Safety Climate

Form Approved

OMB No. 0920-XXXX

Exp. Date XX/XX/XXXX

Safety Climate (waves 1-4)

1. The safety of workers is a high priority with management where I work

i. Strongly Agree

ii. Agree

iii. Disagree

iv. Strongly Disagree

2. There are no significant compromises or shortcuts taken when worker safety is at stake

i. Strongly Agree

ii. Agree

iii. Disagree

iv. Strongly Disagree

3. Where I work, employees and management work together to ensure the safest possible working conditions

i. Strongly Agree

ii. Agree

iii. Disagree

iv. Strongly Disagree

4. The safety and health conditions where I work are good

i. Strongly Agree

ii. Agree

iii. Disagree

iv. Strongly Disagree

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 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 Information Collection Review Office, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-XXXX).