ATSDR Recommendation Follow-up Form

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Overview

Follow-up
Options

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Sheet 1: Follow-up

Attachment 4i. ATSDR Recommendation Follow-up Form
ATSDR Recommendation Follow-Up Form
ATSDR estimates the average public reporting burden for this collection of information as 10 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 or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Information Collection Review Office, 1600 Clifton Road NE, MS H21-8, Atlanta, Georgia 30333; ATTN: PRA (0923-0057).
Basic site information
Site name:
Zip code:
Were recommendations provided for this site? (If yes, complete entire form. If no, end here.)
Recommendation #1
Description of recommendation (1-2 sentence max):
Select the recommendation category:
Potential health concern address (1 sentence max):
Recommendation status:
Impact on exposure:
Date recommendation was adopted, if applicable:
Status update on recommendation if not yet implemented:
Type(s) of stakeholder(s) involved in recommendation acceptance process: (Select all applicable)
Type(s) of stakeholder(s) responsible for implementing recommendation: (Select all applicable)
Description of actions taken to follow-up on recommendations:
Recommendation #2
Description of recommendation (1-2 sentence max):
Select the recommendation category:
Potential health concern address (1 sentence max):
Recommendation status:
Impact on exposure:
Date recommendation was adopted, if applicable:
Status update on recommendation if not yet implemented:
Type(s) of stakeholder(s) involved in recommendation acceptance process: (Select all applicable)
Type(s) of stakeholder(s) responsible for implementing recommendation: (Select all applicable)
Description of actions taken to follow-up on recommendations:
Recommendation #3
Description of recommendation (1-2 sentence max):
Select the recommendation category:
Potential health concern address (1 sentence max):
Recommendation status:
Impact on exposure:
Date recommendation was adopted, if applicable:
Status update on recommendation if not yet implemented:
Type(s) of stakeholder(s) involved in recommendation acceptance process: (Select all applicable)
Type(s) of stakeholder(s) responsible for implementing recommendation: (Select all applicable)
Description of actions taken to follow-up on recommendations:
Recommendation #4
Description of recommendation (1-2 sentence max):
Select the recommendation category:
Potential health concern address (1 sentence max):
Recommendation status:
Impact on exposure:
Date recommendation was adopted, if applicable:
Status update on recommendation if not yet implemented:
Type(s) of stakeholder(s) involved in recommendation acceptance process: (Select all applicable)
Type(s) of stakeholder(s) responsible for implementing recommendation: (Select all applicable)
Description of actions taken to follow-up on recommendations:
If more than four recommendations were provided for this document, copy lines 23-27 and columns A-B and paste below as needed.

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Sheet 2: Options

These are the display options for the drop-downs in the form. It will be hidden tab when the form is used.
Yes		Impose institutional or regulatory controls to eliminte/reduce/limit exposure				Non-verifiable	Describes a recommendation to an individual community member that cannot be verified and is therefore acceptabley deemed non-verifiable
No		Evacuate/relocate exposed population				Pending acceptance	Describes a recommendation that has been provided to a stakeholder, but has not yet been accepted by that stakeholder. Acceptance is defined as agreeing with the recommendation and committing to implement the recommendation in the future, but not yet having implemented the recommendation.
		Conduct exposure Investigation				Accepted	Describes a recommendation that has been provided to a stakeholder, and that stakeholder accepts the recommendation and commits to implement it in the future, but has not yet implemented it.
		Conduct ATSDR health study				Implemented	Describes a recommendation that has been fully implemented to reduce or remove the hazardous environmental exposure to the full extent recommended.
		State-funded health study				Rejected	Describes a recommendation that was rejected and not accepted or implemented by the stakeholder
		Conduct/continue monitoring				Eliminated	Describes a recommendation that was eliminated by the health assessment due to lack of application at a follow-up date.
		Other site source/media/contamination characterization
		ATSDR health education activity				For the purposes of recommendations, a stakeholder will be described as any entity for which a recommendation can reasonably be tracked and would impact >1 person, such as a regulatory authority, a business owner, a local or state decision-maker, etc.
		State-led health education activity
		Remediation (e.g. site clean up) to eliminate/reduce hazards
		Restrict use of source of hazards
						Reduction
		Community leader				Total Elimination
		Community advocacy group				Unknown
		Federal regulatory agency
		State regulatory agency
		Local regulatory agency
		Other regulatory agency
		Industry/Business