### Page 1

CENTERS FOR DISEASE CONTROL AND PREVENTION

NATIONAL INSTITUTE FOR OCCUPATIONAL SAFETY

AND HEALTH

+ + + + +



### lst INTERNATIONAL SYMPOSIUM ON TOTAL WORKER HEALTH

+ + + + +



### SESSION 3.5 TOWN HALL FORUM: SHARE YOUR INPUT TO THE NATIONAL AGENDA FOR TOTAL

WORKER HEALTH

+ + + + +



### TUESDAY OCTOBER 7, 2014

+ + + + +



### The Town Hall met in Rooms E1/E2, Natcher Building, National Institutes of Health, 9000 Rockville Pike, Bethesda,

Maryland, at 12:30 p.m., Sara L. Tamers,

PhD, MPH, Health Research

Scientist/Coordinator for Research Program

Development and Collaboration, NIOSH, CDC,

facilitating.

Neal R. Gross and Co., Inc. 202-2344433 Washington DC www.nealrgross.com

### Page 2

T-A-B-L-E 0-F C-O-N-T-E-N-T-S

PAGE

Opening Comments: by Dr. Sara Tamers . . . . . . . . . . . 3

Strategic Goal 1: Research . . . . . . . 4

Strategic Goal 2: Practice . . . . . . . 4

Strategic Goal 3: Policy . . . . . . . . 5

Strategic Goal 4: Capacity Building. .. 5

Oral Comments:

Dr. Robert McLellan, American College of Occupational and Environmental Medicine, AECOM. . . . . .10

Ms. Jane Jacobs, National Cancer Institute . . . . . . . . . . . .17

Ms. Maureen Johnson, IBM . . . . . .21

Ms. Barbara Fahmy, Colorado i Division of Worker's Compensation. . . .24

Dr. Cecilia Watkins, Western Kentucky University. . . . . . . . . . .26

Dr. Anna Allen, WW Occupational Medicine . . . . . . . . . . . . . . . .28

Mr. Dave Heidorn, Manager of Government Affairs and Policies, the American Society of Safety Engineers, ASSE . . . . . . . . . . . . .29

Closing Comments by Dr. Sara Tamers . . . . . . . . . . .31

Neal R. Gross and Co., Inc. 202-234-4433 Washington DC www.nealrgross.com

### Page 3

1 P-R-O-C-E-E-D-I-N-G-S

2 (12:45 p.m.)

3 DR. TAMERS: Okay, we're going to

4 get started. You all get comfortable. Thank

5 you for joining us. This is the Town Hall for

6 the proposed National Total Worker Health

7 Agenda. So we thank you for coming, during

8 your lunch break.

9 My name is Sara Tamers, on behalf

10 of the Office for Total Worker Health, which

11 hopefully, by Day 2, everybody knows who we

12 are. We really appreciate you attending this

13 first of three Town Halls this week, actually.

14 So the purpose, quite simply, here

15 is to get comments from you, our stakeholders,

16 on how we at the Office for Total Worker

17 Health and NIOSH might develop the most

18 relevant, appropriate and influential,

19 hopefully, National Total Worker Health

20 Agenda.

21 Hopefully, everyone has been able

22 to peruse a copy of the Agenda. There should

Neal R. Gross and Co., Inc. 202-234-4433 Washington DC www.nealrgross.com

### Page 4

1 have been some at the registration, at the

2 NIOSH table. If not, we have placed some

3 additional copies in the back, so please feel

4 free to help yourself.

5 A11 right, so I'm not going to

6 spend this time going over the intricacies of

7 the Agenda, but simply to say, among other

8 elements, it contains four strategic goals,

9 each of which has a number of sub-goals. And

10 so let's just review those four strategic

11 goals now.

12 So Strategic Goal 1 relates to

13 research. And, as you see, that is to advance

14 and conduct etiologic surveillance and

15 intervention research that builds the evidence

16 base for effectively integrating health

17 protection and health promotion activities in

18 the workplace.

19 Strategic Goal 2 relates to

20 practice. And that is to increase the

21 awareness and adoption of effective integrated

22 occupational safety and health protection and

Neal R. Gross and Co., Inc. 202-2344433 Washington DC www.nealrgross.com

### Page 5

1 health promotion activities in the workplace.

2 Strategic Goal 3 

### relates to

3 

### policy. And that is to create guidance for

4 policies that promote the integration of

5 occupational safety and health protection and

6 health promotion activities in the workplace.

7 And last, but most certainly not

8 least, Strategic Goal Number 4 relates to

9 capacity building. And it is to build

10 professional capacity to strengthen the Total

11 Worker Health workforce and Total Worker

12 Health field to support the development,

13 

### growth, and maintenance of integrated -- ---

14 occupational safety and health protection and

15 health promotion activities in the workplace.

16 So for those of you who will be

17 providing oral comment today, as well as those

18 of you who might be providing written comment,

19 and I'11 explain how to do so momentarily, we

20 ask that you consider these three questions.

21 The first of which is really

22 seeking your view on what we currently have in

Neal R. Gross and Co., Inc. 202-234-4433 Washington DC www.nealrgross.com

### Page 6

1 this draft, in this proposed Agenda. What do

2 you think of the goals? Is there anything

3 that you might alter?

4 The second relates to bridges, or

5 links, between the work that, perhaps, you're

6 currently doing in your organization and

7 institution and what you see, currently, in

8 the Agenda.

9 And the third, quite simply, is

10 asking for any major missing components, or

11 gaps, that you feel that you've already

12 identified in the draft, as it is now, which

13 will be very useful as we move forward with

14 the development.

15 So speaking of potential

16 additional points of consideration, I just

17 want to briefly touch on one that we've

18 already self-identified, at NIOSH, with the

19 help of stakeholders, and that is that

20 currently the draft does not include what you

21 might term, suitability criteria, for those

22 employers to meet in order to engage with us

Neal R. Gross and Co., Inc. 202-234-4433 Washington DC www.nealrgross.com

### Page 7

1

2 partnerships. So we are aware of that.

3 One model that was put forth that

4 we might consider to develop such criteria,

5 includes the OSHA VPP criteria. Certainly,

6 there are others that we'11 be exploring in

7 due course, so just to give you an example of

8 one of those additional points.

9 All right, so now let's get to the

10 guidelines for the Town Hall oral comments.

11 So first, for those of you who will be

12 providing oral comment we ask, for

13 transcription purposes, that you first

14 introduce yourself, name and affiliation.

15 we also, respectfully, ask that

16 you limit your comments to a maximum of five

17 minutes each. Keep in mind that included in

18 that five-minute allotment will be any

19 questions that you have to us at NIOSH, and so

20 we would actually, respectfully, discourage

21 you from taking this time to pose questions,

22 because we really want it to be a forum to

Neal R. Gross and Co., Inc. 202-234-4433 Washington DC www.nealrgross.com

### Page 8

1 hear from you, rather than a discourse.

2 With that said, I will certainly

3 be making myself available at the conclusion

4 of the Town Hall, as I'm sure, some of my

5 colleagues will do, in order to answer any

6 clarifying questions you might have.

7 I'd like to just touch on our very 

# I

8 technical timekeeping method. The lovely

9 Jessica will be our timekeeper. Green

10 indicates start. A yellow folder indicates

11 you 

### have one minute left, and the red

12 indicates stop. If you hear a bell, it means

13 we really, respectfully, ask you to stop.

14 So in addition to the three

15 questions that we went over that you might

16 consider in your comments, we really would

17 like you to use this time, if you may, to

18 highlight the most critical salient points to

19 be included in the National Total Worker

20 Health Agenda that you feel, perhaps, are not

21 currently.

22 Any remaining points, if you

Neal R. Gross and Co., Inc. 202-234-4433 Washington DC www.nealrgross.com

### Page 9

1 could, please, submit those to the docket, and ,

2 I'11 explain that in the next slide. And

3 again, keep in mind that all oral comments

4 today and in the future Town Hall forums will

5

6 So speaking of the docket, there

7 is another way by which you might comment on

8 the Draft Agenda. You may do so in a written

9 format via two ways, and you 

### needn't write

10 this information down, there is a handout,

11 again, in the back of the room, a one page

12 handout, or on the NIOSH desk, or

13 registration, so through the Internet via

14 regulations.gov , or if you prefer, via mail,

15 certainly, we appreciate that.

16 Keep in mind there is a deadline

17 to do so, as you see listed here, of December

18 22nd, and all comments, those provided here

19 today, and the written ones, will be reviewed

20 at that time and responded to accordingly.

21 So we have a few people already

22 signed up to provide oral comment. So what

Neal R. Gross and Co., Inc. 202-234-4433 Washington DC www.nealrgross.comPage 10

i 1 

### I 2 

# I 3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22 we'd like to do is, I will read those off,

first, the list, and then we'11 go one-by-one.

And should we have additional

time, at the conclusion of this, we would

invite those of you, who di,d not sign up, to

come to the mic first come first serve until,

essentially, we run out of time.

So first, just I'11 read off this

list, we will be hearing from Dr. Robert

McLellan. Next, and keep your tickets out,

I'11 be reading the last two digits, we'11 be

hearing from Number 1, followed by Number 2,

then Number 3, and you guessed it, Number 4,

and finally, Number S. So should be easy

enough to remember.

Sut, so we have six of you

speaking today, so thank you for that, and we

will begin with Dr. Robert McLellan. The mic

is right here. Thank you, Adele.

(Off microphone discussion)

DR. MCLELLAN: I'm Dr. Robert

McLellan, and I am submitting comments on

Neal R. Gross and Co., Inc. 202-234-4433 Washington DC www.nealrgross.com

### Page 11

1 behalf of the American College of Occupational 

## I

2 and Environmental Medicine.

3 ACOEM applauds NIOSH efforts to

4 create a national agenda for advancing Total

5 Worker Health and bringing focused attention

6 to TWH research, practice, policy and training

7 is essential to advancing this initiative.

8 We fully concur with NIOSH that

9 the integration of health protection and

10 health promotion in the workplace is key to

11 achieving the healthiest workforce possible.

12 Creating a culture.of health and

13 safety in the workplace is a fundamental

14 building block for a national cultural of

15 health and safety.

16 ACOEM believes that health and

17 safety strategies in the workplace, however,

18 must also be integrated with those in the home

19 and community. And promoting the health and

20 safety of our citizens is foundational to the

21 future economical sustainability of our

22 country.

Neal R. Gross and Co., Inc. 202-234-4433 Washington DC www.nealrgross.com

### Page 12

1 ACOEM published a paper in the

2 Journal of Occupational Environmental Medicine

3 on this topic in 2011, titled Workplace Health

4 Protection and Promotion, a New Pathway for a

5 Healthier and Safer Workforce.

6 We recently convened a summit

7 meeting, just two months ago, to further the

8 work that we began with that paper in 2011,

9 and we wanted to share several consensus

10 viewpoints from that meeting that we believe

11 should be considered in shaping the National

12 Agenda.

13 First is the need for more -

14 research, demonstrating that health promotion

15 programs can positively influence workplace

16 safety, just as health protection programs can

17 positively influence workplace wellness. We

18 intuitively believe this to be the case, but

19 we need more empirical evidence.

20 Second, we believe a key gap

21 continues 

### to exist, in terms of a commonly

22 shared set of inetrics that places demonstrated

Neal R. Gross and Co., Inc. 202-234-4433 Washington DC www.nealrgross.com

### Page 13

1 economic value on TwH programs.

2 The Draft Agenda rightly notes

3 that the business case for prevention remains

4 a key question for employers. Most often, the

5 economic value of health promotion and

6 protection programs has been based on a

7 consideration of whether a return on

8 investment, or ROI, has been achieved.

9 However, published articles with

10 report on the ROI of workplace health

11 interventions frequently fail to detail the

12 methodology used to calculate the ROI.

13 ACOEM believes that for research

14 purposes, standardization of an ROI

15 methodology should be pursued. On the other

16 hand, few health interventions have been

17 demonstrated to have a true ROI. Instead,

18 most health interventions are assessed by

19 their cost effectiveness, or other endpoints,

20 such as quality of life years.

21 ACOEM believes that other measures

22 of the value of TWH should be encouraged by

Neal R. Gross and Co., Inc. 202-234-4433 Washington DC www.nealrgross.com

### Page 14

1 NIOSH. For example, NIOSH could establish an

2 agenda to identify a suite of inetrics that

3 affect the economic sustainability of a

4 business. These metrics might then contribute

5 to a universally accepted index of the

6 economic value of health promotion and health

7 protection.

8 During our summit meeting, there

9 was great agreement on the need for practical

10 advice that can help bridge activities in the

11 health protection community with those in the

12 health promotion community within workplaces.

13 However, health and safety

14 professionals yearn for hands-on practical

15 advice aimed specifically at operational

16 approaches to integration of programs.

17 FIe applaud the call, therefore,

18 for the development and dissemination of best

19 practices. However, to maximize the

20 practicality of the adoption of these best

21 practices, NIOSH should consider creating a

22 standardized template for collecting and Web

Neal R. Gross and Co., Inc. 202-234-4433 Washington DC www.nealrgross.com

### Page 15

1 publishing best practices, which would provide

2 users sufficient detail to be actionable.

3 Templates for disseminating best

4 practices have been developed by the business

5 community and could easily be adapted by NIOSH

6 for this purpose.

7 We concur that advancing policy

8 supportive of Total Worker Health is vital to

9 the successful efforts to achieve the

10 healthiest workforce possible.

11 In particular, exploring

12 opportunities to transf'er concepts of TWH to

13 the general healthcare delivery system holds -

14 the potential for more rapid adoption of TWH.

15 For example, group health insurers

16 might team with Worker's Comp insurers to

17 provide incentives to policyholders to promote

18 TWH. Worker's Comp insurers might offer TWH

19 support, as part of their risk management

20 services.

21 Finally, ACOEM agrees that the

22 future of TWH ultimately depends on training

Neal R. Gross and Co., Inc. 202-234-4433 Washington DC www.nealrgross.com

### Page 16

1 future practitioners. As TWH becomes a

2 recognized approach to improving worker

3 health, TWH training courses, practitioners,

4 and services are likely to proliferate in the

5 marketplace.

6 NIOSH should help define

7 parameters of this training and education, as

8 well as the defining basic competencies of TWH

9 practitioners, to assure the availability of

10 a uniformed product.

il ACOEM is a long time partner with

12 NIOSH and our efforts, on behalf of worker

13 health, are closely aligned. As always, we

14 want to offer our resources that we can make

15 available to help with this important project.

16 We'11 offer detailed written comments later,

17 and I thank you for the opportunity.

18 DR. TAMERS: Thank you, very much,

19 Dr. McLellan. A11 right, next we have Number

20 1. Wonderful.

21 (Off microphone discussion)

22 DR. TAMERS: And don't forget,

Neal R. Gross and Co., Inc. 202-234-4433 Washington DC www.nealrgross.com

### Page 17

1 your name and affiliation, please.

2 MS. JACOBS: Right.

3 DR. TAMERS: Thank you.

4 MS. JACOBS: My name is Jane

5 Jacobs. I work for the National Cancer

6 Institute, which is one of the 27 institutes

7 at National Institutes of Health. I am the

8 lead for our workplace wellness within NCI.

9 And my specific office is within the Office of

10 the Director and the Office of Workforce

11 Planning and Development.

12 I wanted to frame my comments by

13 saying that these are informal. That, by:

14 default, anyplace that I appear professionally

15 I quote represent NCI, but what I'm about to

16 say is not the official position of NCI. I

17 mean, we did not take a stand on this, or

18 prepare anything in advance.

19 I've just been working in this

20 field for a long time. I have a lot of

21 colleagues at the National Cancer Institute,

22 throughout the Institute, and also throughout

Neal R. Gross and Co., Inc. 202-234-4433 Washington DC www.nealrgross.comPage 18

1 NIH. I've come to many similar conferences,

2 and so these are two points that I am

3 suggesting be considered, just from my own

4 experience.

5 So with that frame, the following

6 two points. One is, I'm not clear exactly

7 where it might fit in the strategic framework

8 that you outlined, but I am hoping that there

9 is more research on the roles of supervisors

10 and middle managers in implementing Total

11 Worker Health, occupational health, and

12 workplace wellness.

13 I understand and appreciate that

14 Total Worker Health is, basically, the melding

15 of occupational health and safety and what has

16 become more well-known as workplace wellness.

17 And I will tell you that my

18 individual work responsibility focus is more

19 on the workplace wellness end, but we are

20 including health and safety in our efforts.

21 Then, there is a more vigorous

22 occupational health and safety entire

Neal R. Gross and Co., Inc. 202-234-4433 Washington DC www.nealrgross.com

### Page 19

1 department at NIH, because we have

2 laboratories and health and safety is a very

3 important aspect there.

4 But the majority of workers at the

5 National Cancer Institute, and I would hazard

6 to guess, at NIH, are not lab workers, they

7 work in offices. They administer grants, they

8 review grants, they do educational programs,

9 communication programs.

10 And, really, what we have found is

11 that you can have fantastic Total Worker

12 Health, or workplace wellness offerings, so

13 that's on one side.

-- --



### 14 You can have employees, who would

15 definitely benefit from, and are increasingly

16 interested in those programs and activities

17 and principles, and right in the middle you've

18 got the supervisors and the managers.

19 So to me the challenge is, how we

20 integrate workplace wellness into the workday

21 in a way that can gain the support of, and is

22 acceptable to managers and supervisors.

Neal R. Gross and Co., Inc. 202-234-4433 Washington DC www.nealrgross.com

### Page 20

1 That is one of our biggest

2 challenges. And I believe, there is research

3 from the Gallup Organization on wellness that

4 also focuses on this same arena.

5 One suggestion I have in that

6 realm is, what we're trying to do is emphasize

7 that this is about individual health and

8 wellness. So you may not take an hour out of

9 your workday to go to the gym, but you may be

10 convinced that standing up at your desk and

11 moving your arms around, or maybe walking the

12 stairs for three minutes, as a break every

13 hour, is extremely valuable to your health.

14 So whatever we need to do to get

15 supervisors and managers in favor of this, and

16 supporting it, I think is going to be key to

17 everything else in this realm.

18 My second point is much shorter,

19 which is, at conferences like this we often

20 hear about research and research results. X

21 was measured, or tried, or set up, and it

22 worked, or it didn't work, or it had negative

Neal R. Gross and Co., Inc. 202-234-4433 Washington DC www.nealrgross.com

### Page 2]

1 effect, or positive effect, all of which is

2 very valuable.

3 

### I'm hoping, in the research

4 

### agenda, there's increased emphasis on the why.

5 

### And I say that because, NCI also has produced

6 

### many models in various agencies, and we're

7 

### doing several aspects of workplace wellness 

# I

8 

### that we believe will be models, as well that

9 

### other people can adapt.

10 

### But, if you don't know the why

11 

### something worked, or it doesn't work, it's

12 very difficult to adapt. So thank you for

13 

### this opportunity.

14 

### DR. TAMERS: Thank you. And next

15 

### we'11 hear from Number 3.

16 

### (Off microphone discussion)

17 

### DR. TAMERS: Pardon me. Number 2.

18 

### Thank you.

19 

### MS. JOHNSON: I thought I was

20 going to miss my moment in the sun.

21 DR. TAMERS: Apparently, I can't

22 count today.

Neal R. Gross and Co., Inc. 202-234-4433 Washington DC www.nealrgross.comPage 22

1 MS. JOHNSON: My name is Maureen

2 Johnson and, although, I work for IBM, like

3 our previous speaker, I am certainly not

4 speaking for my employer.

5 I'm a certified safety

6 professional, over 25 years of experience,

7 mostly in the occupational health and safety

8 arena.

9 A couple of years ago I took on

10 the opportunity, and I know sometimes people

il think that's an overused word, to head-up the

12 development of an injury and violence free

13 living program for IBM, globally.

14 And this is IN Health promotion,

15 not occupational health and safety, although,

16 obviously, many of the principles are the

17 same.

18 I echo our first speaker's request

19 that there be a body of knowledge put together

20 that provides employers with a template with

21 best practices and with ideas for developing

22 effective injury prevention programs, as well

Neal R. Gross and Co., Inc. 202-234-4433 Washington DC www.nealrgross.com

### Page 23

1 as looking at the health aspects, which are,

2 obviously, very important, and injury

3 prevention and violence free living, thinking

4 about, again, a global perspective, you know,

5 what's working in different parts of the

6

7 I realize NIOSH is a United

8 States-based organization, but my employer and

9 many other employers are international

10 globally integrated companies, and that really

11 would be something that would benefit us by

12 having a body of scientific research and

13 knowledge that shows what works, what-doesn't --

14 work, and why something does, or does not _

15 work.

16 Secondarily, I'd also like to

17 offer the perspective of a safety professional

18 that, indeed, we get most of our training and

19 education in the occupational arena and,

20 mostly, that's why our employers have hired

21 us.

22 However, as we think about Total

Neal R. Gross and Co., Inc. 202-234-4433 Washington DC www.nealrgross.com

### Page 29

1 Worker Health and safety, it would be really

2 beneficial to think about integration of the

3 wellness and health promotion concepts at

4 traditionally safety and industrial hygiene

5 conferences.

6 So I happen to also be a member of

7 the American Society Safety and Engineers.

8 I'm not speaking for them, either, but I go to

9 our annual conference, it's in Dallas in 2015,

10 you know, thinking about the concept of health

11 promotion wellness and, particularly, injury

12 prevention off the job, might be an area for

13 NIOSH and other organizations to really pursue

14 working with our group, or AIHA, the American

15 Industrial Hygiene Association, to really try

16 to promote that integration in our education,

17 as health and safety professionals. Oh, and

18 I'm finished on the green. Thank you.

19 DR. TAMERS: Thank you. A11

20 right, now we're back on track. Number 3.

21 MS. FAHMY: Good afternoon. My

22 name is Barbara Fahmy, and I am with the

Neal R. Gross and Co., Inc. 202-234-4433 Washington DC www.nealrgross.com

### Page 25

1 Colorado Division of Worker's Compensation,

2 which is part of the Colorado Department of

3 Labor and Employment.

4 And I will also say that these are

5 informal comments, and I don't know if I

6 represent the opinions of the senior

7 management at the Colorado Department of Labor ,

8 and Employment.

9 Just a couple of short comments.

10 My suggestion is that you incorporate into

11 your research agenda specific research that,

12 in the unfortunate event that a worker does

13 become injured on the job, how can that14 injured worker receive high quality and cost

15 effective care and eventually be reintegrated

16 back into the workforce?

17 And my second comment is, one

18 thing I've been hearing a lot, and maybe it's

19 because of the specific lectures that I've

20 been attending, is that since workplaces now

21 have four generations of workers, what is the

22 best way to maximize the diversities of

Neal R. Gross and Co., Inc. 202-234-4433 Washington DC www.nealrgross.comPage 26

1 strengths and compensate for the weaknesses,

2 or areas of improvement, if you will, to

3 maintain a safe and pleasant and productive

4 environment? That's all. Thank you very

5 much.

6 DR. TAMERS: Thank you. Next

7 we'11 hear from Number 4. Lucky Number 4, are

8 you still with us?

9 (No response.)

10 DR. TAMERS: A11 right, we'11 come

11 back to you. Number 5, please.

12 DR. WATKINS: Hello. I'm Dr.

13 Cecilia Watkins from Western Kentucky

14 University. And one of the things that I've

15 been hearing are a lot of good processes and

16 studies and strategies that's come out of a

17 lot research here.

18 I have 12 years background in

19 academia and trying to train the workforce in

20 health promotion. The biggest challenge in

21 health promotion is trying to get people out

22 there that are skilled and trained in that

Neal R. Gross ancS Co., Inc. 202-234-4433 Washington DC www.nealrgross.com

### Page 27

1 area, because a lot of the people that are

2 doing the work are HRs, or occupational nurses

3 that have been thrown into the position and

4 haven't really had the proper training.

5 And with all of these wonderful

6 strategies and processes, it really doesn't do

7 any good, if we don't have skilled people out

8 there to put them into place.

9 Total Worker Health is a great

10 concept and I think it's the way to go, but

11 again, if you don't have trained people out

12 there to put it in place in the real world, it

13 won't matter. So that's what I say, is that

14 we need to get universities and people

15 involved, so we can train people.

16 And also, opportunities for people

17 that are already out there to get some type of

18 certification that will give them the proper

19 training, not a two-hour something that just

20 gives them a certificate paper, something that

21 really train them and help them to do the job.

22 DR. TAMERS: Thank you, very much.

Neal R. Gross and Co., Inc. 202-234-4433 Washington DC www.nealrgross.com

### Page 28

1 A11 right, did we win back Number 4? A11

2 right.

3 DR. ALLEN: Hello. My name is

4 Anna Allen. I'm a physician at WW

5 Occupational Medicine. And, again, these are

6 my personal comments, not in representation of

7 the University.

8 I would like NIOSH to keep in mind

9 that there is a large part of the working

10 population that is in rural areas and are very

11 difficult to get to now, and I see this being

12 a even more difficult issue, trying to get the

13 information out about Total Worker Health and

14 the benefits.

15 I mean, we're still struggling

16 with elevated injury rates and disability

17 rates from injuries, as it is, so, you know,

18 I would like that to be kept in mind.

19 And also, again, the Appalachian

20 region is, 

### you know, where we focus and,

21 again, that has some unique issues, culturally

22 and economically, to get the information out

Neal R. Gross and Co., Inc. 202-234-4433 Washington DC www.nealrgross.com

### Page 29

1 and get people trained and onboard with this.

2 So thank you.

3 DR. TAMERS: Thank you. A11

4 right, well we still have some time leftover.

5 I would now invite anyone, who is not part of

6 the lottery and would like to speak, at this

7 time, to come up to the mic, first come first

8 serve.

9 Please keep in mind, those of you

10 who might have joined us late, five minute

11 maximum time allotment, at this point and

12 time. And please introduce yourself, name and

13 affiliation. Thank you.

14 MR. HEIDORN: Dave Heidorn,

15 Manager of Government Affairs and Policies

16 with the American Society of Safety Engineers.

17 And, Maureen Johnson can always speak for

18 ASSE. She's actually one of the leaders among

19 the members of bringing this issue to ASSE.

20 I don't know, when you read these

21 documents, to me, everything is here. For my

22 perspective, working with safety

Neal R. Gross and Co., Inc. 202-234-4433 Washington DC www.nealrgross.com

### Page 30

1 professionals, how I can make a comment to say

2 that NIOSH really needs to focus on Goal

3 Number 2.

4 I'm not sure how to say that,

5 because I know NIOSH shares the same concerns

6 we have, but how you do really research the

7 practice, as was one of John Howard's first

8 efforts at NIOSH, to really put that, as a key

9 goal of it, we need things that are done very

10 simply and very easily, so that the very, very

11 busy typical safety and health professional,

12 who's usually not even able to get to all the

13 safety concerns each day in their job, how

14 they can also be aware of all the great stuff

15 that's happening in this field.

16 And I think it's a really, really

17 common issue out there that, and God bless all

18 of us, but I don't think researchers see that

19 on a day-to-day basis.

20 You already have amazing amounts

21 of information, I just sat through the trucker

22 session. That stuff should be out there

Neal R. Gross and Co., Inc. 202-234-4433 Washington DC www.nealrgross.com

### Page 31

1 somehow now, you know, not as a goal in the

2 future.

3 And this is not a new issue.

4 Almost every issue I've dealt with NIOSH it's

5 

### the same, and I know NIOSH shares these

6 

### concerns, also, but how we all work together,

7 

### how the OC docs, how ASSE, AIJ, how we can

8 

### work together to get this happening now, not

9 

### in the future, is the key goal.

10 

### And I'm not sure how to tell you

11 

### how to change the wording here to make that

12 happen, but I think it's really, really

13 important. So thanks for this effort. The

14 goals are great. And ASSE, and we would like

15 

### to support those, you know, totally. Thank

16 

### you.

17 

### DR. TAMERS: Thank you. LVould

18 

### anybody else like to comment?

19 

### (No response.)

20 DR. TAMERS: A11 right, well

21 please keep in mind, we have another Town Hall

22 this evening at 5:00 

### p.m., should any of you

Neal R. Gross and Co., Inc. 202-234-4433 Washington DC www.nealrgross.com

### Page 32

1 change your mind.

2 For those of you who might be

3 joining us during our Healthier Federal

4 

### Workers conference, later on in the week, we

5 

### will also have a Town Hall on Thursday.

6 

### And all the wise, there is again

7 

### that mechanism of doing so in a written

8 

### format, and all the information on how to do

9 

### so can be found on a one page handout by the

10 

### door. So we thank all of you for your

11 

### comments and we hope you enjoy the rest of the

12 conference.

13 (Whereupon, the meeting in the

14 

### above-entitled matter was concluded at 1:14

15 

### p.m.)

16

17

18

19



### 20

21

22

Neal R. Gross and Co., Inc. 202-234-4433 Washington DC www.nealrgross.comPaqe 33

A able 3:21 30:12 above-entitled 32:14 academia 26:19 acceptable19:22 accepted 14:5 achieve15:9 achieved 13:8 achieving 11:11 ACOEM 11:3,16 12:1 13:13,21 15:21 16:11 actionable 15:2 activities 4:17 5:1,6 5:15 14:10 19:16 adapt 21:9,12 adapted 15:5 addition 8:14 additiona14:3 6:16 7:8 10:3 Adele 10:19 administer 19:7 adoption 4:21 14:20 15:14 advance 4:13 17:18 advancing 11:4,7 15:7 advice 14:10,15 AECOM 2:10 Affairs 2:19 29:15 affect 14:3 aftiliation 7:14 17:1 29:13 afternoon 24:21 agencies 21:6 agenda 1:7 3:7,20 3:22 4:7 6:1,8 8:20 9:8 11:4 12:12 13:2 14:2 21:4 25:11 ago 12:7 22:9 agreement 14:9 agrees15:21 AIHA 24:14 AIJ 31:7 aimed 14:15 aligned 16:13

Allen 2:17 28:3,4 allotment 7:18 29:11 alter 6:3 amazing 30:20 American 2:9,19 11:1 24:7,14 29:16 amounts 30:20 Anna 2:17 28:4 annua124:9 answer 8:5 anybody 31:18 anyplace17:14 Appalachian 28:19 Apparently 21:21 appear17:14 applaud 14:17 applauds11:3 appreciate 3:12 9:15 18:13 approach 16:2 approaches 14:16 appropriate 3:18 area 24:12 27:1 areas 26:2 28:10 arena 20:4 22:8 23:19 arms 20:11 articles 13:9 asking 6:10 aspect19:3 aspects 21:7 23:1 ASSE 2:20 29:18 29:19 31:7,14 assessed 13:18 Association 24:15 assure 16:9 attending 3:12 25:20 attention 11:5 availability 16:9 available 8:3 16:15 aware 7:2 30:14 awareness 4:21 back 4:3 9:11 24:20

25:16 26:11 28:1 background 26:18 Barbara 2:14 24:22 base 4:16 based 13:6 basic 16:8 basically 18:14 basis 30:19 began 12:8 behalf 3:9 11:1 16:12 believe 12:10,18,20 I 20:2 21:8 believes 11:16 13:13,21 bell 8:12 beneficia124:2 benefit 19:15 23:11 benefits 28:14 best 14:18,20 15:1 15:3 22:21 25:22 Bethesda 1:14 biggest 20:1 26:20 bless 30:17 block 11:14 - body 22:19 23:12 break 3:8 20:12 bridge 14:10 bridges 6:4 brfefly 6:17 bringing 11:5 29:19 build 5:9 building 1:13 2:7 5:9 11:14 builds 4:15 business 13:3 14:4 15:4 busy 30:11

C-O-N-T-E-N-T-S 2:1 calculate 13:12 call 14:17 Cancer 2:12 17:5 17:21 19:5

capacity 2:7 5:9,10 care 25:15 case 12:18 13:3 CDC 1:18 Cecilia 2:15 26:13 CENTERS 1:1 certainly 5:7 7:5 8:2 9:15 22:3 certiflcate 27:20 certification 27:18 certified 22:5 challenge 19:19 26:20 challenges 20:2 change 31:11 32:1 citizens11:20 clarifying 8:6 clear 18:6 closely 16:13 Closing 2:21 Collaboration 1:18 colleagues 8:5 17:21 collecting 14:22 College 2:10 11:1 Colorado 2:14 25:1 25:2,7 come 10:6,6 18:1 26:10,16 29:7,7 comfortable 3:4 coming 3:7 comment 5:17,18 7:12 9:7,22 25:17 30:1 31:18 comments 2:3,8,21 3:15 7:10,16 8:16 9:3,18 10:22 16:16 17:12 25:5 25:9 28:6 32:11 wmmon 30:17 commonly 12:21 communication 19:9 community 11:19 14:11,12 15:5 Comp 15:16,18 companies 23:10

compensate 26:1 Compensatfon 2:14 25:1 competencies 16:8 components 6:10 concept24:10 27:10 concepts 15:12 24:3 concerns 30:5,13 31:6 concluded 32:14 conclusion 8:3 10:4 concur 11:8 15:7 conduct 4:14 conference 24:9 32:4,12 conferences18:1 20:19 24:5 consensus 12:9 consider 5:20 7:4 8:16 14:21 consideration 6:16 13:7 considered 12:11 18:3 contains 4:8 continues 12:21 contribute 14:4 CONTROL 1:1 convened 12:6 convinced 20:10 copies 4:3 copy 3:22 cost 13:19 25:14 count21:22 country 11:22 couple 22:9 25:9 course 7:7 courses 16:3 create 5:3 11:4 creating 11:12 14:21 criteria 6:21 7:4,5 critical 8:18 cultural 11:14

Neal R. Gross and Co., Inc. 202-234-4433 Washington DC www.nealrgross.comPage 34

culturally 28:21 culture 11:12 currently 5:22 6:6 6:7,20 8:21

D Dallas 24:9 Dave 2:18 29:14 day 3:11 30:13 day-to-day 30:19 deadline 9:16 dealt 31:4 December 9:17 default 17:14 define 16:6 defining 16:8 definitely 19:15 delivery 15:13 demonstrated 12:22 13:17 demonstrating 12:14 department 19:1 25:2,7 depends 15:22 desk 9:12 20:10 detai113:11 15:2 detailed 16:16 develop 3:17 7:4 developed 15:4 developing 22:21 development 1:18 5:12 6:14 14:18 17:11 22:12 different 23:5 difficult 21:12 28:11,12 digits 10:11 Director 17:10 disability 28:16 discourage 7:20 discourse 8:1 discussion 10:20 16:21 21:16 DISEASE 1:1 disseminating 15:3 dissemination 14:18 diversities 25:22

Division 2:14 25:1 docket 9:1,5,6 docs 31:7 documents 29:21 doing 6:6 21:7 27:2 32:7 door 32:10 Dr 2:3,9,15,17,21 3:3 10:9,18,21,21 16:18,19,22 17:3 21:14,17,21 24:19 26:6,10,12,12 27:22 28:3 29:3 31:17,20 draft 6:1,12,20 9:8 13:2 due 7:7

El/E21:13 easily 15:5 3 0: 10 easy 10:14 echo 22:18 economic 13:1,5 14:3,6 economical 11:21 economically 28:22 education 16:7 23:19 24:16 educational 19:8 effect 21:1,1 effective 4:21 22:22 25:15 effectively 4:16 effectiveness 13:19 effort 31:13 efforts 11:3 15:9 16:12 18:20 30:8 either 24:8 elements 4:8 elevated 28:16 emphasis 21:4 emphasize 20:6 empirical 12:19 employees 19:14 employer 22:4 23:8 employers 6:22 13:4 22:20 23:9

23:20 Employment 25:3 25:8 encouraged 13:22 endpoints 13:19 engage 6:22 Engineers 2:20 24:7 29:16 enjoy 32:11 entire 18:22 environment 26:4 Environmental 2:10 11:2 12:2 essential 11:7 essentially 10:7 establish 14:1 etiologic 4:14 evening31:22 event 25:12 eventually 25:15 everybody 3:11 evidence 4:15 12:19 exactiy 18:6 example 7:7 14:1 15:15 exist 12:21 experience 18:4 22:6 explain 5:19 9:2 exploring 7:6 15:11 extremely 20:13

facilitating 1:19 Fahmy 2:14 24:21 24:22 fail 13:11 fantastic 19:11 favor 20:15 Federal 32:3 feel4:3 6:11 8:20 field 5:12 17:20 30:15 finally 10:14 15:21 finished 24:18 first3:13 5:21 7:11 7:13 10:2,6,6,8

12:13 22:18 29:7 29:7 30:7 fit 18:7 five 7:16 29:10 five-minute 7:18 focus 18:18 28:20 30:2 focused 11:5 focuses 20:4 folder 8:10 followed 10:12 following 18:5 forget16:22 format 9:9 32:8 forth 7:3 forum 1:7 7:22 forums 9:4 forward 6:13 found 19:10 32:9 foundationa111:20 four 4:8,10 25:21 frame 17:12 18:5 framework 18:7 free 4:4 22:12 23:3 frequently 13:11 fully 11:8 fundamenta111:13 further 12:7 future 9:4 11:21 15:22 16:1 31:2,9

gain 19:21 Gallup 20:3 gap 12:20 gaps 6:11 genera115:13 generations25:21 give 7:7 27:18 gives 27:20 global 23:4 globally 22:13 23:10 go 10:2 20:9 24:8 27:10 goal 2:4,5,6,7 4:12 4:19 5:2,8 30:2,9 31:1,9

goals 4:8,11 6:2 31:14 God 30:17 going 3:3 4:5,6 20:16 21:20 good 24:21 26:15 27:7 Government 2:19 29:15 grants 19:7,8 great14:9 27:9 30:14 31:14 green 8:9 24:18 group 15:15 24:14 growth 5:13 guess 19:6 guessed 10:13 guidance 5:3 guidelines 7:10 gym 20:9

Hall 1:7,13 3:5 7:10 8:4 9:4 31:21 32:5 Halls 3:13 hand 13:16 handout 9:10,12 32:9 hands-on 14:14 happen 24:6 31:12 happening 30:15 31:8 hazard 19:5 head-up 22:11 health 1:2,5,8,14 1:16 3:6,10,17,19 4:16,17,22 5:1,5,6 5:11,12,14,15 8:20 11:5,9,10,12 11:15,16,19 12:3 12:14,16 13:5,10 13:16,18 14:6,6 14:11,12,13 15:8 15:15 16:3,13 17:7 18:11,11,14 18:15,20,22 19:2

Neal R. Gross and Co., Inc. 202-234-4433 Washington DC www.neatrgross.comPage 35

19:12 20:7,13 22:7,14,15 23:1 24:1,3,10,17 26:20,21 27:9 28:13 30:11 Health-related 7:1 healthcare 15:13 Healthier 12:5 32:3 healthiest 11:11 15:10 hear 8:1,12 20:20 21:15 26:7 hearing 10:9,12 25:18 26:15 Heidorn 2:18 29:14 29:14 Hello 26:12 28:3 help 4:4 6:19 14:10 16:6,15 27:21 high 25:14 highlight 8:18 hired 23:20 holds 15:13 home 11:18 hope 32:11 hopefully 3:11,19 3:21 hoping 18:8 21:3 hour 20:8,13 Howard's 30:7 HRs 27:2 hygiene 24:4,15

IBM 2:13 22:2,13 ideas22:21 identified 6:12 identify 14:2 implementing 18:10 important 16:15 19:3 23:2 31:13 improvement 26:2 improving 16:2 incentives15:17 include 6:20 included 7:17 8:19 9:5 includes 7:5

including 18:20 incorporate 25:10 increase 4:20 increased 21:4 increasingly 19:15 index 14:5 indicates 8:10,10 8:12 individua118:18 20:7 industrfal 24:4,15 influence 12:15,17 influential 3:18 informal 17:13 25:5 information 9:10 28:13,22 30:21 32:8 initiative 11:7 injured 25:13,14 injuries 28:17 injury 22:12,22 23:2 24:11 28:16 INPUT 1:7 Institute 1:2 2:12 17:6,21,22 19:5 institutes1:13 17:6 17:7 institution 6:7 insurers15:15,16 15:18 integrate 19:20 integrated 4:21 5:13 11:18 23:10 integrating 4:16 integration 5:4 11:9 14:16 24:2 24:16 interested 19:16 international l :4 23:9 Internet9:13 intervention 4:15 interventions13:11 13:16,18 intricacies 4:6 introduce 7:14

29:12 intuitively 12:18 investment 13:8 invite 10:5 29:5 involved 27:15 issue 28:12 29:19 30:17 31:3,4 issues 28:21

J Jacobs 2:11 17:2,4 17:5 Jane2:11 17:4 Jessica 8:9 job 24:12 25:13 27:21 30:13 John 30:7 Johnson 2:13 21:19 22:1,2 29:17 joined 29:10 joining 3:5 32:3 Journal 12:2

K keep 7:17 9:3,16 10:10 28:8 29:9 31:21 Kentucky 2:16 26:13 kept 28:18 key 11:10 12:20 13:4 20:16 30:8 31:9 know 21:10 22:10 23:4 24:10 25:5 28:17,20 29:20 30:5 31:1,5,15 knowledge 22:19 23:13 knows 3:11

L 1:15 lab 19:6 Labor 25:3,7 laboratories 19:2 large 28:9 late 29:10

lead 17:8 leaders 29:18 lectures25:19 left 8:11 leftover 29:4 let's 4:10 7:9 life 13:20 limit 7:16 links 6:5 list 10:2,9 listed 9:17 living 22:13 23:3 long 16:11 17:20 looking 23:1 lot 17:20 25:18 26:15,17 27:1 loftery 29:6 lovely 8:8 Lucky 26:7 lunch 3:8

mail 9:14 maintain 26:3 maintenance 5:13 major 6:10 majority 19:4 making 8:3 management 15:19 25:7 Manager 2:18 29:15 managers 18:10 19:18,22 20:15 marketplace 16:5 Maryland 1:15 matter 27:13 32:14 Maureen 2:13 22:1 29:17 maximize 14:19 25:22 maximum 7:16 29:11 McLellan 2:9 10:10,18,21,22 16:19 mean 17:17 28:15 means 8:12

measured 20:21 measures 13:21 mechanism 32:7 Medicine 2:10,17 11:2 12:2 28:5 meet 6:22 meeting 12:7,10 14:8 32:13 melding 18:14 member 24:6 members 29:19 met 1:13 method 8:8 methodology 13:12 13:15 metrics 12:22 14:2 14:4 mic 10:6,18 29:7 microphone 10:20 16:21 21:16 middle 18:10 19:17 mind 7:17 9:3,16 28:8,18 29:9 31:21 32:1 minute 8:11 29:10 minutes7:17 20:12 missing 6:10 model 7:3 models 21:6,8 moment 21:20 momentarily 5:19 months 12:7 move 6:13 moving 20:11 MPH 1:16

N name 3:9 7:14 17:1 17:4 22:1 24:22 28:3 29:12 Natcher 1:13 national 1:2,7,13 2:11 3:6,19 8:19 11:4,14 12:11 17:5,7,21 19:5 NCI 17:8,15,16 21:5

Neal R. Gross and Co., Inc. 202-234-4433 Washington DC www.nealrgross.comPage 36

need 12:13,19 14:9 20:14 27:14 30:9 needn't 9:9 needs 30:2 negative 20:22 new 12:4 31:3 NIH 18:1 19:1,6 NIOSH 1:18 3:17 4:2 6:18 7:1,19 9:12 11:3,8 14:1,1 14:21 15:5 16:6 16:12 23:7 24:13 28:8 30:2,5,8 31:4 31:5 notes 13:2 number 4:9 5:8 ]0:12,12,13,13,14 16:1921:15,17 24:20 26:7,7,11 28:1 30:3

nurses 27:2

O-F 2:1 obviously 22:16 23:2 OC 31:7 occupational 1:2 2:10,17 4:22 5:5 5:14 11:1 12:2 18:11,15,22 22:7 22:15 23:19 27:2 28:5 OCTOBER 1:10 offer 15:18 16:14 16:16 23:17 offerings 19:12 office 3:10,16 17:9 17:9,10 offices 19:7 official 17:16 Oh 24:17 Okay 3:3 onboard 29:1 one-by-one 10:2

ones 9:19 Opening 2:3 operational14:15 opinions 25:6

opportunities 15:12 27:16 opportunity 16:17 21:1322:10 oral2:8 5:17 7:10 7:12 9:3,22 order 6:22 8:5 organization 6:6 20:3 23:8 organizations 24:13 OSHA 7:5 outlined 18:8 overused 22:11

P-R-O-C-E-E-D-... 3:1 p.m 1:15 3:2 31:22 32:15 page 2:2 9:11 32:9 paper 12:1,8 27:20 parameters 16:7 Pardon 21:17 part 15:19 25:2 28:9 29:5 particular 15:11 particularly 24: 11 partner 16:11 partnerships7:2 parts 23:5 Pathway 12:4 people 9:21 21:9 22:10 26:21 27:1 27:7,11,14,15,16 29:1 personal28:6 perspective 23:4,17 29:22 peruse3:22 PhD 1:16 physician 28:4 Pike 1:14 place 27:8,12 placed 4:2 places 12:22 Planning 17:11 pleasant26:3

please 4:3 9:1 17:1 26:11 29:9,12 31:21 point20:18 29:11 points 6:16 7:8 8:18,22 18:2,6 policies 2:19 5:4 29:15 policy 2:6 5:3 11:6 15:7 policyholders 15:17 population 2 8: 10 pose 7:21 posit'ion 17:16 27:3 positive 21:1 posit'ively 12:15,17 possible 11:11 15:10 potential 6:15 15:14 practical 14:9,14 practicality 14:20 practice 2:5 4:20 11:6 30:7 practices 14:19,21 15:1,4 22:21 practitioners 16:1 16:3,9 prefer 9:14 prepare 17:18 prevention 1:1 13:3 22:22 23:3 24:12 previous 22:3 principles 19:17 22:16 processes 26:15 27:6 produced 21:5 product 16:10 productive 26:3 professiona15:10 22:6 23:17 30:11 professfonally 17:14 professionals 14:14

24:17 30:1 program 1:17 22:13 programs 12:15,16 13:1,6 14:16 19:8 19:9,16 22:22 project 16:15 proliferate 16:4 promote 5:4 15:17 24:16 promoting 11:19 promotion 4:17 5:1 5:6,15 11:10 12:4 12:14 13:5 14:6 14:12 22:14 24:3 24:11 26:20,21 proper 27:4,18 proposed 3:6 6:1 protection 4:17,22 5:5,14 11:9 12:4 12:16 13:6 14:7 14:11 provide 9:22 15:1 15:17 provided 9:18 provides 22:20 providing 5:17,18 7:12 published 12:1 13:9 publishing 15:1 purpose 3:14 15:6 purposes 7:13 13:14 pursue 24:13 pursued 13:15 put 7:3 22:19 27:8 27:12 30:8

quality 13:20 25:14 question 13:4 questions 5:20 7:19 7:21 8:6,15 quite 3:14 6:9 quote 17:15 rapid 15:14

rates 28:16,17 read 10:1,8 29:20 reading10:11 rea127:12 realize 23:7 really 3:12 5:21 7:22 8:13,16 19:10 23:10 24:1 24:13,15 27:4,6 27:21 30:2,6,8,16 30:16 31:12,12 realm 20:6,17 receive 25:14 recognized 16:2 recorded 9:5 red 8:11 region 28:20 registration 4:1 9:13 regulations.gov 9:14 reintegrated 25:15 relates 4:12,19 5:2 5:8 6:4 relevant3:18 remaining 8:22 remains 13:3 remember 10:15 report13:10 represent17:15 25:6 representation 28:6 request22:18 research 1:16,17 2:44:13,15 11:6 12:14 13:13 18:9 20:2,20,20 21:3 23:12 25:11,11 26:17 30:6 researchers30:18 resources16:14 respectfully 7:15 7:20 8:13 responded 9:20

Neal R. Gross and Co., Inc. 202-234-4433 Washington DC www.nealrgross.com



### _ _ _Page 37

response 26:9 31:19 responsibility 18:18 rest32:11 results 20:20 return 13:7 review 4:10 19:8 reviewed 9:19 right4:5 7:9 10:19 16:19 17:2 19:17 24:20 26:10 28:1 28:2 29:4 31:20 rightly 13:2 risk 15:19 Robert 2:9 10:9,18 10:21 Rockville 1:14 ROI 13:8,10,12,14 13:17 roles 18:9 room 9:11 Rooms 1:13 run 10:7 rura128:10

safe 26:3 Safer 12:5 safety 1:2 2:19 4:22 5:5,14 11:13,15 11:17,20 12:16 14:13 18:15,20,22 19:2 22:5,7,15 23:17 24:1,4,7,17 29:16,22 30:11,13 salient 8:18 Sara 1:15 2:3,21 3:9 sat 30:21 saying 17:13 scientific 23:12 Scientist/Coordi... 1:17 second 6:4 12:20 20:18 25:17 Secondarily 23:16 see4:13 6:7 9:17 28:11 30:18

seeking 5:22 self-identified 6:18 senior 25:6 serve 10:6 29:8 services 15:20 16:4 session 1:7 30:22 set 12:22 20:21 shaping 12:11 share 1:7 12:9 shared 12:22 shares 30:5 31:5 short 25:9 shorter 20:18 shows 23:13 side 19:13 sign 10:5 signed 9:22 similar 18:1 simply 3:14 4:7 6:9 30:10 six 10:16 skilled 26:22 27:7 slide 9:2 Society 2:19 24:7 29:16 speak 29:6,17 speaker22:3 speaker's 22:18 speaking 6:15 9:6 10:17 22:4 24:8 specific 17:9 25:11 25:19 specifically 14:15 spend 4:6 stairs 20:12 stakeholders 3:15 6:19 stand 17:17 standardization 13:14 standardized 14:22 standing 20:10 start 8:10 started 3:4 States-based 23:8 stop 8:12,13 strategic 2:4,5,6,7

4:8,10,12,19 5:2,8 18:7 strategies l 1:17 26:16 27:6 strengthen 5:10 strengths 26:1 struggling 28:15 studies 26:16 stuff 30:14,22 sub-goals 4:9 submit 9:1 submitting 10:22 successfu115:9 sufficient 15:2 suggesting 18:3 suggestion 20:5 25:10 suitability 6:21 suite 14:2 summit 12:6 14:8 sun 21:20 supervisors 18:9 19:18,22 20:15 support 5:12 15:19 19:21 31:15 supporting 20:16 supportive 15:8 sure 8:4 30:4 3 1: 10 surveillance 4:14 sustainability 11:21 14:3 SYMPOSIUM 1:4 system 15:13

T-A-B-L-E 2:1 table 4:2 take 17:17 20:8 Tamers 1:15 2:3,21 3:3,9 16:18,22 17:3 21:14,17,21 24:19 26:6,10 27:22 29:3 31:17 31:20 team 15:16 technical 8:8 te1118:17 31:10 template 14:22

22:20 Templates 15:3 term 6:21 terms 12:21 thank 3:4,7 10:17 10:19 16:17,18 17:3 21:12,14,18 24:18,19 26:4,6 27:22 29:2,3,13 31:15,17 32:10 thanks31:13 thing 25:18 things 26:14 30:9 think 6:2 20:16 22:11 23:22 24:2 27:10 30:16,18 31:12 thinking 23:3 24:10 third 6:9 thought21:19 three 3:13 5:20 8:14 20:12 thrown 27:3 Thursday 32:5 tickets ] 0:10 time 4:6 7:21 8:17 9:20 10:4,7 16:11 17:20 29:4,7,11 29:12 timekeeper 8:9 timekeeping 8:8 titled 12:3 today 5:17 9:4,19 10:17 21:22 topic 12:3 Total 1:5,7 3:6,10 3:16,19 5:10,11 7:1 8:19 11:4 15:8 18:10,14 19:11 23:22 27:9 28:13 totally 31:15 touch 6:17 8:7 Town 1:7,13 3:5,13 7:10 8:4 9:4 31:21 32:5

track 24:20 traditionally 24:4 train 26:19 27:15 27:21 trained 26:22 27:11 29:1 training 11:6 15:22 16:3,7 23:18 27:4 27:19 transcription 7:13 transfer 15:12 tried 20:21 trucker 30:21 true 13:17 try 24:15 trying 20:6 26:19 26:21 28:12 TUESDAY 1:10 TWH 11:613:1,22 15:12,14,18,18,22 16:1,3,8 two 9:9 10:11 12:7 18:2,6 two-hour 27:19 type 27:17 typica130:11

ultimately 15:22 understand 18:13 unfortunate 25:12 uniformed 16:10 unique 28:21 United 23:7 universally 14:5 universities27:14 University 2:16 26:14 28:7 use 8:17 useful 6:13 users 15:2 usually 30:12

valuable 20:13 21:2 value 13:1,5,22

Neal R. Gross and Co., Inc. 202-234-4433 Washington DC www.nealrgross.comPage 38

14:6 various21:6 view 5:22 viewpoints 12:10 vigorous 18:21 violence 22:12 23:3 vital 15:8 VPP 7:5

W walking 20:11 want 6:17 7:22 16:14 wanted 12:9 17:12 Watkins 2:15 26:12,13 way 9:7 19:21 25:22 27:10 ways 9:9 we'117:6 10:2,11 16:16 21:15 26:7 26:10 we're 3:3 20:6 21:6 24:20 28:15 we've 6:17 weaknesses 26:1 Web 14:22 week 3:13 32:4 well-known 18:16 wellness 12:17 17:8 18:12,16,19 19:12 19:20 20:3,8 21:7 24:3,11 went 8:15 Western 2:15 26:13 win 28:1 wise 32:6 wonderfu116:20 27:5 word 22:11 wording 31:11 work6:5 12:8 17:5 18:18 19:7 20:22 21:11 22:2 23:14 23:15 27:2 31:6,8 workday 19:20 20:9 worked 20:22

21:11 worker 1:5,8 3:6 3:10,16,19 5:11 5:11 7:1 8:19 11:5 15:8 16:2,12 18:11,14 19:11 24:1 25:12,14 27:9 28:13 Worker's 2:14 15:16,18 25:1 workers 19:4,6 25:21 32:4 workforce 5:11 11:11 12:5 15:10 17:10 25:16 26:19 working 17:19 23:5 24:14 28:9 29:22 workplace 4:18 5:1 5:6,15 11:10,13 11:17 12:3,15,17 13:10 17:8 18:12 18:16,19 19:12,20 21:7 workplaces 14:12 25:20 works 23:13 world 23:6 27:12 write 9:9 written 5:18 9:8,19 16:16 32:7 WVU 2:17 28:4

X X 20:20

Y
yearn 14:14 years 13:20 22:6,9 26:18 yellow 8:10

Z

12:4 4:12 10:12 16:20

1:14 32:14 10 2:10 12 26:18 12:301:15 12:45 3:2 17 2:12 lst 1:4

2 2 2:5 3:11 4:19 10:12 21:17 30:3 2011 12:3,8 20141:10 2015 24:9 212:13 22nd 9:18 24 2:14 25 22:6 262:16 27 17:6 28 2:17 29 2:20

3 3 2:3,6 5:2 10:13 21:15 24:20 3.5 1:7 312:21

4 4 2:4,5,7 5:8 10:13 26:7,7 28:1

5 5 2:6,7 10:14 26:11 5:00 31:22

6

7 71:10

8

Neal R. Gross and Co., Inc. 202-234-4433 Washington DC www.nealrgross.com[c3:]

C E R T I F I C A T E

This is to certify that the foregoing transcript

In the matter of: Town Hall Forum - Afternoon Session

Before: CDC and NIOSH

Date: 10-07-14

Place: Bethesda, MD

was duly recorded and accurately transcribed under

my direction; further, that said transcript is a

true and accurate

- record of the proceedings.

Court Reporter

NEAL R. GROSS

COURT REPORTERS AND TRANSCRIBERS 1323 RHODE ISLAND AVE., N.W. (202)234-0433 WASHINGTON, D.C. 20005-3701 www.nealrgross.com