Memo 1

OMB Approval No. ___________

Date ____________

Sample Respondent Name

(Company)

(Address)

(City, State, Zip Code)

Dear (Respondent):

I am David Michaels, Assistant Secretary of the Occupational Safety and Health Administration (OSHA). OSHA is conducting a comprehensive study of workplace safety and health practices, and we hope you will participate by completing a survey questionnaire about your place of business. Your establishment was randomly selected from a publicly available database of business establishments in the United States, and your participation in this survey is completely voluntary.

Information from this survey will be used by OSHA for developing outreach and regulatory programs related to various aspects of worker health and safety. For example, this survey will provide OSHA with better information on how various sizes of establishments in various industries manage health and safety. The survey will also be used in developing better estimates of the possible benefits and costs of wider implementation of safety and health programs. I would very much appreciate it if you would take the time to respond to this survey.

The survey is being conducted for OSHA by its contractor, Eastern Research Group, Inc., (ERG) of Lexington, Massachusetts. ERG will collect the information and analyze it for OSHA. ERG will not provide any employer names or identifiers to OSHA.

This survey should take between 15 and 30 minutes to complete. We have enclosed a paper copy of the survey if you wish to fill out and return it in the enclosed, stamped envelope. However, we think the quickest and easiest way to complete the survey is via ERG’s website at www.erg.com.XXXX. Your pass code for accessing the web based survey is: . Your pass code is unique to you. You can begin the survey and then stop and save your answers to finish later.

The aggregated results of the survey will be made available on OSHA’s website, as well as on the original ERG survey website, once the information has been collected, compiled, and tabulated. (As noted above, these results will not be identifiable by establishment name or other identifiers.) If you would like to automatically receive tabulated results when available, you will be able to request this information when completing the survey on ERG’s website.

The survey has been written to collect information from employers across all sectors of the economy. The questions have been structured so respondents can skip over questions that are not relevant to them. As a result, you may not need to provide an answer to every numbered question.

If you are not responsible for safety and health practices at your establishment, please forward this request to the person or people at your establishment best suited and qualified to respond to questions about safety and health practices.

If you have questions about the survey you may contact Andreas Lord at ERG (tel.: 781-674-7381; email: andreas.lord@erg.com). At OSHA, contact either Paul Bolon (202-693-1960; bolon.paul@dol.gov) or Chuck McCormick (202-693-1740; mccormick.charles@dol.gov).

Thank you for your attention to this important matter, and for your firm’s help in informing OSHA about this important issue.

Sincerely,

David Michaels, PhD, MPH

Assistant Secretary of Labor

Paperwork Reduction Act 1995

According the Paperwork Reduction Act of 1995 (PRA), no persons are required to respond to a collection of information unless such a collection displays a valid OMB Control number. We are required by the PRA to inform you that the public reporting burden for this collection of information is voluntary and is estimated to average between 15 and 30 minutes per completed survey, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. If you have comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, please send them to Department of Labor, OSHA, Directorate of Evaluation and Analysis, Room N 3641 200 Constitution Ave, NW, Washington, DC, 20210.