Form 1 Electronic Survey for Soliciting Feedback for the Heat I

Form Approved

OMB Control Number: 1225-0093

Expiration Date: 02/29/2024

Heat Illness Prevention Campaign GovDelivery Script/Prompt Language – June 2022

Survey Introduction:

Thank you for your interest in receiving the “Heat Source,” a monthly newsletter that provides information on heat-related illness prevention.

Email (Required):

Please fill out this optional questionnaire to determine how the Heat Illness Prevention campaign can better meet your needs for producing materials and topics on heat illness prevention. Please choose the responses that most apply to you or your workers.

1. I am primarily interested in heat illness prevention information for (select one):

   • Work performed exclusively outdoors

   • Work performed mostly outdoors

   • Work performed half outdoors, half indoors

   • Work performed mostly indoors

   • Work performed exclusively indoors

2. Targeted heat alerts for the following geographic locations would help me better protect myself or my workers (select one or more).

• Alabama (AL)

• Alaska (AK)

• Arizona (AZ)

• Arkansas (AR)

• California (CA) - Northern

• California (CA) - Bay Area

• California (CA) - Greater Sacramento

• California (CA) - San Joaquin Valley

• California (CA) - Southern California

• Colorado (CO)

• Connecticut (CT)

• Delaware (DE)

• District of Columbia (DC)

• Florida (FL)

• Georgia (GA)

• Hawaii (HI)

• Idaho (ID)

• Illinois (IL)

• Indiana (IN)

• Iowa (IA)

• Kansas (KS)

• Kentucky (KY)

• Louisiana (LA)

• Maine (ME)

• Maryland (MD)

• Massachusetts (MA)

• Michigan (MI)

• Minnesota (MN)

• Mississippi (MS)

• Missouri (MO)

• Montana (MT)

• Nebraska (NE)

• Nevada (NV)

• New Hampshire (NH)

• New Jersey (NJ)

• New Mexico (NM)

• New York (NY)

• North Carolina (NC)

• North Dakota (ND)

• Ohio (OH)

• Oklahoma (OK)

• Oregon (OR)

• Pennsylvania (PA)

• Rhode Island (RI)

• South Carolina (SC)

• South Dakota (SD)

• Tennessee (TN)

• Texas (TX)

• Utah (UT)

• Vermont (VT)

• Virginia (VA)

• Washington (WA)

• West Virginia (WV)

• Wisconsin (WI)

• Wyoming (WY)

• American Samoa (AS)

• Guam (GU)

• Northern Mariana Islands (MP)

• Puerto Rico (PR)

• Virgin Islands (VI)

• International

3. Additional resources relevant to the following industries) would be beneficial to me or my workers (select one or more).

• Administrative and Support and Waste Management and Remediation Services

• Advertising

• Aerospace and Defense

• Agriculture

• Apparel

• Arts, Entertainment, and Recreation

• Automotive

• Banking

• Biotechnology

• Business Services

• Chemicals

• Communications

• Construction

• Consulting

• Education

• Educational Services

• Electronics

• Energy

• Engineering

• Entertainment

• Environmental

• Finance

• Food and Beverage

• Government

• Healthcare

• Hospitality

• Insurance

• Machinery

• Management of Companies and Enterprises

• Manufacturing

• Media

• Not For Profit

• Oil and Gas

• Other

• Professional

• Professional, Technical, and Scientific Services

• Professional Certification Body

• Recreation

• Retail

• Shipping

• Technology

• Telecommunications

• Transportation

• Utilities

4. My preferred method to receive information about heat illness prevention is (select one or more).

• Social media (e.g., Facebook, Twitter, Instagram, LinkedIn, YouTube, etc.)

• eNewsletters

• Podcasts

• Email

• Blogs

• Outdoor media (e.g., billboards, bus signs, etc.)

• Ads on internet or web

• Radio

• Print newspapers

• Magazine

• Websites

• Apps

• Mobile device/text messaging

• Television (e.g., cable, local, network nightly)

• Search engines (e.g., Google, Bing, Yahoo! Search)

5. Heat illness prevention materials in languages other than English and Spanish would be beneficial to me or my workers (select one).

• Yes

• No

If yes, which language(s): _________________________________

6. The Heat Illness Prevention Campaign materials ARE inclusive of which of the following demographic groups (select one or more).

• White

• Black or African American

• American Indian or Alaska Native

• Asian

• Native Hawaiian or Other Pacific Islander

• Hispanic, Latino, or Spanish

• Male

• Female

• Transgender

• Nonbinary/gender non-conforming

7. The Heat Illness Prevention Campaign materials ARE NOT inclusive of which of the following demographic groups (select one or more).

• White

• Black or African American

• American Indian or Alaska Native

• Asian

• Native Hawaiian or Other Pacific Islander

• Hispanic, Latino, or Spanish

• Male

• Female

• Transgender

• Nonbinary/gender non-conforming

PAPERWORK REDUCTION ACT BURDEN STATEMENT

Public reporting burden for this voluntary collection of information is estimated to average 3 minutes per response, including time for reviewing instructions, searching existing data sources, gathering, and maintaining the data needed, and completing and reviewing the collection of information. Persons are not required to respond to the collection of information unless it displays a current valid OMB control number. If you have any comments about this estimate or any other aspects of this data collection, including suggestions for reducing this burden, please send them to [email protected] or to US Department of Labor, OSHA Directorate of Standards and Guidance N-3609, 200 Constitution Avenue, NW, Washington, DC 20210.