Provider Questionnaire

ATTACHMENT G

PROVIDER QUESTIONNAIRE

Form Approved OMB No. 0920-xxxx Exp. Date XX/XX/20XXXX/XX/20XX

Provider Questionnaire – Paper Copy of Web Questionnaire

Thank you for your willingness to help us in this important project designed to determine critical training needs for future professionals in occupational safety and health.

If there is someone else in your organization who would be a more knowledgeable respondent for this survey, we ask that you forward the letter or email containing the User ID and password to that individual.

If more than one individual is needed to complete the survey, we ask that you work together in to provide information that is as complete as possible.

If you have any questions, please contact Westat toll-free at 1-xxx-xxx-xxxx (or by email: xxxxxx@Westat.com).

Public reporting of this collection of information is estimated to average 22 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and compiling 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 current 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 D-74, Atlanta, Georgia 30333; ATTN: PRA (XXXXXX).

Overview

This page provides information about: (each of these bullets will be bookmarked to the relevant section below)

• How to navigate through the survey

• When are your answers saved

• How to clear your answers

• How to print the survey and/or your responses

• The three ways to leave the survey: Exit, Timeout, and Submit

• Where you can get help if you have additional questions

How to navigate through the survey

Each page of the survey has two buttons that allow you move forward and backward through the pages of the survey. They are the “Previous Page” and “Next Page” buttons. On most pages, these buttons appear at both the top and the button of the page. You can change your responses as often as you like, and you can revisit sections of the survey as often as you like.

When are your answers saved?

Your answers are saved each time you move to a new page, go back to an earlier page, or exit the survey by clicking on “Save & Exit”. If you click on the X in your browser window to exit the survey, your responses on the current page will not be saved. If you need to leave the survey before you have completed it, always click on the “Save & Exit” button that appears on each page of the survey.

The three ways to leave the survey: Exit, Timeout, and Submit

Exit

You do not have to complete the survey in one sitting. If you wish to exit the survey to return at a later time, all you have to do is click on the “Save & Exit” button and all your responses will be saved. However, your survey will not be considered complete until you “submit” it (see Submit section below).

Timeout

After 25 minutes of inactivity (that is, you haven’t interacted with the survey in 25 minutes), you will be given a “timeout” warning. After you get this warning, you’ll have 5 minutes to resume activity or you will be timed out. If you are timed out, new or changed responses to the questions on your current page will not be saved.

Submit

After you have navigated through the last section of the survey, you will be taken to a Finish page. If you have left any questions blank, you will be notified of this and you will be given the opportunity to go back and fill in missing answers. If you are satisfied that you are done with the survey, you will be instructed to click on the “Submit Survey” button, and this will complete your participation. Once you have clicked on this button, your survey is considered complete and you will not be able to access the survey online again.

How to print the survey and/or your responses

There are two ways to print the survey and/or your responses. To print the entire survey, including any answers you might have already entered, click on the “Print” button which appears at both the top and the button of most pages. To print just the page you are on, please use your browser’s print button.

Where you can get help if you have additional questions

If you have any questions, please email us at xxxxxxx@westat.com. You can also call us toll-free at 1-xxx-xxx-xxxx.

You will see that this survey largely asks about “your program.” For purposes of this survey, please consider your program to consist of all of the training offered within a specified area of occupational safety and health (OS&H), including the undergraduate and graduate levels. If part of your training in an area of OS&H is funded by NIOSH, please also consider aspects of the training that are not funded by NIOSH. If your training in a given OS&H area offers degree options through both online and traditional campus-based class work, please consider both options as being within the same program.

It is our understanding that your program currently offers a degree or concentration in [OSH AREA].

We have a short series of questions about this program, and your expectations for the future.

NOTE: Each parenthetical below will be automatically filled by the web instrument for the particular OSH area being asked about (e.g., “Occupational Safety,” “Industrial Hygiene,” “Occupational Health Nursing,” etc.). Occupational Medicine Programs will be asked a version specifically tailored these programs, shown on pages 7- 8

Q1. Which of the following educational levels does your program offer for (OSH AREA)?

Mark all that apply

• Bachelor’s degree

• Master’s degree

• Doctoral degree

Q2. How many students do you expect will graduate from your program in 2010 with a:

[Screen will show only the degrees marked above]

1. Bachelor’s degree/concentration in (OSH AREA)? ____

2. Master’s degree/concentration in (OSH AREA)? ____

3. Doctoral degree/concentration in (OSH AREA)? ____

Q3. How many students, in total, do you expect will graduate from your program in the next five years (2011 to 2015) with a:

[Screen will show only the degrees marked above] Total Over

5 Years

1. Bachelor’s degree/concentration in (OSH AREA)? ____

2. Master’s degree/concentration in (OSH AREA)? ____

3. Doctoral degree/concentration in (OSH AREA)? ____

Q4. Over the last 5 years, has the number of students entering your program to earn degrees in (OSH AREA) increased, decreased, or remained about the same?

• Increased  Q4b Q4b. By approximately what percent,

• Decreased  Q4b. cumulatively, over 5 years? ________

• Remained about the same

Q5. Over the last 5 years, has the quality (e.g., test scores, motivation, dedication) of students applying to your program to earn degrees in (OSH AREA) increased, decreased, or remained about the same?

• Increased

• Decreased

• Remained about the same

Q6. What obstacles (if any) exist at your institution for the typical student who may wish to study (OSH AREA)? Check all that apply

• No obstacles

• Financial

• Job prospects

• Lack of knowledge of the program

• Program rigor

• Other obstacles (Specify): ______________________________

Q7a [ASK IF BACHELOR’S MARKED IN QUESTION 1] Approximately what percent of graduates obtain a job in (OSH AREA) within two years of leaving your program with a Bachelor’s degree in (OSH AREA)?

_____ percent

Q7b [ASK IF MASTER’S OR HIGHER DEGREE MARKED IN QUESTION 1] Approximately what percent of graduates obtain a job in (OSH AREA) within two years of leaving your program with a Master’s or higher degree in (OSH AREA)?

_____ percent

Q7c   Thinking about your program graduates who have obtained jobs over the last few years, approximately what percent of your graduates have gone to work within the following economic sectors?

 

                        Government:                                        _____ %

                         OS&H Consulting Services:                  _____ %

Manufacturing:                                     _____ %

Mining:                                                  _____%

                       Construction:                                        _____ %

                       Transportation, Warehousing, Utilities: _____%

                        Agriculture, Forestry & Fishing:            _____ %

                        Health Care & Social Services:              _____ %

                        Wholesale or Retail trade                      _____%

                        Educational Services:                             _____%

                        Other sectors:                                        _____%

                        TOTAL                                                 100 %

Q8. Over the last 5 years, has the level of general (recurring) funding from your university/college for training in (OSH AREA) increased, decreased, or remained about the same?

• Increased

• Decreased

• Remained about the same

Q9. Over the last 5 years, has your program received funding from any source outside the university for the support of students in (OSH AREA)?

• Yes  Please list the major sources of this funding:_________________________

• No  Skip to Q11

Q10. Over the last 5 years, has the level of funding from outside sources for the support of students in (OSH AREA) increased, decreased, or remained about the same?

• Increased

• Decreased

• Remained about the same

Q11. How many faculty members trained in (OSH AREA) or a related area does your program currently employ?

Full-time faculty: _____

Part-time/adjunct faculty: _____

Q12. How many full-time faculty members trained in (OSH AREA) or a related area do you expect your program will hire over the next 5 years?

________

Q13. How many full-time faculty members trained in (OSH AREA) or a related area do you expect will retire or leave the profession over the next 5 years?

________

Q14. Does your program in (OSH AREA) offer students an internship or other practice experience?

• Yes

• No

QUESTIONS SPECIFIC TO OCCUPATIONAL MEDICINE PROGRAMS

NOTE: ALL OTHERS WILL SKIP TO THE ACCREDITATION SECTION ON PAGE 9

Q1. How many students do you expect will complete your Occupational Medicine program in 2010?

______________

Q2. How many students, in total, do you expect will complete your program in the next five years (2011 to 2015)?

______________ TOTAL OVER 5 YEARS

Q3. Over the last 5 years, has the number of students entering your Occupational Medicine program increased, decreased, or remained about the same?

• Increased  Q3b Q3b. By approximately what percent,

• Decreased  Q3b. cumulatively, over 5 years? ________

• Remained about the same

Q4. Over the last 5 years, has the quality (e.g., test scores, motivation, dedication) of students applying to your Occupational Medicine program increased, decreased, or remained about the same?

• Increased

• Decreased

• Remained about the same

Q5. What obstacles (if any) exist at your institution for the typical student who may wish to study Occupational Medicine? Check all that apply

• No obstacles

• Financial

• Job prospects

• Lack of knowledge of the program

• Program rigor

• Other obstacles (Specify): ______________________________

Q6a. Approximately what percent of graduates obtain board certification in Occupational Medicine after leaving your program?

_____ percent

Q6b. Approximately what percent of graduates obtain a job in Occupational Medicine within two years of leaving your program?

_____ percent

Q6c   Thinking about the last few years, approximately what percent of your graduates have obtained jobs within the following economic sectors?

 

                        Government:                                        _____ %

                         OS&H Consulting Services:                  _____ %

Manufacturing:                                     _____ %

Mining:                                                  _____%

                       Construction:                                        _____ %

                       Transportation, Warehousing, Utilities: _____%

                        Agriculture, Forestry & Fishing:            _____ %

                        Health Care & Social Services:              _____ %

                        Wholesale or Retail trade                      _____%

                        Educational Services:                             _____%

                        Other sectors:                                        _____%

                        TOTAL                                                 100 %

Q7. Over the last 5 years, has the level of general (recurring) funding from your university/college for training in Occupational Medicine increased, decreased, or remained about the same?

• Increased

• Decreased

• Remained about the same

Q8. Over the last 5 years, has your program received funding from any source outside the university for the support of students in Occupational Medicine?

• Yes  Please list the major sources of this funding:_________________________

• No  Skip to Q10

Q9. Over the last 5 years, has the level of funding from outside sources for the support of students in Occupational Medicine increased, decreased, or remained about the same?

• Increased

• Decreased

• Remained about the same

Q10. How many faculty members trained in Occupational Medicine or a related area does your program currently employ?

Full-time faculty: _____

Part-time/adjunct faculty: _____

Q11. How many full-time faculty members trained in Occupational Medicine or a related area do you expect your program will hire over the next 5 years?

________

Q12. How many full-time faculty members trained in Occupational Medicine or a related area do you expect will retire or leave the profession over the next 5 years?

________

Accreditation

NOTE: OCCUPATIONAL MEDICINE PROGRAMS WILL SKIP TO THE CONTINUING EDUCATION SECTION ON THE NEXT PAGE

Q1. Is any of your program’s training in (OSH AREA) accredited? If so, please indicate by whom:

• Yes, all of this training is accredited ___________________________________

• Some of the training is accredited  ____________________________________

• No, none of this training is accredited

NOTE: IF Q2 INDICATES THAT AT LEAST SOME TRAINING FOR OSH AREA HAS RECEIVED PROGRAM-SPECIFIC ACCREDITATION, THEN RESPONDENT WILL BE SKIPPED TO CONTINUING EDUCATION SECTION ON NEXT PAGE

Q2. What are the reasons why you have not obtained program-specific accreditation in (OSH AREA)?

Mark all that apply

• It is too expensive

• It requires too much work

• It offers too little value

• There is no accreditation organization for (OSH AREA)

• Other reason (please specify):_________________________________

Continuing Education

Q1. Does your program offer Continuing Education courses on topics related to (OSH AREA):

• Yes

• No

Q2. How many people do you anticipate will take Continuing Education courses offered by your program during 2010 on topics related to (OSH AREA)?

__________

Q3. Over the last 5 years, has the number of attendees in your Continuing Education courses in these areas increased, decreased, or remained about the same?

• Increased

• Decreased

• Remained about the same

• Our CE courses in this area are too new

NOTE: IF NO CE IS OFFERED, Q4-Q5 WILL BE SKIPPED

Q4. Trends Observed:  We would like to know about important trends you have noticed in Continuing Education (with respect to needs, format, offerings, locations, etc.). What are the most important trends that you have seen?

________________________________________

Q5. Changes Anticipated:  What important changes do you anticipate making in your Continuing Education program over the next 5 to 10 years?

________________________________________

END

Thank you for your responses to this survey. We have only two more questions for you…

Q1. Trends Observed:  We would like to know how the occupational safety and health professions have been changing. What are the most important trends that you have seen?

________________________________________

Q2. Changes Needed:  What important changes do you anticipate making in your occupational safety and health training programs over the next 5 to 10 years?

________________________________________

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