Consent

National Institute of Standards and Technology

National Construction Safety Team Investigative Study of the June 24, 2021 Champlain Towers South Condominium Collapse in Surfside, FL

OMB Control # XXXX-XXXX

INTERVIEW CONSENT & INFORMATION SHEET

Consent Statement

You are being asked to participate in an investigative study conducted by the National Construction Safety Team at the National Institute of Standards and Technology (NIST).

NIST is conducting a full technical investigation of the collapse of the Champlain Towers South Condominium in Surfside, FL that occurred on June 24, 2021 under the authority of the National Construction Safety Team (NCST) Act, which is authorized by Congress. The goal of the NIST investigation is to determine the technical cause of the collapse and, if appropriate, to recommend changes to building codes, standards and practices, or other actions to improve the structural safety of buildings. There are millions of high-rise condominium units in Florida alone, many of them aging structures near the coast. While a NIST investigation is intended to identify the cause of the Champlain Towers South Condominium collapse, it could also uncover potential issues in other similar buildings nearby and throughout the nation.

As part of this work, NIST seeks to interview eyewitnesses, first responders, engineers, vendors, contractors, maintenance staff, construction workers, residents, condominium owners, government officials, and others. During this interview, depending on your standpoint, you will be asked to:

• describe your experiences with the building before and/or during the collapse (e.g., what you saw, heard, felt and did before and in response to the building collapse);

• describe your knowledge of the building prior to the collapse (e.g., construction, maintenance); or

• describe any additional information that may help explain the technical cause of the building failure.

We understand that you may not remember everything perfectly. That’s okay, please respond to the best of your ability. This is an investigative study that is intended to provide benefits to the nation in the form of improved life safety to prevent future building collapse.

If you agree to take part in this investigative study, the interview will be recorded so that we can represent your experiences as accurately as possible. Please check one of the following:

I agree ___ do not agree ___ to be audio recorded.

Your participation in this investigative study is voluntary and without compensation. Also, you may refuse to answer any specific question raised during the interview. All the records of your interview will be kept confidential to the extent permitted by law, including the Freedom of Information Act (FOIA) (5 U.S.C. 552) and the Privacy Act (5 U.S.C. 552a). Information collected in this interview may be shared with other NIST personnel or other investigators appointed by NIST. Any reports that are produced based on information from the investigation of this event, including that which is provided by you in interviews, will not include any personally identifiable information, for example, your name or phone number.

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PRA Statement

A Federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for failure to comply with an information collection subject to the requirements of the Paperwork Reduction Act of 1995 unless the information collection has a currently valid OMB Control Number. The approved OMB Control Number for this information collection is XXXX XXXX. Without this approval, we could not conduct this survey/information collection. Public reporting for this information collection is estimated to be approximately 90 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the information collection. All responses to this information collection are voluntary. Send comments regarding this burden estimate or any other aspect of this information collection, including suggestions for reducing this burden to the National Institute of Standards and Technology (NIST). Attn: Maria Dillard, Engineering Laboratory, National Institute of Standards and Technology, E-mail: maria.dillard@nist.gov or Phone: 202-281-0908

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Privacy Act Statement

Authority: The National Institute of Standards and Technology Act, as amended, 15 U.S.C. 271 et seq. (which includes Title 15 U.S.C. 272) and section 12 of the Stevenson-Wydler Technology Innovation Act of 1980, as amended, 15 U.S.C. 3710a.

National Construction Safety Team (NCST) Act (Public Law 107-231)

Purpose: NIST is conducting a full technical investigation of the collapse of the Champlain Towers South Condominium in Surfside, FL that occurred on June 24, 2021, under the authority of the National Construction Safety Team (NCST) Act, which is authorized by Congress. As part of this work, NIST seeks to interview eyewitnesses, first responders, engineers, vendors, contractors, maintenance staff, construction workers, residents, condominium owners, government officials, and others who can describe experiences with the building before and/or during the collapse, describe knowledge of the building prior to the collapse (e.g., construction, maintenance), and generally, provide any additional information that may help explain the technical cause of the building failure.

Routine Uses: NIST will use this information to conduct investigations and research to determine the technical cause of the collapse and, if appropriate, to recommend changes to building codes, standards and practices, or other actions to improve the structural safety of buildings. Disclosure of this information is also subject to all the published routine uses as identified in the Privacy Act System of Records Notice NIST-6: Participants in Experiments, Studies, and Surveys.

Disclosure: When you agree to participate in an interview, you are indicating your voluntary consent for NIST to use the information you provide for the purpose stated.

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I have read this interview information sheet or it was read to me. I know that participating in this investigative study is voluntary. I choose to participate in this investigative study. I have received, on the date signed, a copy of this document comprised of 3 pages.

Name of participant (printed): __________________________________________

Signature _______________________________ Date__________________

Please contact Maria Dillard if you have any further questions about this investigative study:

Maria Dillard

Engineering Laboratory

National Institute of Standards and Technology

100 Bureau Drive Gaithersburg, Maryland 20899-8664

E-mail: maria.dillard@nist.gov

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