Form 0920-0953 Worker Notification Feedback Survey

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery

survey_FINAL_08292018

Worker Notification Feedback Survey

OMB: 0920-0953

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Attachment A

Worker Notification Feedback Survey









































Form Approved

OMB No. 0920-0953

Exp. Date 8/31/2021





Please let us know what you think about [X]. Do not provide your name or other information that would identify you such as your address or telephone number.

  1. Please check all that apply:

    • I received a letter from NIOSH because I am a current [or former, if appropriate] worker in a NIOSH study.

    • I received a letter from NIOSH because I am a family member of a worker in a NIOSH study.

    • I did not receive a letter from NIOSH, but I know someone who did.

    • I received a letter from NIOSH, but I am not sure why.

    • I found [X] by searching the internet (e.g., Google).

Comments:

______________________________________________________________________________________

______________________________________________________________________________________
______________________________________________________________________________________

  1. Does the information we provide in [X] meet your needs?

    • Yes

    • Not sure

    • No

Comments:
______________________________________________________________________________________

______________________________________________________________________________________
______________________________________________________________________________________

  1. Do you think that we understand the issues that are important to workers?

    • Yes

    • Not sure

    • No

Comments:
______________________________________________________________________________________

______________________________________________________________________________________
______________________________________________________________________________________





Public reporting burden of this collection of information is estimated to average 10 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 (0920-0953).







  1. Do you think that we have workers’ best interest in mind?

    • Yes

    • Not sure

    • No

Comments:
______________________________________________________________________________________

______________________________________________________________________________________
______________________________________________________________________________________



  1. Do you think that we have the knowledge needed to evaluate health and safety in your workplace?

    • Yes

    • Not sure

    • No

Comments:
______________________________________________________________________________________

______________________________________________________________________________________
______________________________________________________________________________________

  1. Do you think that [X] provides helpful recommendations?

    • Yes

    • Not sure

    • No

Comments:
______________________________________________________________________________________

______________________________________________________________________________________
______________________________________________________________________________________

  1. Do you trust the information presented in [X]?

    • Yes

    • Not sure

    • No

Comments:
______________________________________________________________________________________

______________________________________________________________________________________
______________________________________________________________________________________

  1. Please check all that apply:

    • I use the internet to look for health information.

    • I get health information from printed sources such as books, magazines, and pamphlets.

    • I prefer to have printed copies of health information mailed to me.

    • I looked up further information on [X] using the links provided [in/on X].

    • I plan on contacting NIOSH at the email address or telephone number provided [in/on X].

    • I plan on requesting printed copies of [X].

    • I plan on sharing [X] with my doctor.

Comments:

______________________________________________________________________________________

______________________________________________________________________________________
______________________________________________________________________________________

  1. Please share any other comments you have. ______________________________________________________________________________________

______________________________________________________________________________________
______________________________________________________________________________________


Thank you for taking the time to complete our survey. Your feedback will help us improve how we communicate our research. If you have questions, or would like to request printed copies of [X], please send an email to GHartle@cdc.gov, or call (513) 458-7118.

File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorCDC User
File Modified0000-00-00
File Created2021-01-20

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