Consent Form for Workers

Attachment 6b. Consent Form for Workers

OMB No. _______________Exp. Date _______________

Improving Safety among Workers in the Commercial Aviation Industry in Alaska

National Institute of Occupational Safety and Health

Consent to be in a Research Study (10/05/2020)

Researcher

Rosyland Frazier

Principal Investigator

Institute of Social and Economic Research

University of Alaska Anchorage

(907) 786-5432 [email protected]

What is this about?

The Alaska Aviation Workers Safety Study is research on ways to reduce injuries and increase safety for workers in the Alaska aviation industry. We are asking pilots, mechanics, ramp, baggage, cargo, dock, and customer service agents to complete a survey to learn:

• What you do in your job

• How risky is your job

• What practices and procedures put you at risk

• What you do to reduce risk

• Have you been injured or made ill while doing your job

• What you think would make your job safer

As part of this research air carrier operators have completed a survey that asks similar questions.

What will I do?

You will complete an online survey that asks questions on topics like the ones listed above and others about your job and safety. We don’t ask questions about matters that are usually private such as criminal behavior, alcohol or drug use, sexual behavior, or religious beliefs. It will take about 15-25 minutes to complete the survey.

Who is paying for this?

The National Institute for Occupational Safety and Health, or NIOSH, is paying for this study. NIOSH is a federal agency that studies worker safety and health. NIOSH has hired the University of Alaska's Institute of Social and Economic Research (ISER) to conduct and analyze these safety surveys.

Who will know what I said?

Neither your name nor your company’s name will be on any reports or publications about this study. Neither NIOSH, the Federal Aviation Administration, nor anyone other than two researchers at ISER will know who participated or what any person said. A computer program will assign a number to your answers; this computer file will not have your name or address. The federal Office of Management and Budget has reviewed and approved the survey for this project. We will protect your information to the extent allowed by law.

Will I receive any benefits from answering this survey?

There are no benefits for you personally for completing this survey. However, the results of this study may benefit aviation workers in Alaska.

Are there risks or will I feel uncomfortable from being in this research?

Questions asking about injuries or illnesses because of your job may make you feel uncomfortable. There are no other known risks.

Am I a volunteer?

Yes, being in this study is voluntary. You may stop at any time and don’t have to answer any questions you don’t want to answer. You may skip a question if you wish. Nothing bad will happen if you choose not to answer some or all of the questions.

What if I have questions?

If you have questions about this research, contact Rosyland Frazier at the phone number or email address at the top of this page. If you have questions about your rights as a research participant, contact the UAA Office of Research Integrity and Compliance at (907) 786-1099 or [email protected]

Reporting burden

Reporting burden for this collection of information is estimated to average between 30 and 40 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 0MB 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; Centers for Disease Control and Prevention; 1600 Clifton Road, MS D-24; Atlanta, Georgia 30333; ATIN: PRA (0920-0518)

Do you agree to be in this study?

Agreeing to be in this research study means you are 18 years old or older, have read this form, and are willing to answer the questions. If you have questions at any time in this study, please contact one of the people listed above.

• Yes, I agree to be in this research study.

• No, I do not want to be in this research study.

There is a copy of this consent form online at the website: www.iseralaska.org