Initial Telephone Screening contact with coal mines

Page 2 - [RESPONDENT NAME]

Form Approved

OMB No. XXXX-XXXX

Exp. Date XX/XX/XXXX

Appendix G

NIOSH Survey of Mine Safety Interventions

Introductory Telephone Script

INTRO: Hi, my name is ____ and I’m calling from ICF International on behalf of the National Institute for Occupational Safety and Health, or NIOSH. May I please speak with [name of Mine Operator or Mine Safety Manager]?

[If the Safety Manager or Mine Operator is not available, phone representative gets name and uses name in call back]

RESPONDENT on phone  Good afternoon. We are conducting a survey on behalf of the NIOSH Mining Program to assess whether NIOSH’s safety interventions meet the needs of the coal mining industry. This is not a sales call. My call today is to let you know that [Mine Name] is one of 300 mines selected to receive a survey from NIOSH in the mail in about two weeks.

The survey—which also will be available to complete over the Internet—is completely voluntary, and will only take about 30 minutes for you to complete. Your name and your mine’s name will not be associated with any survey responses. NIOSH will use the findings from this survey to enhance the awareness, use and effectiveness of its safety innovations, and will not publish the survey results for individual mines, but only as a group. This means NIOSH will not release information that allows the identification of individual mines unless compelled by law.

In about two weeks, you can expect to receive a copy of the survey along with a self-addressed stamped envelope for easy return. We’ll also be including instructions on how to complete the survey online, if that is more convenient for you. Just to ensure we have the correct mailing address for [Mine name], is your current address [Give address we have on file currently]?

If incorrect, ask respondent for clarification.

Thank you very much--your participation in the upcoming survey is strongly encouraged and greatly appreciated by NIOSH. If you have any questions, you can call the Project Director, Linda J. McWilliams, by telephone (412-386-6116) or e-mail (LMcWilliams@cdc.gov).

Public reporting burden of this collection of information is estimated to average 5 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data 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 Reports Clearance Officer; 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (xxxx-xxxx).