F orm Approved OMB No.: 0920-0260
Expiration Date: xx/xx/20xx
Followback Survey – After the Health Hazard Evaluation Site Visit
NIOSH wants to know what you think about the health hazard evaluation at [workplace name] so far. Your feedback will help us create a better experience for you and others. We will keep your information secure according to federal laws. We will report only summary information and will not identify you.
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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 H21-8, Atlanta, Georgia 30333; ATTN: PRA (0920-0260).
Followback
Survey Form 1A
Thank you for completing this survey!
C
all
the Followback Coordinator at 513-841-4382 if you have questions or
comments.
We may contact you again at the end of the
evaluation.
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
Author | Barbara Jenkins |
File Modified | 0000-00-00 |
File Created | 2023-12-12 |