telephone interview

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A'rrACRMKNT3 Example Script for a Telephone Interview EEOICPA Dose Reconstruction Telephone Interview Version # 1: Claimant is Covered Employee Hello, my namei s - {Name of Interviewer}-' I'm calling from Contractor}-" May I speakw ith - {Name of claimant} _? {Name of IF THE PERSONA NSWERINGA SKSW HY YOUA REC ALLING: I am an interviewer from - {Name of Contractor} -" We are calling on behalf of the National Institute for Occupational Safety and Heal~ an agency of the United States government. IF {NAME OF THE CLAIMANT} IS NOT HOME, ASK: When is a good time to call back to speak with - {Name of the Claimant}. ? Day- Date- --I J Time:-:- AM/PM IF THE CLAIMANT NO LONGER RESmES AT THIS ADDRESS, ASK: Do you know - {Name of the Claimant} ,s currenta ddresso r phonen umber? IF YES: Recordn ew address/phonneu mberh ere: IF RESPONDENT IS UNWILLING TO DIVULGE THIS INFORMATION, ASK: Would you relay a message to - {Name of the Claimant} _? lFYES: Provide toll-free number for Claimant to call IF RESPONDENT DOES NOT KNOW CLAIMANT'S CURRENT ADDRESS OR PHONE NUMBER, END CALL. IPublicr eportingb mden of this collection offiiiOrmatioDJe:Sst imatetdo avmgeonc homsp err esponse, including the time for reviewing instructions,s earchinge xisting datas omces,g atheringa nd maintaiDingt he clata 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 co~ts regarding this bmden estimate or any other aspect of this collection of information, including suggestionsfo r reducingt his bmden to CDCIA TSDR ReportsC learance IO fficer, 1600C lifton Road NE, MS D-24, Atlanta,_ Georgi3a0 3:.. A TI'N: PRA (0920-XXXX). ONCE THE CLAIMANT COMES TO THE PHONE, USE THE SCRIPT BELOW: I am an interviewerf rom - {Name of Contractor}- andw e are calling on behalf of the National Institute for OccUpational Safety and Health, also known as NIOSH. BEGIN HERE IF RESPONDENT IS ALREADY ON THE PHONE (I.E., ANSWERED THE PHONE): I am calling regardinga claim you submittedf or compensationu nder the Energy Employees OccupationalllinessC ompensationP rogram. NIaSH, an Institute of the Centersf or Disease Control andP revention( CDC), provides assistancefo r certainc laims. We will help develop what is called a "radiation dose reconstruction" for your claim, to estimate how much radiation exposure you may have experienced during your work at nuclear weapons production facilities. NIaSH recently sent you a letter explaining how we would like to work with you. Did you receive the letter? _Yes ___No IF NO, CONFIRM THE RESPONDENT'S ADDRESS. What is your current address? Name:~ Street address: City, State, Zip Code: We will sendy ou anotherc opy of the letter. It is importantb ecauseit explainst he role of NIOSH in assisting you in your claim. It also explains the types of information we may needf rom you for your doser econstructionsa, ndt he protectionsN IOSH gives to your information under the Privacy Act However, if you wotild like, we can get started now. Otherwise we can call back after you have received the letter. Would you prefer continuing now or waiting until you have the letter? IF CLAIMANT WOULD PREFER TO CONTINUE AFl'ER RECEIVING THE NIOSH LETTER: You should have the letter within 3 work days. When would be a good time to call you back? Date ~ _/ Time AM/PM IF CLAIMANT INDICATES THIS IS NOT A GOOD TIME: When would be a good time to call you back? Date. Time AM/PM IF CLAIMANT IS ABLE TO BE INTERVIEWED NOW: Interviewer's Name Date CONTINUE WITH THE STATEMENTS BELOW: As you may know, NIOSH is responsible for estimating the occupational radiation doses receivedb y personsw ith cancera pplying for compensationfr om the EnergyE mployees Occupationalll1nesCs ompensationP rogram. For this purpose,y ou have a very importantr ole. We will be interviewing you to help ensure that the information NIOSH uses to estimate your radiation dosesis as completea nd precisea sp ossible. The type of information we will be seekingf rom you will dependo n your specificw ork eXperiencea nd on infonnation we already have. This interview should take no more than an hom, although we may have to call you back for additional infonnation. If we need to divide this interview into a couple of shorter calls, we can do that as well. You should understandth at your participationi n this interview is voluntary. However,i f you choosen ot to be interviewed,t hiS would hinderN IOSHin conductingt he doser econs1IUctiofno r your claim. Choosingn ot to be interviewedm ay also result in a doser econstructiont hat incompletelyo r inaccuratelye stimatesth e radiationd oset o which you may have beene xposed Should you choose to be interviewed, the information you provide will be treated in a confidential manner, unless otherwise compelled by law. The infomlation you provide will be sharedw ith NIOSH staffworking on your doser econstructiona nd with staff of the Department of Labor involved in adjudicating your claim. Do you wish to be interviewed? Yes -No IF No: CONFIRM THAT THE CLAIMANT UNDERSTANDS THE POTENTIAL CONSEQUENCES OF NON-PARTICIPATION. IF THE CLAIMANT UNDERSTANDS AND DOES NOT WANT TO BE INTERVIEWED: Do you have any questionst hen, aboutt he doser econstructionp rocess? Yes -No IF YES: Answer the questions and then thank the claimant and conclude the call. If there are questionsy ou cannot answer,n otify the claimantt hat someonef rom yom £inn or NIOSH will contact them shortly to respond to their question. IF YES: First we will review with you the information we already have from the Department of Labor and Department of Energy. Then we will ask a variety of questions to iden~ any infonnation that may be missing from records. At the end of the interview we will answer any questions you may have aboutt he'remaiIlj_ngst epsi n the processo f reconstructingy our radiation doses. Do you have any questions or concerns before we get started? Yes -No IF YES: Answer the questionsa s responsivelya sp ossible,w ithout technically complicatede xplanations. C1A1mAnmtsa y havec oncernsa bout the quality of their radiationm onitoring. Cla1mantsm ay have concerns about how a dose reconstmction could account for doses that were not monitored or recorded. Explain a few approachesu sedt o addressth esep roblems. C1A1msmItD ClatJtltJ InterviewerI nitials 000 DO DO DODD Day Month Year Date Section 1: Tele hone Interview Introducto uestions USE TELEPHONE SCRIPT TO INTRODUCE INTERVIEW Section 2: Emolovment Historv IF THE CLAIMANT IS READY TO BE INTERVIEWED: I'll start by reviewingt he employmenth istory we receivedfr om the Departmento f Labor, which you submitted with your claim. First I'll ask you to confirm whether our records on the jobs you have held are correct. As we dO this, we will correct whatever might be wrong and fill-in any additional jobs relevant to your claim that may not be included in our records. Then I'll ask you specific questionsa bout eachj ob. 1. What jobs havey ou held working for DOE, DOE contractors,o r AWEs? Start Date ( mm/ yyyy ) Supervisor~s End Date Name Employer Job Title START WITH THE MOST RECENT JOB AND ASK THE FOLWWING QUESTIONS IN SECTIONS 3 - 7. REPEAT THESE FOR EACH DOE! AWE JOB INCLUDED IN THE EMPLOYMENT HISTORY. Section 3: Detailed Work Historv: Concerning your job with (Name of employer): How many hours per week did you work on this job? hrs/week 2. How many hours per week did your job involve potential exposure to radiation and/or radioactive materials? _hIs/week 4. Which buildings or locations did you work in, for eacho f your routine duties? Building/Location Duties 5 Describe what you did on the job, as routine duties. Obtain additional detaIls on duties, as necessary: 5.1 What types of radioactivem aterialsw ere presento r processeda, nd in what foIm(s ) (solid, liquid, or gas)? Review the list below individually, as necessary. Radionuclide Resoonse IsotoRe(S) ifknown FOIDl .Y. _N. pK . .Y. .N. pK -. Y . .N - DK - _V. .N_DK - .Y- _N_DK - .Y. .N_DK - .YY~K ~Y _N _DK _~Y_N_DK ~ Y - N - DK - ~Y_N_DK - .Y_N_DK - _Y_N_DK - .Y _N _DK . _Y_N~K - .Y _N _DK - _Y_N. _DK - .Y_N. _DK . _Y_N. .DK - _Y_N- .DK - .Y- _N. .DK . _8 _8 _8 _8 -$ _8 _8 _S S - --8 ~$ ~S -..;..5 _8 _S _8 _S 8 -$ _8 _8 0 _O ~9 _c G _G ~G ~ G G - _O _O G -. G =a _O _O _G _O -:,.0 _G _G _G Tritium Co Sr/Y Tc I Cs Tl Pb Po Rn (progeny) Ra Ac Eu Th (natural) Pa U (natural) U (enriched) Np Pu Am Cm Cf y N DK s L G Others s -s -s L ~-t.L 0 -0 -0 (l} -(2) _(3) 5.2 What quantitieso f radioactivem aterialsw ere presento r processed( ounces,p ounds, kilograms, drums) over what time periods? 5.3 What types of production processes involving radioactive materials occurred in areas where you worked? . 5.4 What typeso f radiation-generatinge quipmentw ere presento r used( e.g.,n eutron devices,'radiographye quipment)? 5.5 What specific tasks did you perfonn, using what types of radioactive materials (in what quantities),a nd/orr adiation generatinge quipment? 5.6 What exposure/contam;natiocno ntrol measuresw ere usedt o protect you? ."" Measure'l~' Freauencv of use _Hoods '. _Always - Sometime-s Never _Glove boxes _Always - Sometime-s Never _Shielding _Always - Sometimes- Never .Othere nclosures( explain) _Always - Sometimes- Never .Localv entilation . .Always- Sometimes- Never _Anti-cont8-mjnatiocnlo thing. .Always- Sometimes- Never - Respirators . .Always- Sometime-s Never _Other personal protective . .Always - Sometimes - Never equipment (specify) Showers _Always - Sometimes Never 5.7 Did you conduct your work under a radiation work permitting system? Yes No Don't know IF "No" OR" DON'T KNOW", GOT O QUESTION6 , IF "YES": 5.8 During what time period(s)? Section 4: Radiation Monitorine I'd like to ask a few questions about personal or area radiation monitoring related to your job. 6. Did you or your co-workers (working in the same area as you) routinely wear radiation IF "No" OR "DON'T KNOW", GO TO QUESTION7 , IF "YES": 6.1 For which duties or in which buildings or locations, and during what time periods (e.g., which years) did you or your co-workers (working in the same areas as you) routinely wear radiation dosimetry badges? Building! Location Time Period Duties Wore badge (check = yes) Only co-worker wore badge IF THE CLAIMANT Dm NOT WEAR A BADGE, GO TO QUESTION 7, IF CLAIMANT WORE A BADGEI:' ll asky ou several questionsa bout badgep ractices. I realize that badgep ractices changed over time, so please recall to the best of your ability any changes and the time period that they cover: 6.2 How often did you wear your badge? Time Period Fr~uency 6.3 How often was your badge exchanged? Time Period Freauency dosimetry badges? _Yes _No _Don't know 6.4 Where on your body was your badge worn? Time Period Body Location Did you participate in a biological radiation monitoring program (urine/fecal/breath)? ". -, - 7. 8 Do you have copies of your dosimeter badge or biological monitoring records? _Yes, badge _Yes, biological _No IF "No" GOT O QUESTION9 , IF "YES" : 8.1 Would you provide copies to us? Yes -No IF "YES" GO TO QUESTION 9, IF "No" EXPLAIN THE IMPORTANCE OF THIS INFORMATION AND ADDRESS ANY CONCERNS, AS FEASIBLE. IF THE ANSWER REMAINS "No": 8.2 Why not? 9. Did you routinely survey yourself (frisk) for externalc ontam;nation? IF "No" GO TO QUESTION 1 0, "IF "YES": 9.1 Whm did you surveyy ourself, beforeo r after showering?- Before After Was there general area air monitoring for radiation performed in the work environment? Yes No _Don't lmow 1-0. IF "No" OR" DON'T KNOW" GO TO QUESTION1 1, IF "YES": When (over what time periods) did this occur? Weret here any radiation surveyst akent o characterizep otential for externale xposure? Yes No .u - I es, unne _Yes, fecal _Yes, breath No Don't know Don't know IF "No" OR "DON~T KNOW" GO TO QUESTION 12, IF "YES": IF CLAIMANT WORKED AT FERNALD, MALINCKRODT, OR FUSRAP, OR IF THE CLAIMANT RESPONDEDIN QUESTION 4 THAT HE WORKED WITH RADIUM AND/OR THORIUM, ASK THE FOLLOWING QUESTION; IF NOT, GO TO QUESTION 13: 12. Was there monitoring in any of the buildings or areas you worked for exposure to radon? Yes No Don't know IF "No" OR" DON'T KNOW" GOT O QUESTION1 3, IF "YES": 12. 1 Which buildings or areas? 13 Were you ever restricted from the workplaceo r certainj ob dutiesb ecausey ou had. reacheda radiation dose limit? _Yes ~o Section 5: Radiation Incidents / need to ask you about any radiation exposure or contamination incidents that may have occurred while you were in this job. For each incident you may recall, /'11 ask a series of questions: 4. Were you ever involved in an incident involving radiation exposure or contamination? Yes No IF "No" GO TO QUESTION 15, IF "YES" ASK THE FOLLOWING QUESnONS FOR EACH INCIDENT mENTIFIED: 14.1 What happened and when?~- Which radioactive materials were involved, and in what form and quantity? Which radiation-generatinge quipmentw as involved? Where did it take place? Who was involved? What actions were taken to remedy the exposure or cont1irnination? 14.7 What were your location and activities during the incident?- What precautions were taken to protect you? What types of personal protective equipment, if my, did you use? How long were you exposed dming the incident? Did you receive chelation therapy or other medical treatment as a result of radiation exposure from this incident? _Yes No _Don't Know IF "No" OR" DoN'T KNOW" GO TO QUESTION1 4.12, IF "YES": Please describe the medical treatment you received: Chelation Therapy l4.12 Did you receive biological monitoring after the incident? Yes -No IF "No" GO TO QUESTION 15, IF "YES": 14.13 What type of biological monitoring? 14.14 Do you have records of this monitoring? Yes -No IF "No" GO TO QUESTION 15, IF "YES": Are you willing to provide copies of these records to NIOSH? _Yes No IF "YES" GO TO QUESTION 15, IF "No" EXPLAIN THE IMPORTANCE OF THIS INFORMATION AND ADDRESS ANY CONCERNS, AS FEASIBLE. IF THE ANSWER REMAINS NO: 14.16 Whynot? Section 6:ReQuired medical screenine x ravs Some workers were required to periodically have medical x rays as a condition ofemployment: 15. Were you ever required to have medical x rays for this job, as a condition of employment? Yes No IF"No" GO TO QUESTION 16, IF "YES" : 15.1How often were you x-rayed, and over what time period(s)? Time Period Frequency of x rays 15.2Do you have records of these x rays? _Yesf,o r all x rays _Yesf,o r somex rays No IF "No" GO TO QUESTION 16, IF "YES": 15.3WoUldy ou provide us with copieso f theser"e cords? Yes -No Section 7: Other relevant information We Ire nearly done reviewing this job. This is an opportunity for you to identify other relevant information that might help us complete your dose reconstruction: 16. Have we missed asking you about any conditions, situations, or practices that occuned during this job which you think may be useful to us in estimating your radiation doses? Yes _No IF "No", GO TO QUESTION 17, IF "Y~": . 16.1 Df oer shcorwib elot hnigs, w ainthd wahsm o wucahs dinevtoalivl aesdp : ossible,i n teImSo f. what occurred,w here,w hen, 17. Are you aware of any records related to the information you have proVided that may help us estimate your doses? _Yes: Source/Ty,ne -Personal Physician Site Medical Records .Incident Reports .Safety Meeting Notes Other (describe) .No IF "No" AND THIS IS THE LAST JOB TO REVIEW, GO TO QUESTION 18. IF "YES" AND THE RECORDS ARE FROM A PERSONAL PHYSICIAN, ASK THE CLAIMANT TO OBTAIN AND PROVWE THE RELEVANT MEDICAL RECORDS TO NIOSH. NOTE: COMPLETE SEcnONS 3-7 FOR EACH JOB LISTED IN QUESTION 1. Section 8: Final Questions - Identifvine co-workers and other witnesses Depending on what information is available to us from DOE and other sources, we may or may not need to try to speak with your supervisors, co-workers, or others who can help us with your dose reconstruction. However we would like help from you now, so that we can contact others efficiently if we need to. 18. Can you namec o-workerso r other witnessess, uch as consultingi ndustrial hygienistso r radiation safetys pecialists,w ho can confirm or expandu pon the information you have provided us? Yes -No DuT'S IT! THANKSF OR TAKINGT HE TIME TOA NSWERA LL THESEQ UES770NS.W E REALLYA PPRECL4TE YOURH ELP. Do YOUH A VBA NY QUESTIONSA BOUTT HED OSER ECONSTRUC110PNR OCESSO R CUIMS PROCESSF, ROMH EREF ORWARD?
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