[NIOSH] Heat-related Changes in Cognitive Performance

OMB 0920-1331

Latest Forms, Documents, and Supporting Material

Document Name
Form 0920-1331 Appx O_ Exertion and Thermal Sensation Scale (M/FF/CW) Form
Form 0920-1331 Appx N_ Release of Information (HIPPA) (M/FF/CW) Form
Form 0920-1331 Appx M_ Consent Form Environment Chamber (M/FF/CW) Form and Instruction
Form 0920-1331 Appx L Consent (Field component) _Miners Form and Instruction
Form 0920-1331 Appx G_Health Screen Questionnaire -- Environment Chamber (M/FF/CW) Form
Form 0920-1331 Appx F_Physcal Examination (M/FF/CW) Form
Form 0920-1331 Appx C_Initial Participant Questionnaire: Field (Health screening) Form and Instruction
Appendix Q IRB amendment approval.pdf Supplementary Document
PIA.pdf Supplementary Document
Appendix B 60 day FRN.pdf Supplementary Document
Appendix A Federal Mine Safety and Health Act.docx Supplementary Document
SMRD_Heat stress_SSB.docx Supporting Statement B
SSA_SMRD_Heat Stress_02-27-24.docx Supporting Statement A
Cognitive test: N-back -- no form (M/FF/CW) Instruction
Consent - Research Study (PVT Cognitive Test) - Field (M/FF/CW) Instruction
Appx O_ Exertion and Thermal Sensation Scale (M/FF/CW) Form
Appx N_ Release of Information (HIPPA) (M/FF/CW) Form
Fingerstick blood sample for point of care testing Instruction
Fitting of Chest Strap (M/FF/CW) Instruction
Ingestion of Temperature Pill (M/FF/CW) Instruction
Appx K_Field Recruitment Script (PVT Cognitive Test) _Miner Instruction
Fitting of Chest Strap (M) Instruction
Consent Form - (Ingestion of Temperature Pill (M)) Instruction
Appx M_ Consent Form Environment Chamber (M/FF/CW) Form and Instruction
Appx L Consent (Field component) _Miners Form and Instruction
Appx I_ Pre-Test Questionnaire (M/FF/CW) Other-App (WORD)
Appx H_PANAS sleepiness fatigue (M/FF/CW) Other-WORD
Appx G_Health Screen Questionnaire -- Environment Chamber (M/FF/CW) Form
Appx F_Physcal Examination (M/FF/CW) Form
Appx E -Pre-Shift Questionnaire on Heat Stress (App) Miners Other-App (WORD)
Appx D - Questionnaire on Heat Stress (App) Miners-- Shift for field Other-App (WORD)
Appx C_Initial Participant Questionnaire: Field (Health screening) Form and Instruction