Federal Agency Occupational Safety and Health (OSH) Training

Survey – Part II

PAGE 1

Survey respondents, please complete the following questions. 	

Your name (Open-ended text box)

Your Department or Independent Agency Name (Drop down box with all
Departments and Independent Agencies listed.  Option set to select one
answer choice only.)

For Departments only, please identify your Agency, Bureau or Division
Name (Open-ended text box)

Your Email address (Open-ended text box)

Your Phone Number (Open-ended text box)

Your Job Title (Open-ended Text box)

PAGE 2

Are you the chief Safety and Health Manager for your Department or
Independent Agency?  (Check boxes with the answer choices Yes, No, or
Don’t Know). Set up a conditional question.  If Yes is selected,
SurveyMonkey will automatically forward the respondent to the next
question.  If No or Don’t Know are selected, SurveyMonkey will
automatically forward respondent to end of survey Thank You message. 

PAGE 3

Does your Department or Independent Agency develop and deliver any of
its own “in-house” occupational safety and health training? (Check
boxes with the answer choices Yes, No, or Don’t Know).  Set up
conditional question.  If Yes is selected, SurveyMonkey will
automatically forward the respondent to the next question.  If No or
Don’t Know are selected, SurveyMonkey will automatically forward
respondent to end of survey Thank You message. 

PAGE 4

For each individual “in-house” developed OSH training your agency is
willing to share with other federal agencies, please answer the
questions below.  You will be able to enter multiple training topics
following this format.  

Training 1

What is the title of the training?  (Open-ended text box)

Please provide the goal of the training or a brief description of the
training topic(s).  (Open-ended text box)

What is the intended occupational group for this training?  Please
select all that apply. (Check boxes with answer choices and open-ended
text box for other)

Answer choices: Top Management Officials, Supervisors, Safety and Health
Specialists, Collateral Duty Safety and Health Personnel, Employees and
Employee Representatives, and Other (Open-ended text box)

What is the intended industry group for this training? Please select all
that apply. 

(Check boxes with answer choices and open-ended text box for other)

Answer choices: Agriculture, Construction, Forestry, Health Care,
Maritime, Public Order/Law Enforcement, All industry groups, and Other
(Open-ended text box)

In what format is the training distributed? Please select all that
apply. (Check boxes with answer choices and open-ended text box)

	Answer choices: Formal Classroom, Audio/Video Conferencing, Web-based
Self-Study, Paper-based Self-Study (ex. Manuals and text books),
Electronic media Self-Study (ex. DVDs, CDs, and VCR Cassettes). 

Is this training currently accessible through the Agency’s public
Internet webpage?  Please note, training available through the
agency’s Intranet webpage may or may not be accessible to non-agency
public audiences.  (Check boxes Yes, and No). 

Could this training be made available through the agency’s public
Internet webpage?

(Check boxes Yes, No, and Not Sure). 

How much time is needed to complete this training? Please specify the
duration in hours or days. (Open-ended text box)

Which of the following groups is your Department or Independent Agency
willing to share this “in-house” occupational safety and health
training with? Please select “Yes” or “No” for each group:
(Check boxes Yes, or No). 

OSHA

Other Federal Agencies

Private Sector Organizations

Do you have any additional Occupational Safety and Health Training (OSH)
you are willing to share (Check boxes with the answer choices Yes and
No) * Set up conditional question.  If Yes is selected, SurveyMonkey
will automatically forward the respondent to the next question.  If No
or Don’t Know are selected, SurveyMonkey will automatically forward
respondent to end of survey questions about agency training office
contact. 

* These questions will be repeated for each individual training item an
agency would like to include. 

PAGE 5

What agency office should parties interested in shared “in-house”
training contact? 

Agency training office: (Open-ended text box)

Agency training office phone number:  (Open-ended text box)

Agency training office email address: (Open-ended text box)

PAGE 6

“Thank you” message

