Exposure Measurement Form – Pre-activity questionnaire administration notice

Appendix N5a

Federal Government Study on the Use of Recycled Tire Crumbs in Synthetic Turf Fields

Your role as a synthetic turf (or natural grass field user) participant

Please arrive 30 minutes before your practice for the questionnaire and pre-activity urine collection and stay 15 minutes after for your post-activity urine collection.

Please arrive at:

Please refrain from eating any grilled, barbequed, smoked, or deep fried foods for 24 hours before your scheduled appointment.

We will give you/your child a $25 gift card as a “thank you” when you or he/she completes the interview. The gift card can be used at most stores or for online shopping.

People who also provide urine samples will get additional gift cards ($10 pre-activity and $15 post-activity).

This study will be conducted following all state, local, and CDC guidelines in place at the time the study is conducted. ATSDR team members will be monitored twice daily for fever and any COVID-19-related symptoms and will wear masks and gloves to ensure the protection of participants. Similarly, participants will be monitored for fever and COVID-19-related symptoms prior to their entry into the testing facility and will be asked to wear a face covering or mask. If you do not have a mask, one will be provided to you.

If you or your child have any questions about the study or wish to drop out, please contact:

Kelsey Benson

[email protected]

770-488-0684

Thank you for participating!