Form 0920-0260 HHE Followback Survey - FINAL Report - 1YR Later

NIOSH Health Hazard Evaluation Survey: One Year Later
10.

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

Form Approved
OMB No.: 0920-0260
Expiration Date:

Followback Survey
Final Report ‒ One Year Later
The National Institute for Occupational Safety and Health (NIOSH) surveys people
involved with its health hazard evaluations. We want to learn about your workplace
now and actions taken regarding our recommendations.
Your responses will be kept securely according to federal laws. Our reports include
only summary information and will not identify you.
Thank you for completing this survey.

6/25/2014

Administrative area

Followback Survey Form 3B
18782

Please mail the completed survey to NIOSH in the enclosed postage paid envelope.
Call Barbara Jenkins at 513-458-7132 if you have any questions about the survey.
Public reporting burden of this collection of information is estimated to average 15 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 (0920-0260).

NIOSH Health Hazard Evaluation Survey: One Year Later
This survey asks what has happened at the workplace in the year since NIOSH completed the
health hazard evaluation. Please mark one response for each question, like this: ●

NIOSH Health Hazard Evaluation Survey: One Year Later
Recommendations to Employees

Was Action taken?

9G.
O Yes
O No
O Nothing needed to change

1.

Do you think NIOSH helped make things better at
the work place?

2.

If yes to Question 1, please describe the positive changes.

O
O
O
O

Yes
No
I don’t know
No longer applies

O
O
O
O

Yes
No
I don’t know
No longer applies

O
O
O
O

Yes
No
I don’t know
No longer applies

O
O
O
O

Yes
No
I don’t know
No longer applies

O
O
O
O

Yes
No
I don’t know
No longer applies

O
O
O
O

Yes
No
I don’t know
No longer applies

9H.

9I.

3. Do you still use, refer to, or discuss the NIOSH
letter?

O Yes
O No

4. Did the NIOSH evaluation change your behaviors
about workplace health and safety?

O Yes
O No

9J.

5. If yes, please explain.

9K.

6. Did the NIOSH evaluation change your thinking
overall about workplace health and safety?
7. If yes, please explain.

O Yes
O No
9L.

NIOSH Health Hazard Evaluation Survey: One Year Later
Recommendations to Employees

NIOSH Health Hazard Evaluation Survey: One Year Later
The recommendations that NIOSH made are in the left column below. First are the
recommendations made to Managers, then those made to Employees.
Please answer all of the questions, marking one response for each question.

Was Action taken?

9A.
O
O
O
O

Yes
No
I don’t know
No longer applies

Recommendations to Managers

Was Action Taken?

8A.

9B.
O
O
O
O

Yes
No
I don’t know
No longer applies

O
O
O
O

Yes
No
I don’t know
No longer applies

8C.

O
O
O
O

Yes
No
I don’t know
No longer applies

8D.

O
O
O
O

Yes
No
I don’t know
No longer applies

O
O
O
O

Yes
No
I don’t know
No longer applies

O
O
O
O

Yes
No
I don’t know
No longer applies

O
O
O
O

Yes
No
I don’t know
No longer applies

O
O
O
O

Yes
No
I don’t know
No longer applies

O
O
O
O

Yes
No
I don’t know
No longer applies

O
O
O
O

Yes
No
I don’t know
No longer applies

O
O
O
O

Yes
No
I don’t know
No longer applies

8B.

9C.

9D.

9E.
8E.

9F.
8F.

NIOSH Health Hazard Evaluation Survey: One Year Later

NIOSH Health Hazard Evaluation Survey: One Year Later

Recommendations to Managers

Was Action Taken?

Recommendations to Managers

8G.

O
O
O
O

8N.

8H.

8I.

8J.

8K.

Yes
No
I don’t know
No longer applies

8O.

O
O
O
O

Yes
No
I don’t know
No longer applies

O
O
O
O

Yes
No
I don’t know
No longer applies

O
O
O
O

Yes
No
I don’t know
No longer applies

O
O
O
O

Yes
No
I don’t know
No longer applies

8P.

8Q.

8R.

8L.

8M.

Was Action Taken?
O
O
O
O

Yes
No
I don’t know
No longer applies

O
O
O
O

Yes
No
I don’t know
No longer applies

O
O
O
O

Yes
No
I don’t know
No longer applies

O
O
O
O

Yes
No
I don’t know
No longer applies

O
O
O
O

Yes
No
I don’t know
No longer applies

8S.
O
O
O
O

Yes
No
I don’t know
No longer applies

O
O
O
O

Yes
No
I don’t know
No longer applies

O Yes
O No
O I don’t know
O No longer applies
8T.

O
O
O
O

Yes
No
I don’t know
No longer applies