Attachment B Draft Survey Instrument Combined

OMB Package, WRAAK “Voice In the Workplace” Chief Evaluation Office, Department of Labor

Attachment B

Survey Instrument Combined

August 25, 2012

(Columns are ABSOLUTE)

I.D.#: (1-6)

**AREA CODE AND TELEPHONE NUMBER:

______ ______

____________________________________________ (1161 - 1170)

**INTERVIEW TIME:

______ ______

____________________________________________ (1716 - 1721)

ENTITYID

QID:117057 ENTITY_ID

(Programmer: Code from fone file)

ENTITYID(916-925)

(Programmer: Code from fone file)

SA

QID:33653 SAMPLE TYPE:

1 Landline

2 Cell Phone

(NOTE: All interviews are recorded. The recording begins when the respondent answers the phone. This statement is read after the "Continue" response is entered after the Introduction and before the first question) This call will be recorded for quality assurance.

1 (Continue)

2 (Refused) - (Thank and Terminate) (1984)

_____(73)

_____(53)

INTRODUCTION

SB Hello, this is ____, with The Gallup Poll. We are conducting a national survey about

workplaces and employment.

Gallup will not share any individual responses with the government or your employer.

IF RESPONDENT SAYS THEY ARE NOT EMPLOYED SO THEY DON’T WANT TO PARTICIPATE:

It is important that we speak with all types of adults, whether you are currently working or not.

IF RESPONDENT ASKS ABOUT SURVEY LENGTH:

This survey is estimated to take about 18 minutes to complete.

READ IF NECESSARY:

Would you like me to provide you with an address where you can send comments regarding the burden estimate or any other aspect of this survey, including suggestions for reducing this burden? (IF YES, READ ADDRESS BELOW)

Chief Evaluation Office

U.S. Department of Labor

200 Constitution Avenue NW

Room S2316

Washington, DC 20210

The OMB control number for this study is OMB No. XXXXXXXX.

QID:55903 Skip: (If code 1 in SA, Continue;
Otherwise, Skip to SB1_2)

SB1_1 Including yourself, how many adults over the age 18 in this household are currently working either full-time or part time and are not self-employed? (Code actual)

Number of working adults in household___________________________

98 (DK)

99 (Refused)

INTERVIEWER NOTE: IF 00 in SB1_1 SKIP to Read before S2_a, ALL OTHER SKIP TO SC

SB1_2 Are you at least 18 years of age and currently working either full-time or part

time and not self-employed?

1 Yes (SKIP TO SD1)

2 No (SKIP TO READ BEFORE S2_a)

8 (DK) (SKIP TO READ BEFORE S2_a)

9 (Refused) (SKIP TO READ BEFORE S2_a)

SC Among the people living in the household who are CURRENTLY WORKING fulltime or part-time and are not self-employed, may I please speak with the person 18 years of age or older, who had the most recent birthday?

1 Yes, male respondent available

2 Yes, female respondent available

3 No one in household 18 or older

4 Respondent not available

5 No one in the household working (SKIP TO READ BEFORE S2_a)

8 (Soft Refusal)

9 (Hard Refusal) (Thank, Terminate, and Tally)

(If code 2 in SA, Continue;

Otherwise, Skip to S1)

SD1

QID:33664 First, to confirm, have I reached you on your cell phone?

1 Yes

2 No

3 (DK)

4 (Refused)

(If code 1 in SD1, continue. Else Skip to S1)

SD5

QID:33672 Is the CELL PHONE I have reached you on mainly used for personal use, or only for business purposes?

1 Personal use

2 Used only for business

3 BOTH (Volunteered)

4 (DK)

5 (Refused)

(If code 1 or 3 in SD5, continue. Otherwise, Thank, Terminate and Tally)

SD6

QID:33666 For your safety, are you currently driving?

1 Yes

2 No

3 (DK)

4 (Refused)

SD6(2122)

QID:118638 Skip: (If code 1 in SD6, Set time to call back;
If code 2 in SD6, Continue;
Otherwise, Thank and Terminate)

S1. Please tell me your age. (Open ended and code actual age)

00 (Refused)

18-

98

99 99+

(If code 00-17 in S1, Thank and Terminate; Otherwise, Continue)

S2. Next I have a few questions on your employment status. Currently, are you? (READ A-H)

1 Yes

2 No

8 (DK)

9 (Refused)

A. Employed full-time working at least 30 hours a week.

B. Employed part-time, working less than 30 hours a week. C. Employed as Temporary, Day Laborer or Seasonal worker

D. Self Employed

E. A full-time student

F. Retired

G. Homemaker

H. Not employed

If code 1 IN S2A-C, Skip to S3. If code 1 in S2H, Continue. Otherwise, Thank, Terminate and Tally.

READ: I just have few additional questions for you before I let you go.

S2_a Within the last week did you do any work for pay?

1 Yes

2 No

8 (DK)

9 (Refused)

If code 1 in S2_a, Continue. Otherwise, Thank, Terminate and Tally.

S2_b Within the past six months did you do any work for pay?

1 Yes

2 No

8 (DK)

9 (Refused)

All in S2_b, Thank, Terminate and Tally.

S3. Do you currently have more than one job?

1 Yes

2 No

6 (DK)

7 (Refused)

INTERVIEWER NOTE: IF S3 = 1, THEN READ: For the next set of questions please refer to what you consider to be your “primary” job or the one where you spend the most time. (READ 1-4)

S4 How are you paid? (READ 1-4)

1 Salary

2 Hourly

3 Paid by unit produced or action performed

4 Daily

6 (DK)

7 (Refused)

PROGRAMMER NOTE: RANDOMLY SELECT OSHA OR WHD MODULE HERE

S5 SURVEY MODULE:

1 OSHA Module

2 WHD Module

ASK ALL

OUTCOME /LOYALTY

Q1. Using a five-point scale, where 5 means extremely satisfied and 1 means not at all satisfied, please rate your overall satisfaction with your current employer. You may use any number from 1 to 5.

5 Extremely satisfied

4

3

2

1 Not at all satisfied

8 (DK)

9. (Refused)

Using a five-point scale where 5 means extremely likely and 1 means not at all likely, how likely are you to do the following;

Q2. Recommend your employer to your family and friends as a great place to work

5 Extremely likely

4

3

2

1 Not at all likely

8. (DK)

9 (Refused)

Q3. Choose to leave your employer to work someplace else

5 Extremely likely

4

3

2

1 Not at all likely

8. (DK)

9 (Refused)

PERCEIVED VOICE

READ: Now I would like to ask you about you workplace climate. On a scale of one to five, where 5 is strongly agree and 1 is strongly disagree, please indicate your level of agreement with each of the following items. You may use any number from 1 to 5. (READ AND ROTATE Q4-Q11)

Q4. I have the opportunity to provide input into decisions that affect my work.

5 Strongly agree

4

3

2

1 Strongly disagree

8 (DK)

8. (Refused)

Q5. I am involved in helping to set goals for my workgroup or department.

5 Strongly agree

4

3

2

1 Strongly disagree

8 (DK)

9 (Refused)

Q6. My employer encourages employees to make suggestions for how to make the workplace better.

5 Strongly agree

4

3

2

1 Strongly disagree

8 (DK)

9 (Refused)

Q7. I make suggestions to my supervisor or management about how to make the workplace better.

5 Strongly agree

4

3

2

1 Strongly disagree

8 (DK)

9 (Refused)

Q8. Management always takes suggestions from workers seriously about how to make the workplace better.

5 Strongly agree

4

3

2

1 Strongly disagree

8 (DK)

9 (Refused)

Q9. I have held back from making a suggestion about how make the workplace better because I was concerned about how my supervisor or management would react

5 Strongly agree

4

3

2

1 Strongly disagree

8 (DK)

9 (Refused)

Q10. There is an effective process in my workplace for resolving workplace problems that individual employees have.

5 Strongly agree

4

3

2

1 Strongly disagree

8 (DK)

9 (Refused)

Q11. If I needed to raise a concern about my workplace, I’m confident my supervisor would do something to help me.

5 Strongly agree

4

3

2

1 Strongly disagree

8 (DK)

9 (Refused)

Q12. Does your workplace have any of the following ways for you to notify management of a problem or concern? (READ AND ROTATE A-G)

1. Yes

2. No

8 (DK)

9 (Refused)

1. Suggestion system

2. Regular meetings with supervisors

3. ‘Open door policy’

4. Hot-line

5. Union Grievance procedure

6. Other grievance procedure

7. Peer review system

8. Ombudsman (ahm-BUDS-men) (READ IF NECESSARY: A person in your workplace who investigates and attempts to resolve complaints or problems)

General Voice

READ: Now I would like to ask you some questions about your legal rights as a worker.

QID:79889 On a scale of one-to-five, where 5 is strongly agree and 1 is strongly disagree, please indicate your level of agreement with each of the following items. You may use any number from 1 to 5.

Q13. I know enough about my legal rights as a worker to be able to recognize problems when they

occur.

5 Strongly agree

4

3

2

1 Strongly disagree

8 (DK)

9 (Refused)

Q14. If I wanted to learn more about my legal rights as a worker, I could easily get that information

5 Strongly agree

4

3

2

1 Strongly disagree

8 (DK)

9 (Refused)

Q15. If I saw something happening in my workplace that I thought was a violation of workers’ legal rights, I would speak up about it.

5 Strongly agree

4

3

2

1 Strongly disagree

8 (DK)

9 (Refused)

Q16. I can raise concerns about my rights in the workplace without fear of being treated differently or punished.

5 Strongly agree

4

3

2

1 Strongly disagree

8 (DK)

9 (Refused)

PERCEIVED NON-COMPLIANCE

Q17. I trust the management of my organization

5 Strongly agree

4

3

2

1 Strongly disagree

8 (DK)

9 (Refused)

Q18. I trust my coworkers to always do what is right

5 Strongly agree

4

3

2

1 Strongly disagree

8 (DK)

9 (Refused)

Q19. My employer is always open and honest with employees about the way they do business.

5 Strongly agree

4

3

2

1 Strongly disagree

8 (DK)

9 (Refused)

Q20. Employees in my workplace are sometimes not paid for the time they work.

5 Strongly agree

4

3

2

1 Strongly disagree

8 (DK)

9 (Refused)

Q21. Employees in my workplace are sometimes exposed to health and safety risks.

5 Strongly agree

4

3

2

1 Strongly disagree

8 (DK)

9 (Refused)

If S5=1 CONTINUE, IF S5=2 SKIP TO NOTE WHD MODULE

ACTUAL VOICE

Actual Knowledge

Q22. How much do you know about your health and safety rights as a worker? By health and safety rights I mean two things: 1) what your employer is required to do to create a safe workplace, and 2) your legal rights for what you can do to make sure that you are safe in the workplace

(READ 1-4)

1 A great deal

2 Some

3 Not too much

4 Nothing at all

8 (DK/does not apply)

9 (Refused)

Q23. Are there any laws or regulations that cover what your employer is REQUIRED to do to keep you healthy and safe in your workplace?

1 Yes

2 No

8 (DK/does not apply)

9 (Refused)

(IF CODE 2, 8 or 9 IN Q23, “Actually, there are laws that cover what your employer is required to do to keep you healthy and safe in your workplace.”)

Q24. Please tell me whether any of the following statements applies to your current workplace. (READ AND ROTATE A-D)

1 Yes

2 No

8 (DK/does not apply)

9 (Refused)

1. There are chemicals, dust or hazardous materials in your workplace

2. There are loud noises in your workplace, meaning noises so loud that you need to raise your voice to be heard by someone standing near you

3. There are employees who regularly work from heights or on ladders

4. There are employees who regularly work around equipment or machinery with moving parts

READ: Next I have a few questions about some of the laws that employers are required to

follow to avoid health and safety risks, or dangers in the workplace. I am interested in finding out what you know about the laws, but if you do not know the answer, that is ok, just please say so. (READ AND ROTATE Q25A-F)

INTERVIEWER NOTE: * indicates the correct answer choice if respondent ASKS for correct response

Q25A. Are employers required to provide air conditioning in the summer or heat in the winter?

1 Yes

2 No*

8 (DK)

9 (Refused)

Q25B. Are employers required to provide some kind of protection from falling for anyone working up high?

1 Yes*

2 No

8 (DK)

9 (Refused)

Q25C. Are employers required to train their workers on the hazards of chemicals they might come into contact with?

1 Yes*

2 No

8 (DK)

9 (Refused)

Q25D. If protective glasses or gloves are required to do your job, can your employer require that you provide your own glasses or gloves?

1 Yes

2 No*

8 (DK)

9 (Refused)

Q25E. In a workplace where a respirator is NOT required, do employers have to provide a respirator to any employee that requests one? (READ IF NECESSARY: A respirator is a protective mask that filters out particles and fumes as you breathe)

1 Yes

2 No*

8 (DK)

9 (Refused)

Q25F. Do employers have to warn employees about the dangers of the products that they use? For example, products used in hair salons, cleaning agents or solvents used in factories, or glues used in construction.

1 Yes*

2 No

8 (DK)

9 (Refused)

Actual Access

READ: Thank you. Now I’d like to ask you about your current workplace.

Q26 Does your current employer do any of the following to educate workers about their health and safety rights? (READ AND ROTATE A-C)

1 Yes

2 No

8 (DK)

9 (Refused)

1. Hang posters in your workplace with information about your health and safety rights

2. Provide classroom or online training for workers about your health and safety rights

3. Provide other resources such as a website or other materials to educate workers about health and safety rights

Q27. Are you learning about health and safety rights in the workplace from any of the following other resources? (READ AND ROTATE A-F)

1 Yes

2 No

8 (DK)

9 (Refused)

1. From a union representative

2. From a community group, worker rights center, or faith based group

3. From the U.S. Occupational Safety and Health Administration (OSHA) (READ IF NECESSARY: not including posters or materials in your workplace from OSHA)

4. From another federal government agency

5. From a state government agency

6. From the internet (READ IF NECESSARY: Not including internal websites hosted by your employer)

Q28. Does your employer educate workers about protection from health and safety risks on a regular basis, on an as-needed basis, only when a new employee is being trained, or not at all?

(READ 1-4)

1 On a regular basis

2 As needed basis

3 Only when a new employee is being trained

4 Not at all

7 (Does not apply)

8 (DK)

9 (Refused)

Direct Experience

Q29. Please indicate whether or not any of the following have ever happened in your current workplace. (READ A-C)

1. Yes

2. No

8 (DK)

9 (Refused)

1. You have known about a possible health or safety risk in your workplace.

2. Because of conditions at your workplace, you have been injured or gotten sick.

3. Because of conditions at your workplace, you know someone else who has been injured or gotten sick.

Q30. When was the MOST RECENT time (read A-C as appropriate)? (READ 1-3)

1 Within the past year

2 1-5 years ago

3 More than 5 years ago

8 (DK)

9 (Refused)

1. (IF CODE 1 IN Q29A) You have known about a possible health or safety risk in your workplace

2. (IF CODE 1 IN Q29B) You were injured or sick because of conditions at your workplace

3. (IF CODE 1 IN Q29C) Someone else was injured or sick because of conditions at your workplace

INTERVIEWER NOTE: IF CODE 1 TO ANY in Q30A-C CONTINUE. IF CODE 3, 8 or 9 TO ALL IN Q30A-C, SKIP TO Q42.

Q31. In the past year, how many times (READ A-C as appropriate) ? (READ 1-5)

1. Once

2. Twice

3. Three times

4. Four times

5. Five times or more

6 (Not at all in the past year – DO NOT READ)

8 (DK)

9 (Refused)

1. (IF CODE 1 IN Q29A) Have you known about a possible health or safety risk in your workplace

2. (IF CODE 1 IN Q29B) Have you gotten injured or sick because of conditions at your workplace

3. (IF CODE 1 IN Q29C) Has someone else gotten injured or sick because of conditions at your workplace

INTERVIEWER READ: For the next set of questions, I want you to think about the MOST RECENT health or safety risk you saw or heard about.

Q32. Briefly, can you tell me what the health or safety risk was on this MOST RECENT incident? (OPEN-END)

1. Other (list)

2. (DK)

3. (Refused)

4. None/no more responses

5. HOLD

98 (DK/does not apply)

99 (Refused)

Q33. Did this MOST RECENT risk relate to you personally, to someone else, or both?

1. Myself

2. Someone else

3. Both

8. (Don’t know)

9 (Refused)

Q34. Still thinking about this most recent incident, please tell me whether or not each of the following was a way you realized that it might be a health or safety risk (READ AND ROTATE A-F, THEN G)

1 Yes

2 No

8 (DK)

9 (Refused)

A. Someone became sick or was injured

B. You knew it because you had recently received training

C. You had seen a similar risk before or had previous experience with this type of risk

D. Something just didn’t seem right

E. You knew it because of your familiarity with the law

F. Someone else told you that it was a health or safety risk

G. (IF CODE 2 TO ALL IN Q34 A-F) How did you realize that there might be a risk? (Open ended) specify ____________________

Q35. Did you report the situation directly to your supervisor or employer?

1. Yes

2. No

8 (DK)

9 (Refused)

Q36. Did you talk to anyone else about it?

1 Yes

2 No

8 (DK)

9 (Refused)

(IF CODE 1 IN Q36, CONTINUE. IF CODE 2 in Q35 AND code 2 in Q36, Skip to Q41. IF CODE 1 in Q35 AND CODE 2, 8, or 9in Q36, SKIP Q38; Otherwise, skip to Q42.)

Q37. Who did you talk to? OPEN END AND CODE ALLOW UP TO 5 RESPONSES

1. Other (list)

2. (DK)

3. (Refused)

4. None/no more responses

5. HOLD

6 Co-worker

7 Family/friend

8 Union representative

9 Supervisor

10 Employee representative or committee (Non-union)

11 Community group/worker rights center/faith-based group

12 Occupational Safety and Health Administration (OSHA)

13 State government official

14 Other federal government official

15 Consulate

16 Other

17 Did not talk to anyone about it

98 (DK/does not apply)

99 (Refused)

1. First response

2. Second response

3. Third response

4. Fourth response

5. Fifth response

(IF CODE 1 IN Q35 OR CODES 8-15 IN Q37A-E, CONTINUE; OTHERWISE SKIP TO NOTE BEFORE Q41)

Q38. Was anyone punished, disciplined, fined or fired as a result of you raising your concern?

1 Yes

2 No

8 (DK/does not apply)

9 (Refused)

If code 2 in Q38, Continue; Otherwise, Skip to Q40.

Q39. Was there an inquiry, an investigation or any changes made as a result of you raising your concern?

1 Yes

2 No

8 (DK/does not apply)

9 (Refused)

If code 1 IN Q39, Continue; Otherwise, Skip to NOTE before Q41.

Q40. Please tell me whether any of the following specific actions were taken as a result of you raising your concern. (READ AND ROTATE A-F, then G)

1 Yes

2 No

8 (DK/does not apply)

9 (Refused)

1. Your supervisor or employer looked into the matter

2. There was a formal investigation of the matter

3. The employer took action to prevent the situation from occurring again

4. You were punished or threatened with punishment

5. Someone else was punished, threatened with punishment, or fired

6. Your employer was fined by the government or another authority

7. Were any other actions taken as a result of you raising your concern? (specify)

(IF Q35=2 and Q36=2) or (Q37 not equal to8, 9 or 10) CONTINUE, otherwise SKIP to Q42)

Q41. Please indicate whether each of the following was a reason why you did not report the potential health or safety risk to your supervisor or employer. READ AND ROTATE A-M, then N

1 Yes

2 No

7 (Does not apply)

8. DK

9 (Refused)

1. It was not serious enough to complain about

2. You were asked not to report it

3. You did not think you would be taken seriously

4. You feared losing your job

5. You feared being treated differently by management

6. You feared being treated differently by your peers or co-workers

7. You feared it might put your employer at risk

8. You feared it might cause your team to lose bonuses or incentives

9. You did not know how to report it

10. (IF Q33=2) It was none of your business

11. You did not have proof that a risk occurred

12. There was no way to report anonymously

13. Someone else reported it so you did not need to

14. (IF CODE 2 TO ALL IN Q41A-L) What was the reason? (specify)

DECISION TO VOICE

Q42. In the future, how likely would you be to raise your concern to your supervisor or employer if each of the following happened? Use a five-point scale, where 5 is extremely likely and 1 is not

at all likely. (READ A-C)

5 Extremely likely

4

3

2

1. Not at all likely

8 (DK/does not apply)

9 (Refused)

1. If you witnessed repeated health or safety risks in your workplace

2. If you witnessed a very serious health or safety risk

3. If you were injured on the job or got sick because of workplace conditions

IF CODE 4 or 5 TO ANY IN Q42A-C, CONTINUE. ELSE SKIP TO NOTE BEFORE Q44.

Q43. How likely would you be to talk to each of the following if you suspected a possible health or safety risk in your workplace? Use a five-point scale, where 5 is extremely likely and 1 is not at all likely (ROTATE A-H).

5 Extremely likely

4

3

2

1 Not at all likely

7 (Does not apply)

8 (DK)

9 (Refused)

1. Your supervisor

2. Some other supervisor or person in a position of authority

3. A union representative

4. A community group, worker rights center, or faith-based group

5. US Occupational Safety and Health Administration OSHA

6. Other federal government agency

7. State government agency

8. Anonymous hotline or suggestion box

(IF ALL Q42 A-C = 1, 2, or 3 CONTINUE, Otherwise SKIP to DEMOGRAPHICS)

Q44. Please tell me whether each of the following is a reason why you would not be likely to raise your concern. (READ AND ROTATE A-J)

1 Yes

2 No

8 (DK/does not apply)

9 (Refused)

1. You don’t know who to raise your concern to

2. You don’t think you would be taken seriously

3. You would fear losing your job

4. You would fear being treated differently by management

5. You would fear being treated differently by peers or co-workers

6. You would fear it might put your employer at risk

7. You would fear it might cause your team to lose bonuses or incentives

8. You don’t think anything would be done about it

9. You may not have proof that it occurred

10. There is no way to report anonymously

(ALL IN Q44, SKIP TO DEMOGRAPHICS)WHD MODULE

IF S5=2 CONTINUE, ELSE SKIP TO DEMOGRAPHICS

ACTUAL VOICE

Actual Knowledge

READ: Now I would like to ask you some questions about your legal rights as a worker.

Q22A. How much do you know about your legal rights as a worker, in terms of how much you get paid? (READ 1-4)

1 A great deal

2 Some

3 Not too much

4 Nothing at all

8 (DK)

9 (Refused)

Q22B. How much do you know about your legal rights as a worker in terms of the hours you are required to work? (READ 1-4)

1 A great deal

2 Some

3 Not too much

4 Nothing at all

8 (DK)

9 (Refused)

Q22C. Are there any laws that specify how much workers get paid for the hours they work?

1 Yes

2 No

8 (DK)

9 (Refused)

(IF CODE 2, 8 , or 9 IN Q22C, “Actually, there are laws that cover the wages and hours that workers are entitled to.”)

READ: Next I have a few questions about some of the laws regarding wages and hours. I am interested in finding out what you know about the laws, but if you do not know the answer, that is ok, just please say so. (READ AND ROTATE Q23 and Q24A-F)

INTERVIEWER NOTE: * indicates the correct answer choice if respondent ASKS for correct response

Q23. What is the current federal minimum wage? (DO NOT READ RESPONSE CATEGORIES)

1. (DO NOT READ) Respondent reports amount less than $7.25 but not $2.13

2. (DO NOT READ) Respondent reports $7.25*

3. (DO NOT READ) Respondent reports $2.13

4. (DO NOT READ) Respondent reports amount greater than $7.25

98 (Don’t know)

99 (Refused)

Q24A. Can employers require hourly workers to work for a small amount of time before or after working hours WITHOUT paying them for that time? [INTERVIEWER READ IF NECESSARY: For example in order to prepare for work or clean up at the end of a shift?]

1 Yes

2 No*

8 (DK)

9 (Refused)

Q24B_1 (if s4=1) Can an employer require salaried employees to work MORE than 40 hours per week without overtime pay? (Read if Necessary: A salaried employee is someone who gets a guaranteed amount of pay regardless of how many hours they work.)

1 Yes*

2 No

8 (DK)

9 (Refused)

Q24B_2 (IF S4<>1) Do employers have to pay hourly workers more than their regular hourly rate when they work more than 40 hours in a week?

1 Yes*

2 No

8 (DK)

9 (Refused)

Q24C. As you may know, employees who receive “tips” must be paid a minimum of $2.13 per hour by their employer. If an employee’s tips plus the $2.13 do not add up to the minimum wage, is the employer REQUIRED to make up the difference?

1 Yes*

2 No

8 (DK)

9 (Refused)

Q24D. Can an employer deduct time for lunch breaks AUTOMATICALLY for hourly workers, even if the employee did not take that time off?

1 Yes

2 No*

8 (DK)

9 (Refused)

Actual Access

READ: Thank you. Now I’d like to ask you about your current workplace.

Q25. Does your current employer do any of the following to educate workers about their wage and hour rights? (READ AND ROTATE A-C)

1. Yes

2. No

8 (DK)

9 (Refused)

1. Hang posters in your workplace with information about your wage and hour rights

2. Provide training for workers about your wage and hour rights

3. Provide other resources such as a website or other materials to educate workers about wage and hour rights

Q26. Are you learning about wage and hour rights in the workplace from any of the following other resources? (READ AND ROTATE A-F)

1 Yes

2 No

8 (DK)

9 (Refused)

1. From a union representative

2. From a community group, worker rights center, or faith based group

3. From the U.S. Department of Labor Wage and Hour Division (WHD) (READ IF NECESSARY: not including posters or materials in your workplace from DOL)

4. From another federal government agency

5. From a state government agency

6. From the internet (READ IF NECESSARY: Not including internal websites hosted by your employer)

Q27. Does your workplace educate workers about wage and hour rights on a regular basis, on an as-needed basis, only when a new employee is being trained, or not at all?

(READ 1-4)

1 On a regular basis

2 As needed basis

3 Only when a new employee is being trained

4 Not at all

7 Does not apply

8 (DK)

9 (Refused)

Direct Experience

Q28. Even if you didn’t experience it yourself, have you ever known about any of the following possible violations of wage and hour laws in your current workplace? (READ A-E)

1. Yes

2. No

8 (DK)

9 (Refused)

1. You or someone you know didn’t get paid at all for a day or more of work they performed

2. You or someone you know didn’t get paid for overtime work

3. You or someone you know didn’t get paid what the employer promised

4. You or someone you know were paid less than the minimum wage

5. You or someone you know were required to work off the clock or through breaks

(IF CODE 2, 8 or 9 TO ALL IN Q28A-E, SKIP TO Q41.)

Q28_1. Were any of the violations something that related to you personally, to someone else, or both?

1. Myself

2. Someone else

3. Both

Q29. When was the MOST RECENT time (read A-E as appropriate)?

1 Within the past year

2 1-5 years ago

3 More than 5 years ago

8 (DK)

9. (Refused)

1. (IF CODE 1 IN Q28A) You or someone you know didn’t get paid at all

2. (IF CODE 1 IN Q28B) You or someone you know didn’t get paid for overtime

3. (IF CODE 1 IN Q28C)You or someone you know didn’t get paid what the employer promised

4. (IF CODE 1 IN Q28D) You or someone you know were paid less than the minimum wage

5. (IF CODE 1 IN Q28E) You or someone you know were required to work off the clock or through breaks

INTERVIEWER NOTE: IF CODE 1 TO ANY in Q29A-E CONTINUE. IF CODE 3, 8 or 9 TO ALL IN Q29A-E, SKIP TO Q41. OTHERWISE, SKIP TO READ BEFORE Q31.

Q30. In the past year, how many times (READ A-E as appropriate)

1. Once

2. Twice

3. Three times

4. Four times

5. Five times or more

6 (Not at all in the past year – DO NOT READ)

8 (DK)

9 (Refused)

1. (IF CODE 1 IN Q28A) Have you or someone you know didn’t get paid at all

2. (IF CODE 1 IN Q28B) Have you or someone you know didn’t get paid for overtime

3. (IF CODE 1 IN Q28C)Have you or someone you know didn’t get paid what the employer promised

4. (IF CODE 1 IN Q28D) You or someone you know were paid less than the minimum wage

5. (IF CODE 1 IN Q28E) You or someone you know were required to work off the clock or through breaks

INTERVIEWER READ: For the next set of questions, I want you to think about the MOST RECENT violation of wage and hour rights you experienced or heard about.

(AUTOCODE Q31 IF ONLY ONE RESPONSE IN Q28A-E, otherwise, ask Q31)

Q31. Briefly, can you tell me what the violation of wage or hour rights was on this MOST RECENT incident? (OPEN-END)

1. Other (list)

2. (DK)

3. (Refused)

4. None/no more responses

5. HOLD

(IF CODE 3 IN Q28_1, CONTINUE. ELSE SKIP TO Q33)

Q32. Did this MOST RECENT violation relate to you personally, to someone else, or both?

1. Myself

2. Someone else

3. Both

8. (DK)

9 (Refused)

Q33. Still thinking about this most recent incident, please tell me whether or not each of the following was a way you realized there might be a violation of wage and hour rights? (READ AND ROTATE A-E, then F)

1 Yes

2 No

8 (DK)

9 (Refused)

1. You knew it because your employer told you about your wage and hour rights when you were hired

2. You had seen a similar violation before or had previous experience with this type of violation

3. Something just didn’t seem right

4. You knew it because of your familiarity with the law

5. Someone else told you that it was a violation

6. (IF CODE 2 TO ALL IN Q33 A-E)How did you realize that there might be a violation? (Open ended) specify____________________________

Q34. Did you report the situation directly to your supervisor or employer?

1. Yes

2. No

8 (DK)

9 (Refused)

Q35. Did you talk to anyone else about it?

1 Yes

2 No

8 (DK)

9 (Refused)

(IF CODE 1 IN Q35, CONTINUE. OTHERWISE SKIP TO NOTE BEFORE Q37)

Q36. Who did you talk to? OPEN END AND CODE ALLOW UP TO 5 RESPONSES

1. Other (list)

2. (DK)

3. (Refused)

4. None/no more responses

5. HOLD

6 Co-worker

7 Family/friend

8 Union representative

9. Supervisor

10 Employee representative or committee (Non-union)

11 Community group/worker rights center/faith-based group

12 Department of Labor Wage and Hour Division

13 State government official

14 Other federal government official

15 Consulate

16 Other

17 Did not talk to anyone about it

98 (DK/does not apply)

99 (Refused)

1. First response

2. Second response

3. Third response

4. Fourth response

5. Fifth response

(IF CODE 1 IN Q34OR CODES 8-15 IN Q36, CONTINUE; OTHERWISE SKIP TO NOTE BEFORE Q40)

Q37. Was anyone punished, fined or fired as a result of you raising your concern?

1 Yes

2 No

8 (DK/does not apply)

9 (Refused)

Q38. Was there an inquiry, an investigation or a change in procedures as a result of you raising your concern?

1 Yes

2 No

8 (DK/does not apply)

9 (Refused)

Q39. Please tell me whether any of the following specific actions were taken as a result of you raising your concern? (READ AND ROTATE A-G, THEN H)

1 Yes

2 No

8 (DK/does not apply)

9 (Refused)

1. Your supervisor or employer looked into the matter

2. There was a formal investigation of the matter

3. The employer took action to prevent the violation from occurring again

4. You were punished or threatened with punishment

5. Someone else was punished, threatened with punishment, or fired

6. Your employer was fined by the government or another authority

7. Your employer agreed to pay the amount (IF CODE 1 OR 3 IN Q32: you/IF CODE 2 IN Q32: your co-worker) should have been paid

8. Were any other actions taken as a result of you raising your concern? (specify)

(IF Q34=2 and Q35=2) or ( Q36 is NOT EQUAL TO 8, 9 or 10) CONTINUE, otherwise SKIP to Q41)

Q40. Please indicate whether each of the following was a reason why you did not talk to your supervisor or employer about the wage and hour violation. READ AND ROTATE A-M, then N

1 Yes

2 No

7 Does not apply

8. DK

9 (Refused)

1. It was not serious enough to complain about

2. You were asked not to report it

3. You did not think you would be taken seriously

4. You feared losing your job

5. You feared being treated differently by management

6. You feared being treated differently by your peers or co-workers

7. You feared it might put your employer at risk

8. You feared it might hurt your team performance

9. You did not know how to report it

10. (IF Q32=2) It was none of your business

11. You did not have proof that a violation occurred

12. There was no way to report anonymously

13. Someone else reported it so you did not need to

14. (IF CODE 2 TO ALL IN Q40A-L) What was the reason? (specify)

Q41. In the future, how likely would you be to raise your concern to your supervisor or employer if each of the following happened? Use a five-point scale, where 5 is extremely likely and 1 is not at all likely, (READ A-C)

5 Extremely likely

4

3

2

1. Not likely at all

8 (DK/does not apply)

9 (Refused)

1. You are working more than 40 hours a week and not being paid overtime

2. You are required to work during your lunch break without being paid

3. You are required to work off the clock before or after your shift without pay

IF CODE 4 or 5 TO ANY IN Q41A-C, CONTINUE. ELSE SKIP TO NOTE BEFORE Q43.

Q42. How likely would you be to talk to each of the following if you were not being paid for the work you were doing? Use a five-point scale, where 5 is extremely likely and 1 is not at all likely, (READ AND ROTATE A-G)

5 Extremely likely

4

3

2

1 Not at all likely

7 Does not apply

8 (DK)

9 (Refused)

1. A coworker

2. Your supervisor

3. Some other supervisor or person in a position of authority in your workplace

4. A union representative

5. A community group, worker rights center, faith-based center

6. U.S. Department of Labor Wage and Hour Division

7. Other federal government agency

8. State government agency

9. Anonymous hotline or suggestion box

(IF ALL Q41 A-C = 1, 2, or 3 CONTINUE, Otherwise SKIP to DEMOGRAPHICS)

Q43. Please tell me whether each of the following is a reason why you would not be likely to raise your concern? (READ AND ROTATE A-K)

1 Yes

2 No

8 (DK/does not apply)

9 (Refused)

1. You wouldn’t know who to raise your concern to

2. You don’t think you would be taken seriously

3. You would fear losing your job

4. You would fear being treated differently by management

5. You would fear being treated differently by peers or co-workers

6. You would fear it might put your employer at risk

7. You don’t think anything would be done about it

8. You would fear it might hurt your team performance

9. You may not have proof that it occurred

10. There is no way to report anonymously

11. Someone else would be more appropriate to report it

DEMOGRAPHICS

D1 Gender

1 Male

2 Female

(Interviewer note: Fill in based on judgment)

D2 Is your primary job with the government, a private company or a non-profit organization?

1 Federal government

2 State or local government

3 Private company

4 Non-profit organization

5 Other

8 (DK)

9 (Refused)

D3 Do you consider yourself to be in lower management, middle management, or not in a management role?

1. Lower management

2. Middle management

3. Not in a management role

4. (Upper management)

8 (DK)

9 (Refused)

D4 In what industry or area do you currently work? (READ IF NECESSARY 11-92)

11	Agriculture, Forestry, Fishing and Hunting
21	Mining, Quarrying, and Oil and Gas Extraction
22	Utilities
23	Construction
31	Manufacturing
42	Wholesale Trade
44	Retail Trade
48	Transportation and Warehousing
51	Information
52	Finance and Insurance
53	Real Estate and Rental and Leasing
54	Professional, Scientific, and Technical Services
55	Management of Companies and Enterprises
56	Administrative and Support and Waste Management and Remediation Services
61	Educational Services
62	Health Care and Social Assistance
71	Arts, Entertainment, and Recreation
72	Accommodation and Food Services
81	Other Services (except Public Administration)
92	Public Administration

1. Other (specify)

98 (DK)

99 (Refused)

PROGRAMMER NOTE : (IF CODES 11, 21, 23, 31, 48, 62 in D33, CONTINUE. ELSE SKIP TO D6)

D5 You mentioned you worked in (CODE response from D4), please tell me more about the type of industry you work in … (READ CODES AS APPROPRIATE)

111 (IF CODE 11 IN D4) Crop production

112 (IF CODE 11 IN D4) Animal production

113 (IF CODE 11 IN D4) Forestry and logging

114 (IF CODE 11 in D4) Fishing, hunting and trapping

115 (IF CODE 11 in D4) Support activities for Agriculture and Forestry

211 (IF CODE 21 IN D4) Oil and Gas extraction

212 (IF CODE 21 IN D4) Mining (except oil and gas)

213 (IF CODE 21 IN D4) Support activities for mining

236 (IF CODE 23 IN D4) Construction of buildings

237 (IF CODE 23 IN D4) Heavy and Civil engineering construction

238 (IF CODE 23 IN D4) Specialty trade contractors

311 (IF CODE 31 IN D4) Food manufacturing

312 (IF CODE 31 IN D4) Beverage and tobacco product manufacturing

313 (IF CODE 31 IN D4) Textile mills

314 (IF CODE 31 IN D4) Textile product mills

315 (IF CODE 31 IN D4) Apparel manufacturing

316 (IF CODE 31 IN D4) Leather and allied product manufacturing

321 (IF CODE 31 IN D4) Wood product manufacturing

322 (IF CODE 31 IN D4) Paper manufacturing

323 (IF CODE 31 IN D4) Printing and related support activities

324 (IF CODE 31 IN D4) Petroleum and coal products manufacturing

325 (IF CODE 31 IN D4) Chemical manufacturing

326 (IF CODE 31 IN D4) Plastics and rubber products manufacturing

327 (IF CODE 31 IN D4) Nonmetallic mineral product manufacturing

331 (IF CODE 31 IN D4) Primary metal manufacturing

332 (IF CODE 31 IN D4) Fabricated metal manufacturing

333 (IF CODE 31 IN D4) Machinery manufacturing

334 (IF CODE 31 IN D4) Computer and electronic product manufacturing

335 (IF CODE 31 IN D4) Electrical equipment, appliance, and component manufacturing

336 (IF CODE 31 IN D4) Transportation equipment manufacturing

337 (IF CODE 31 IN D4) Furniture and related product manufacturing

339 (IF CODE 31 IN D4) Miscellaneous manufacturing

481 (IF CODE 48 IN D4) Air transportation

482 (IF CODE 48 IN D4) Rail transportation

483 (IF CODE 48 IN D4) Water transportation

484 (IF CODE 48 IN D4) Truck transportation

485 (IF CODE 48 IN D4) Transit and ground passenger transportation

486 (IF CODE 48 IN D4) Pipeline transportation

487 (IF CODE 48 IN D4) Scenic and sightseeing transportation

488 (IF CODE 48 IN D4) Support activities for transportation

491 (IF CODE 48 IN D4) Postal Service

492 (IF CODE 48 IN D4) Couriers and messengers

493 (IF CODE 48 IN D4) Warehousing and storage

621 (IF CODE 62 IN D4) Ambulatory health care services

622 (IF CODE 62 IN D4) Hospitals

623 (IF CODE 62 IN D4) Nursing and residential care facilities

624 (IF CODE 62 IN D4) Social assistance

D6 QID: 104958

QVID: 102944 Are you a member of, or covered by, a union?

1 Yes

2 No

8 Don't know

If S4=2, 3, or 4 CONTINUE, OTHERWISE SKIP TO D8

D7 Do you get either an electronic or paper pay stub every time you are paid by your employer?

1 Yes

2 No

3 Sometimes

7 Does not apply

8 (DK)

9 (Refused)

D8 When you were first hired, did your employer tell you about any tax deductions they had to take from your pay?

1 Yes

2 No

7 Does not apply

8 (DK)

9 (Refused)

D9

Do you consider yourself to be an independent contractor? READ: Generally, an independent contractor is a person who is not on an employer payroll, receives a 1099, has no payroll deduction, controls who they work for and the hours they work.

1 Yes

2 No

8 Don't know

If S4=2, 3, or 4 CONTINUE, OTHERWISE SKIP TO D11

D10

QID: 120518

QVID:119822If you work more hours than 40 hours a week, do you receive overtime pay?

1 Yes

2 No

3 (Depends)

4 (DK)

5 (Refused)

D11 What is the total number of employees in your entire company or organization including all locations? Just your best estimate.

1 Less than 25

2 25 to less than 50

3 50 to less than 100

4 100 to less than 500

5 500 to less than 1,000

6 1,000 to less than 5,000

7 5,000 or more

8 Not applicable

98 Don’t know

99 Refused

D11a. Does your company or organization operate out of more than one location?

1. Yes

2. No

8 (Don’t know)

9 (refused)

(IF CODE 1 IN D11A, CONTINUE. ELSE SKIP TO D13)

D12 What is the total number of employees at your location? Just your best estimate.

1 Less than 25

2 25 to less than 50

3 50 to less than 100

4 100 to less than 500

5 500 to less than 1,000

6 1,000 to less than 5,000

7 5,000 or more

8 Don’t know

9 Refused

D13

QID: 47794

QVID: 69334 For how long have you worked for your current employer? (Code actual)

01 01-

94 94

95 95+

96 Less than six months

97 Six months to less than one year

98 (DK)

99 (Refused)

(IF CODE 1 IN D11A, CONTINUE. ELSE SKIP TO D15)

D14

QID: 47794

QVID: 69334 For how many years have you worked at your current location? (Code actual)

01 01-

94 94

95 95+

96 Less than six months

97 Six months to less than one year

98 (DK)

99 (Refused)

D15

QID: 43689

QVID: 58511 And how many years have you worked with your current manager or immediate supervisor?

01 Less than 1 year

02 1 year to less than 3 years

03 3 years to less than 7 years

04 7 years to less than 10 years

05 10 years to less than 15 years

06 15 years to less than 20 years

07 20 years to less than 25 years

08 25 years to less than 30 years

09 30 years or more

10 (Does not apply)

11 (DK)

12 (Refused)

D16 What is the highest level of education you have completed? (Open ended and code)

1 Less than high school graduate (0-11)

2 High school graduate (12)

3 Some college

4 Trade/Technical/Vocational training

5 College graduate

6 Postgraduate work/Degree

8 (DK)

9 (Refused)

D17 What is the total number of hours you work per week at your primary job? (Code actual)

98 (DK)

99 (Refused)

IF S3 = 1 CONTINUE, otherwise SKIP to D19

D18 Across all the jobs you hold, how many total hours do you work on a weekly basis? (Code actual)

98 (DK)

99 (Refused)

D19 ETHNICITY: Are you of Hispanic, Latino or Spanish origin or descent, such as Mexican, Puerto Rican, Cuban, or other Spanish origin?

1 Yes

2 No

8 (DK)

9 (Refused) _____(2705)

D20

QID:145637 Next, I am going to read you a list of racial groups. As I read each one, please tell me whether you are -- or are not -- a member of that racial group. You may consider yourself to be a member of more than one racial group. How about __________?

(Interviewer: read D20A-D20E,)

1 Yes

2 No

3 (DK)

4 (Refused)

D20A	QID:145638	White	D20A(2478) D20A_2(2478)
D20B	QID:145639	Black or African-American	D20B(2479) D20B_2(2479)
D20C	QID:145640	Asian	D20CREC(2003) D20C(2480) D20C_2(2480) D20C1(2570)
D20C_1	QID:146901	American Indian or Alaska Native	D20C_1(2570) D20C_1_2(2570)
D20D	QID:145641	HOLD	D20D(2481)
D20E	QID:168229	Native Hawaiian or other Pacific Islander	D20E(2348)

D21

QID:34901

QVID:40625 What is your total annual income from your primary job, before taxes? (READ IF NECESSARY: I would like to know your own income, and not your household’s total income) (READ 1-9)

1 Under $20,000

2 $20,000-$24,999

3 $25,000-$29,999

4 $30,000-$34,999

5 $35,000-$39,999

6 $40,000-$49,999

7 $50,000-$74,999

8 $75,000-$99,999

9 $100,000 or more

IF S4=2 CONTINUE, otherwise SKIP to D23

D22 What is your hourly wage?

98 (DK)

99 (Refused)

D23 May I please have your ZIP code?

(Programmer: (Open ended and code actual ZIP Code) [SURVENT NOTE: Check ZIP Code against list of valid U.S. ZIP Codes])

99998 (DK)

99999 (Refused)

QND12(3190-3194)

ZIPMTCH

QID:34308 [DO NOT ASK; AUTOCODED BY SURVENT:] Valid Zip Code Provided.

1 Yes

2 No

ZIPMTCH(3902)

QID:103483 Skip: (If code 1 in ZIPMTCH, Skip to Note #2 before D23;
Otherwise, Continue)

D23B

QID:34310 I just need to confirm your home ZIP Code is: (response in D32).

1 Yes, correct ZIP Code given

2 No, incorrect ZIP Code given

QND12B(3990)

QID:83332 Skip: (Note #1: If code 1 in D32B, Continue;
Otherwise, Reset to D22)

(If code 2 in SA and code 1 in SD1, Continue;

Otherwise, Skip to Note before D23)

D23C

QID:33668 In addition to a cell phone, do you also have regular landline telephone service in your home?

1 Yes

2 No

3 (DK)

4 (Refused)

QID:118639 Skip: (If code 1 in D32C, Continue; If code 2 in D32C, autocode D23A=1 and skip to D24. Otherwise, Skip to note before D23;

D23D

QID:33670 Do you use that landline telephone to make and receive calls, or is it ONLY used for other purposes, such as connecting to the Internet, connecting to a fax machine, or for business purposes?

1 Use to make and receive calls

2 Only used for fax, etc.

3 (DK)

4 (Refused)

QID:136278 Skip: (Note #2: If code 1 in SA OR code 2 in SD1
OR code 1 in D32D, Continue;
Otherwise, Skip to D24)

D24

QID:34312 How many different residential phone NUMBERS do you have coming into your household, not including lines dedicated to a fax machine, modem, or used strictly for business purposes? Do not include cellular phones.

(Programmer: (Open ended and code actual number))

(Interviewer: A VOIP or cable phone line would count as a landline.)

0 Zero

1 One

2 Two

3 Three

4 Four

5 Five or more

6 (DK)

7 (Refused)

D15(3049)

QID:117196 Skip: (If code 0 in D33, Continue;
Otherwise, Skip to Note before D23B)

D24A

QID:34314 Is this a cell phone-only household without any telephone landlines?

1 Yes

2 No

8 (DK)

9 (Refused)

D15A(3056)

(IF SA=1 AND D23=0 AND D23A=2,8,or 9, SKIP TO D23C)

QID:103421 Skip: (If code 1-7 in D33, Continue;
Otherwise, Skip to Note before D23C)

D24B

QID:103422 Do you have a working cell phone?

1 Yes

2 No

3 (DK)

4 (Refused)

D15B(2587)

QID:136279 Skip: ([If code 1 in SA AND code 1 in D33B] OR
[If code 1 in D32D], Continue;
Otherwise, Skip to D24)

D24C

QID:103424 Of all the telephone calls your household receives (read 1-3)?

1 All or almost all calls are received on cell phones

2 Some are received on cell phones and some on regular phones, OR

3 Very few or none are received on cell phones

4 (DK)

5 (Refused)

D25 (CODE ONLY:) Was this interview conducted in English or Spanish?

1 English

2 Spanish _____(2471)

(VALIDATE PHONE NUMBER AND

THANK RESPONDENT BY SAYING:)

This completes the interview. Again, this is _____, with the Gallup Poll. I would like to thank you for your time. Our mission is to "help people be heard" and your opinions are important to Gallup in accomplishing this.

Gallup® is a trademark of Gallup, Inc. All other trademarks are the property of their respective owners. Copyright © 2008-2009, 2012 Gallup, Inc. All rights reserved.

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