Attachment G

Attachment G. Web Page Informational Materials

Attachment G1. Home Page and ‘Home Page’ Tab

OMB # xxxxxxx; Expiration Date: xx/xx/xxxx

Thank you for agreeing to participate in the Health and Safety Practices Survey of Healthcare Workers. It is being conducted by the National Institute for Occupational Safety and Health (NIOSH) and their contractor, Westat. Your answers, combined with those of other survey respondents, will provide valuable data on health and safety practices and the types of exposure controls used by healthcare workers who handle or come in contact with hazardous chemicals.

The survey should take about 30 minutes to complete. There are no right or wrong answers, so please choose the survey responses that best describe your situation. So that we can best understand your experiences we encourage you to answer all the questions that apply to you. However, you are free to skip any questions you do not wish to answer.

This is a secure website. Your responses will be saved as you move through the survey. You may exit and reenter the survey later using the Resume Survey Code that will be provided to you. Once you click the “Submit” button at the end of the survey, you may not reenter. If you have any questions, please click on the “Contact Us” tab at the top of the page.

Attachment G2. ‘About NIOSH’ Tab

The National Institute for Occupational Safety and Health (NIOSH) is the U. S. federal agency responsible for conducting research and making recommendations for the prevention of work-related injury and illness. NIOSH is part of the Centers for Disease Control and Prevention (CDC) in the U.S. Department of Health and Human Services.

The Occupational Safety and Health Act of 1970 created both NIOSH and the Occupational Safety and Health Administration (OSHA). OSHA is in the U.S. Department of Labor and is responsible for developing and enforcing workplace safety and health regulations. NIOSH assures safe and healthful working conditions for working men and women by providing research, information, education, and training in the field of occupational safety and health. NIOSH and OSHA often work together toward the common goals of protecting worker health and ensuring occupational safety.

Attachment G3. ‘FAQs’ Tab

Frequently Asked Questions (FAQs)

• Who is conducting the survey?

• Who is the target population for the survey?

• What is the survey about?

• How will the survey results be used?

• How much time does it take to complete the survey?

• Can I exit the survey and re-enter where I left off?

• Are my answers to the survey confidential?

• Are there any risks with completing the survey?

• Will my professional association have access to the data?

• Who do I call if I have questions about the survey?

• Who do I call if I have questions about my rights as a survey participant?

Who is conducting the survey?

The National Institute for Occupational Safety and Health (NIOSH) is sponsoring the Health and Safety Practices Survey of Healthcare Workers. As part of the Centers for Disease Control and Prevention (CDC) in the U.S. Department of Health and Human Services, NIOSH is the U.S. federal agency responsible for conducting research and making recommendations for the prevention of work-related illness and injury. Not to be confused with NIOSH, the Occupational Safety and Health Administration (OSHA) in the Department of Labor is responsible for developing and enforcing safety and health regulations. Westat, a survey research company, is a partner in contract with NIOSH and will be conducting the survey for NIOSH.

Who is the target population for the survey?

Survey participants will be from various professional organizations who have agreed to make the survey available to their members. These organizations represent various healthcare occupations which are likely to use or come into contact with one or more of the hazardous chemical agents under study.

What is the survey about?

The survey will gather information about health and safety practices and the types of exposure controls used by healthcare workers who are likely to use or come in contact with hazardous chemical agents in your job. The chemical agents under study include aerosolized medications, antineoplastic agents, chemical sterilants, high level disinfectants, surgical smoke, and anesthetic gases.

How will the survey results be used?

NIOSH will use the data to guide interventions and future research. The participating professional organizations indicated that the data will be useful for benchmarking, identifying areas for expanding guidelines and for health and safety promotion.

How much time does it take to complete the survey?

The survey will take most respondents about 30 minutes to complete. We estimate that about 10% of respondents will complete additional questions on one of the hazardous chemical agents. This will add about 10 minutes to their completion time.

Can I exit the survey and re-enter where I left off?

Respondents can exit the survey at any time and answers will be saved automatically. Respondents will be given a Resume Survey Code, only known to themselves, to re-access the survey. Respondents returning to the survey within 24 hours will be able to resume the survey where they stopped. Because many of the questions are time-sensitive, respondents returning after a 24-hour period will be asked to begin the survey again.

Are my answers to the survey confidential?

The link to the survey has only been distributed to members of the participating professional organizations. Although the participating professional organizations are aware who received the invitation. They will not know which members complete the survey. Your professional organization will not have access to your answers and will not know whether you choose to complete the survey.

All data collection activities will be conducted in full compliance with the CDC regulations to maintain the privacy of data obtained on persons and to protect the rights and welfare of human subjects, as contained in Title 28 of the Code of Federal Regulations, Parts 22 and 46.

The survey data will be stored on a secure server by Westat. Your answers are only used for study purposes and will be presented in grouped or summary data. This is an anonymous survey. We are not collecting personal information such as names, addresses, or phone numbers, or employer names.

Are there any risks with completing the survey?

Risks to participants are low, since no information in identifiable form will be collected. The survey will ask questions about your work as it relates to the frequency and duration of use of selected chemical agents, work practices, use of engineering controls and personal protective equipment, and any work-related injuries, illnesses or exposures that you experienced in the past year. If a particular question troubles you, and you do not want to answer the question, you can skip the question. You may also stop taking the survey at any time. While the survey is completely voluntary we encourage you to complete the survey. It is only with the generous help of people like you that our research can be successful.

Will my professional association have access to the data?

Your professional association will not have access to your answers or whether or not you choose to complete the survey. They will only be given aggregate information about the health and safety practices for members who volunteered to participate.

Who do I call if I have questions about the survey?

Please contact NIOSH Project Officers who will be happy to answer your questions.

For technical questions, please contact:

Name Telephone Available time Email

Help Desk 1-888-219-5667 (toll free) 9AM~5PM EST craigray@westat.com

For all other questions, please contact:

Name Telephone Available time Email

Jim Boiano 513-841-4246 7AM~330PM EST jboiano@cdc.gov

Andrea Steege 513-841-4538 830AM~5PM EST asteege@cdc.gov

Who do I call if I have questions about my rights as a survey participant?

Please call Cheryl Estill, Chair, NIOSH Human Subjects Review Board, at 513-533-8591.

Attachment G4. ‘Privacy and Security’ Tab

Privacy & Security

This web page and the Health and Safety Practices Survey of Healthcare Workers web page are stored on a secure server operated by Westat, which is under contract to NIOSH to conduct the survey. Westat is strongly committed to maintaining the security of our computer systems. With respect to the collection, use and disclosure of personal information, Westat makes every effort to ensure compliance with applicable Federal law, including, but not limited to, the Privacy Act of 1974, the Paperwork Reduction Act of 1995, and the Freedom of Information Act.

When you log in to complete the survey, you will be provided with a Resume Survey Code so that you can re-enter the survey. The Resume Survey Code will only be known to you. No attempt will be made by the researchers to identify or track respondents.

Unauthorized attempts to alter the content of this web page or the survey are strictly prohibited and may be punishable under the Computer Fraud and Abuse Act of 1986 and the National

Information Infrastructure Protection Act of 1996.

All data collection activities will be conducted in full compliance with the CDC regulations to maintain the privacy of data obtained on persons and to protect the rights and welfare of human subjects, as contained in Title 28 of the Code of Federal Regulations, Parts 22 and 46.

Attachment G5. ‘Disclaimer’ Tab

Disclaimer

The Health and Safety Practices Survey of Healthcare Workers home page and survey pages are maintained on a secure server operated by Westat.

Westat is an employee-owned corporation providing research services to agencies of the U.S. Government, as well as businesses, foundations, and state and local governments.

References to any products in the survey do not constitute endorsement by NIOSH or the U.S. Government.

Attachment G6. ‘Contact Us’ Tab

Contact Us

Should you have any questions about the survey, please contact the following NIOSH project officers:

For technical questions, please contact:

Name Telephone Available time Email

Help Desk 1-888-219-5667 (toll free) 9AM~5PM EST craigray@westat.com

For all other questions, please contact:

Name Telephone Available time Email

Jim Boiano 513-841-4246 7AM~330PM EST jboiano@cdc.gov

Andrea Steege 513-841-4538 830AM~5PM EST asteege@cdc.gov