| Instructions: Please fill this out for each restaurant that is contacted (columns B-F will be pre-filled based on the random sampling list generated for each site) |
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| EstablishmentID: Assign if restaurant is participating - this will be the identifier used on all study materials and should start with site abbreviation and then a number (e.g., TN-Tennessee, SN-Southern Nevada, NYS-New York State, NYC - New York City, RI - Rhode Island, HC - Harris County, MN - Minnesota, FC - Franklin County) |
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| Columns B-F: will be prefilled in order based on the random sampling list with the information provided by each site |
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| Other contact information: record any other information that you use to contact a restaurant |
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| 1. Response code: U - Unable to Contact; C - Closed; R - Refused; P - Participating; I1 - Ineligible - Not an EHS-Net restaurant; I2 - Ineligible - Language manager; O - Other |
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| 2. Restaurant tye: Type should be determined by recruiter, you should not ask during recruitment; I - Independently owned; C - Chain; U - Unsure |
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| 3. Difficulty in communication: Assess your level in communicating with the establishment for recruitment |
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| 4. Phone calls: Indicate if you called the restaurant to participate in the study; Y - Yes; Blank - No |
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| 4a. Number of calls: Number of times you attempted to call the restaurant (max 5 calls) |
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| 5. Postcard/letter: Indicate if you mailed the restaurant a notice about the study; Y - Yes; Blank - No |
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| 5a. Number of mailings: Number of times you mailed the restaurant |
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| 6. E-mail: Indicate if you e-mailed the restaurant about the study; Y - Yes; Blank - No |
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| 6a. Number of e-mails: Number of e-mails you sent to the restaurant |
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| 7. In person visit: Indicate if you visited the restaurant to participate in the study; Y - Yes; Blank - No |
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| 7a. Number of visits: Number of onsite visits to recruit the restaurant |
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| 8. Social Media: Indicate if you used other social media tools to inform the restaurant about the study; if yes, indicate what social media tools were used |
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| 8a. Number of attempts: Number of times you used the social media tool |
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| 9. Other: Indicate if you used other methods to inform the restaurant about the study; If yes, indicate what method was used |
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| 9a. Number of attempts: Number of times other outreach was conducted |
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| 10. Consent: Indicate where consent to participate is provided; P - Phone; Ons - Onsite; Oth - Other |
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| 11. Comments/Reason for refusal: record any comments about the recruitment or reasons provided for not participating in the study |
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| EstablishmentID |
Permit number/Site specific identifier |
Business Name |
Address |
Phone |
e-mail |
Other contact information |
1. Response Code |
2. Restaurant type |
3. Difficulty in communication |
4. Phone calls |
4a. Number of calls |
5. Postcard/letter |
5a. Number of mailings |
6. E-mail |
6a. Number of e-mails |
7. In person visit |
7a. Number of visits |
8. Social Media |
8a. Number of attempts |
9. Other |
9a. Number of attempts |
10. Consent |
11. Comments/Reason for refusal |