Welcome! We are excited that you have decided to apply for Work@Health® training and technical assistance. This project is funded by the Centers for Disease Control and Prevention.
Informed Consent
We’d like to give you some more information to help you decide whether or not you would like to participate.
• You are being asked to share your contact information so that we can communicate with you about the Work@Health® Program.
• Your participation is voluntary, and you may skip any questions you do not want to answer. You may also choose to stop filling out the form at any time.
• This form is designed to take approximately 30 minutes to complete.
• All responses you provide will be maintained in a secure manner. We will not disclose your responses or anything about you unless we are compelled by law. Your responses will be combined with other information we receive and reported in aggregate as feedback from the group. In our project reports, your name will not be linked to the information or comments you provide.
• There are no risks or benefits to you personally for completing this form.
• CDC is authorized to collect information for this project under the Public Health Services Act.
• If you have any questions, you can contact Jason Lang. His phone number is 770-488-5597 and his email is jlang@cdc.gov.
