Intervention log - control restaurants

Assessment of Ill Worker Policies Study

P_Att 5 Intervention Log 201211

Resaturant intervention log - control restaurants

OMB: 0920-1227

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Attachment 5 – Intervention Log


Intervention Log

Form Approved

OMB No. 0920-1227

CDC estimates the average public reporting burden for this collection of information as 30 minutes per response, including the time for reviewing instructions, searching existing data/information sources, gathering and maintaining the data/information 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 to: CDC/ATSDR Information Collection Review Office, MS D-74, 1600 Clifton Road, NE, Atlanta, GA 30333 ATTN: PRA (0920-1227).

Exp. Date 5/31/2021




Restaurant Code


Y N

Was an intervention provided on this visit



Date



File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorCDC User
File Modified0000-00-00
File Created2021-02-14

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