QID Telephone Quality Control Worksheet for 20xx Vegetable C

	NATIONAL AGRICULTURAL STATISTICS SERVICE	TELEPHONE QUALITY CONTROL WORKSHEET for 20XX VEGETABLE CHEMICAL USE SURVEY	Form Approved OMB Number 0535-0218 Approval Expires XX/XX/XXXX Project code 136
U.S. Department of Agriculture Rm 5829, South Building 1400 Independence Avenue, S.W. Washington, D.C. 20250-2000 1-800-727-9540 Fax: 202-690-2090 E-mail: [email protected]

State: _________________________________________________		Farm, Ranch, or Operation Name: __________________________________________
Version:		Operator’s name: __________________________________________
ID/POID: ______________________________________________		Address: __________________________________________________
Enumerator: __________________________________________		__________________________________________________
Interview Date & Time: ________________________________		Telephone: ________________________________________________
Survey Respondent: __________________________________	Operator/Mgr Spouse Accountant/ Partner Other Bookkeeper
Current Respondent: __________________________________	Operator/Mgr Spouse Accountant/ Partner Other Bookkeeper

INTRODUCTION:

[Introduce yourself, and ask for the survey respondent. Rephrase in your own words.]

Recently you should have been contacted by one of our interviewers, Mr./Ms. ,

for the Vegetable Chemical Use Survey. This telephone call is part of our survey quality assurance measures

to verify that personal contact was actually made with you for that purpose. Your response is voluntary and not required by law, but your cooperation will be appreciated. Facts about your farm/ranch will be kept confidential.

1. During the past few days, do you recall an interview with Mr./Ms. , for the purpose of obtaining information about your farming or ranching operation?

YES - [Go to item 3.]

NO - [Go to item 2.]

DON'T REMEMBER - [Go to item 2.]

2. During the past few days, did any other person from the Agricultural Statistics Service, NASS, or USDA, interview you to obtain information about your farm or ranch?

YES - [Go to item 3.]

NO - [Conclude interview.]

DON'T REMEMBER - [Conclude interview.]

3. Did the person conducting the interview ask you to verify the spelling of your name, address

and the operation name?

YES

NO

DON'T REMEMBER

[Continue on back.]

4. Now I need to verify items that are critical to our survey procedures.

Reported

Verified

a. Total acres of all vegetables (Section A, item 4)

_______________________

_______________________

b. Chemical applications to target vegetables

None, Positive

None, Positive

5. Did Mr./Ms. conduct the interview in a knowledgeable and professional manner?
YES NO – Explain: ____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
6. Do you have any additional comments you would like to make concerning our survey contact?
______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________
This concludes the interview. Thank you for your help.
Signature:___________________________________________________	Date:____________________________________________________