Form 0920-22SF Workplace Survey

Participant ID: __________

Form Approved

OMB No. 0920-xxxx

Exp. Date: xx/xx/20xx

NIOSH Engineered Stone Silicosis Project

Workplace Practices Survey

REDCap Survey

Thank you for your participation and taking time to answer questions about your workplace. The purpose of this survey is to help the National Institute for Occupational Safety and Health (NIOSH) better understand the countertop industry and best practices or barriers to occupational safety and health. NIOSH is a federal public health research agency. NIOSH is not part of the Occupational Health and Safety Administration (OSHA) and does not enforce health and safety laws.

Section 1: Point of Contact Information

First, we would like to collect workplace contact information. This information is to assist NIOSH in contacting your workplace should you request additional information from NIOSH. NIOSH will not directly identify you or your workplace in any of our study findings.

1. First Name:

2. Last Name:

3. Work phone number:

4. Work email address:

Section 2: Workplace Information

Next, we would like to learn more about your workplace.

5. Name of company:

6. Company address:

7. What year was the company established?

8. Are there additional facility locations or worksites where work is performed? Select all that apply.

£ Fixed, permanent (e.g., brick and mortar) worksite(s)

£ Mobile worksite(s)

£ Subcontracting worksite(s)

£No additional facility locations or worksites

Public reporting burden of this collection of information is estimated to average 15 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-xxxx).

9. a. Has this company previously operated under one or more different names?

£ Yes (Ask question 9. b.)

£ No (Skip to question 10)

b. What were previous company name(s) and year(s) of operation?

10. About how many people work for this company?

11. About how many workers perform tasks working directly with stone countertop products, such as cutting and grinding stone?

12. a. Does your workplace hire temporary or seasonal workers?

£ Yes (Ask question 12.b.)

£ No (Skip to question 13)

b. About how many temporary or seasonal workers do you hire per year?

Section 3: Production Volume and Practices

Next, we would like to learn more about the type of stone materials your workplace uses, tasks performed, and engineering controls or safety measures in place.

13. a. Does your workplace work with engineered stone, natural stone, or both?

£ Engineered stone (Ask questions 13.b-e.)

£ Natural stone (Ask questions 13.f-h)

£ Both (Ask questions 13.b-h)

2. About how much of total production is engineered stone?

£ Less than 25%

£ 25-50%

£ 50-75%

£ More than 75%

2. About how many square feet of engineered countertop product do you cut/install annually?

3. What brand(s) or supplier(s) of engineered stone do you use?

4. Has your volume of engineered stone increased over the last 5 years?

£ No increase in production volume

£ Less than 25%

£ 25-50%

£ 50-75%

£ More than 75%

2. About how much of total production is natural stone?

£ Less than 25%

£ 25-50%

£ 50-75%

£ More than 75%

2. About how many square feet of natural stone countertop product do you cut/install annually?

3. What types of natural stone are used?

£ Granite

£ Soapstone

£ Marble

£ Other:

14. What other materials (non-stone) are used regularly in production? (For example: adhesives, glues, solvents).

15. What work tasks are performed by production employees? (Select all that apply)

Task:	Select if task is performed:	What equipment is used for this task? (If none, write “none”)
Cutting with Computer Numerical Control (CNC) machine	£
Cutting by hand	£
Grinding, shaping, finishing	£
Polishing	£
Laminating	£
Cleaning tools or work area	£
Templating	£
Onsite install or finishing	£
Other (please specify):	£

16. How often is dry work (without the use of water) performed by production workers?

£ Never

£ Rarely (<10%)

£ Sometimes (10-25%)

£ Frequently (26-50%)

£ Very frequently (51-99%)

£ Always

17. What methods are currently used to reduce dust in the workplace? (Select all that apply)

Control	Select if used:
General exhaust ventilation	£
Local exhaust ventilation (LEV) (e.g., on-tool dust suppression)	£
Wet cutting/wet work methods (with the use of water)	£
Open doors or windows	£
Other dust control methods (please specify) Provide fillable text box if other is selected.	£

18. What housekeeping methods are currently used in the workplace? (Select all that apply)

Method:	Select if used:
HEPA-filtered vacuuming	£
Dry sweeping	£
Compressed air	£
Wet sweeping	£
Pre-wash stone slabs	£
No housekeeping procedures	£
Other, please specify (provide free text box if selected)	£

19. What personal protective equipment (PPE) is currently used by production workers?

Images and descriptions for respirators available at: What are Air-Purifying Respirators? (cdc.gov)

PPE:	Used:	Which tasks do workers perform while using this PPE?
NIOSH-approved N95 respirator	£ Yes £ No
Half-face respirator	£ Yes (Ask cartridge question) £ No
	If yes, are the following cartridges used: £ Particulate filter £ Organic vapor cartridge £ Combination particulate filter and organic vapor cartridge £ Unsure
Powered air-purifying respirator (PAPR)	£ Yes £ No
Other PPE, such as gloves, protective glasses, other examples (please describe):	£ Yes £ No

20. What do you see as the countertop industry’s greatest challenge to keeping workers safe and healthy?

If nothing, please leave blank.

21. a. Does your workplace have a written Respiratory Protection Program?

£ Yes (Ask question 21.b.)

£ No (Skip to question 22)

£ Don’t know (Skip to question 22)

b. Are workers fit-tested for the selected respiratory protection?

£ Yes (Ask question 21.c.)

£ No (Skip to question 22)

£ Don’t know

c. How often is respirator fit testing performed?

£ At initial hire

£ Annually

£ Other:

22. Is respirator training provided to production workers?

£ Yes

£ No

£ Don’t know

23. Are medical evaluations ever provided for workers?

£ Yes (If yes, open frequency options below)

£ At hire

£ Annually

£ Other:

£ No

£ Don’t know

24. Does the company coordinate lung function testing (spirometry) for workers?

£ Yes (If yes, open frequency options below)

£ At hire

£ Annually

£ Other:

£ No

£ Don’t know

25. Does the company coordinate chest x-rays for workers?

£ Yes (If yes, open frequency options below)

£ At hire

£ Annually

£ Other:

£ No

£ Don’t know

26. a. Has air monitoring for respirable silica ever been performed at your company?

£ Yes (Ask 26.b.)

£ No (Skip to question 27)

£ Don’t know

b. Do you know if measured respirable silica levels were over occupational exposure limits?

£ Yes

£ No

£ Don’t know

27. Would you be interested in receiving information and resources about respirable silica and how to protect workers in the countertop industry?

£ Yes

£ No

£ Maybe

28. Would you be interested in helping NIOSH learn how to better protect worker health and safety by partnering with NIOSH to perform industrial hygiene sampling or medical surveillance of production workers? This would be entirely free to the company. NIOSH would not directly identify you, your workers, or your workplace in any of our study findings.

£ Yes

£ No

£ Maybe

29. Are you aware of OSHA’s Respirable Crystalline Silica Standard?

£ Yes

£ No

£ Maybe

Thank you for your participation and for taking the time to answer these questions. If you have questions about the survey or would like to speak with someone at NIOSH, please contact: Alyson Fortner afortner@cdc.gov or Reid Harvey iez1@cdc.gov.