has the information you acquired from any source about engineered nanomaterials been used?

(Check all that apply.)

 Informed safety and health practices

 Informed [company/organization] policies for handling of engineered nanomaterials

 Incorporated into training materials

 Incorporate into product information (e.g., SDS)

 Modifications to products

 Modifications to processes

 Other. Please specify:

_________________________________________________________________________________

_________________________________________________________________________________

15. Does your location(s) implement a safety and health program for your employees?

Safety and health programs may have a variety of names, including Accident Prevention Program, Injury and Illness Prevention Program, Comprehensive Safety and Health Program and, for laboratories, Chemical Hygiene Plan (CHP).

(Check one.)

 Yes

 No

16. Which of the following safety and health practices are used at your location(s)? For each practice that you identify, is there separate or specific guidance for its application to engineered nanomaterials?

If the safety and health programs vary by location, please report the most typical for the locations for which you are knowledgeable, for example programs at your largest location or the most common programs across locations.

	Safety and health practices used at your location(s)? (Check one.)	IF YES IN COLUMN 1: Separate or specific guidance for engineered nanomaterials? (Check one.)
HAZARD IDENTIFICATION AND EVALUATION:
Determination of routes of exposure	 Yes   No	 Yes  No
Identification of processes or job tasks where workers may be exposed	 Yes   No	 Yes  No
Evaluation of new processes/procedures for hazards	 Yes   No	 Yes  No
Review of purchase orders for possible hazardous materials	 Yes   No	 Yes  No
PROTECTION:
Use of exposure controls (elimination, substitution, engineering, administrative, Personal Protective Equipment [PPE])	 Yes   No	 Yes  No
Assessment of effectiveness of exposure controls	 Yes   No	 Yes  No
Assessment of need for PPE	 Yes   No	 Yes  No
Maintenance of engineering controls (e.g., dust collection systems)	 Yes   No	 Yes  No
Spill cleanup procedures	 Yes   No	 Yes  No
Waste management/disposal procedures	 Yes   No	 Yes  No
SCREENING OR MONITORING:
Medical screening and surveillance	 Yes   No	 Yes  No
Exposure monitoring	 Yes   No	 Yes  No
ADMINISTRATIVE OR PROCEDURAL:
Systematic review and update of safe use procedures	 Yes   No	 Yes  No
Method for reporting hazards, illnesses, and injuries	 Yes   No	 Yes  No
Development of internal [company/organization] exposure guidelines	 Yes   No	 Yes  No
OTHER:
Other. Please specify: _________________________________	 Yes   No	 Yes  No

17. In cases where you do not have specific safety and health practices or guidelines for engineered nano-materials, what surrogate hazards or substances do you use to inform your safety and health practices or guidelines?

(Check all that apply.)

 Nuclear hazards

 Asbestos

 Biohazards

 General chemical hazard. Please specify: ___________________________________

 Other. Please specify: ___________________________________

 None. We do not use other hazards or substance as a model for engineered nanomaterials

18. Which of the following engineering controls are used to reduce or prevent worker exposure to any potential chemical or material hazards at your location(s)? For each engineering control you identify, is that control required when working with engineered nanomaterials?

	Used to reduce any potential chemical or material hazard? (Check one.)	IF YES IN COLUMN 1: Required when working with engineered nanomaterials? (Check one.)
Separate HVAC system	 Yes   No	 Yes  No
Pressure differentials	 Yes   No	 Yes  No
Designed or separate work areas (e.g., control room)	 Yes   No	 Yes  No
Closed system piping	 Yes   No	 Yes  No
Cleanroom	 Yes   No	 Yes  No
Laboratory fume hood	 Yes   No	 Yes  No
Laminar low flow ventilated enclosure	 Yes   No	 Yes  No
Biosafety cabinet (BSC)	 Yes   No	 Yes  No
Glove box	 Yes   No	 Yes  No
Local exhaust ventilation (other than fume hood, BSC or glovebox)	 Yes   No	 Yes  No
High-efficiency particulate air (HEPA) filtration	 Yes   No	 Yes  No
Ultra-low particulate air (ULPA) filtration	 Yes   No	 Yes  No
Working with nanomaterial in a slurry or suspension	 Yes   No	 Yes  No
Other, please specify): __________________________________	 Yes   No	 Yes  No

19. Which of the following personal protective equipment (PPE) is used by individuals working with engineered nanomaterials at your location(s)?

(Check all that apply.)

 No PPE is used

 Coveralls or lab coats. Please specify. (Check all that apply)

 Woven

 Nonwoven

 Gloves

 Eye/face protection

 Shoe covers

 Hair bonnets

 Respirators. Please specify. (Check all that apply)

 Disposable filtering facepiece

 Elastomeric half-facepiece respirator

 Elastomeric full-facepiece respirator

 Powered loose fitting facepiece

 Powered tight fitting facepiece

 Other type of respirator, please specify:

__________________________________

 Other type of PPE. Please specify:

__________________________________

__________________________________

20. Does your workforce receive any informal or formal training on the safe use or handling of engineered nanomaterials?

(Check one.)

 Yes

 No  GO TO QUESTION 23, PAGE 10

 Don’t Know  GO TO QUESTION 23, PAGE 10

21. How is this training provided?

(Check all that apply.)

 Formal training from internal training staff and resources

 Informal training from colleagues and peers

 External or consultant training resources

 Other. Please specify:

__________________________________

__________________________________

22. For this question, employees are categorized by their level of possible contact with engineered nanomaterials.

Regular Contact – Employees regularly handle or use engineered nanomaterials as a matter of routine during the course of their average work day.

Occasional Contact – Employees may have infrequent, short contact with engineered nanomaterials over the course of an average work day (i.e., an employee that moves through a space where engineered nanomaterials are being handled or used such as maintenance or janitorial staff).

No contact –Employees do not have any type of contact with engineered nanomaterials

For each level of employee at your location(s), indicate if they receive training on the following practices regarding the safe use or handling of engineered nanomaterials. Include full-time staff, part-time staff, contractors working onsite, and/or temporary staff.

	Employees with.…			Training not provided
	Regular Contact	Occasional Contact	No Contact
Types of engineered nanomaterials and general engineered nanomaterial awareness				
Where to locate information about the safety and health practices regarding engineered nanomaterials				
Routes of exposure to engineered nanomaterials				
Use or maintenance of exposure controls (elimination, substitution, engineering, administrative, PPE) for engineered nanomaterials				
Use or maintenance of respirators for engineered nanomaterials				
Procedures for spill cleanup, waste management, or disposal procedures of engineered nanomaterials				
Method for reporting hazards, illnesses and injuries related to engineered nanomaterials				

23. Is worker awareness or knowledge of engineered nanomaterials assessed at your location(s)?

(Check one.)

 Yes

 No  GO TO QUESTION 25

 Don’t Know  GO TO QUESTION 25

24. How is it assessed?

(Check all that apply.)

 Periodic surveys

 Random inspections

 Regular inspections

 Other, please specify:

__________________________________

__________________________________

25. What type of process emission or exposure monitoring is conducted at your location(s)?

(Check all that apply.)

 None. Monitoring is not

conducted  GO TO QUESTION 27

 Filter-based air sampling for mass

 Filter-based air sampling for electron microscopy

 Direct reading particle counters

 Wipe sampling

 Dermal sampling

 Other, please specify:

__________________________________

__________________________________

26. When is process emission or exposure monitoring conducted?

(Check all that apply.)

 Initial process start-up

 Changes in process or control(s)

 During upset conditions (i.e., response conditions, in response to a spill or similar unanticipated event)

 Periodically (e.g., annually)

 Other, please specify:

__________________________________

__________________________________

27. Does your [company/organization] produce documents related to engineered nanomaterials?

(Check one.)

 Yes

 No  GO TO QUESTION 29

 Don’t Know  GO TO QUESTION 29

28. What types of documents related to engineered nanomaterials are produced?

(Check all that apply.)

 Journal articles

 Scientific publications

 Articles for trade magazines

 Comments on public policies that are intended to be disseminated (either within or outside of your [company/organization])

 Comments or input on NIOSH documents

 Comments or input to industry or materials standards

 Comments or input to professional, scientific or trade associations

 Blogs

 Safety Data Sheets

 Instructions for how to use your products or guidance for measuring engineered nanomaterials

 Information provided to your customers along with your products or services

 Information from your [company’s/organization’s] standard operating procedures or practices for the handling or use of engineered nanomaterials

 Other, please specify:

__________________________________

__________________________________

29. Does your [company/organization] have an occupational safety and health office, department, or individual?

(Check one.)

 Yes

 No  GO TO QUESTION 31, PAGE 11

 Don’t Know GO TO QUESTION 31, PAGE 11

30. How many occupational safety and health (OS&H) professionals are employed at your location(s)?

An OS&H professional is someone who has a degree in OS&H or certification from a nationally recognized accrediting body and who devotes a significant portion of their work time to OS&H responsibilities. Be sure to count yourself if applicable.

(Write in the number of OS&H professionals.)

 Don’t Know

31. Altogether, how long have you worked with engineered nanomaterials?

(Enter number of years.)

Years

32. What is your current position at your [company/organization]?

Please specify:

__________________________________

__________________________________

33. Do you have any certification in occupational safety and health (OS&H)? For example, Certified Industrial Hygienist (CIH), Certified Safety Professional (CSP), or Chemical Hazardous Material Manager (CHHM).

(Check one.)

 Yes, please specify:

__________________________________

__________________________________

 No

34. Are your responsibilities regarding occupational safety and health your:

(Check one.)

 Full-time responsibility

 Part-time responsibility

 Other duty as assigned (i.e., responsibilities are done with other responsibilities)

 None of the above

 Other, please specify:

__________________________________

__________________________________

35. Is there any other information on occupational safety and health regarding engineered nanomaterials you wish you add?

(Check one.)

 No

 Yes, please specify:

________________________________________________________________________________________

________________________________________________________________________________________

________________________________________________________________________________________

________________________________________________________________________________________

________________________________________________________________________________________

Please return the completed survey in the enclosed pre-paid envelope to:

Fulfillment Department

Attn: ____

THANK YOU!