Completing this survey constitutes your consent to participate. Informed consent information can be viewed by clicking on the Consent Information link. Consent Information
The purpose of this survey is to identify risk factors for lung problems among workers in the healthcare industry. It is anticipated that completing this survey will take no more than 30 minutes.
Any risks from completing this survey are minimal. The only risk we anticipate is the potential for loss of confidentiality. However, we are not collecting any personal identifying information (e.g., name, address, phone number, social security number) and we will not share your responses with anyone outside the NIOSH team. To help protect your confidentiality, 1199SEIU has assigned an identification number that will be used to identify all survey data you provide and will allow us to notify the union of members that have completed the survey. The form linking your name and your identification number will be kept by 1199SEIU and will not be provided to members of the NIOSH team. At no time will your name or contact information ever be made available to NIOSH.
If you are injured or harmed through negligence of a NIOSH employee you may be able to obtain compensation under Federal Law. If you want to file a claim against the Federal government your contact point is: General Law Division of OGC, request the Claims Office: (202) 233-0233. If you are injured or harmed through the negligence of a NIOSH contractor, your claim would be against the contractor, not the federal government. If an injury or harm should occur to you as the result of your participation or if you have questions about your rights if you participate in this survey, you should contact:
Michael Humann, Associate Service Fellow, 304-285-6193 or
Mark A. Toraason, Chair NIOSH HSRB, 513-533-8591.
Your participation is voluntary and you may withdraw your consent and participation in this survey at any time without penalty or loss of benefits to which you are otherwise entitled.
There are no direct benefits to you personally for participating in the survey. However, what we learn from conducting this survey may help reduce the occurrence of lung problems among health care workers through effective intervention strategies.
Public reporting burden of this collection of information is estimated to average 30 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 (0920-0983)