Form 7100-001 Focus Group Work Sheet

OMB Control # 2010-0042 Expiration Date: 3/31/2021

Focus Group/Work Sheet/Section 1

There are no right or wrong answers. We seek your own thoughts in answering the following questions:

• On a scale of 1 to 5, with “5” being Very Knowledgeable and “1” being Not at All Knowledgeable, how knowledgeable are you about proper safety and usage of pesticides?

Please indicate your 1 to 5 score here: _____

• Who is primarily responsible for communicating about the safe handling of pesticides e.g. farm supervisor/team leader, farm owner, other [please specify])

Describe below who you feel is primarily responsible for providing this information:

_________________________________________________________

• Have you recently received any pesticide safety training? If “YES”, briefly answer these additional questions:

• Where did training take place/what location? ___________________________________________________________

• Who provided the training (describe by person’s title)? ___________________________________________________________

• When (approximately what month/year was your most recent training)? ___________________________________________________________

• How often have you received such training over the past three years? ____________________________________________________________

• How helpful did you find the training? Be candid in your assessment: Use the scale of 1 to 5, with “5” being Very Helpful and “1” being Not Very Helpful.

My score is: ________

• What specific educational materials have been given to you or posted regarding:

• Worker health & protection safety/The Worker Protection Standard? Please list examples of materials that you have been handed or seen on location:

1.

2.

3.

4.

5.

• How useful are these materials in preparing you for your daily work? Please use the 1 to 5 scale with “5” being Very Useful and “1” being “Not at all Useful” describe how useful the materials are to YOU.

My score is: ________

Paperwork Reduction Act Notice:

This collection of information is approved by OMB under the Paperwork Reduction Act, 44 U.S.C. 3501 et seq. (OMB Control No. 2010-0042). 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. The public reporting and recordkeeping burden for this collection of information is estimated to be 1.67 hours per response. Send comments on the Agency’s need for this information, the accuracy of the provided burden estimates and any suggested methods for minimizing respondent burden including through the use of automated collection techniques to the Director, Regulatory Support Division, U.S. Environmental Protection Agency (2821T), 1200 Pennsylvania Ave., NW, Washington, D.C. 20460.  Include the OMB control number in any correspondence.  Do not send the completed form to this address.

OMB Form # 7100-001 Page 2 of 2