Recruitment Tracking Form

P_Att08_RecrTrackingForm_20180802.docx

Human Health Effects of Drinking Water Exposures to Per- and Polyfluoroalkyl Substances (PFAS) at Pease International Tradeport, Portsmouth, NH (The Pease Study)

Recruitment Tracking Form

OMB: 0923-0061

Document [docx]
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Attachment 8.

Pease Study

Recruitment Tracking Form


Adult Study ID No. |_________________| (record any alias study IDs to ensure linkages)

Parent Study ID No. |_________________|

Child Study ID No. |_________________|


Contact Information Label

NW = Non-working Number

NH = No One Home

EN = Not Eligible

EY = Yes Eligible

AN = Appointment Not Scheduled

AS = Appointment Scheduled (note date/time)

AR = Appointment Rescheduled (note date/time)

AX = Appointment No-Show

CC = Consent Complete

IP = Partial Interview

IC = Completed Interview

O = Other (explain)

No.

DATE

mm/dd/yy

TIME

hh:mm

OUTCOME

CODE(S)

COMMENTS

INTERVIEWER

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File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorCDC User
File Modified0000-00-00
File Created2021-10-07

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