FINAL REPORT

Designing a Household Survey of Injuries and 

Illnesses

Contract Number: GS-10F-0033M 

Order Number: DOL-BLS-15-F-0073

DECEMBER 9, 2016 PRESENTED TO:

Elizabeth Rogers

Karen Shahpoori

US Department of Labor

Bureau of Labor Statistics

2 Massachusetts Ave, NW

Washington, DC 20212

PRESENTED BY:

NORC at the University of Chicago

55 East Monroe Street, 30th Floor

Chicago, IL 60603

Phone (312) 759-4000

AUTHORS: 

Lisa Lee

Kennon Copeland

Kristen Neishi

David Gleicher

Nola du Toit

Rene Bautista
NORC | Designing a Household Survey of Injuries and Illnesses

FINAL REPORT | I 

Table of Contents

Executive Summary

Report on Suitability of Existing Surveys and Frames (Deliverable #5)

Report on Household Design (Deliverable #9)

Report on Existing Questions and Survey Instruments on Workplace Injuries and 

Illnesses (Deliverable #6)

OMB Package (Deliverables #7, #11, and #12)

Questionnaire Development Report (Deliverable #14)

Appendices

Appendix A: Presentation of Household Survey Design Report (Deliverable #10)

Appendix B: Cognitive Interview Round 1 Memo

Appendix C: Cognitive Interview Round 2 Memo

Appendix D: Cognitive Interview Round 3 Memo

Appendix E: Presentation of Questionnaire Development Report (Deliverable #15)

Appendix F: Final HSOII Questionnaire
NORC | Designing a Household Survey of Injuries and Illnesses

FINAL REPORT

Executive Summary
NORC | Designing a Household Survey of Injuries and Illnesses

FINAL REPORT | 1 

Executive Summary

The Survey of Occupational Injuries and Illnesses (SOII) is the primary source of information for the 

Bureau of Labor Statistics (BLS) on nonfatal workplace injuries and illnesses (Wiatrowski, 2014a). In 

this surveillance system, sampled employers maintain logs on workplace injuries and illnesses that occur 

during a specified reference period that meet recordability requirements for occupational injuries and 

illnesses as defined by the Occupational Safety and Health Administration (OSHA, U.S. Occupational

Safety and Health Administration, 2014). The SOII estimates are subject to underreporting due to 

potential filtering effects on reporting of work-related injuries and illnesses (Wiatrowski, 2014b). 

Employers may wish to underreport or misclassify injuries and illnesses to keep injury and illness rates 

low. Further, the employer may not be aware of reportable events that occurred because some workers do 

not report incidents due to concern that they may risk losing their job or other opportunities such as a 

raise or promotion.

One way to reduce underreporting due to the effects of filtering is to collect information on workplace

injuries and illnesses directly from workers in a household survey. NORC assisted BLS in developing a 

survey design and questionnaire for a household survey on nonfatal occupational injuries and illnesses

(HSOII). The current report (Deliverable #16) presents the work that NORC completed in developing a 

survey design and a questionnaire for the HSOII. The reports, pretesting materials, draft questionnaire,

cognitive interview protocols, memos, and final questionnaire that NORC produced are included in 

separate sections of this report and in a series of appendices. 

Section 1 of this report includes the Report on Suitability of Existing Surveys and Frames (Deliverable 

#5). This report presents an assessment of the suitability of existing surveys and sampling frames for a 

household survey or survey module on occupational injuries and illnesses. The key factor that limits the 

existing surveys that could be used as the vehicle for an HSOII survey module is sample size due to the 

need to have sufficient sample to allow for calculation of estimates by selected industry and occupation 

groups. The most cost effective option for the HSOII would be to add a supplemental module to an 

existing survey. The report discusses the three existing surveys that could potentially provide sufficient 

sample sizes for this purpose—the American Community Survey (ACS), the Current Population Survey 

(CPS), and the Behavioral Risk Factor Surveillance System (BRFSS). Of these three, the CPS is the only 

one that, for various reasons, appears feasible; this survey also provides advantages in terms of the 

existing collection of employment, industry and occupation data that would be relevant to HSOII. A 

second, more costly, option would involve using the data from one of these three surveys to screen and 
NORC | Designing a Household Survey of Injuries and Illnesses

FINAL REPORT | 2 

select sample for a standalone follow-up survey. The National Immunization Survey (NIS) could also be 

used for this purpose. The NIS, unlike the other three existing surveys, provides the opportunity to 

include an HSOII screener directly in the survey to identify eligible sample for an HSOII follow-up 

survey. A third, even costlier, option would be to develop an HSOII sample design using an existing 

sample frame. The feasibility and cost effectiveness of this option is limited in comparison to the other 

available options; no data on employment/industry/occupation for selected housing units would be 

available, as would be the case if drawing sample from an existing survey. The report presents additional 

options for developing a sample frame for HSOII, include the use of multiple surveys, implementing a 

multi-year survey, or use of a panel survey.

The Report on Household Survey Design (Deliverable #9) in Section 2 of this report presents survey 

design options given the requirements of sample representativeness, data quality, timeliness, and cost for 

the HSOII. The research conducted for this report led to the conclusion that the option that best meets the 

multiple requirements of the HSOII is to conduct the survey through the use of supplemental questions 

following the CPS Annual Social and Economic Survey (ASEC, also referred to as the March 

supplement). Persons eligible for the HSOII could be determined immediately after completion of the

CPS and ASEC interview, based on data that had been collected during the interview. This option, 

however, would add burden for those respondents who qualify for the full HSOII interview based on 

reporting a workplace injury/illness in the HSOII screener. An alternative option that would result in 

lower burden would be to add the HSOII screening questions to the CPS in another month, such as June 

or July, when no other major supplements are typically conducted. If the option of adding questions to 

the CPS is not feasible, another alternative is to use the ACS as a sample frame for the HSOII and 

conducting a separate standalone survey. This option would entail higher costs but would add flexibility 

to the sample design and stratification by allowing selected industries and occupations to be targeted, 

which would not be possible with the CPS options. 

NORC presented the work on the HSOII survey design to BLS on June 12, 2016 (Deliverable #10). The 

slides from this presentation are included in Appendix A. 

The Instrument Design activities included a literature review on existing questions on workplace injury 

and illness, preparation of materials for a submission to the Office of Management and Budget (OMB, 

including materials for respondent recruitment, draft HSOII questionnaire and protocol), iterative testing 

of the questionnaire in three rounds of cognitive interviews, preparation of a final report, and a 

presentation to BLS. 
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Section 3 of this report presents the Report on Existing Questions and Survey Instruments on Workplace 

Injuries and Illnesses (Deliverable #6). This report includes a review of the literature on methodological 

issues related to accurate reporting of information on workplace injuries and illnesses and proxy 

reporting; the report also includes findings from a search for existing questions that measure concepts 

relevant to the HSOII. The literature review on existing questions covered methods for screening for 

potential instances of workplace injury and illness and items on characteristics of the injury/illness, details 

on the worker’s occupation and industry, and demographic questions. Finally, the report presents 

considerations in designing the HSOII. Differences between the establishment SOII and a household 

version need to be considered in the design of the HSOII, such as the use of employer vs. household 

member as respondent, and the longer reference period for recall that a household survey would entail in 

comparison to the SOII recordkeeping task. Helping respondents to the HSOII understand what type of 

incidents are eligible to be reported, prompting recall over a 12-month reference period, and proxy 

reporting are key challenges in designing the HSOII.

Section 4 of this report includes the full package of materials that NORC prepared for BLS to submit for 

Office of Management and Budget (OMB) clearance (Deliverables #7, #11, and #12). This package 

presents the methodology of the cognitive testing of the HSOII instrument, as well as sample recruitment 

materials, an eligibility screener, cognitive interview protocol with draft HSOII instrument, and a 

participant consent form. The study procedures and materials were approved by OMB and were reviewed 

and approved by the NORC Institutional Review Board (IRB) as well.

NORC conducted three rounds of cognitive testing of the draft HSOII questionnaire and delivered memos 

to BLS after each round (Deliverable #13). Cognitive testing was conducted with a total of 64 

respondents. Interviews were conducted in person during Round 1 of testing and moved to the phone 

mode during Round 2. Cognitive probing was conducted concurrently for most interviews, with 

retrospective probing for the final 13 interviews in order to accurately assess administration time. Fiftyeight of the participants were main respondents who were recruited to be interviewed about a workplace 

injury or illness. Six of the respondents were other adult household members of the main respondents; 

they were invited to serve as proxy respondents. Proxy and main respondent pairs reported on their own 

workplace injuries and illnesses (if any), and those of the other member of pair. The findings indicated 

that the main and proxy respondents were overall fairly accurate in reporting the workplace injuries and 

illnesses of other household members. Finally, the report presents administration timing by section for 

the final 13 timing interviews. Mean administration time (summed across mean timings per section) was 

25.49 minutes; median timing was 24.66 minutes. 
NORC | Designing a Household Survey of Injuries and Illnesses

FINAL REPORT | 4 

Appendices B through D include the memos from each round of pretesting and the cognitive interview 

protocols used in each round. Each memo presents detailed information on recruitment efforts, respondent 

characteristics, and cognitive interview findings from each round of testing, as well as recommended 

revisions to the questionnaire. Section 5 of this report presents the final Questionnaire Development 

Report (Deliverable #14). This report summarizes the three rounds of cognitive testing and provides a 

section-by-section discussion of the measurement objectives in each questionnaire section, highlights 

from the cognitive testing, and final decisions on revisions to the questionnaire. The final questionnaire 

begins with a Screener section that determines whether a respondent worked in the last 12 months. If a 

respondent did work, the next screener questions capture whether the respondent experienced a workplace 

injury or illness and the month/year in which the incident occurred. For each incident reported in the 

screener, the interviewer collects information on the characteristics of the injury/illness, medical attention 

that may have been received, effects of the injury/illness on work and on pay, occupation and industry at 

the time of the injury/illness, and demographic characteristics including current occupation and industry. 

A separate loop through the instrument is completed for each injury/illness captured in the screener. The 

information collected in the interview allows for determination of whether each injury/illness meets the 

criteria to be recordable. 

NORC gave a presentation to BLS on the development and testing of the HSOII questionnaire On 

October 28, 2016 (Deliverable #15). Slides from this presentation are included in Appendix E. The final 

version of the HSOII questionnaire is presented in Appendix F. This version includes final changes 

decided upon after the final round of testing. 
NORC | Designing a Household Survey of Injuries and Illnesses

FINAL REPORT

Report on Suitability of Existing Surveys and Frames 

(Deliverable #5)
Survey Design and Questionnaire for a 

Household Survey on Occupational 

Injuries and Injuries

Report on Suitability of Existing Surveys and 

Frames (Deliverable #5)

JANUARY 11, 2016 PRESENTED TO:

U.S. Bureau of Labor Statistics

2 Massachusetts Ave, NW

WASHINGTON, DC 20212

PRESENTED BY:

NORC at the University of Chicago

Kennon R. Copeland, PhD

Senior Vice President and Director

Statistics and Methodology

4350 East West Highway

Bethesda MD 20814

Phone (301) 634 9347
NORC | Survey Design and Questionnaire for a Household Survey on Occupational Injuries and Injuries

HSOII SAMPLE FRAME ASSESSMENT REPORT | I 

Table of Contents 

Executive Summary.................................................................................................................... 1

1. Introduction......................................................................................................................... 3

2. Background......................................................................................................................... 4

2.1 Design Options............................................................................................................ 4

2.2 Assessment Criteria .................................................................................................... 5

3. Review and Assessment Scope ........................................................................................ 6

4. Assumptions....................................................................................................................... 8

4.1 Eligible Population....................................................................................................... 8

4.2 Within-HU Sampling.................................................................................................... 8

4.3 Minimum Sample Size................................................................................................. 9

4.4 Potential Maximum Sample Size................................................................................. 9

4.4 Impact of I/O Sample Requirements on Possible Maximum Sample Size................11

5. Findings.............................................................................................................................13

5.1 Population Representation........................................................................................13

Sampling Frame and Survey Coverage Information .................................................13

Availability of Sample Cases .....................................................................................15

Implications ...............................................................................................................17

5.2 Survey Mode and Use of Proxy Respondents ..........................................................19

Survey Mode .............................................................................................................20

Use of Proxy Respondents........................................................................................20

Sampled Persons within HU......................................................................................20

Implications ...............................................................................................................20

5.3 Availability of Key Information ...................................................................................21

Employment Data......................................................................................................22

Injury and Illness Data...............................................................................................23

Implications ...............................................................................................................24

5.4 Timeliness of Calendar Year Estimates ....................................................................25

Implications ...............................................................................................................26

5.5 Availability of Auxiliary Data for Sample Design Efficiency .......................................27

6. Discussion.........................................................................................................................28

6.1 Screening vs. Add-on Module ...................................................................................28
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Add-on Module..........................................................................................................28

Screening ..................................................................................................................30

6.2 Survey Costs .............................................................................................................31

Data Collection..........................................................................................................32

Sample Design..........................................................................................................32

Pre-sample Selection Data Processing.....................................................................33

CAPI vs. CATI ...........................................................................................................33

Sample Size ..............................................................................................................34

Pre-weighting Data Processing.................................................................................34

Survey Weighting ......................................................................................................34

Option 4 (Multiple Surveys).......................................................................................34

Option 6 (Multi-Year Survey).....................................................................................35

Option 7 (Panel Survey)............................................................................................35

Existing Survey(s) .....................................................................................................35

Rough Cost Assessment...........................................................................................35

7. Summary ...........................................................................................................................37

Appendix A. Detail About Design Options .............................................................................39

Appendix B. Links to Home Pages for Existing Surveys......................................................46

Appendix C. Definitions for Criteria Ratings..........................................................................47
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List of Tables and Exhibits 

Table 3.1: Existing surveys under consideration ................................................................................. 6

Table 3.2: List of sampling frames used for existing surveys under consideration ............................. 7

Table 4.4.1: Population data, distributions, incidence rates for 7 industry group illustration .............. 10

Table 4.4.2: Population data, distributions, incidence rates for 6 industry group illustration .............. 11

Table 5.1.1: Profile of existing survey coverage................................................................................... 14

Table 5.1.2: Profile of existing survey sample size and response rates................................................ 16

Table 5.1.3: Summary ratings for sample frame coveage..................................................................... 17

Table 5.1.4: Summary ratings for existing survey coverage, sample size, and response rates............. 18

Table 5.2.1: Profile of existing survey data collection mode and rules................................................ 19

Table 5.2.2: Summary ratings for existing survey data collection rules............................................... 21

Table 5.3.1: Profile of existing survey employment information ......................................................... 22

Table 5.3.2: Profile of existing survey injury/illness information ........................................................ 23

Table 5.3.3: Summary ratings for existing survey employment and industry/occupation information 24

Table 5.4.1: Profile of existing survey frequency, respondent burden, and timing .............................. 25

Table 5.4.2: Summary ratings for existing survey frequency, respondent burden, and timing............. 26

Table 6.1.1: Counts of summary ratings of 5/4/3 for existing surveys, by assessment criteria group.. 29

Table 6.1.2: Timing, frequency of repeated CPS supplements............................................................. 30

Table 6.2.1: Preliminary assessment of relative costs for existing surveys and design options........... 36

Table 7.1: Summary assessment of use of existing surveys and sampling frames relative to design 

options 1-4 and single frame vs. multi-frame and/or multi-year design ........................... 37
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Executive Summary 

The Bureau of Labor Statistics is seeking to develop a household survey on nonfatal occupational injuries 

and illnesses (HSOII) to provide information on the level of underestimation of incidence rates from the 

Survey of Occupational Injuries and Illnesses and to provide information relative to the potential reasons 

for the underestimates. This report provides NORC’s assessment of the suitability of existing surveys and 

sampling frames for potential use for a household occupational injury and illness module or follow-on

survey. The key limiter in terms of what existing surveys could be used as a single sampling frame for 

the HSOII is sample size, given the need to provide sufficient sample to allow estimates by selected 

industry and occupation groups. Other factors such as respondent rules, availability of information on 

employment/industry/occupation/injuries/illnesses, and timing of data collection and release also affect 

the extent to which an existing survey is suitable for use as a sampling frame for the HSOII.

The least expensive option for implementing the HSOII would be to add a supplemental module to an 

existing survey (referred to as Option 1 in this report), as contact/response conversion efforts and 

associated costs are already covered through the existing survey. Only three existing surveys – the 

American Community Survey (ACS), the Current Population Survey (CPS), and the Behavioral Risk 

Factor Surveillance System (BRFSS) – offer sufficient sample sizes for such a design. Adding a 

supplemental HSOII module to the ACS raises substantial feasibility issues in obtaining approvals, while 

adding to the BRFSS raises substantial operational issues given the federal-state cooperative nature of the 

survey and states’ determining which modules to include. Thus, CPS appears to be the only existing 

survey that can be considered for use as a single frame approach in which a supplemental HSOII module 

is added to an existing survey. CPS offers other advantages as well, such as currently collecting 

employment/industry/occupation data and having short data collection and release periods.

A second, but more expensive option would be to utilize data from an existing survey to screen and select 

sample for a HSOII conducted as a follow-up survey to the existing survey (referred to as Option 2 in this 

report). For this option, CPS, ACS, and BRFSS again offer sufficient sample sizes for consideration; 

however, employment data for BRFSS are collected only if a state-optional module is implemented and 

thus it would be more difficult to efficiently identify HSOII-eligible individuals from BRFSS. A 

refinement to this option, which would add the National Immunization Survey (NIS) as a candidate 

survey in light of its large sample size of selected housing units, would be to add HSOII-specific screener 

questions to an existing survey and utilize the expanded existing survey data to screen and select sample 

for a HSOII conducted as a follow-up survey to the existing survey (referred to as Option 3 in this report). 
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HSOII SAMPLE FRAME ASSESSMENT REPORT | 2 

A third, but still more expensive, option would be to develop a sample design specific to HSOII utilizing 

an existing sampling frame, such as Census Master Address File, United States Postal Service Delivery 

Sequence File, or landline and telephone numbers (referred to as Option 5 in this report). This option 

would not have access to information on employment/industry/occupation for housing units and would 

thus result in a less efficient sample design than that possible under Options 2 or 3. Given the availability 

of existing surveys under Options 1-3 and the higher costs with developing a sample from a sampling 

frame rather than from an existing survey, this option does not appear to offer advantages to warrant its 

recommendation.

Refinements to the selected option, through use of multiple surveys (referred to as Option 4 in this 

report), implementation of multi-year surveys (referred to as Option 6 in this report), and use of panel 

surveys (referred to as Option 7 in this report), could be considered made to reduce costs and/or recall 

error. There appear to be only four other existing surveys sample sufficient to be considered for Option 4: 

National Health Interview Survey (NHIS); Survey of Income and Program Participation (SIPP); 

AmeriSpeak (AS); and KnowledgePanel (KP), although issues of coordinating implementation across 

multiple surveys make such an approach less desirable should other alternatives be available. Options 6 

and 7 appear to be the most promising refinements for Options 1-3, offering the ability to target smaller 

annual sample sizes and thus lower annual costs with a modification to the concept of the time period 

represented by annual estimates (Option 6) or allowing multiple contacts with sample HUs to reduce data 

collection costs and reduce recall error.
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1. Introduction 

The Survey of Occupational Injuries and Illnesses (SOII) is the primary source of information on nonfatal 

workplace injuries and illnesses. Existing research points to an underestimate of injuries and illnesses in 

the SOII attributed to a variety of factors including an employer/employee incentive to underreport these 

occurrences.

One way to avoid the filtering effect of collecting establishment data on employee injuries and illnesses is 

to collect data directly from workers in a household survey. In such a survey, workers eligible for the 

survey would be identified outside the sphere of the employer. The Bureau of Labor Statistics (BLS) has 

contracted with NORC at the University of Chicago (NORC) to provide assistance in the development of 

a survey design and questionnaire for a household survey on nonfatal occupational injuries and illnesses.

This report provides NORC’s assessment of the suitability of existing surveys and sampling frames for 

potential use for a household occupational injury and illness module or follow-on survey. The assessment 

includes such factors as frame coverage, subject matter overlap, data collection mode, timeline, and cost. 

This report is intended to provide BLS with a comprehensive review of the key aspects of the existing 

surveys and sampling frames as they relate to the target population for a household survey of occupational 

injuries and illnesses (abbreviated in this report as HSOII), along with summary comparisons of the 

alternatives. This report is not intended to provide recommendations to BLS.

The report begins with background for the problem at hand – key issues associated with the design of a 

HSOII, including likely design options and the key assessment criteria used in this report. The set of 

existing surveys and sampling frames considered within this report is then identified. Assumptions made 

while carrying out the review and assessment of existing surveys are then presented. Detailed and 

summary information for each criterion is then presented, along with a discussion of implications as they 

relate to the HSOII. A summary discusses the relationship between the design options, and use of 

existing surveys, as well as the relative costs associated with the design options and use of existing 

surveys and sampling frames.
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2. Background 

The sample design for the HSOII must result in a nationally representative household survey of workers 

that allows estimates by employment relationship (employee vs. self-employed), sector (private vs. 

government), industry, and occupation meeting publishability/quality criteria for the HSOII.

Total sample size requirements are not addressed in this document, other than a discussion of relative 

magnitudes that would likely be required. For discussion purposes in this report, the assumption will be 

made that each sampled person will provide a full year of data for the survey, although we recognize 

other designs may be considered. This aspect will be addressed later, along with development of 

recommended data collection procedures.

2.1 Design Options

Rather than developing a new survey design and sample for the HSOII, BLS would like to consider costefficient options that leverage existing surveys and/or sampling frames. Given this, several design 

options could be considered for the HSOII1

. (See Appendix A for additional detail.)

1. Add a supplemental module to an existing survey. Under this option, BLS would work with the 

survey sponsor to add a module to the existing survey questionnaire to collect any additional data 

required for the HSOII.

2. Use data from an existing survey to screen for persons eligible for the HSOII, select a subsample of 

HSOII eligible persons, and conduct a follow-on survey to collect any additional data required for the 

HSOII.

3. A variant of Option 2 would be to add appropriate supplemental questions to the existing survey 

questionnaire to aid in screening for or stratifying persons eligible for the HSOII. As in Option 2, the 

enhanced data from the existing survey would be used to screen for persons eligible for the HSOII, 

select a subsample of HSOII eligible persons, and conduct a follow-on survey to collect any 

additional data required for the HSOII.

4. Utilize multiple surveys under Options 1, 2, and/or 3.

5. Utilize an existing sampling frame to develop an optimal sample design for the HSOII.

 

1 Options 1, 2, and 7 were identified in Survey of Occupational Injuries and Illnesses: Employee Survey Cost Benefit Analysis, 

May 12, 2015.
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6. Implement any of Options 1-5 as a multi-year survey, analogous to the design utilized for the ACS, in 

which independent samples are interviewed each year and the data aggregated to create multi-year 

estimates. Such a design could support annual estimates at the national level and multi-year estimates 

for lower-level estimates, such as by industry and occupation.

7. Implement any of Options 2-6 as a panel survey, analogous to the rotation group design utilized for 

the CPS, in which sample persons are interviewed in more than one year. Under such an approach, 

persons sampled for the HSOII would be eligible for interview in multiple years. Note that this 

option cannot be used with Option 1 (Supplemental Module in Existing Survey) unless the existing 

survey utilizes a panel design.

2.2 Assessment Criteria 

As stated in the RFP, assessment of HSOII sample frame options must take the following factors into 

consideration (reordered to reflect the sequence in which they are discussed within this document):

1. Does the survey frame or survey provide an adequate (i.e. unbiased) representation of the population 

of workers that are in scope for the proposed survey?

2. Is the mode conducive to asking questions that may involve recall bias?

3. Does the respondent selected to respond to the survey also serve as a proxy respondent for others in 

the household?

4. For existing surveys, is any of the information we wish to collect on occupation, industry, 

employment relationship, and/or occupational injuries and illnesses already collected?

5. Will the frame permit producing calendar year estimates in a time frame similar to that currently used 

by SOII? 

6. Does the survey frame contain variables that would be useful (i.e. increase sampling efficiencies) for 

stratification?

7. Would the answers to questions 1-6 change if the survey is merely used to screen for potential 

respondents rather than including a full module of 15-20 questions on occupational injury and illness?

While information relevant to Factors 1-6 are presented in Section 5: Findings, Factor 7 is addressed, 

along with information on survey costs, in Section 6: Discussion.
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3. Review and Assessment Scope

NORC has identified a set of fourteen existing surveys to consider for use in the HSOII using information 

provided by BLS2 and NORC knowledge of government and non-governmental surveys. The final list 

includes the six surveys listed by BLS (CPS, NHIS, BRFSS, MEPS-HH, NHANES, and NLSY), five 

additional government surveys (ACS, NIS, SIPP, SCF, and NSFG), the General Social Survey (GSS), and 

two probability-based online panels (POPs) offered by NORC (AmeriSpeak, abbreviated here as AS) and 

GfK (KnowledgePanel, abbreviated here as KP). Table 3.1 lists the existing surveys, along with the 

organization conducting the survey, and the sampling frame used for the survey3

. 

Table 3.1: Existing surveys under consideration

In addition, as requested by BLS during an early project status meeting, NORC has identified the set of 

sampling frames used for the existing surveys. Table 3.2 lists the six sampling frames, noting the existing 

surveys using the sampling frame.

 

2 SOII Research on Data Collection from Employees Literature Review, January 15, 2015

3 Links to home pages for each of the existing surveys listed in Table 3.1 are provided in Appendix B.

Survey Organization Sampling Frame

American Community Survey (ACS) Census Census Master Address File (MAF)

Current Population Survey (CPS) BLS, Census Census Master Address File (MAF)

National Health Interview Survey (NHIS) NCHS, Census Census data for selecting segments;

Listing of housing units (HUs) within sampled segments

Behavioral Risk Factor Surveillance System (BRFSS) CDC, States RDD landline and cell phones

Medical Expenditure Panel Survey - Household Component 

(MEPS-HC) AHRQ NHIS Respondents

National Health and Nutrition Examination Survey (NHANES) NCHS Census data for selecting segments;

Listing of dwelling units (HUs) within sampled segments

National Longitudinal Survey of Youth (NLSY) BLS Census data for selecting segments;

Listing of housing units (HUs) within sampled segments

National Immunization Survey (NIS) CDC, NORC RDD landline and cell phones

Survey of Income and Program Participation (SIPP) Census Census Master Address File (MAF)

Survey of Consumer Finance (SCF) FRB, NORC US Postal Service Delivery Sequence File (USPS DSF);

IRS tax return administrative listing

National Survey of Family Growth (NSFG) NCHS, ISR US Postal Service Delivery Sequence File (USPS DSF)

General Social Survey (GSS) NORC US Postal Service Delivery Sequence File (USPS DSF)

AmeriSpeak (AS) NORC US Postal Service Delivery Sequence File (USPS DSF)

KnowledgePanel (KP) GfK US Postal Service Delivery Sequence File (USPS DSF)
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Table 3.2: List of sampling frames used for existing surveys under consideration

IRS tax return administrative data listing, which is utilized along with USPS DSF for SCF, is excluded for 

consideration as a sampling frame. NHIS, which serves as the sampling frame for MEPS-HC, is captured

in consideration of the existing surveys. Thus the first four sampling frames listed are considered here.

Sampling Frame Surveys

Census Master Address File (MAF) ACS, CPS, SIPP

Census Data plus Listing within Sampled Segments NHIS, NHANES, NLSY

US Postal Service Delivery Sequence File (USPS DSF) GSS, SCF, AS, KP

RDD Frame of both Landline and Cellular Numbers BRFSS, NIS

IRS tax return administrative listing SCF

NHIS MEPS-HC
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4. Assumptions 

We present here assumptions that were made for purposes of discussion in this document, along with 

discussion around derivation of these assumptions.

4.1 Eligible Population

For purposes of this report, it is assumed the target population for the HSOII is workers aged 16+ years, 

with a worker being anyone who worked in at least one of the prior 52 weeks. Sample counts for existing 

surveys represent the total number of persons for which a completed interview was obtained, regardless of 

employment status. Thus, these counts must be scaled to the HSOII target population of workers. It is 

assumed that 65.1% of the population aged 18+ is eligible for the HSOII, which was determined in the 

following manner. 

Data from the 2014 ACS show that 75.1% of the U.S. population aged 16-64 worked at least one of the 

prior 52 weeks. This is as compared to November 2015 CPS data reporting 69.0% of the U.S. population 

aged 16-64 was employed the week containing November 12, 2015. While the difference between the 

two estimates is a function of the differing collection periods (calendar year 2014 vs Nov 2015), a more 

important factor is the reference period (employed in the 12 months vs. employed in the week containing 

Nov 12, 2015). The Nov 2015 CPS ratio of Civilian Labor Force (CLF) to Population (72.5%) for 

persons aged 16-64 is closer (difference of -2.6 percentage points) to the ACS result. As the Nov 2015 

CPS ratio of CLF to Population for persons aged 16+ is 62.5%, adding the 2.6 percentage point difference 

yields the assumed worker eligibility rate of 65.1% for persons aged 16+. For existing surveys in which 

the sample population is other than persons aged 16+, similar calculations were used to determine the 

eligibility rate for the covered population.

4.2 Within-HU Sampling

As little or no correlation among persons within a HU would be expected for the HSOII, it would be most 

cost-efficient to sample all eligible persons within a HU. The assumption is made that all eligible persons 

within a HU would be selected. With the exception of designs that are limited by the information 

available for sampled persons within a sampled HU (such as Option 1 (Supplemental Module in Existing 

Survey) and possibly Option 2 (Follow-on to Existing Survey, no Change to Existing Survey) for some 

existing surveys), we assume all persons within a HU eligible for HSOII will be included in the sample.
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4.3 Minimum Sample Size

As discussed in the background material provided by BLS4, an effective sample size of 5,100 personyears should be targeted to achieve 80% power for detecting a 20% difference from the employer-based 

SOII (abbreviated here as ESOII) at the national level based on current overall prevalence levels. In 

addition to quantifying the under-reporting of injuries and illnesses in the ESOII, BLS is also interested in 

better understanding where under-reporting occurs. This will require a larger total sample size, with 

determination of specific population subgroups for which larger sample sizes are to be targeted than that 

expected from an overall effective sample size of 5,100 person-years. 

Assuming a required effective sample size of 5,100 to provide adequately powered estimates at the 

national level for the overall incidence rate and recognizing possible design effects5

, the minimum 

number of completed interviews with workers is 6,630 for a CATI survey and 7,295 for a CAPI survey6

. 

We might assume a maximum 75% yield rate of completed interviews from persons sampled from 

existing surveys, which takes into account person level response rates along with possible eligibility rates 

(which must be considered as either the information available from the existing survey does not provide 

the ability to identify all and only eligible workers, or the sampled persons’ eligibility status may have 

changed). This results in minimum numbers of sampled persons of 8,840 for a CATI survey and 9,277 

for a CAPI survey.

Thus, the minimum number of sampled persons is 1.73 (CATI) to 1.91 (CAPI) times the effective sample 

size. As these are likely minimums, for ease of conversion, we assume a ratio of 2.0. These values will 

be further examined and determined during the course of the project as survey design recommendations 

are developed.

4.4 Potential Maximum Sample Size

While not an objective of this project, there are several approaches which could be taken to identifying 

specific subgroups for oversampling and determining the target sample sizes for the subgroups. One 

approach, which would result in the largest overall effective sample size need, would be to target 

 

4 Survey of Occupational Injuries and Illnesses: Employee Survey Cost Benefit Analysis, May 12, 2015.

5 Within the Pilot Study Design for the SOII Employee Study report (September 1, 2015), possible design effects were listed as 

1.3 (due to weighting) for a telephone (CATI) survey and 1.43 (the product of 1.2 due to weighting and 1.192 due to clustering) 

for a face-to-face (CAPI) survey.

6 Estimated minimum number of completed interviews calculated as the minimum effective sample size (5,100) as reported in the 

Survey of Occupational Injuries and Illnesses: Employee Survey Cost Benefit Analysis (May 12, 2015) and the possible design 

effects (1.3 for a CATI survey and 1.43 for a CAPI survey), as reported in the Pilot Study Design for the SOII Employee Study 

report (September 1, 2015).
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achievement of 80% power for either detecting a 20% difference from the employer-based SOII 

(abbreviated here as ESOII) or a difference of 0.7 percentage points from the ESOII, based on current 

prevalence levels at the industry sector and occupational group level. A very rough sample size estimate 

can be made assuming effective sample size needs of 5,100 for each subgroup7

, which would yield a total 

effective sample size need of 102,000 to support the 20 industry sector levels and of 117,300 to support 

the 23 major occupational groups, implying a total effective sample size need well above 100,000 to 

support both industry and occupation (this sample size would also support employment relationship and 

sector), with total number of completed interviews above 130,000-145,000 and a total number of sampled 

persons in excess of 200,000.

An alternative to the most expansive approach would be to collapse industry and occupation to derive a 

smaller set of subgroups, say 5-10 each. This would yield total effective sample size needs on the order 

of 25,000-50,000 (this sample size would also support employment relationship and sector), and a total 

number of sampled persons on the order of 50,000-100,000.

As an illustration, provided in Table 4.4.1, one could consider defining the seven collapsed industry 

groups, based upon relative population size and 2014 incidence rates. This grouping would ensure each 

industry group has at least 10% of workers, and would yield five groupings with 2014 incidence rates 

about the overall incidence rate. Total effective sample size required would be on the order of 36,000, 

and a total number of sampled persons on the order of 72,000.

Table 4.4.1:Population data, distributions, incidence rates for 7 industry group illustration

 

7 Actual sample size needs would be derived to power detecting differences for the subgroup based upon the current prevalence 

level for the subgroup.

Industry Group Count Proportion Group 2 digit Min 2 digit Max

Agriculture & Goods-producing1 21,960 15.4% 3.8 3.6 5.5

Trade & Transportation2 26,507 18.6% >3.6 2.9 4.8

Professional & Business Services 19,973 14.0% 1.5 0.9 2.6

Health Care and Social Assistance 18,811 13.2% 4.5 N/A N/A

Leisure & Hospitality 15,330 10.8% 3.6 3.5 4.2

Other Service-producing3 20,598 14.5% <2.6 0.7 2.6

State & Local Government 19,240 13.5% 5.0 4.1 5.4

Total Non-farm 142,418 100.0% 3.4

1

Agriculture & Related Industries (employment from CPS), Mining/Logging, Construction, Manufacturing, 

2

Wholesale Trade, Retail Trade, Transportation

3

Utilities, Information, FIRE, Education, Other Services

Nov 2015 Employment 2014 Incidence Rate
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A third alternative would be to identify selected industry and occupations which might most likely be 

associated with under-reporting that is of practical significance as well as statistical significance, and are 

of sufficient size to allow for adequate sample. One could focus on those industries and occupations with 

high rates of injuries and illnesses, under the assumption that the magnitude of under-reporting of 

industries and occupations with low rates would be relatively small. For example, the 2014 incidence rate 

for Finance and Insurance was 0.7. Assuming a 20% under-reporting of injuries and illnesses for this 

industry, the actual rate would be 0.9, which could be considered not of practical significance. 

Conversely, the 2014 incidence rate for Health Care and Social Assistance was 4.5; a 20% underreporting of injuries and illnesses would mean an actual rate of 5.6, a much more dramatic difference in 

level. Again, this sample size would also support employment relationship and sector.

As an illustration, provided in Table 4.4.2, one could identify the five industry groups with an incidence 

rate above the overall average of 3.4 and which contain at least 10% of total workers, based upon relative 

population size and 2014 incidence rates. A sixth grouping would consist of the remaining Serviceproviding industries. Total effective sample size required would be on the order of 31,000, and a total 

number of sampled persons on the order of 62,000.

Table 4.4.2: Population data, distributions, incidence rates for 6 industry group illustration

4.4 Impact of I/O Sample Requirements on Possible Maximum Sample Size

When considering the adequacy of the sample sizes for the surveys under consideration (this factor does 

not affect assessment of the sampling frames), it must be remembered that the sample distribution for the 

existing surveys is predetermined based upon the sample design of the survey and cannot be adjusted to 

fit the needs of the HSOII. In other words, given the sample designs for the surveys are focused on 

providing general population estimates (whether for the full population of persons aged 18+ years, or for 

Industry Count Proportion Group 2 digit Min 2 digit Max

Agriculture & Goods-producing1 21,960 15.4% 3.8 3.6 5.5

Retail Trade & Transportation2 20,570 14.4% N/A 3.6 4.8

Health Care and Social Assistance 18,811 13.2% 4.5 N/A N/A

Leisure & Hospitality 15,330 10.8% 3.6 3.5 4.2

Other Service-producing3 46,608 32.7% N/A 0.7 2.9

State & Local Government 19,240 13.5% 5.0 4.1 5.4

Total Non-farm 142,518 100.0% 3.4

1

Agriculture & Related Industries (employment from CPS), Mining/Logging, Construction, Manufacturing, 

2

Retail Trade, Transportation

3

Wholesale Trade, Utilities, Information, FIRE, Professional & Business Services, Education, Other Services

Nov 2015 Employment 2014 Incidence Rate
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some selected age subgroups), the sample distribution relative to industry and occupation can be 

reasonably expected to be similar to the distribution of the total population. There will be some 

deviations based upon oversampling of selected populations, if utilized by the survey, but the 

oversampled populations tend to be minorities and the elderly, which should not dramatically affect the 

industry and occupation distributions. Thus, in assessing the adequacy of the survey to provide sufficient 

sample for selected or collapsed industries and occupations, one cannot compare the total sample size 

need for the HSOII with the total sample size of the survey.

To achieve the roughly 62,000 sampled persons from the immediately prior illustration, we make an 

assumption for discussion purposes within this document that an effective sample size of 5,100 is needed 

for each grouping, and a total number of sampled persons from each grouping on the order of 10,200. If 

sampling from an existing survey of the full population, the existing survey would need to have sufficient 

numbers of workers to fill sample size requirements for all industry groups. Given the proportion of 

workers within each industry group (with a minimum value of 10.9%), the existing survey would need to 

have ~100,000+ workers for an expectation of meeting the sample size requirements for the six industry 

groups. 
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5. Findings 

In this section we address each of the assessment criteria, presenting detailed information on sample 

design and data collection for each existing survey and sampling frame from documentation available 

online, and discussing the implications of that information as it relates to an HSOII.

To aid in summarizing the information on the existing surveys, topline “ratings,” ranging from 0 (zero, 

lowest rating) to +++++ (five, highest rating) were developed for the assessment criteria and are presented 

here. These topline “ratings” are intended to provide a quick view of the relative value of each survey for 

the criteria. Appendix C provides the definitions used in the ratings for all the criteria.

5.1 Population Representation

Population representation can be viewed not only in terms of potential for bias (i.e., extent and nature of 

undercoverage of the population of interest), as referenced in the RFP, but also in terms of adequacy of 

sample size for generating reliable estimates (i.e., of sufficiently small variance) for subpopulations of 

interest.

Sampling Frame and Survey Coverage Information

Undercoverage for a sampling frame refers to the extent of the population of interest which is missing 

from the frame. When considering use of an existing survey as the frame for the HSOII, there can also be 

undercoverage due to population exclusions made as part of the survey data collection process.

Table 5.1.1 provides information on coverage for the surveys under consideration – the sampling frame 

used by each survey, known coverage gaps in the frame, population exclusions that are made during data 

collection, and an estimate of the resultant coverage of the target population of workers (based upon the 

frame exclusions and population exclusions).
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Table 5.1.1:Profile of existing survey coverage

Frames utilizing the Census Master Address File (MAF), Census data plus listing of selected segments, 

and the US Postal Service Delivery Sequence File (USPS DSF) offer essentially complete coverage of the 

population of interest, assuming listing is carried out in areas where the DSF addresses do not provide 

sufficient information to locate the address (~2% of all HUs). Surveys utilizing these sampling frames 

that have no exclusions from the population of interest, as is the case for ACS, CPS, NHIS, NHANES, 

SIPP, and SCF (military and institutionalized population are not in scope for the HSOII), would thus 

provide unbiased representation of the population of interest for the HSOII.

RDD landline and cell phone sampling frames lack coverage for the roughly 2.9% of adults living in 

households with no telephone8

. Persons living in households with no telephone tend to be younger, 

minority, renters, lower income, and lower education9

. 

 

8 Blumberg SJ, Luke JV. Wireless substitution: Early release of estimates from the National Health Interview Survey, July–

December 2014. National Center for Health Statistics. June 2015. Available from: http://www.cdc.gov/nchs/nhis.htm.

9 Khare, M. and Chowdhury, S. An Evaluation of Methods to Compensate for Noncoverage of Nontelephone 

Households using Information on Interruptions in Telephone Service and Presence of Wireless Phones. Proceedings 

of the Section on Survey Research Methods, Joint Statistical Meetings, American Statistical Association. 2006. 

3221-3228.

ACS Census Master Address File (MAF) None None 100%

CPS Census Master Address File (MAF) None Military, Institutionalized Population 100%

NHIS Census Data for selecting segments;

HU Listing for sampled segments None Military, Institutionalized Population 100%

BRFSS

RDD frame of both landline and cellular 

numbers

HU's without 

phones Institutionalized Population ~97%

MEPS-HC NHIS Respondents None Military, Institutionalized Population 100%

NHANES Census Data for selecting segments;

HU Listing for sampled segments None Military, Institutionalized Population 100%

NLSY Census Data for selecting segments;

HU Listing for sampled segments None

Only includes

NLSY-97: US residents born 1980-1984

NLSY-79: US residents born 1957-1964

~27%

NIS

RDD frame of both landline and cellular 

numbers

HU's without 

phones

Only includes

HU's with children aged 6 mo - 17 years ~40%

SIPP Census Master Address File (MAF) None None 100%

SCF USPS DSF None None 100%

NSFG USPS DSF None Only includes persons aged 15-44 years ~50%

GSS USPS DSF None Non-English/Spanish 98%+

AS USPS DSF None Non-English/Spanish 98%+

KP USPS DSF None Non-English/Spanish 98%+

NOTES

Coverage is relative to the U.S. population of all workers, including those who work as independent contractors

Sampling Frame Survey Exclusions Frame Coverage 

Gaps

Estimated Coverage of 

Workers in Eligible 

Sample

Survey

Coverage
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As mentioned above, survey exclusions may also contribute to undercoverage of the target population of 

workers. GSS, AS, and KP include only English and Spanish speakers. Census data on languages spoken 

and degree of English language proficiency from the ACS suggest such an exclusion would affect less 

than 2% of the population10. Eligibility for NSFG is limited to persons aged 15-44 years, and thus

represent approximately 50% of the full HSOII target population of workers aged 18+. While the sample 

frame used for the NIS is nearly complete, the target population is households with children, resulting in a 

net coverage of the eligible sample on the order of 35% of the full HSOII target population of workers 

(2014 ACS data show 31.3% of households contain a related child; however, such households will have 

younger adults who are more likely to be workers than the full 18+ population; thus it was assumed to 

bump up the coverage of eligible workers). Finally, the target population for the NLSY is an eight year 

birth cohort (NLSY-79) and a five year birth cohort (NLSY-97), which combined represent roughly 27% 

of the full HSOII target population of workers aged 18+11. 

Availability of Sample Cases

Here we look at the extent to which the existing surveys offer sample sufficient to meet the needs for the 

HSOII (expected to be 100,000+ as discussed in Section 4) and at the frequency necessary to allow for 

annual estimates for the HSOII.

Table 5.1.2 provides the periodicity of the existing surveys under consideration along with information on 

annual sample sizes – approximate HU sample sizes (number selected for the survey, number screened, 

and number at which a completed interview was obtained) and an estimate of the number of completed 

interviews with workers, based upon number of completed interviews and the assumptions detailed in 

Section 4. 

 

10 Ryan, C. Language Use in the United States: 2011. U.S. Census Bureau. August 2013. Available from 

https://www.census.gov/prod/2013pubs/acs-22.pdf. 

11 2014 ACS data show that adults aged 30-34 and 50-57 years (the 2014 age range for the two NLSY cohorts) make up ~23.5% 

of adults aged 18+ years; however, their higher employment rates relative to older age groups increases their proportion of the 

population of workers aged 16-64 years to 27%.
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Table 5.1.2: Profile of existing survey sample size and response rates

The surveys which appear to have sufficient numbers of completed interviews with workers (100,000+, as 

discussed in Section 4) to be considered as a stand-alone sample frame for the HSOII are ACS, CPS, and 

BRFSS. The large number of HU’s selected and screened for NIS make it a candidate for use under 

Option 3 (Follow-on to Existing Survey, Additional Screening Questions in Existing Survey). 

While NHIS and MEPS-HC both have more than 15,000 annual completed interviews with workers and 

thus could support the sample needed for the HSOII at the national level, they could not support achieving 

target sample sizes for selected or collapsed industry and occupation. They could, however, be used in a 

multiple survey design (Option 4), although not together as MEPS-HC is a subset of NHIS. 

SIPP has from ~58,000 to ~28,000 completed interviews with workers, depending upon Wave. However, 

the SIPP sample is selected every 2.5 to 4 years, suggesting SIPP should be considered only as part of a 

multiple survey (Option 4) and/or panel design (Option 7).

Selected Screened

HU's HU's HU's Workers

ACS Monthly 3.5MM 3.5MM 2.3MM ~3.2MM 96.7%

CPS Monthly, 4-8-4 Rotation 225,000 180,000 165,000 ~230,000 ~90% Half of annual sample is 

new in current year

NHIS Quarterly 68,000 57,000 44,500 ~30,000 58.9%

BRFSS Annual 6.4MM 850,000 460,000 ~300,000 ~50% RoR varies from 34% to 64% 

across states

MEPS-HC Annual 17,000 17,000 14,000 ~19,000 52.8% Half of annual sample is 

new current year

NHANES Biennial 46,000 Not Found 10,000 ~4,000 71.0%

Same sample cases across 

consecutive odd/even 

years

NLSY* Biennial 150,000 135,000 Not Applicable ~11,000 78.7% (79)

83.9% (97)

Same sample cases across 

time

NIS Quarterly 9.5MM

(phone #'s) 1.1MM 50,000 0 62.6% (Landline)33.5% (Cell) State-level design

SIPP Sample selected every 

2.5 to 4 years 65,500 52,000 42,000 (Wave 1)20,000 (Wave 16)

~58,000 (Wave 1)

~28,000 (Wave 16)

80.6% (Wave 1)

61.8% (Wave 16)

2014 panel to be 

interviewed once annually

2014-2017

SCF Triennial 14,000 13,500 6,000 ~4,000

51.7%:

68.7% (ABS)

34.7% (list)

Dual-frame design (ABS 

(4,500) + list sample (1,500) 

of high income HU's)

NSFG Varies 12,000 11,500 10,400 ~6,700 72.8%

Most recent round collected 

data from 2011 to 2013

GSS Biennial 5,200 4,300 2,500 ~1,700 71.2%

AS As Needed 59,000 15,000 7,500 Panel HUs ~10,000 Panel 

Members 36.6%

Panel members replaced for 

attrition;

Panel size to triple in 2016

KP As Needed Not Found Not Found 30,000 Panel HUs ~41,000 Panel 

Members <10% Panel members replaced for attrition

* NLSY79 Response rates represent retention rates of 1991 sample respondents;

 NLSY97 Response rates represent retention rates of original respondents

Survey Completed Comments Sample Selection 

Frequency

Sample Size (approximate)

Response Rate
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The POPs (AS, KP), while offering 30,000+ workers on their panels (with the AS expansion planned for 

2016), are fairly constant panels, and thus offer little additional sample across time. As such, they should 

be considered for use only in a multiple survey (Option 4) and/or panel design (Option 7). 

The remaining existing surveys (NHANES, NLSY, SCF, NSFG) offer very small sample sizes. In 

addition samples are not selected every year, which further adversely affects their viability for use in the 

HSOII, although they could be considered as part of a multiple frame and/or panel design.

Further information on survey and frame suitability for Options 1-4 and single frame vs. multiframe/multi-year designs is provided in Section 7.

Implications

Table 5.1.3 provides the summary “rating” indicators of value relative to Population Representation 

(limited to frame coverage) for the four sampling frames under consideration.

Table 5.1.3: Summary ratings for sample frame coveage

Three sampling frames offer complete coverage for the HSOII population of interest – Census MAF, 

Census data plus listing within sampled segments, and USPS DSF with listing in areas where the DSF 

addresses do not provide sufficient information to locate the address (~2% of all HUs). Each could thus be 

used as the sampling frame for HSOII. There is often reluctance on the part of federal agencies to utilize 

the Census MAF, as confidentiality of the addresses is protected and cannot be provided by Census under 

Title 13. Another issue for consideration is whether Census data review board (DRB) would allow 

release of a public use microdata sample (PUMS) file that would meet all BLS needs. RDD frames of 

landline and cellular phones offer an alternative choice with nearly complete coverage (~97%), although 

persons in non-telephone households do have different demographic and socio-economic characteristics 

than the full population, and thus appropriate ratio adjustment methods would be required to minimize 

any potential coverage bias.

Table 5.1.4 provides the summary “rating” indicators of value relative to Population Representation for 

the existing surveys under consideration.

Census MAF +++++

Census Data +++++

USPS DSF +++++

RDD Telephone ++++

Frame 

Coverage

Sampling 

Frame
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Table 5.1.4: Summary ratings for existing survey coverage, sample size, and response rates

All surveys with the exception of NLSY, NIS, and NSFG were rated 4 or 5 for Coverage. NLSY and 

NSFG eligible populations are subsets of the full 18+ population, while NIS eligible population is 

children <18. Six surveys (ACS, CPS, NHIS, BRFSS, MEPS-HC, NIS) were rated 4 or 5 for Sample 

Selection Frequency, being selected annually or more frequently. Three surveys (ACS, CPS, BRFSS) 

were rated 4 or 5 for Sample Size, with SIPP being the only other survey rated 3 or higher for Sample 

Size. Finally, ACS, CPS, and NLSY were rated 4 or 5 for Response Rate, with four others (NHANES, 

SIPP, NSFG, GSS) being rated 3.

ACS is rated 5 for all criteria, while CPS is rated 4 or 5 for all criteria, suggesting both could be 

candidates to serve as a single sampling frame for the HSOII. BRFSS is rated 4 or 5 for all criteria with 

the exception of Response Rate (rating of 2 for response rate ~50%, ranging from 34%-64% across 

states), suggesting it could likewise serve as a single sampling frame for the HSOII depending upon the 

potential magnitude of nonresponse bias not controlled through weighting. Finally, although the NIS 

interviewed sample does not include any workers (NIS target population is children), the selected sample 

size is of sufficient size to consider for use should additional screening questions be added to the for use 

in the HSOII design.

Two of the remaining surveys (NHIS, MEPS-HC) could be considered under Option 4 (Multiple 

Surveys); however, these two surveys could not be used together, given MEPS-HC is selected from 

Screened

HU's HU's Workers

ACS +++++ +++++ +++++ +++++ +++++ +++++ +++++

CPS +++++ +++++ +++++ ++++ ++++ ++++ +++++

NHIS +++++ +++++ +++++ +++ +++ ++ ++

BRFSS ++++ ++++ ++++ +++++ +++++ ++++ ++

MEPS-HC +++++ +++++ ++++ ++ ++ ++ ++

NHANES +++++ +++++ ++ + ++ 0 +++

NLSY +++++ + ++ 0 0 + ++++

NIS ++++ 0 +++++ +++++ +++ 0 ++

SIPP +++++ +++++ ++ +++ +++ +++ +++

SCF +++++ +++++ ++ + 0 0 ++

NSFG +++++ ++ ++ + ++ + +++

GSS +++++ +++++ ++ 0 0 0 +++

AS +++++ ++++ + 0 ++ ++ +

KP +++++ ++++ + 0 ++ ++ 0

Response 

Rate

Sample 

Selection 

Frequency

Sample Size

Completed Survey

Coverage

Frame 

Coverage

Estimated 

Coverage of 

Workers in 

Eligible Sample
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NHIS. Although the remaining surveys could also be considered under Option 4 (Multiple Surveys), their 

profiles relative to Sample Selection Frequency and Sample Size would likely make their use cost 

ineffective. 

5.2 Survey Mode and Use of Proxy Respondents

Given Mode and Respondent Rules are components of the Data Collection process, both are discussed in 

this section. In addition, given the impact of within-HU person sampling, that factor is also discussed in 

this section. Table 5.2.1 provides information on data collection mode, within-HU person sampling, and 

respondent rules for the existing surveys.

Table 5.2.1:Profile of existing survey data collection mode and rules

Mode Sampled Persons Respondent Rules

ACS

Three stage:

1) Mail/Internet (50%)

2) CATI (7%)

3) CAPI (44%)

All persons Adult HH respondent

CPS

PV (MIS 1, 5)

Phone (MIS 2-4, 6-8 if HH 

agrees; ~85% telphone)

All persons 16+

Self-report, if possible;

Knowledgeable Adult as 

proxy (~50%)

NHIS CAPI

One adult 18+

One child <18

Self-report (adult)

Knowledgeable adult (child)

BRFSS CATI One adult 18+ Self-report

MEPS-HC CAPI All persons Most knowledgeable adult

NHANES CAPI One, some, all, or none of persons in 

the HU Self-report

NLSY CATI (90%)/CAPI (10%) All persons in HH within age cohort Self-report

NIS CATI

All children 19-35 mo (NIS)

One child 13-17 years (NIS-Teen)

One child 6-18 mo/3-12 years (NIS-Flu)

Knoweldgeable Adult

SIPP CAPI (Waves 1,2,6)

CATI (Waves 3,4,5,7-16) All persons 15+ Self-report

SCF CAPI

Economically dominant single 

individual or financially most 

knowledgeable member

Self-report

NSFG CAPI One eligible person aged 15-44 years Self-report

GSS CAPI One adult 18+ Self-report

AS Internet/CATI All persons 18+ Self-report

KP Internet All persons 18+ Self-report

Data Collection

Survey
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Survey Mode

Survey mode is of interest under Option 1 (Supplemental Module in Existing Survey). For options 

utilizing a follow-up survey, the mode utilized for HSOII would not have to be the same as that used in 

the existing survey. 

Most surveys utilize an interviewer/respondent interaction in conducting the survey (CAPI and/or CATI). 

The exceptions are the POPs (AS, KP, which use Web self-reporting) and ACS, in which 50% of 

completes are self-reported via mail/internet.

Thus, the distinguishing factor among the surveys is whether interviews are conducted in person or over 

the phone, in either case using computer-assisted interviewing (CAI) technology. The relative 

advantages/disadvantages of mode relative to minimizing potential recall bias will be addressed in a 

separate report addressing questionnaire and data collection process.

Use of Proxy Respondents

Respondent rules and the use of proxy respondents are of interest under Option 1 (Supplemental Module 

in Existing Survey). For options utilizing a follow-up survey, respondent rules utilized for HSOII would 

not have to be the same as those used in the existing survey. All surveys with the exception of ACS and 

MEPS-HC instruct interviewers to obtain self-reports for sampled persons aged 18+ years. For CPS, 

although the interviewer seeks to obtain self-reports, proxy respondents are utilized for roughly half the 

completed interviews.

Sampled Persons within HU

A consideration for all options, but especially for Option 1 (Supplemental Module in Existing Survey), is 

whether all persons are sampled within a HU. As little to no correlation between persons within a HU 

would be expected for the HSOII, it would be most cost-efficient to sample all eligible persons within a 

HU. ACS, CPS, MEPS-HC, NLSY, and the POPs sample all persons within the HU. NHANES may 

select all persons, but they may also select one, some, or no persons within the HU.

Implications

Table 5.2.2 provides the mode(s) used and summary “rating” indicators of value relative to Data 

Collection Rules.
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Table 5.2.2: Summary ratings for existing survey data collection rules

Collection mode and respondent rules are of interest under Option 1 (Supplemental Module in Existing 

Survey), adding a supplemental module to an existing survey. With the exception of ACS (which utilized 

Mail, Web, CATI, and CAPI collection), all surveys use CAI, either CATI (BRFSS, NIS), CAPI (NHIS, 

MEPS-HC, NHANES, SCF, NSFG, GSS), Web (KP), a combination of CATI and CAPI (CPS, NLSY), 

or a combination of Web and CATI (AS). Advantages/ disadvantages of CATI vs. CAPI relative to recall 

bias will be discussed in a separate report addressing questionnaire and data collection process.

NLSY, SIPP, AS, and KP were each rated 5 for both Sampled Persons and Respondent Rules. ACS, 

CPS, and MEPS-HC sample all adults within a HU; however, ACS and MEPS-HC obtain data from one 

HH respondent, while roughly 50% of CPS person level completes are obtained from a proxy respondent. 

While NHIS, BRFSS, NHANES, SCF, NSFG, and GSS seek self-reports, they do not sample all adults 

within a HU.

5.3 Availability of Key Information

The two primary types of information of interest for the HSOII data collection are employment data and 

injury/illness data. The greater the concordance between data collected in the existing survey and data 

needed for the HSOII, the greater the value of the existing survey.

Sampled 

Persons

Respondent 

Rules

ACS Mail/Web/CATI/CAPI +++++ ++

CPS CAPI/CATI +++++ +++

NHIS CAPI +++ +++++

BRFSS CATI +++ +++++

MEPS-HC CAPI +++++ ++

NHANES CAPI +++ +++++

NLSY CAPI/CATI +++++ +++++

NIS CATI N/A N/A

SIPP CAPI/CATI +++++ +++++

SCF CAPI +++ +++++

NSFG CAPI +++ +++++

GSS CAPI +++ +++++

AS Web/CATI +++++ +++++

KP Web +++++ +++++

Survey

Data Collection

Mode
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Employment Data

Table 5.3.1 describes availability of industry, occupation, employment relationship, and sector 

information from the current data collection for the surveys.

Table 5.3.1:Profile of existing survey employment information

Industry and occupation (I/O) information and employment relationship, is obtained in all surveys with 

the exception of NIS (as the survey target population is children) and BRFSS (for which employment data 

are collected in only if a state-optional module is implemented). In some surveys, I/O information is 

obtained only if currently employed (CPS, NHANES), while in other surveys I/O information is obtained 

on most recent job if not currently employed (ACS) or the job the individual worked at for the longest 

time period (NHIS). 

Two other relevant pieces of information for the HSOII are whether the sample person has been employed 

at some time in the prior 12 months (obtained in ACS, NHIS, MEPS-HC, and NLSY), and whether the 

sample person is a multiple jobholder (obtained in CPS and NLSY). For multiple jobholders, CPS 

obtains I/O information for a second job, whereas other surveys collect I/O information for only one job. 

Employment Status Multiple 

Jobholder Occupation Industry Employment Relationship Sector

ACS Prior 12 months Yes Chief job activity/ business Chief job activity/ business Chief job activity/ business Chief job activity/ business

CPS Week containing 12th 

of month Yes Up to two jobs Up to two jobs Yes Yes

NHIS Prior 12 months Yes

Main current job activity/ 

business, else for job 

worked longest

Main current job activity/ 

business, else for job 

worked longest

Main current job activity/ 

business, else for job 

worked longest

Main current job activity/ 

business, else for job 

worked longest

BRFSS Current/Prior 12 

months No

Obtained in optional 

module (Industry/ 

Occupation)

Obtained in optional 

module (Industry/ 

Occupation)

Obtained in optional 

module (Industry/ 

Occupation)

No

MEPS-HC Prior 12 months Yes

Main current job activity/ 

business, else for most 

recent job

Main current job activity/ 

business, else for most 

recent job

Yes Yes

NHANES Current No Main job or business Main job or business Yes Yes

NLSY Prior 12 months Yes All jobs worked Obtained for all jobs 

worked Yes Yes

NIS No No No No No No

SIPP Prior 3 months Yes Up to two jobs

Type (Mfg, Whole Trade, 

Retail Trade, Service, Oth) 

for up to two jobs

Yes Yes

SCF

Current (R);

Current 

(R spouse/partner)

Yes Up to two jobs Up to two jobs Yes Yes

NSFG

Prior 12 months (R);

Prior week (R 

spouse/partner)

Yes No No No No

GSS Current No One current job No Yes Yes

AS If asked as part of a 

given survey

If asked as part 

of a given survey

If asked as part of a given 

survey

If asked as part of a given 

survey Yes If asked as part of a given survey

KP If asked as part of a 

given survey

If asked as part 

of a given survey

If asked as part of a given 

survey

If asked as part of a given 

survey

If asked as part of a given 

survey

If asked as part of a given 

survey

Available Information

Survey
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In collecting I/O information when persons have multiple jobs, some ask the person to report for the 

“chief” job activity/business (ACS), and others collect I/O information for the “main” job 

activity/business (NHIS, MEPS-HC). 

Injury and Illness Data

Table 5.3.2 describes availability of industry, occupation, employment relationship, and sector 

information from the current data collection for the existing surveys.

Table 5.3.2: Profile of existing survey injury/illness information

As might be expected, NHIS, BRFSS, MEPS-HC, and NHANES are the surveys in which injury and 

illness information is collected. MEPS-HC is the one survey which collects identifies work-related 

accidents/injuries, and thus would be of value for screening under Option 2 (Follow-on to Existing 

Survey, no Change to Existing Survey), as well as providing useful background information for a 

supplemental module to MEPS-HC under Option 1 (Supplemental Module in Existing Survey). For the 

other surveys, use of injury and illness data could be of benefit when developing a supplemental module 

under Option 1 (Supplemental Module in Existing Survey). 

Injuries Illnesses Comments

ACS No No

CPS No No

NHIS

Number of work days missed in prior 12 months 

due to injury/illness;

non-specific as to where injury/illness occurred

Number of work days missed in prior 12 months 

due to injury/illness;

non-specific as to where injury/illness occurred

Obtains other information 

in injuries/illnesses which 

could be informative

BRFSS Falls within prior 12 months; 

did fall result in injury Chronic

MEPS-HC Identifies accidents/injuries that occurred while at 

work

Obtains information on ER/medical provider 

visits, hospital stays

NHANES Obtains information on ER/medical provider visits, 

hosptial stays

Obtains information on ER/medical provider 

visits, hospital stays

NLSY Extent to which pain interfered with work 

activities in prior 4 weeks Selected chronic

NIS No No

SIPP No No Questions on disability 

payments

SCF No No Questions on disability 

payments

NSFG No No

GSS No No

AS If asked as part of a given survey Selected chronic

KP If asked as part of a given survey If asked as part of a given survey

Survey Injury/Illness Data
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Implications

Table 5.3.3 provides the summary “rating” indicators of value relative to Availability of Employment and 

Injury/Illness Information.

Table 5.3.3: Summary ratings for existing survey employment and industry/occupation 

information

Availability of employment and I/O information from an existing survey can allow for targeted 

interviewing under either a supplemental module (Option 1: Supplemental Module in Existing Survey) or 

use of collected data to screen for follow-up (Option 2: Follow-on to Existing Survey, no Change to 

Existing Survey) design. NLSY provides the most comprehensive information, being rated 5 for all 

employment information categories, identifying persons employed at any point within the prior 12 

months (the target population for HSOII), and I/O information for all jobs. Other surveys with a rating of 

3+ for all employment information categories are ACS, CPS, NHIS, MEPS-HC, SIPP, and SCF. For 

these surveys, employment status may not cover the prior 12 months and I/O information is often not 

collected for all jobs. The information from these surveys may be of value under Options 1

(Supplemental Module in Existing Survey), 2 (Follow-on to Existing Survey, no Change to Existing 

Survey), or 3 Follow-on to Existing Survey, Additional Screening Questions in Existing Survey (). 

Availability of relevant injury and illness data is very limited. Only MEPS-HC (identifies 

accidents/injuries occurring at work) and NHIS (obtains number of work days missed due to 

injury/illness) obtain data that could potentially be useful for Options 1 (Supplemental Module in Existing 

Survey), 2 (Follow-on to Existing Survey, no Change to Existing Survey), or 3 (Follow-on to Existing 

Survey, Additional Screening Questions in Existing Survey). 

Survey

Employment 

Status

Multiple 

Jobholders Occupation Industry Employment 

Relationship Sector Injury Illness

ACS +++++ +++++ +++ +++ +++++ +++++ 0 0

CPS +++ +++++ ++++ ++++ +++++ +++++ 0 0

NHIS +++++ +++++ +++ +++ +++++ +++++ ++++ ++++

BRFSS +++++ 0 ++ ++ +++++ 0 ++ +

MEPS-HC +++++ +++++ +++ +++ +++++ +++++ +++++ ++

NHANES +++ 0 +++ +++ +++++ +++++ ++ ++

NLSY +++++ +++++ +++++ +++++ +++++ +++++ +++ +

NIS 0 0 0 0 0 0 0 0

SIPP ++++ +++++ ++++ +++ +++++ +++++ 0 0

SCF +++ +++++ ++++ ++++ +++++ +++++ 0 0

NSFG +++++ +++++ 0 0 0 0 0 0

GSS +++ 0 +++ 0 +++++ +++++ 0 0

AS + + + + +++++ + + +

KP + + + + + + + +

Employment Information Injury/Ilness Information
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5.4 Timeliness of Calendar Year Estimates

Data from the ESOII is released roughly eleven months following the end of the ESOII estimation period, 

which is the calendar year. Survey timeliness is primarily of consideration for Option 1 (Supplemental 

Module in Existing Survey), adding a supplemental module to an existing survey. Survey timeliness must 

also be considered for Options 2 (Follow-on to Existing Survey, no Change to Existing Survey) and 3

(Follow-on to Existing Survey, Additional Screening Questions in Existing Survey), wherein data from 

the survey is utilized in the sample design of the HSOII, to avoid deterioration over time of the accuracy 

of the information for use in the HSOII sample design and data collection process. 

In addition to data timeliness, additional related considerations include the frequency with which sample 

cases are interviewed, the respondent burden associated with the existing survey (based on OMB 

clearance packages), and the frequency with which estimates are generated from the existing survey.

Table 5.4.1 provides information on these characteristics of the existing survey data collection process 

and estimate generation. Availability of the survey data is based on publication of the survey data. It 

may be possible that the information needed for use in a HSOII design may be available for use by BLS 

earlier.

Table 5.4.1: Profile of existing survey frequency, respondent burden, and timing

Two surveys (NLSY, NSFG) do not publish results prior to current publication of ESOII data. Seven 

other surveys (ACS, BRFSS, NHANES, NIS, SIPP, SCF, GSS) publish data less than two months prior to 

Survey Collection Period Collection Frequency for 

Sample Unit

Respondent 

Burden

Estimate 

Periodicity Data Release Lag

ACS Calendar Year Once 30-40 min Annual ~9 months

CPS Two weeks 4 consecutive months, same 

4 months 12 months later ~8 min Monthly ~3 weeks

NHIS Calendar Year Once ~53 min Annual ~6 months

BRFSS Calendar Year Once ~16 min Annual ~9 months

MEPS-HC 5 Months 5 times over 2 years ~107 min Annual ~7 months

NHANES 24 Month Period Once ~150 min Biennial ~10 months

NLSY 12 Months Every 2 years ~61 min Biennial ~15 months

NIS Calendar Year Once ~32 min Annual ~9 months

SIPP One Calendar Year Once a year for 4 years 

(current panel) ~60 min Annual ~9 months

SCF One Calendar Year Once ~75 min Triennial ~9 months

NSFG 12 Month Period (for 

each of 4 samples) Once ~70 min (M)~100 min (F)

Varies (4 years, 

current) ~12 months

GSS 7 Months Once ~90 min Biennial ~9 months

AS Varies Multiple Varies Varies ~1 month

KP Varies Multiple Varies Varies ~1 month
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current publication of ESOII data. Only five surveys (CPS, NHIS, MEPS-HC, AS, KP) publish estimates 

within a timeframe that might be considered “safe” for HSOII.

Several surveys (CPS, MEPS-HC) collect data from a given sample unit multiple times within a year, 

Such a collection frequency could be advantageous under Option 1 (Supplemental Module in Existing 

Survey) implemented as a panel survey (Option 7), as it would allow for bounding interviews and recall 

periods of less than 12 months. These issues will be discussed further in a separate report addressing 

questionnaire and data collection process.

Seven surveys (MEPS-HC, NHANES, NLSY, SIPP, SCF, NSFG, GSS) have estimated respondent 

burden of one hour or more, while two (CPS, BRFSS) have estimated respondent burdens less than 20 

minutes. 

Implications

Table 5.4.2 provides the summary “rating” indicators of value relative to Timeliness of Calendar Year 

Estimates.

Table 5.4.2:Summary ratings for existing survey frequency, respondent burden, and timing

For Option 1 (Supplemental Module in Existing Survey), only CPS has a short interview length in 

conjunction with a data release timeframe meeting likely timing necessary for BLS to obtain information 

from the existing survey and supplemental module to support the existing SOII timeframe for publication 

of results. 

Survey Collection Frequency 

for Sample Unit

Interview 

Length

Estimate 

Periodicity

Data Release 

Lag

ACS ++++ +++ +++++ ++++

CPS +++++ +++++ +++++ +++++

NHIS ++++ ++ +++++ +++++

BRFSS ++++ ++++ +++++ ++++

MEPS-HC +++++ + +++++ +++++

NHANES ++++ + ++ ++++

NLSY ++ + ++ +

NIS ++++ +++ +++++ ++++

SIPP ++++ + +++++ ++++

SCF ++++ + ++ ++++

NSFG ++++ + ++ +

GSS ++++ + ++ ++++

AS +++++ ++++ +++++ +++++

KP +++++ ++++ +++++ +++++
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Utilizing screening information from an existing survey to select the HSOII sample (Options 2: Followon to Existing Survey, no Change to Existing Survey, 3: Follow-on to Existing Survey, Additional 

Screening Questions in Existing Survey) should be possible from a timing perspective under all surveys 

with the exception of NLSY and NSFG.

5.5 Availability of Auxiliary Data for Sample Design Efficiency

Data collected in the existing surveys can be utilized to improve the efficiency of the HSOII design under 

Options 2 (Follow-on to Existing Survey, no Change to Existing Survey) and 3 (Follow-on to Existing 

Survey, Additional Screening Questions in Existing Survey). Under Option 2 (Follow-on to Existing 

Survey, no Change to Existing Survey), the assumption is that HSOII design will be developed utilizing 

the information collected as part of the existing survey data collection instrument, whereas Option 3 

(Follow-on to Existing Survey, Additional Screening Questions in Existing Survey) assumes additional 

screening information may be collected in the existing survey to enhance the efficiency of the HSOII 

design.

The primary gains to be made will be derived from information discussed in Section 5.3: Availability of 

Key Information. Availability of employment data for persons within sample HUs from existing surveys 

will be valuable in stratification for the HSOII design under Options 2 (Follow-on to Existing Survey, no 

Change to Existing Survey) and 3 (Follow-on to Existing Survey, Additional Screening Questions in 

Existing Survey), especially in terms of obtaining sufficient sample sizes within industry and occupation 

groups.

While the design could consider screening out sample HUs with only elderly, retired individuals, it is 

possible that the residents at the HU have changed and thus eligible persons could be missed. A sample 

design could sample such HUs at a lower rate than other HUs so as to ensure representation but with 

lower sample sizes and costs.

Other information about the HU and persons within the HU, such as age, race, gender, and number of 

persons, may be of some value for stratification. Number of person in the HU is available from all 

existing surveys. Age, race, and gender is available for the sampled persons.
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6. Discussion

Within this section, we discuss some two topics that are more global in nature:

1. From Section 2, assessment criterion 7 – Would the implications discussed for assessment criteria 1-6 

change if the survey is merely used to screen for potential respondents (i.e., Options 2: Follow-on to 

Existing Survey, no Change to Existing Survey, or 3: Follow-on to Existing Survey, Additional 

Screening Questions in Existing Survey) rather than including a full module of 15-20 questions on 

occupational injury and illness (i.e., Option 1: Supplemental Module in Existing Survey)? 

2. What can be posited at this stage of the project as to potential costs associated with use of various 

existing surveys and design options?

6.1 Screening vs. Add-on Module

Add-on Module

Option 1 (Supplemental Module in Existing Survey) would result in the most cost-effective survey 

design, as contact/response conversion efforts and associated costs are carried out through the existing 

survey. The primary challenges in implementing Option 1 (Supplemental Module in Existing Survey) are

existing survey: 1) sample size; 2) timing; 3) and respondent burden. 

Table 6.1.1 presents counts of the summary ratings of 5, 4, or 3 assigned to existing surveys, across the 

assessment criteria.

Existing surveys with the largest number of assigned high summary ratings are CPS (12-5’s, 17-5/4’s, 19-

5/4/3’s) and ACS (13-5’s, 15-5/4’s, 18-5/4/3’s). These two surveys each have sufficient sample size to be 

considered as single frames for the HSOII and have high assigned ratings for Employment and I/O 

Information. These two aspects make CPS and ACS potential candidates for adding a HSOII module to 

the existing survey. Timing of ACS data release (~9 months) and respondent burden (~30-40 min), result 

in ACS being less ideal for Option 1 (Supplemental Module in Existing Survey) than is CPS. It may also 

be argued a priori that ACS could not be utilized in an HSOII design as the likelihood of receiving 

approval to add a supplemental module to ACS would be near, if not at, zero. 
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Table 6.1.1: Counts of summary ratings of 5/4/3 for existing surveys, by assessment criteria 

group

NHIS (18-5/4/3’s) and SIPP (17-5/4/3’s) are the two other existing surveys with similar counts of high 

ratings. While both have high assigned ratings for Employment and I/O Information, their sample sizes 

are not sufficient to be considered as single frames for adding a HSOII module to the existing survey, and 

their respondent burdens are each high. In addition, SIPP sample are only selected every 2.5 to 4 years.

A combination of Option 1 (Supplemental Module in Existing Survey) and Option 4 (Multiple Surveys) 

could be considered to open up the existing surveys which could be considered. However, coordinating 

approvals to add modules to multiple surveys and the field effort across multiple agencies make this 

appear undesirable.

A combination of Option 1 (Supplemental Module in Existing Survey) and Option 6 (Multi-year Survey) 

could also be considered to increase sample size. However, sample sizes for the other existing surveys 

would require use of a three-year estimation period, not a two-year estimation period.

CPS is currently used as a frame for a number of supplemental modules, as indicated in Table 6.1.2. Each 

supplement is conducted in one given month of the year on an annual, biennial, or triennial basis.

Coverage/ 

Sample Size/ 

Response Rate

(7)

Data Collection 

Mode & Rules

(2)

Employment & 

I/O Information

(8)

Survey Frequency, 

Respondent Burden 

& Timing

(4)

ACS 7/0/0 1/0/0 4/0/2 1/2/1 13/2/3

CPS 4/3/0 1/0/1 3/2/1 4/0/0 12/5/2

NHIS 3/0/2 1/0/1 4/2/2 2/1/0 10/3/5

BRFSS 2/4/0 1/0/1 2/0/0 1/3/0 6/7/1

MEPS-HC 2/1/0 1/0/0 5/0/2 3/0/0 11/1/2

NHANES 2/0/1 1/0/1 2/0/3 0/2/0 5/2/5

NLSY 1/1/0 2/0/0 6/0/1 0/0/0 9/1/1

NIS 2/1/1 0/0/0 0/0/0 1/2/1 3/3/2

SIPP 2/0/4 2/0/0 3/2/1 1/2/0 8/4/5

SCF 2/0/0 1/0/1 3/2/1 0/2/0 6/4/2

NSFG 1/0/1 1/0/1 2/0/0 0/1/0 4/1/2

GSS 2/0/1 1/0/1 2/0/2 0/2/0 5/2/4

AS 1/1/0 2/0/0 1/0/0 3/1/0 7/2/0

KP 1/1/0 2/0/0 0/0/0 3/1/0 6/2/0

Survey

Assessment Criteria Group

Total
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Table 6.1.2:Timing, frequency of repeated CPS supplements

There are a set of nine criteria considered before implementing a CPS supplement, which HSOII would 

appear to meet. Key among the criteria as they would relate to HSOI are respondent burden 

(“supplemental inquiry must not add more than 10 minutes of interview time per respondent or 25 

minutes per household”), compatibility of the supplement with CPS (“must not introduce a concept that 

could affect the accuracy of responses to the basic CPS information”), and confidentiality (“information 

that could be used to indirectly identify an individual with a high probability of success will be 

suppressed”). Note that, to provide sufficient sample size in implementing HSOII as a CPS supplement, 

and to reduce the potential for seasonality affecting survey responses, it would be necessary to implement 

HSOII as a CPS supplement in multiple months

Screening

When considering implementing Options 2 (Follow-on to Existing Survey, no Change to Existing 

Survey) or 3 (Follow-on to Existing Survey, Additional Screening Questions in Existing Survey), the 

primary challenges are existing survey: 1) sample size; 2) timing; 3) and availability of key information.

As discussed in Section 5.1, ACS, CPS, and BRFSS are the only surveys with sample sizes sufficient to 

serve as single frames for an HSOII survey design. As indicated in Table 6.1.1, the Employment and I/O 

Information available from BRFSS would likely be insufficient to develop a sufficiently efficient sample 

design for use with Option 2 (Follow-on to Existing Survey, no Change to Existing Survey). In addition, 

Month Supplement Frequency

Displace Workers Biennial

Job Tenure/Occupational 

Mobility Biennial

Unbanked/Underbanked Biennial

Feb

Public Participation in the 

Arts

Annual

Mar

Annual Social and Economic 

Supplement Annual

Apr Child Support Biennial

May

Jun Fetility Biennial

Jul Tobacco Use Triennial

Aug Veterans Annual

Sep Volunteers Annual

Oct School Enrollment Annual

Nov Voting and Registration Biennial

Dec Food Security Annual

Jan
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as BRFSS is implemented by individual states, not all of which use currently existing available optional 

modules, it seems best not to consider as a single frame source. 

CPS could be considered for both Options 2 (Follow-on to Existing Survey, no Change to Existing 

Survey) and 3 (Follow-on to Existing Survey, Additional Screening Questions in Existing Survey). As 

with Option 1 (Supplemental Module in Existing Survey), it is unlikely ACS could be used for Option 3 

(Follow-on to Existing Survey, Additional Screening Questions in Existing Survey), although it could be 

considered for Option 2 (Follow-on to Existing Survey, no Change to Existing Survey). The discussion 

relative to other existing surveys and Option 1 (Supplemental Module in Existing Survey) would also 

argue against their use for Option 3 (Follow-on to Existing Survey, Additional Screening Questions in

Existing Survey), with one exception. NIS could be considered for use with Option 3 (Follow-on to 

Existing Survey, Additional Screening Questions in Existing Survey), given its large sample size of 

sampled telephone numbers. This would require adding a few additional questions to the NIS screener, 

seeking to identify eligible workers with the sample HU, as well as eligible children.

Use of other existing surveys could be considered for Option 2 (Follow-on to Existing Survey, no Change 

to Existing Survey), although the smaller sample sizes would likely require combining Option 2 (Followon to Existing Survey, no Change to Existing Survey) with Options 4 (Multiple Surveys) and 6 (Multiyear Survey) to achieve the overall sample sizes needed for HSOII.

6.2 Survey Costs

Survey costs are also a critical factor in establishing an approach to an HSOII. The following factors will 

affect survey costs:

1. Data collection costs associated with Options 1 (Supplemental Module in Existing Survey), 2 

(Follow-on to Existing Survey, no Change to Existing Survey), 3 (Follow-on to Existing Survey, 

Additional Screening Questions in Existing Survey), and 5 (Utilize Existing Sampling Frame) is 

utilized. 

2. The need for and complexity of the sample design and sample selection;

3. The extent of files required and complexity associated with pre-sample selection processing of data 

from existing surveys;

4. Use of CAPI vs CATI data collection;

5. Required sample size;

6. The extent of files required and complexity associated with processing the HSOII data files;

7. The complexity associated with survey weighting.
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8. Use of Option 4 (Multiple Surveys); 

9. Use of Option 6 (Multi-year Survey); 

10. Use of Option 7 (Panel Survey); 

11. Which existing survey(s) is utilized.

Each factor is discussed briefly below. More extensive and detailed discussion will be provided in the 

Survey Design report.

Data Collection

Option 1 (Supplemental Module in Existing Survey) will incur the lowest data collection survey costs, as 

it utilizes an existing survey sample and data collection process. Data collection costs would be incurred 

related to interviewer time to ask the additional questions in the HSOII and potentially additional required 

follow-ups to complete the HSOII module beyond those needed for the existing survey. 

Options 2 (Follow-on to Existing Survey, no Change to Existing Survey) and 3 (Follow-on to Existing 

Survey, Additional Screening Questions in Existing Survey) would incur substantially higher data 

collection costs as all interviewer costs associated with contacting, obtaining participation, and screening 

would be borne by HSOII. Option 3 (Follow-on to Existing Survey, Additional Screening Questions in 

Existing Survey) would also incur additional costs associated with asking the additional screening 

questions as part of the existing survey interview. This may be partially, but likely not fully, offset by a 

reduction in interview time for the HSOII under Option 3 (Follow-on to Existing Survey, Additional 

Screening Questions in Existing Survey) given improved screening information.

Option 5 (Utilize Existing Sampling Frame) would incur the highest HSOII data collection costs, given 

additional efforts needed for locating, contacting, obtaining participation, and screening for sample that 

has not been contacted previously as part of an existing survey.

Sample Design

Option 1 (Supplemental Module in Existing Survey) will incur no costs for developing a sample design 

and selecting a sample as it utilizes that for the existing survey.

Options 2 (Follow-on to Existing Survey, no Change to Existing Survey) and 3 (Follow-on to Existing 

Survey, Additional Screening Questions in Existing Survey) will incur sample design and selection costs, 

for which the design component will likely be more involved than that associated with Option 5 (Utilize 

Existing Sampling Frame). This will be due to the additional design information available from the 
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existing survey and the need to oversample selected industry and occupation groups to control total 

sample size.

Sample design and selection costs for Option 4 (Multiple Surveys) will be even higher than those for 

Options 2 (Follow-on to Existing Survey, no Change to Existing Survey), 3 (Follow-on to Existing 

Survey, Additional Screening Questions in Existing Survey), and 5 (Utilize Existing Sampling Frame), 

due to the additional complexity of optimally designing a dual frame survey.

Pre-sample Selection Data Processing

Costs for this component would be expected to be lowest for Option 5 (Utilize Existing Sampling Frame). 

This is due to the need under Options 1 (Supplemental Module in Existing Survey), 2 (Follow-on to 

Existing Survey, no Change to Existing Survey), and 3 (Follow-on to Existing Survey, Additional 

Screening Questions in Existing Survey) to become familiar with and process data from an existing 

survey on an annual or perhaps more frequent basis. Depending upon how early in the existing survey 

data processing the HSOII relevant data files are created, the extent of data checking and cleaning needed 

before the files are ready for use in the HSOII sample design, selection, questionnaire data feeds may be 

significant. This issue would be compounded under Option 4 (Multiple Surveys). 

CAPI vs. CATI

Data collection costs would be expected to be greater for CAPI than for CATI under Options 2 (Followon to Existing Survey, no Change to Existing Survey) and 3 (Follow-on to Existing Survey, Additional 

Screening Questions in Existing Survey), given higher costs associated with field travel, and assumed 

useful information from the existing survey for CATI to utilize in contacting the sample cases. Given 

HSOII would not incur most of the overhead interviewing costs (locating, contacting, screening, obtaining 

participation, etc.), the cost differential between CAPI and CATI should be much less for Option 1 

(Supplemental Module in Existing Survey). 

Under Option 5 (Utilize Existing Sampling Frame), there would likely be a need for a larger selected 

sample size for CATI, to account for ability to contact HUs though a telephone call, along with associated 

higher locating and contacting costs for CATI than for CAPI, relative to Options 1 (Supplemental Module 

in Existing Survey), 2 (Follow-on to Existing Survey, no Change to Existing Survey), and 3 (Follow-on to 

Existing Survey, Additional Screening Questions in Existing Survey). However, CAPI costs would also 

be much higher given the need for locating and contacting sample HUS.
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Sample Size

Costs will be greater with larger required sample sizes, due almost exclusively to increased data collection 

costs. The impact on costs for sample design and selection, data processing, and survey weighing 

associated with larger sample sizes can be assumed to be negligible.

Pre-weighting Data Processing

As with Pre-sample Selection Data Processing, costs for this component would be expected to be lowest 

for Option 5 (Utilize Existing Sampling Frame), again due to the need under Options 1 (Supplemental 

Module in Existing Survey), 2 (Follow-on to Existing Survey, no Change to Existing Survey), and 3 

(Follow-on to Existing Survey, Additional Screening Questions in Existing Survey) to become familiar 

with and process data from an existing survey on an annual or perhaps more frequent basis. Depending 

upon how early in the existing survey data processing the HSOII relevant data files are created, the extent 

of data checking and cleaning needed before the files are ready for use in the HSOII sample design, 

selection, questionnaire data feeds may be significant. This issue would again be compounded under 

Option 4 (Multiple Surveys). 

Survey Weighting

Cost differences for survey weighting would primarily be associated with the initial development of the 

weighting methodology and programming. Option 1 (Supplemental Module in Existing Survey) should 

again be expected to have the lowest costs, as it leverages the survey weights developed for the existing 

survey. While development of the weighting methodology and programming for Options 2 (Follow-on to 

Existing Survey, no Change to Existing Survey), 3 (Follow-on to Existing Survey, Additional Screening 

Questions in Existing Survey), and 5 (Utilize Existing Sampling Frame) would be somewhat greater, they 

would be expected to have a minimal impact of the overall survey costs. Development of the weighting 

methodology and programming for Options 6 (Multi-year Survey) and 7 (Panel Survey) should likewise 

have minimal impact on the overall survey costs. Development of the weighting methodology and 

programming for Option 4 (Multiple Surveys) will require the greatest effort and costs; however, again 

should not noticeably affect the overall survey cost.

Option 4 (Multiple Surveys)

Costs for multiple survey approach (Option 4) would be greater than the costs for a corresponding single 

frame approach, as well as adding more complexity to the sample design creation and post-survey 

processing. These costs may, however, be partially offset through improved sample design efficiencies 

resulting in lower required sample sizes than a single survey approach. 
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Option 6 (Multi-Year Survey) 

Costs for a multi-year survey (Option 6) would be lower than those for a corresponding single year 

survey, due to spreading a given sample size requirement across multiple years. Data collection costs 

could be as much as 50% lower (as number of interviews per year in a two year design would be roughly 

half that for the single year survey), although the actual reduction may be less. 

Option 7 (Panel Survey) 

Costs for a panel survey (Option 7) with one interview per year would be lower than those for a 

corresponding survey selecting independent sample each survey period, as subsequent interviews of 

sample persons previously interviewed generally will cost less than new contacts. Note that the HSOII in 

general should benefit from this situation as it will be recontacting sample persons from the existing 

surveys (with the exception of Option 5: Utilize Existing Sampling Frame). Cost reductions would be 

dependent upon the rotation scheme and number of interviews defined for the panel survey. Should a 

panel design be developed that requires more frequent (e.g., bi-annual or quarterly) interviews of sample 

cases, then the cost reduction mentioned above would not be realized.

Existing Survey(s)

While pending further investigation and consideration, the survey(s) utilized is believed to have little 

impact on costs, after accounting for the other factors previously listed. 

Rough Cost Assessment

In an attempt to summarize the information presented above and to provide an initial point of discussion, 

Table 6.2.1 presents a preliminary and very rough assessment of the likely relative costs of the existing 

survey/sampling frame and design option combinations. Within Table 6.2.1, dollar signs ($) are used to 

represent ordering of costs associated with various categories/levels within a factor. The number of dollar 

signs, however, should not be interpreted as signifying the relative magnitude of costs among 

categories/levels, nor relative magnitude of costs across factors. Further work along this line will be 

carried out as part of development of the Survey Design report.
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Table 6.2.1: Preliminary assessment of relative costs for existing surveys and design options

Option 1: Option 2: Option 3: Option 5: Option 4: Option 6: Option 7:

Supplemental 

Module in 

Existing Survey

Follow-on to 

Existing Survey, no 

Change to Existing 

Survey

Follow-on to Existing 

Survey, Additional 

Screening Questions 

in Existing Survey

Utilize Existing 

Sampling Frame

Multiple 

Surveys

Multi-year 

Survey

Panel 

Survey

Data Collection $ $$ $$-$$$ $$$ N/A

Sample Design $ $$-$$$ $$-$$$ $$ $$$$

Pre-sample Selection Data Processing $$-SSS $$-$$$ $$-$$$ $ $$$$

Mode

 CAPI $-$$ $$$$ $$$$ $$$$$ N/A

 CATI $ $$$ $$$ $$$$$ N/A

Sample Size

 50,000 $ $ $ $ N/A

 100,000 $-$$ $$ $$ $$ N/A

 150,000 $$ $$$ $$$ $$$ N/A

Pre-weighting Data Processing $$-$$$ $$-$$$ $$-$$$ $ $$$$

Survey Weighting $ $-$$ $-$$ $-$$ $$$

Option 4: Multiple Surveys

 Single survey $$

 Two surveys $$$-$$$$

Option 6: Multi-year Surveys

 One year $$$-$$$$

 Two years $-$$

Option 7: Panel Surveys+A10

 One interview per year $

 Two interview per year $$

 Four interviews per year $$$-$$$$

HSOII Survey Design Option

Factor
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7. Summary 

Utilization of the existing surveys and sampling frames in the HSOII survey design is related to the 

design option of interest. Table 7.1 presents the existing surveys/sampling frames relative to their 

potential use in design Options 1-4 and single frame vs. multi-frame/multi-year designs. The assessment 

as to potential use is based upon sample size, which were assumed to be required to be 100,000+ for use 

as a single frame, and at least 15,000 to be considered for use in a multi-survey and/or multi-year design.

Table 7.1: Summary assessment of use of existing surveys and sampling frames relative to 

design options 1-4 and single frame vs. multi-frame and/or multi-year design

When considering most likely approval constraints, CPS is the only existing survey that can be 

considered for use as a single frame approach under Option 1 (Supplemental Module in Existing Survey), 

as ACS raises substantial feasibility issues in obtaining approvals, while adding to the BRFSS raises 

substantial operational issues given the federal-state cooperative nature of the survey and states’ 

determining which modules to include. CPS also appears to be the only existing survey that could be 

used as a single frame approach under both Options 2 (Follow-on to Existing Survey, no Change to 

Existing Survey) and 3 (Follow-on to Existing Survey, Additional Screening Questions in Existing 

Survey). ACS could also be considered for use as a single frame approach under Option 2 (Follow-on to 

Option 1:

Supplemental 

Module in 

Existing Survey

Option 4:

Utilize Existing 

Sampling Frame

Single Frame Single Frame

Multi-Frame/ 

Multi-year Single Frame

Multi-Frame/ 

Multi-year

Single Frame

ACS No Yes No No No N/A

CPS Yes Yes No Yes No N/A

NHIS No No Yes No Yes N/A

BRFSS No Yes No No No N/A

MEPS-HC No No Yes No Yes N/A

NHANES No No No No No N/A

NLSY No No No No No N/A

NIS No No No Yes No N/A

SIPP No No Yes No Yes N/A

SCF No No No No No N/A

NSFG No No No No No N/A

GSS No No No No No N/A

AS No No No No Yes N/A

KP No No No No Yes N/A

Census MAF N/A N/A N/A N/A N/A Yes

Census Data N/A N/A N/A N/A N/A Yes

USPS DSF N/A N/A N/A N/A N/A Yes

RDD Telephone N/A N/A N/A N/A N/A Yes

Survey/Sampling Frame

Design Option

Option 2:

Follow-on to Existing Survey, 

no Change to Existing Survey

Option 3:

Follow-on to Existing Survey, 

Additional Screening Questions in 

Existing Survey
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Existing Survey, no Change to Existing Survey) but not Option 3 (Follow-on to Existing Survey, 

Additional Screening Questions in Existing Survey), while NIS could also be considered for use as a 

single frame approach under Option 3 (Follow-on to Existing Survey, Additional Screening Questions in 

Existing Survey). Given states have the option of determining which modules to implement, BRFSS does 

not appear to be a desirable source for a sampling frame for HSOII.

NHIS and SIPP have sufficient sample to be considered for use under Option 1 (Supplemental Module in 

Existing Survey), 2 (Follow-on to Existing Survey, no Change to Existing Survey), or 3 (Follow-on to 

Existing Survey, Additional Screening Questions in Existing Survey) in a multi-survey (Option 4) and/or 

multi-year (Option 6) approach. Although they do not routinely collect employment information, AS and 

KP have sufficient sample to be considered for use under Option 3 (Follow-on to Existing Survey, 

Additional Screening Questions in Existing Survey) in a multi-survey (Option 4) and/or multi-year 

(Option 6) approach. Implementation of a multi-survey (Option 4) approach does require consideration 

of operational aspects of implementation for two or more surveys, such as coordinating approval to add a 

supplemental module to more than one existing survey, as well as the need for different structures in the 

modules to account for differences among the multiple surveys.
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Appendix A. Detail About Design Options

As listed in Section 2, seven design options have been identified. These options are not, however, 

mutually exclusive and some could be used in combination. Options 1, 2, and 3 refer to the survey 

instrument and data collection process that would be used for the HSOII. Option 4 (Multiple Surveys) 

was proposed to address potential sample size issues associated with some of the existing surveys, and 

could be used in conjunction with Options 1, 2, and/or 3. Option 5 (Utilize Existing Sampling Frame)

(utilize an existing sample frame) is separate from considering use of an existing survey as the sample 

frame for the HSOII. Option 5 (Utilize Existing Sampling Frame) (multiple years) was proposed to 

address potential survey data collection costs associated with sufficient annual sample sizes, and could be 

used with any of Options 1-5. Finally, Option 7 (panel survey) was proposed to address potential recall 

error associated with a 12 month recall period, and could be utilized with any of Options 2-6 (this 

approach would only be utilized with Option 1 (Supplemental Module in Existing Survey) for an existing 

panel survey [CPS, MEPS-HC]).

Option 1: Add a supplemental module to an existing survey

Under this option, a module of questions would be added to the existing survey questionnaire, to be asked 

following the completion of the existing survey questionnaire. To the extent possible, data collected as 

part of the existing survey questionnaire would be used in screening for eligible respondents; however, it 

may be necessary to include additional screening questions to the HSOII module. 

To avoid changes to the data collection process for the existing survey, the assumption is made that:

1. The same within-HU sample selection rules used for the existing survey would be used for the HSOII 

module (e.g.., if the existing survey selects one person age 18+ years for the survey, the HSOII would 

also treat that same person as sampled for HSOII and would not collect data for other eligible 

residents within the HU).

2. The same respondent rules used for the existing survey would be used for the HSOII module (i.e., if 

each existing survey eligible person in the HU is interviewed, then the HSOII module would be 

conducted with each specific HSOII eligible person; if the existing survey interviews one HU 

respondent who reports data for all existing survey eligible persons within the HU, then the HSOII 

module would obtain data for all HSOII eligible persons from the HU respondent).

Under this option, the HSOII would be collected under the same time schedule as for the existing survey. 

Upon completion of data collection and data processing for the existing survey, HSOII data processing 

could begin. Data files required to be transmitted from the existing survey would include cleaned data 
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from the existing survey (for specified data elements such as HU characteristics and person 

demographics), the raw data from the HSOII supplemental module, sample disposition codes from the 

existing survey and HSOII supplemental module, and the existing survey weight file (to include weights 

and adjustment factors from the existing survey weighting calculation). Note that the existing survey 

weight file could be delivered after the other data files, to allow HSOII data cleaning and editing to begin 

as early as possible.

HSOII data collected as a supplement to an existing survey could be affected by seasonality if data 

collection is not evenly distributed across the calendar year; such a situation could occur if the collection 

period is less than 12 months or if data collection is clustered nonrandomly in certain months. 

Refinements to this option could be considered, such as, if the existing survey does not collect data for all 

HSOII eligible persons, should HSOII data collection be limited to those persons jointly eligible for the 

existing and HSOII surveys, or should an attempt be made to collect data under the HSOII module for all 

HSOII eligible person, regardless of their interview status for the existing survey?.

By collecting HSOII data concurrent with collection of existing survey data, Option 1 will result in the 

lowest HSOII data collection costs among Options 1, 2,and 3. 

Option 2: Use data from an existing survey to screen for persons eligible for the HSOII, select a 

subsample of HSOII eligible persons, and conduct a follow-on survey to collect any additional data 

required for the HSOII

Under this option, the HSOII would utilize data from the existing survey to identify HSOII eligible 

persons within the HU, after data collection for the existing survey has been completed and a data file of 

sufficient completeness and quality from the existing survey is available. This option assumes the data 

currently collected in the existing survey, along with data available on the sample frame and usual 

auxiliary data will be the only data available for use in the sample design and data collection initiation.

The extent of relevant and correlated data collected in the existing survey will affect the efficiency of the 

HSOII sample design. For example, if no data on and individual’s industry/occupation were available, 

the HSOII sample design would not be able to a priori oversample selected industry and occupation 

groups to ensure sufficient sample sizes for each group, such oversampling would need to be built into the 

data collection process. In addition, the extent of information available from the existing survey would 

drive the extent of additional screening questions needed to be included in the HSOII.
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Regardless of the extent of data available from the existing survey, it would be necessary to also select 

sample, albeit it at a lower sampling rate, from HUs with no HSOII eligible persons. This is necessary to 

ensure representation of the target population as persons may change work status between the existing 

survey interview and the HSOII interview, and residents within a HU may change.

Given the need to collect HSOII data during a follow-up contact with the HU, Option 2 would incur 

higher data collection costs than Option 1. These higher costs would be more significant for a CAPI 

approach than for a CATI approach.

Option 3: Add appropriate supplemental questions to the existing survey questionnaire to aid in 

screening for or stratifying persons eligible for the HSOII

Under this option, it is assumed additional screening questionnaires could be added to the existing survey 

questionnaire. The purpose of the additional screening questions would be to improve the efficiency of 

the HSOII sample design and selection by providing information that would allow for stratification of the 

existing survey sample as well as for oversampling of selected subpopulations needed to meet sample size 

and publication requirements.

By ensuring collection of relevant and correlated data in the existing survey, this Option will result in the 

most efficient HSOII sample design among Options 1-3. As with Option 2, regardless of the extent of 

data available from the existing survey, it would be necessary to also select sample, albeit it at a lower 

sampling rate, from HUs with no HSOII eligible persons

Given the addition of questions to the existing survey, Option 2 would incur higher data collection costs 

for a given sample size and collection Mode than Option 1 and likely than Option 2. However the 

improved efficiency of the sample design may offset the per complete collection costs and result in survey 

costs of a similar magnitude to those for Option 1.

Option 4: Utilize multiple surveys under Options 1, 2, and/or 3

This option would be used primarily if it is determined there is no single existing survey which can be 

used or which meets the planned HSOII budget under Options 1, 2, or 3, and that there are two or more

other existing surveys which can be used but which individually do not meet the HSOII sample size 

requirements. This approach is analogous to that used in dual-frame estimation for RDD surveys 

selecting sample from both a landline and cell telephone sample frame.
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Under this option, the multiple existing surveys can be thought of as independent samples of the 

population of interest. From a weighting and estimation perspective, the data from each sample is 

independently weighted to derive survey weights representing the total population. It is at this point the 

multiple samples are combined, with weights adjusted so as to minimize the variance associated with 

estimates from the combined samples. The adjustment made to the individual sample weights is 

proportional to the inverse of the individual variances; thus, samples with lower variance receive larger 

relative adjustments.

Survey weighting for the multiple survey approach is initially carried out separately for each survey. The 

final stage of weighting entails adjusting survey weights to combine the sample so as to minimize 

variance. Essentially, the weights from each survey are adjusted inverse to their variance, with weights 

for sample cases from the lower variance survey receiving a larger adjustment, and weights for sample 

cases from the higher variance survey receiving a smaller adjustment. The weight adjustments sum to 

one, and are derived as in the formula below.

λλAA = vvvvvv�YY�BB�

vvvvvv�YYAA

� � + vvvvvv�YY�BB�

where A and B refer to the surveys.

This approach can be utilized for integration of more than two surveys. If information about the bias of 

each estimate is available, then mean squared error (MSE) is used rather than variance to derive the 

adjustment factor.

This approach can also be used to combine surveys that only partially overlap in terms of population, such 

as would be the case if NSFG (for which the eligible adult population is 18-44) were utilized. This is also 

the situation for dual-frame RDD telephone surveys, as the landline and cell telephone sample frames 

only overlap for dual use landline/cell telephone HU’s. The landline telephone frame uniquely covers the 

landline only HU population, while the cell telephone frame uniquely covers the cell only HU population. 

In the case of partially overlapping existing surveys, weighting is again initially carried out separately for 

each survey, with weights derived appropriate to the overlap population and the non-overlap population. 

The final stage of weighting entails adjusting survey weights for sample representing the overlap 

population. Weights for the non-overlap population are not affected.

λλAA,PP1 = vvvvvv�YY�BB,PP1�

vvvvvv�YY�AA,PP1� + vvvvvv�YY�BB,PP1�

Where P1 refers to the overlap population between survey A and survey B.
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Option 4 would incur sample design/selection, questionnaire design, and data processing costs somewhat 

greater than those for a single existing survey approach. However, the efficiency of the dual-frame design 

may yield sample sizes sufficiently less than those from a single survey design to result in total survey 

costs not substantially higher than those of a similarly efficient single survey design utilizing the same 

collection mode.

Option 5: Utilize an existing sampling frame to develop an optimal sample design for the HSOII

This option makes use of an existing sample frame rather than existing surveys. The advantage of Option 

5 is the access to the full target population for sample design and selection, as opposed to being limited to 

that sample selected and interviewed for an existing sample. This advantage becomes more important the 

larger the HSOII sample requirement and the more publication levels required.

The HSOII sample design would only be able to utilize information available on the sample frame, which 

are limited to geographic information about the frame units, perhaps supplemented with data from 

auxiliary data sources. As a result, an HSOII sample design selected from one of the four sample frames 

would likely be less efficient than that of an HSOII sample design selected from an existing survey.

In addition, data collection costs can be expected to be noticeably greater for an HSOII sample design 

selected from one of the four sample frames, as all initial locating, sample clean up, etc., will be incurred 

by the HSOII rather than leveraging information from an existing survey. In addition, one might expect 

higher response rates when contacting sample cases interviewed previously than when contacting “virgin” 

sample cases.

Option 6: Implement any of Options 1-5 as a multi-year survey

Under this option, sample is combined across multiple years in creating an estimate for a given year (e.g., 

data collected in 2014 and 2015 would be combined to generate estimates for 2015, data collected in 2015 

and 2016 would be combined to generate estimates for 2016, etc.). This approach is analogous to that 

utilized in the ACS for generating 3- and 5-year estimates.

As illustrated below, utilizing a two-year survey design, the sample (n17) from 2017 would be combined

with the sample (n18) from 2018 to generate a two-year estimate for the period 2017-2018. The sample 

(n18) from 2018 would then be combined with the sample (n19) from 2019 to generate a two-year 

estimate for the period 2018-2019.
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The advantage of the multi-year survey design is reduced data collection costs for a given sample size. In 

the illustration above, the data collection costs for each year would be roughly half those incurred to 

achieve an equivalent one year sample size of 2nYY for 20YY.

The consideration is that the estimates released each year would be for a two year period rather than for 

one calendar year. Given injury and illness incidence rates tend to be stable across time, this approach 

may be acceptable. One variation of this approach would be to generate national level, overall incidence 

rate estimates from the sample interviewed within the calendar year, and generate lower level estimates 

from the sample combined across years.

Option 7: Implement any of Options 2-6 as a panel survey

Under this option, selected sample units are interviewed multiple times across a designated period. This 

approach is analogous to CPS, wherein sample units are interviewed four consecutive months, and then 

interviewed the same four months the following year. Each month, new sample units are selected into 

CPS (a new rotation group, RG), and sample units having completed their eighth interview are dropped 

from the sample (a retired RG).

Illustrated below is a panel design with quarterly interviews. Each RG is interviewed 5 quarters before 

being retired, with a new RG selected and introduced into the survey each quarter. Thus in any given 

quarter, interviews would take place with sample from 5 RG’s, with sample cases being asked about 

injuries and illnesses occurring in the prior quarter. Estimates for 2018 would be based upon data from 8 

RG’s, with two RG’s contributing data for all 4 quarters in 2018, while the other RG’s would contribute 

data for the number of quarters they reported for 2018. The net sample size would be 5nYY.RR. 

2017 2018 2019 2020

n17

n18

n19

n20
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The advantage of the panel survey design is reduced recall error. There may also be some reduced data 

collection costs as the locating and gaining cooperation would require less effort when interviewing 

sample cases a second, third, etc., time than when interviewing sample cases for the first time.

Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2

n17.1

n17.2

n17.3

n17.4

n18.1

n18.2

n18.3

n18.4

n19.1

n19.2

2017 2018 2019
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Appendix B. Links to Home Pages for Existing Surveys

Survey Home Page Link

American Community Survey (ACS) http://www.census.gov/programs-surveys/acs/

Current Population Survey (CPS) http://www.bls.gov/cps/home.htm

National Health Interview Survey 

(NHIS) http://www.cdc.gov/nchs/nhis.htm

Behavioral Risk Factor Surveillance 

System (BRFSS) http://www.cdc.gov/brfss/

Medical Expenditure Panel Survey - 

Household Component (MEPS-HC) http://meps.ahrq.gov/mepsweb/survey_comp/household.jsp

National Health and Nutrition 

Examination Survey (NHANES) http://www.cdc.gov/nchs/nhanes.htm

National Longitudinal Survey of 

Youth (NLSY) http://www.bls.gov/nls/

National Immunization Survey 

(NIS) http://www.cdc.gov/nchs/nis.htm

Survey of Income and Program 

Participation (SIPP) http://www.census.gov/sipp/

Survey of Consumer Finance (SCF) http://www.federalreserve.gov/econresdata/scf/scfindex.htm

National Survey of Family Growth 

(NSFG) http://www.cdc.gov/nchs/nsfg.htm

General Social Survey (GSS) http://www3.norc.org/GSS+Website/

AmeriSpeak (AS) http://www.norc.org/Research/Capabilities/Pages/amerispeak.

aspx

KnowledgePanel (KP) http://www.knowledgenetworks.com/knpanel/index.html
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Appendix C. Definitions for Criteria Ratings

While the detailed information profiles the survey design environment for each existing survey, it is not 

conducive to easily comparing surveys nor to readily assessing the extent to which each existing survey 

fulfills needs for implementing the HSOII. To that end, the following definitions were created to provide 

for summarization of the survey design environment for each existing survey. These definitions are 

intended to represent relative, rather than exact, summary ratings. These ratings reflect the existing 

surveys as they are now configured, and do not imply modifications to existing surveys are not possible.

Criteria 1: Population Representation

Criteria 2: Survey Mode and Use of Proxy Respondents

Screened

HU's HU's Workers

+++++ None 100% Monthly or Quarterly 500.000+ 350,000+ 500.000+ 90%+

++++ Non-telephone 90%-99% Annually 100,000-499,999 70,000-349,999 100,000-499,999 75%-89%

+++ N/A 75%-89% N/A 50,000-99,999 35,000-69,999 50,000-99,999 60%-74%

++ N/A 50%-74% Biennial+ 15,000-49,999 10,000-34,999 15,000-49,999 40%-59%

+ N/A 20%-49% As Needed 5,000-19,999 4,000-14,999 5,000-14,999 25%-39%

0 N/A <20% N/A <10,000 <7,000 <5,000 <25%

Response 

Rate

Sample Selection 

Frequency Rating

Coverage Sample

Frame Coverage 

Gaps

Estimated 

Coverage of 

Workers in 

Eligible Sample

Completed

Sampled 

Persons Respondent Rules

+++++ All persons 18+ Self-respondent

++++ N/A N/A

+++ Sample of 

persons 18+ Self-report, if possible

++ N/A HH respondent

+ N/A N/A

0 N/A N/A

Rating

Data Collection
NORC | Survey Design and Questionnaire for a Household Survey on Occupational Injuries and Injuries

HSOII SAMPLE FRAME ASSESSMENT REPORT | 48

Criteria 3: Availability of Key Information

Criteria 4: Timeliness of Calendar Year Estimates

Employment 

Status

Multiple 

Jobholders Occupation Industry Employment Relationship Sector Injury Illness

+++++ Prior 12 months Yes All jobs All jobs Yes Yes Accidents/

injuries at work N/A

++++ Prior 3 months N/A Up to 2 jobs Up to 2 jobs N/A N/A Work days missed Work days missed

+++ Current N/A One job One job N/A N/A Pain interfered w/ 

work activities N/A

++ N/A N/A Optional 

module

Optional 

module

Optional 

module

Optional 

module

ER/provider visits;

hospital stays;

falls w/in 12 mo

ER/provider visits;

hospital stays

+ If asked as part 

of a given survey

If asked as 

part of a 

given survey

If asked as 

part of a 

given survey

If asked as 

part of a 

given survey

If asked as 

part of a 

given survey

If asked as 

part of a 

given survey

If asked as part of a 

given survey

Selected Chronic;

If asked as part of a 

given survey

0 Not obtained Not obtained Not obtained Not obtained Not obtained Not obtained Not obtained Not obtained

Employment Information Injury/Ilness Information

Rating

Rating

Collection 

Frequency for 

Sample Unit

Interview Length Estimate 

Periodicity Data Release Lag

+++++ Multiple times 

w/in 12 months <15 min

Annual or more 

frequent

<7 months

++++

Once w/in 12 

months 16-25 min N/A 8-9 months

+++ N/A 26-40 min N/A 10 months

++

Once w/in 24+ 

months 41-59 min Less frequently than annual N/A

+ N/A 60+ min N/A 11+ months

0 N/A N/A N/A N/A
NORC | Designing a Household Survey of Injuries and Illnesses

FINAL REPORT

Household Survey Design Report 

(Deliverable #9)
Survey Design and Questionnaire for a 

Household Survey on Occupational 

Injuries and Injuries

Household Survey Design Report 

(Deliverable #9)

APRIL 21, 2016 PRESENTED TO:

U.S. Bureau of Labor Statistics

2 Massachusetts Ave, NW

WASHINGTON, DC 20212

PRESENTED BY:

NORC at the University of Chicago

Kennon R. Copeland, PhD

Senior Vice President and Director

Statistics and Methodology

4350 East West Highway

Bethesda MD 20814

PHONE (301) 634 9347
NORC | Survey Design and Questionnaire for a Household Survey on Occupational Injuries and Injuries

HSOII SURVEY DESIGN REPORT | I 

Table of Contents 

Executive Summary.................................................................................................................... 1

1. Introduction......................................................................................................................... 3

2. HSOII as Supplemental Module to CPS............................................................................ 5

2.1 CPS Sample Design and Collection Periodicity .......................................................... 5

2.2 CPS-HSOII Survey Design.......................................................................................... 8

2.2.1 Option 1 for HSOII Survey Design: Supplemental questions included in CPS 

every March, following ASEC .......................................................................... 9

2.2.2 Option 2 for HSOII Survey Design: Supplemental questions included in CPS 

every June or July .........................................................................................14

2.2.3 CPS-HSOII Sample Size and Precision...........................................................18

3. HSOII Sample Selected from ACS...................................................................................25

3.1 ACS Sample Design and Collection..........................................................................25

3.2 Option 3 for the HSOII Survey Design: Standalone Survey using ACS Sample.......26

4. Summary ...........................................................................................................................31
NORC | Survey Design and Questionnaire for a Household Survey on Occupational Injuries and Injuries

HSOII SURVEY DESIGN REPORT | II 

List of Tables and Exhibits 

Table 2.1.1: CPS monthly sample sizes ................................................................................................ 6

Figure 2.1.1: Illustration of CPS rotation group (RG) collection schedule ............................................ 7

Table 2.1.2: CPS sample counts by month, RG, and year..................................................................... 8

Figure 2.2.1.1: Illustration of HSOII Option 1 collection schedule: Annual collection in March, prior 

calendar year reference period ........................................................................................ 11

Figure 2.2.1.2: Illustrative flowchart of HSOII Option 1 data collection interview process..................... 13

Figure 2.2.2.1: Illustration of HSOII Option 2 collection schedule: Annual collection in June, prior 12 

months reference period.................................................................................................. 15

Figure 2.2.2.2: Illustrative flowchart of HSOII Option 2 data collection interview process..................... 17

Table 2.2.3.1: HSOII expected sample counts under Option 1 and Option 2 ........................................ 18

Table 2.2.3.2: Sizes, incidence rates by 7-industry grouping................................................................. 19

Table 2.2.3.3: Sizes, incidence rates by 6-occupation grouping ............................................................ 19

Table 2.2.3.4: Expected interviewed sample sizes by 7-industry grouping under Option 1 and Option 

2 ....................................................................................................................................... 20

Table 2.2.3.5: Expected interviewed sample sizes by 6-occupation grouping under Option 1 and Option 

2 ....................................................................................................................................... 20

Table 2.2.3.6: 2014 ACS distributions for weeks worked, usual hours worked for persons aged 16-64 

years ................................................................................................................................ 21

Table 2.2.3.7: Estimated distributions for weeks worked, usual hours worked for persons aged 16+ 

years ................................................................................................................................ 22

Table 2.2.3.8: Estimated distributions for weeks worked, usual hours worked for persons aged 16+ 

years ................................................................................................................................ 22

Table 2.2.3.9: Estimated distributions for weeks worked, usual hours worked for persons aged 16+ 

years ................................................................................................................................ 23

Table 2.2.3.10: Estimated distributions for weeks worked, usual hours worked for persons aged 16+ 

years ................................................................................................................................ 23

Table 3.1.1: ACS sample sizes................................................................................................................... 26

Table 3.2.1: Estimated distributions for weeks worked, usual hours worked for persons aged 16+ years 27

Table 3.2.2: Estimated distributions for weeks worked, usual hours worked for persons aged 16+ years 28

Figure 3.2.1: Illustrative flowchart of HSOII Option 2 data collection interview process........................ 29

Table 4.1: Comparison of Option 1, Option 2, and Option 3 in terms of survey design components....... 31
NORC | Survey Design and Questionnaire for a Household Survey on Occupational Injuries and Injuries

HSOII SURVEY DESIGN REPORT | 1 

Executive Summary 

The Bureau of Labor Statistics is seeking to develop a household survey on nonfatal occupational injuries 

and illnesses (HSOII) to provide information on the level of underestimation of incidence rates from the 

Survey of Occupational Injuries and Illnesses and to provide information relative to the potential reasons 

for the underestimates. This report provides NORC’s recommendations for survey design options 

intended to meet, to the extent possible, requirements in terms of sample representativeness, data quality, 

timeliness, and cost for a HSOII. 

The option identified as best meeting the multiple aims of sample representation, data quality, timeliness, 

and cost (Option 1) is to conduct the HSOII through use of supplemental questions following the Current 

Population Survey (CPS) Annual Social and Economic Survey (ASEC, sometimes referred to as the CPS 

March Supplement) for those sample persons identified as meeting the HSOII eligibility requirements. 

Using the ASEC for eligibility screening and framing of the reference period would result in the lowest 

respondent burden and cost for the HSOII. Although roughly one-third of sample persons would not need 

to be asked any HSOII questions and almost all the remaining sample would be asked only a few 

injury/illness screener questions, the key disadvantage to this option is extended respondent burden for 

the roughly 3% of sample persons that would be asked the full HSOII questionnaire after the CPS and 

ASEC questionnaires. 

Given potential issues with cumulative respondent burden associated with adding HSOII supplemental 

questions to the CPS March Supplement, or to the CPS in January or February when other supplements

are already fielded, a second option (Option 2) is to add supplemental questions to the CPS in June or 

July, when there is no major supplement conducted every year, is also presented. Although slightly more 

costly than the ASEC option and entailing slightly more screening and respondent burden, this option 

does meet the HSOII aims of sample representation, data quality, timeliness, and cost.

Finally, should adding supplemental questions to the CPS not be operationally feasible, an option (Option 

3) that uses American Community Survey (ACS) respondents as a sampling frame for selecting the 

HSOII sample is presented. This alternative, while incurring much higher respondent burden and costs, 

offers flexibility in terms of sample design and stratification to allow targeting selected industries and 

occupations which is not possible with the CPS options.

Both Option 1 and Option 2 with expected numbers of completed interviews ranging from 51,000 to 

57,000 can be expected to have budgets less than $1 million. The sample size for Option 3 is flexible 
NORC | Survey Design and Questionnaire for a Household Survey on Occupational Injuries and Injuries

HSOII SURVEY DESIGN REPORT | 2 

based upon budget; however, keeping budget below $1 million would likely limit number of completed 

interviews to less than 50,000.
NORC | Survey Design and Questionnaire for a Household Survey on Occupational Injuries and Injuries

HSOII SURVEY DESIGN REPORT | 3 

1. Introduction 

The Survey of Occupational Injuries and Illnesses (SOII) is the primary source of information on nonfatal 

workplace injuries and illnesses in the U.S. Existing research points to an underestimate of injuries and 

illnesses in the SOII attributed to a variety of factors including an employer/employee incentive to 

underreport these occurrences.

One way to avoid the filtering effect of collecting establishment data on employee injuries and illnesses is 

to collect data directly from workers in a household survey. In such a survey, workers eligible for the 

survey would be identified and interviewed outside the sphere of the employer. The Bureau of Labor 

Statistics (BLS) has contracted with NORC at the University of Chicago (NORC) to provide assistance in 

the development of a survey design and questionnaire for a household survey on nonfatal occupational 

injuries and illnesses (referred to here as HSOII). 

The sample design for the HSOII must result in a nationally representative household survey of workers 

that allows estimates by employment relationship (employee vs. self-employed), sector (private vs. 

government), industry, and occupation, and meeting publishability/quality and timing criteria for the 

HSOII. 

In an earlier NORC report1

, the CPS and American Community Survey (ACS) were identified as the most 

suitable options for providing the sample frame for the HSOII because they provide sufficient sample size 

to allow both national estimates and estimates by selected groups, and because information collected in 

each of these surveys would be available to ease the identification of eligible respondents. This report 

provides details as to recommended sample design options from the CPS (Option 1 and Option 2) and 

ACS (Option 3).

This report provides NORC’s recommendations for survey design options intended to meet, to the extent 

possible, requirements in terms of sample representativeness, data quality, timeliness, and cost. The 

option identified as best meeting the multiple aims of sample representation, data quality, timeliness, and 

cost is to conduct the HSOII through use of supplemental questions following the Current Population 

Survey (CPS) Annual Social and Economic Survey (ASEC, sometimes referred to as the CPS March 

Supplement) for those sample persons identified as meeting the HSOII eligibility requirements. Given 

potential issues with adding HSOII supplemental questions to the CPS March Supplement, or to the CPS 

in January or February when other supplements are already fielded, an alternative approach that uses 

 

1 Survey Design and Questionnaire for a Household Survey on Occupational Injuries and Illnesses: Report on Suitability of 

Existing Surveys and Frames, December 14, 2015.
NORC | Survey Design and Questionnaire for a Household Survey on Occupational Injuries and Injuries

HSOII SURVEY DESIGN REPORT | 4 

supplemental questions to the CPS in June or July, when there is no major supplement conducted every 

year, is also presented. Finally, should adding supplemental questions to the CPS not be operationally 

feasible, an alternative approach that uses American Community Survey (ACS) respondents as a sampling 

frame for selecting the HSOII sample is presented. This alternative, while much more costly, offers 

flexibility in terms of sample design and stratification to allow targeting selected industries and 

occupations which is not possible with the CPS options.
NORC | Survey Design and Questionnaire for a Household Survey on Occupational Injuries and Injuries

HSOII SURVEY DESIGN REPORT | 5 

2. HSOII as Supplemental Module to CPS

The survey design option identified as best meeting the multiple aims of sample representation, data 

quality, timeliness, and cost is to conduct the HSOII as a supplement to the Current Population Survey 

(CPS) in March of each year, following completion of the Annual Social and Economic Supplement 

(ASEC). Given potential logistical and respondent burden issues associated with fielding the HSOII 

supplemental questions following a major CPS supplement, an alternative would be to field the HSOII 

during June or July when there is no major supplement. 

The key advantages to adding supplemental HSOII questions to the CPS are that the CPS offers sufficient 

sample size for the HSOII, provides at least partially screening of the CPS sample for HSOII eligibility, 

and allows reduced data collection costs through the CPS location, contact, and participation process. 

Depending upon which CPS month the HSOII questions are included, there will be some potential 

cognitive issues associated with discrepant reference periods between CPS and HSOII. Additionally, the 

CPS ASEC provides full screening of the CPS sample for HSOII eligibility, through the Work Experience 

series of questions, thereby minimizing respondent burden among possible CPS alternatives for including 

supplemental HSOII questions. The ASEC also serves to reorient respondents to thinking in terms of job 

and economic experience the prior calendar year as opposed to the prior week as is the case for the core 

CPS. For these reasons, fielding HSOII in March is the preferred alternative.

2.1 CPS Sample Design and Collection Periodicity

The CPS utilizes a national and state-based sample design with (per the BLS Handbook of Methods2) 

approximately 72,000 housing units (HUs) selected from 754 geographically defined PSU’s being 

identified for interviewing each month. Of the 72,000 HUs, approximately 60,000 are eligible, with 

approximately 110,000 persons aged 16 years and older interviewed each month. 2015 CPS data 

provided to NORC by BLS show slightly higher HU sample counts and somewhat lower response rates, 

as shown in Table 2.1.1. 

 

2 BLS Handbook of Methods: Chapter 1, Labor Force Data Derived from the Current Population Survey, 

http://www.bls.gov/opub/hom/pdf/homch1.pdf. 
NORC | Survey Design and Questionnaire for a Household Survey on Occupational Injuries and Injuries

HSOII SURVEY DESIGN REPORT | 6 

Table 2.1.1: CPS monthly sample sizes

The CPS monthly sample is organized into eight rotation groups (RGs), with approximately 9,000 

sampled HUs in each RG, with each RG being a nationally representative sample of HUs under the same 

sample design and yielding approximately 13,000 completed CPS questionnaires for persons aged 16+ at 

more than 6,500 occupied HUs. Each RG is included in the active sample for four consecutive months 

(referred to as months in sample 1 to 4, or MIS-1 to MIS-4), then rested (i.e., not included in the active 

sample) for eight months, then returned to the active sample for a final four consecutive months (referred 

to as MIS-5 to MIS-8, and corresponding to the same four calendar months as initially included in the 

active sample). CPS estimates for a given calendar month are comprised of sample data from the eight 

RGs in the active sample for the month. The CPS rotation scheme is visualized as in Figure 2.1.1.

For example, the RG introduced in Jan, 2016 will be in the active sample (following horizontally in the 

outlined row of Figure 3.1.1) Jan, Feb, Mar, and Apr of 2016 (MIS-1 to MIS-4 for the RG), and again 

Jan, Feb, Mar, and Apr of 2017 (MIS-5 to MIS-8 for the RG). In Jan, 2016 the RG introduced in Jan, 

2016 is in the active sample for its first month in sample (MIS-1) along with (following vertically in the 

outlined column of Figure 3.1.1) RGs introduced in Oct, Nov, and Dec of 2015, and completing their 

respective MIS-4, MIS-3, and MIS-2 in active sample, respectively, as well as RGs introduced in Oct, 

Nov, and Dec of 2014 and Jan 2015, and completing their respective MIS-8, MIS-7, MIS-6, and MIS-5 in 

active sample.

BLS Handbook of 

Methods

2015 Monthly 

Average

HUs Total 72,000 73,744

Eligible 60,000 61,117

w/ Interview1 55,500 53,320

Persons 16+ 110,000 104,000

CPS Sample Counts

Monthly

1

 Interview rates 92%-93% (BLS Handbook of Methods), 87.2% (2015 

Monthly Average)
NORC | Survey Design and Questionnaire for a Household Survey on Occupational Injuries and Injuries

HSOII SURVEY DESIGN REPORT | 7 

Figure 2.1.1: Illustration of CPS rotation group (RG) collection schedule

RG Intro Date Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17

Oct-14

Nov-14

Dec-14

Jan-15

Feb-15

Mar-15

Apr-15

May-15

Jun-15

Jul-15

Aug-15

Sep-15

Oct-15

Nov-15

Dec-15

Jan-16

Feb-16

Mar-16

Apr-16

May-16

Jun-16

Jul-16

Aug-16

Sep-16

Oct-16

Nov-16

Dec-16

Jan-17

Feb-17

Mar-17

Apr-17

COMMENTS:

1) Sample HUs in a RG are interviewed for four consecutive months (referred to as MIS-1 to MIS-4), then again the same four consecutive months the following year (referred to as 

MIS-5 to MIS-8)

2) In each month, sample HUs from 8 RGs are included in the active sample, with the RGs encompassing MIS-1 to MIS-8

Data Collection Month

Shaded boxesin outlined horizontal row below show interview months for RG introduced Jan 2016

1st interview Jan 2016, 4th interview Apr 2016, 5th interview Jan 2017, 8th (and last) interview Apr 2017

Shaded boxesin outlined vertical column to left show RGs interviewed in Jan 2016

RG introduced in Oct 2014 is being interviewed 8th (and last) time

RG introduced in Jan 2015 is being interviewed 5th time

RG introduced in Oct 2015 is being interviewed 4th time

RG introduced in Jan 2016 is being interviewed 1st time
NORC | Survey Design and Questionnaire for a Household Survey on Occupational Injuries and Injuries

HSOII SURVEY DESIGN REPORT | 8 

The CPS yields in the order of 1.25MM annual interviews with persons aged 16 years and older. Given 

the RG structure, however, with the same HUs being in active sample for multiple months, the CPS 

annually interviews on the order of 350,000 unique individuals aged 16 years and older in roughly 

180,000 occupied HUs. Given the proportion of persons 16+ who worked at least one day of the year 

(~65.1% based on data from the ACS), the CPS annually interviews approximately 230,000 unique 

workers eligible for HSOII. Table 2.1.2 provides data relative to CPS sample numbers.

Table 2.1.2: CPS sample counts by month, RG, and year

In each calendar year, there are sample units from a total of 27 RGs in active sample for at least one 

month in the year. Of these, 18 RGs are in active sample for four consecutive months in the year – nine 

for their first through fourth months in active sample, and nine for their fifth through eighth months. 

There are another three RGs in active sample for four non-consecutive months in the year, and six RGs in 

active sample for less than four months in the year.

2.2 CPS-HSOII Survey Design

A HSOII that is a supplemental module or set of questions to the CPS could be designed as one of three 

alternatives: A) include module in all of the RGs in the active sample in one specific month of the year, as 

is the case with current CPS supplements; B) include module in all or a specified subset of the RGs in the 

active sample in several specific months of the year; and C) include module in a specified subset of the 

RGs in the active sample in all months of the year. 

Alternatives B and C, while operational feasible, introduce logistical issues due to the need to coordinate 

with multiple CPS supplements and the potential for differing context effects in fielding the HSOII 

Total Unique2

HUs Total 73,744 9,218 884,928 248,886

Eligible 61,117 7,640 733,404 206,270

w/ Interview 53,320 6,665 639,840 179,955

16+ Interviewed 104,000 13,000 1,248,000 351,000

Workers3 67,687 8,461 812,245 228,444

2

 27 unique RGs are in the active CPS sample at least one month in the year

3

 Based on data from ACS and CPS, an estimated 65.1% of persons 16+ worked at 

least one week in the prior year

Monthly

CPS Sample Counts (Based on 2015 Monthly Average)

RG1 Annual

1

 RG is comprised of 1/8 of the monthly sample
NORC | Survey Design and Questionnaire for a Household Survey on Occupational Injuries and Injuries

HSOII SURVEY DESIGN REPORT | 9 

following different introductory questions sets from the different CPS supplements. Thus, two options 

have been identified for fielding HSOII as a supplemental module or set of questions to the CPS.

The sampling frame for HSOII under both Option 1 and Option 2 will consist of sample HU’s selected for 

the CPS within designated RGs for a specified month. The sample for HSOII Option 1 will consist of all 

CPS sampled HUs in all RGs active in March, while the sample for HSOII Option 2 will consist of all 

CPS sampled HUs in all RGs active in either June or July.

Under both Option 1 and Option 2, all sample HUs within all RGs in active sample in one specified 

month would be included in the HSOII sample. Respondents would be asked to report on injuries and 

illnesses for a 12 month period, whether the prior calendar year (Option 1) or the most recent 12 month 

(Option 2) period. 

From a recall error perspective, while January would be the most desirable month for the HSOII, due to 

being able to collect data for the preceding calendar year with the smallest time gap between the end of 

the reference period and data collection, March is recommended for a different reason – the March 

Annual Social and Economic Supplement obtains employment status within the prior calendar year, and 

thus already collects the screening data for the HSOII. The HSOII supplement could be conducted in 

other months, but the reference period would be the prior 12 months rather than a calendar year, which is 

less desirable.

2.2.1 Option 1 for HSOII Survey Design: Supplemental questions included in CPS every 

March, following ASEC 

NORC’s preferred survey design option for the HSOII is to conduct it annually in conjunction with the

March CPS and Annual Social and Economic (ASEC) Supplement. Among other information, this 

supplement collects information on worker status for the past calendar year. The content and structure of 

this supplement blends well with the HSOII because it sets up the prior calendar year as the reference 

period for the respondent and identifies those HU members who are in the eligible age range and who 

worked in the last calendar year. Since the ASEC supplement would collect the necessary eligibility 

screening, no screening questions will be needed for the HSOII. Rather, data collected during ASEC as to 

work status during the prior calendar year will be used to determine whether to field HSOII questions for 

individual CPS sample persons. Based upon prior ACS and CPS estimates, roughly 35% of CPS sample 

persons did not work at least one week in the prior year and thus would be asked no HSOII questions. 

For the roughly 65% of CPS sample persons that are eligible for HSOII, based upon prior ESOII 

estimates, roughly 95% would be asked only one or a small number of questions to determine they had no 

HSOII-qualifying event within the prior calendar year. Thus, it is expected that approximately 3% of the 
NORC | Survey Design and Questionnaire for a Household Survey on Occupational Injuries and Injuries

HSOII SURVEY DESIGN REPORT | 10

CPS sample persons would be asked the full HSOII set of questions to collect data on their injury and/or 

illness event(s). Given data from ACS on worker status, we would expect just over one-third of 

CPS/ASEC respondents would not be asked any HSOII questions, as they would not have worked in the 

prior year.

Given the CPS rotation scheme, each HU would be interviewed as part of the HSOII for two consecutive 

years in March. Each time, they would recall work-related injuries and illnesses for the prior calendar 

year (January through December); data on injuries and illnesses would thus be collected for a total 24-

month period. However, only the second of the two interviews would be a bounded interview. As 

illustrated in Figure 2.2.1.1, in March 2016, the RGs that entered the sample between December 2015 and 

March 2016 would be interviewed for the Household SOII for the first time in March 2016; these groups 

would be interviewed for a second time in March of 2017.
NORC | Survey Design and Questionnaire for a Household Survey on Occupational Injuries and Injuries

HSOII SURVEY DESIGN REPORT | 11

Figure 2.2.1.1: Illustration of HSOII Option 1 collection schedule: Annual collection in March, prior calendar year reference period

RG Intro Date Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17

Oct-14

Nov-14

Dec-14

Jan-15

Feb-15

Mar-15

Apr-15

May-15

Jun-15

Jul-15

Aug-15

Sep-15

Oct-15

Nov-15

Dec-15

Jan-16

Feb-16

Mar-16

Apr-16

May-16

Jun-16

Jul-16

Aug-16

Sep-16

Oct-16

Nov-16

Dec-16

Jan-17

Feb-17

Mar-17

Apr-17

Data Collection Month

Shaded boxesin outlined vertical column to left show RGs interviewed in Mar 2016

RG introduced in Dec 2014 is being interviewed 8th (and last) time in CPS and 2nd (and last) time in ASEC and HSOII

RG introduced in Mar 2015 is being interviewed 5th time in CPS and 2nd (and last) time in ASEC and HSOII

RG introduced in Dec 2015 is being interviewed 4th time in CPS and 1st time in ASEC and HSOII

RG introduced in Mar 2016 is being interviewed 1st time in CPS and 1st time in ASEC and HSOII

Shaded boxesin outlined vertical column to right show RGs interviewed in Mar 2017

RG introduced in Dec 2015 is being interviewed 8th (and last) time in CPS and 2nd (and last) time in ASEC and HSOII

RG introduced in Mar 2016 is being interviewed 5th time in CPS and 2nd (and last) time in ASEC and HSOII

RG introduced in Dec 2016 is being interviewed 4th time in CPS and 1st time in ASEC and HSOII

RG introduced in Mar 2017 is being interviewed 1st time in CPS and 1st time in ASEC and HSOII
NORC | Survey Design and Questionnaire for a Household Survey on Occupational Injuries and Injuries

HSOII SURVEY DESIGN REPORT | 12

Note, however, that since the CPS is a sample of HUs, not of household members, there will be instances 

in which members of the HU will have moved between Household SOII interviews. In this case, the new 

HU members would be interviewed if they meet eligibility criteria, without use of a bounding interview.

An advantage of Option 1 is the utility of conducting the interview in conjunction with the ASEC; using 

the ASEC for eligibility screening and framing of the reference period will ease the burden for the HSOII. 

However, the reference period for the survey would be the prior calendar year, which begins up to 15 

months prior to the date of the March interview. The longer reference period and more distant beginning 

of the reference period present issues for recall of relevant incidents. This issue is ameliorated to some 

degree by the fact that the ASEC asks questions about the prior calendar year and thus the respondent has 

been keyed in prior to HSOII on thinking in terms of the prior calendar year.

Another advantage of Option 1 is the cost savings which can be realized through a CPS supplement, 

wherein sample location, contact, and participation is carried out through the CPS process.

A disadvantage to the ASEC is extending respondent burden. Typically the CPS takes less than 8 

minutes to complete. However, the ASEC adds 24 minutes to the survey time. The addition of the 

HSOII would make the survey even longer for respondents who experienced illness or injury, by roughly 

10-15 minutes. However, roughly a third of the sample persons would have no additional response 

burden (the roughly 35% not working in the prior calendar year) and just over 60% would have minimal 

additional response burden (of the roughly 65% of sample persons working in the prior calendar year, 

over 95% would only be asked whether they experienced a work-related injury or illness (calculations in 

this report assume an average of 1 minute of respondent burden for HSOII injury/illness screening), and 

would answer in the negative, thus incurring only one minute of additional response burden, based upon 

data from the Establishment SOII). Any sizable increase in respondent burden would be incurred by 

roughly 3% of the CPS sample persons, those answering affirmatively to the HSOII screening question. 

This additional response burden would be on the order of 10-15 minutes (calculations in this report 

assume an average of 12.5 minutes). See Figure 2.2.1.2 for an illustrative flowchart of the HSOII 

interview process and persons following each stream.
NORC | Survey Design and Questionnaire for a Household Survey on Occupational Injuries and Injuries

HSOII SURVEY DESIGN REPORT | 13

Figure 2.2.1.2: Illustrative flowchart of HSOII Option 1 data collection interview process

~1 minute

~1 minute

ASEC: Did not work in 

2015

No HSOII questions

(~35%)

Each Person 16+

~12.5 minutes

Yes

(<5% of 65%=~3%)

End HSOII HSOII Questions

ASEC Completed 

Interview ASEC Nonresponse

ASEC: Worked in 2015

HSOII Screener: Workrelated injury/illness?

(~65%)

No

(>95% of 65%=~62%)

Obtain HSOII 

Cooperation

Occupied Vacant

CPS Sample HU's

CPS Completed 

Interview Nonresponse
NORC | Survey Design and Questionnaire for a Household Survey on Occupational Injuries and Injuries

HSOII SURVEY DESIGN REPORT | 14

2.2.2 Option 2 for HSOII Survey Design: Supplemental questions included in CPS every 

June or July

Recognizing the potential logistical and respondent burden issues associated with Option 1, Option 2 

proposes that HSOII be fielded as a set of supplemental questions following completion of the CPS each 

June or July. Screening questions will be required of all CPS sample persons not identified in the CPS 

interview as employed in the CPS reference or reporting having worked in the prior 12 months as part of 

the CPS unemployment questions. Although the number of screening questions should be small, they 

would be asked of the least the 35% of persons that ACS and CPS estimate as having not worked in the 

prior year. For the roughly 65% of CPS sample persons that are eligible for HSOII, they would be read 

an introductory statement to explain the time period for which questions are being asked to reframe their 

thinking to the prior 12 months. Roughly 95% of these persons would be asked only one or a small 

number of questions to determine they had no HSOII-qualifying event within the prior 12 months. Thus, 

it is expected that less than 5% of the CPS sample persons would be asked the full HSOII set of questions 

to collect data on their injury and/or illness event(s).

Given the CPS rotation scheme, each HU would be interviewed as part of the HSOII for two consecutive 

years in June or July. Each time, they would recall work-related injuries and illnesses for the prior 12 

month period; data on injuries and illnesses would thus be collected for a total 24-month period for 

sample persons. However, only the second of the two interviews would be a bounded interview. As 

illustrated in Figure 2.2.2.1, in June 2016, sample HUs in the RGs that entered the sample between March 

and June 2016 would be interviewed for the HSOII for the first time in June 2016; these groups would be 

interviewed for a second time in June of 2017. Note that the persons interviewed in the overlapping RGs

from one year to the next may not completely overlap, although this will be a small minority. First, as 

CPS is a sample of HUs and not persons, households may have moved from one year to the next. Second, 

HUs interviewed in one year may be nonrespondents the next year, and vice versa.
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Figure 2.2.2.1: Illustration of HSOII Option 2 collection schedule: Annual collection in June, prior 12 months reference period

RG Intro Date Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-16 Jun-16 Jul-16

Oct-14

Nov-14

Dec-14

Jan-15

Feb-15

Mar-15

Apr-15

May-15

Jun-15

Jul-15

Aug-15

Sep-15

Oct-15

Nov-15

Dec-15

Jan-16

Feb-16

Mar-16

Apr-16

May-16

Jun-16

Jul-16

Aug-16

Sep-16

Oct-16

Nov-16

Dec-16

Jan-17

Feb-17

Mar-17

Apr-17

May-17

Jun-17

Jul-17

Data Collection Month

Shaded boxesin outlined vertical column to left show RGs interviewed in Jun 2016

RG introduced in Mar 2015 is being interviewed 8th (and last) time in CPS and 2nd (and last) time in HSOII

RG introduced in Jun 2015 is being interviewed 5th time in CPS and 2nd (and last) time in HSOII

RG introduced in Mar 2016 is being interviewed 4th time in CPS and 1st time in HSOII

RG introduced in Jun 2016 is being interviewed 1st time in CPS and 1st time in HSOII

Shaded boxesin outlined vertical column to right show RGs interviewed in Jun 2017

RG introduced in Mar 2016 is being interviewed 8th (and last) time in CPS and 2nd (and last) time in HSOII

RG introduced in Jun 2016 is being interviewed 5th time in CPS and 2nd (and last) time in HSOII

RG introduced in Mar 2017 is being interviewed 4th time in CPS and 1st time in HSOII

RG introduced in Jun 2017 is being interviewed 1st time in CPS and 1st time in HSOII
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Note, however, that since the CPS is a sample of HUs, not of household members, there will be instances 

in which members of the HU will have moved between Household SOII interviews. In this case, the new 

HU members would be interviewed if they meet eligibility criteria, without use of a bounding interview.

A key advantage of Option 2 is the utility of conducting the interview in conjunction with the CPS, i.e.,

the cost savings which can be realized through a CPS supplement, wherein sample location, contact, and 

participation is carried out through the CPS process.

A disadvantage of Option 2 is the potential for recall error when asking respondents to report any workrelated injury/illness events that occurred in the 12 months prior to the date of the interview. Not only 

will the respondent be asked to recall events from the prior 12 months, but they will also be implicitly 

asked to change their frame of reference from the prior week or month, which is the basis for most of the 

CPS questions, to the prior 12 months. A secondary disadvantage of Option 2 is the need for an 

eligibility question for any sample persons for which it has not been determined whether they worked in 

the prior 12 months. For persons determined through the CPS questions to be currently employed, it is 

known that they are eligible for HSOII. Similarly, for some categories of persons not classified as 

employed, there are CPS questions that may determine the persons to have worked in the prior 12 months 

and therefore eligible for HSOII. However, for all others, it will be necessary to ask a HSOII eligibility 

screener question (calculations in this report assume an average of 1 minute of respondent burden for 

HSOII eligibility screening). Figure 2.2.2.2 provides an illustration of the process flow for HSOII under 

Option 2. Proportions for stream under CPS: Worked in Prior 12 Months are assumptions based upon 

CPS data available from Employment Situation tables.
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Figure 2.2.2.2: Illustrative flowchart of HSOII Option 2 data collection interview process

~1 minute

~1 minute

~1 minute

~12.5 minutes

No

(~97% of 36%=~35%)

Yes

(~3% of 36%=~1%)

Yes

(<5% of 65%=~3%)

HSOII Questions

HSOII Screener: Workrelated injury/illness?

(~65%)

No

(>95% of 65%=~62%)

End HSOII

No

(~90% of 40%=~36%)

Yes

(~10% of 40%=~4%)

HSOII Eligibility 

Screener: Worked in 

prior calendar year?

CPS: Worked in Prior 12 

Months

CPS: Not Employed Last 

Week

(~40%)

Nonresponse CPS Completed 

Interview

CPS: Employed Last 

Week

(~60%)

Each Person 16+

CPS Sample HU's

Occupied Vacant

Obtain HSOII 

Cooperation
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2.2.3 CPS-HSOII Sample Size and Precision

The interviewed sample size for Option 1 could be expected to be smaller than that for Option 1, due to 

the impact of conditional nonresponse to ASEC in addition to conditional nonresponse for HSOII. For 

Option 1, consideration could be given to including the ASEC supplemental samples of 6,500 Hispanic 

HUs and 19,000 CHIP HUs3 which, based upon CPS response rates and ACS worker rates, could add an 

additional 23,406 sample persons eligible for HSOII. However, these ASEC supplemental samples are 

carried out under an extended collection period (Feb-Apr rather than just Mar), which may not be 

advisable for HSOII. As indicated in Table 3.1.2, an expected 67,687 CPS sample persons, less ASEC 

nonresponse4 under Option 1, would be eligible for the HSOII in any given month. See Table 2.2.3.1 for 

expected sample sizes for Option 1 (both using only the March CPS sample and adding in the ASEC 

Hispanic and CHIP supplemental samples) and Option 2.

Table 2.2.3.1: HSOII expected sample counts under Option 1 and Option 2

While the CPS utilizes a state-based sample design, for purposes of discussion, it is reasonable to assume 

that eligible workers in the CPS or combined CPS/ASEC sample will be distributed by industry and 

occupation as is the full population. In the Sampling Frame Report5

, we recommended collapsing across 

industry groups given the sample size associated with CPS. Table 2.2.3.2.a shows a collapsed seven 

industry grouping based on industry size and 2014 estimated injury/illness incidence rate, while Table 

3.2.3.3 shows a collapsed six occupation grouping based on occupation size and 2014 estimated days 

away from work incidence rate. Industry and occupation sizes are based upon 2016 Current Employment 

Statistics (CES) estimates.

 

3 Current Population Survey, 2015 ASEC Technical Documentation (http://www2.census.gov/programssurveys/cps/techdocs/cpsmar15.pdf). 

4 2013 ASEC conditional nonresponse was 10.13% (http://www.lisdatacenter.org/wp-content/uploads/our-lis-documentation-byus13-survey.pdf). Information conveyed by BLS to NORC indicates 2015 ASEC conditional nonresponse was ~15%. For Table 

III.C.1, a 15% conditional nonresponse for ASEC was used.

5 Report on Suitability of Existing Surveys and Frames, December 14, 2015

Eligible Workers CPS Hispanic CHIP Total

CPS Interviews 67,687 N/A N/A 67,687

ASEC Interviews 57,534 5,966 17,439 80,940 N/A

HSOII Interviews* 51,781 5,370 15,696 72,846 57,534

*HSOII conditional response rate assumed to be 90% following CPS+ASEC, 85% following CPS

Option 1: March

ASEC Supplements

HSOII Expected Sample Counts

Option 2:

June or 

July
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Table 2.2.3.2: Sizes, incidence rates by 7-industry grouping

Table 2.2.3.3: Sizes, incidence rates by 6-occupation grouping

Assuming eligible workers in the CPS sample were distributed as the full population, Table 2.2.3.4 and 

Table 2.2.3.5 provide expected HSOII interviews by industry and occupation grouping for Option 1 

(using only March CPS ASEC respondents) and Option 2.

Industry Group Count Proportion Group 2 digit Min 2 digit Max

Agriculture & Goods-producing1 22,096 15.4% 3.8 3.6 5.5

Retail Trade & Transportation2 20,742 14.5% >3.6 3.6 4.8

Professional & Business Services 20,019 14.0% 1.5 0.9 2.6

Health Care and Social Assistance 18,977 13.3% 4.5 N/A N/A

Leisure & Hospitality 15,435 10.8% 3.6 3.5 4.2

Other Service-producing3 26,653 18.6% <2.9 0.7 2.9

State & Local Government 19,273 13.5% 5.0 4.1 5.4

Total 143,195 100.0% 3.4

1

Agriculture & Related Industries (employment from CPS), Mining, Construction, Manufacturing

2

Retail Trade, Transportation

3

Wholesale Trade, Utilities, Information, FIRE, Education, Other Services

Feb 2016 Employment 2014 Incidence Rate

Occupation Grouping Count Proportion Group Occ Min Occ Max

Technical1 14,134 10.5% <0.2 0.08 0.19

Management, Science & Arts2 9,680 7.2% <0.5 0.37 0.48

Office, Sales & Education3 44,323 32.8% <0.6 0.50 0.59

Healthcare & Services4 26,217 19.4% <1.1 0.95 1.10

Production, Construction & Installation5 19,916 14.7% <2.1 1.37 2.03

Support, Maintenance, Protection & Transportation6 20,858 15.4% >2.2 2.21 2.99

Total 135,128 100.0% 1.07

5

Production,Farming/Fishing/Forestry, Construction/Extraction, Installation/Maintenance/Repair

6

Healthcare Support, Building/Grounds Cleaning/Maintenance, Protective Service, Transportation/Material Moving

Feb 2016 Employment

2014 Incidence Rate for Days Away from 

Work

1

Computer/Mathematical, Legal, Business/Financial Operations, Architecture/Engineering

2

Management, Life/Physical/Social Science, Arts/Design/Entertainment/Sports/Media, 

3

Office/Administrative, Sales/Related, Education/Training/Library

4

Community/Social Services, Food Preparation/Serving Related, Healthcare Practitioners/Technical, Personal Care/Service
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Table 2.2.3.4: Expected interviewed sample sizes by 7-industry grouping under Option 1 and 

Option 2

Table 2.2.3.5: Expected interviewed sample sizes by 6-occupation grouping under Option 1 

and Option 2

To determine precision associated with the expected sample sizes, we first estimate the effective sample 

sizes. The design effect associated with national level estimates of the Civilian Labor Force (analogous to 

workers) for the CPS sample is 0.7946

. With the additional impact of nonresponse, we assume the design 

 

6 Technical Paper 66: Design and Methodology, Current Population Survey (https://www.census.gov/prod/2006pubs/tp-66.pdf) 

Industry Group Count Proportion Option 1 Option 2

Agriculture & Goods-producing1 22,096 15.4% 7,990 8,878

Retail Trade & Transportation2 20,742 14.5% 7,500 8,334

Professional & Business Services 20,019 14.0% 7,239 8,043

Health Care and Social Assistance 18,977 13.3% 6,862 7,625

Leisure & Hospitality 15,435 10.8% 5,581 6,202

Other Service-producing3 26,653 18.6% 9,638 10,709

State & Local Government 19,273 13.5% 6,969 7,744

Total 143,195 100.0% 51,781 57,534

Feb 2016 Employment Expected HSOII Interviews

1

Agriculture & Related Industries (employment from CPS), Mining, Construction, Manufacturing

2

Retail Trade, Transportation

3

Wholesale Trade, Utilities, Information, FIRE, Education, Other Services

Occupation Grouping Count Proportion Option 1 Option 2

Technical1 14,134 10.5% 5,416 6,018

Management, Science & Arts2 9,680 7.2% 3,709 4,121

Office, Sales & Education3 44,323 32.8% 16,984 18,871

Healthcare & Services4 26,217 19.4% 10,046 11,163

Production, Construction & Installation5 19,916 14.7% 7,632 8,480

Support, Maintenance, Protection & Transportation6 20,858 15.4% 7,993 8,881

Total 135,128 100.0% 51,781 57,534

6

Healthcare Support, Building/Grounds Cleaning/Maintenance, Protective Service, Transportation/Material Moving

Feb 2016 Employment Expected HSOII Interviews

1

Computer/Mathematical, Legal, Business/Financial Operations, Architecture/Engineering

2

Management, Life/Physical/Social Science, Arts/Design/Entertainment/Sports/Media, 

3

Office/Administrative, Sales/Related, Education/Training/Library

4

Community/Social Services, Food Preparation/Serving Related, Healthcare Practitioners/Technical, Personal Care/Service

5

Production,Farming/Fishing/Forestry, Construction/Extraction, Installation/Maintenance/Repair
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effect for HSOII equals 1.0, and thus the expected sample sizes in Table 2.2.3.4 and Table 2.2.2.5 are 

equivalent to the effective sample sizes.

Sample interviews will take place with both full-time and part-time workers, and with workers employed 

all 52 weeks of the year and those employed for less time. Table 2.2.3.6 presents 2014 ACS data on work 

status, from which estimates of FTEs for the HSOII sample interviews can be derived.

Table 2.2.3.6: 2014 ACS distributions for weeks worked, usual hours worked for persons 

aged 16-64 years

The data in 2.2.3.6 represent persons aged 16-64. It is reasonable to assume that persons aged 65+ are 

less likely to work full-time and less likely to work all weeks in the year. For purposes of this analysis, 

we assumed that the proportion of workers aged 65+ working full-time is half that of workers aged 16-64, 

with the difference equally allocated across part time status categories, and that the proportion of workers 

aged 65+ working 50 to 52 weeks is half that of workers aged 16-64, with the difference equally allocated 

across weeks worked categories. The result, along with distribution for total workers aged 16+ is 

provided in Table 2.2.3.7.

Total Workers

WEEKS WORKED

 Worked 50 to 52 weeks 55.1% 73.8%

 Worked 40 to 49 weeks 5.6% 7.5%

 Worked 27 to 39 weeks 4.7% 6.3%

 Worked 14 to 26 weeks 4.0% 5.4%

 Worked 1 to 13 weeks 5.3% 7.1%

 Did not work 25.3%

USUAL HOURS WORKED

 Usually worked 35 or more hours per week 56.7% 75.9%

 40 or more weeks 50.6% 67.7%

 50 to 52 weeks 47.1% 63.1%

 Usually worked 15 to 34 hours per week 14.4% 19.3%

 40 or more weeks 8.9% 11.9%

 50 to 52 weeks 7.1% 9.5%

 Usually worked 1 to 14 hours per week 3.6% 4.8%

 40 or more weeks 1.3% 1.7%

 50 to 52 weeks 1.0% 1.3%

 Did not work 25.3%

Population 16 to 64 years
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Table 2.2.3.7: Estimated distributions for weeks worked, usual hours worked for persons aged 

16+ years

Based on the distributions by weeks worked and usual hours worked, the average FTE across the worker 

population is 0.80. Assuming this relationship holds across industry, the effective sample size of worker 

years from Option 1 and Option 2, along with expected standard errors and expected relative standard 

errors for estimated injury/illness incidence rates are represented in Table 2.2.3.8 and Table 2.2.3.9. 

Expected standard errors were derived assuming HSOII estimated incidence rates for an industry 

grouping will be 25% higher than those from ESOII.

Table 2.2.3.8: Estimated distributions for weeks worked, usual hours worked for persons aged 

16+ years

16-64 65+ Total

WEEKS WORKED

 Worked 50 to 52 weeks 73.8% 36.9% 71.5%

 Worked 40 to 49 weeks 7.5% 16.7% 8.1%

 Worked 27 to 39 weeks 6.3% 15.5% 6.9%

 Worked 14 to 26 weeks 5.4% 14.6% 5.9%

 Worked 1 to 13 weeks 7.1% 16.3% 7.7%

USUAL HOURS WORKED

 Usually worked 35 or more hours per week 75.9% 38.0% 73.6%

 40 or more weeks 67.7% 26.2% 65.2%

 50 to 52 weeks 63.1% 15.7% 60.1%

 Usually worked 15 to 34 hours per week 19.3% 38.3% 20.5%

 40 or more weeks 11.9% 18.0% 12.3%

 50 to 52 weeks 9.5% 12.6% 9.7%

 Usually worked 1 to 14 hours per week 4.8% 23.8% 6.0%

 40 or more weeks 1.7% 9.4% 2.2%

 50 to 52 weeks 1.3% 8.5% 1.8%

Workers

Industry Group Option 1 Option 2 2014 ESOII HSOII Option 1 Option 2 Option 1 Option 2

Agriculture & Goods-producing1 6,392 7,102 3.8 4.8 0.27 0.25 7.0 5.3

Trade & Transportation2 6,000 6,667 ~3.9 4.9 0.28 0.26 7.1 5.4

Professional & Business Services 5,791 6,435 1.5 1.9 0.18 0.17 11.9 9.0

Health Care and Social Assistance 5,490 6,100 4.5 5.6 0.31 0.30 6.9 5.2

Leisure & Hospitality 4,465 4,961 3.6 4.5 0.31 0.29 8.6 6.5

Other Service-producing3 7,710 8,567 ~1.8 2.3 0.17 0.16 9.4 7.1

State & Local Government 5,575 6,195 5.0 6.3 0.32 0.31 6.5 4.9

Total 41,425 46,027 3.4 4.3 0.10 0.09 2.9 2.2

Expected Relative Standard 

Expected HSOII Worker Years Error for Incident Rate

Expected Standard Error for 

Incident Rate

1

Agriculture & Related Industries (employment from CPS), Mining/Logging, Construction, Manufacturing

2

Wholesale Trade, Retail Trade, Transportation

3

Utilities, Information, FIRE, Education, Other Services

Estimated Injury/Illness 

Incidence Rate
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Table 2.2.3.9: Estimated distributions for weeks worked, usual hours worked for persons aged 

16+ years

For comparison purposes, Table 2.2.3.10 presents relative standard errors from the 2014 ESOII for 

selected industries. 

Table 2.2.3.10: Estimated distributions for weeks worked, usual hours worked for persons aged 

16+ years

As can be seen, relative standard errors for the HSOII will be larger than those for thee ESOII. However, 

for the suggested industry and occupation groupings and assumed HSOII estimated incidence rates, the 

sample size is sufficient to power 95% one-sided tests of differences between ESOII and HSOII incidence 

Occupation Group Option 1 Option 2 2014 ESOII HSOII Option 1 Option 2 Option 1 Option 2

Technical1 4,333 4,814 0.4 0.6 0.11 0.11 25.4 19.3

Management, Science & Arts2 2,967 3,297 1.2 1.5 0.23 0.21 18.4 14.0

Office, Sales & Education3 13,587 15,097 1.6 2.1 0.12 0.12 7.4 5.6

Healthcare & Services4 8,037 8,930 3.2 4.0 0.22 0.21 6.9 5.2

Production, Construction & Installation5 6,105 6,784 5.3 6.6 0.32 0.30 6.0 4.6

Support, Maintenance, Protection & Transportation6 6,394 7,105 8.6 10.8 0.39 0.37 4.5 3.4

Total 41,425 46,027 3.4 4.3 0.10 0.09 2.9 2.2

Expected Relative Standard 

Error for Incident Rate

7

Incidence Rates derived using ratio of injury/illness incidence rates to days away from work incidence rates (3.13) for industry

4

Community/Social Services, Food Preparation/Serving Related, Healthcare Practitioners/Technical, Personal Care/Service

5

Production,Farming/Fishing/Forestry, Construction/Extraction, Installation/Maintenance/Repair

6

Healthcare Support, Building/Grounds Cleaning/Maintenance, Protective Service, Transportation/Material Moving

Expected HSOII Worker 

Years

Estimated Injury/Illness 

Incidence Rate7

Expected Standard 

Error for Incident Rate

1

Computer/Mathematical, Legal, Business/Financial Operations, Architecture/Engineering

2

Management, Life/Physical/Social Science, Arts/Design/Entertainment/Sports/Media

3

Office/Administrative, Sales/Related, Education/Training/Library

Estimated Injury/ 

Illness Incidence Rate

Relative Standard 

Error for Incident Rate

Industry Group 2014 ESOII 2014 ESOII

Natural Resources & Mining 3.8 2.9

Construction 3.6 2.4

Manufacturing 4.0 0.8

Trade, Transportation & Utilities 3.6 0.9

Information 1.4 4.4

Finance, Insurance & Real Estate 1.2 4.2

Professional & Business Services 1.5 2.6

Educational & Health Services 4.2 0.8

Leisure, Entertainment & Hospitality 3.6 1.4

Other Services 2.5 4.1

State & Local Government 5.0 1.6

Total 3.4 0.5
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rates, at the 0.80 level, for all with the exception of the occupation groupings with estimated ESOII 

incidence rates less than 1.5.
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3. HSOII Sample Selected from ACS

If it is determined to not be feasible to include the HSOII as a supplement to the CPS, the preferred

alternative approach would be to select sample from American Community Survey (ACS) respondents 

and conduct the HSOII as a standalone follow-on survey. The key advantages of the ACS as a sampling 

frame for a standalone HSOII are its sample size and the data available from the ACS data collection for 

use in HSOII sample design stratification. In particular, ACS data provides information as to each 

person’s work status, industry, occupation as of the date of the ACS interview. The key disadvantage is 

cost, as HSOII would incur all data collection costs, from location, to contact, to participation, and 

respondent burden, as screening and profile information would need to be obtained from all sample.

3.1 ACS Sample Design and Collection

The ACS utilizes a county/county-equivalent level sample design to select roughly 3.54MM HUs and 

200,000 persons in group quarters (GQs) each year for interviewing. HU sample is released monthly, 

with data collection occurring over a three month period through a combination of mail, web, telephone, 

and personal visit. Personal visit followup occurs in the third month with a sample of residual 

nonrespondents. GQ data collection varies depending on type of GQ, but with a similar annual sample 

design.

The ACS collects data on worker status in the prior 12 months, along with industry and occupation data 

and other demographic and socioeconomic characteristics of interest for stratification of the HSOII. As a 

result, sample size targets could be established by industry group and occupation group, with 

oversampling of specified groups (whereas in the CPS option, sample size distributions by industry and 

occupation groups would be expected to be similar to those seen in the general population).

Given average occupancy data for HUs, total annual sample sizes from ACS are represented in Table 

3.1.1. As can be seen, the ACS sample interviews include roughly 2.3MM workers.
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Table 3.1.1: ACS sample sizes

As with the CPS sample, it is reasonable to assume that the distribution of workers in the ACS sample is 

similar to that in the total population. Thus, any industry which constitutes at least 0.5% of the total 

workforce would be expected to have at least 10,000 sample cases in the ACS.

3.2 Option 3 for the HSOII Survey Design: Standalone Survey using ACS Sample

Under Option 3, the ACS would serve as a sampling frame from which a subsample of HUs and GQs 

would be selected for interview. The design would be stratified by employment relationship, industry, 

and occupation to provide minimally sufficient sample sizes to meet estimation requirements. In addition, 

work status would also be used as a stratifier to improve the efficiency of the design. Although sector is 

the one other dimension of interest for estimates, it is implicitly treated as a stratifier given the proposed 

industry grouping treats state/local government as a separate grouping.

Given the time lag between ACS data collection and likely availability of the ACS data file for use in 

HSOII sampling, the ACS information will have aged and will be out of date for some persons (e.g., HU 

members moved, changes in employment status). The HSOII sample would have to include sample from 

ACS HUs in which there were no workers at the time of the ACS, to ensure full coverage of the target 

population, although at much lower sampling rates. Many of these latter sample would result in finding 

no eligible persons for the HSOII, and thus reduce the efficiency of the sample design.

Stratification for the sample design would look like the layout in Table 3.2.1. ACS HUs and GQs would 

be designated to strata based upon the characteristics of the persons aged 16+ within the HU at the time of 

the ACS interview. Most HUs would have more than one person aged 16+, and thus a hierarchy for 

classifying HUs to strata must be developed. Several approaches could be considered, such as classifying 

the HU based on a hierarchy established among the strata, using the relative population sizes of the strata 

HU Sample GQ Sample

HUs Selected 3,540,532 N/A

Final HU Interviews 2,322,722 N/A

Occupied HUs 1,881,261 N/A

Persons Selected N/A 207,403

Final Person Interviews 4,513,063 165,116

16+ 3,535,344 162,694

Workers 2,271,962 35,793

2014 ACS Sample Size
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to assign HUs to the smallest stratum for which they qualify, or identifying a reference person for each 

HU and classifying the HU based upon that person’s characteristics (e.g., youngest, first person listed).

Table 3.2.1: Estimated distributions for weeks worked, usual hours worked for persons aged 

16+ years

As recommended in the Sampling Frame Report, the number of industry and occupation groupings should 

be limited to five to seven, with effective sample sizes of 5,100 for each industry grouping, occupation 

grouping, and self-employed stratum, given the data collection costs associated with a standalone survey. 

As opposed to Option 1 and Option 2, the industry groupings for Option 3 can be defined as preferred for 

purposes of the HSOII analysis. For example, industries (occupations) with the highest estimated 

incidence rates of with the highest likelihood of incidence rate underestimation could be defined as strata, 

keeping one stratum as a residual industry (occupation).

The sample size designated for the stratum consisting of HUs with no reported worker from the ACS 

would be small, allowing HSOII to represent the full population of workers, but controlling costs as a 

very small proportion of sample from this stratum would be expected to yield eligible person.

Total selected sample sizes would be derived based upon expected design effect, response rates, persons 

interviewed per HU, workers per HU, and FTE per worker. Given differential sampling rates across 

strata and the extremely small sampling rate for the Not a Worker stratum, we can expect design effects to 

be relatively large, perhaps on the order of 1.5 to 2.0. Response rates could be expected to be in the 50% 

Industry Occupation All Weeks Partial Weeks All Weeks Partial Weeks Self-Employed Not a Worker

Ind 1 Occ 1

Occ 2

...

Occ m

Ind 2 Occ 1

Occ 2

...

Occ m

...

Ind n Occ 1

Occ 2

...

Occ m

Overall

Full-time Part-time

Employee

Employment Relationship

Work Status
NORC | Survey Design and Questionnaire for a Household Survey on Occupational Injuries and Injuries

HSOII SURVEY DESIGN REPORT | 28

to 75% range. Average number of workers interviewed per HU will be on the order of 1.4 to 1.6. FTE 

per worker should be at least as great as that in the general population, perhaps 0.8 to 0.85.

Translating these data into selected sample sizes to yield effective sample sizes of 5,100 at the industry 

group, occupation group, and self-employed level is represented in Table 3.2.2. As can be seen, the 

selected sample size of HUs for each industry grouping, occupation grouping, and self-employed could 

range from 7,500 to 18,214 depending on the actual parameters. With 5 industry groupings and 5 

occupation groupings, this would translate into roughly 38,500 to 91,000 selected HUs, plus some 

number of HUs selected from the Not a Worker stratum.

Table 3.2.2: Estimated distributions for weeks worked, usual hours worked for persons aged 

16+ years

The overall the costs of conducting the HSOII as a standalone survey would be much higher than 

conducting it as a CPS supplement, since it will not be possible to take advantage of an existing data 

collection mechanism. In addition, given the outdated information on worker status, some sample HUs 

would yield no HSOII eligible persons while still incurring the cost of contact and screening. Should 

there be any plans for some type of personal visit nonresponse followup, it would be advantageous to 

utilize a PSU design, perhaps overlapping with CPS PSUs to take advantage of experienced Census 

interviewers.

Figure 3.2.1 provides an illustration of the process flow for HSOII under Option 2. Prior to beginning the 

HSOII interview, several steps not required for Option 1 or Option 2 will need to be completed: a) 

obtaining cooperation at the HU (calculations in this report assume an average of 2 minute of respondent 

burden for HSOII cooperation); b) rostering individuals in the HU aged 16+ years (calculations in this 

report assume an average of 2 minute of respondent burden for rostering); and c) collecting demographic 

information for persons aged 16+ years (calculations in this report assume an average of 2 minute of 

respondent burden for collecting demographics). Note that, the proportion of HSOII-eligible individuals 

is assumed to be 80% as opposed to the 65% population average. This is due to the ability to stratify the 

ACS sample into HUs assumed to have HSOII-eligible persons with undersampling of HUs assumed to 

have no HSOII-eligible persons.

Selected HU Sample 13,661 18,214 12,857 17,143 11,953 15,938 11,250 15,000 9,107 12,143 8,571 11,429 7,969 10,625 7,500 10,000

Response Rate 0.50 0.50 0.50 0.50 0.50 0.50 0.50 0.50 0.75 0.75 0.75 0.75 0.75 0.75 0.75 0.75

HU Interviews 6,830 9,107 6,429 8,571 5,977 7,969 5,625 7,500 6,830 9,107 6,429 8,571 5,977 7,969 5,625 7,500

Workers per HU 1.4 1.4 1.4 1.4 1.6 1.6 1.6 1.6 1.4 1.4 1.4 1.4 1.6 1.6 1.6 1.6

Worker Interviews 9,563 12,750 9,000 12,000 9,563 12,750 9,000 12,000 9,563 12,750 9,000 12,000 9,563 12,750 9,000 12,000

FTE Rate 0.8 0.8 0.85 0.85 0.8 0.8 0.85 0.85 0.8 0.8 0.85 0.85 0.8 0.8 0.85 0.85

FTE Interviews 7,650 10,200 7,650 10,200 7,650 10,200 7,650 10,200 7,650 10,200 7,650 10,200 7,650 10,200 7,650 10,200

Design Effect 1.5 2.0 1.5 2.0 1.5 2.0 1.5 2.0 1.5 2.0 1.5 2.0 1.5 2.0 1.5 2.0

Effective Sample 5,100 5,100 5,100 5,100 5,100 5,100 5,100 5,100 5,100 5,100 5,100 5,100 5,100 5,100 5,100 5,100
NORC | Survey Design and Questionnaire for a Household Survey on Occupational Injuries and Injuries

HSOII SURVEY DESIGN REPORT | 29

Figure 3.2.1: Illustrative flowchart of HSOII Option 2 data collection interview process

In a standalone survey, it could be possible to reduce survey cost by including data collection via selfadministered questionnaire (SAQ). Survey respondents could be provided with a mail or Web 

questionnaire to complete independently. Given the screening effort required to identify individuals who 

worked during the survey reference period, and the small percentage of workers who will have 

experienced a workplace injury or illness, conducting some initial screening via SAQ prior to interviewer 

contact could increase efficiency. It would require pretesting to determine whether an initial screening 

~2 min

~2 min

~2 min

~1 minute

~1 minute

ACS Sample HU's

Occupied Vacant

Nonresponse HU Cooperates with 

HSOII

~12.5 minutes

Contact HU

Determine HU Status

Obtain Cooperation

Each Person 16+

Demographics

HSOII Screener: Workrelated injury/illness?

No

(>95% of 80%=~76%)

Yes

(<5% of 80%=~4%)

End HSOII HSOII Questions

HSOII Eligibility 

Screener: Worked in 

prior calendar year?

No

(20%)

Yes

(80%)

Roster 16+
NORC | Survey Design and Questionnaire for a Household Survey on Occupational Injuries and Injuries

HSOII SURVEY DESIGN REPORT | 30

via SAQ would work and whether respondents can report accurately to the employment, injury and illness 

questions that would be included.
NORC | Survey Design and Questionnaire for a Household Survey on Occupational Injuries and Injuries

HSOII SURVEY DESIGN REPORT | 31

4. Summary 

Table 4.1 profiles the three Options relative to survey design components, preliminary estimated 

respondent burden, and preliminary estimated data collection cost per completed interview.

Table 4.1: Comparison of Option 1, Option 2, and Option 3 in terms of survey design 

components

Preliminary estimated respondent burden is based upon assumed respondent burden for required 

components of the HSOII data collection as listed in the illustrative flowcharts for the three Options. 

Preliminary estimated data collection cost per completed interview for Option 1 and Option 2 was 

determined assuming interviewer time would be equal to estimated respondent burden plus 5 minutes per 

interview for review and administrative activities along with an assumed four hour per interviewer 

training in preparation for the HSOII, and that fully loaded interviewer costs are on the order of $30-$35 

per hour. Preliminary estimated data collection cost per completed interview for Option 3 was assumed 

to be on the order of $15-$25 per completed interview by mail or web, based upon similar NORC 

experience and depending upon level of incentives offered.

Option 1 (HSOII implemented following March CPS ASEC supplement) provides the lowest expected 

data collection cost (on the order of $300k-$350k) and average respondent burden (~1.8 min), as it 

ACS-based

Component Option 1 Option 2 Option 3

Max completed interviews

51,781

(could add ~20,000 if utilize ASEC 

supplemental sample)

57,534 up to ~1.5MM

Ability to stratify by I/O No No Yes

Incur cost for sample unit 

locating, contact, participation No No Yes

Need for HSOII eligibility 

screening

No Yes-some Yes-all

Reference Period Calendar year Recent 12 months Recent 12 months

Need to reorient respondent to 

reference period No - already done with ASEC Yes No

Number of years HU in HSOII 2 2 1*

Average respondent burden ~1.8 min ~2.2 min ~7.4 min

Breakout of burden

 Obtain cooperation 100% (ASEC completes) @ 1 min 100% (CPS completes) @ 1 min 100% (sample HUs) @ 2 min

 Roster 16+ in HU none none 100% (participating HUs) @ 2 min

 Demographics none none 100% @ 2 min

 HSOII eligibility screener none 36% @ 1 min 100% @ 1 min

 HSOII injury/illness screener 65% @ 1 min 65% @ 1 min 80% @ 1 min

 HSOII injury/illness questions 3% @ 12.5 min 3% @ 12.5 min 4% @ 12.5 min

Estimated data collection cost per 

complete $5.70-$6.75 $5.70-$6.75 $15-$25

CPS-based

*Sample design could have year-to-year overlap
NORC | Survey Design and Questionnaire for a Household Survey on Occupational Injuries and Injuries

HSOII SURVEY DESIGN REPORT | 32

utilizes existing sample and data collection processes. Collected data would be relative to a calendar year. 

Costs would be related to the cost of the add-on module, questionnaire modifications to accommodate the 

supplemental HSOII questions, and post-survey data processing for the HSOII.

Option 2 (HSOII implemented following June or July CPS) would avoid the issue of conducting the 

HSOII in the same month as a Jan, Feb, or Mar CPS supplement. This option would entail an additional 

screening step for persons not identified as HSOII eligible through the CPS, and thus somewhat higher 

average respondent burden (~2.2 min) and greater data collection cost (on the order of $350k-$400k) than 

Option 1. Collected data would be relative to the 12 months prior to June or July.

Option 3 (HSOII selected from ACS and conducted as a standalone survey) provides the most flexibility 

in terms of stratification and establishing sample sizes for specific industries and occupations. However, 

the average respondent burden associated with Option 3 (~7.4 min) would be roughly three to four times 

greater than that of Option 1 and Option 2. In addition, data collection costs for Option 3 (on the order of 

$15-$25 per completed interview) would be much greater than those for Option 1 and Option 2, due to the 

need for more screening and additional questions under an independent survey environment. Thus, under 

Option 3, between 40,000 and 66,000 completed interviews would incur data collection costs on the order 

of $1 million. In addition, Option 3 would incur costs associated with activities not required under 

Option 1 and Option 2 (sample selection, collecting household roster and demographic data, and sample 

unit locating, contact, and participation). Collected data would be relative to the 12 month period prior to 

the collection period, which could be timed somewhat to BLS preference.
NORC | Designing a Household Survey of Injuries and Illnesses

FINAL REPORT

Report on Existing Questions and Survey 

Instruments on Workplace Injuries and Illnesses 

(Deliverable #6)
FINAL REPORT

Existing Questions and Survey Instruments

Deliverable #6

NOVEMBER 29, 2016 PRESENTED TO:

U.S. Bureau of Labor Statistics

2 Massachusetts Ave, NW

Washington, DC 20212

PRESENTED BY:

NORC at the University of Chicago

55 East Monroe Street, 30th Floor

Chicago, IL 60603

Phone (312) 759-4000

AUTHORS: 

Lisa Lee

Nola du Toit

Rene Bautista
NORC | Existing Questions and Survey Instruments

FINAL REPORT | I 

Table of Contents

Introduction................................................................................................................................. 1

Respondent Reporting of Information on Workplace Injuries and Illnesses ......................... 2

Survey response process............................................................................................ 3

Effects of cues on the survey response process......................................................... 6

Accuracy of event dating............................................................................................. 8

Overview of recall bias in respondent reports in the context of injuries and 

illnesses.........................................................................................................10

Proxy respondents..............................................................................................................12

Sources of error for proxy-reported data in the context of injuries and illnesses ......12

Conceptual Map and Presentation of Existing Surveys........................................................16

Conceptual Map..................................................................................................................17

Existing Surveys .................................................................................................................17

Limitations of Existing Surveys..................................................................................18

The SOII....................................................................................................................18

OSHA log and OSHA Form 301................................................................................19

National Longitudinal Survey of Youth 1979 (NLS79 2014 and NLS79 1993)..........19

Australian Bureau of Statistics: National Health Survey (NHS 2011)........................21

National Health Interview Survey (NHIS 2014 and NHIS 1991)................................22

Health and Retirement Study (HRS 2014) ................................................................23

European Union: Labour Force Survey (EU LFS 2013)............................................24

Discussion................................................................................................................................. 25

Designing the Household SOII ...........................................................................................25

Screener Questions...................................................................................................26

Reference Period. .....................................................................................................28

Survey mode. ............................................................................................................28

Proxies. .....................................................................................................................29

Next Steps ..........................................................................................................................29

References................................................................................................................................. 31

Appendix A................................................................................................................................35

Screener questions.............................................................................................................35

Direct screener..........................................................................................................35

Indirect screener........................................................................................................36

Occupation..........................................................................................................................38
NORC | Existing Questions and Survey Instruments

FINAL REPORT | II 

Direct questions about occupation and industry........................................................38

Employment at time of illness or injury......................................................................41

Description of the illness or injury .......................................................................................42

What happened.........................................................................................................42

Timing of the injury or illness.....................................................................................45

Type of injury or illness..............................................................................................46

Types of health conditions that are not specifically work-related ..............................48

Effect of illness or injury ............................................................................................50

Employee characteristics....................................................................................................54

Appendix B................................................................................................................................55

NLS79 Attachment 8 – code list for injuries........................................................................55

NHIS list of body parts ........................................................................................................56
NORC | Existing Questions and Survey Instruments

FINAL REPORT | 1 

Introduction 

The Survey of Occupational Injuries and Illnesses (SOII), conducted by the U.S. Bureau of Labor 

Statistics (BLS), serves as the primary source of information on nonfatal workplace injuries and illnesses

(Wiatrowski, 2014). In this surveillance system, sampled employers report information on workplace 

injuries and illnesses according to Occupational Safety and Health Administration (OSHA) requirements. 

The requirements for recording occupational injuries and illnesses are defined by OSHA to be recordable 

cases (U.S. Occupational Safety and Health Administration, 2014). In the SOII, private industry and 

governmental entities report data on non-fatal workplace injuries and illnesses over a one-year survey 

reference period (U.S. Bureau of Labor Statistics, 2012). Incidents that must be recorded by employers

are those that result in (1) loss of consciousness, (2) days away from work, (3) restricted work activity or 

job transfer, or (4) medical treatment beyond first aid. 

Undercounting of injuries and illnesses is thought to be an issue for the SOII (Rosenman et al. 2006; 

Boden and Ozonoff, 2008). Various factors may contribute to this undercount. BLS has indicated that 

there may be a filtering effect in the reporting of workplace injuries and illnesses. Filtering occurs when 

barriers to reporting of workplace injuries and illnesses exist (Azaroff, Levenstein, & Wegman, 2002). 

For example, employee reports of work-related injuries or illnesses to employers may be subject to 

filtering because of employee concerns of negative repercussions from the employer, such as job loss or 

being overlooked for promotion. Days away from work may be subject to filtering if employees do not 

report the injury due to inability to afford time off from work. Filtering of reports of medical treatment 

(beyond first aid) that was needed may occur if workers do not realize the connection between their 

medical condition and the workplace, they cannot afford medical care, or health care providers do not 

recognize the work-relatedness of the injury or illness. Even if employees are willing to report, it is 

possible that they do not recognize all the incidents that would be reportable.

BLS has asked NORC to assist in developing a survey design and instrument for a household SOII, in 

which employees would be asked directly about the workplace injuries and illnesses they have 

experienced. In this household survey, a nationally representative sample of workers will be selected and 

surveyed. The Household SOII should collect demographic information, 

industry/occupation/employment relationship, and the nature of the injury and part of body affected. 

Further, BLS has noted that the incidents that would be of interest to collect in the Household SOII would 

include not only those that are OHSA recordable, but other cases as well. For example, federal 

employees and individuals who are self-employed are currently not counted as recordable cases but could 
NORC | Existing Questions and Survey Instruments

FINAL REPORT | 2 

be of interest in a household survey of workplace injuries and illnesses (Monthly Labor Review, June 

2014). In addition, it could be useful to collect information on whether injuries or illnesses that occurred 

were reported to the employer or whether a Worker’s Compensation claim was filed for the injury or 

illness. Although the criteria for the establishment SOII may be too complex for a household survey, the 

survey should collect information that is reasonably consistent with the establishment survey. This would 

allow comparison along the same factors, that is, injuries or illnesses resulting in days off from work, 

restrictions or job transfer, or medical treatment. In addition, the Household SOII would ideally capture 

information about what happened or caused the injury or illness, the employee’s tenure in the job, and 

where the injury or illness occurred. As part of the process of developing this survey, a review of existing 

surveys was conducted to identify questions on workplace injuries and illnesses. We present findings 

from this review of surveys and also present a discussion on the potential effects of recall bias and proxy 

reporting on the quality of data collected from a household survey of workplace injuries and illnesses. 

This report is organized in the following sections. First we discuss issues related to respondent reporting 

and the use of proxy reporting. Following that, we consider the content proposed by BLS for inclusion in 

the Household SOII. Next, we present major surveys, including the employer version of the SOII, that 

collect data on workplace illness and injury, in some form or another, as well as the advantages and 

disadvantages of these surveys as a model for the Household SOII. Finally, we present a discussion of 

considerations in designing the Household SOII and next steps in drafting a questionnaire. The report 

also includes (1) Appendix A, which logs all the relevant questions and response categories from relevant 

surveys, and (2) Appendix B, with code lists from the surveys reviewed. 

Respondent Reporting of Information on Workplace Injuries and Illnesses

The current SOII is designed to gather information on workplace injuries and illnesses from a broad 

spectrum of employer types. In a household version of the SOII, respondents would vary in important 

characteristics that could affect their ability to report, such as age, education level, health status, and 

ability to communicate in English. Unlike employers, who may refer to records to report information on 

injuries and illnesses that occurred, workers may or may not have records from which to report. Records 

such as worker’s compensation forms or medical records may be available to the respondent. 

Respondents can be encouraged to collect records and have them available at the time of the interview. 

However, if respondents have not collected records for the interview, they may have to rely on their 

memory when responding to the survey or rely on others answering on their behalf. Further, if the 

Household SOII is added as a module to an existing survey, it is possible that the parent survey will 
NORC | Existing Questions and Survey Instruments

FINAL REPORT | 3 

constrain the ability to provide respondents with advance instructions on records to have available for the 

interview.

In designing a Household SOII, we will be guided by principles of questionnaire design that are likely to 

produce the most effective questionnaires (Dillman, Smyth, & Christian, 2014; Krosnick & Presser, 2010; 

Bradburn, Sudman, & Wansink, 2004; Tourangeau, Rips, & Rasinski, 2000; Converse & Presser, 1986; 

Sudman & Bradburn, 1983). As survey experts would recommend, survey questions and response 

options should be crafted to use simple, straightforward language. Questions should ask for information 

that respondents would generally be able to provide and response options should cover the range of 

possible answers that respondents would want to give.

In addition to questions that are easy to understand, the burden on the respondent with regard to difficulty 

of providing answers and time required to complete should also be minimized. Based on guidance from 

BLS on what should be included in the survey, it is anticipated that the Household SOII respondent 

questionnaire would not be extremely lengthy. However, the instrument could potentially be difficult for 

respondents due to the type of information requested and level of detail required. Questions that ask for 

information that respondents do not have or that require manipulating information (as may be required 

when attempting to estimate the date of the injury or illness, or length of time in the job) will increase 

respondent burden. 

By following best practices for questionnaire design, we seek to minimize measurement error. 

Measurement error occurs when the true value of a construct being measured in a survey is different from 

the value a respondent provides (Groves, 1989). For example, a respondent who is asked “Have you had a 

work-related injury or illness in the past three months?” might respond “no” even if he had been suffering 

muscle strain resulting from work-related duties, such as lifting heavy objects. Failing to recognize the 

muscle strain as an injury that could be reported or not making the connection to work activities would 

result in measurement error in the form of underreporting. 

Survey response process. In making recommendations for the design of a survey instrument for the 

Household SOII, we are guided by survey response models that highlight what respondents must do to 

successfully answer survey questions (Tourangeau et al., 2000; Dillman et al., 2014; Cannell, Miller & 

Oksenberg, 1981; Strack & Martin, 1987; Turner & Martin, 1984; Tourangeau & Rasinski, 1988; 

Sudman, Bradburn & Schwarz, 1996). These models also guide us in determining how to design 

questionnaires that minimize the challenges that survey respondents face. Respondents must complete 

four tasks to respond to a survey question; note that although the stages are presented sequentially, these 
NORC | Existing Questions and Survey Instruments

FINAL REPORT | 4 

processes may, in fact, occur in parallel. Measurement error can occur at any stage of the survey response 

process.

■ understanding of the question, 

■ retrieving relevant information from memory, 

■ constructing an answer, and

■ reporting a response. 

Comprehension. At the first stage, understanding of a question can be influenced by factors such as the 

wording of the question and the context in which it is asked. To be able to correctly report having 

experienced a workplace injury or illness, workers must recognize that they experienced something that 

counts as an injury or illness and they must also recognize that it is related to work.

For example, the basic screening question in the National Health Interview Survey (NHIS), asks whether 

the respondent or anyone in the family has experienced an injury. Although the term “injury” is familiar 

to most respondents, it may not cue all injuries that would be relevant to a Household SOII. Some 

injuries, such as muscle strain or tendonitis, may be less clearly defined as injuries as compared to cuts 

and fractures. Cuts and fractures often result from a discrete event (such as a fall or other accident) 

whereas conditions such as muscle strain or tendonitis may emerge over time (such as constant lifting of 

heavy items during routine work activities). The term “injury” could bring to mind for some respondents 

only discrete events directly tied to an incident at work in which the injury occurred. If other types of 

injuries are not cued by the question they are unlikely to be reported, resulting in an undercount. 

Although it may be possible to help clarify what kinds of medical incidents count as injuries and illnesses 

by including examples (such as “concussion” or “carpal tunnel syndrome”), the use of medical 

terminology can also pose a barrier to comprehension as well if the examples chosen are unfamiliar to 

some respondents.

Retrieval. At the second stage of the survey response process, the respondent must retrieve information 

from memory that is relevant to respond to the question. The cues to aid recall that are available in the 

question, how recently the relevant events happened, and the salience of the events to the respondent, are 

among the factors that may play a role in recall (Schwarz & Hippler, 1991; Schuman & Presser, 1981; 

Tourangeau & Rasinski, 1988). 

A further consideration is that there may be aspects of an event that the respondent cannot report on 

firsthand. If the worker’s injury or illness was severe enough, proxy report would likely be required. 
NORC | Existing Questions and Survey Instruments

FINAL REPORT | 5 

However, such incidents are likely to be rare. The effects of proxy respondents on measurement error are 

discussed later in this section. Further, there are instances in which the employee may simply not have the 

information required by the survey. For example, although employers are able to report occupation and 

industry information of the employees, the employees themselves may vary in their ability to provide this 

kind of information, particularly industry information.

Judgment and estimation. At the third stage of the response process, the respondent must construct an 

answer to the survey question. Some questions require the reporting of information that most respondents 

can retrieve directly without having to estimate or formulate an answer. Demographic questions such as 

the worker’s age and gender are examples of such items. Many other survey questions require 

respondents to construct an answer in some way with the information he or she has available. For 

example, the SOII asks for information such as hours worked before the incident in question occurred. If 

asked of respondents, this may require them to compute a response based on what they can remember 

about the day of the injury or illness, such as the time they began work and the time the incident occurred. 

With some injuries or illnesses that may develop more gradually, designating a specific time of the 

incident may not be possible (for either employee or employer). In addition to the issues of 

comprehension when injuries or illnesses develop gradually, another issue to consider at this stage of the 

response process is respondent uncertainty about whether an injury or illness that occurred is related to 

work. Some instances, such as being injured by a piece of machinery at work, are clearly work-related. It 

may be less clear to respondents whether to count other injuries, such as hearing loss, as work-related.

Response. At the final stage of the response process, the respondent must provide a response to the 

question. Although sometimes questions allow respondents to answer in their own words, more often 

respondents must choose from a set of response options. To minimize burden and measurement error, 

response options provided for a question should be complete and mutually exclusive. Ability to respond 

may be affected by whether the respondent finds a choice that adequately represents the response he/she 

wants to give. Concerns about privacy and confidentiality may also influence response. In particular, 

respondents who may have been encouraged or pressured by employers not to report the injury or illness 

may have concerns that their survey information will be used against their employer, with negative 

consequences for themselves. A household survey holds promise in allowing respondents to report their 

experiences completely outside the realm of the employer. Yet, if respondents still have concerns about 

the potential impact of revealing information, underreporting could occur.

In addition to issues of privacy and confidentiality, social desirability may lead to overreporting for 

certain conditions (Nelson 1996). Social desirability occurs when respondents want to present 
NORC | Existing Questions and Survey Instruments

FINAL REPORT | 6 

themselves favorably, according to the focus of the survey. Regardless of age, education, or injuryrelated factors and symptoms, respondents who scored higher on a social desirability scale, measured by 

inclination to be honest, helpful, or polite, were more likely to report health-related problems (Willebrand, 

Wikehult Ekselius, 2005). However, while in a study on the validity of self-reporting safety and injury 

within the home, Watson et al (2003) find more underreporting than overreporting. Nederhof (1985) 

suggests using social desirability scales to identify respondents prone to providing invalid data. Also, the 

use of specific forced-choice responses, randomizing response options, and self-administration of the 

questionnaire are used to reduce social desirability (Nederhof 1985).

Effects of cues on the survey response process. Since forgetting increases with the passage of 

time (Ebbinghaus, 1964; Shum & Rips, 1999; Bradburn, Rips, & Shevell, 1987; Wagenaar, 1986 Sudman 

et al., 1996; Tourangeau et al., 2000), longer survey reference periods could produce more extensive 

underreporting as compared to shorter reference periods. Regardless of the time period for which 

employees must report, however, the presence of effective cues will facilitate the survey response 

process. Broadly speaking, cues range from the background information and instructions given to survey 

respondents, to the specific wording of the questions themselves. The cues provided in the survey context 

can help respondents understand the intent of the survey questions (Schwarz & Hippler, 1991; Schuman 

& Presser, 1981) and can also facilitate the recall of relevant information for answering the question (e.g., 

Tourangeau & Rasinski, 1988). In a questionnaire, prior survey questions can also provide context for 

later questions. 

The type of information being recalled is also a factor in how forgetting influences recall accuracy, with 

forgetting varying by topic (Tourangeau, et al., 2000 Wagenaar, 1986; Linton, 1975). As already 

mentioned, autobiographical information, such as respondent age and gender, are timeless inquiries in 

which the survey reference period is not expected to affect accuracy of reporting. Events that are unique 

or more salient may have an advantage for recall. In contrast, recall of event details (such as whether, 

how, and when an injury occurred, and number of work days missed) may be more sensitive to elapsed 

time. Thus, an elapsed time of three months could be appropriate for injuries that required 

hospitalization, whereas superficial injuries may require a shorter elapsed time to minimize

underreporting of incidents (Warner et al., 2015). 

Apart from the rich context that a survey may provide for enhancing respondent understanding of the 

questions and recall of relevant information, simply spending time on the survey task is likely to improve 

the recall process and survey reporting. Providing additional time for respondents to recall information 

may help improve recall. For example, some evidence suggests that longer questions, even those that do 
NORC | Existing Questions and Survey Instruments

FINAL REPORT | 7 

not provide additional content can aid recall and reporting (Sudman et al., 1996; Bradburn, Sudman, and 

Associates, 1979). 

Some survey items may be more effective in cuing respondents than others. For example, the NHIS 

begins with a brief introductory statement that provides time for respondents to comprehend what is being 

asked and begin recall of relevant information. Further the use of randomized cues to types of injuries or 

poisonings enhances respondents’ understanding of what counts and reminds them of specific incidents 

that could be relevant to report. The NHIS screening question on injuries presents one of ten lists of 

injury conditions, with each list containing four items (Chen, Warner, Fingerhut, & Makuc, 2009). The

survey instrument is programmed to randomly select one of the ten lists to be presented. The examples 

are intended to provide cues to comprehension of what counts as an injury and what to include in 

responding to the questions. The use of randomly selected sets of cues is intended to ensure that no 

particular types of injury conditions being cued become overrepresented in respondent reports. As 

described in Appendix III of Chen et al. (2009), frequency data from the National Hospital Ambulatory 

Medical Care Survey—Emergency Department (NHAMC—ED) was examined to determine the 

frequency of different injuries conditions. Frequency of injury condition was used to determine the 

frequency with which the condition appeared across the randomized list of cues. In an analysis of the 

effect of the selected set of examples on reporting, Chen et al. (2009) did not find any evidence that 

reports of an injury were significantly affected by the particular examples given.

Some evidence from a redesign of the National Crime Survey (NCS), the predecessor survey to the 

National Crime Victimization Survey (NCVS), suggests that specific cues can enhance recall (Taylor & 

Rand, 1995). The NCS screener was redesigned to add “short cues” to different kinds of crimes to 

prompt respondents about the different kinds of crimes they may have experienced. For example, for 

questioning on attacks and threats, cues to the types of objects that could have been used in the attack 

were added. Additional screener items cues respondents about various locations in which crimes could 

have occurred and various persons who could have committed the crime. This redesigned screener 

increased reports of some types of crime (Kindermann, Lynch, & Cantor, 1977). For example, reports of 

minor crimes increased relative to reports of major crimes; reports of crimes committed by persons the 

victim knew relative to reports of crimes committed by strangers. These findings suggest that for the 

Household SOII, cuing specific types of injuries and illnesses, places in which they could have occurred, 

and causes of the injuries and illnesses could be effective in cuing recall. 

In their research on food consumption, Tourangeau, Conrad, Couper, and Ye (2014) illustrate how 

providing examples impact the frequency of response and increase accuracy. Unlike Chen et al. (2009), 
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Tourangeau et al. (2014) did find that reports on specific foods consumed were influenced by the 

examples given, with reports higher for a food item when it was cued. The effect was greater when the 

cue was an atypical example of the category. It will be important to clearly define injury and illness. To 

avoid overreporting of specific types of injuries or illnesses, it will be important to provide a wide range 

of examples, perhaps randomized across respondents, that will fit into different categories, such as minor 

or severe injury, or typical versus atypical types of injury or illness. 

Accuracy of event dating. Accurate estimates of workplace injuries and illnesses depend not only on 

successful recall of incidents that occurred, but also accurate recall of dates the injuries and illnesses 

happened. However, people tend to be inaccurate in remembering when events occurred (Bradburn, 

2000). Since the Household SOII is intended to produce annual estimates, respondents must report on 

incidents that occurred during a specified time period, the survey reference period. If the Household SOII 

is conducted as a prospective survey, with sampled households keeping records on workplace injuries and 

illnesses for the duration of the study period, issues of recall bias could be minimized, since workers can 

presumably record incidents as they occur. Recall becomes an issue to the extent that respondents may 

not always record incident in a timely manner. Accurate recall of dates would be essential in a 

retrospective survey design. 

Most surveys tend to require recall of past events. With the passage of time, errors in recalling the date of 

an event increase (Gaskell, Wright, & O’Muircheartaigh, 2000; Neter & Waksberg, 1964; Huttenlocher,

Hedges, & Bradburn, 1990). Because dating error increases with time, when incorrectly reporting the 

dates of events, respondents tend to push more events into the survey reference period than they push out 

of it. Since more events outside the reference period are incorrectly reported as having occurred within it

than the other way around, the net effect is forward telescoping, which is often observed as a “piling up” 

of events at the boundary of the reference period. Establishing accurate annual estimates of injuries and 

illnesses may require procedures to correct for telescoping, such as including a bounding interview (Neter 

& Waksberg, 1964). In longitudinal surveys, respondents would provide information at the baseline 

interview (called the bounding interview) on the injuries and illnesses that they experienced within a 

specified reference period. The information collected in the bounding interview would be used to

eliminate reports from outside the reference period at the subsequent interview. For example, a worker 

who reported a concussion that occurred a few weeks before the baseline interview could potentially 

report that concussion again at a follow-up interview a year later. Information from the baseline 

interview can be used to remind the respondent of the previously reported injury or to confirm with the 

respondent that the concussion reported at the follow-up is a new injury not related to the previously 

reported incident. In this way, bounding improves the accuracy of reports by using the information from 
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prior interviews to reduce reports outside the reference period in later interviews. A cost disadvantage of 

this approach is that obtaining bounded estimates requires an addition interview.

An alternative method proposed by Sudman and colleagues is to bound within a single interview 

(Sudman, Finn, and Lannom, 1984). In this method, within a single interview, respondents are asked to 

recall events that occurred during two different time periods (such as this month vs. last month). In 

comparison to interviews using unbounded recall, Sudman et al. found that the bounded reports alleviated 

telescoping. To implement this technique in the Household SOII, respondents would be asked first about 

work-related injuries and illnesses that occurred more distantly, such as 6 to 12 months ago, and then 

would be asked to report on the incidents that occurred in the last 6 months. Only data from the second 6-

month period would be included in creating estimates. 

Since error in recall of dates increases with elapsed time, a shorter reference period will result in less error 

than a longer one. As will be discussed in the next section, more minor workplace injuries and illnesses 

may be more subject to forgetting. While a shorter reference period would be helpful to minimize the 

effect of memory erosion, it will also reduce the number of self-reports experienced in a short period of 

time. Consequently, the appropriate reference period for the Household SOII will likely depend on 

additional considerations. In other words, given the low incidence of workplace injuries and illnesses in 

the general population, shorter reference periods will greatly constrain the number of individuals who 

would have experienced a relevant incident to report. Although a shorter reference period may yield the 

most accurate reporting, a survey design that incorporates such a short reference period would likely be 

cost prohibitive. Further discussion of the balance between costs and optimal design for reducing survey 

error will be covered in the Household Survey Design Report. 

Some aspects of workplace injuries and illnesses may make them easy to remember. For more severe 

injuries and illnesses, the event itself could be a “personal” landmark event (Gaskell, et al., 2000; Loftus 

& Marburger, 1983). Personal landmark events are unusual or unique events in one’s life. Just as 

graduating from college or getting married could be landmark events, receiving a serious injury such as 

fracture or concussion at work that required time off and medical care could be a landmark as well. For 

these more severe incidents, which would be less likely to be forgotten or dated incorrectly, a longer 

reference period may be feasible. Since the presence of landmark events can help respondents with the 

dating of events, it is possible that encouraging respondents to think of personal landmarks that occurred 

during the reference period can help them both recall and accurately date more minor injuries and 

illnesses that may have occurred. 
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An interviewing tool that makes use of landmark events to enhance recall is the Event History Calendar 

(Glasner, van der Vaart, & Belli, 2012; Freedman, Thornton, Camburn, Alwin, & Young-Demarco, 

1988). In a standard “question-list” approach, respondents are presented with scripted questions and their 

answers are recorded in a set of response options. However, in the EHC approach, respondents 

participate in a more conversational interview in which they record major life events on a calendar as part 

of the interviewing process. Completing the calendar is thought to facilitate the recall of autobiographical 

information and dating of life events by providing more recall cues for respondents than what a standard 

interview format would provide (Belli, Lee, Stafford, & Chou, 2004). For the Household SOII, a possible 

approach would be to use an EHC with a 12-month reference period in which the respondent is asked to 

provide personal landmark events marking three-month intervals. 

Overview of recall bias in respondent reports in the context of injuries and illnesses.

Studies on recall bias in studies of injuries and illnesses demonstrate that respondent reports of injuries 

and illnesses decrease with elapsed time and that this effect is greater for less severe injuries. (Warner, 

Schenker, Heinen, & Fingerhut, 2005; Moshiro, Heuch, Anstrom, Setel, & Kvale, 2005; Mock, 

Acheampong, Adjei, & Koepsell, 1999). Warner et al. (2005) found that error was lowest for reporting of 

less severe injuries when the time between injury and the survey interview was in the range of three to six 

weeks. They found that more severe injuries were less likely to be forgotten and a longer reference period 

of three months would be feasible. In an analysis of injury rates among the general population in a region 

in Tanzania, Moshiro et al. (2005) found similar results for recall of injuries for a recall period of 12 

months. In the month prior to the interview, reports of both minor and severe injuries were greater than in 

succeeding months of the year, with the decline in reporting being greater with elapsed time for more 

minor injuries. Similarly, in a study with a sample of the general population in Ghana, (Mock et al., 

1999) conducted a month-by-month analysis of reporting of injuries showed that rates of injury for 

months closer to the interview date than for months at the end of the reference period of 12 months. 

Consistent with other studies, Mock et al. found more severe injuries were less subject to forgetting than 

less severe injuries. 

The effect is seen in proxy reports as well (Harel et al., 1994)–a further elaboration of other issues related 

to proxy response is presented later in this report. In the NHIS 1988 Child Health Supplement, which 

included proxy reports of injuries sustained by children, adult household members were asked to report 

injuries that occurred over the last 12 months. Harel et al. (1994) compared one-month recall periods 

across the reference period. They found that estimates of injury rates based on a recall period closest to 

the interview were higher than estimates based on more distant months. These findings also hold true for 
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reports of workplace injuries among older workers in the Health and Retirement Study (Zwerling et al., 

1995).

In a study using data from the NHIS, evidence of forward telescoping was shown in a higher average 

number of injuries and poisonings reported in the last week of the reference period (Warner et al., 2005). 

It is likely that respondents reported some incidents that happened outside the reference period. If the 

Household SOII were to take the form of a panel survey, it would be possible to implement bounding 

procedures, in which incidents reported during the previous interview are not double-counted in the 

current one. This would allow for more accurate placement of incidents in the appropriate reference 

period. However, as the studies reviewed on recall bias (e.g., Warner et al., 2005; Moshiro et al., 2005; 

Mock et al., 1999), forgetting of injuries and illnesses that occurred may be the greatest barrier to

obtaining accurate estimates. Improving the accuracy of estimates of workplace injuries and illnesses will 

require addressing issues of increased forgetting through the use of both appropriate reference periods and 

the use of effective cues to enhance recall. 

A review by Heinen, McGee, & Warner (2004) of injury questions used in household surveys in 14 

different countries found broad differences in methodology, the criteria for inclusion of the injury in the 

survey, and the length of the reference period. For example, some surveys allowed the use of proxy 

respondents while others did not. The definition of an injury varied in terms of severity and whether the 

respondent required medical attention or was limited in activities. Further, the reference period varied 

from 15 days to one year, with most surveys requiring recall for at least three months. Although not all 

surveys cited in this article have been reviewed yet, NORC will conduct further review to determine 

whether we can draw on any of the surveys in drafting the Household SOII.

A report on cognitive testing that was conducted on the NHIS questions on injuries and poisonings 

reveals some of the difficulties with survey response that respondents can encounter (Miller, Whitaker, 

Beatty, & Wilson, 2002). The cognitive testing was conducted on the 2002 NHIS questions on injuries 

and poisonings. The researchers found that the scope of the words “injury” and “poisoning” was not 

sufficiently understood by respondents. The term “injury” tended to cue more serious incidents; 

respondents did not consider the full range of severity for injuries that would be in scope for the survey. 

Similarly, understanding of the term “poisoning” was not broad enough to include all potential types of 

poisoning. The results also showed limited understanding of what counts as “medical treatment,” 

excluding tests such as x-rays from consideration. The cognitive interview results also revealed that 

respondents miss some information when questions are too lengthy; for example, they forgot to include 

poisoning in their answer. Further, respondents revealed the difficulty of reporting for others in the 
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family, either because they did not know the circumstances for others in the household or simply forgot to 

include others in their responses. 

Proxy respondents 

Proxy respondents serve as survey replacements in situations when the selected individuals are unable to 

report information about themselves (for example, minors or impaired respondents). Similarly, proxy 

informants are used when selected individuals are not available at the time of data collection. The 

selected respondent may be, for example, on an extended trip or institutionalized (such as in a hospital or 

correctional facility). Furthermore, proxies are sometimes used for cost efficiency reasons; for example, 

to minimize multiple visits in a household, multiple interviews in an establishment survey, or to reduce 

the number of callbacks in a telephone survey (Clarridge & Massagli, 1989; Cohen, 2008; Mingay, 

Shevell, Bradburn, & Ramirez, 1994; Moore, 1988; Nelson, Longstreth, Koepsell, & Van Belle, 1990). 

While survey protocols allow the use of proxy reporting to increase response rates (and minimize the 

possibility of nonresponse bias), as in any other survey design, the use of proxy informants involves other 

trade-offs. Namely, the information reported by proxies may differ from the actual answer that the 

selected individual would have provided (Cohen, 2008). Proxy-provided information is subject to 

measurement error. That is, proxy respondents may not be able to provide information accurately due to 

telescoping or memory erosion, low saliency of the biographical event, or because the selected individual 

chose not to reveal information to others (Mingay et al., 1994). 

Different mechanisms of the proxy interviewing process can contribute to two components of the 

measurement error; namely, bias and variance. Consequently, information provided by proxies can 

potentially produce estimates whose uncertainty varies due to different levels of error that occur at 

random (i.e., not in a consistent direction) or estimates that are likely to be biased due to a systematic 

under- or overreporting of information (Cohen, 2008; Nelson et al., 1990). 

Sources of error for proxy-reported data in the context of injuries and illnesses 

The literature on proxy response includes a study suggesting that proxy reports are likely to increase in 

quality when proxy respondents are familiar with the situation of the selected sample person. Namely, in 

the context of labor force activities (i.e., number of hours worked for pay last week), Kojetin and Mullin 

(1995) found that proxies who indicated that they were familiar with an individual’s labor activities 

(through communication with the individual, reading directly about the event, or by noticing the person’s 

activities) were more likely to provide consistent information about the person, compared to proxies who 
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did not have this familiarity. Furthermore, it also appears that spouses tend to be better proxies than 

siblings or relatives (other than parents) when reporting on behalf of the individual (Kojetin & Mullin, 

1995). 

Although familiarity with the person’s situation may be a quality indicator of proxy-provided data in 

general, the type of illness or symptom is an important factor. Magaziner, Bassett, Hebel and GruberBaldini (1996) indicate that when illnesses are likely to be known by others —such as chronic 

conditions— the chances of underreporting decreases; but when less noticeable conditions are not shared 

with other members of the household, conditions are likely to be underreported. For instance, in a study 

focused on information provided by at-home female proxies, arthritis tends to be better reported 

compared to other less well defined conditions such as sleeplessness (Clarridge & Massagli, 1989). 

Furthermore, Bassett, Magaziner and Hebel (1990) suggest that the type of illness combined with the role 

in the family may have an impact on the data reported. The authors found that husbands tend to 

underreport less noticeable illness of wives such as depression compared to other informants in the 

household such as daughters. The same effect of visibility on reporting for injuries may hold as well. We 

may expect, for example, that an injury that limits the full range of arm motion would only be noticeable 

if the injured individual attempted an action that required full motion. Concussions as well may be 

difficult to discern unless a bruise or cut were also associated with the head injury. That is, a possible 

decline in cognitive abilities due to a concussion may not be immediately distinguished from other factors

that could have caused the decline, such as aging. 

A study conducted among older women —who were asked to nominate a person who knew them well 

enough to report on their behalf— indicates that cognitive status is better reported compared to affective 

status (Bassett et al., 1990). According to Bassett and colleagues (1990), the bias (albeit small) found in 

their study regarding affective measures could be explained by the fact that cognitive questions are less 

open to interpretation. For instance comparing “Could the respondent tell me today’s date” (i.e., a 

cognitive measure) would yield more consistent answers in the respondent-proxy pair, in contrast to “Do 

you think the respondent, in the past two weeks has ever felt depressed or very unhappy” (i.e., an 

affective measure) —despite the fact that the proxy informant seemed to know the individual well. 

Besides cognitive and affective measures for assessing familiarity with respondent, questioning about 

physical, observable conditions may also provide a measure of quality. Clarridge and Massagli (1989) 

examine the number, nature, and length of exposure for health conditions as they related to reporting bias 

among proxies. They found that length of exposure related to physical complaints, such as joint pain, 

backache, chest pain, or problems with eye or ears, as well as vision or hearing, aided in the accuracy of 

reporting. 
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In a study conducted among older individuals selected for a longitudinal study, proxy respondents were 

more likely to provide consistent reports of stroke over time than intended individuals, presumably 

because a stroke may affect some cognitive functions among survivors (Beckett, Weinstein, Goldman, & 

Yu-Hsuan, 2000). Similarly, Turner and colleagues (1997), report that proxy respondents seem to provide 

more reliable reports than elderly individuals with chronic obstructive pulmonary disease (characterized 

by shortness of breath and cough), a condition that typically worsens over time. 

In studying the effects of cohabitation, Shardell and colleagues (2012) found that among hip fracture 

patients, discrepancies on disabilities and depressive symptoms between self-reports and proxy-provided 

reports decrease when proxies have lived with the intended individual for one year or more. Nonetheless, 

Shaw, McColl and Senga (2000) documented that proxies not cohabitating with the selected individual 

(and with less frequency of contact with the individual), yield better proxy-respondent agreement than 

those in close proximity. It is possible that the nature of metrics could explain these results. In Shaw and 

colleagues’ (2000) study, the metrics of interest were focused on independent living status or functional 

capacity (i.e., cutting food, washing hair, dressing, ability to go to the toilet, and others). Presumably, 

more distant proxy respondents were able to observe the individual’s condition in a more objective way, 

compared to proxies in cohabitation. Biases found in Shaw’s (2000) study suggest that such proxies tend 

to under-report the individual’s abilities and over-report their dependence. 

A recent study of usability testing conducted through eye-tracking technology for online questionnaires 

suggests that when respondents provide information about themselves, they take longer to answer relative 

to situations where they report on behalf of others living in the same household (Olmsted-Hawala, 

Holland, & Nichols, 2014). Olmsted-Hawala and colleagues (2014)0 examined number of fixations, 

duration of fixations on questions and answers, and number of times respondents rechecked questions and 

answers. Based on these qualitative examinations of eye-tracking patterns, the researchers suggest that 

when proxies are more certain of information they are reporting on behalf of others, they spend more time 

on the question; when they are unsure, they tend to guess or fabricate data to move on quickly, especially 

if a skip option is not provided. 

In many household surveys, proxies are used to provide information on other members of the household. 

For example, the NHIS collects health information for all household members from one household 

respondent. The Consumer Expenditure (CE) survey currently asks one household respondent to provide 

expenditure information for other household members. 1

 Recognizing the issues with data quality in 

 

1 Information on the Consumer Expenditure Survey can be found at: http://www.bls.gov/cex/
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asking one household member to report for others, redesign efforts for the CE survey have focused on 

methodologies allowing for the collection of expenditure information from all household members ages 

15 and older. 2

 As an additional example, the NCVS, which collects information on the number of crime 

victimizations and characteristics of these incidents over the past six months interviews all eligible 

household members ages 12 and older. The collection of data directly from individuals rather than by 

proxy is intended to capture more complete data on victimization, since proxy respondents may 

underreport number of incidents or details of those incidents. 3

Although obtaining information directly from a respondent rather than by proxy may yield higher data 

quality, cost considerations often dictate the use of proxies. To maintain data quality at the highest extent 

possible, it will be important to select the household member that is considered most knowledgeable 

about the health status of other household members. In addition to selecting the respondent who is most 

knowledgeable, the interview protocol should allow respondents an avenue for indicating for which 

questions or household members they do not feel confident reporting about. However, flexibility in 

selection of the household respondent will vary depending on the design of the Household SOII. If the 

Household SOII design entails adding a module to an existing survey, then the Household SOII will likely 

follow the respondent selection criteria for the survey to which the module is added. As a standalone 

survey, the Household SOII would have the flexibility to adopt the criteria deemed optimal for collecting 

data on workplace injuries and illnesses. Optimally, the ideal proxy respondent would be the one most 

familiar with the circumstances of the individual for which he/she is reporting. In a household with 

multiple members, however, it is possible that no single respondent is the most knowledgeable about all 

other respondents. 

As part of the cognitive testing, the quality of the proxy data could potentially be assessed by 

interviewing, whenever possible, both the proxy and the sample member about whom proxy reports were 

obtained. The degree of concordance between the proxy-reported and self-reported data can be 

compared. However, this would add burden to participating households and complexity to the pretest 

procedures. As an alternative measure of data quality from proxies, household members can be asked to 

provide an assessment on the ability of each potential proxy respondent to provide data on them. The 

concordance among household members on which individual is the best able to report may provide 

guidance on how to construct a protocol for selecting the household respondent for the Household SOII.

 

2 Information on the redesign of the Consumer Expenditure Survey can be found at: http://www.bls.gov/cex/geminiproject.htm

3 Information on the National Crime Victimization Survey and guidance on proxy reporting can be found at: 

http://www.bjs.gov/index.cfm?ty=dcdetail&iid=245, http://www.bjs.gov/content/pub/pdf/ncvstd13.pdf
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To make a more definitive recommendation on the ideal selection process for the household respondent, 

NORC proposes an examination of the selection process used in other national surveys. Given that 

accurate reporting for the Household SOII depends on knowing that an individual experienced an injury 

or illness and that the incident was work-related, methodological literature on proxy reporting of work 

history and health status will likely yield the best information. If this examination would be useful, we 

will identify available methodological reports and published papers for surveys such as the NHIS, the 

Behavioral Risk Factor Surveillance System (BRFSS), Current Population survey (CPS), and others to 

determine best evidence-based practices.

As part of the cognitive testing, we will need to consider options for testing the household respondent 

selection process and quality of proxy data. Although testing of respondent pairs is an option, this adds 

complexity to the interview process. Data quality could also be assessed via comparison of the data with 

records (such as health records, workers compensation claim forms). However, asking respondents to 

provide this information adds burden and may discourage interview participation. Further, if records are 

requested in advance of the interview, respondents may review the records prior to the interview, 

allowing them to report more accurately. 

Conceptual Map and Presentation of Existing Surveys

The section includes two parts. First we present key concepts identified by BLS as required in the 

Household SOII. We also include optional items that may be included in the survey. The purpose of this 

first section is to present the concepts that we aim to measure with the Household SOII. 

In the second part we review several major large-scale surveys that can be used to inform the Household 

SOII. We also discuss data collection tools, such as the OSHA log, that include information about 

employment injury and illness. We focus on the concepts captured in these surveys as they relate to the 

Household SOII and include a discussion of their strengths and weaknesses. These surveys are included 

to illustrate the types of information captured in other surveys, but also their limitations. These existing 

surveys will be used to inform the Household SOII questionnaire. 
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Conceptual Map

We created the following conceptual map of the Household SOII (Figure 1). Variables identified as 

important by BLS are noted, along with suggestions that emerged from our review of existing surveys.

Figure 1: Conceptual Map for the Household SOII

Domain Sub domain Details Timing or type Levels

Screener

Direct Any injury/illness Most severe flag Caused by work

Indirect Health conditions Most recent flag Made worse by work

All injury/illness (loops)

Occupation/industry

Industry Relationship (e.g. contractor) At time of injury/illness Length of time at job

Occupation Sector (e.g. gov, public) Current Job history

Type (e.g. self-empl)

Level (e.g. full time)

Illness/injury

Illness Event (e.g. fell of ladder) At time of accident Days from work

Injury Source (e.g. ladder) Long-term effects Worker's compensation

Body part (e.g. head) Reporting

Location of injury/illness Transfer/restriction

Number of accidents Medical attention

Conditions (e.g. neck pain)

When it occurred, timing

Demographics

Respondent Age/DOB

Household roster Race/ethnicity

Sex/gender

Current employment

Proxy

Respondent

Proxy

LEGEND

Requested by BLS

Suggested by NORC

Structural

Existing Surveys

We consulted multiple sources of information, including current literature on accidents and injuries, 

academic research centers, such as ICPSR, and general internet searches, to discover surveys that include 

measures of accidents and injuries that would be relevant to a Household SOII. Below we discuss the 

limitations to the surveys in general. Following that we present the advantages and disadvantages of each 

survey as they pertain to injury and illness at the workplace. Together these surveys can inform a 
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Household SOII, but they also illustrate the dearth of measures compatible to the establishment SOII. We 

will keep these limitations in mind when crafting items for the Household SOII. 

Limitations of Existing Surveys

This section illustrates the types of information captured by other surveys, but also notes limitations. 

Overall, we find the following limitations. First, surveys vary by focus. To some extent, they capture 

injury, illness, poisonings, or accidents. However, no one survey captures all these items as they relate to 

work. In addition, they do not capture accidents that did not result in injury, or the effects of illness that 

were exacerbated by the workplace. Second, they do not completely capture all illness and injury. Some 

surveys ask for the most recent, while others only ask about the most severe. Yet others ask about all 

injuries directly tied to work, but neglect illness that results from work, but manifesting later in life. 

Third, the primary survey for comparison, the establishment SOII, is limited in its scope by only 

including in the sample certain types of employers and excluding those who are self-employed, part-time, 

or performing contract work. A fourth limitation to existing surveys is that they do not clearly outline

which injuries or illness were reported to the employer and thus captured in the establishment SOII. 

While the existing surveys present many options, none of the surveys are ideal. Consequently, while 

using the surveys discussed below for guidance, NORC will craft new measures for the Household SOII. 

The sections below present the surveys we examined, their primary concepts, as well as their strengths 

and weaknesses. In addition, Appendix A presents the actual survey items. The Appendix classifies the 

questions into four types, focusing on the key concepts that should be measured in the Household SOII: 

(1) screener questions, (2) occupation and industry of the employee, (3) incidents of work-related injury 

and illness and questions that details of the incident, and (4) employee characteristics.

The SOII

The SOII captures the items listed below. While the Household SOII will collect data that is also 

reflected in the SOII, it will extend beyond this survey to include data from the population outside the 

SOII’s scope, including the self-employed and private households. 

SOII survey

Employee name

Job title

Date of injury or onset of illness

Number of days away from work

Number of days of job transfer or restriction

Type of work, date hired or length of service

Medical care—emergency room, in-patient treatment

Time employee began work

Time of event

Timing—before, during, after work shift

Description—what happened, what was the 

injury/illness, what object or substance harmed the 

employee
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SOII survey

Demographics: age, racial and ethnic background, 

gender4

OSHA log and OSHA Form 301

These forms are completed by employers for each recordable incident of workplace injury or illness. 

Employers use these records to inform the SOII. BLS has expressed interest in capturing incidents 

beyond those that meet the criteria for being recordable incidents. Examples of cases that are beyond the 

criteria for recordable incidents include incidents involving employees who are not in scope, such as 

private contractors, workers on small farms and those who are self-employed. 

The concepts recoded in the OSHA documents include: 

OSHA log

Job title

Date hired

Where the event occurred

Describe injury or illness, parts of body affected, and 

object/substance that directly injured or made person ill.

Check only one box for the most serious outcome for 

that case (e.g., DAFW or DJTR)

What was the employee doing just before the incident 

occurred? 

What happened?

What object or substance directly harmed the 

employee?

Date of injury or onset of illness

Date of injury or illness

Time employee began work

Time of event

If the employee died, when did the death occur?

Type: Injury

Type: skin disorder

Type: Respiratory condition

Type: Poisoning

Type: Hearing loss

Type: All other illnesses

Days away from work

Job transfer or restriction

Other recordable cases

Days away from work

Days on job transfer or restriction

OSHA form 301

Date of birth

Sex

What was the injury or illness?

Name of physician or other health care professional

If treatment was given away from the worksite, where 

was it given?

Was employee treated in an emergency room

Was employee hospitalized overnight as an inpatient?

National Longitudinal Survey of Youth 1979 (NLS79 2014 and NLS79 1993) 

The NLS79 is a longitudinal study with a nationally representative cohort of 12,686 American men and 

women born between 1957 and 1964. The NLS79 is conducted by the Bureau of Labor and Statistics. 

Launched in 1979, the biennial survey collects data on labor force participation, education, household 

characteristics, dating and marriage, income, health, attitudes, and crime and substance abuse. The 

 

4 Reporting of race and ethnicity on the SOII is voluntary.
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NLS79 also periodically includes supplements to the core questionnaire. Beginning in 1988, the NLY79 

started collecting data on work-related injury and illness. The NLS79 (1993) included questions that 

asked respondents (R) about their health and injuries at work.

The NLSY questions collect a wide array of information of relevant to the Household SOII, including the 

following topics:

A screener question that asks for incidents at any job 

that resulted in an injury or illness

Asks for month/year instead of exact date of incident

Asks for activity at time of incident (e.g., meal break, 

normal work activity)

Part of body affected

Type of injury (illness?) it was

Total days missed

Did injury (illness) cause lay off, quitting of job, firing

Which of injury/illness discussed was most severe?

Did injury cause missed work, reassignment, working 

less than full time, reduced duties

Screening for injury and illness: As part of the NLSY survey the respondent reports on all jobs held 

since the last interview. When answering the questions on injury and illness, the respondent would have 

already reported on these jobs. The respondent is asked about any incident at any of these jobs that 

resulted in injury or illness. The respondent must respondent “yes” to this screener question before being 

asked for details about the incident.

Advantages: The NLSY survey covers both injuries and illnesses. Also, at the time the respondent 

answers questions about injuries or illnesses experienced, he/she has recalled all jobs held in the reference 

period. The prior recall of jobs held may enhance recall of work-related incidents, since it allows the 

respondent time to think about all jobs held. For respondents with multiple jobs, reporting jobs held first 

may help the respondent account for all jobs in formulating an answer to the injury and illness question. 

Finally, the NLS79 has good coverage of the measures in the SOII (see Appendix A). 

Disadvantages: There is only one screener question, and so only one opportunity to capture relevant 

incidents. A response of “no” to the screener question could result in underreporting. There are no 

explicit cues regarding the types of injury and illness that are relevant to the survey. Some types of injury 

and illness may be easily recalled but respondents may be unaware of the full scope of incidents that 

should be reported. This could lead to underreporting of certain types of injuries and illnesses. 

Helpful links

NLS79 (2014)

https://www.nlsinfo.org/content/cohorts/nlsy79

https://www.nlsinfo.org/content/cohorts/nlsy79/other-documentation/questionnaires

https://www.nlsinfo.org/sites/nlsinfo.org/files/attachments/141219/nlsy79r26mainquex103114_ONJOB

S.html

NLS79 (1993) 
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https://www.nlsinfo.org/sites/nlsinfo.org/files/attachments/121210/11.Health.html

Australian Bureau of Statistics: National Health Survey (NHS 2011)5

The National Health Survey is a household survey conducted by the Australian Bureau of Statistics 

(ABS) in 2011/2012. Data are collected using Computer Assisted Personal Interview (CAPI), as well as 

face-to-face interviews. The survey collects basic demographic and relationship data on all household 

residents. Data are also collected on the health and socio-economic characteristics of a randomly selected 

adult and child aged 0 to 17 years. Questions include long term health conditions and health-related risk 

factors, such as smoking and alcohol consumption. Physical measurement are also taken from 

respondents and children over age 2. The NHS 2011/2012 includes data on 18,355 households.

This survey includes questions on the following topics related to the Household SOII: 

A screener question on whether a condition the 

respondent reported is the result of an injury.

Age when injury occurred 

Where injury occurred (e.g., work, school, etc.)

Screening for injury: This survey collects information on the respondent’s medical conditions. 

Following that, the survey asks whether the conditions resulted from an injury. The survey collects 

relatively limited information about the injury.

Advantages: Thinking about current medical conditions may help cue recall of workplace injuries that 

would be relevant for the Household SOII. Although asking about current medical conditions would not 

capture all the incidents of interest in the Household SOII, it is worthwhile to consider questions on 

medical conditions as cues to recall.

Disadvantages: Medical conditions due to workplace injuries that are resolved by the time of the survey 

would not be reported. Also, conditions that may develop gradually, such as carpal tunnel syndrome or 

muscular and skeletal disorders that respondents may not associate with a specific injury, are also not 

covered by this survey.

Helpful links

http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/03622F616EBBFE87CA257B8D00229E7F?opendocument

http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/4363.0.55.001Chapter2002011-13

http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/4363.0.55.0012011-13?OpenDocument

 

5 We are currently attempting to contact staff at the Australian Bureau of Statistics to obtain a copy of the Multipurpose Household Survey 

(MPHS). The MPHS is a questionnaire module fielded as part of the Labour Force Survey. This module contains questions on Accidents at 

Work.
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National Health Interview Survey (NHIS 2014 and NHIS 1991) 

Since 1957, the NHIS has monitored health in the U.S. The survey is conducted by the National Center 

for Health Statistics (NCHS) which is part of the Centers for Disease Control and Prevention (CDC). The 

household survey covers a wide range of topics. The Core questionnaire includes demographic 

information about everyone in the household. Health status, injuries, access to health care and utilization, 

health-related behaviors, and activity levels, as well basic income and demographic data, is collected from 

a randomly selected adult and child in the home. The NHIS (2014) included data from 44,552

households.

Besides the core questionnaire, the NHIS also includes supplemental surveys that include topics relevant 

to current health concerns. In 1991, the NHIS (1991) included a supplement on unintentional injury and 

poisoning. While some questions on injury and poisonings have been asked in some form or another at 

every survey since 1957, the 1991 supplement also included sections on unintentional injuries and 

occupational health.

This survey includes questions on the following topics related to the Household SOII: 

A screener question on injuries and poisonings in the last 

three months. The question begins with some 

statements about injuries and poisonings, and that they 

can be unexpected, accidental or on purpose and that 

they or others could have caused the injury or poisoning. 

What activity involved in at time

How many different times injured

Did R seek medical advice/How many times serious 

enough to seek medical professional

When injury happened (date/how long ago)

How injury or poisoning happened (e.g., on a bike, fall, 

etc.)

Parts of body hurt

In what way body part was hurt (e.g., broken, cut)

Did R get follow-up care—ambulance/fire truck, 

emergency room, doctor’s office, phone call to doctor

Was R hospitalized for at least one night, and how 

many nights hospitalized

How did R fall (e.g., stairs, ladder) and what caused 

fall (e.g., slipping, jumping)

R’s activity at time of injury or poisoning (includes 

working at paid job)

Where R was when the injury or poisoning happened 

(e.g., home, school). It is not clear how place of 

employment would be categorized.

Was R employed and level of employment (e.g., full 

time, part time) at time of injury or poisoning

Days of work missed as a result of the injury or 

poisoning

Screening for injury and illness: The NHIS includes a detailed set of questions focusing on injuries and 

poisonings. The survey does not cover illnesses in general. A household respondent reports for 

himself/herself and for other household members. 

Advantages: The length and content of the screener question allows respondents time to retrieve 

information about any injuries and illnesses they may have experienced. This may result in more 

complete reporting of incidents relevant to the survey. In addition, the use of randomized examples of 
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injuries and poisonings provides cues to the respondent about what types of incidents are of interest and 

should be reported. Also, the reference period for this survey is three months, which is a relatively short 

time frame that may help alleviate underreporting due to forgetting. Finally, the survey captures injuries 

and poisonings that happened while the respondent was at work.

Disadvantages: The survey does not collect some of the detailed measures required by the SOII. The 

opening statement in the screener question provides some cues to the relevant incidents but could include 

additional cues (such as need for medical attention). Finally, the questions on poisonings are rather 

specific and the survey does not explicitly ask about illnesses.

Helpful links

http://www.cdc.gov/nchs/nhis/about_nhis.htm

ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Dataset_Documentation/NHIS/2014/srvydesc.pdf

http://www.cdc.gov/nchs/nhis/injury_poisoning.htm

http://www.cdc.gov/nchs/nhis/injury_poisoning/ip_questions.htm

http://www.cdc.gov/nchs/data/nhis/injury_poisoning/ip_questions_1997_present.htm

Health and Retirement Study (HRS 2014)

The Health and Retirement Study (HRS), sponsored by the National Institute on Aging and the Social 

Security Administration, is a longitudinal panel study of Americans over the age of 50. Conducted since 

1992, this study includes a representative sample of about 20,000 individuals who are interviewed every 

two years. The HRS examines changes in labor force participation, income, work, physical health and 

functioning, and other topics, among older Americans.

This survey includes questions on the following topics related to the Household SOII: 

What health condition causes this impairment or 

problem?

Are you limited in any way in activities because of an 

impairment or problem?

Was the impairment or health problem you just 

mentioned the result of an accident or injury?

Did the accident or injury occur at work, at home, or 

somewhere else?

Was this impairment or health problem in any way 

caused by the nature of your work? 

How many times have you been injured on the job since 

R’s last interview; date of last injury

Does your employer do anything special to help you 

out so that you can continue working?

Did your employer get someone to help you?

Did your employer shorten your work days?

What kind of business or industry did you work in  

that is, what did they make or do at the place where 

you worked?

What sort of work did you do on that job?
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Screening for injury and illness: The HRS focuses on impairments or health problems that the 

respondent may currently have that limit the kind of paid work or amount of work the respondent may 

engage in. Thus, this survey does not collect information needed to create an annual estimate of

workplace injuries and illnesses. 

Advantages: The screener question cues respondents by focusing attention on current impairments and 

health problems that may limit paid work. This is slightly different from asking about specific incidents 

of workplace injury and illness that may have occurred. Although this question alone would not capture 

all the incidents of interest in the Household SOII, it suggests an approach that can be used in conjunction 

with direct questioning to cue workplace injuries and illnesses that may be in scope for a Household SOII.

Disadvantages: The incident that may have led to the respondent’s impairment or health problem is not 

limited to those occurring within a given time period. Unlike what is needed for the Household SOII, the 

questions focus is on the respondent’s current state. 

Helpful links

http://hrsonline.isr.umich.edu/

http://hrsonline.isr.umich.edu/modules/meta/2014/core/codebook/h14_00.html

http://hrsonline.isr.umich.edu/modules/meta/2014/core/codebook/h14m1_ri.htm

European Union: Labour Force Survey (EU LFS 2013) 

The United Kingdom’s version of the European Union’s (EU) Labor Force Survey (LFS) has been 

administered quarterly to residents of Great Britain since 1992. The survey is conducted on behalf of the 

Department of Enterprise, Trade and Investment (DETINI) by the Office for National Statistics (in Great 

Britain) and the Central Survey Unit of the Department of Finance and Personnel (Northern Ireland). The 

sample is representative of the entire population of the UK and currently includes approximately 41,000 

respondent households in each quarter. In this panel design, households participate for five quarters and 

each quarter a fifth of the panel rotates out and replace by new sample. 

Thinking of the last 12 months, have you had any 

accidents at work or in the course of work?

Did any of these accidents result in an injury to yourself?

How many accidents resulting in injury did you have 

during those months?

How soon were you able to start work again after the 

accident?

Please could you describe how the accident happened?

Was that (most recent) injury caused by...a road 

accident?

(Thinking of your most recent injury) how would you 

describe the injury you received?

Which bones did you fracture/break?

Was the job you were doing when this accident 

occurred the one you previously mentioned as.....?

May I just check, was the job you were doing when 

you were injured the one you previously mentioned 

as...?
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Screening for injury and illness: The survey includes a question on injury and illness that may have 

prevented the respondent from working. Household respondents who have worked within the last three 

months are asked this question. 

Advantages: The EU LFS (2013) asks directly about getting injured at work and how the injury came 

about. It also asks, in detail, about the types of injuries received and the body parts affected. In addition, 

the survey includes questions about the respondents’ employment at the time of the injury and how the 

accident affected their job. 

Disadvantages: The reference period for questions on injuries at work is 12 months. Respondents are 

less likely to accurately recall accidents and injuries over that length of time. Some questions only refer 

to the most recent injury, limiting the scope of the survey. The focus of the question is on “accidents” the 

respondent experienced that may have caused injury. It is unclear how the use of this term could alter 

respondent interpretation of what to include and whether their interpretation will be consistent with 

information collecting in the SOII.

Helpful links

http://www.ons.gov.uk/ons/guide-method/method-quality/specific/labour-market/labour-marketstatistics/volume-2---2013-questionnaire.pdf

http://www.ons.gov.uk/ons/about-ons/get-involved/taking-part-in-a-survey/information-for-households/a-toz-of-household-and-individual-surveys/labour-force-survey/index.html

http://www.ons.gov.uk/ons/guide-method/method-quality/index.html

Discussion

Designing the Household SOII

A household version of the SOII differs in significant ways from the establishment SOII. These 

differences are important to consider in designing a survey that best minimizes measurement error. The 

primary difference between the establishment SOII and a household version is in who responds to the 

survey. In the Household SOII, the employee or a proxy is the respondent whereas for the establishment 

survey an individual representing the employer completes the survey. The individual who completes the 

survey for the employer may have the advantage of having been trained in how to complete the task and 

being more experienced with the reporting requirements as compared to household respondent such as the 

employee or proxy. 
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Additionally, the employer has been required to maintain logs from which to complete the survey, 

keeping records in prospective fashion as incidents occur. In contrast, most survey respondents either 

report from memory or must locate records that would be helpful in completing the survey task. 

Depending on the survey design, the Household SOII could be either a prospective design (such as diarykeeping) or a retrospective design. 

As a further consideration, household respondents can face additional challenges in completing the 

Household SOII due to complexities of their employment histories. Employers only report on incidents 

that happened at their establishment. Employees may have more than one job at a given time or in 

succession during the reference period; recalling incidents that may have happened at any job held during 

the reference period will add to the task demands for them.

In designing the Household SOII, it will be important to consider carefully the structure of the screener 

questions that will capture eligible incidents, an appropriate reference period for the survey, suitable 

modes of administration, as well as the optimal selection of proxy respondents.

Screener Questions. Currently, employers complete forms for the establishment SOII whenever a 

recordable incident occurs. Successful reporting of incidents relies on employee and supervisor 

recognition of eligible incidents and follow-through by the employer to record the incident on OSHA 

forms. Unlike the household survey, the establishment SOII does not have an item analogous to a 

screener question.

The household survey relies on household informants to report eligible incidents in response to one or 

more screener questions designed to capture potentially eligible incidents. In order to produce accurate 

annual estimates of workplace injuries and illnesses, screener questions must effectively cue respondents 

to report that a workplace injury or illness did occur. Unless an employee who experienced a workplace 

injury or illness, or his/her proxy reports affirmatively to the screener question(s), the incident will go 

uncounted.

The screener questions in the surveys we examined vary in how directly they screen for workplace 

injuries and illnesses. NLS79, the HRS, and the EU Labour Force survey each include screener questions 

that ask directly whether a workplace injury occurred (with the NLS79 including illnesses as well). The 

NHIS Unintentional Injuries supplement, NHS, NHIS 2014 and the HRS ask less directly. They ask 

questions on illnesses, poisoning, conditions the respondent currently has, or limitations in his/her 

activities first. Then a follow-up question asks whether the health problem is related to an incident at 

work. Although less direct, screener questions framed around the respondent’s conditions or limitations 
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suggest alternatives for cuing recall that could be of value to the Household SOII. As noted in our 

discussion of issues of memory and recall, retrieval of relevant information requires effective cues. Using 

different kinds of cues for recall can allow respondents more time to process and more avenues for 

retrieving the needed information. However, it is important to consider that respondents could have 

difficulty ascertaining whether a health condition was actually work-related, or whether work only 

worsened an existing condition. Further, questions on general health conditions may be received 

differently and may be more sensitive than questions that directly address work-related injuries and 

illnesses. Even the direct approach taken by the NLS79 incorporates cues, since the respondent will have

already answered questions about jobs held during the reference period before being asked about any 

injuries or illnesses that may have occurred. Stepping through the respondent’s job history serves as a 

reminder of the workplaces at which incidents would have occurred. Especially for respondents with 

more complex job histories, this exercise could enhance recall. To further enhance the cues available for 

recall, questions concerning duties performed at work, physical demands of these duties, and 

characteristics of the work environment, could be included as well.

An approach to screening that would require additional time, but would provide rich cues for recall of 

workplace injuries and illnesses would incorporate multiple screening questions. As an example, the 

NCVS6

, is a two-part survey instrument in which respondents are first administered a brief screener 

consisting of a series of questions to capture crime incidents that could potentially fall in the scope of the 

survey. Respondents who answer affirmatively to any of the screener questions would complete an 

incident report to provide the details necessary to ascertain whether the incident is eligible, and to collect 

details about the incident. The Household SOII could take a similar approach to screening and collection 

of follow-up information.

For the Household SOII, it will be useful to consider different approaches to structuring the screener 

questions. As we develop a draft questionnaire, we will discuss with BLS the factors to consider in the 

design of the screening:

■ The number of screener questions to use

■ Direct questioning vs. indirect questioning

■ Types of recall cues to incorporate in the screening

In our examination of the screener questions in various surveys, we noted that some questioning is direct, 

asking a targeted question on whether an injury or illness related to work was experienced. However, 

 

6 Information on the NCVS is available at: http://www.bjs.gov/index.cfm?ty=dcdetail&iid=245
NORC | Existing Questions and Survey Instruments

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some screener questions take what we consider an indirect approach, asking first about illnesses, injuries, 

or health conditions in general, and then establishing whether they may be a result of the workplace injury 

or illness. 

Reference Period. In the current SOII, establishments are aware of the requirement to report on all 

incidents of workplace injury and illness that occur during the specified 12-month period. This 

prospective approach has the advantage that employers are aware of reporting requirements and can 

record the needed information at the time incidents occur. Recall bias should be far less of an issue with 

this approach. However, for the Household SOII, an issue that remains to be decided is whether a similar 

prospective approach is feasible. In a prospective approach, households would be notified in advance that 

they were selected to participate in the survey. They would be instructed on how to keep records and 

would then record any incidents of workplace injury or illness that occur during the study period. Issues 

of forgetting would be somewhat reduced in this approach, although households could still delay 

reporting and then ultimately record the details from memory. 

The surveys we examined all involve retrospective recall, that is, recall of events that occurred during a 

specified reference period. As the survey reference period increases, addressing issues of recall bias 

become more urgent, since recall of workplace injuries and illnesses declines with elapsed time (e.g., 

Warner et al., 2005; Oshiro et al., 2005; Zwerling et al., 1995). Forgetting is more pronounced for less 

serious incidents. Thus, if workplace injuries and illnesses of all levels of severity are to be captured most 

accurately, a shorter reference period would be preferable. Based on the limited number of articles we 

have found to date on recall of injuries, the reference period should be three months or even less if 

possible. However, although the level of forgetting would be reduced, a short reference period would 

capture relatively few incidents. A longer reference period, perhaps six months to a year, would likely be 

feasible. The idea reference period for the Household SOII will be determined out as part of the work on 

the household survey design that is currently in progress. 

Survey mode. The surveys we examined are all conducted in computer-assisted intervieweradministered modes. As can be seen in Appendix A, many of the example survey questions we found 

include complex series of questions in which navigation and text fills would be difficult without the use 

of a programmed instrument. In addition, the presence of an interviewer to encourage full reports from 

respondents and to clarify questions is likely to be advantageous for data quality.

Although the potential complexity of the Household SOII instrument suggests that a computer-assisted 

telephone interview (CATI) or a computer-assisted personal interview (CAPI) survey format would be 
NORC | Existing Questions and Survey Instruments

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better modes than mail or Web modes, the low incidence of workplace injuries and illnesses could make 

survey costs prohibitive if the Household SOII were a standalone interviewer-administered survey. 

However, adding the Household SOII as a module to an existing survey would have significant cost 

advantages. A further option to consider is whether, once a sample has been selected, whether conducting 

screening via mail or Web mode, potentially with telephone follow-up, would be an effective way to 

identify workers within a household who may have experienced a workplace injury or illness. These 

screening methods would require access to respondent addresses to facilitate the sending of a mail 

questionnaire or invitation to complete the screener via a Web survey. Once respondents have screened 

in as having experienced a potential workplace injury or illness, follow-up interviews could occur to 

collect information needed to ascertain that a reportable incident occurred and to capture the details of the 

incident.

Proxies. Some of the surveys examined allow proxies to report for household members who may not be 

available at the time of the interview. While proxy respondents may represent some cost efficiencies 

related to data collection (i.e., reduce the number of visits to the household), proxy reports may introduce 

some bias. Namely, if proxy informants are asked to report on injuries or illness that are not noticeable, or 

if the proxy does not know the details of other household members’ injuries and illnesses, or the proxy 

informant is simply not familiar enough with the selected participant, proxy reports are likely to be less

complete than self-reports. Nonetheless, proxies may offer some advantages in situations where 

respondents are unable to participate (i.e., cognitive impairment) or in situations where respondents have 

communication limitations (for instance, language barriers). Given that proxy respondents are used as a 

method to minimize nonresponse and proxy answers are typically considered equally valuable as 

respondent information, it will be important to design the Household SOII with proxy response in mind. 

In the household SOII consideration should be given to selecting an appropriate proxy and adding skip 

patterns for information that is unknown to the proxy informant, regardless of whether the household 

survey is a stand-alone questionnaire or a module of an existing survey. 

Next Steps

After discussion with BLS, NORC will embark on next steps toward designing the Household SOII. We 

will draft a questionnaire incorporating the key concepts to be measured in the Household SOII. We will 

draw on questions we identified in our search and conduct further search as needed to identify additional 

candidate items from the literature. The survey items we identified, for the most part, cannot be used 

directly in the Household SOII. We will adapt the questions and draft additional questions as needed.
NORC | Existing Questions and Survey Instruments

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Key considerations in designing the Household SOII include the following:

■ Standalone survey or module in existing survey

■ Mode

■ Proxy respondent selection criteria

■ Reference period

■ Number of screener questions

■ Effective cues to recall

■ Definitions of key terms

In collaboration with BLS, we will consider whether the Household SOII will be a standalone survey or a 

module of an existing survey. If it will be a module in an existing survey then certain features of the 

survey, such as mode, selection of the household respondent, and perhaps the reference period, would be 

consistent with the parent survey. Some key variables, such as respondent demographics, employment 

history, and industry and occupation, could be available from the sampling frame of the parent survey. 

We will work together with BLS to select the most suitable strategies for cuing and screening for 

incidents of workplace injury and illness. NORC anticipates creating draft questionnaires to share and 

discuss with BLS prior to submitting the full draft questionnaire (Deliverable #11). We look forward to 

working with BLS on the drafts to arrive at the optimal instrument for upcoming cognitive testing 

activities.
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Appendix A 

Screener questions

Direct screener

A few surveys ask directly about injuries or illnesses that occur at work.

NLS79 1993

Q10-12 [R42853.00] First, since [lintdate], have you had an incident at any job we previously discussed that 

resulted in an injury or illness to you?

Yes

No

Q10-45 [R42883.00] Is the [injury] we've just discussed the MOST SEVERE injury or illness that 

you have received or gotten since [lintdate] while you were working at any 

job we have already talked about?

Yes

No

HRS 2014

M051 Since R’s LAST IW MONTH, YEAR, have you had any injuries at work that required 

special medical attention or treatment or interfered with your work activities?

Yes

No

M052 How many times have you been injured on the job since R’s LAST IW MONTH, YEAR?

EU LFS (UK) 2013

ACCDNT Thinking of the twelve months since [full date], have you had any accident resulting in injury

at work or in the course of your work?

Yes

No

ANYACC Thinking of the last 12 months [reference to time period], have you had any accidents at work 

or in the course of work?

Yes

No

INJURY Did any of these accidents result in an injury to yourself? Yes

No

INJNO How many accidents resulting in injury did you have during those months? One

Two or more
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HEALNO How many health problems have you had in the last 12 months [reference to time period] that 

have been caused or been made worse by your work?

One

Two or more

Indirect screener

Other surveys ask respondents to first establish if they have an illness, injury, or health condition. Some of the surveys include follow up 

questions about the illness, injury, or condition and whether it occurred as a result of their job or an accident at work.

NHIS 1991: Unintentional Injuries Supplement

1a During the past 12 months, did anyone in the family have a head injury where 

he or she lost consciousness or completely blacked out?

Some evidence of head injury, but not 

conclusive

Yes

No

Not ascertained -

head injury reported for

family, no individual

identified

Not ascertained, includes dummy records

Unknown

2a How many head injuries did _____ have in the past 12 months where ____ lost consciousness or completely blacked out?

3b Was _____ at work at _____ job or business when this injury occurred? Yes

No 

Not ascertained

Unknown

NA (Did not have

head injury)

NHS 2011/2012

ALLCON_Q02 The next few questions are about [all of] the [condition/s] you have told me 

about.

[Are any of these/Is this] [condition/s] the result of any injury?

Yes

No

ALLCON_Q07 Thinking about the injury that resulted in your [condition], where did that injury 

occur?

Work
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School/study

In a motor vehicle accident

Exercise or sport

Home

Other

NHIS 2014

FIJ.010_00.000 The next set of questions is about INJURIES AND POISONINGS. People can 

be injured or poisoned unexpectedly, accidentally or on purpose. They may 

have hurt themselves or others may have caused them to be hurt. DURING THE 

PAST THREE MONTHS, that is since [fill1: (date 91 days before today's 

date)], [fill2: did you/did you or anyone in your family] have an injury where 

any part of [fill3: your/the] body was hurt, for example, with a [fill4: (random 

set of injury examples)]?

Yes

No

FIJ.150_00.000 What activity [fill1: were you/was ALIAS] involved in at the time of the [fill2: 

injury/poisoning]?

Driving or riding in a motor vehicle

Working at a paid job

Working around the house or yard

Attending school

Unpaid work (such as volunteer work)

Sports and exercise

Leisure activity (excluding sports)

Sleeping, resting, eating, or drinking

Cooking

Being cared for (hands-on care from other 

person)

Other, please specify

HRS 2014

M507 Are you limited in any way in activities because of an impairment or problem? Yes

No

M523 Did the accident or injury occur at work, at home, or somewhere else? Work

Home

Somewhere else
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M557 Was this impairment or health problem in any way caused by the nature of your 

work?

Yes

No

M002 Do you have any impairment or health problem that limits the kind or amount 

of paid work you can do?

Yes

No

M020 Was the impairment or health problem you just mentioned the result of an 

accident or injury?

Yes

No

M021 Did the accident or injury occur at work, at home, or somewhere else? Work

Home

Somewhere else

Occupation

Surveys capture the occupation and industry of respondents. Some surveys ask respondents about the job they had at the time of an injury, or 

illness. Length at current job and hire dates are also captured.

Direct questions about occupation and industry

SOII

None Employee job title [open ended]

1 Check the category which best describes the employee's regular type of job 

or work: (optional)

Office, professional, business, or management staff

Healthcare

Delivery or driving

Sales

Food service

Product assembly, product manufacture

Cleaning, maintenance of building, grounds

Repair, installation or service of machines, equipment

Material handling (e.g., stocking, loading/unloading, 

moving, etc.)
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Construction

Farming

Other:____________________

4 Employee’s date hired: ______/______/______ OR check length of service 

at establishment when incident occurred:

Less than 3 months

From 3 to 11 months

From 1 to 5 years

More than 5 years

OSHA Log

C Job title

4 Date hired

NLS79 2014

Q6-23K Since [Date of last interview], have you done any work at all for which you 

were paid?

Yes

No

Q6-

8_JOBVER_3

What [is your current/was your ([dli loop 1])] employment situation with 

[employer name ([dli loop 1])] [just before you left ([dli loop 1])]? Would 

you characterize it as..

Traditional/regular employment (employee working for 

employer) 

Non-traditional employment (temporary/contract/on-call 

work)

Self-employment

Other 

Q6-8H_A1 On this job with [employer name ([dli loop 1])], [are/were ([dli loop 1])] you 

self-employed?

Yes

No

On this job, [are/were ([dli loop 1])] you an independent contractor, 

independent consultant, or freelancer? That is, someone who 

[obtains/obtained ([dli loop 1])] customers on [HISR/HERR] own to provide 

a product or service.

Yes

No

On this job, [are/were ([dli loop 1])] you paid by a temporary help agency 

that [assigns/assigned ([dli loop 1])] you to assist other employers?

Yes

No

On this job, [are/were ([dli loop 1])] you an on-call worker? Yes
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No

Please give me the name of your business, or a brief description of the type 

of work you [do/did ([dli loop 1])] in this job.

HRS 2014 

M579 Which company or organization was that? Current employer

Most recent employer

Last employer

Self-employment

Other

W200_3 Did you work for someone else, were you self-employed or what? SOMEONE ELSE

SELF-EMPLOYED

W202_3 What kind of business or industry did you work in, that is, what did they 

make or do at the place where you worked?

[open ended]

W201_3 What sort of work did you do on that job? [open ended]

EU LFS (UK) 2013

INDD What did the firm/organisation you worked for mainly make or do 

(at the place where you worked)? 

EQ 

Describe fully - probe manufacturing or processing distribution etc. and 

main goods produced, materials used, wholesale or retail etc. 

INDT [Enter a title for the industry]

SECTOR And was that... A private firm or business, a limited company 

OCCT What was your (main) job in the week ending Sunday the [date]? or some other kind of organization 

OCCD What did you mainly do in your job? 

STAT Were you working as an employee or were you self-employed? Employee 

Self-employed 

Government Scheme 

Unpaid family worker 
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Employment at time of illness or injury

NLS79 1993

Q10-13 [R42854.00] What is the name of the employer you were working for when the 

MOST RECENT incident that resulted in an injury or illness to you 

occurred? 

EU LFS (UK) 2013

WCHJB May I just check, was the job you were doing when you were injured 

the one you previously mentioned as...?

[Occupation title – main job] 

[Occupation title – second job] or (N/A) 

or was it some other job? 

WOCCT What was your job?

WOCCD What did you mainly do in your job?

JOB1 Was the job you were doing when this accident occurred the one you 

previously mentioned as.....?

Main job [reference to main job]

Second job [reference to second job]

Last job

Job one year ago, if other than last job

Some other job

NHIS 2014

FIJ.170_00.000 At the time of this [fill1: injury/poisoning], [fill2: were you/was 

ALIAS] employed full-time, part-time, or not employed?

Full-time 

Part-time

Not employed
NORC | Existing Questions and Survey Instruments

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Description of the illness or injury

What happened

SOII

10 What was the employee doing just before the incident occurred? 

Describe the activity as well as the tools, equipment, or material 

the employee was using. Be specific. Examples: “climbing a 

ladder while carrying roofing materials”; “spraying chlorine from 

hand sprayer”; “daily computer key-entry.”

[Link to code list: 

http://www.bls.gov/iif/osh_oiics_2010_3.pdf] 

11 What happened? Tell us how the injury or illness occurred. 

Examples: “When ladder slipped on wet floor, worker fell 20 

feet”; “Worker was sprayed with chlorine when gasket broke 

during replacement”; “Worker developed soreness in wrist over 

time.”

[Link to manual for event code list: 

http://www.bls.gov/iif/osh_oiics_2010_2_4.pdf] 

12 What was the injury or illness? Tell us the part of the body that 

was affected and how it was affected; be more specific than 

“hurt,”

“pain,” or “sore.” Examples: “strained back”; “chemical burn, 

hand”; “carpal tunnel syndrome.”

[Link to manual for code list for body part and nature of 

illness/injury: 

http://www.bls.gov/iif/osh_oiics_2010_2_2.pdf

http://www.bls.gov/iif/osh_oiics_2010_2_1.pdf] 

13 What object or substance directly harmed the employee? 

Examples: “concrete floor”; “chlorine”; “radial arm saw.” If this 

question does not apply to the incident, leave it blank.

[Link to manual for source code list: 

http://www.bls.gov/iif/osh_oiics_2010_2_3.pdf] 

OSHA Log

E Where the event occurred [open ended]

F Describe injury or illness, parts of body affected, and 

object/substance that directly injured or made person ill.

[open ended]

G Check only one box for the most serious outcome for that case Death (part of another question)

14 What was the employee doing just before the incident occurred? [open ended]

15 What happened? [open ended]

17 What object or substance directly harmed the employee? [open ended]

NLS79 1993

Q10-18 [R42856.00] Which one category on this card best describes the activity you 

were engaged in at the time of the incident?

1 Employer-directed travel

2 Employer-directed training

3 Meal break
NORC | Existing Questions and Survey Instruments

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4 Rest break

5 Personal business

6 Normal work activity

7 Other activity (SPECIFY)

EU LFS (UK) 2013

ROAD Was that (most recent) injury caused by...? A road accident

Or in some other way?

EROAD May I just check, was this accident a road accident?

NHIS 1991: Unintentional Injuries Supplement

3c What was the cause of this head injury? Motor vehicle accident

Other accident

Assault

Other non-accident

Not ascertained

Unknown

NA (Did not have head injury)

NHIS 2014

FIJ.060_00.000

FIJ.065_00.000 

[fill1: How did [fill2: your/ALIAS’s] [fill3: injury/poisoning] on 

[fill4: ^IPDATEM ^IPDATED (starting with most recent if 

multiple)] happen?/How did this [fill3: injury/poisoning] happen?] 

Please describe fully the circumstances or events leading to the 

[fill3: injury/poisoning], and any objects, substances, or other 

people involved.

In a motor vehicle

On a bike, scooter, skateboard, skates, skis, horse, etc.

Pedestrian who was struck by a vehicle such as a car or 

bicycle

In a boat, train, or plane

Fall

Burned or scalded by substances such as hot objects or 

liquids, fire, or chemicals

Other

FIJ.130_00.000 How did [fill: you/ALIAS] fall? Stairs, steps, or escalator

Floor or level ground
NORC | Existing Questions and Survey Instruments

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Curb (including sidewalk)

Ladder or scaffolding

Playground equipment

Sports field, court, or rink

Building or other structure

Chair, bed, sofa, or other furniture

Bathtub, shower, toilet, or commode

Hole or other opening

Other

FIJ.150_00.000 What activity [fill1: were you/was ALIAS] involved in at the time 

of the [fill2: injury/poisoning]?

Driving or riding in a motor vehicle 

Working at a paid job

Working around the house or yard

Attending school

Unpaid work (such as volunteer work)

Sports and exercise

Leisure activity (excluding sports)

Sleeping, resting, eating, or drinking

Cooking

Being cared for (hands-on care from other person)

Other, please specify
NORC | Existing Questions and Survey Instruments

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Timing of the injury or illness

Also included in this section are questions as to how long respondent has had a health condition, or age at time of injury or illness.

SOII

None Date of injury or onset of illness

8 Time employee began work: Am/pm

9a Time of event: Am/pm

Check if time cannot

be determined

9b Event occurred: (optional) Before

During 

After work shift

OSHA Log

D Date of injury or onset of illness [open ended]

11 Date of injury or illness [open ended]

12 Time employee began work [open ended]

13 Time of event [open ended]

18 If the employee died, when did the death occur? [open ended]

NLS79 2014

Q10-17 [R42855.02] In what month and year did the most recent incident occur that 

resulted in an injury or illness to you?

[open ended]

HRS 2014 — SECTION M

M052 How many times have you been injured on the job since R’s 

LAST IW MONTH, YEAR?

[open ended]

M053 On what date did your (most recent) injury happen? [open ended]

NHIS 2014

FHS.288_01.000 How long [fill: have you/has ALIAS] had [CONDITION]? [open ended]

FHS.288_01.000 How long [fill1: have you/has ALIAS] had the injury that caused 

[fill2:your/his/her] limitation?

[open ended]

NHS 2011

ALLCON_Q08 How old [were/was] [you/(proxy name)] when the injury 

occurred?

[open ended]
NORC | Existing Questions and Survey Instruments

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Type of injury or illness

OSHA Log

M1 Type: Injury

M2 Type: skin disorder

M3 Type: Respiratory condition

M4 Type: Poisoning

M5 Type: Hearing loss

M6 Type: All other illnesses

OSHA form 301

16 What was the injury or illness?

NLS79 1993

Q10-19 

[R42857.00]

Did the incident result in an injury or an illness? Injury

Illness

Q10-21 

[R42859.00]

What part of the body was hurt or affected? [open ended then coded]

Q10-27 

[R42865.00]

What kind of [Q10-19] was it? [Link to code list in Appendix]

EU LFS (UK) 2013

TYPINJ (Thinking of your most recent injury) how would you describe the injury 

you received?

Amputation (not loss of fleshy finger tips, teeth or nails - count 

as superficial)

Fracture/broken bones (not cartilage in nose - count as 

superficial)

Dislocation of joints (without fracture)

Strain/sprain

Superficial (inc. bruising, abrasions, scratches, foreign body in 

eye)

Lacerations/ open wounds

Loss of sight (temporary or permanent)

Chemical or hot metal burn to the eyeball, or any penetrating 

injury to the eyeball (not the eye area of the face generally)

Burns/ scalds (not to the eye)

Lack of oxygen (asphyxia) or poisoning
NORC | Existing Questions and Survey Instruments

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Other type of injury

Multiple injuries, no one injury type obviously more severe

SITEFR Which bones did you fracture/break? Fingers or thumbs

Toes

Wrist or ankle

Other bones in hand or foot

Other bones in arm or leg

Head, neck, spine or pelvis

or other bones

ACCURH Still thinking of the accident you just mentioned, did you... Lose consciousness, even briefly?

Suffer from hypothermia or heat induced illness?

Need resuscitation?

Stay in hospital for more than 24 hours?

Not experience any of the above

ACCKIND Please could you describe how the accident happened? Contact with moving machinery or material being machined

Hit by a moving, flying or falling object

Hit by a moving vehicle

Strain/sprain

Superficial (inc. bruising, abrasions, scratches, foreign body in 

eye)

Lacerations/ open wounds

Loss of sight (temporary or permanent)

Chemical or hot metal burn to the eyeball, or any penetrating 

injury to the eyeball (not the eye area of the face generally)

Burns/ scalds (not to the eye)

Lack of oxygen (asphyxia) or poisoning

Other type of injury

Multiple injuries, no one injury type obviously more severe

SERIOS How would you describe this health problem?

Consider most serious health problem

Bone, joint or muscle problem

Breathing or lung problem

Skin problem
NORC | Existing Questions and Survey Instruments

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Hearing problem

Stress, depression or anxiety

Headache and/or eyestrain

Heart disease or attack, or other problems in the circulatory 

system

Infectious disease (virus, bacteria or other type of infection)

Stomach, liver, kidney or digestive problem

Other types of health problem

NHIS 2014

FIJ.070_00.000 In this injury, what parts of [fill: your/ALIAS’s] body were hurt? [Link to list in Appendix]

Types of health conditions that are not specifically work-related

NHS 2011

ALLCON_Q04 Which conditions? [open ended]

NHIS 2014

FHS.270_00.000 What conditions or health problems cause [fill: ALIAS]’s limitations? Vision/problem seeing

Hearing problem

Speech problem

Asthma/breathing problem

Birth defect

Injury

Intellectual disability, also known as mental retardation

Other developmental problem (for example, cerebral palsy)

Other mental, emotional or behavioral problem

Bone, joint, or muscle problem

Epilepsy or seizures

Learning disability

Attention Deficit/Hyperactivity Disorder (ADD/ADHD)

Other impairment/problem (Specify one)
NORC | Existing Questions and Survey Instruments

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Other impairment/problem (Specify one)

Refused

Don't know/not sure

FIJ.072_00.000 In what way was [fill1: your/ALIAS’s] [fill2: first entry--^IJBODY (text) 

or ^IJBODYOS] hurt?

Broken bone or fracture

Sprain, strain, or twist

Cut

Scrape

Bruise

Burn

Insect bite

Animal bite

Other, specify

Refused

Don't know

HRS 2014

M503 What health condition causes this impairment or problem? [list]

EU LFS (UK) 2013

HEAL Do you have...? Problems or disabilities (including arthritis or rheumatism) 

connected with your arms or hands?

...Legs or feet?

...Back or neck?

Difficulty in seeing (while wearing spectacles or contact lenses)?

Difficulty in hearing?

A speech impediment?

Severe disfigurements, skin conditions, allergies?

Chest or breathing problems, asthma, bronchitis?

Heart, blood pressure or blood circulation problems?

Stomach, liver, kidney or digestive problems?

Diabetes?

Depression, bad nerves or anxiety?

Epilepsy?
NORC | Existing Questions and Survey Instruments

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Severe or specific learning difficulties?

Mental illness or suffer from phobias, panics or other nervous 

disorders?

Progressive illness not included elsewhere (eg cancer not 

included elsewhere, multiple sclerosis, symptomatic HIV, 

Parkinson's disease, Muscular Dystrophy)?

Other health problems or disabilities?

Effect of illness or injury

Medical care

SOII

6 Was employee treated in an emergency room? Yes

No

7 Was employee hospitalized overnight as an in-patient? Yes

No

OSHA form 301

6 Name of physician or other health care professional

7 If treatment was given away from the worksite, where was it given? [Address]

8 Was employee treated in an emergency room

9 Was employee hospitalized overnight as an in-patient?

NHIS 1991: Unintentional Injuries Supplement

2b Did ____ receive medical care for ___ most recent injury? Yes

No 

Not ascertained

Unknown

NA (Did not have

head injury)

2d Did ____ stay in a hospital overnight or longer because of this head injury? Yes

No 

Not ascertained
NORC | Existing Questions and Survey Instruments

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Unknown

NA (Did not have head

injury or did not get/

did not know if medical

treatment received for

most recent head injury)

NHIS 2014

FIJ.018_00.000 Of [fill1: the ^TFINJ3M/all the] times that [fill2: you were/ALIAS was] injured, how 

many of those times was the injury serious enough that a medical professional was 

consulted?

01-91 1-91 times

FIJ.080_02.000 Did [fill1: you/ALIAS] get MEDICAL ADVICE, TREATMENT, or FOLLOW-UP CARE 

for this [fill2: injury/poisoning]? An emergency vehicle, such as an ambulance or fire truck

Yes

No

FIJ.080_02.000 Did [fill1: you/ALIAS] get MEDICAL ADVICE, TREATMENT, or FOLLOW-UP CARE 

for this [fill2: injury/poisoning]?

A visit to an emergency room

Yes

No

FIJ.080_02.000 Did [fill1: you/ALIAS] get MEDICAL ADVICE, TREATMENT, or FOLLOW-UP CARE 

for this [fill2: injury/poisoning]?

A visit to a doctor’s office or other health clinic

Yes

No

FIJ.080_02.000 Did [fill1: you/ALIAS] get MEDICAL ADVICE, TREATMENT, or FOLLOW-UP CARE 

for this [fill2: injury/poisoning]?

A phone call to a doctor, nurse, or other health care professional

Yes

No

FIJ.080_02.000 Did [fill1: you/ALIAS] get MEDICAL ADVICE, TREATMENT, or FOLLOW-UP CARE 

for this [fill2: injury/poisoning]?

Any place else?

Yes

No

FIJ.090_00.000 [fill1: Were you/Was ALIAS] hospitalized for at least one night as a result of this [fill2:

injury/poisoning]?

Yes

No

FIJ.091_00.000 How many nights [fill: were you/was ALIAS] in the hospital? 1-94 nights 

95+ nights 
NORC | Existing Questions and Survey Instruments

FINAL REPORT | 52 

Effect on work

SOII

None Number of days away from work [open ended]

None Number of days of job transfer or restriction [open ended]

OSHA Log

h Days away from work [open ended]

i Job transfer or restriction [open ended]

j Other recordable cases [open ended]

k Days away from work [open ended]

l Days on job transfer or restriction [open ended]

NLS79 1993

Q10-30 

[R42868.00]

Did the [Q10-19] cause you to miss one or more scheduled days of work, 

not counting the day of the incident?

Yes

No

Q10-32 

[R42870.00]

Did the [injury] cause you ... to be assigned to another job on a temporary basis? Yes

No

Q10-33 

[R42871.00]

Did the [injury] cause you ... to work at your regular job less than full time? Yes

No

Q10-34 

[R42872.00]

Did the [injury] cause you ... to work at your regular job, but be unable to perform all of the 

normal duties of the job?

Yes

No

Q10-31 

[R42869.00]

Not counting the day of the incident, how many days altogether was this? [open ended]

Q10-37 

[R42875.00]

Did the [injury] (also) cause you... to be laid off? Yes

No

Q10-38 

[R42876.00]

Did the [injury] (also) cause you... to quit? Yes

No

Q10-39 

[R42877.00]

Did the [injury] (also) cause you... to be fired? Yes

No
NORC | Existing Questions and Survey Instruments

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Q10-40 

[R42878.00]

Did the [injury] (also) cause you... 

to change occupations?

Yes

No

Q10-41 

[R42879.00]

Did you lose any wages because of the [injury]? Yes

No

EU LFS (UK) 2013

GOBACK How soon were you able to start work again after the accident? Still off paid work,

Expects never to do paid work again,

Same day,

The day after the accident,

On the second day after the accident,

On the third day after the accident,

On the fourth day after the accident,

On the fifth day or longer after the accident,

TIMEDAYS How many days after the accident did you go back to work?

NHIS 2014

FIJ.171_00.000 As a result of this [fill1: injury/poisoning], how many days of work did [fill2: you/ALIAS] 

miss?

None 

Less than one day

One to five days 

Six or more days

HRS 2014

M028 At the time your health started to limit your ability to work, did your employer do anything 

special to help you out so that you could stay at work?

Yes

No

No help needed

Left immediately

W211_1 Did your employer get someone to help you? Yes

No

W214_1 Did your employer shorten your work days? Yes

No
NORC | Existing Questions and Survey Instruments

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Employee characteristics

SOII

None Employee’s name [open ended]

2 Employee’s race or ethnic background: (optional-check one or more) American Indian or Alaska Native

Asian

Black or African American

Hispanic or Latino

Native Hawaiian or Other Pacific Islander

White

Not available

3 Employee’s age ______ OR date of birth: ______/______/______

5 Employee’s gender: Male

Female

OSHA form 301

3 Date of birth

5 Sex Female

Male
NORC | Existing Questions and Survey Instruments

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Appendix B 

NLS79 Attachment 8 – code list for injuries

11800 - 11807 Railway accidents 11880 - 11888 Accidental falls

11810 - 11819 Motor vehicle traffic accidents 11890 - 11899 Accidents caused by fire and flames

11820 - 11825 Motor vehicle nontraffic accidents 11900 - 11909 Accidents due to natural and 

environmental factors

11826 - 11829 Other road vehicle accidents 11910 - 11915 Accidents caused by submersion, 

suffocation and foreign bodies

11830 - 11838 Water transport accidents 11916 - 11929 Other accidents and late effects of 

accidental injury

11840 - 11845 Air and space transport accidents 11930 - 11949 Drugs, medicaments and biological 

substances causing adverse effects in therapeutic use

11846 - 11848 Vehicle accidents not elsewhere 

classifiable

11950 - 11959 Suicide and self-inflicted injury

11850 - 11858 Accidental poisoning by drugs, 

medicaments and biologicals

11960 - 11969 Homicide and injury purposely inflicted 

by other persons

11860 - 11869 Accidental poisoning by other solid and 

liquid substances, gases and vapours

11970 - 11978 Legal intervention

11870 - 11876 Misadventures to patients during 

surgical and medical care

11980 - 11989 Injury undetermined whether 

accidentally or purposely inflicted

11878 - 11879 Surgical and medical procedures as the 

cause of abnormal reaction of patient or later 

complication

11990 - 11999 Injury resulting from operations of war
NORC | Existing Questions and Survey Instruments

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NHIS list of body parts

1 Ankle

2 Back

3 Buttocks

4 Chest

5 Ear

6 Elbow

7 Eye

8 Face

9 Finger/thumb

10 Foot

11 Forearm

12 Groin

13 Hand

14 Head (not face)

15 Hip

16 Jaw

17 Knee

18 Lower leg

19 Mouth

20 Neck

21 Nose

22 Shoulder

23 Stomach

24 Teeth

25 Thigh

26 Toe

27 Upper arm

28 Wrist

29 Other, specify
NORC | Designing a Household Survey of Injuries and Illnesses

FINAL REPORT

OMB Package 

(Deliverables #7, #11, and #12)
FINAL REPORT

OMB Package 

(Deliverables #7, #11, and #12)

MARCH 24, 2016
NORC | OMB Package

FINAL REPORT | I 

NOTE TO THE 

REVIEWER OF:

OMB CLEARANCE 1220-0141

“Cognitive and Psychological Research” 

FROM: Polly Phipps and Robin Kaplan

Office of Survey Methods Research

SUBJECT: Submission of Materials for the Household Survey of 

Injuries and Illnesses

Please accept the enclosed materials for approval under the OMB clearance package 

1220-0141 “Cognitive and Psychological Research.” In accordance with our 

agreement with OMB, we are submitting a brief description of the study. 

The total estimated respondent burden for this study is 165 hours. 

If there are any questions regarding this project, please contact Polly Phipps at 202-

691-7513. 
NORC | OMB Package

FINAL REPORT | II 

Table of Contents

Introduction................................................................................................................................. 1

Background................................................................................................................................. 1

Purpose ................................................................................................................................ 1

Methodology................................................................................................................................ 2

General approach................................................................................................................. 2

Recruitment .......................................................................................................................... 2

Sampling....................................................................................................................... 2

Method for recruiting ..................................................................................................... 3

Interviews.............................................................................................................................. 4

Participants ................................................................................................................................. 4

Sample characteristics.......................................................................................................... 4

Proxy reporting............................................................................................................ 5

Burden Hours .............................................................................................................................. 6

Data Confidentiality .................................................................................................................... 6

Attachments ................................................................................................................................ 7

Appendix...................................................................................................................................... 8
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FINAL REPORT | 1 

Introduction 

The purpose of this memorandum is to inform you that the Bureau of Labor Statistics (BLS) plans to 

conduct cognitive interviews for Designing a Household Survey of Injury and Illness (HSOII) under the 

generic clearance of survey improvement projects (OMB #1220-0141). 

The objectives of the cognitive interviews are to evaluate the HSOII survey questions for correct 

interpretation and to assess the ability of respondents to accurately answer the survey questions. The 

results of this research will be used to refine the HSOII questionnaire items and item order. 

Background 

The Survey of Occupational Injuries and Illnesses (SOII) is an annual survey of over

230,000 establishments used to generate estimates of non-fatal workplace injuries and illnesses that occur 

during the survey year. Existing research points to an underestimate of injuries and illnesses attributed to 

a variety of factors including an employer/employee incentive to underreport these occurrences. A 

potential solution is to contact workers directly through a household survey. Such a survey would be 

expected to produce estimates that are not “filtered” by establishment-level reporting involved in the 

SOII. Ideally, a household survey would sample from the universe of all workers, including those who 

work as independent contractors. It should also allow BLS to produce annual calendar year estimates of 

injuries and illnesses by employment relationship (contractor vs. employee), sector (private, government), 

and broad industry and occupational groups. BLS intends to conduct a series of cognitive interviews 

between March and September 2016 to develop and test an HSOII instrument. 

Purpose

The purpose is to develop a survey design and questionnaire on non-fatal occupational injuries and 

illnesses that covers the population of workers and allows BLS to estimate injuries and illnesses by 

employment relationship, broad industry, and occupation at the national level. 

A series of cognitive interviews will be conducted to test and fine-tune wording and question ordering 

revisions to the existing instrument. The cognitive interviews will enable the research team to identify 

problems with items, the organization and order of the instrument, revealing potential sources of response 

error in the HSOII that the research team will draw on to inform their design efforts. 
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The cognitive interviews will assess issues such as:

■ Respondent understanding of terms in the survey, such as illness and injury

■ Respondent confidence in responses

■ Recall techniques when answering factual questions, such as when an injury or illness occurred and 

what happened

■ Suitability of response options 

■ Ease of answering questions

■ Issues with sensitive questions

■ Consistency of answers within the questionnaire and in comparison to the expected range of answers

Methodology 

General approach

The cognitive interviews will be conducted by staff with training and experience in cognitive 

interviewing. The research team anticipates completing up to three rounds of cognitive interviews with 30 

respondents per round for a maximum total of 90 cognitive interviews. Interviewing in rounds will allow 

the team to evaluate the effectiveness of a set of proposed instrument changes in one round, revise the 

instrument as needed, and test the revisions in the next round. The interviews will be audio-recorded if 

respondent consent is granted. 

A full set of materials for use in conducting interviews are attached to this OMB clearance package. 

These materials include: sample flyer, Frequently Asked Questions, eligibility screener, cognitive 

interview protocol, and participant consent form. 

Recruitment 

Sampling. The study will be conducted in the Chicago and Bethesda areas. NORC at the University of 

Chicago (NORC) will use a non-probability sample of 90 participants for this research. Respondents will 

be adults who have experienced a workplace injury or illness in the past 12 months and adults who work 

in occupations that place them at higher risk of experiencing workplace injuries and illnesses. In addition, 

some respondents will be from the general population of workers, who may not have experienced a 

workplace injury or illness. For testing of proxy response, described further below, the proxy respondent 

will be an adult from the household of a recruited respondent. 
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Method for recruiting. NORC will obtain participants through a variety of channels. Flyers (see 

Attachment 1) will be distributed through neighborhoods, community centers, public libraries, 

supermarkets, and shopping malls. The flyer will also be posted online on Craigslist and other social 

media sites (Twitter, Facebook, etc.). 

Additional recruitment avenues to explore are American Job Centers (One-Stop Career Centers)1, which 

provide assistance to those seeking employment. These centers may be helpful in providing outreach to 

recently or newly employed individuals who would be willing to be interviewed. In addition, the 

Outreach Training Program2

, which provides basic safety and health information and education for 

employers and employees, will be approached to help with reaching individuals whose occupations 

increase their likelihood of experiencing a workplace injury or illness. In addition, we will contact trade 

unions in Chicago to distribute information. We will provide copies of the recruitment flyer to these 

centers for them to make available to interested individuals.

Other sites of interest are community colleges and not-for-profit organizations focused on human services 

offering vocational training. Also, temporary work agencies and associations in alliance with the 

Occupational Safety & Health Administration can be approached for recruiting. These institutions will be 

contacted by email and telephone to inform them of the study. We will gain cooperation and provide 

flyers for these organizations to distribute and post. 

As an additional method of recruiting, we will ask respondents who have agreed to participate in the study 

to pass on study information to others they know. To assure that we recruit individuals in occupations in 

which workers have a higher risk of experiencing workplace injury and illness, we will ask respondents to 

recruit others in the same occupation.

Recruitment materials will direct individuals interested in participating in an interview to contact NORC 

(via telephone or email, to be determined). A trained NORC staff member will explain the study and the 

cognitive interview process, answer any questions the respondent may have, and screen the respondent. 

The Frequently Asked Questions are presented in Attachment 2; the recruitment script and screener and 

are presented in Attachment 3. 

 

1 http://www.dol.gov/dol/topic/training/onestop.htm#doltopics and http://www.careeronestop.org/

2 https://www.osha.gov/dte/outreach/generalindustry/index.html
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Interviews

We anticipate that the first round of interviews will be conducted face-to-face with respondents in 

laboratory cognitive interviews. Recruited respondents who are completing in-person laboratory 

cognitive interviews will come to NORC’s offices in either downtown Chicago or the University of 

Chicago campus, to NORC’s Bethesda office. An in-person interview allows the interviewer to observe 

both verbal and nonverbal cues in assessing how the instrument is working. Later interview rounds will 

include some telephone interviews as well.

Interviewers will follow a cognitive interview protocol in which the interviewer asks probing questions 

throughout the survey to examine question comprehension, recall of information, judgment processes, and 

sensitivity of questions. The protocol is included in Attachment 4. Analysis of the cognitive interview 

data, revision of the questions, and updating of the cognitive interview protocol will be ongoing 

throughout data collection. Since this research involves pretesting of a questionnaire, we expect that 

modifications to the questionnaire will be made throughout the course of the study. The goals of the 

testing and overall design of the study will remain the same. However, findings from earlier interviews 

will be used to improve the survey instrument to be tested in later interviews.

Prior to participating in the study, respondents will first be informed of their rights and the study 

confidentiality. The interviewer will address the respondent’s questions and concerns and then 

participants will sign the consent form (Attachment 5). At the end of the interview respondents will 

receive compensation of $40. 

Participants 

Sample characteristics

There are several characteristics of respondents that are of specific interest in the sample recruitment for 

this study. Individuals who respond to the recruitment flyer will be screened (Attachment 3) to ensure 

that a broad range of respondent characteristics in terms of gender, age, education level, race and 

ethnicity, and occupation are included in the sample. Respondents will also be asked about whether they 

have experienced a workplace injury or illness to ensure that respondents who have experienced a 

workplace injury or illness are included in the sample. All respondents will be 18 years of age or older. 
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Potential respondents who are in professions in which workers have a high likelihood of experiencing a 

workplace injury or illness (such as individuals who work in construction, food service, manufacturing, 

and health care), and individuals who indicate that they have experienced a workplace injury or illness,

will be the focus of recruitment efforts. However, some respondents from the more general population of 

workers or who have not experienced a workplace injury or illness will also be invited to participate to 

ensure that the questionnaire works well with a variety of respondents. In addition, some respondents 

participating in pairs interviews, described below, will be adult members of a recruited respondent’s 

household.

Proxy reporting

An individual who is knowledgeable about the household, or knowledge about the work history and 

injuries/illnesses of other household members could potentially serve as respondent or proxy. In 

developing initial plans for respondent recruitment, we will conduct interviews that include both proxy 

and self-reporting. As the survey design develops, the recruitment plans will be adapted according to 

decisions made concerning the use of proxy respondents. To test the accuracy of proxy reports, we will 

interview two adult members from the same household. We will attempt to recruit up to 20 pairs of 

respondents so that self and proxy reports may be compared. Each member of the respondent pair will 

receive the $40 compensation for study participation.
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Burden Hours

Respondent burden includes time spent on the following:

1. Responding to the flyer 

2. Screening process and collection of background information 

3. Appointment scheduling and confirmation

4. Interview

The total estimated burden associated with this study is 165 hours

Activity Number of 

Respondents 

Average Time 

(minutes)

Total 

Burden 

(minutes)

Telephone inquiry: Estimate that 

300 individuals will respond to the 

flyer and receive information 

about the study

300 5 1500 

Screening and collection of 

background information: Estimate 

that 200 individuals will decide to 

be screened for participation

200 10 2000 

Appointment scheduling and 

confirmation: Estimate that 100 

individuals will be scheduled for 

an interview and receive 

confirmation phone call or email

100 10 1000 

Interview: 90 individuals will be 

interviewed 90 60 5400 

Total burden 9,900 minutes

(165 hours)

Data Confidentiality

Cognitive interview respondents will be informed of confidentiality verbally and through the consent 

form (Attachment 5). The consent form indicates that the purpose of the study is to improve a BLS 

survey, that participation is voluntary, and that responses will be used for statistical purposes only. 

Respondents will also be informed that the interview will be audio-recorded or that someone may observe 

the interview. To protect respondent confidentiality, respondents will be assigned a unique identifier.
NORC | OMB Package

FINAL REPORT | 7 

Although quotes may be used in the final reports, quotes will not be attributed to a name and no 

respondent will be identifiable based on any quotes used. The signed consent forms will be kept 

separately from the interview files in a locked cabinet for the duration of the study and will be destroyed 

after the final report is completed.

Attachments 

1: Sample flyer 

2. Frequently Asked Questions 

3: Eligibility Screener 

4: Cognitive Interview Protocol

5: Participant Consent Form
NORC | OMB Package

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Appendix 

Attachment 1: Recruitment Materials: Flyer

EARN $40 BY COMPLETING AN INTERVIEW! 

 Have you had an on-the-job injury in the last year?

 Have you had an illness related to your job in the last year?

 Do you do any of the following kinds of work? 

 Construction

 Food service

 Health care

 Cleaning and maintenance

 Manufacturing

 Stocking, loading, moving 

If you said YES to any of these questions, we want you to take part in 

an interview on workplace injuries and illnesses!

The interview will last no more than 60 minutes and can be 

completed at NORC’s offices in downtown Chicago or the University 

of Chicago campus [OR Bethesda] during regular business hours. 

If you are interested, please contact NAME at: 

WorkerStudy@norc.org

312-XXX-XXXX
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Attachment 2: Frequently Asked Questions

What is the study about? 

This study is being conducted on behalf of the Bureau of Labor Statistics to try to learn how 

many people experience workplace injuries or illnesses each year.

Who is the Bureau of Labor Statistics (BLS)?

The Bureau of Labor Statistics (BLS) is the principal fact-finding agency for the Federal 

Government in the broad field of labor economics and statistics. The BLS is an independent 

national statistical agency that collects, processes, analyzes, and disseminates essential statistical 

data to the American public, the U.S. Congress, other Federal agencies, State and local 

governments, business, and labor. Learn more at www.bls.gov. 

Who is NORC?

NORC is a not-for-profit social science research organization affiliated with the University of 

Chicago. NORC is conducting this study on behalf of the Bureau of Labor Statistics (BLS). You 

can learn more about NORC at its website, www.norc.org, or by contacting the Study Director, 

Dr. Lisa Lee at Lee-Lisa@norc.org or calling xxx-xxx-xxxx. 

Do I have to participate? 

Participation is voluntary. You may choose whether or not you want to be in this study. If you 

decide to be in the study, you may choose to skip any question you do not want to answer or stop 

participating at any time.

How much will I be paid?

You will be given $40 for participating in the study. 

How long will the study take?

The interview will take less than 60 minutes.

Why should I participate? 

Your input on how the questionnaire is working will help improve the data BLS collects. By 

participating in this study you can help make sure that the BLS collects the most complete and 

accurate data possible on workplace injury and illness in the United States, information that is 

used to inform policies designed to keep employees safe

Who do I contact if I have questions about my rights as a respondent?

If you have any questions regarding your rights as a study participant, you may call the NORC 

IRB Manager, toll-free, at 866-309-0542. 

How is my privacy protected?

Your answers will always be kept private, and none of the information that you provide will be 

used for any purpose other than research. Your name or any information that could identify you 

will never be used. 
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Attachment 3: Recruitment Script and Screener Questions 

Hello. My name is [NAME] and I work for NORC at the University of Chicago. I am calling 

you about your interest in the Worker Study. Is this a good time to talk? I would like to tell you 

about the study and you can let me know if you are still interested. 

NORC is conducting this study for the Bureau of Labor Statistics (BLS) under OMB number 

1220-0141 in an effort to try to improve the way that information on work-related injuries and 

illnesses is collected. We are helping to develop a survey for workers like yourself to ask about 

the injuries and illnesses related to your job that you may have experienced. For this study, you 

will come to NORC’s offices for an interview. The interview will include questions on the type 

of work you do, whether you have had a work-related injury or illness, and details about any 

injury or illness you may have experienced. The interview will take about one hour and you will 

be paid $40 in compensation. 

Your answers will always be kept private, and none of the information that we collect about you 

will be used for any purpose other than research. BLS will not receive your name or any other 

identifying information about you. Also, your participation is completely voluntary and you may 

choose to skip any questions the interviewer asks or stop participating at any time. We will first 

ask some questions which will take approximately 10 minutes to determine if you are eligible to 

participate.

Would you like to participate? 

[IF YES] Great. I am going to ask you a few background questions to confirm your 

eligibility. Then we can schedule an appointment time for you.  GO TO SCREENER 

QUESTIONS

[IF NO] That's okay. We appreciate your call. But for research purposes, we would like 

to know why you choose not to participate. Thank you. NOTE TO RECRUITER: IF 

POTENTIAL RESPONDENT DECIDES AFTER HEARING ABOUT THE STUDY 

THAT HE/SHE DOES NOT WANT TO PARTICIPATE, ASK WHY NOT AND 

OFFER TO ANSWER QUESTIONS. RECORD THE RESPONDENT’S REASONS 

FOR NOT PARTICIPATING BELOW:
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FINAL REPORT | 11 

Eligibility Screener

1. Since [DATE], did you do ANY work for pay or profit? 

a. YES 

b. NO

2. How many jobs have you had since [DATE]? 

_____ jobs 

3. What type of work do you do [did you do] at each job?: [RECORD VERBATIM AND 

CODE]

a. Office, professional, business, or management staff 

b. Healthcare

c. Delivery or driving

d. Sales

e. Food service 

f. Product assembly, product manufacture 

g. Cleaning, maintenance of building, grounds 

h. Repair, installation or service of machines, equipment 

i. Material handling (e.g., stocking, loading/unloading, moving, etc.) 

j. Construction 

k. Farming

l. Other:____________________ 

4. Since [DATE], have you experienced any injuries or illnesses related to any job you had? 

a. YES Please describe this incident.

b. NO

Now I would like to ask you about other adult members of your household, that is, persons ages 

18 and older who live with you. 

5. Since [DATE], has any adult member of your household done any work at all for which 

they were paid? [RECORD NAMES]

[ASK Q6 THROUGH Q8 FOR EACH HOUSEHOLD MEMBER.]

6. How many jobs has [NAME] had since [DATE]? 

_____ jobs 
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7. What type of work does/did [NAME] do? [RECORD VERBATIM AND CODE]

a. Office, professional, business, or management staff 

b. Healthcare

c. Delivery or driving

d. Sales

e. Food service 

f. Product assembly, product manufacture 

g. Cleaning, maintenance of building, grounds 

h. Repair, installation or service of machines, equipment

i. Material handling (e.g., stocking, loading/unloading, moving, etc.) 

j. Construction 

k. Farming

l. Other:____________________ 

8. Since [DATE], did [NAME] experience any injuries or illnesses related to any job he/she 

had? 

9. [IF INTERVIEW TO BE CONDUCTED IN PERSON] Would you and [OTHER 

ADULT HOUSEHOLD MEMBER NAME] be able to come in person to our offices in 

downtown Chicago/Bethesda to complete an interview? 

a. YES, DOWNTOWN OFFICE

b. YES, HYDE PARK OFFICE

c. YES, BETHESDA OFFICE

d. NOFIND OUT WHERE RESPONDENT WOULD LIKE TO BE 

INTERVIEWED; WE WILL DETERMINE IF TRAVEL ARRANGEMENTS 

CAN BE MADE; CONTINUE SCREENING.

10. RESPONDENT GENDER. ASK IF UNSURE.

a. MALE

b. FEMALE

11. How old are you? 

_______ years
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12. What is the highest degree or level of school you have completed? 

a.NO SCHOOLING COMPLETED

b.NURSERY SCHOOL TO 8TH GRADE

c.9TH-12TH GRADE, NO DIPLOMA

d.HIGH SCHOOL GRADUATE (HIGH SCHOOL DIPLOMA OR THE 

EQUIVALENT)

e.VOCATIONAL/TECHNICAL/BUSINESS/TRADE SCHOOL CERTIFICATE 

OR DIPLOMA (BEYOND THE HIGH SCHOOL LEVEL)

f. SOME COLLEGE, BUT NO DEGREE

g.ASSOCIATE DEGREE

h.BACHELOR'S DEGREE

i. MASTER'S, PROFESSIONAL OR DOCTORATE DEGREE

j. DON’T KNOW

k.REFUSED

13. Are you of Hispanic, Latino, or Spanish origin? 

a.YES

b.NO

14. What is your race? Please choose one or more. 

a.American Indian or Alaska Native

b.Asian

c.Black or African American

d.Native Hawaiian or other Pacific Islander

e.White

f. DON’T KNOW

g.REFUSED

IF RESPONDENT IS ELIGIBLE

OK, it looks like you are eligible to participate in the study. SCHEDULE 

APPOINTMENT

We would like to audio-record the interview so that we may review our conversation as we 

prepare a summary of our findings. Is this OK with you? [NOTE TO RECRUITER: THIS 

QUESTION IS NOT MEANT TO ASK FOR CONSENT. RESPONDENTS WILL BE ASKED 

AGAIN ABOUT RECORDING DURING THE CONSENT PROCESS. THEY WILL HAVE 

THE OPPORTUNITY TO DECIDE NOT BE RECORDED AND STILL PARTICIPATE IN 
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THE INTERVIEW. WE PREFER TO RECRUIT RESPONDENTS WHO ARE LIKELY TO 

CONSENT TO RECORDING.]

a. YES

b. NO

Ok, let’s schedule an appointment for you [and NAME] to come in for the interview. 

COLLECT CONTACT INFORMATION AND SCHEDULE APPOINTMENT. IF 

PAIRS INTERVIEW, WHEN CALLING/EMAILING TO REMIND RESPONDENT 

OF APPOINTMENT, CONFIRM THAT OTHER ADULT HAS AGREED TO COME 

AND KNOWS OF APPOINTMENT.

If RESPONDENT IS NOT ELIGIBLE

I’m sorry that right now we have enough people who have similar characteristics as you. 

Could I put your name on the waiting list and call you if a slot opens up? 

1. YES

2. NO
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Attachment 4: Cognitive Interview Protocol 

HOUSEHOLD SURVEY OF OCCUPATIONAL INJURIES AND ILLNESSES

DRAFT cognitive interview protocol

MATERIALS NEEDED FOR INTERVIEW

□ INTERVIEWER PROTOCOL BOOKLET (THIS BOOKLET)

□ CONSENT FORM (TWO COPIES)

□ $40 CASH IN ENVELOPE

□ PAYMENT RECEIPT

□ FULLY CHARGED DIGITAL RECORDER AND EXTRA BATTERIES

□ NOTE PAPER, PENS AND PENCILS

STEP 1: INFORMED CONSENT

PROVIDE RESPONDENT WITH A COPY OF THE INFORMED CONSENT FORM. ASK 

THE RESPONDENT TO READ THE FORM, ANSWER ANY QUESTIONS, AND HAVE 

THE RESPONDENT SIGN THE FORM. LEAVE A SEPARATE COPY OF THE FORM 

WITH THE RESPONDENT.

□ SIGNED CONSENT FORM COLLECTED

□ COPY OF CONSENT FORM GIVEN TO RESPONDENT

□ IF THE RESPONDENT HAS CONSENTED TO RECORDING, START 

THE RECORDER.

STEP 2: COMPLETION OF THE QUESTIONNAIRE

BEGIN QUESTIONNAIRE. 

Interviewer probe bank (use as appropriate):

• “How did you come up with that answer?”

• “Can you tell me in your own words what you think the question is asking?” 

• “Can you tell me more about that?” 

 If you pick up on a visual cue that suggests an issue or confusion: 

• “Tell me what you are thinking.” 

• What does the word [term] in this question mean to you? 

• You said [answer]. Can you tell me more about that? 
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FINAL REPORT | 16 

If R is uncertain and asking for confirmation: 

• There is not a right or wrong answer for this question. I am interested in hearing 

your thoughts on what the question is asking. 

INTERVIEWER: If this interview is with a proxy respondent, please modify language 

accordingly. For example, instead of asking “Did you do ANY work for pay or profit?” ask “Did 

[your husband/wife/brother/he/she] do ANY work for pay or profit?” 

Survey Introduction

This survey is about work-related injuries and illnesses that you may have experienced. I would 

like to ask you questions about your work history and about the injuries and illnesses you may 

have had that are related to your job. The information that you provide in this survey is 

confidential. Your name and your answers to the questions will not be shared with anyone 

outside of NORC, the survey organization conducting this survey. I would be happy to answer 

any questions you may have about the survey. [ANSWER RESPONDENT QUESTIONS.] 

Let’s begin. 

Screener

1. Since [DATE: ONE YEAR AGO FROM TODAY], did you do ANY work for pay or 

profit?

a. Yes  ELIGIBLE, CONTINUE

b. No  NOT ELIGIBLE, END INTERVIEW

c. DK

d. REF

Any injury 

2. Since [DATE: ONE YEAR AGO FROM TODAY], have you experienced any injuries 

or illnesses related to any job you had? 

a. Yes  COLLECT BRIEF DESCRIPTION, CONFIRM WORK-RELATED

b. No

c. DK

d. REF
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3. Since [DATE: ONE YEAR AGO FROM TODAY], have you experienced an injury or 

illness, related to any job you had, that caused you to... 

a. Lose consciousness? 1) YES 2) NO 3)DK 4)REF 

b. Be unable to work for a day or more? 1) YES 2) NO 3)DK 4)REF 

c. Restrict your work activities? 1) YES 2) NO 3)DK 4)REF

d. Transfer jobs? 1) YES 2) NO 3)DK 4)REF

e. Get medical treatment other than first aid? 1) YES 2) NO 3)DK 4)REF

IF YES, COLLECT BRIEF DESCRIPTION AND CONFIRM WORK-RELATED.

4. Since [DATE: ONE YEAR AGO FROM TODAY], have you experienced any of the 

following injuries related to any job you had? CUES: 

a. Sprains, strains or tears

b. Soreness or pain

c. Bruises or contusions

d. Cuts, lacerations or punctures 

e. Broken bones 

f. Injury to muscles or joints

g. Open wounds 

h. Burns 

i. Carpal tunnel syndrome 

j. Any other injury? 

1) YES  COLLECT BRIEF DESCRIPTION, CONFIRM WORKRELATED

2) NO

3) DK

4) REF

5. Since [DATE: ONE YEAR AGO FROM TODAY], have you experienced any of the 

following illnesses, related to any job you had? CUES: 

a. Skin disorders 

b. Respiratory conditions 

c. Poisonings, 

d. Hearing loss 

e. A disease or infection

f. Cancer 

g. Any other illness? 

1) YES  COLLECT BRIEF DESCRIPTION, CONFIRM WORK-RELATED

2) NO
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3) DK

4) REF

IF R HAS NOT REPORTED ANY INJURIES OR ILLNESSES ASK ABOUT 

INJURIES/ILLNESSES EVER EXPERIENCED. ELSE GO TO Q7.] 

6. Have you EVER experienced any injuries or illnesses related to any job you had? 

a. YES  COLLECT BRIEF DESCRIPTION, CONFIRM WORK-RELATED

b. NO  GO TO PROBES AT END OF SCREENER SECTION THEN SKIP TO 

DEMOGRAPHICS

c. DK  GO TO PROBES AT END OF SCREENER SECTION THEN SKIP TO 

DEMOGRAPHICS

d. REF  GO TO PROBES AT END OF SCREENER SECTION THEN SKIP TO 

DEMOGRAPHICS

7. [IF YES TO ANY INJURIES OR ILLNESSES] How many total times [since [DATE: 

ONE YEAR AGO FROM TODAY], did you experience/have you ever experienced] an 

injury or illness related to any job you had? [THIS WILL CREATE THE LOOPS.] 

________TIMES 

8. [FOR EACH INJURY/ILLNESS] In what month and year did this injury/illness occur? 

MONTH/YEAR

ENTER MM/YYYY

DK

REF

INTERVIEWER: CONFIRM NUMBER OF INCIDENTS AND BRIEF DESCRIPTION OF 

EACH. IF INJURY/ILLNESS EXPERIENCED WITHIN PAST YEAR, RESPONDENT WILL 

REPORT ON THOSE. OTHERWISE, IF NO INJURY/ILLNESS WITHIN PAST YEAR, 

RESPONDENT WILL REPORT ON INJURIES/ILLNESSES EVER EXPERIENCED.

Probes:

Screener

• I started off by telling you that this survey is about work-related injuries and illnesses, 

or injuries and illnesses related to your job. In your own words, what would be a 
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work-related injury or illness? Can you give me some examples of some things that 

would count as work-related injuries and illnesses? What would not count? 

• I asked you this question: “Since [DATE: ONE YEAR AGO FROM TODAY], have 

you experienced any injuries or illnesses related to any job you had?” In your own 

words, what is this question asking? 

• Tell me about the kind of work you do. Did you ever get hurt or sick because of the 

work you do? Tell me about that. 

• I asked you about whether you ever experienced any injury or illness, related to any job 

you had, that caused you to get medical treatment other than first aid. What does “first 

aid” mean to you? What kind of treatment counts as first aid? What kind of treatment 

doesn’t count? 

• Have you ever experienced a work-related injury or illness? Tell me about that. 

• The questions gave some examples of injuries and illnesses [LIST FROM Q4 AND 

Q5]. Tell me what you think of this list. Which ones have you heard of? Which ones 

had you not heard of? 

• How easy or hard was it to remember when the injury/illness happened? Can you tell 

me more about that? How did you figure out when the injury/illness happened? 

Notes to interviewer:

The goal of the screener section is to enumerate all instances of work-related injuries and 

illnesses that occurred during the reference period. What issues do respondents have in 

reporting these incidents? Do they understand the types of injuries and illnesses to report? 

Can they accurately report only those that are work-related? How do they determine the 

boundary of the reference period and determine whether an incident occurred within the RP?

IF NO INCIDENTS OF WORK-RELATED INJURIES AND ILLNESSES, GO TO 

DEMOGRAPHICS SECTION.
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Injury or Illness

 

[FOR FIRST INJURY/ILLNESS START AT Q10] 

[FOR SECOND AND FOLLOWING INJURY/ILLNESS START AT Q9]

9. [FOR SECOND/THIRD/ETC. LOOPS] How is this injury/illness related to the other 

injury/illness you mentioned? Is this related to [the other/another] injury/illness you 

already mentioned or is it a different injury/illness?

a. RELATED TO THE OTHER/ANOTHER INJURY/ILLNESS [GO TO NEXT 

LOOOP]

b. THIS IS A DIFFERENT INJURY/ILLNESS [CONTINUE]

c. DK

d. REF

10. [FOR EACH LOOP] What happened? How did the injury or illness occur? [For 

example: “When ladder slipped on wet floor, I fell 20 feet”; “I was sprayed with chlorine 

when gasket broke during replacement”; “I developed soreness in wrist over time.”] 

[OPEN ENDED]

11. [FOR EACH LOOP] What were you doing just before the incident occurred? Describe 

the activity as well as the tools, equipment, or material you were using. Be specific. 

[Examples: “climbing a ladder while carrying roofing materials”; “spraying chlorine from 

hand sprayer”; “daily computer key-entry.”] 

a. DESCRIBE THE ACTIVITY.

DK

REF

b. DESCRIBE THE TOOLS, EQUIPMENT, OR MATERIAL THAT YOU WERE USING.] 

[OPEN ENDED]

DK

REF
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12. [FOR EACH LOOP] What object or substance directly harmed you? [Examples: 

“concrete floor”; “chlorine”; “radial arm saw.”] 

a. FLOORS, WALKWAYS, GROUND SURFACES

b. VEHICLES

c. WORKER MOTION OR POSITION

d. CONTAINERS

e. PARTS AND MATERIALS

f. OTHER _______________ 

g. NOT APPLICABLE

h. DK

i. REF

Body part/type of injury 

13. [FOR EACH LOOP] [INTERVIEWER NOTE: R should be more specific than “hurt,” 

“pain,” or “sore.” For example: “strained back”; “chemical burn, hand”; “carpal tunnel 

syndrome.”] 

a. How did this injury or illness happen? 

a. OVEREXERTION AND BODILY REACTION WHILE LIFTING, 

PULLING, ETC., OR PERFORMING A REPETITIVE MOTION

b. FALLS, SLIPS OR TRIPS, FALLS ON THE SAME LEVEL

c. CONTACT WITH OBJECTS OR EQUIPMENT, STRUCK BY OBJECT 

OR EQUIPMENT

d. INJURY CAUSED BY ANOTHER PERSON OR AN ANIMAL

e. INCIDENT RELATED TO A CAR, TRAIN, AIRPLANE OR OTHER 

FORM OF TRANSPORTATION

f. EXPOSURE TO SOMETHING HARMFUL, SUCH AS ELECTRICITY, 

RADIATION, HEAT OR COLD, A NEEDLE OR SHARP OBJECT

g. OTHER ____________________ 

h. DK

i. REF

b. What part of your body was affected? 

a. ARM

b. WRIST

c. SHOULDER

d. FINGERS
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FINAL REPORT | 22 

e. HANDS

f. HEAD

g. KNEE

h. ANKLE

i. FOOT

j. TOE

k. BACK LOCATIONS (THORACIC, LUMBAR, SACRAL, 

COCCYGEAL)

l. ENTIRE BODY

m. LUNGS

n. OTHER ORGANS

o. OTHER ________________________ 

p. DK

q. REF

c. How was it affected? What type of injury or illness affected your [PART OF

BODY]?

a. SPRAINS, STRAINS, TEARS

b. SORENESS, PAIN

c. BRUISES, CONTUSIONS

d. FRACTURES

e. CUTS, LACERATIONS, PUNCTURES

f. BROKEN BONE

g. INJURY TO MUSCLES OR JOINTS

h. STRAINS OR SPRAINS

i. OPEN WOUNDS, CUTS, BRUISES OR BURNS

j. PAIN

k. CARPAL TUNNEL SYNDROME

l. SKIN DISORDERS

m. RESPIRATORY CONDITIONS

n. POISONINGS

o. HEARING LOSS

p. A DISEASE OR INFECTION

q. AN ILLNESS SUCH AS CANCER

r. ANY OTHER INJURY OR ILLNESS?

s. DK

t. REF
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FINAL REPORT | 23 

Probes:

Date of injury/illness

• You said that the injury/illness happened in [Q8 MONTY/YEAR]. Tell me how you 

remembered the month and year this injury/illness occurred. How sure are you about 

that date?

Notes to interviewer:

How certain is the R of the month/year of the injury/illness? How did R determine when the 

incident happened? 

Probes:

Characteristics of incident

• Tell me more about what happened. 

• [READ QUESTION] Can you tell me in your own words what you think this question 

is asking?

• [IF R DOES NOT INDICATE HOW INJURY/ILLNESS IS WORK-RELATED] Tell 

me more about how this injury/illness was related to your job. Where were you when 

this happened? What were you doing? What caused the injury/illness? Tell me more 

about the injury/illness. 

Notes to interviewer:

Questions 10 through 13 are intended to capture (event or exposure, source of the 

injury/illness, part of body affected, and nature of the injury/illness). Do the questions elicit 

the information needed? Are the response options adequate to capture the information Rs 

give? Use general probing to elicit more information about the incident. (For example, if R 

says “I cut myself” ask: What part of your body was injured? What did you get cut with? 

What were you doing at the time? 

Medical attention
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14. [FOR EACH LOOP] Was the injury/illness serious enough that a medical professional 

was consulted?

a. Yes  What type of medical professional did you see? (specify)___ 

___________________ 

b. No 

c. DK

d. REF

15. [FOR EACH LOOP]Did you get medical advice, treatment, or follow-up care for this 

injury/illness from...? 

Yes No Not 

needed

DK/REF

An emergency vehicle, such as an ambulance or 

fire truck

An emergency room

A doctor’s office or other health clinic 

Please include on site offices or clinics at your 

place of employment 

A phone call to a doctor, nurse, or other health 

care professional

Any place else? Specify

16. [FOR EACH LOOP] Were you in the hospital? 

a. YES  How many nights were you in the hospital? _______ nights 

b. NO

c. DK

d. REF

17. Did you receive a medical diagnosis from your healthcare professional?

a. YES  What was your medical diagnosis? 

b. NO

c. DK

d. REF
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Effect on work 

18. [FOR EACH LOOP] Did you report this injury/illness to your employer? 

a. YES [SKIP TO Q20]

b. NO

c. DK

d. REF

19. [FOR EACH LOOP] IF NO TO REPORTING TO EMPLOYER: Why did you not 

report this injury/illness to your employer? 

a. Avoid being laid off YES NO DK REF

b. Avoid loss of wages YES NO DK REF

c. Avoid loss of promotion or advancement YES NO DK REF

d. Avoid job transfer or restriction YES NO DK REF

e. Employer would not recognize the injury/illness as 

work-related YES NO DK REF

f. Employer wants to keep injury and illness rates low YES NO DK REF

g. Realized the injury/illness was work-related after 

leaving the job YES NO DK REF

h. Other (specify) YES NO DK REF

20. [FOR EACH LOOP] Did the injury/illness cause you to...? 

YES NO NOT 

NEEDED

DK/REF

a. Be unable to work the next day, whether or 

not you were actually scheduled to work? 

[ASK FOLLOW-UP QUESTION]

b. Work at your regular job less than your 

usual number of hours? 

c. Work at your regular job, but be unable to 

perform all of the normal duties of the job? 

d. Be assigned to another job on a temporary 

basis?

e. Be transferred?

f. Receive temporary disability benefits?
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FINAL REPORT | 26 

g. Quit your job?

h. Be laid off?

i. Be fired?

j. Change occupations?

k. Lose any wages?

l. OTHER (SPECIFY)

IF NO WORK DAYS MISSED, GO THROUGH PROBES THEN SKIP TO INTRO TO Q23.

Probes:

Medical attention (tailor probes based on whether R reported receiving medical attention) 

• Can you tell me in your own words what you think this question is asking? 

• Who do you think of as a medical professional? Who would you include or not 

include? [IF NEEDED ASK IF THESE WOULD COUNT: medical doctor, nurse, 

physician’s assistant, chiropractor, paramedic]

• Did you go to a doctor, nurse, or other health care provider after [INCIDENT]? Did 

you go to the hospital or did paramedics come? 

• Is/Was there a medical clinic at your place of employment? Did you see anyone at that 

clinic?

• Did you speak to a doctor, nurse, or another health care provider by phone after the 

incident? 

• Tell me more about the medical care you received after the injury/illness happened.

• I asked you about whether you received a medical diagnosis. What does the term 

“medical diagnosis” mean to you? How do you get a medical diagnosis? Who gives 

you a medical diagnosis? Does a medical diagnosis have to come from a doctor or 

other health care professional?

Temporary disability

• I asked about whether you received temporary disability benefits. Have you heard of 

temporary disability benefits? Can you tell me what this term means?
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Notes to interviewer:

Does the R consider all potential sources of medical attention? Does R provide a complete 

report of medical care received, including both immediate and follow-up care?

Probes:

Effect on work 

• [IF YES TO MORE THAN ONE ITEM IN Q19] Tell me more about the reasons why 

you did not tell your employer about this injury/illness. Which was the main reason for 

not telling your employer? 

• IF YES TO ANY ITEM IN Q20: Tell me more about [TEXT FILL]. [E.g., Tell me 

more about your normal job duties. What duties were you unable to perform? OR Tell 

me more about why you quit your job? When did you quit? How was that related to 

your injury/illness?] 

• What does the term [TEXT FILL] mean to you? Can you give me an example? [E.g., 

What does it mean to you to be assigned to another job on a temporary basis? What 

does it mean to you to be transferred?] 

• What kind of effect did the injury/illness have on your work schedule? Job duties? 

Ability to work? Ability to keep your job? The pay you received? 

Notes to interviewer:

Observe for signs of acquiescence bias in Q19. Are Rs saying “yes” because a reason sounds 

plausible or because it was a reason why R did not report an injury/illness? Ask for more 

detail and main reasons. How did R determine an answer to each item in Q19? Probe to 

explore understanding of terms, ability to accurately report on consequences of the 

injury/illness.

21. [FOR EACH LOOP] IF YES ON MISSING DAYS OF WORK: How many calendar 

days, or days in a row, were you not able to work? This may include both the days you 

were scheduled to work and days you were not scheduled.

 ____DAYS 

DK

REF
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22. [FOR EACH LOOP] How many days after the injury/illness were you able to start work 

again?

a. _____DAYS AFTER THE INJURY/ILLNESS

b. STILL OFF PAID WORK

c. EXPECTS NEVER TO DO PAID WORK AGAIN

d. BACK TO WORK SAME DAY

e. DK

f. REF

Probes:

Calendar days missed

• How did you figure out the number of days you were not able to work? 

• Walk me through the timeline of when you were injured and when you got back to 

work. 

• I asked you [REPEAT QUESTION AND ITALICIZED INSTRUCTION ON 

CALENDAR DAYS NOT ABLE TO WORK]. Can you tell me in your own words 

what you think this question is asking? Can you think of a simpler way to ask this 

question? What does the term “calendar day” mean to you?

• You said you missed XX calendar days of work. How did you figure that out?

• Did your doctor or another medical professional recommend that you take days off 

from work? How many days off did they recommend? 

Notes to interviewer:

Is R able to distinguish between work shifts vs. calendar days of work missed? Does R 

correctly report calendar days missed? How does R determine the days missed? 

If reported no days missed in Q20, confirm that R is thinking of calendar days, not work shifts. 
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Workers’ compensation

Workers’ compensation is insurance that provides you with your lost wages and medical care 

when you become injured or ill due to your job. The next questions are about income you may 

have received from workers’ compensation. 

23. [FOR EACH LOOP] Has anyone filed a workers’ compensation claim for this 

injury/illness?

a. YES

b. NO [SKIP TO Q25]

c. DK

d. REF 

24. Who filed the workers’ compensation claim?

a. EMPLOYER

b. EMPLOYEE

c. FAMILY MEMBER OF EMPLOYEE

d. OTHER SPECIFY

e. DK

f. REF

GO TO SKIP INSTRUCTION BEFORE Q26.

25. [FOR EACH LOOP] IF NO ON QUESTION ABOUT WORKERS’ COMPENSATION: 

What was the main reason you or your employer did not file a workers’ compensation 

claim for this injury/illness?

a. Not eligible (did not meet waiting period)

b. Employer refused 

c. Did not inform employer 

d. Worker unaware of workers’ compensation coverage 

e. Other reason, please specify

f. DK

g. REF

SKIP INSTRUCTION: IF YES TO Q20—MISSED DAYS OF WORK, GO TO Q26. ELSE IF 

WORKERS’ COMPENSATION CLAIM FILED (i.e., Q23=YES) SKIP TO Q27. ELSE GO TO 

PROBES AT END OF SECTION THEN SKIP TO Q28.
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26. IF R MISSED DAYS OF WORK FOLLOWING THE INJURY/ILLNESS: MARK YES 

OR NO FOR EACH QUESTION

YES NO NOT 

NEEDED

DK/REF

Workers compensation is insurance that provides 

you with your lost wages and medical care when 

you become injured or ill due to your job. Did you 

receive workers’ compensation? 

Being kept on salary means that, after an injury or 

illness, your employer continued to pay the wages 

and other compensation you were receiving when 

the injury or illness occurred. Were you kept on 

salary? 

Short-term or temporary disability benefits provide 

you with a portion of your income if you are 

temporarily unable to work due to a medical 

condition. Did you receive short term (temporary) 

disability? 

Did you use sick leave, annual leave, or personal 

time off?

Did you take leave without pay?

Other-specify _____________

Definitions:

Workers compensation is insurance that provides you with your lost wages and medical care 

when you become injured or ill due to your job. 

Being kept on salary means that, after an injury or illness, your employer continued to pay the 

wages and other compensation you were receiving when the injury or illness occurred. 

Short-term or temporary disability benefits provide you with a portion of your income if you are 

temporarily unable to work due to a medical condition. 

SKIP INSTRUCTION: IF WORKERS’ COMPENSATION CLAIM FILED (i.e., Q23=YES), 

GO TO Q27. ELSE GO TO PROBES AT END OF SECTION AND THEN SKIP TO Q28.
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27. [FOR EACH LOOP] IF FILED A WORKERS’ COMPENSATION CLAIM: Is there an 

open claim pending for this injury/illness? 

a. YES

b. NO

c. DK

d. REF

Probes:

Workers’ compensation

• ASK PROBES TAILORED TO THE REASONS R REPORTS ON WHY NO WC 

CLAIM WAS FILED BY EMPLOYER. EXAMPLES: Tell me more about the 

reasons why your employer did not file a workers’ compensation claim for this 

injury/illness? What did your employer say? Why did the employer refuse? How sure 

are you about whether or not your employer filed a claim? 

• Can you tell me what it means to file a workers’ compensation claim? Tell me what 

you know about that process. 

• Have you heard of [TEXT FILL]? Please tell me in your own words what you think 

[TEXT FILL] means: workers’ compensation, kept on salary, short-term or temporary 

disability, sick leave/annual leave/personal time off, leave without pay. 

Notes to interviewer:

Do Rs know what workers’ compensation is? Do they know whether a WC form was filed? 

Are the terms in Q26 familiar to Rs and are the definitions helpful? 
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Occupation and Industry at Time of Injury or Illness

[FOR EACH LOOP] Thinking about the time of the injury/illness [TEXT FILL 

DESCRIPTION]. 

 Were you employed full-time or part-time?

a. Full-time 

b. Part-time

c. DK

d. REF

28. In a typical week, how many hours did you work? ______hours 

IF NECESSARY: Was it greater than or equal to 35 hours per week? 

DK

REF

Probes:

Hours worked

• Do you work the same number of hours per week, or not? How did you determine how 

many hours per week you typically work? 

Notes to interviewer:

Does R have any difficulty recalling FT vs. PT work? How do Rs with irregular work 

schedules, seasonal employment, etc., answer the question? Does the number of hours per 

week typically worked accord with report of FT/PT status? 
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29. At the time of the injury/illness, were you ...? 

a. An employee of a private for-profit company or business, or of an individual, for 

wages, salary, or commissions? 

b. An employee of a private not-for-profit, tax-exempt, or charitable organization? 

c. A local government employee (city, county, etc.)? 

d. A state government employee? 

e. A federal government employee? 

f. Self-employed in own not incorporated business, professional practice, or farm? 

g. Self-employed in own incorporated business, professional practice, or farm? 

h. Working without pay in family business or farm? 

i. DK

j. REF

30. For whom did you work? [OPEN ENDED] 

DK

REF

31. What kind of business or industry was this? [OPEN ENDED] 

DK

REF

32. Was this business or organization mainly manufacturing, retail trade, wholesale trade, or 

something else? 

a. Manufacturing 

b. Retail trade 

c. Wholesale trade 

d. Something else 

e. DK

f. REF

33. What did they make or do where you worked? [OPEN ENDED] 

DK

REF

34. In what state were you employed at this job? 

DK

REF
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35. What kind of work did you do? (For example: registered nurse, personnel manager, 

supervisor of order department, secretary, accountant) [OPEN ENDED]

DK

REF

36. What were your most important activities or duties? (For example: patient care, directing 

hiring policies, supervising order clerks, typing and filing, reconciling financial records) 

[OPEN ENDED]

DK

REF

37. At this job, were you a member of a union or covered by a collective bargaining 

agreement?

a. YES

b. NO

c. DK

d. REF

38. About how many workers were employed by [TEXT FILL EMPLOYER NAME]? 

a. 1 to 10 workers 

b. 11 to 49 workers 

c. 50 to 249 workers 

d. 250 to 999 workers 

e. 1000 or more workers 

f. DK

g. REF

Probes:

Employment characteristics for job at time of injury/illness

• Q38 (union): Have you heard of unions? Have you heard of a collective bargaining 

agreement? Tell me what those words mean to you. 

• Q38: Tell me how you decided on your answer. Tell me about the collective 

bargaining agreement. What union do/did you belong to? 
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• Q39 ON HOW MANY WORKERS: Tellme how you figured out your answer to this 

question. Walk me through how you figured out that answer. How certain are you of 

your answer? 

Notes to interviewer:

Observe respondent ability to understand and respond to questions about employment at time 

of the injury/illness. Probe as needed to explore an issues with response. Are respondents 

able to accurately report answers for Q38 and Q39? 

IF R HAS ADDITIONAL INJURIES/ILLNESSES TO REPORT, GO BACK TO Q9. ELSE 

GO TO Q40.

Demographic Characteristics

Race/ethnicity

39. Are you Spanish, Hispanic, or Latino? 

a. YES 

b. NO

c. DK

d. REF

40. [I am going to read you a list of five race categories.] Please choose one or more races 

that you consider yourself to be: 

a. White

b. Black or African American

c. American Indian or Alaska Native

d. Asian

e. Native Hawaiian or Other Pacific Islander

f. Other ________ 

g. DK

h. REF
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Age

41. What is your date of birth? Enter MM/DD/YYYY 

DK

REF

42. As of last week, that would make you approximately (AGE) years old. Is that correct? 

[IF NECCESARY] Even though you don’t know your exact birthdate, what is your best guess as 

to how old you were on your last birthday? 

______ years 

DK

REF

Marital Type

43. Are you now married, widowed, divorced, separated or never married? 

a. MARRIED - SPOUSE PRESENT 

b. MARRIED - SPOUSE ABSENT 

c. WIDOWED 

d. DIVORCED 

e. SEPARATED 

f. NEVER MARRIED

g. DK

h. REF

Gender 

44. Are you male or female?

a. MALE

b. FEMALE
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Education 

45. What is the highest level of school you have completed or the highest degree you have 

received? 

a. Less than 1st grade 

b. 1st, 2nd, 3rd or 4th grade 

c. 5th or 6th grade 

d. 7th or 8th grade 

e. 9th grade or 10th grade 

f. 11th grade 

g. 12th grade NO DIPLOMA 

h. High school graduate - high school diploma or the equivalent (For example: GED) 

i. Some college but no degree 

j. Associate degree in college - Occupational/vocational program 

k. Associate degree in college -- Academic program 

l. Bachelor's degree (For example: BA, AB, BS) 

m. Master's degree (For example: MA, MS, MEng, MEd, MSW, MBA) 

n. Professional School Degree (For example: MD,DDS,DVM,LLB,JD) 

o. Doctorate degree (For example: PhD, EdD) 

Current Industry and Occupation 

The next questions are about your current job. If you have more than one job, please tell me 

about the job at which you usually work the most hours. If you work the same number of hours 

at two jobs, please tell me about the job where you were employed the longest. 

46. What is your current employment status? Are you currently employed full-time, parttime, or are you not employed? 

a. FULL-TIME 

b. PART-TIME

c. NOT CURRENTLY EMPLOYED [SKIP TO END OF SURVEY]

d. DK

e. REF

47. [IF CURRENTLY EMPLOYED] Is this job the same job with the same employer that 

you have already told me about? 

a. Same job with same employer [FOLLOW SKIP BELOW]

b. Different job, same employer [SKIP TO Q49]

c. Different employer [SKIP TO Q49]

d. DK

e. REF
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48. [IF YES AND ONLY ONE LOOP FOR INJURY/ILLNESS THEN SKIP TO END OF 

SURVEY. ELSE IF YES AND MORE THAN ONE REPORTED INJURY/ILLNESS 

AND EMPLOYER ASK:] Which job and employer is that? 

49. Currently, in a typical week, how many hours do you work? ______hours 

IF NECESSARY: Was it greater than or equal to 35 hours per week? 

DK 

REF

50. Are you ...? 

a. An employee of a private for-profit company or business, or of an individual, for 

wages, salary, or commissions? 

b. An employee of a private not-for-profit, tax-exempt, or charitable organization? 

c. A local government employee (city, county, etc.)? 

d. A state government employee? 

e. A federal government employee? 

f. Self-employed in own not incorporated business, professional practice, or farm? 

g. Self-employed in own incorporated business, professional practice, or farm? 

h. Working without pay in family business or farm? 

i. DK

j. REF

51. For whom do you work? [OPEN ENDED] 

DK

REF

52. What kind of business or industry is this? [OPEN ENDED] 

DK

REF

53. Is this business or organization mainly manufacturing, retail trade, wholesale trade, or 

something else? 

a. Manufacturing 

b. Retail trade 

c. Wholesale trade 

d. Something else, specify: 

e. DK

f. REF
NORC | OMB Package

FINAL REPORT | 39 

54. What do they make or do where you work? [OPEN ENDED] 

DK

REF

55. What kind of work do you do? (For example: registered nurse, personnel manager, 

supervisor of order department, secretary, accountant) [OPEN ENDED]

DK

REF

56. What are your most important activities or duties? (For example: patient care, directing 

hiring policies, supervising order clerks, typing and filing, reconciling financial records) 

[OPEN ENDED]

DK

REF

Probes:

Employment characteristics for current job

• Use general probes as needed to investigate issues with these questions.

• Is the job you reported your only job or do you have more than one job? 

• [REREAD THE ITALICIZED INSTRUCTION ON WHICH JOB TO REPORT ON]. 

In your own words, what do you think this instruction means?

Notes to interviewer:

These questions are the same as for the job at time of the incident. Continue to observe for 

issues to explore. 

Does R notice that this set of questions is about the current job? If R has more than one job, 

did R report on the correct one? 

How do Q47 and Q48 function for determining that the current and former job are the same?
NORC | OMB Package

FINAL REPORT | 40 

Debriefing questions for self-interview:

Recall and reference period

• How easy or difficult was it for you to answer questions about injuries/illnesses that 

occurred over the last year? 

• How sure are you that the injury/illness you told me about happened in the last year? 

• Were there any questions that were particularly difficult to answer? Tell me more 

about that? 

• If I asked you about injuries/illnesses that happened during the past year, how easy or 

hard would it be to answer the questions I asked you? 

• When you signed up to do the survey, you may have seen a flyer or someone from 

NORC ask you about injuries and illnesses related to work that you may have had. Did 

you think about those injuries/illnesses you had, or did you do anything to get ready for 

the interview before you came? Tell me about that.

• Imagine that you didn’t know ahead of time that this survey was going to be about 

work-related injuries and illnesses. If someone called you or came to your door, and 

asked you whether you had ever had a work-related injury or illness, do you think you 

would have remembered? How hard would these questions in the survey be, if you 

didn’t know in advance what the survey was about? 

Sensitivity

• Were you worried/Would you be worried about telling your employer about an 

injury/illness? Was it/Would it be hard for you to tell your employer? Tell me more 

about that. 

• Were you worried/Would you be worried about telling the government about an 

injury/illness? Why? Tell me more about that.

• Were you worried/Would you be worried about telling anyone else about a workrelated injury/illness? Tell me more about that.

Review of selected items

• I’d like to ask you a little more about [QUESTION]. You said [FILL]. In your own 

words, what do you think that question was asking? How did you decide on your 

answer?
NORC | OMB Package

FINAL REPORT | 41 

General debriefing

• What are your suggestions on how to improve the survey? 

• What questions were the most difficult for you to answer? 

• What questions were the easiest to answer?

Notes to interviewer:

Is reporting work-related injuries and illnesses to the employer a sensitive issue? Why or why 

not? Is telling others outside the workplace about these incidents sensitive? Why or why not? 

What questions are the most and least difficult for Rs to answer? What answers are they 

uncertain about? Do they have suggestions for improving the survey? 

Return to any questions that need further exploration. 

Debriefing questions for proxy respondents:

Proxy

• What is your relationship to [RESPONDENT NAME]?

• How much would you say you know about R’s job? 

• How familiar would you say you are with R’s work-related injury/illness? Are you 

aware of the medical treatment he/she received when the injury/illness occurred? Are 

you aware of how this affected R’s job? How did you learn about R’s injury/illness? 

Who in your household besides R would be the best person to answer the kinds of 

questions I asked?

• What questions were the hardest for you to answer for R? Why? How much would you 

say you know about [QUESTION TOPIC]? How easy/hard is it to remember the 

information the question asked about? Tell me more. 

• What questions were the easiest for you to answer for R? Why? How much would you 

say you know about [QUESTION TOPIC]? How easy/hard is it to remember the 

information the question asked about? Tell me more. 
NORC | OMB Package

FINAL REPORT | 42 

Sensitivity

• Were you worried/Would you be worried about telling anyone else about R’s workrelated injury/illness? Tell me more about that.

Review of selected items

• I’d like to ask you a little more about [QUESTION]. You said [FILL]. In your own 

words, what do you think that question was asking? How did you decide on your 

answer?

General debriefing

• What are your suggestions on how to improve the survey? 

• What questions were the most difficult for you to answer? 

• What questions were the easiest to answer?

Notes to interviewer:

Is proxy reporting of work-related injuries and illnesses a sensitive issue? Why or why not?

What questions are the most and least difficult for Rs to answer? What answers are they 

uncertain about? Do they have suggestions for improving the survey? 

Return to any questions that need further exploration. 
NORC | OMB Package

FINAL REPORT | 43 

Debriefing questions for those with no injury/illness to report:

Terms

How familiar are you with the following terms? Please tell in your own words what these 

terms mean to you? 

Workers’ compensation, etc.

• Worker’s compensation

• Temporary disability 

• Short-term disability

• Being kept on salary 

• Sick leave

• Annual leave 

• Personal time off

Medical professional/calendar days/work shifts

ASK R: In the last year, have you had any injury or illness that was serious enough that a 

medical professional was consulted? Please include any injury whether or not it was workrelated.

• Who do you think of as a medical professional? Who would you include or not 

include? [IF NEEDED ASK IF THESE WOULD COUNT: medical doctor, nurse, 

physician’s assistant, chiropractor, paramedic]

• When you became injured or ill, how many calendar days were you unable to do your 

usual activities? 

• Did you miss any work shifts? How many? 

• You said you were not able to do your usual activities for XX calendar days. How did 

you figure that out? 

• You said you missed XX work shifts. How did you figure that out? 
NORC | OMB Package

FINAL REPORT | 44 

Unions/collective bargaining agreement

• Have you heard of unions? Have you heard of a collective bargaining agreement? Tell 

me what those words mean to you. 

• Q39 (how many workers): Tell me how you figured out your answer to this question. 

Walk me through how you figured out that answer. How certain are you of your 

answer?

Understanding of terms 

• Have you heard of the term “calendar days”? What does that term mean to you? What 

about the term “work shift”? What does that term mean to you? How are these terms 

the same? Different?

• Who do you think of as a medical professional? Who would you include or not 

include? [IF NEEDED ASK IF THESE WOULD COUNT: medical doctor, nurse, 

physician’s assistant, chiropractor, paramedic]

• Now I’d like to ask you about the term “medical diagnosis.” What does the term 

“medical diagnosis” mean to you? How do you get a medical diagnosis? Who gives 

you a medical diagnosis? Does a medical diagnosis have to come from a doctor or 

other health care professional?

STEP 3: END OF INTERVIEW

Thank you for taking part in this survey. 

□ STOP THE RECORDER.

RECRUITMENT QUESTION:

We are looking for additional respondents like you who would be interested in helping with the 

study. Do you know anyone who had a work-related injury or illness who might be interested in 

participating? If yes, would you mind if we gave you a flyer about the study and send you an 

email about the study that you could forward to them? 
NORC | OMB Package

FINAL REPORT | 45 

INTERVIEWER: ANSWER ANY RESPONDENT QUESTIONS. 

This concludes the interview. I would be happy to answer any questions that you have. Thank 

you for your help with this study. 

□ PAY THE RESPONDENT AND OBTAIN SIGNATURE ON RECEIPT.

MATERIALS TO TAKE AWAY FROM INTERVIEW

□ INTERVIEWER PROTOCOL BOOKLET (THIS BOOKLET)

□ SIGNED CONSENT FORM

□ SIGNED PAYMENT RECEIPT

□ DIGITAL RECORDER AND BATTERIES

□ NOTE PAPER, PENS, PENCILS
NORC | OMB Package

FINAL REPORT | 46 

Attachment 5: Participant Consent Form 

CONSENT FORM

The Bureau of Labor Statistics (BLS) is conducting research to increase the quality of BLS 

surveys. This study is intended to suggest ways to improve the procedures the BLS uses to 

collect survey data. 

The BLS, its employees, agents, and partner statistical agencies, will use the information you 

provide for statistical purposes only and will hold the information in confidence to the full extent 

permitted by law. In accordance with the Confidential Information Protection and Statistical 

Efficiency Act of 2002 (Title 5 of Public Law 107-347) and other applicable Federal laws, your 

responses will not be disclosed in identifiable form without your informed consent. The Privacy 

Act notice on the back of this form describes the conditions under which information related to 

this study will be used by BLS employees and agents. 

During this research you may be audio and/or videotaped, or you may be observed. If you do not 

wish to be taped, you still may participate in this research. 

We estimate it will take you an average of [enter #] minutes to participate in this research 

(ranging from [enter #] minutes to [enter #] minutes).

Your participation in this research project is voluntary, and you have the right to stop at any 

time. If you agree to participate, please sign below.

Persons are not required to respond to the collection of information unless it displays a currently 

valid OMB control number. The OMB control number is 1220-0141 and expires April 30, 2018. 

------------------------------------------------------------------------------------------------------------

I have read and understand the statements above. I consent to participate in this study. 

___________________________________ ___________________________ 

Participant's signature Date

___________________________________ 

Participant's printed name

___________________________________ 

Researcher's signature
NORC | Designing a Household Survey of Injuries and Illnesses

FINAL REPORT

Questionnaire Development Report 

(Deliverable #14)
FINAL REPORT

Designing a Household Survey of 

Occupational Injuries and Illnesses

Questionnaire Development Report 

(Deliverable #14)

NOVEMBER 15, 2016 PRESENTED TO:

U.S. Bureau of Labor Statistics

2 Massachusetts Ave, NW

WASHINGTON, DC 20212

PRESENTED BY:

NORC at the University of Chicago

55 East Monroe Street, 30th Floor

Chicago, IL 60603

Phone (312) 759-4000

AUTHORS: 

Lisa Lee

Kristen Neishi

David Gleicher
NORC | Designing a Household Survey of Occupational Injuries and Illnesses

FINAL REPORT | I 

Table of Contents

Introduction................................................................................................................................. 1

Methodology................................................................................................................................ 2

Screener....................................................................................................................................... 6

Injury or Illness ........................................................................................................................... 7

Medical Attention........................................................................................................................ 9

Effect on Work...........................................................................................................................10

Effect on Pay .............................................................................................................................11

Occupation and Industry and Demographic Characteristics ...............................................12

Proxy Interviewing....................................................................................................................14

Interview Timing........................................................................................................................15
NORC | Designing a Household Survey of Occupational Injuries and Illnesses

FINAL REPORT | II 

List of Exhibits

Exhibit 1: Screening and Recruitment Questions Included in AmeriSpeak Omnibus Survey ................... 3

Exhibit 2: Respondent Recruitment............................................................................................................ 4

Exhibit 3: Respondent Characteristics......................................................................................................... 4

Exhibit 4: Example coding of the Characteristics of Reported Injuries and Illnesses................................ 8

Exhibit 5: Administration Time for the HSOII......................................................................................... 15
NORC | Designing a Household Survey of Occupational Injuries and Illnesses

FINAL REPORT | 1 

Introduction 

NORC conducted cognitive testing on behalf of the Bureau of Labor Statistics (BLS) to inform the design 

of the Household Survey of Occupational Injuries and Illnesses (HSOII). As detailed in the review of 

literature on existing questions, the Survey of Occupational Injuries and Illnesses (SOII) is the primary 

source of information for BLS on nonfatal workplace injuries and illnesses. The SOII is an establishment 

survey that relies on reports from employers to derive estimates of the incidence of workplace injuries and 

illnesses. 

However, underreporting of injuries and illnesses is a concern for the SOII. Potential filtering effects may 

lead to employers and workers not reporting all injuries or illnesses that may be in scope for the survey. 

Employers may wish to keep injury and illness rates low, or may not be aware of all injuries and illnesses 

that occur. Workers may avoid reporting injuries and illnesses due to concern about job loss, and loss of 

pay or opportunities for advancement. 

BLS requested that NORC assist in developing a survey instrument for the HSOII that would successfully 

capture non-fatal recordable injuries and illnesses as determined by the Occupational Safety and Health 

Administration (OSHA) criteria. Specifically, incidents that result in any of the following need to be 

captured by the HSOII:

■ Loss of consciousness

■ Days away from work

■ Restricted work activity or transfer to another job

■ Medical treatment beyond first aid

Based on a review of the literature, NORC identified existing survey questions that addressed issues of 

interest for the SOII. NORC also explored cognitive issues that HSOII respondents could face, such as 

comprehension of complex questions or recall of dates and event details. Further, due to the potential that 

survey data would need to be collected by a household respondent rather than the injured/ill worker, the 

literature review examined issues associated with proxy reporting. 

This report presents the results of the HSOII questionnaire design effort. The report begins with a 

methodology section that describes the recruitment process, respondent characteristics, interviewing staff, 

and cognitive interview procedures. The report then presents the final HSOII instrument along with 

discussion of the major findings from the three rounds of cognitive testing. 
NORC | Designing a Household Survey of Occupational Injuries and Illnesses

FINAL REPORT | 2 

Appendix A includes a copy of the final HSOII questionnaire. Appendices B and following include

memos presenting the findings from each of the three rounds of cognitive interviews and the cognitive 

interview protocols used in each round. 

Methodology 

Cognitive interviews were conducted to test and refine the draft HSOII questionnaire. These interviews 

examined respondents’ cognitive processing of the questions. The data from the interviews were used to 

inform revisions to the questionnaire to improve clarity of the questions and response options and to 

improve question flow.

NORC conducted three rounds of interviews with a total of 64 respondents. Cognitive probing was 

conducted concurrently for most interviews. In the final 13 interviews, conducted as part of Round 3, 

interviewers switched to retrospective probing in order to obtain estimates of questionnaire administration 

time. Round 1 interviews (n=12) were conducted in-person in Chicago. In Round 2 (n=22 interviews), 

15 interviews were conducted in-person in Chicago and Bethesda and seven were conducted by phone. 

Round 3 interviews (n=30) were all conducted in the phone mode. 

Recruitment strategy varied by round. Several different strategies and avenues for recruitment were tried. 

In Round 1, NORC posted online advertisements on Craigslist in Chicago and posted paper flyers in 

targeted locations in the Chicago area. Round 2 continued these methods, expanding to Craigslist 

advertisements in Bethesda as well, and incorporating Facebook advertisements in both Chicago and 

Bethesda. Though the reach for these Facebook ads was extensive and the click rate was on-par with the 

rate found in previous NORC internal research (7%), we received no calls or e-mails from people who 

were interested in participating based on the Facebook ads. Respondents who participated in Round 2 

were recruited though Craigslist, personal contacts or contacts of previous respondents, and flyers.

In Round 3, NORC paid to have two screening questions placed in the August Amerispeak Omnibus 

Survey (see Exhibit 1): 
NORC | Designing a Household Survey of Occupational Injuries and Illnesses

FINAL REPORT | 3 

Exhibit 1: Screening and Recruitment Questions Included in AmeriSpeak Omnibus Survey

Q1. The next question is about work-related injuries and illnesses you or someone in your household 

may have had in the last year.

In the last year, have you (or anyone in your household) experienced any injuries or illnesses related to 

any job you had? 

Examples: sprains, pain, bruises, cuts, broken bones, burns, carpal tunnel syndrome, skin problems, 

respiratory problems, hearing loss, diseases, infections.

Yes  GO TO Q2

No  END

Q2. Would you or your household member like to be contacted in the next few weeks about 

participating in an interview on workplace injuries and illnesses? 

Interviews would be by phone and each eligible participant in your household will receive [$40 in 

AmeriSpeak points].

Yes

No

A total of 183 of 1096 respondents indicated that they or a household member had experienced a 

workplace injury or illness in the last 12 months. Of these, 115 participants indicated they were interested 

in participating in an interview for HSOII. NORC followed up with all of these respondents. Forty-four

respondents replied to NORC’s request for an interview, and NORC was able to secure and complete 19 

interviews as a result of this recruitment strategy, including three proxy interviews with other household 

members. The rest of the interviews for Round 3 were recruited through Craigslist postings. Since the 

mode for Round 3 was that of a phone interview, NORC was able to post in different locations and 

recruitment through this method was quite effective.

NORC posted Craigslist ads in the following cities for Round 3:

Tucson, AZ

Houston, TX

Louisville, KY

San Francisco, CA

Oklahoma City, OK 
NORC | Designing a Household Survey of Occupational Injuries and Illnesses

FINAL REPORT | 4 

Exhibit 2 shows the number of people reached, as well as the number responding to a recruitment 

advertisement and number interviewed for each recruitment method.

Exhibit 2: Respondent Recruitment

Method

Number reached – 

Number that saw the 

initial ad or were sent an 

initial contact

Personal contacts – 

number that contacted 

NORC to express 

interest in participating

Number interviewed 

from this source 

(includes proxies 

recruited through other 

respondents)

Flyer/personal contact Unknown 23 6 

Craigslist Unknown 61 39

Facebook Number of people shown 

an ad (reach): 

100849

Number of clicks ads 

received: 7621 

0 0 

AmeriSpeak Survey respondents: 1096

Screened in: 183

Agreed to be contacted: 

115

44 19

Exhibit 3 shows respondent characteristics for all respondents that were interviewed, including proxies. 

64 were interviewed, data are missing from one respondent for whom demographic data was not 

collected.

Exhibit 3: Respondent Characteristics

Characteristic Category Number of Respondents

Q41 – Ethnicity (Spanish, Hispanic or 

Latino?)

Yes 8 

No 53

Do not know 2 

Refuse 0

Q42 - Race White 26

Black or African American 29

American Indian or Alaska Native 5

Asian 4 

Native Hawaiian or Other Pacific 0

Other (specify) 6 

Do not know 0 

Refuse 0

Q43-44 – Age categories Under 25 3 

25-39 26

40-54 21

55-70 13
NORC | Designing a Household Survey of Occupational Injuries and Illnesses

FINAL REPORT | 5 

Characteristic Category Number of Respondents

70 or older 0 

Q45 - Marital Status Married 19

Widowed 0 

Divorced 10

Separated 0

Never married 34

Do not know 0

Refuse 0 

Q46 - Sex

Male 31

Female 32

Q47 – Education level

High school diploma or less 15

Some college but no degree 8

Associate’s degree (any type) 18

Bachelor’s degree or above 22

Q48 – Current Employment Status

Full-Time 31

Part-Time 15

Not currently employed 17

Do not know 0 

Refuse 0 

Q52-Q59 – Description of occupation at the 

time of injury

Oil field equipment operator 1

Firefighter 1 

Mechanic 2

Casino tournament manager 1 

Retail worker 3 

Warehouse worker 3

Legal clerk 1 

Maintenance 1

Landscaping 2 

Drain equipment production 1 

Nursing 2

Data entry 2 

Civil engineering 1

Medical staff associate 1 

Electrical equipment installation 1 

NA because proxy (no injury) 3

Projection equipment specialist 1 

Welding 1

Quality control in oil refinery 1 

Teaching 1 

Q52-Q59 – Description of occupation at the 

time of injury

Medical waste disposal driver 1

Maintenance 2 

Personal care aide 2

Construction worker 3 
NORC | Designing a Household Survey of Occupational Injuries and Illnesses

FINAL REPORT | 6 

Characteristic Category Number of Respondents

Retail worker 3 

Warehouse worker 1

Restaurant food service 4 

Merchandiser 1 

Office manager 1

Mail carrier 1 

NA because proxy (no injury) 1

Security services 1 

Cake decorator 1 

Q52-Q59 – Description of occupation at the 

time of injury

Stocking/inventory 3

Commodity trader 1 

NA (Respondent was a proxy) 2

Bank assistant manager 1 

Shipping/loading 2 

Museum assistant 1

Administration 1 

Accounting 1

Screener

The Screener section of the questionnaire includes an introductory statement to be read to all respondents 

and a series of questions to determine whether the respondent experienced a workplace injury or illness in 

the last 12 months, how many injuries/illnesses the respondent experienced, and month/year of 

occurrence for each. The introductory statement indicates that the survey is about work-related injuries 

and illnesses and that incidents that occurred in the last 12 months (since CURRENT MONTH of LAST 

YEAR) are in scope.

Respondents who did not work for pay or profit in the last 12 months (A1) do not continue with the 

survey. They skip immediately to the end of the interview. Those who have worked in the last 12 months 

proceed to a series of questions on injuries and illnesses they may have experienced that are related to a 

job they had. A2 is a general question, while A4 and A6 include cues to specific injuries and illnesses in 

order to prompt recall. For any injury or illness the respondent names, the respondent provides a brief 

description of what happened and is asked to report the month and year in which the injury/illness 

occurred.

During cognitive testing, we found that the questions on when the injury/illness occurred did not work 

well for injuries and illnesses that are gradual in onset (such as carpal tunnel syndrome, asthma, or 
NORC | Designing a Household Survey of Occupational Injuries and Illnesses

FINAL REPORT | 7 

anxiety). We developed an alternative wording for asking about month/year of occurrence for these types 

of incidents. In this alternative wording, if necessary, the interviewer determines whether the 

injury/illness occurred on a specific day or whether it developed over time. For those injuries/illnesses 

that developed over time, the interviewer ascertains that the respondent did experience symptoms during 

the reference period.

The final version of the questionnaire reflects some additional changes made after the last round of 

testing. In consultation with BLS, the following changes were made:

■ Question A8 was removed. This item screened for work-related injuries and illnesses that may have 

resulted in symptoms that related directly to recordability (such as losing consciousness or being 

unable to work for a day or more). Due to the length of the instrument, NORC suggested removing 

this question, since it seems to yield few additional reports. 

■ Question B1 from the section on Injury or Illness, which asks whether the injury/illness reported is 

related to an injury/illness already mentioned, was moved to the Screener. This question became a 

probe to be read if necessary to determine whether the injuries/illnesses reported in the Screener were 

separate instances of injury/illness.

Injury or Illness

The Injury or Illness section of the questionnaire is intended to capture the characteristics of the workrelated injury or illness that are reported in the Screener section. The questions are open-ended to capture 

narrative responses for determining the nature, part of body, event, and source(s) for each injury or 

illness. 

An earlier version of the questions, derived from the SOII forms (i.e., What happened? How did the 

injury or illness occur? What were you doing just before the incident occurred?), was found to work well 

for acute and physical injuries such as breaking a bone due to falling off a ladder, but was problematic for 

non-physical and gradual onset conditions such as carpal tunnel or asthma. Revisions were made to adjust 

the wording of the questions to address this issue. Based on two rounds of cognitive interview data, the 

current question wording appears to work well for both types of injuries and illnesses. 

As reflected in the final questionnaire, a few additional changes were made to this section after the three 

rounds of cognitive interviews were completed. One change was to remove one of the questions from this 

section (formerly B1: How is this injury/illness related to the other injury/illness you mentioned? Is this 
NORC | Designing a Household Survey of Occupational Injuries and Illnesses

FINAL REPORT | 8 

related to [the other/another] injury/illness you already mentioned or is it a different injury/illness?). This 

set of questions was removed since it was determined that it would function better as a probe in the 

Screener section to determine the relatedness of and the total number of injuries/illnesses the respondent 

experienced. Another change is that the examples that were read to respondents as part of questions B1 

and B3, formerly B2 and B4, were removed (i.e., “When ladder slipped on wet floor, I fell 20 feet”; “I 

developed soreness in wrist over time.”; “strained back”; “chemical burn on hand”; “fainted or passed 

out.”). These were instead included as optional examples to be read only if the interviewer deems it 

necessary for enhancing clarity for respondents. 

Overall, we did not observe that respondents had any other notable issues with this section of the 

questionnaire and the questions appear to provide sufficient information to determine the nature, part of 

body, event, and source(s) for each injury/illness. Exhibit 4 shows two examples of the coding for the 

reported injuries and illnesses based on responses to the questions in this section combined with verbatim 

responses collected in the “Screener” section, and other questions such as medical diagnosis if relevant. 

Exhibit 4: Example coding of the Characteristics of Reported Injuries and Illnesses

Characteristic Description

Nature Third degree burn

Part of Body Leg, hip

Event Machine press caught R’s leg after it had been activated or turned on accidentally by someone 

else. 

Source Machinery

Characteristic Description

Nature Pain in neck, back and shoulder; strained neck

Part of Body Neck, back, and shoulder

Event Developed over time due to carrying heavy books and use of computer

Source Books, computer 
NORC | Designing a Household Survey of Occupational Injuries and Illnesses

FINAL REPORT | 9 

Medical Attention

The questions on Medical Attention are intended to capture the medical advice and treatment that 

respondents received for their reported injury or illness. The medical attention questions are primarily 

closed-ended, asking about who provided the medical advice or treatment, where the medical advice or 

treatment was administered, and what (if any) medical diagnosis the respondent received. 

This series of questions was iteratively revised after each round of cognitive interviews to address issues 

with respondent confusion about specific terms or phrases and to improve the overall content and flow. A 

number of changes were implemented and tested across the three rounds of cognitive interviews: 

■ Incorporated the phrase “health care professional” to replace “medical professional” to more 

inclusively refer to the professionals who may provide medical attention to the respondent.

■ Rephrased the question “Were you in the hospital?” to clarify that being “admitted” to the hospital is 

the focus of the question.

■ Added questions on whether the health care professional recommended that the respondent take days 

off from work.

■ Added simplified language for the term “medical diagnosis” to be read by the interviewer if 

necessary.

■ Reordered questions and revised skip patterns to improve flow. 

Overall, based on what we observed across the three rounds of interviews, the revised questions on 

medical attention worked well. A few final changes were made to this section after the third round of 

cognitive interviews to address the remaining sources of respondent confusion and incorporate additional 

content requested by BLS. For example, we observed respondent confusion about what counts as being 

treated at or admitted to the hospital, particularly with regard to urgent care, outpatient care, and ER. 

These changes have been implemented into the final questionnaire and include: 

Combined two separate questions on getting medical advice or treatment for the injury/illness into one 

single series of questions to improve question flow. 

■ Added text to clarify the reporting of receiving medical advice or treatment from an urgent care or 

outpatient facility. 
NORC | Designing a Household Survey of Occupational Injuries and Illnesses

FINAL REPORT | 10 

■ Added a follow-up question to the question asking about how many days off the health care 

professional recommended to ascertain whether the respondent took the recommended days off of 

work.

Effect on Work

The “Effect on Work” section of the questionnaire captures information on how a respondent’s workrelated injury or illness affected various aspects of his/her ability to work. The questions ask about the 

respondent’s ability to work the next day; work the usual number of hours; perform normal duties of the 

job; quitting, being laid off or fired, and changing occupation due to the injury/illness.

In earlier rounds of testing, we found that some questions did not function well. Respondents were 

uncertain about the difference between being “assigned to another job on a temporary basis” and being 

“transferred.” Some interpreted these terms to refer to changing job locations, changing their job duties, 

or changing jobs entirely. Questions on ability to work the day after an injury/illness were potentially 

confusing for respondents who worked part-time, had not been scheduled to work the day after the 

injury/illness, or never returned to work after the injury/illness. In addition, cognitive testing revealed that 

in some cases, respondents may not receive medical care or take time off for their injury/illness until well 

after it occurs. Further, some of the items that worked well with physical injuries (e.g., broken arm) and 

injuries/illnesses related to a specific incident (e.g., falling off a ladder), did not work well with chronic 

and gradual onset conditions. In addition, initial testing revealed that the term “calendar days,” used in 

questions concerning days of work missed, was not understood well. 

To address the issues described above, some of the key changes implemented across rounds of testing 

include:

■ Reordered questions. Some questions on whether the employer knew of the injury/illness that had 

been included in this section were moved to the section on Effect on Pay, since they were more 

closely related to that section. 

■ Revised questions to eliminate confusing terminology. For example, “change occupations” was 

revised to “change the kind of work you do.”

■ Added questions to capture days of work missed due to the injury or illness to accommodate 

situations in which medical care and effects on work do not occur until much later after the injury or 

illness occurred.
NORC | Designing a Household Survey of Occupational Injuries and Illnesses

FINAL REPORT | 11 

■ Added a new series of questions on Effect on Work that is more relevant to those with chronic or 

gradual onset injuries or illnesses. Interviewers ascertain in the Screener whether the injury/illness 

reported is chronic/gradual onset. If so, in the section on Effect on Work, the interviewer would ask 

the alternate set of questions. These questions determine whether the symptoms of the chronic or 

gradual onset injury/illness resulted in effects on work at any time during the reference period.

After the final round of cognitive testing, a few additional changes were made to this section upon 

discussion with BLS:

■ Combined two separate questions on being laid off and being fired into one question since 

respondents did not always make a distinction between these two options. 

■ Added a skip instruction so that respondents indicating they quit would not be asked about being laid 

off or fired.

Effect on Pay

The questions in the section on Effect on Pay are intended to capture the various ways the injury or illness 

affected respondents’ income or pay. The section begins with questions on whether the respondent’s 

employer knew about the injury/illness and, if not, why the employer did not know. The questions then 

turn to workers’ compensation, ascertaining whether a claim was filed, why a claim may not have been 

filed, and whether the respondent received workers’ compensation. The section closes with questions on 

short-term or temporary disability, paid time off, and taking leave without pay due to the work-related 

injury or illness.

This series of questions was tested and revised to improve clarity of specific terms and improve question 

flow. As noted in the discussion of the section on Effect on Work, questions were moved across sections 

to improve question flow.

Some of the key changes implemented across rounds of testing include:

■ Moving the series of questions on employer knowledge of the injury/illness to this section from Effect 

on Work.

■ Revising skip patterns to assure that questions were directed at the appropriate group (e.g., questions 

on receiving workers’ compensation directed only to respondents who had filed a claim).

■ Removing the phrase “kept on salary.” This term was not familiar to respondents.

■ Revising the terms “sick leave,” “annual leave,” and “personal time off.” Respondents were not 

certain whether these terms referred to paid or unpaid time off. These terms were changed to “paid 

sick leave,” “paid annual leave,” and “paid time off.”
NORC | Designing a Household Survey of Occupational Injuries and Illnesses

FINAL REPORT | 12 

Cognitive testing indicated that the questions on whether the employer knew of the injury/illness and 

reasons why an employer did not know worked well. The list of reasons resonated with respondents who 

had not informed their employers of their injury/illness. However, the findings also indicated that 

respondents varied considerably in how certain they were about the source of the compensation they 

received due to a workplace injury/illness. Some respondents who had received workers’ compensation 

expressed this with certainty. These respondents often knew the percentage of their pay being provided 

by workers’ compensation and by their employers and were clear on the number of days off they were 

given to recover from their injury/illness. However, other respondents indicated that they were directed 

to a particular doctor or clinic for care, but were uncertain who was paying for the medical care.

After the final round of cognitive testing, a few additional changes were made to this section upon 

discussion with BLS:

■ Turning the separate yes/no questions in E2 (question on reasons for not telling the employer) into an 

open-ended question. This change was made both to reduce administration time for the question and 

to capture the most important reason(s) for not telling the employer about the injury/illness.

■ Revising the response options in E5, the question on the main reason for not filing a workers’ 

compensation claim. The option, “you did not inform employer” was removed since this topic was 

already covered in earlier questions in this section. Further, the remaining response options were 

revised and reordered to both shorten the question and to clarify meaning.

Occupation and Industry and Demographic Characteristics

The latter sections of the questionnaire are intended to capture respondents’ demographic characteristics 

and their occupation and industry both at the time of the injury or illness and currently at the time of the 

survey. The demographic characteristics section includes standard questions that ask about race and 

ethnicity, date of birth, age, marital type, gender, and education. No issues were observed with the 

demographic questions over the three rounds of cognitive interviews and therefore, no revisions were 

made to questions in this section. 

The occupation and industry questions capture full-time vs. part-time employment status, hours worked in 

a typical week, type of employer, name of employer, and the relative size of the employer. For the 

majority of cases, the interviewer simply confirmed that the respondent’s employer and position remained 

the same from the time of the injury or illness to the current time period. However, this series of questions 

was repeated if the respondent had changed employers or positions since the injury or illness occurred. 
NORC | Designing a Household Survey of Occupational Injuries and Illnesses

FINAL REPORT | 13 

While we did not observe any significant issues that respondents had answering the occupation and 

industry questions, many of the questions were identified as needing minor revision to address issues with 

respondent comprehension and clarity. The questions about full-time vs. part-time employment status and 

name of employer were revised for Round 2 testing to clarify that it is the employer’s designation of the 

respondent as full- or part-time and the name of the respondent’s employer that are of interest. Another 

change that was made for Round 2 testing was to revise the structure of the question on type of employer 

to help prompt respondents prior to hearing the response options that the question was asking them to 

select the best fitting category. The question about the size of the employer (based on number of 

employees) was also revised for Round 2 testing to clarify that it is asking about the size of the employer 

at the respondent’s particular work location. This was based on the Round 1 finding that respondents were 

unclear whether to report the number of employees across all employer locations or just the location at 

which they were employed. 

We also observed an issue that was specific to respondents who worked for a temporary help/staffing 

agency or were contractors assigned to different work locations. Respondents with these circumstances 

were sometimes uncertain as to which company to report on. Thus for Round 3 testing, revisions were 

implemented to direct this group of respondents on how to answer questions on their employment. These 

revisions included: 

■ A new question asking whether the respondent worked for a temporary help agency or a temporary 

staffing agency.

■ Instruction for those working for temporary agencies that they should answer the questions based on 

the place where they work on a day-to-day basis.

While the above changes appeared to improve respondent’s understanding of the questions, we continued 

to observe a few respondents that answered incorrectly or were unsure of how to arrive at the correct 

answer, particularly for the questions on type of employer and size of employer. 

After the final round of cognitive testing, one additional change was made to this section upon discussion 

with BLS:

■ Added new questions for respondents who report more than one injury or illness to determine if they 

are working for the same employer and in the same position as they previously reported for the first 

injury or illness. Based on responses to these questions, the interviewer will be able to determine 

whether to skip the respondent to the next section/end of the questionnaire or to proceed with asking 

the occupation and industry questions for the second (or subsequent) injury or illness. 
NORC | Designing a Household Survey of Occupational Injuries and Illnesses

FINAL REPORT | 14 

Proxy Interviewing

Across the three rounds of data collection, we conducted six proxy interviews where another member of 

the respondent’s household was also invited to take part in an interview to assess the accuracy of proxy 

response. We collected data on each member of the pair and compared self- and proxy-reported answers 

to selected questions. 

In general, for work-related injuries/illnesses that occurred because of a discrete event or incident, we 

found that respondents and their proxies provided consistent responses to questions about the incidence of 

a work-related injury or illness in the last 12 months, timeframe of when it occurred, characteristics of the 

injury/illness, medical attention or treatment received, and workers compensation. We observed slightly 

more discrepancies between self-and proxy-reporting for chronic/gradual onset injuries or illnesses. A 

few examples are provided below: 

■ Self-respondent (12A) reported the incidence of carpal tunnel during the screener section of the 

questionnaire; however, proxy respondent (12B) did not report carpal tunnel occurring in respondent 

12A. 

■ Proxy respondent (64B) reported that respondent (64A) had anxiety/depression that started in 2015. 

Self-respondent (64A) did not report anxiety/depression in response to any of the screener questions.

Regardless of the type of injury (discrete or chronic/gradual), we observed a few minor discrepancies 

between self and proxy reporting on questions about effect of the injury/illness on work, effect of the 

injury/illness on income or pay, and employment at the time of the injury/illness, specifically with regard 

to using paid sick leave, paid annual leave, or paid time off, taking leave without pay, part-time or fulltime employment status, and name of employer. A few examples are provided below: 

■ Self-respondent (17A) said he was laid off, referring to the months he was unable to work; however, 

proxy respondent (17B) reported that 17A was not laid off. Self-respondent reported no to losing 

wages whereas proxy respondent reported yes to 17A losing wages because 17A does not earn as 

much as he used to. Self-respondent reported yes to getting paid sick leave, paid annual leave, or paid 

time off) whereas proxy respondent reported no. 

■ Self-respondent (12A) reported taking 22 days off from work and 25 days before returning to work. 

However, proxy respondent (12B) reported that 12A did not return to work. Self-respondent further 

explained that the doctor advised she take 3 weeks off. She then returned to work but was not 

working full-time hours and her hours kept getting reduced so she eventually quit.
NORC | Designing a Household Survey of Occupational Injuries and Illnesses

FINAL REPORT | 15 

Interview Timing

For the last 13 Round 3 cognitive interviews, the cognitive interview protocol was switched from 

concurrent to retrospective probing to allow for timing of interview administration. When looking at total 

administration time, interviews ranged from 20 to 48 minutes, with respondents completing from one to 

three loops depending on the number of injuries/illnesses they reported.

To provide more detailed information on the contribution of each section of the questionnaire to 

administration time, NORC determined the mean and median administration time for each section of the 

instrument. Exhibit 5 shows these timings by section. When a respondent completed more than one loop,

their time for a particular section was averaged across each loop they completed for that section. Note 

that for the section on Occupation at Time of Injury/Illness, if the respondent had the same job for more 

than one incident, the timing for the first loop was used for calculating mean and median, since the 

interviewer only spent enough time on the second loop to ascertain that the questions could be skipped. A 

measure of total time for each respondent was calculated by adding up the mean times across sections for 

each respondent. The exhibit includes mean and medians for this total time.

Note that subsequent to Round 3 interviews, in collaboration with BLS, NORC implemented additional 

changes to the instrument, some of which were intended to reduce administration time. For example, 

removing Screener question A8, and converting question E2 in Effect on Pay from a yes/no format to 

open-ended both reduce administration time. Some streamlining of the questions on Medical Attention 

also likely reduced administration time.

Exhibit 5: Administration Time for the HSOII

Section

Mean Timing

(minutes)

Median Timing

(median)

Screener 7.22 6.67

Injury/Illness 3.61 3.00

Medical Attention 2.78 2.83

Effect on Work 3.11 2.42

Effect on Pay 2.73 2.28

Occupation at Time of Injury/Illness 3.26 3.25

Demographics 1.40 1.25

Current Occupation 1.37 0.83

Total Time 25.49 24.66
NORC | Designing a Household Survey of Injuries and Illnesses

FINAL REPORT

Appendices
NORC | Designing a Household Survey of Injuries and Illnesses

FINAL REPORT

Appendix A: Presentation of Household 

Survey Design Report 

(Deliverable #10)
Household Survey Design Report

Designing a Household Survey on 

Occupational Injuries and Illnesses

(HSOII) 

June 1, 2016
Outline

• Motivation/Objectives

• Existing Surveys/Sampling Frames Assessment

• Fielding HSOII through CPS Supplement

Following completion of March CPS Annual Social and Economic 

(ASEC) supplement

Following completion of June or July CPS

• Fielding HSOII through Sample from ACS

• Summary/Comments

2
Motivation/Objectives

• Current Status

Establishment-based SOII (ESOII)

Research points to underestimates

 Employer/employee incentive to underreport, among other factors

• Potential Future State

Parallel survey of households, with estimates not “filtered” by 

establishment level reporting

Provide “unbiased” estimates from which to adjust ESOII 

estimates or to better discuss levels and trends

• Sample Design Considerations

Representativeness

Allow national level estimates by employment relationship, sector, 

broad industry and occupation

Meet cost (<$1MM), publication timing, publishability/quality 

requirements

3
Existing Surveys/Sampling Frames Assessment

• Sampling Frame Options

Add supplemental HSOII module to existing survey

Screen for eligible persons from existing survey, conduct followon survey for HSOII

 Add HSOII-specific screeners to existing survey as necessary

Select HSOII sample from existing survey/sampling frame

Utilize multiple surveys

• Sample Design Options

Independent samples each year

Rotating panel survey

 As in CPS, sample units interviewed more than one year, with 

panels rotating in and out

Multi-year survey

 As with ACS, data aggregated across years

4
Existing Surveys/Sampling Frames Assessment

• Surveys Considered

5

Survey Organization Sampling Frame

American Community Survey (ACS) Census Census Master Address File (MAF)

Current Population Survey (CPS) BLS, Census Census Master Address File (MAF)

National Health Interview Survey (NHIS) NCHS, Census Census data for selecting segments;

Listing of housing units (HUs) within sampled segments

Behavioral Risk Factor Surveillance System (BRFSS) CDC, States RDD landline and cell phones

Medical Expenditure Panel Survey - Household Component 

(MEPS-HC) AHRQ NHIS Respondents

National Health and Nutrition Examination Survey (NHANES) NCHS Census data for selecting segments;

Listing of dwelling units (HUs) within sampled segments

National Longitudinal Survey of Youth (NLSY) BLS Census data for selecting segments;

Listing of housing units (HUs) within sampled segments

National Immunization Survey (NIS) CDC, NORC RDD landline and cell phones

Survey of Income and Program Participation (SIPP) Census Census Master Address File (MAF)

Survey of Consumer Finance (SCF) FRB, NORC US Postal Service Delivery Sequence File (USPS DSF);

IRS tax return administrative listing

National Survey of Family Growth (NSFG) NCHS, ISR US Postal Service Delivery Sequence File (USPS DSF)

General Social Survey (GSS) NORC US Postal Service Delivery Sequence File (USPS DSF)

AmeriSpeak (AS) NORC US Postal Service Delivery Sequence File (USPS DSF)

KnowledgePanel (KP) GfK US Postal Service Delivery Sequence File (USPS DSF)
Existing Surveys/Sampling Frames Assessment

• Sampling Frames Considered

6

Sampling Frame Surveys

Census Master Address File (MAF) ACS, CPS, SIPP

Census Data plus Listing within Sampled Segments NHIS, NHANES, NLSY

US Postal Service Delivery Sequence File (USPS DSF) GSS, SCF, AS, KP

RDD Frame of both Landline and Cellular Numbers BRFSS, NIS

IRS tax return administrative listing SCF

NHIS MEPS-HC
Existing Surveys/Sampling Frames Assessment

• Factors Assessed

Population representation

 Coverage of population of interest

 All persons in HU included in existing survey

 Availability of sufficient sample size

Survey mode and use of proxy respondents

 Mode of interest for HSOII as supplement to existing survey

 Ideally, would not use proxies

Availability of information key to HSOII

 Worker status

 Injury/illness data

Timeliness of calendar year estimates

Availability of auxiliary data for sample design efficiency

 e.g., number of persons, gender, age, race/ethnicity

7
Existing Surveys/Sampling Frames Assessment

• Conclusions

Least expensive option: field HSOII as supplement to existing 

survey

 Require sample size 100,000+

 Three surveys meet criteria: ACS, CPS, BRFSS

 Given other factors, CPS is only option

Second, more expensive option: screen for and select HSOII from 

existing survey and conduct follow-on survey

 Again, ACS, CPS, BRFSS meet criteria

 NIS could be considered if HSOII screeners added to NIS screeners

 Given other factors, ACS most favorable option

Third, most expensive option: utilize existing sampling frame to 

implement HSOII-specific sample design

 e.g., Census MAF, USPS DSF, RDD (landline, cell phone)

 Cost will exceed target, option discarded

8
HSOII Sample Design Options

• Option 1: Supplement to March CPS ASEC

• Option 2: Supplement to June or July CPS

• Option 3: Independent Survey, Sample Selected from 

ACS

9
CPS Overview

• National and state based sample design

Approximately 72,000 sample HU’s per month

4-8-4 rotation group (RG) scheme

 Each RG nationally and state based representative sample of HU’s

 RG in sample 4 consecutive months, out of sample 8 months, in 

sample same 4 consecutive months following year

CPS monthly sample comprised of 8 RG’s

• CPS collects information of interest to HSOII

Employment status prior week (employed, unemployed, NILF)

Industry/occupation for employed

• Supplements conducted most months of the year

Supplement follows completion of CPS interview

March supplement (ASEC) collects worker status for prior 12 

months

10
CPS Overview

• Illustration of CPS RG data collection schedule

11

RG Intro Date Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17

Oct-14

Nov-14

Dec-14

Jan-15

Feb-15

Mar-15

Apr-15

May-15

Jun-15

Jul-15

Aug-15

Sep-15

Oct-15

Nov-15

Dec-15

Jan-16

Feb-16

Mar-16

Apr-16

May-16

Jun-16

Jul-16

Aug-16

Sep-16

Oct-16

Nov-16

Dec-16

Jan-17

Feb-17

Mar-17

Apr-17

COMMENTS:

1) Sample HUs in a RG are interviewed for four consecutive months (referred to as MIS-1 to MIS-4), then again the same four consecutive months the following year (referred to as 

MIS-5 to MIS-8)

2) In each month, sample HUs from 8 RGs are included in the active sample, with the RGs encompassing MIS-1 to MIS-8

Data Collection Month

Shaded boxesin outlined horizontal row below show interview months for RG introduced Jan 2016

1st interview Jan 2016, 4th interview Apr 2016, 5th interview Jan 2017, 8th (and last) interview Apr 2017

Shaded boxesin outlined vertical column to left show RGs interviewed in Jan 2016

RG introduced in Oct 2014 is being interviewed 8th (and last) time

RG introduced in Jan 2015 is being interviewed 5th time

RG introduced in Oct 2015 is being interviewed 4th time

RG introduced in Jan 2016 is being interviewed 1st time
CPS Overview

• CPS sample counts

12

Total Unique2

HUs Total 73,744 9,218 884,928 248,886

Eligible 61,117 7,640 733,404 206,270

w/ Interview 53,320 6,665 639,840 179,955

16+ Interviewed 104,000 13,000 1,248,000 351,000

Workers3 67,687 8,461 812,245 228,444

2

 27 unique RGs are in the active CPS sample at least one month in the year

3

 Based on data from ACS and CPS, an estimated 65.1% of persons 16+ worked at 

least one week in the prior year

Monthly

CPS Sample Counts (Based on 2015 Monthly Average)

RG1 Annual

1

 RG is comprised of 1/8 of the monthly sample
HSOII as Supplement to CPS

• Options

Include HSOII as supplement in all RG’s in one specific month 

each year

Include HSOII as supplement in all/subset of RG’s in multiple 

specific months each year

Include HSOII as supplement in all/subset of RG’s in all months 

each year

• Discussion

2nd, 3rd options discarded due to logistical issues

 Reduce recall period, but introduce logistical issues

 Need to coordinate across multiple supplements

 Potential varying context effects by month

1st option pursued under two scenarios

 Optimal key information availability, recall scenario

 No/infrequent overlap with other supplement 

13
Option 1: HSOII Supplement to March CPS ASEC

• Logistics

HSOII implemented in all RG’s each March

 HSOII would follow completion of ASEC

ASEC questions on worker status in prior calendar year serve as 

screener for HSOII

 Roughly 35% of CPS sample would receive no HSOII questions –

screened as HSOII-ineligible as indicated did not work in prior 12 

months

Sample HU’s in HSOII two consecutive years

 Follows CPS RG scheme

 Each year, half sample would experience 2nd HSOII, half 1st HSOII

Respondents to report on injury/illness in prior calendar year

 During first HSOII interview, recall will be unbounded

 During second HSOII interview, recall is bounded by prior year 

interview

14
Option 1: HSOII Supplement to March CPS ASEC

• Illustration of HSOII Option 1 data collection schedule 

15

RG Intro Date Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17

Oct-14

Nov-14

Dec-14

Jan-15

Feb-15

Mar-15

Apr-15

May-15

Jun-15

Jul-15

Aug-15

Sep-15

Oct-15

Nov-15

Dec-15

Jan-16

Feb-16

Mar-16

Apr-16

May-16

Jun-16

Jul-16

Aug-16

Sep-16

Oct-16

Nov-16

Dec-16

Jan-17

Feb-17

Mar-17

Apr-17

Data Collection Month

Shaded boxesin outlined vertical column to left show RGs interviewed in Mar 2016

RG introduced in Dec 2014 is being interviewed 8th (and last) time in CPS and 2nd (and last) time in ASEC and HSOII

RG introduced in Mar 2015 is being interviewed 5th time in CPS and 2nd (and last) time in ASEC and HSOII

RG introduced in Dec 2015 is being interviewed 4th time in CPS and 1st time in ASEC and HSOII

RG introduced in Mar 2016 is being interviewed 1st time in CPS and 1st time in ASEC and HSOII

Shaded boxesin outlined vertical column to right show RGs interviewed in Mar 2017

RG introduced in Dec 2015 is being interviewed 8th (and last) time in CPS and 2nd (and last) time in ASEC and HSOII

RG introduced in Mar 2016 is being interviewed 5th time in CPS and 2nd (and last) time in ASEC and HSOII

RG introduced in Dec 2016 is being interviewed 4th time in CPS and 1st time in ASEC and HSOII

RG introduced in Mar 2017 is being interviewed 1st time in CPS and 1st time in ASEC and HSOII
Option 1: HSOII Supplement to March CPS ASEC

• Illustrative flowchart of HSOII Option 1 interview process

16

~1 minute

~1 minute

ASEC: Did not work in 

2015

No HSOII questions

(~35%)

Each Person 16+

~12.5 minutes

Yes

(<5% of 65%=~3%)

End HSOII HSOII Questions

ASEC Completed 

Interview ASEC Nonresponse

ASEC: Worked in 2015

HSOII Screener: Workrelated injury/illness?

(~65%)

No

(>95% of 65%=~62%)

Obtain HSOII 

Cooperation

Occupied Vacant

CPS Sample HU's

CPS Completed 

Interview Nonresponse
Option 1: HSOII Supplement to March CPS ASEC

• Advantages

ASEC offers fully screened sample

 Collects worker status for prior calendar year

 Roughly 35% of CPS sample would receive no HSOII questions

ASEC frames reference period to prior calendar year

 Reduces potential for recall error due to misunderstanding period

Offers lowest HSOII cost

 Sample locating, contact, nonresponse follow-up incurred by CPS

 Shortest HSOII interview time given available auxiliary information

• Disadvantages

Extends respondent burden for March CPS

 CPS: ~8 minutes, ASEC: ~24 minutes

 HSOII: 10-15 minutes for ~3% of sample reporting injury/illness, ~1 

minute for 62% reporting no occurrence of injury/illness

Sample distributed roughly as general population

17
Option 2: HSOII as Supplement to June or July CPS

• Logistics

HSOII implemented in all RG’s each June or July

 HSOII would follow completion of CPS

CPS questions on employment status in prior week serve as 

partial screener for HSOII

 CPS sample identified as not employed, and worker status in prior 

12 months not determined (up to ~35%) would be asked screener to 

determine if eligible for HSOII

Sample HU’s in HSOII two consecutive years

 Follows CPS RG scheme

 Each year, half sample would have 2nd HSOII, half 1st HSOII

Respondents to report on injury/illness in prior calendar year

 During first HSOII interview, recall will be unbounded

 During second HSOII interview, recall is bounded by prior year 

interview

18
Option 2: HSOII as Supplement to June or July CPS

• Illustration of HSOII Option 2 data collection schedule 

19

RG Intro Date Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-16 Jun-16 Jul-16

Oct-14

Nov-14

Dec-14

Jan-15

Feb-15

Mar-15

Apr-15

May-15

Jun-15

Jul-15

Aug-15

Sep-15

Oct-15

Nov-15

Dec-15

Jan-16

Feb-16

Mar-16

Apr-16

May-16

Jun-16

Jul-16

Aug-16

Sep-16

Oct-16

Nov-16

Dec-16

Jan-17

Feb-17

Mar-17

Apr-17

May-17

Jun-17

Jul-17

Data Collection Month

Shaded boxesin outlined vertical column to left show RGs interviewed in Jun 2016

RG introduced in Mar 2015 is being interviewed 8th (and last) time in CPS and 2nd (and last) time in HSOII

RG introduced in Jun 2015 is being interviewed 5th time in CPS and 2nd (and last) time in HSOII

RG introduced in Mar 2016 is being interviewed 4th time in CPS and 1st time in HSOII

RG introduced in Jun 2016 is being interviewed 1st time in CPS and 1st time in HSOII

Shaded boxesin outlined vertical column to right show RGs interviewed in Jun 2017

RG introduced in Mar 2016 is being interviewed 8th (and last) time in CPS and 2nd (and last) time in HSOII

RG introduced in Jun 2016 is being interviewed 5th time in CPS and 2nd (and last) time in HSOII

RG introduced in Mar 2017 is being interviewed 4th time in CPS and 1st time in HSOII

RG introduced in Jun 2017 is being interviewed 1st time in CPS and 1st time in HSOII
Option 2: HSOII as Supplement to June or July CPS

• Illustrative flowchart of HSOII Option 2 interview process

20

~1 minute

~1 minute

~1 minute

~12.5 minutes

No

(~97% of 36%=~35%)

Yes

(~3% of 36%=~1%)

Yes

(<5% of 65%=~3%)

HSOII Questions

HSOII Screener: Workrelated injury/illness?

(~65%)

No

(>95% of 65%=~62%)

End HSOII

No

(~90% of 40%=~36%)

Yes

(~10% of 40%=~4%)

HSOII Eligibility 

Screener: Worked in 

prior calendar year?

CPS: Worked in Prior 12 

Months

CPS: Not Employed Last 

Week

(~40%)

Nonresponse CPS Completed 

Interview

CPS: Employed Last 

Week

(~60%)

Each Person 16+

CPS Sample HU's

Occupied Vacant

Obtain HSOII 

Cooperation
Option 2: HSOII as Supplement to June or July CPS

• Advantages

Avoids regularly scheduled supplements

CPS offers partially screened sample

 Not employed (~35% of CPS sample) may require screener, if not 

determined in CPS interview

Offers low HSOII cost

 Sample locating, contact, nonresponse follow-up incurred by CPS

• Disadvantages

Greater potential for recall error

 Reference period would be prior 12 months, not calendar year

Need to screen most persons not employed in prior week

 Work status in prior 12 months determined for some, not all

Need to reframe reference period to prior 12 months, not prior 

week

Sample distributed roughly as general population

21
ACS Overview

• County/county-equivalent level sample design

Approximately 3.5MM sample HU’s, 200k persons in group 

quarters (GQ’s) per year

HU sample released monthly

 Data collection over 3 months for each release

 Combination of mail, web, telephone, personal visit (PV) – PV 

occurs in third month for sample of residual nonrespondents

GQ data collection varies by type

• ACS collects information of interest to HSOII

Worker status in prior 12 months

Industry/occupation

Other demographic/socio-economic data

22
ACS Overview

• ACS sample sizes

23

HU Sample GQ Sample

HUs Selected 3,540,532 N/A

Final HU Interviews 2,322,722 N/A

Occupied HUs 1,881,261 N/A

Persons Selected N/A 207,403

Final Person Interviews 4,513,063 165,116

16+ 3,535,344 162,694

Workers 2,271,962 35,793

2014 ACS Sample Size
Option 3: HSOII as sample selected from ACS

• Logistics

ACS treated as sampling frame for HSOII

 Time lag between ACS data collection an availability for HSOII 

sample selection and fielding will result in aged information

Stratify ACS responding sample

 Key variables: employment relationship, industry/occupation

(Sector falls out from I/O)

 ACS eligible worker/no eligible worker (due to aged ACS 

information)

Allocate sample to meet target reliability for designated 

population subgroups

Utilize telephone number (when available) for HU contact

Screen each HU member aged 16+ years

Conduct HSOII interview for each eligible HU member

24
Option 3: HSOII as sample selected from ACS

• Illustration of HSOII Option 3 stratification

25

Industry Occupation All Weeks Partial Weeks All Weeks Partial Weeks Self-Employed Not a Worker

Ind 1 Occ 1

Occ 2

...

Occ m

Ind 2 Occ 1

Occ 2

...

Occ m

...

Ind n Occ 1

Occ 2

...

Occ m

Overall

Full-time Part-time

Employee

Employment Relationship

Work Status
Option 3: HSOII as sample selected from ACS

• Illustrative flowchart of HSOII Option 3 interview process

26

~2 min

~2 min

~2 min

~1 minute

~1 minute

ACS Sample HU's

Occupied Vacant

Nonresponse HU Cooperates with 

HSOII

~12.5 minutes

Contact HU

Determine HU Status

Obtain Cooperation

Each Person 16+

Demographics

HSOII Screener: Workrelated injury/illness?

No

(>95% of 80%=~76%)

Yes

(<5% of 80%=~4%)

End HSOII HSOII Questions

HSOII Eligibility 

Screener: Worked in 

prior calendar year?

No

(20%)

Yes

(80%)

Roster 16+
Option 3: HSOII as sample selected from ACS

• Advantages

Most flexible for targeting industries, occupations

 e.g., industries (occupations) with highest estimated incidence rates 

from ESOII allocated higher target sample

 Group all other industries (occupations) in residual stratum

• Disadvantages

Highest HSOII cost

 Sample locating, contact, nonresponse follow-up incurred solely by 

HSOII

 Longest HSOII interview time given need to conduct screener for all 

persons

Need for sample from “no ACS-eligible persons” stratum to 

ensure full coverage of population

 Yield (eligible persons) will be small from this stratum

27
Summary Assessment

• Expected sample sizes for Options 1 and 2*

Industry grouping

*Sample sizes for Option 3 can be varied

28

Industry Group Count Proportion Option 1 Option 2

Agriculture & Goods-producing1 22,096 15.4% 7,990 8,878

Retail Trade & Transportation2 20,742 14.5% 7,500 8,334

Professional & Business Services 20,019 14.0% 7,239 8,043

Health Care and Social Assistance 18,977 13.3% 6,862 7,625

Leisure & Hospitality 15,435 10.8% 5,581 6,202

Other Service-producing3 26,653 18.6% 9,638 10,709

State & Local Government 19,273 13.5% 6,969 7,744

Total 143,195 100.0% 51,781 57,534

Feb 2016 Employment Expected HSOII Interviews

1

Agriculture & Related Industries (employment from CPS), Mining, Construction, Manufacturing

2

Retail Trade, Transportation

3

Wholesale Trade, Utilities, Information, FIRE, Education, Other Services
Summary Assessment

• Expected sample sizes for Options 1 and 2*

Occupation grouping

*Sample sizes for Option 3 can be varied

29

Occupation Grouping Count Proportion Option 1 Option 2

Technical1 14,134 10.5% 5,416 6,018

Management, Science & Arts2 9,680 7.2% 3,709 4,121

Office, Sales & Education3 44,323 32.8% 16,984 18,871

Healthcare & Services4 26,217 19.4% 10,046 11,163

Production, Construction & Installation5 19,916 14.7% 7,632 8,480

Support, Maintenance, Protection & Transportation6 20,858 15.4% 7,993 8,881

Total 135,128 100.0% 51,781 57,534

6

Healthcare Support, Building/Grounds Cleaning/Maintenance, Protective Service, Transportation/Material Moving

Feb 2016 Employment Expected HSOII Interviews

1

Computer/Mathematical, Legal, Business/Financial Operations, Architecture/Engineering

2

Management, Life/Physical/Social Science, Arts/Design/Entertainment/Sports/Media, 

3

Office/Administrative, Sales/Related, Education/Training/Library

4

Community/Social Services, Food Preparation/Serving Related, Healthcare Practitioners/Technical, Personal Care/Service

5

Production,Farming/Fishing/Forestry, Construction/Extraction, Installation/Maintenance/Repair
Summary Assessment

• Transforming from completed interviews to worker years

2014 ACS distributions for weeks worked, usual hours worked

30

Total Workers

WEEKS WORKED

 Worked 50 to 52 weeks 55.1% 73.8%

 Worked 40 to 49 weeks 5.6% 7.5%

 Worked 27 to 39 weeks 4.7% 6.3%

 Worked 14 to 26 weeks 4.0% 5.4%

 Worked 1 to 13 weeks 5.3% 7.1%

 Did not work 25.3%

USUAL HOURS WORKED

 Usually worked 35 or more hours per week 56.7% 75.9%

 40 or more weeks 50.6% 67.7%

 50 to 52 weeks 47.1% 63.1%

 Usually worked 15 to 34 hours per week 14.4% 19.3%

 40 or more weeks 8.9% 11.9%

 50 to 52 weeks 7.1% 9.5%

 Usually worked 1 to 14 hours per week 3.6% 4.8%

 40 or more weeks 1.3% 1.7%

 50 to 52 weeks 1.0% 1.3%

 Did not work 25.3%

Population 16 to 64 years
Summary Assessment

• Transforming from completed interviews to worker years

Accounting for workers aged 65+ years

Average FTE across worker population =0.80

31

16-64 65+ Total

WEEKS WORKED

 Worked 50 to 52 weeks 73.8% 36.9% 71.5%

 Worked 40 to 49 weeks 7.5% 16.7% 8.1%

 Worked 27 to 39 weeks 6.3% 15.5% 6.9%

 Worked 14 to 26 weeks 5.4% 14.6% 5.9%

 Worked 1 to 13 weeks 7.1% 16.3% 7.7%

USUAL HOURS WORKED

 Usually worked 35 or more hours per week 75.9% 38.0% 73.6%

 40 or more weeks 67.7% 26.2% 65.2%

 50 to 52 weeks 63.1% 15.7% 60.1%

 Usually worked 15 to 34 hours per week 19.3% 38.3% 20.5%

 40 or more weeks 11.9% 18.0% 12.3%

 50 to 52 weeks 9.5% 12.6% 9.7%

 Usually worked 1 to 14 hours per week 4.8% 23.8% 6.0%

 40 or more weeks 1.7% 9.4% 2.2%

 50 to 52 weeks 1.3% 8.5% 1.8%

Workers
Summary Assessment

• Estimated Required selected sample sizes for Option 3

To achieve 5,100 effective worker years

Based on response rate, workers per HU, FTE rate, design effect

32

Selected HU Sample 13,661 18,214 12,857 17,143 11,953 15,938 11,250 15,000 9,107 12,143 8,571 11,429 7,969 10,625 7,500 10,000

Response Rate 0.50 0.50 0.50 0.50 0.50 0.50 0.50 0.50 0.75 0.75 0.75 0.75 0.75 0.75 0.75 0.75

HU Interviews 6,830 9,107 6,429 8,571 5,977 7,969 5,625 7,500 6,830 9,107 6,429 8,571 5,977 7,969 5,625 7,500

Workers per HU 1.4 1.4 1.4 1.4 1.6 1.6 1.6 1.6 1.4 1.4 1.4 1.4 1.6 1.6 1.6 1.6

Worker Interviews 9,563 12,750 9,000 12,000 9,563 12,750 9,000 12,000 9,563 12,750 9,000 12,000 9,563 12,750 9,000 12,000

FTE Rate 0.8 0.8 0.85 0.85 0.8 0.8 0.85 0.85 0.8 0.8 0.85 0.85 0.8 0.8 0.85 0.85

FTE Interviews 7,650 10,200 7,650 10,200 7,650 10,200 7,650 10,200 7,650 10,200 7,650 10,200 7,650 10,200 7,650 10,200

Design Effect 1.5 2.0 1.5 2.0 1.5 2.0 1.5 2.0 1.5 2.0 1.5 2.0 1.5 2.0 1.5 2.0

Effective Sample 5,100 5,100 5,100 5,100 5,100 5,100 5,100 5,100 5,100 5,100 5,100 5,100 5,100 5,100 5,100 5,100
Summary Assessment

• Estimated incidence rates, relative standard errors from 

ESOII

33

Estimated Injury/ 

Illness Incidence Rate

Relative Standard 

Error for Incident Rate

Industry Group 2014 ESOII 2014 ESOII

Natural Resources & Mining 3.8 2.9

Construction 3.6 2.4

Manufacturing 4.0 0.8

Trade, Transportation & Utilities 3.6 0.9

Information 1.4 4.4

Finance, Insurance & Real Estate 1.2 4.2

Professional & Business Services 1.5 2.6

Educational & Health Services 4.2 0.8

Leisure, Entertainment & Hospitality 3.6 1.4

Other Services 2.5 4.1

State & Local Government 5.0 1.6

Total 3.4 0.5
Summary Assessment

• Expected sample worker years, incidence rate, relative 

standard errors for Options 1 and 2

Industry grouping

34

Industry Group Option 1 Option 2 2014 ESOII HSOII Option 1 Option 2 Option 1 Option 2

Agriculture & Goods-producing1 6,392 7,102 3.8 4.8 0.27 0.25 7.0 5.3

Trade & Transportation2 6,000 6,667 ~3.9 4.9 0.28 0.26 7.1 5.4

Professional & Business Services 5,791 6,435 1.5 1.9 0.18 0.17 11.9 9.0

Health Care and Social Assistance 5,490 6,100 4.5 5.6 0.31 0.30 6.9 5.2

Leisure & Hospitality 4,465 4,961 3.6 4.5 0.31 0.29 8.6 6.5

Other Service-producing3 7,710 8,567 ~1.8 2.3 0.17 0.16 9.4 7.1

State & Local Government 5,575 6,195 5.0 6.3 0.32 0.31 6.5 4.9

Total 41,425 46,027 3.4 4.3 0.10 0.09 2.9 2.2

Expected Relative Standard 

Expected HSOII Worker Years Error for Incident Rate

Expected Standard Error for 

Incident Rate

1

Agriculture & Related Industries (employment from CPS), Mining/Logging, Construction, Manufacturing

2

Wholesale Trade, Retail Trade, Transportation

3

Utilities, Information, FIRE, Education, Other Services

Estimated Injury/Illness 

Incidence Rate
Summary Assessment

• Expected sample worker years, incidence rate, relative 

standard errors for Options 1 and 2

Occupation grouping

35

Occupation Group Option 1 Option 2 2014 ESOII HSOII Option 1 Option 2 Option 1 Option 2

Technical1 4,333 4,814 0.4 0.6 0.11 0.11 25.4 19.3

Management, Science & Arts2 2,967 3,297 1.2 1.5 0.23 0.21 18.4 14.0

Office, Sales & Education3 13,587 15,097 1.6 2.1 0.12 0.12 7.4 5.6

Healthcare & Services4 8,037 8,930 3.2 4.0 0.22 0.21 6.9 5.2

Production, Construction & Installation5 6,105 6,784 5.3 6.6 0.32 0.30 6.0 4.6

Support, Maintenance, Protection & Transportation6 6,394 7,105 8.6 10.8 0.39 0.37 4.5 3.4

Total 41,425 46,027 3.4 4.3 0.10 0.09 2.9 2.2

Expected Relative Standard 

Error for Incident Rate

7

Incidence Rates derived using ratio of injury/illness incidence rates to days away from work incidence rates (3.13) for industry

4

Community/Social Services, Food Preparation/Serving Related, Healthcare Practitioners/Technical, Personal Care/Service

5

Production,Farming/Fishing/Forestry, Construction/Extraction, Installation/Maintenance/Repair

6

Healthcare Support, Building/Grounds Cleaning/Maintenance, Protective Service, Transportation/Material Moving

Expected HSOII Worker 

Years

Estimated Injury/Illness 

Incidence Rate7

Expected Standard 

Error for Incident Rate

1

Computer/Mathematical, Legal, Business/Financial Operations, Architecture/Engineering

2

Management, Life/Physical/Social Science, Arts/Design/Entertainment/Sports/Media

3

Office/Administrative, Sales/Related, Education/Training/Library
Summary Assessment

• Comparison of Options 1, 2, and 3

36

ACS-based

Component Option 1 Option 2 Option 3

Max completed interviews

51,781

(could add ~20,000 if utilize ASEC 

supplemental sample)

57,534 up to ~1.5MM

Ability to stratify by I/O No No Yes

Incur cost for sample unit 

locating, contact, participation No No Yes

Need for HSOII eligibility 

screening

No Yes-some Yes-all

Reference Period Calendar year Recent 12 months Recent 12 months

Need to reorient respondent to 

reference period No - already done with ASEC Yes No

Number of years HU in HSOII 2 2 1*

Average respondent burden ~1.8 min ~2.2 min ~7.4 min

Breakout of burden

 Obtain cooperation 100% (ASEC completes) @ 1 min 100% (CPS completes) @ 1 min 100% (sample HUs) @ 2 min

 Roster 16+ in HU none none 100% (participating HUs) @ 2 min

 Demographics none none 100% @ 2 min

 HSOII eligibility screener none 36% @ 1 min 100% @ 1 min

 HSOII injury/illness screener 65% @ 1 min 65% @ 1 min 80% @ 1 min

 HSOII injury/illness questions 3% @ 12.5 min 3% @ 12.5 min 4% @ 12.5 min

Estimated data collection cost per 

complete $5.70-$6.75 $5.70-$6.75 $15-$25

CPS-based

*Sample design could have year-to-year overlap
Assumptions

• Listed in illustrative interview process flowcharts

• Additional interviewer time

Review/administrative: 5 min per interview

Training: 4 hrs per interviewer

• Interviewer costs:

Options 1, 2: $30-$35/hr

Option 3: $15-$25/ interview (mail/web)

37
Comments

• Option 1

Adds burden to March ASEC

Lowest expected data collection costs (~$300k-$350k) and respondent 

burden (average ~1.8 min)

Calendar year reference period

• Option 2

Avoids annual supplements

Requires screening persons not identified by CPS as HSOII-eligible

Expected data collection costs (~$350k-$400k), respondent burden (~2.2 

min)

12 month reference period (ending May or June)

• Option 3

Greatest sample design flexibility

Expected data collection costs (~1MM with 40k-60k completed 

interviews), respondent burden (~7.4 min)

12 month reference period, timing determined by BLS

38
Summary

• Option 1 best meets multiple aims of sample 

representation, data quality, timeliness, cost

Adds burden to March ASEC

Lowest expected data collection costs (~$300k-$350k) and respondent 

burden (average ~1.8 min)

Calendar year reference period

• Option 2 avoids conflict with annual supplements

Requires screening persons not identified by CPS as HSOII-eligible

Expected data collection costs (~$350k-$400k), respondent burden (~2.2 

min)

12 month reference period (ending May or June)

• Option 3

Greatest sample design flexibility

Expected data collection costs (~1MM with 40k-60k completed 

interviews), respondent burden (~7.4 min)

12 month reference period, timing determined by BLS

39
Thank You!

Kennon R. Copeland

Senior Vice President and Director

Statistics and Methodology

copeland-kennon@norc.org

301-634-9432
NORC | Designing a Household Survey of Injuries and Illnesses

FINAL REPORT

Appendix B: Cognitive Interview Round 1 Memo
1 

Memorandum

To: Elizabeth Rogers & Karen Shahpoori

From: NORC

Re: Household SOII Round 1 Cognitive Interviews

Date: 6/8/2016

Introduction

NORC is conducting cognitive testing on behalf of the Bureau of Labor Statistics (BLS) to inform the 

design of a Household Survey of Occupational Injuries and Illnesses (HSOII). The cognitive interviews 

will provide data to evaluate the HSOII survey questions for correct interpretation and to assess the ability 

of respondents to accurately answer the survey questions. The results of the interviews will be used to 

refine the HSOII questionnaire items and item order. 

Recruitment Strategy. The cognitive interview sample was recruited via advertisements placed in 

Craigslist and the on-site posting of flyers in locations in the Chicago and Northern Indiana areas. Three 

Craigslist ads were posted (May 10, May 19, and May 31). Flyers were posted in nearly 30 venues, 

including supermarkets, laundromats, grocery stores, and gas stations. The recruiter frequently returned 

to these venues to make sure the flyers were still showing. The recruiter also provided flyers to

receptionists and managers at One Stops (such as Work One and Work Force Center), unions (including, 

for example, Electrical workers Local 134 and Sheet Metal Workers Union 73), employment centers

(such as the Martin Luther King Services Center, Illinois Department of Employment Services, and 

Chicago Women in the Trades), and local junior colleges. The recruiter also followed-up with some of 

these managers and receptionists and asked them to email an electronic version of the flyer to people 

using their services; NORC was unable to determine whether any managers did email the flyer to their 

clients. 

Sample Characteristics. Eighteen people were screened for the survey; including two proxy pairs. That 

is, 20 people in total. Of the 18 (excluding proxy partners), 16 were recruited through Craigslist ads. 

Fourteen were eligible for the study and 13 appointments were made. Ten interviews were completed (a 

few did not show up or reschedule), including 2 proxy pairs. There were 12 total completed interviews 
2 

Memorandum

(including 2 proxy interviews). Of the completed interviews, only one respondent was recruited through 

flyers and on-site recruitment. See Exhibit 1 for respondent characteristics.

Two of the twelve recruited respondents (R) were proxies who were invited for an interview primarily to 

discuss the work-related injuries and illnesses of another person recruited from their household. In the 

respondent numbering presented in the discussion of findings, respondent pairs are given the same 

number, the letter “A” was assigned to the respondent who was recruited due to experience with a workrelated injury or illness. The letter “B” was assigned to the proxy who was recruited from the same 

household. During the cognitive interview, both the main respondent and the proxy participated in a selfinterview about their own experiences with workplace injuries and illnesses, and then participated in a 

proxy interview about the other member of the pair. Exhibit 1 displays demographic characteristics of the 

12 respondents who participated in an interview.

Exhibit 1: Respondent Characteristics 

Characteristic Category 

Number of 

Respondents

Q41 – Ethnicity (Spanish, Hispanic 

or Latino?)

Yes 2

No 10

Do not know 0

Refuse 0

Q42 - Race White 6

Black or African American 4

American Indian or Alaska Native 0

Asian 1

Native Hawaiian or Other Pacific Islander 0

Other (specify) 1

Do not know 0

Refuse 0

Q43-44 – Age categories Under 25 1

25-39 5

40-54 3

55-70 3

70 or older 0
3 

Memorandum

Exhibit 1 continued: Respondent Characteristics 

Characteristic Category Number of 

Respondents

Q45 - Marital Status Married – Spouse present 2

Married – Spouse absent 0

Widowed 0

Divorced 1

Separated 0

Never married 9

Do not know 0

Refuse 0

Q46 - Sex Male 5

Female 7

Q47 – Education level

High school diploma or less 0

Some college but no degree 3

Associate’s degree (any type) 3

Bachelor’s degree 5

Master’s, Professional, or Doctoral degree 1

Q48 – Current Employment Status

Full-Time 4

Part-Time 4

Not currently employed 4

Do not know 0

Refuse 0

Q52-Q59 – Description of 

occupation at the time of injury

Stocking/inventory 3

Commodity trader 1

NA (Respondent was a proxy) 2

Bank assistant manager 1

Shipping/loading 2

Museum assistant 1

Administration 1

Accounting 1

Interview. All respondents were interviewed in person at NORC’s downtown Chicago office. The 

interviews were conducted by three methodologists who were experienced in cognitive interviewing. 

Respondents participated in a cognitive interview lasting approximately one hour and were paid $40. 

Interviews in which respondents reported for themselves and by proxy for another household member 
4 

Memorandum

lasted slightly longer interviews not involving respondent pairs, but the difference was minimal because 

not all probes were repeated for each incident of injury or illness. 

Organization of this memo. The discussion of findings from the cognitive interviews focuses on the 

questionnaire items in which issues were observed during the cognitive interviews, although some data on 

items that worked well is included for context. Based on our observations in Round 1 interviews we 

provide a number of recommendations for revisions to the instrument and issues for further discussion. 

We welcome BLS feedback on the suggested revisions. Based on discussion with BLS, NORC will 

revise the instrument for the next round of cognitive testing. 

Survey Introduction

The survey introduction was read to all respondents prior to presenting the first survey question. 

Respondents did not display any issues understanding the introduction and had no questions about it or 

about the survey they were participating in. It should be noted that the participants had already learned 

about the purpose of the survey at the time they were recruited. As a consequence, they had a general 

understanding of the survey before they heard the introduction.

 

Screener

Questions 1 through 5: Screener
5 

Memorandum

Questions 1 through 5 ask respondents whether they worked in the past year and whether they 

experienced any injuries or illnesses related to any job they had. These questions must accomplish 

several goals:

• ascertain that R worked during the reference period

• determine whether R experienced injury or illness related to a job

• gather some characteristics of the first injury/illness (lose consciousness, unable to work for day, 

restrict work activities, transfer jobs, get medical treatment)
6 

Memorandum

Confirming that respondent worked in past year

Most respondents answered Q1 with no issue. Two respondents initially answered “no” but then 

reconsidered and changed their answers to “yes.” 

• R11: R answered “no” to Q1. The interviewer asked when R last worked, and the R said 2 1⁄2 

months. Further probing to this and following questions showed that it had been 2 1⁄2 months 

since the injury and the R had indeed worked since May of 2015. R later said he thought the 

interviewer had asked about working since May of 2016. However, even in this case he should 

have responded yes, since he had worked that month. R thought it would be clearer say “in the

last year” rather than to say the month and year.

• R12A (self-interview): R at first said “no” but then corrected herself (“Wait a minute, you said 

since May?”). The interviewer repeated the question and the R answered “yes.”

Understanding of injury/illness

As will be detailed below, respondents displayed a good understanding of the kinds of injuries and 

illnesses of relevance to the HSOII. While screener question Q2 appears to function well, it is important 

to keep in mind that respondents were screened prior to participation in the study and that this screening 

process may have facilitated response to Q2. Even so, Q4 and Q5 did successfully elicit a few more 

incidents of injury and illness that appeared relevant to the HSOII, further suggesting that the screener 

questions were working well.

Respondents had a good idea of the kinds of conditions that would count as an injury or illness. 

Conditions or incidents such as the following were reported in Q2 by the respondents and proxy 

respondents. The descriptions below are derived from answer to Q2 with some additional detail from 

succeeding questions regarding the injury or illness: 

• R1: Foot injury, tripped and fell wrong on foot

• R2: Hand crushed by box

• R4: Back injury, foot got caught and fell

• R5: Tripped in staircase, tore shoulder

• R6A: Stress/anxiety due to job

• R6B: Trouble breathing while working with cardboard 

• R7: Assault during office break-in, also carpal tunnel mentioned in response to cue (but not last 

year). R also mentioned anxiety because of the attack.
7 

Memorandum

• R8: Arm gave out while loading truck

• R9: Shoulder pain due to repetitive motion

• R11: Fell off step ladder and hurt back, pain in write mentioned in response to carpal tunnel cue

• R12A: Hurt knee in slip and fall, also mentioned carpal tunnel in response to cue, as proxy for 

husband mentioned his cut to finger in response to cue

• R12B: Cut finger with knife while cutting food; as proxy for wife, R mentioned her falling in the 

produce section at work.

R6A (self) and R6B (as proxy for R6A) mentioned an injury/illness that is not clearly physical. R6A 

experienced stress and anxiety due to her job. R7, who experienced an assault at work, reported physical 

injuries but also noted that the list of injury/illness cues was missing emotional issues. The remaining 

respondents reported physical injuries such as sprains and broken bones.

The lists of injuries and illnesses presented as cues in Q4 and Q5 were generally well understood by 

respondents. A few respondents were unclear about the meaning of carpal tunnel syndrome (R1, R2, 

R11). The term “laceration” was also questioned by one respondent (R5). The lists of cues were intended 

to aid recall of injuries and illnesses and did elicit some additional recall: 

• R12A (as proxy for R12B): In serving as proxy respondent for her spouse (who was not known 

to have had an injury/illness prior to the interview), R12A remembered that her husband had 

suffered a cut finger at work, while cutting food. The husband worked in food preparation at a 

college.

• R7: This R recalled experiencing carpal tunnel syndrome due to computer work. The injury 

recurred during the past year but first occurred more than a year ago, and so was out of scope.

• R6B (self-interview): This R was interviewed primarily as a proxy respondent for R6A. 

However, during the presentation of illness cues, R6B was reminded of breathing problems she 

recently experienced while working with cardboard. 

Understanding of work-relatedness of the injury/illness

Respondent explanations of the injury or illness that occurred revealed that most reported incidents that 

were clearly related to their jobs. Many of the incidents reported occurred during the performance of 

tasks at their jobs. There were two instances in which the relation between work and the incident was less 

clear:
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• R9: R qualified to participate in the survey, since he had worked within the last year. However, 

the injury he reported occurred at an unpaid internship he held in the last year. This internship 

involved physical work and the R suffered shoulder pain. R was not sure if the work at the 

internship hurt his shoulder as it was at the same time as a move to new housing. R said that the 

pain came on slowly, so there was not specific event that cause the injury. Consequently, he 

thought it was tied to work, but could not say for sure.

• R5: R fell in the stairwell while leaving work (not clear whether for break or leaving for the day). 

Would this injury count as work-related?

Respondents were probed regarding what would count and not count as a work-related injury or illness. 

Example responses are summarized below. These responses suggest a good general understanding of 

what counts as a work-related injury or illness although the examples provided raise some questions about 

what should count as work-related. It was unclear to at least one respondent that an illness such as asthma 

or cancer could be work-related (R8); however, this misimpression may be common in those who have 

not experienced these illnesses related to work. Another respondent thought that an injury would not 

count if one were doing something, presumably during work, that shouldn’t be done at work (e.g., racing 

golf carts) (R9).

• What counts: Something that occurs during normal work or work hours (R1, R2, R9, R7, R8, 

R6B); a fall, broken bones, chemicals causing sickness (R2, R4, R11); something that would 

prevent you from working (R1).

• What does not count: Getting a cold, normal sickness (R2); asthma or cancer might not count 

(R8); a minor cut or paper cut, stub finger, anything small (R1, R11); something that you are not 

supposed to be doing at work (such as racing golf carts) (R9).

Understanding of reference period and recall of date of incidents

Most respondents seemed to correctly understand the relevant reference period of the survey. However, 

two respondents as noted above misunderstood the time frame of presented in Q1.

Respondents felt they were able to recall in Q8 the dates when incidents occurred. Some cited landmarks 

(such as Christmas, an anniversary) that allowed them to date the incident. Recent timing of the incident 

also helped recall.

• R1: R knew that she was injured during the Christmas season so it was not hard to determine 

month and year of her injury.
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Memorandum

• R4: R mentioned that it was a major event, still suffers ill effects, and there were witnesses as 

well.

• R5: R felt he/she could remember because he/she had been asked often about when the accident 

happened because of filling of insurance claims.

• R8: R said it was easy to remember because of the pain.

• R2: R mentioned it was painful, and happened during the Christmas season.

• R12A/R12B regarding 12A’s injury: Injury happened on their anniversary. They were going to 

meet for lunch to celebrate.

• R12A regarding 12B’s injury: R was not sure when her husband’s injury happened.

For the respondents who suffered injury/illness that developed over time, pinpointing an exact date was 

more difficult (R6A, R9). Respondents who provided the date for a gradual onset injury/illness gave a 

range of months rather than a single month.

• R6A: It was difficult for R to say an exact date as the anxiety came on slowly. R says “It hit its 

peak probably in November of 2015. I mean it was coming on for a while, with conditions 

getting worse and worse...”

• R6B (as proxy for R6A): In reporting on R6A, R6B gave a range of dates (November or 

December). R6B indicates she noticed change in R6A’s mood at this time, and indicated it was 

stress, not a specific incident. R felt it was easy to remember date, since R hears about it all the 

time from 6A.

• R9: R said it came on slowly, indicated it was around May/early June.

Recommendations 

• NORC notes that Q3 is asked only of injuries/illnesses elicited by Q2. If the information 

gathered in this question is useful to know regarding other injuries and illnesses, the question 

should be added as a follow-up to Q4, Q5, and Q6 as well.

• R6A experienced anxiety related to her job. NORC requests clarification from BLS on whether 

anxiety counts as an injury or illness. The current set of questions on the injury/illness is geared 

toward physical illness and revision may be needed to accommodate non-physical conditions.

• R9 experienced an injury at a position for which he was not paid. R5 was not technically 

working at the time of the accident (leaving the office). NORC requests clarification on whether 

injuries/illnesses related to unpaid positions should be included.

• We recommend that we continue to observe the Screener questions in subsequent interviews.
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Injury or Illness: Description

Questions 10-13 – Illness or Injury: Description

Questions Q10 through Q13 are intended to capture the characteristics of the work-related injury or 

illness that the respondent experienced. The information to be gathered in each question (activity, event, 

source, nature, and part of body) is indicated in each question in the box above. Though each question 

has a different intended focus, it was common for respondents to provide the required information after 

the initial question when they described the incident. The rest of the questions tended to add marginal 
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Memorandum

additional levels of detail. Further, we noted that there was some inconsistency within and across 

interviewers in presenting the examples in Q10 (that is, reading of the text that begins, “For example: 

When ladder slipped on wet floor...”). 

Reporting of activity and event

Q10 is generally effective in eliciting descriptions of the activity the respondent was engaged in and the 

actual event in which the injury/illness occurred. Respondents also reported information on the 

injury/illness as part of the screener questions. As noted, some responses to Q10 were more abbreviated 

because the respondent had already provided a description in response to the screener. Q11 is also 

effective in collecting additional detail surrounding the incident and what the respondent was doing just 

before it occurred. However, as will be further discussed below, these questions are geared toward 

injuries and illnesses that result from events that are discrete in time (e.g., falling off a ladder, getting cut) 

and not injuries or illnesses that may develop over time (e.g., asthma, carpal tunnel syndrome). Further, 

the questions are geared toward physical injuries and illnesses; these questions are odd when asked of 

non-physical conditions such as anxiety and stress. 

Some examples of the information gathered with these two questions:

• R1: R was stocking, carrying something heavy, tripped and fell “wrong” on his foot. Q11 and 

probing elicited more detail regarding carrying something heavy, Christmas stuff.

• R4: R He was a new employee and should not have gone on the forklift. He was told to stand on 

it to reach a box, his foot got caught and he fell on his side. Q11 yielded a report that R was 

writing down numbers for tracking packages. 

• R5: R tripped while walking down the stairs, reached out with right arm and heard a tear. Doctor 

did MRI, which revealed a labrum tear in the shoulder. Q11 revealed that just before, R was 

working at a computer for 3-4 hours. R5 was in the stairwell because he was leaving work. 

• R8: R was loading trucks, kept loading and her arm gave out. She couldn’t lift anything with it. 

Q11 revealed that R was stacking boxes just before incident, only using hands (no equipment). 

• R2: R was in a truck loading boxes coming down a conveyer belt. She had her hand on one box, 

another box slammed into her hand. Q11 elicited detail that the box was too heavy and she didn’t 

move it fast enough and the other box came down on her hand.

• R7: R described a man entering office and demanding money. When she said she had none the 

man pushed her and she hit her knee on a low table and twisted her ankle. Q11 revealed that just 

prior, the R was answering the door—the man was ringing the bell.
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• R12A: R12A, who worked at a grocery store, was getting food ready for lunch (that is, setting up 

lunch buffet). R was taking something to the back to dispose of and slipped and fell. Q11 

elicited repetitive information, that R was preparing the hot table for lunch. By Q11, R had 

already provided detailed description in response to screener questions and Q10. The proxy for 

this R, R12B, indicated that there was something wet on the floor and his wife slipped. Q11 

elicited that the proxy did not know what R12A was doing just before. He said probably 

something with boxes and box cutters.

• R11: R said he fell on his back. A box came apart and pushed him. In response to prior screener 

questions, this R already described that he was on a step stool pulling out a box of records and 

that the box came apart. Q11 elicited the detail that he needed to look up some charges and was 

trying to pull out invoices from last year.

• R12B: This R was interviewed as the proxy for R12A. Both he and R12A reported the cut that 

R12B sustained when he worked as a cook at a college. R12A described in screener questions 

that R12B was working on a college campus, cutting carrots in the kitchen and cut his finger 

“kind of bad.” In response to Q10, R12A gave abbreviated account.

For a number of respondents, Q10 and Q11 did not fit the non-physical nature of the injury/illness or its 

gradual onset. 

• R6A: This R’s proxy, R6B, mentioned the pressure R6A is under, sleepless nights. Q11 did not 

make sense for this R, since she was experiencing stress and anxiety from her job, not tied to a 

specific incident.

• R9: R described scrubbing dishes at an aquarium, repetitive motion. Injury came on slowly. R 

indicated it could have been reinjured from a few years ago or unpacking boxes after a move. 

Q11 yielded information that R was scrubbing dishes.

Reporting of source of injury or illness

Along with Q11, Q12 is intended to discover the source of the injury or illness. Some respondents 

appeared able to identify the source of their injury or illness. A couple of these still expressed lack of 

certainty (guesses) as to the source:

• R1: When reading the question, the interviewer read the “concrete floor” example. R1 

immediately said “floor.” The example in the question appeared to be a helpful cue for this 

respondents.
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Memorandum

• R2: R easily identified that a box was the source of the injury (the box coming off the conveyer 

belt slammed into her hand).

• R11: R said that he “guessed” it was the floor. He thought at first it was the box, but that didn’t 

make sense. The box pushed him to the floor.

• R12A: This R repeated part of the question, suggesting confusion with the question. The 

interviewer repeated the question and the R said, “I guess the wet floor.”

• R12B: This R’s wife (R12A) correctly identified a knife as the source of the cut that her husband 

sustained while working in a kitchen.

Other respondents had difficulty correctly identifying the source of their injury or illness. In some of 

these cases, the identified object was involved and was a cause (such as the fork lifter or person who 

shoved the R). In other cases, there seemed to be no object or substance to cite (such as when the 

condition was anxiety). 

• R4: This R said the fork lifter was the source. However, the interviewer noted that the ground or 

floor seems to be the source, since the R fell off the forklift when his foot got caught. The forklift 

did not impact the R’s body, the floor did.

• R5: R said the stairs was the source. This R reached out and broke his fall with his arm. The 

interviewer noted that the floor could have been the source.

• R6A: R experienced anxiety from new owners at the bank where she worked. The reference to 

objects or substances that harmed the R was odd as the stress was brought about by people. R6B 

said it was “more about personnel than anything.” There is no response option for “other 

people.”

• R8: R8 said there was no object or substance, but constant lifting and stacking. For this R, would 

the objects being lifted and stacked be the source?

• R9: R’s identification of scrubbing/moving stuff as the source of injury seems correct. In this 

case, it was an action, however, and not a specific object or substance. Clarification is needed as 

to whether this is correct.

• R7: R7 was pushed by a person. Due to the push, R hit her knee on a table and twisted her ankle. 

R identified the source as the man who pushed her. When the interviewer probed for an object, 

the R indicated the table. NORC is unsure as to whether the person or the table is the source.

• R12B: R did not know what was on the floor that his wife slipped on. After probing, R 

identified the floor as the object. R mentioned that he thought “substance” referred to drugs.
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Memorandum

Reporting how the injury or illness happened

Q13 is a three-part question intended to ascertain the nature of the injury or illness, the part of body and 

how it was affected. The first part of the question (Q13a: How did this injury or illness happen?) is 

perceived by most as a redundant question. Although understood well, Q13a does not seem to add new 

information beyond what has been collected in the prior questions.

A couple of respondents noted the repetitive nature of the questions (R1, R4). Other respondents prefaced 

their answer with “like I said,” suggesting that they felt they had already answered the question (R5, R8, 

R11). R2 laughed (the interviewer interpreted it as laughing at the question). R12A also laughed when 

reporting on her fall. When reporting as proxy on her husband’s injury, R12A expressed with her 

intonation that she had already provided the requested information.

Q13b and Q13c, which collect information on the part of body affected and how it was affected, are 

generally understood well and answered without issue. Most respondents repeat the body part they had 

already mentioned in describing the injury or illness. 

• R1: right foot

• R5: shoulder

• R2: fingers

• R12B: finger (reported by 12A, not clear what R12B’s self report was)

Non-physical types of injury or illness do not fit Q13b and Q13c:

• R4: R indicated the “whole upper body” then clarified to state it was the back and hips. Q13b 

and Q13c are currently phrased in the singular, to refer to a single body part, making it unclear 

whether it is acceptable to report more than one.

• R6B, in reporting on R6A’s anxiety, indicated the body part to be the head. However, this R is 

referring to mental pressure and stress, not a physical injury to the head.

The following R’s also indicated more than one body part. However, the question does not indicate that 

the respondent can select more than one answer: 

• R8: Shoulder and arm

• R9: Shoulders, neck
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Memorandum

• R7: Knee and ankle

• R12B (regarding R12A): Knee and ankle. 

• R12A: Right ankle and right knee. 

• R11: R said “mainly back” but when asked anything else mentioned headache from the fall

Recommendations: 

• Consider adding separate questions that are phrased appropriately for non-physical injuries and 

illnesses, such as anxiety, if these are in scope for the HSOII.

• Is a specific date required for injuries and illnesses of gradual onset? Instructions on how to 

provide a date of injury or illness may be helpful for interviewers and respondents.

• Clarify for interviewers whether the examples in Q10, Q11, Q12, and Q13 are to be read to all 

respondents or read only if necessary. If this text is to be presented to all respondents, removing 

the brackets around it would make it clearer that it is to be read. If this text is to be read only if 

the respondent requires further explanation to understand how to answer the question, then a note 

of “read if necessary” should be inserted.

• Consider making Q13b and Q13c a “choose all that apply” format so that respondent can report

more than one body part and how each was affected.

• Q13a is perceived as redundant and could be deleted.

• Given the very specific nature of the information that is required about each injury/illness, it may 

be difficult to craft questions that can effectively elicit the needed injury/illness characteristics 

without interviewer intervention. Interviewer knowledge of the typology may be necessary to 

ensure that the injury/illness is fully described. It would be helpful to discuss approaches to Q10-

Q13. Should there be added focus on crafting guidance and instruction to interviewers on how to 

probe on and code the characteristics of each injury/illness?
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Memorandum

Injury or Illness: Medical Attention

Questions 14-17 – Medical Attention

This series of questions ascertains the extent of medical advice and treatment that was received after the 

injury or illness.

Understanding of reference period of questions

For the most part, respondents did not report any confusion about the time period being referred to in 

these questions. However, there were two respondents who expressed confusion about this topic.
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Memorandum

• R4: In response to Q17, R4 said “no, not at the moment, because they (the doctors) didn’t know 

what it was.” This respondent clarified afterwards that he did get a diagnosis later on, after an 

MRI and an X-ray were performed. 

• R2: When asked the follow up question on type of medical professional she saw in Q14, the 

respondent asked whether this referred to immediately, when the ambulance was called, or later 

on. 

Understanding of the phrase “medical diagnosis from your health care professional.”

Respondents reported understanding the terms ‘medical diagnosis’ and ‘health care professional.’ Those 

probed on the topic all agreed that a medical diagnosis would have to come from a health care 

professional. All were in agreement that a doctor would count as a medical professional. Respondents 

who were probed on the topic were evenly divided on whether a nurse or medical technician would count 

as a medical professional. R12B stated that only doctors counted as nurses would have to check with 

doctors in any case. Only one of the six respondents probed on the issue thought a chiropractor would 

qualify as a medical professional. It is somewhat surprising that some said they do not count nurses as 

health care professionals. However, in the context of Q17 (receiving a medical diagnosis from a 

healthcare professional) it is possible that respondents were focused on those providers whom they feel 

would provide diagnoses.

Understanding of Q16

Nearly all respondents understood this question to be asking about whether they stayed overnight in the 

hospital. There was one who misunderstood this question:

• R2: R answered “yes” to the question. However, the follow-up question asked how many 

nights. R2 said she was there just that one day. So answer to this question should have been “no”. 

That is, the respondent went to the hospital for treatment but appeared not to have been admitted 

for an overnight stay.

Recommendations:

• In order to clarify the intent of Q16, we recommend changing this question to the following:

“Did you stay overnight in a hospital?” 
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Memorandum

This would distinguish overnight stays from emergency room and doctor’s visits that did not 

result in an overnight stay. Without this change, the question could appear redundant, as the grid 

immediately preceding it contains a question about whether they went to a doctor’s office or 

health clinic, and a question about receiving treatment at an emergency room. 

The other issues encountered were minor and do not require a change at this time. Respondents 

seem to be aware of and generally correct about the meanings of the terms “medical diagnosis” 

and “health care professional.”

Injury or Illness: Effect on Work

Questions 20 – Effect on Work

This grid of questions evaluates the effect the injury or illness had on the respondent’s work status.
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Memorandum

Issues with overlapping categories and ambiguity of questions

Most of those surveyed in Round 1 did report the injury to their employer. The series of questions in the 

grid in Q20 were generally well understood, but some problems did arise due to respondents’ 

misinterpretation of some of the questions.

• For Q20b, R1 asked if this referred to when he took time off, or when he returned. This 

respondent said he was fine after he returned to work, and also didn’t have a typical number of 

hours. This respondent answered “yes.” It is not clear that this would be the intended answer, 

since after the respondent returned, he claims that his hours didn’t change from what they were 

before the injury. 

• R4: This respondent interpreted Q20e as referring to a transfer of duties, saying that he did 

different things after he returned from the injury. Upon probing, this respondent clarified that he 

was not transferred to a different geographic location.

The same respondent, R4, in answering the previous question Q20d, said “yes” and clarified upon 

probing that he was thinking of the job he changed to after he quit his job (where he got injured). 

This was probably due to the fact that the respondent had not yet been asked Q20g, which asks 

more directly whether the injury caused the respondent to quit their job. This respondent 

answered “yes” to that question as well.

• R8, when asked Q20f about disability benefits, at first answered “yes” but then changed this to 

“no.” This respondent elaborated that she was getting worker’s compensation but not disability 

benefits, which she thought of as being due to an illness not related to the specific job. This 

respondent may have been confusing general disability benefits with work-related temporary 

disability benefits. 

• R7 answered “yes” to both Q20d and Q20e, giving the same explanation for both, which was that 

she now voluntarily works from home. This respondent was also self-employed, and noted that it 

was her own choice to do this. Since these questions reference “being assigned” and being 

“transferred,” they are not phrased in ways that account for situations where the worker is selfemployed. The fact that this respondent answered “yes” to both indicates that she was considering 

a change in geography or physical location (working from home) to count. 
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Memorandum

Ambiguity about what is usual number of hours

We observed that many respondents could be in part-time or work situations where hours vary from week 

to week. These types of respondents may find it difficult to answer Q20b, which refers to a ‘usual number 

of hours.’

Recommendations:

There is some ambiguity about whether Q20d and Q20e refer to changes in physical location of the job, a 

change in duties of the job, or a change of job entirely, such as to another company or branch. The intent 

of these questions needs to be clarified and then they should be rephrased accordingly to more fully 

specify their intended content. It is possible Q20d could be merged with either Q20e or Q20c depending 

on whether it refers to a change in duties of the job or a change in physical location. 

Question 21 and 22

These questions attempt to ascertain the time it took for a respondent to return to work after the injury or 

illness, and if they have yet returned from work. Respondent comments suggested that they were evenly 

split on whether they regarded these two questions as asking about the same information or different 

information. 
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Memorandum

The difficulty of determining any difference between these questions led some respondents to treat the 

second question as an opportunity to provide additional information about their scheduling. Many of these 

respondents work on a part-time or ad hoc basis, with irregular schedules or schedules that are only 

confirmed a week in advance, which both complicates the description and encourages them to provide 

details about this schedule in response to these questions, even if it is not necessarily what the questions 

are asking about:

• For Q21, R1 responded “2 months.” After probing, R said he understood this to mean "when you 

were able/cleared to work, even if you didn't actually come back [at that time]." So, when one

would be able to work. However, this same respondent answered ‘the next week’ in response to 

Q22. Probing on this indicated that the respondent meant that once R was ready to return, he told 

his employer, and they scheduled him to start 'the next week.'

• R8: This respondent initially said, “after the injury...about 5 or 6” after being asked Q21, and 

then added that if you can walk, they make you come in (to work). R wanted to continue getting 

paid so she kept going in to work, but was not able to do the kind of work she did before. “If I 

voluntarily leave, I won’t get paid...a lot of days, I would come in a few hours and then leave, just 

to get some type of money.” After probing, the respondent clarified that she went in the next day 

after her injury. After probing on the meaning of the question, R responded that it was asking 

how many days before R was able to go in and perform her normal duties. In response to Q22, R 

says she never really was able to work a full day after the injury. After probing on the meaning of 

this question, R said “How soon were you able to go back to work, to your normal duties.” The 

respondent was able to do something (“sweep a floor”) but was never able to do her normal duties 

– however she had to keep going in to work to get some type of pay. 

Another respondent viewed Q22 as an opportunity to describe how his schedule changed once he did 

return to work:

• R4 responded ‘6 weeks’ to Q21. When probed on timeline, R4 says he was out 40 days. When 

he came back, he was working just a few days out of the week. In response to Q22, R4 said "It 

was part time when I came back, so I'd say 25 hours, tops, when I came back." The respondent 

seemed to think the question was asking how many hours per week he worked when he came 

back. After clarifying/asking again, R4 says it was about 60 days. This is close to, but more than

his response of 6 weeks to Q21 After probing on the meaning of the question, R4 responded, 
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Memorandum

"How long did it take me to recover." R4 said he understood what was asked but initially 

responded with a different answer.

One respondent answered the second question with a different time period than the first, afterwards 

explaining that he returned to work but did something other than what he was doing before: 

• R5 responded “4-5 months” to Q21. R5 thinks the question is clear but it takes some time to think 

of it. For the phrase “calendar days,” R5 thinks it includes every day, as opposed to business 

days. In response to Q22, R5 says “3 months.” R5 added that he's been given some money to train 

people, but this is not the same as what he was doing before, and that happened 3 months ago. So 

the 3 months refers to the time when he went in to do some training for employees – not his 

normal duties, which he had not yet resumed. It was not clear that the respondent thought the 

second question was asking something different. Instead it is more likely that he viewed it as an 

opportunity to supply more information about his situation.

A similar situation, involving an altered form of work, occurred with R7:

• R7: In response to Q21, R said they did not go into office for first 3 days after the burglary, but 

answered phones from home. For Q22, R reported 4 days. 

Reports on chronic conditions are problematic in the entire instrument, and this series of questions is no 

exception. A respondent who was reporting as a proxy for someone who had anxiety due to work reported 

a couple of different instances where she took time off due to this anxiety. Because there were multiple 

instances, this respondent was not sure how to answer Q21 initially: 

• R6B (as proxy for R6A): R6B, was answering as a proxy for someone else who had anxiety at 

work and who had taken multiple instances of days off due to this anxiety. For Q21, this R asked 

if we were asking about “each time.” This respondent thought the meaning of the question as 

“How many days off she's had.” The meaning of calendar day: “1 day, 1 day out of the month.” 

In response to Q22, R6B said, “She (6A) went back to work right away after taking time off.”

The term “calendar days” was interpreted differently within the same question by R2, who defined it as 

both a work day and any day in response to probing:
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Memorandum

• R2: when asked to explain what calendar days are, R2 said, “My working days... Calendar days 

are all the days.” [What are work days?] The days you work, I only worked 5 days In the course 

or probing, the Interviewer confirmed that R2’s answer to Q21 was 20 days, because she worked 

5 days a week, and was counting 4 weeks. Note that R said calendar days are all the days, but 

when asked how many calendar days she missed, she only counted work days.

Recommendation:

• Q21 and Q22 appear to be asking the same thing. If this is the case, then only one of the two 

questions needs to be asked. If they questions were intended to measure different things, then the 

measurement goals of the questions should be clarified and the questions revised to better reflect 

the intent.

Injury or Illness: Workers’ Compensation

Question 26 - Grid of questions about what kinds of compensation the respondent received after 

their injury or illness
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Memorandum

This grid of questions evaluates how and if workers were paid when they missed time at work due to their 

injury or illness. 

Uncertainty about meaning of terms

Some respondents expressed confusion about some of the terms in the questions. Some examples:

• R11 said they were not aware that worker’s compensation covered wages lost. He knew it 

covered the doctor, back brace, and medicine. R11 also had not heard of the phrase “kept on 

salary.”

• R12A also had not heard of the term “kept on salary.”

Uncertainty about whether different types of payment overlap

One respondent also expressed some confusion about whether certain types of payment overlapped. 

• R8 asked for clarification on the topic of being kept on salary. This respondent asked if this meant 

their salary or worker's compensation. If she had to choose, she thought it was asking if she was 

kept on the job's salary, meaning her seniority and benefits, so the respondent said "yes" but 

added she's not getting full pay because she's getting worker's compensation. The respondent 

thought this was confusing because she wasn't sure if her worker's compensation counted (as her 

salary): “the money is coming from the insurance company, not the employer.”

Uncertainty about what category a payment is in

A respondent reported receiving payments, but reported uncertainty at each question in the grid about 

what these payments were or which category they should be in.

• R2 replied “I don’t think so” in response to the question about being kept on salary. When asked 

about short term disability benefits, this respondent replied, “Yes,” adding that in her case, “while 

I am not able to work they are paying for the bills and little payments to me.” 

Uncertainty about whether sick leave, annual leave, or personal time off is paid

Respondents expressed some confusion about whether sick leave, annual leave, or personal time off 

supplied payment during time missed from work. Examples of R comments on these items:
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Memorandum

• R2 said after probing that personal time off would not be paid. 

• R11 defined personal time off as “when you take days off, paid or nonpaid” and sick leave as 

“when you take time off when you are sick” and was not sure if you get paid or not.

• R12A said “no” to this question and supplied definitions for the terms. For sick leave, part-time 

employees don't get full-time benefits. If full-time, if you get sick or hurt, employer must pay you 

for those days. For personal time off, you acquire days. If you’ve been with a company/business 

for x amount of time you earn these days, you can apply them and still get paid.

Recommendations:

• Although respondents expressed some confusion about terms, there is not a single change that 

seems likely to alleviate this generalized confusion. The inclusion of definitions of terms in this 

section is beneficial and the interviewer reading these definitions when necessary is the best 

solution at the moment. A set of definitions for “sick leave, annual leave, and personal time off” 

could be included as well after the questions to be read if necessary.

• The last question, ‘other-specify’ does not make sense if asked simply as written. Respondents 

are not sure what kind of ‘other’ option is being asked about. The question needs to be made 

more specific (such as, “Was there any other kind of compensation you received?”) or removed.

Question 27 - Was there a claim filed for worker’s compensation?

Because this question occurs after a grid of several questions, respondents may have forgotten that the 

question refers to workers’ compensation by the time it is asked. 

• R8 asked what kind of claim this was about when it was asked. It had to be clarified that it was a 

worker’s compensation claim.
26

Memorandum

Recommendations:

• Change the wording of the question to “Is there an open worker’s compensation claim pending 

for this injury/illness?” This will eliminate any possible confusion about what kind of claim the 

question involves.

Occupation and Industry at Time of Injury or Illness

Q28: Employed Full Time or Part Time

These questions are geared to solicit employment status. In general, respondents did not have difficulty 

determining full-time or part-time status. However, below are summaries of a few issues that arose. 

First, some employees may have difficulty deciding if their schedule counts as full-time or part-time. 

Those working irregular hours each week were not sure how to answer. In addition, for some, full-time 

was confused with the presence or absence of benefits, and not only number of hours.

• R1: R was on the border between picking full-time or part-time status. He thought he was not 

full-time so that the employer would not have to pay benefits. R reported that some weeks he 

was full-time, while other weeks he was only part-time. However, when asked for hours worked 

in a typical week, R1 reported 30-35 hours, which would generally not be considered full-time.

• R2: R said full-time but reported 33-35 hours in a typical week. This number of hours may be 

just below what is considered full-time employment.

• R9: In response to the Q, R said he had an internship. He also only worked 30-33 hours each 

week.

• R7: In response to this Q, R said she was not paid. R co-owns the company and gets profit 

shares. Since R does report 30-ish hours worked in a typical week, it seems that she should be 

able to report herself as part-time.

• R5: R considered himself to be full-time because it’s over 30 hours (he reported 32 hours in a 

typical week). R said that he heard the technical definition of full-time was 30 hours.
27

Memorandum

• Of the respondents reporting a full-time status, most reported working at least 40 hours. One 

respondent reported 33-35 and said it depends on the workload.

Q29: Hours worked in typical week 

This question captures the number of hours that respondents work in a typical week. Many respondents

give a range of hours worked, or qualified the answer in some way, such as “depending on workload.” In 

addition, it could be difficult for workers to provide exact number of hours. Some of the workers who 

gave ranges or qualified answers stated they were full-time (R4, R8, R2, R11). Respondents with variable 

schedules would certainly have difficulty providing a single estimate of hours; doing so could require 

them to average across a number of unspecified weeks, or to be clear on what a “typical” week would be.

• R1 (30-35 hours)

• R8 (40+ hours, up to 43) 

• R2 (33-35 hours) 

• R7 said 30-ish, “depends on assignments”

• R4 said about 40

• R11 said around 45

• R9 (30-33 hours) 

• R6b as proxy for R6A (45-50 hours)

• R12Aself (30-32 hours, but R12B proxy for R12A said 40).

Recommendations

• This question on full or part-time status alone provided an inadequate measure of employment 

status. This question should be asked in tandem with number of hours worked in a typical week. 

Consequently, it could be dropped from the survey. The real value of employment status comes 

from the questions on number of hours each week. 
28

Memorandum

• Guidance should also be provided for those who work without pay, such as interns and owners 

working for profit-share only. 

• It may be helpful to include a preamble that clarifies for respondents the number of hours that 

would be required to be considered employed full time.

• For number of hours, R could be prompted to provide a single estimate instead of a range. 

Alternatively the question could capture a range of hours and the middle-point determined during 

data processing.

Type of Employer

Q30: Type of employer

These questions ask about the type of employer the respondent works for. These questions generally 

worked well, but there was one issue that was observed with some frequency. 

Difficulty of classifying respondent workplace

Though respondents did not report confusion about the answer categories, some respondents had 

difficulty knowing how to classify their workplace and place it within these categories.

• R1 asked what a grocery store would be, chose private for profit.
29

Memorandum

• R2 asked if the company would be private (it was a major shipping company). 

• R7: it is private company she co-owns, so self-employed. 

• R12B, proxy for 12A: R had difficulty picking an option. R hesitated before picking for privatefor-profit. 

• R12A seems to have answered correctly, but slight hesitation was noted. R12A (for self) said 

private. 

• R12B initially said that he worked for NWU, cooking at fraternity houses. However, after other 

questions it became clear that R actually worked for a private company that was subcontracted by 

NWU. 

• R4 asked for Q to be repeated. This respondent commented that the question was “wordy.”

Recommendations

In order to make the question easier to read and reduce cognitive burden for respondents, we propose a 

slight change to the question stem:

Current question stem: 

(Were/Was) (name/you) employed by government, by A private company, a nonprofit organization, 

or (was/were) ( you/he/she) self –employed or working in the family business?

a. Government 

b. Private-for-profit company 

c. Non-profit organization including tax exempt and charitable organizations 

d. Self-employed 

e. Working in the family business 

Proposed question stem:

(Were/Was) (name/you) employed by government, by a private, for-profit company, a nonprofit 

organization, or (was/were) ( you/he/she) self-employed or working in the family business?

a. Government 

b. Private-for-profit company 

c. Non-profit organization including tax exempt and charitable 

organizations 

d. Self-employed 

e. Working in the family business 

This proposed change eliminates a needless repetition of the subject of the question (respondent or proxy) 

and alters one of the choices to match exactly what it is labeled as in the response options. This change 
30

Memorandum

also serves to accentuate the difference between this option (for-profit company) and the other response 

options. 

Employer Details

Q32: For whom did R work?

The purpose of this question is to capture the name of the place where respondent is employed. Some 

respondents showed hesitation about providing the actual name of the company for which they worked. 

For others, it seemed that providing a generic name, such as “construction company” or “grocery store” 

was sufficient. It was not clear that the actual company name, such as “UPS”, was being requested.

• When speaking about the injuries to R12A, both R12A and R12B refused to provide the actual 

name. They are currently in a lawsuit with the employer (a major food chain) over the injury and 

did not want to provide that information.

• R12b (on self) did not answer these questions correctly. Initially he said that he worked for 

NWU. However, later it came out that R worked for a private company that caters to NWU 

(cooking at fraternity houses). After probing it became clear. However, R kept going back and 

forth between NWU and the catering company. The private company is “Quality Frozen Food”.

• R4 preferred not to say but described the type of company (stocking/UPS/shipping type 

company). 

• R7 said “construction company,” but it was not clear if she did not want to provide the name or 

did not understand the question. 

• Reporting on her own injuries, R6A said “bank” and did not want to say the name of the bank. 

However, R6B as proxy for R6A reported that the bank changed names a few times and provided 

the most recent name. 

Recommendations

• The question was not clear in terms of soliciting the actual employer name. Text could be added 

to the question that asks for the company name, “What is the name of the company where you 

were employed?” 

• Respondents were not able to distinguish between their own employer and sub-contractors. 

Preamble language could be added to note the distinction, “Not including sub-contractors and 

hiring agents, for whom did you work?”
31

Memorandum

• As for sensitivity of the question, the interviewer could remind respondents about the 

confidentiality of the data.

Questions 33 and 34: Kind of business/industry and manufacturing/retail trade/wholesale trade/ 

something else. 

The purpose of these questions is to capture the nature of respondents’ employers. While some 

respondents were confident in their answers, a few respondents were uncertain how to respond. When 

asked about the kind of business (Q33, open-ended), responses included “grocery store” or “food service” 

(R1, R12A, R12B), “commodity trading” (R5), “shipping” (R4, R8, R2), “bank” (R6A, R6B), 

“insurance” (R11), and “construction” (R7). R9 was an intern at an aquarium and responded “not sure, 

research?” For Q34, some respondents had trouble deciding between answers. 

• R4: A respondent, who does “stock and inventory” for a stock/shipping company said it was half 

manufacturing and half retail. The company offers shipping services (if this counts as retail) but 

it is not clear what the company manufactures.

• R2: R worked for shipping company, but said she didn’t know and guessed manufacturing.

• R9: An intern at an aquarium indicated he was unsure and said “research” and then chose “other” 

(service).

• R6B: was not sure and asked, “What would you call a bank?” R went with an “other” response.

• R5: A commodities trader indicated chose “other” (trader).

• R7: Respondent worked for a construction company that does remodeling and rehab. She said 

that they provide a service, but in the retail trade, so was unsure how to answer.

• R11: R’s company services mortgages (although he does accounting). He chose something else 

(but did not specify).
32

Memorandum

• R12B (on self): He worked for a private company that provided food service to NWU. However, 

he answered “other, government” because “it is a school.” However, R should have been 

answering for the private retail company. 

• R12B (on R12A): As proxy for R12A (who worked in a grocery store) seemed to have some 

difficulty deciding. He finally chose retail trade, which appears to be the correct category for 

grocery stores.

Recommendations

Some respondents may benefit from hearing explanations for each term. The questions need clarification 

of what counts as manufacturing, retail trade, and wholesale trade. It would be helpful to confirm 

whether Round 1 respondents answered correctly. 

Q39: Union or CBA

Q39 asks respondents whether they are members of a union or covered by a collective bargaining 

agreement. Two of the respondents answered affirmatively (R7, R8). One proxy respondent (6B, 

reporting on 6A) thought that R6A was part of a union, but R6A indicated that she was not. Many 

respondents had heard of unions but collective bargaining agreements were not familiar to most 

respondents. Nevertheless, respondents seemed fairly certain of whether they themselves were union 

members or covered by a collective bargaining agreement. 
33

Memorandum

Q40: Number of workers 

This question is about the relative size of the place where the respondent works. There were two major 

issues encountered with this question.

Cases where subcontractors or contractors are employed

Some respondents worked at places that employed contractors or subcontractors, and were unsure 

whether these should be included in the count. Additionally, employees themselves could be contractors.

• R7 said 1-10 or higher if subcontractors are included. Do subcontractors count? How many are 

there?

• R9 said his intern group included 10-14 people. They wondered whether it was correct to include 

only interns and not others at the site.

• R12B (on self) worked for a private company that provided catering services at NWU. R went 

back and forth between speaking about working for NWU and working for the catering service. 

Interviewer had to probe about which one to include. Initially R was starting to give a count for 

the university workers, but was probed on the question and then gave the amount for the private 

company (8).

Cases where the employee works at a branch of a larger organization or an employer with multiple shifts

Respondents were unsure in certain situations whether to answer for their local branch or the entire 

company, or their particular shift vs. the total of all shifts.

• R1 did not know whether to include all locations or just the one where they worked (the store was 

part of a larger chain). R estimated 200, just for the location he worked at.

• 6A provided the local total for her branch of the bank of 20 and a total of 1500 for all branches.

• R8 wanted to know whether to count per shift or total. 1500 per shift, 6500 total
34

Memorandum

Some respondents seemed certain of the number of workers were employed by their company: 

• R4: estimated 20 to 30 from looking around. This respondent said he thought of his “day to day” 

when coming up with the number.

• R5 said 1 to 10 workers, noting that it was a small place so he was certain.

• R11: 30. R is in accounting and just knows.

Proxy respondents were less certain about their answers:

• R12A said 250. R12B (as proxy for R12A) said don’t know... a lot.

• 6B as proxy for 6A guessed 8 but then said “not sure.”

Recommendations:

Because respondents expressed some confusion in cases where there is an employer with multiple 

branches, we recommend adding a clarifying note after the question:

(If your employer has multiple locations, please answer [only for the location where you 

worked/for all locations.])

If contractors and subcontractors are intended to count towards the total, an additional clarifying note 

could be added after the 1st: 

(Please include contractors and subcontractors in you count.)

Proxy Respondents

For two of the recruited respondents, R6A and R12A, another adult member of the respondent’s

household was also invited to take part in an interview. We collected data on each member of these two 

pairs, four individuals in total, in both self-interviews and proxy interviews. We examined self- and 

proxy-reported answers to selected questions to assess the accuracy of proxy response. The data are 

presented in Exhibit 2. In this exhibit, the focal respondent is the person about whom the data are being 

collected. For each focal respondent, we compare the data from selected questions from the respondent’s 

self-interview and proxy interview (conducted with the respondent’s household member).
35

Memorandum

As Exhibit 2 shows, there is overall agreement between respondents and proxies on the injury or illness 

that occurred and approximately when it happened. Reports on how the injury or illness affected work 

were less consistent.

Exhibit 2: Proxy Reporting

Question Focal 

Respondent

Self vs. Proxy Comparison

Screener 

(Q1 - Q8)

6A • Self (6A) and proxy (6B) both noted the R’s condition, anxiety 

attacks and stress. Self (6A) also noted “soreness or pain” and 

“skin disorders” in response to Q4 and Q5, which proxy (6B) did 

not mention (both may have been related to the anxiety, not 

different incidents).

• Dates matched.

6B • Self (6B) and proxy (6A) did not initially report injury/illness at 

Q1. However, at Q5, both mentioned that 6B had respiratory 

issues, likely related to working with cardboard.

• Due to time constraints and interruption by call, interview was 

abbreviated. Not all Qs available for comparison.

12A • Self (12A) and proxy (12B) agreement that injury occurred, fall 

at grocery store where R worked.

• Agreed on date of fall (anniversary).

• Self mentioned carpal tunnel, which proxy did not mention.

12B • Both reported 12B’s injury. At Q4, proxy (12A) reported that 

12B had cut finger when cutting carrots at work. The R (12B) 

reported this injury in response to Q on “ever” experienced 

injury or illness.

• Self (12B) and proxy (12A) generally agreed on date, about a 

year ago. Self thought it was more than a year ago so only 

reported it in response to “ever” Q. Proxy thought injury was 

within the reference period.
36

Memorandum

Injury or 

Illness (Q10 – 

Q13

6A • Agreement about respondent 6A being “pushed beyond limit” 

(6A), and “all the pressure she’s under” (6B). 

• 6A self-reported additional effects of stress (bodily reaction skin 

condition, headaches, etc.), that the proxy (6B) did not mention.

6B • Missing data.

12A • Self (12A) and proxy (12B) agreed on the event (slipped on wet 

floor and fell), source (floor), body part (knee and ankle) and 

nature (sprain). 

• Self (12A) reported more detail than proxy (right knee and 

ankle, torn tendons, ligaments, etc.).

12B • Self and proxy agreed on event (cutting carrots), source (knife), 

body part (finger), and nature (cut)

Medical 

Attention 

(Q14)

6A • Self (6A) and proxy (6B) agreed that the R consulted a medical 

professional.

• Both reported doctor and therapist.

6B • Missing data.

12A • Self (12A) and proxy (12B) agreed that medical professional 

consulted.

• Both reported trip to emergency room.

12B • Self and proxy reported that R saw doctor. From proxy’s 

explanation, this happened the day after the cut.

Effect on 

Work—

Report to 

Employer 

(Q18)

6A • Self said reported “not right away.” Proxy was not sure but 

thought R reported.

6B • Missing data

12A • Both said the incident was reported to the employer.

12B • Both said the incident was reported to the employer.

Effect on 

Work—

Injury/Illness 

Caused... 

(Q20)

6A • Self and proxy agreed on all parts of Q20 except receipt of 

temporary disability benefits. R said “yes” but proxy said “no.”

6B • Missing data

12A • Self and proxy agreed on many items, except temporary 

disability benefits (self=yes, proxy=no), quit job (self=yes, 
37

Memorandum

proxy=no), laid off (self=yes but not sure, proxy=no), change 

occupations (self=somewhat yes, proxy=no). Self-report yielded 

more “yes” responses than proxy report.

12B • Self (12B) and proxy (12A) agreed on most items. They did not 

agree on unable to work next day (self=yes, proxy=no, although 

12B was confused by the question), unable to perform normal 

duties (self=yes, proxy=no), quit your job (self=yes, proxy=no). 

Effect on 

Work—Days 

Missed (Q21 – 

Q22)

6A • Self and proxy reports appeared to be in conflict, but the lack of 

consistency could be due to different interpretations of the 

questions. 6A self-reported that the doctor advised a break but in 

answer to the question (days not able to work) she said she could

work. Proxy (6B) reported a few instances in which 6A had 

taken days off here and there (but was not talking about 

immediately after anxiety episode). 

• R reported she went back the day after for a few days and then 

took time off. Proxy report agrees.

6B • Missing data

12A • Self and proxy reports conflict. R self-reported 22 days off for 

Q21 and 25 for Q22. However, proxy said the R did not return 

to work. The R’s report is based on doctor advice that she take 3 

weeks off. R said she did return to work but not full hours and 

the hours kept getting reduced and she quit.

12B • R12B did not understand questions well and could not provide a 

number of days for Q21 and Q22. The proxy said R12B did not 

miss days of work.

Effect on 

Work—

Workers’ 

Comp (Q23)

6A • R6A self-reported that no WC claim was filed. Proxy did not 

know.

6B • Missing data

12A • R12A said no claim was filed but proxy said yes.

12B • Both R and proxy agreed that no claim was filed.
38

Memorandum

Additional Recommendations and Issues for Discussion

In addition to the recommendations presented by questionnaire section or item above, we present the 

following additional recommendations and items for discussion:

• Guidelines are needed for when and how often to repeat the question stem for questions in grids.

• In intro to Q10 there is a typo that we will correct...”Now I going to ask you more about..” should 

be “Now I am going to ask you more about...”

• We are not certain why there are separate response options for “spouse present” and “spouse 

absent” in the marital status question (Q45). Should R be probed to determine whether spouse is

present or absent?

• Do we read the education categories in Q47 or not?

• We noticed that the consent form refers to the Privacy Act notice on the back of the consent form. 

Can BLS provide this so we can include it with the consent form?
1 

HOUSEHOLD SURVEY OF OCCUPATIONAL INJURIES AND ILLNESSES

DRAFT cognitive interview protocol

MATERIALS NEEDED FOR INTERVIEW

□ INTERVIEWER PROTOCOL BOOKLET (THIS BOOKLET) AND SHOWCARDS

□ CONSENT FORM (TWO COPIES)

□ $40 CASH IN ENVELOPE

□ PAYMENT RECEIPT

□ FULLY CHARGED DIGITAL RECORDER AND EXTRA BATTERIES

□ NOTE PAPER, PENS AND PENCILS

STEP 1: INFORMED CONSENT

PROVIDE RESPONDENT WITH A COPY OF THE INFORMED CONSENT FORM. ASK THE RESPONDENT 

TO READ THE FORM, ANSWER ANY QUESTIONS, AND HAVE THE RESPONDENT SIGN THE FORM. 

LEAVE A SEPARATE COPY OF THE FORM WITH THE RESPONDENT.

□ SIGNED CONSENT FORM COLLECTED

□ COPY OF CONSENT FORM GIVEN TO RESPONDENT

□ IF THE RESPONDENT HAS CONSENTED TO RECORDING, START THE RECORDER.

STEP 2: COMPLETION OF THE QUESTIONNAIRE

BEGIN QUESTIONNAIRE. 

Interviewer probe bank (use as appropriate):

• “How did you come up with that answer?”

• “Can you tell me in your own words what you think the question is asking?”

• “Can you tell me more about that?”

If you pick up on a visual cue that suggests an issue or confusion: 

• “Tell me what you are thinking.”

• What does the word [term] in this question mean to you?

• You said [answer]. Can you tell me more about that?

If R is uncertain and asking for confirmation:

• There is not a right or wrong answer for this question. I am interested in hearing your thoughts on what 

the question is asking.

INTERVIEWER: If this interview is with a proxy respondent, please modify language accordingly. For example, instead 

of asking “Did you do ANY work for pay or profit?” ask “Did [your husband/wife/brother/he/she] do ANY work for pay 

or profit?”

Survey Introduction

This survey is about work-related injuries and illnesses that you may have experienced. I would like to ask you questions 

about your work history and about the injuries and illnesses you may have had that are related to your job. The 

information that you provide in this survey is confidential. Your name and your answers to the questions will not be 
2 

shared with anyone outside of NORC, the survey organization conducting this survey. I would be happy to answer any 

questions you may have about the survey. [ANSWER RESPONDENT QUESTIONS.] Let’s begin. 

Screener

1. Since [CURRENT MONTH, ONE YEAR AGO], did you do ANY work for pay or profit?

a. Yes  ELIGIBLE, CONTINUE

b. No  NOT ELIGIBLE, END INTERVIEW

c. DK

d. REF 

Any injury

2. Since [CURRENT MONTH, ONE YEAR AGO], have you experienced any injuries or illnesses related to any job 

you had?

a. Yes  COLLECT BRIEF DESCRIPTION, CONFIRM WORK-RELATED

b. No  SKIP TO Q4

c. DK

d. REF 

3. Did that injury/illness cause you to... 

Yes No DK REF

Lose consciousness? 

Be unable to work for a day or more?

Restrict your work activities?

Transfer jobs?

Get medical treatment other than first aid?

IF YES, COLLECT BRIEF DESCRIPTION AND CONFIRM WORK-RELATED.

4. [Other than the injury/illness you just mentioned], since [CURRENT MONTH, ONE YEAR AGO], have you 

experienced any of the following injuries related to any job you had? I’m going to read a list of examples... 

CUES

a. Sprains, strains or tears

b. Soreness or pain

c. Bruises or contusions

d. Cuts, lacerations or punctures

e. Broken bones

f. Injury to muscles or joints

g. Open wounds

h. Burns 

i. Carpal tunnel syndrome

j. Any other injury? 

1) YES  COLLECT BRIEF DESCRIPTION, CONFIRM WORK-RELATED

2) NO

3) DK

4) REF 

5. [Other than what you have already mentioned], since [CURRENT MONTH, ONE YEAR AGO], have you 

experienced any of the following illnesses, related to any job you had? I’m going to read a list of examples... 

CUES: 

a. Skin disorders
3 

b. Respiratory conditions

c. Poisonings,

d. Hearing loss

e. A disease or infection

f. Cancer 

g. Any other illness? 

1) YES  COLLECT BRIEF DESCRIPTION, CONFIRM WORK-RELATED

2) NO

3) DK

4) REF 

IF R HAS NOT REPORTED ANY INJURIES OR ILLNESSES ASK ABOUT INJURIES/ILLNESSES EVER

EXPERIENCED. ELSE GO TO Q7.]

6. Have you EVER experienced any injuries or illnesses related to any job you had?

a. YES  COLLECT BRIEF DESCRIPTION, CONFIRM WORK-RELATED

b. NO  GO TO PROBES AT END OF SCREENER SECTION THEN SKIP TO 

DEMOGRAPHICS

c. DK  GO TO PROBES AT END OF SCREENER SECTION THEN SKIP TO 

DEMOGRAPHICS

d. REF  GO TO PROBES AT END OF SCREENER SECTION THEN SKIP TO 

DEMOGRAPHICS

7. [IF YES TO ANY INJURIES OR ILLNESSES] How many total times [since CURRENT MONTH, ONE YEAR 

AGO ], did you experience/have you ever experienced] an injury or illness related to any job you had? [THIS 

WILL CREATE THE LOOPS.] ________TIMES

8. [FOR EACH INJURY/ILLNESS] In what month and year did this injury/illness occur? 

MONTH/YEAR

ENTER MM/YYYY

DK

REF 

INTERVIEWER: CONFIRM NUMBER OF INCIDENTS AND BRIEF DESCRIPTION OF EACH. IF 

INJURY/ILLNESS EXPERIENCED WITHIN PAST YEAR, RESPONDENT WILL REPORT ON THOSE. 

OTHERWISE, IF NO INJURY/ILLNESS WITHIN PAST YEAR, RESPONDENT WILL REPORT ON 

INJURIES/ILLNESSES EVER EXPERIENCED.

Probes:

Screener

• I asked you this question: “Since [CURRENT MONTH, ONE YEAR AGO], have you experienced any 

injuries or illnesses related to any job you had?” In your own words, what is this question asking?

• In your own words, what would be a work-related injury or illness? Can you give me some examples of some 

things that would count as work-related injuries and illnesses? What would not count?

• Tell me about the kind of work you do. Tell me about other times when you got hurt or sick because of the 

work you do.

• [I asked you about whether you ever experienced any injury or illness, related to any job you had, that caused 

you to get medical treatment other than first aid]. What does “first aid” mean to you? What kind of treatment 

counts as first aid? What kind of treatment doesn’t count?
4 

• The questions gave some examples of injuries and illnesses [CHOOSE FEW FOR EACH PERSON 

SHOWCARD FROM LIST FROM Q4 AND Q5]. Are you familiar with [LIST]? Which ones have you heard 

of? Which ones had you not heard of? 

• How easy or hard was it to remember when the injury/illness happened? Can you tell me more about that? 

How did you figure out when the injury/illness happened?

Notes to interviewer:

The goal of the screener section is to enumerate all instances of work-related injuries and illnesses that occurred during 

the reference period. What issues do respondents have in reporting these incidents? Do they understand the types of 

injuries and illnesses to report? Can they accurately report only those that are work-related? How do they determine 

the boundary of the reference period and determine whether an incident occurred within the RP?

IF NO INCIDENTS OF WORK-RELATED INJURIES AND ILLNESSES, GO TO DEMOGRAPHICS SECTION.

Injury or Illness

 

[FOR FIRST INJURY/ILLNESS START AT Q10] 

[FOR SECOND AND FOLLOWING INJURY/ILLNESS START AT Q9]

9. [FOR SECOND/THIRD/ETC. LOOPS] How is this injury/illness related to the other injury/illness you 

mentioned? Is this related to [the other/another] injury/illness you already mentioned or is it a different 

injury/illness?

a. RELATED TO THE OTHER/ANOTHER INJURY/ILLNESS [GO TO NEXT LOOP]

b. THIS IS A DIFFERENT INJURY/ILLNESS [CONTINUE]

c. DK

d. REF 
5 

“Now I going to ask you more about [INJURY/ILLNESS #.... ].”

10. [WORKER ACTIVITY + some EVENT and SOURCE] [FOR EACH LOOP] What 

happened? How did the injury or illness occur? [For example: “When ladder slipped on 

wet floor, I fell 20 feet”; “I was sprayed with chlorine when gasket broke during 

replacement”; “I developed soreness in wrist over time.”] [OPEN ENDED]

11. [EVENT and SOURCE] [FOR EACH LOOP] What were you doing just before the 

incident occurred? Describe the activity as well as the tools, equipment, or material you 

were using. Be specific. [Examples: “climbing a ladder while carrying roofing 

materials”; “spraying chlorine from hand sprayer”; “daily computer key-entry.”] 

a. DESCRIBE THE ACTIVITY.

DK

REF 

b. DESCRIBE THE TOOLS, EQUIPMENT, OR MATERIAL THAT YOU 

WERE USING.] [OPEN ENDED]

DK

REF 

12. [SOURCE] [FOR EACH LOOP] What object or substance directly harmed you? [Examples: “concrete floor”; 

“chlorine”; “radial arm saw.”] 

a. FLOORS, WALKWAYS, GROUND SURFACES

b. VEHICLES

c. WORKER MOTION OR POSITION

d. CONTAINERS

e. PARTS AND MATERIALS

f. OTHER _______________

g. NOT APPLICABLE

h. DK

i. REF 

Body part/type of injury

13. [NATURE and PART] [FOR EACH LOOP] [INTERVIEWER NOTE: R should be more specific than “hurt,” 

“pain,” or “sore.” For example: “strained back”; “chemical burn, hand”; “carpal tunnel syndrome.”] 

a. How did this injury or illness happen?

a. OVEREXERTION AND BODILY REACTION WHILE LIFTING, PULLING, ETC., 

OR PERFORMING A REPETITIVE MOTION

b. FALLS, SLIPS OR TRIPS, FALLS ON THE SAME LEVEL

c. CONTACT WITH OBJECTS OR EQUIPMENT, STRUCK BY OBJECT OR 

EQUIPMENT

d. INJURY CAUSED BY ANOTHER PERSON OR AN ANIMAL

e. INCIDENT RELATED TO A CAR, TRAIN, AIRPLANE OR OTHER FORM OF 

TRANSPORTATION

f. EXPOSURE TO SOMETHING HARMFUL, SUCH AS ELECTRICITY, 

RADIATION, HEAT OR COLD, A NEEDLE OR SHARP OBJECT

g. OTHER ____________________

CHECKLIST

1. Description or 

diagnosis for 

injury/illness (this is 

the OIICS nature) 

2. Part or parts of body 

affected, including 

body systems 

(OIICS part, 

obviously)

3. How the 

injury/illness/exposu

re happened (OIICS 

event) 

4. Vehicles, tools, 

chemicals, surfaces, 

or any other objects 

involved; this can be 

multiple objects; this 

can also just be the 

person’s body 

moved incorrectly 

(OIICS sources) 
6 

h. DK

i. REF 

b. What part of your body was affected?

a. ARM

b. WRIST 

c. SHOULDER

d. FINGERS

e. HANDS

f. HEAD

g. KNEE

h. ANKLE

i. FOOT

j. TOE

k. BACK LOCATIONS (THORACIC, LUMBAR, SACRAL, COCCYGEAL)

l. ENTIRE BODY

m. LUNGS

n. OTHER ORGANS

o. OTHER ________________________

p. DK

q. REF 

c. How was it affected? What type of injury or illness affected your [PART OF BODY]?

a. SPRAINS, STRAINS, TEARS

b. SORENESS, PAIN

c. BRUISES, CONTUSIONS

d. FRACTURES 

e. CUTS, LACERATIONS, PUNCTURES

f. BROKEN BONE

g. INJURY TO MUSCLES OR JOINTS

h. STRAINS OR SPRAINS

i. OPEN WOUNDS, CUTS, BRUISES OR BURNS

j. PAIN

k. CARPAL TUNNEL SYNDROME

l. SKIN DISORDERS

m. RESPIRATORY CONDITIONS

n. POISONINGS

o. HEARING LOSS

p. A DISEASE OR INFECTION

q. AN ILLNESS SUCH AS CANCER

r. ANY OTHER INJURY OR ILLNESS?

s. DK

t. REF 

Probes:

Characteristics of incident

• [READ QUESTION] Can you tell me in your own words what you think this question is asking?

• [IF R DOES NOT INDICATE HOW INJURY/ILLNESS IS WORK-RELATED] Tell me more about how this 

injury/illness was related to your job. Where were you when this happened? What were you doing? What 

caused the injury/illness? Tell me more about the injury/illness. 
7 

Notes to interviewer:

Questions 10 through 13 are intended to capture (event or exposure, source of the injury/illness, part of body affected, 

and nature of the injury/illness). Do the questions elicit the information needed? Are the response options adequate to 

capture the information Rs give? Use general probing to elicit more information about the incident. (For example, if R 

says “I cut myself” ask: What part of your body was injured? What did you get cut with? What were you doing at the 

time?

Medical attention

14. [FOR EACH LOOP] Was the injury/illness serious enough that a medical professional was consulted?

a. Yes  What type of medical professional did you see? (specify)___ ___________________

b. No 

c. DK

d. REF 

15. [FOR EACH LOOP] Did you get medical advice, treatment, or follow-up care for this injury/illness from...? 

Yes No Not 

needed

DK/REF

An emergency vehicle, such as an ambulance or fire truck

An emergency room

A doctor’s office or other health clinic 

Please include on-site offices or clinics at your place of employment

A phone call to a doctor, nurse, or other health care professional

Any place else? Specify

16. [FOR EACH LOOP] Were you in the hospital? 

a. YES  How many nights were you in the hospital? _______ nights

b. NO

c. DK

d. REF 

17. Did you receive a medical diagnosis from your healthcare professional?

a. YES  What was your medical diagnosis?

b. NO

c. DK

d. REF 

Probes:

Medical attention (tailor probes based on whether R reported receiving medical attention)

• Tell me more about the medical care you received after the injury/illness happened.

• Can you tell me in your own words what you think this question is asking?

• Who do you think of as a medical professional? Who would you include or not include? [IF NEEDED ASK IF 

THESE WOULD COUNT: medical doctor, nurse, physician’s assistant, chiropractor, paramedic]

• I asked you about whether you received a medical diagnosis. What does the term “medical diagnosis” mean to 

you? How do you get a medical diagnosis? Who gives you a medical diagnosis? Does a medical diagnosis have 

to come from a doctor or other health care professional?

• IF NEEDED] Did you go to a doctor, nurse, or other health care provider after [INCIDENT]? Did you go to the 

hospital or did paramedics come? 

• Is/Was there a medical clinic at your place of employment? Did you see anyone at that clinic?

• Did you speak to a doctor, nurse, or another health care provider by phone after the incident? 
8 

Notes to interviewer:

Effect on work

18. [FOR EACH LOOP] Did you report this injury/illness to your employer?

a. YES [SKIP TO Q20]

b. NO

c. DK

d. REF 

19. [FOR EACH LOOP] IF NO TO REPORTING TO EMPLOYER: Why did you not report this injury/illness to 

your employer? 

a. Avoid being laid off YES NO DK REF 

b. Avoid loss of wages YES NO DK REF 

c. Avoid loss of promotion or advancement YES NO DK REF 

d. Avoid job transfer or restriction YES NO DK REF 

e. Employer would not recognize the injury/illness as 

work-related YES NO DK REF 

f. Employer wants to keep injury and illness rates low YES NO DK REF 

g. Realized the injury/illness was work-related after 

leaving the job YES NO DK REF 

h. Other (specify) YES NO DK REF 

Probes:

Effect on work

• [IF YES TO Q19] Tell me more about the reasons why you did not tell your employer about this injury/illness. 

Which was the main reason for not telling your employer? Tell me more about that.

Notes to interviewer:

Observe for signs of acquiescence bias in Q19. Are Rs saying “yes” because a reason sounds plausible or because it 

was a reason why R did not report an injury/illness? Ask for more detail and main reasons. How did R determine an 

answer to each item in Q19? Probe to explore understanding of terms, ability to accurately report on consequences of 

the injury/illness.

20. [FOR EACH LOOP] Did the injury/illness cause you to...?

YES NO NOT 

NEEDED

DK/REF

a. Be unable to work the next day, whether or not you were actually scheduled to 

work? [BE SURE TO ASK Q21]

b. Work at your regular job less than your usual number of hours?

c. Work at your regular job, but be unable to perform all of the normal duties of 

the job?

d. Be assigned to another job on a temporary basis?

e. Be transferred?

f. Receive temporary disability benefits?

g. Quit your job?

h. Be laid off?

i. Be fired?

j. Change occupations?

k. Lose any wages?

l. OTHER (SPECIFY)
9 

IF NO WORK DAYS MISSED, GO THROUGH PROBES THEN SKIP TO INTRO AT Q23.

Probes:

Effect on work

• IF YES TO ANY ITEM IN Q20: Tell me more about [TEXT FILL]. [E.g., Tell me more about your normal 

job duties. What duties were you unable to perform? OR Tell me more about why you quit your job? When 

did you quit? How was that related to your injury/illness?] 

• What does the term [TEXT FILL] mean to you? Can you give me an example? [E.g., What does it mean to 

you to be assigned to another job on a temporary basis? What does it mean to you to be transferred?] 

• What kind of effect did the injury/illness have on your work schedule? Job duties? Ability to work? Ability to 

keep your job? The pay you received? 

Temporary disability

• I asked about whether you received temporary disability benefits. Have you heard of temporary disability 

benefits? Can you tell me what this term means?

21. [FOR EACH LOOP] IF YES ON MISSING DAYS OF WORK Q20a: How many calendar days, or days in a 

row, were you not able to work? This may include both the days you were scheduled to work and days you were 

not scheduled.

____DAYS

DK

REF 

22. [FOR EACH LOOP] How many days after the injury/illness were you able to start work again?

a. _____DAYS AFTER THE INJURY/ILLNESS

b. STILL OFF PAID WORK

c. EXPECTS NEVER TO DO PAID WORK AGAIN

d. BACK TO WORK SAME DAY

e. DK

f. REF 

Probes:

Calendar days missed

• You said you missed XX calendar days of work. How did you figure that out?

• Walk me through the timeline of when you were injured and when you got back to work. 

• Did your doctor or another medical professional recommend that you take days off from work? How many 

days off did they recommend?

• I asked you [REPEAT QUESTION AND ITALICIZED INSTRUCTION ON CALENDAR DAYS NOT 

ABLE TO WORK]. Can you tell me in your own words what you think this question is asking? Can you think 

of a simpler way to ask this question? What does the term “calendar day” mean to you?

Notes to interviewer:

Is R able to distinguish between work shifts vs. calendar days of work missed? Does R correctly report calendar days 

missed? How does R determine the days missed? 

If reported no days missed in Q20a, confirm that R is thinking of calendar days, not work shifts.
10 

Workers’ compensation

Workers’ compensation is insurance that provides you with your lost wages and medical care when you become injured or 

ill due to your job. The next questions are about income you may have received from workers’ compensation.

23. [FOR EACH LOOP] Has anyone filed a workers’ compensation claim for this injury/illness?

a. YES

b. NO [SKIP TO Q25]

c. DK

d. REF 

24. Who filed the workers’ compensation claim?

a. EMPLOYER

b. EMPLOYEE

c. FAMILY MEMBER OF EMPLOYEE

d. OTHER SPECIFY

e. DK

f. REF 

GO TO SKIP INSTRUCTION BEFORE Q26.

25. [FOR EACH LOOP] IF NO ON QUESTION ABOUT WORKERS’ COMPENSATION: What was the main 

reason you or your employer did not file a workers’ compensation claim for this injury/illness?

a. Not eligible (did not meet waiting period)

b. Employer refused

c. Did not inform employer

d. Worker unaware of workers’ compensation coverage

e. Other reason, please specify

f. DK

g. REF 

SKIP INSTRUCTION: 

#1: IF YES TO Q20a—MISSED DAYS OF WORK, GO TO Q26. 

#2: ELSE IF WORKERS’ COMPENSATION CLAIM FILED (i.e., Q23=YES) SKIP TO Q27. 

#3: ELSE GO TO PROBES AT END OF SECTION THEN SKIP TO INTRO BEFORE Q28.

26. IF R MISSED DAYS OF WORK FOLLOWING THE INJURY/ILLNESS: MARK YES OR NO FOR EACH 

QUESTION

YES NO NOT 

NEEDED

DK/REF

Did you receive workers’ compensation? 

Being kept on salary means that, after an injury or illness, your 

employer continued to pay the wages and other compensation you 

were receiving when the injury or illness occurred. Were you kept on 

salary? 

Short-term or temporary disability benefits provide you with a portion 

of your income if you are temporarily unable to work due to a medical 

condition. Did you receive short term (temporary) disability? 

Did you use sick leave, annual leave, or personal time off?

Did you take leave without pay?

Other-specify _____________
11 

Definitions:

Workers compensation is insurance that provides you with your lost wages and medical care when you become injured or 

ill due to your job.

Being kept on salary means that, after an injury or illness, your employer continued to pay the wages and other 

compensation you were receiving when the injury or illness occurred.

Short-term or temporary disability benefits provide you with a portion of your income if you are temporarily unable to 

work due to a medical condition. 

27. [FOR EACH LOOP] IF FILED A WORKERS’ COMPENSATION CLAIM: Is there an open claim pending for 

this injury/illness?

a. YES

b. NO

c. DK

d. REF 

Probes:

Workers’ compensation

• ASK PROBES TAILORED TO THE REASONS R REPORTS ON WHY NO WC CLAIM 

WAS FILED BY EMPLOYER. EXAMPLES: Tell me more about the reasons why your 

employer did not file a workers’ compensation claim for this injury/illness? What did your 

employer say? Why did the employer refuse? How sure are you about whether or not your 

employer filed a claim?

• Can you tell me what it means to file a workers’ compensation claim? Tell me what you know 

about that process.

• Have you heard of [TEXT FILL]? Please tell me in your own words what you think [TEXT 

FILL] means: workers’ compensation, kept on salary, short-term or temporary disability, sick 

leave/annual leave/personal time off, leave without pay.

Notes to interviewer:

Do Rs know what workers’ compensation is? Do they know whether a WC form was filed? Are the 

terms in Q26 familiar to Rs and are the definitions helpful? 

Occupation and Industry at Time of Injury or Illness

[FOR EACH LOOP] Thinking about the time of the injury/illness [TEXT FILL DESCRIPTION]. 

 

28. Were you employed full-time or part-time?

a. Full-time 

b. Part-time

c. DK

d. REF 

29. In a typical week, how many hours did you work? ______hours

IF NECESSARY: Was it greater than or equal to 35 hours per week?

DK

REF 
12 

Probes:

Hours worked

• Do you work the same number of hours per week, or not? How did you determine how many hours per week 

you typically work?

Notes to interviewer:

Does R have any difficulty recalling FT vs. PT work? How do Rs with irregular work schedules, seasonal employment, 

etc., answer the question? Does the number of hours per week typically worked accord with report of FT/PT status?

30. (Were/Was) (name/you) employed by government, by A private company, a nonprofit organization, or (was/were) 

( you/he/she) self –employed or working in the family business?

a. Government 

b. Private-for-profit company 

c. Non-profit organization including tax exempt and charitable organizations 

d. Self-employed 

e. Working in the family business 

31. Would that be the federal, state, or local government? 

a. Federal

b. State 

c. Local

32. For whom did you work? [OPEN ENDED] 

DK

REF 

33. What kind of business or industry was this? [OPEN ENDED] 

DK

REF 

34. Was this business or organization mainly manufacturing, retail trade, wholesale trade, or something else? 

a. Manufacturing 

b. Retail trade 

c. Wholesale trade 

d. Other (agriculture, construction, service, government, etc.)

e. DK

f. REF 

35. What did they make or do where you worked? [OPEN ENDED]

DK

REF 

36. In what state were you employed at this job?

DK

REF 

37. What kind of work did you do? (For example: registered nurse, personnel manager, supervisor of order 

department, secretary, accountant) [OPEN ENDED]

DK

REF 
13 

38. What were your most important activities or duties? (For example: patient care, directing hiring policies, 

supervising order clerks, typing and filing, reconciling financial records) [OPEN ENDED]

DK

REF 

39. At this job, were you a member of a union or covered by a collective bargaining agreement?

a. YES

b. NO

c. DK

REF 

40. About how many workers were employed by [TEXT FILL EMPLOYER NAME]?

a. 1 to 10 workers

b. 11 to 49 workers

c. 50 to 249 workers

d. 250 to 999 workers

e. 1000 or more workers

f. DK

g. REF 

Probes:

Employment characteristics for job at time of injury/illness

• Q39 (union): Have you heard of unions? Have you heard of a collective bargaining 

agreement? Tell me what those words mean to you.

• Q39: Tell me how you decided on your answer. Tell me about the collective bargaining 

agreement. What union do/did you belong to?

• Q40 ON HOW MANY WORKERS: Tell me how you figured out your answer to this 

question. Walk me through how you figured out that answer. How certain are you of your 

answer?

Notes to interviewer:

Observe respondent ability to understand and respond to questions about employment at time of the 

injury/illness. Probe as needed to explore an issues with response. Are respondents able to accurately 

report answers for Q39 and Q40? 

IF R HAS ADDITIONAL INJURIES/ILLNESSES TO REPORT, GO BACK TO Q9. ELSE GO TO Q41. 

Demographic Characteristics

Race/ethnicity

41. Are you Spanish, Hispanic, or Latino? 

a. YES 

b. NO

c. DK

d. REF 

42. [I am going to read you a list of five race categories.] Please choose one or more races that you consider yourself 

to be: 

a. White

b. Black or African American

c. American Indian or Alaska Native
14 

d. Asian

e. Native Hawaiian or Other Pacific Islander

f. Other ________ 

g. DK

h. REF 

Age

43. What is your date of birth? Enter MM/DD/YYYY 

DK

REF 

44. As of last week, that would make you approximately (AGE) years old. Is that correct? 

[IF NECCESARY] Even though you don’t know your exact birthdate, what is your best guess as to how old 

you were on your last birthday? 

______ years

DK

REF 

Marital Type

45. Are you now married, widowed, divorced, separated or never married? 

a. MARRIED - SPOUSE PRESENT 

b. MARRIED - SPOUSE ABSENT 

c. WIDOWED 

d. DIVORCED 

e. SEPARATED 

f. NEVER MARRIED

g. DK

h. REF 

Gender

46. Are you male or female?

a. MALE

b. FEMALE

Education

47. What is the highest level of school you have completed or the highest degree you have received? 

a. Less than 1st grade 

b. 1st, 2nd, 3rd or 4th grade 

c. 5th or 6th grade 

d. 7th or 8th grade 

e. 9th grade or 10th grade 

f. 11th grade 

g. 12th grade NO DIPLOMA 

h. High school graduate - high school diploma or the equivalent (For example: GED) 

i. Some college but no degree 

j. Associate degree in college - Occupational/vocational program 

k. Associate degree in college -- Academic program 

l. Bachelor's degree (For example: BA, AB, BS) 

m. Master's degree (For example: MA, MS, MEng, MEd, MSW, MBA) 

n. Professional School Degree (For example: MD,DDS,DVM,LLB,JD) 

o. Doctorate degree (For example: PhD, EdD)
15 

Current Industry and Occupation

The next questions are about your current job. If you have more than one job, please tell me about the job at which you 

usually work the most hours. If you work the same number of hours at two jobs, please tell me about the job where you 

were employed the longest.

48. What is your current employment status? Are you currently employed full-time, part-time, or are you not 

employed?

a. FULL-TIME 

b. PART-TIME 

c. NOT CURRENTLY EMPLOYED [SKIP TO END OF SURVEY]

d. DK

e. REF 

49. [IF CURRENTLY EMPLOYED] Is this job the same job with the same employer that you have already told me 

about?

a. Same job with same employer [FOLLOW SKIP BELOW at Q50] 

b. Different job, same employer [SKIP TO Q48] 

c. Different employer [SKIP TO Q48] 

d. DK

e. REF 

50. [IF YES AND ONLY ONE LOOP FOR INJURY/ILLNESS THEN SKIP TO END OF SURVEY. ELSE IF YES 

AND MORE THAN ONE REPORTED INJURY/ILLNESS AND EMPLOYER ASK:] Which job and employer 

is that? 

51. Currently, in a typical week, how many hours do you work? ______hours

IF NECESSARY: Was it greater than or equal to 35 hours per week?

DK 

REF 

 

52. (Were/Was) (name/you) employed by government, by A private company, a nonprofit organization, or (was/were) 

( you/he/she) self -(or working in the family business?)

a. Government 

b. Private-for-profit company 

c. Non-profit organization including tax exempt and charitable organizations 

d. Self-employed 

e. Working in the family business 

53. Would that be the federal, state, or local government? 

d. Federal

e. State 

f. Local

54. For whom do you work? [OPEN ENDED] 

DK

REF 

55. What kind of business or industry is this? [OPEN ENDED]

DK

REF 

56. Is this business or organization mainly manufacturing, retail trade, wholesale trade, or something else? 

a. Manufacturing 
16 

b. Retail trade 

c. Wholesale trade 

d. Other (agriculture, construction, service, government, etc.)

e. DK

f. REF 

57. What do they make or do where you work? [OPEN ENDED]

DK

REF 

58. What kind of work do you do? (For example: registered nurse, personnel manager, supervisor of order 

department, secretary, accountant) [OPEN ENDED]

DK

REF 

59. What are your most important activities or duties? (For example: patient care, directing hiring policies, 

supervising order clerks, typing and filing, reconciling financial records) [OPEN ENDED]

DK

REF 

Probes:

Employment characteristics for current job

• Use general probes as needed to investigate issues with these questions.

• Is the job you reported your only job or do you have more than one job? 

• [REREAD THE ITALICIZED INSTRUCTION ON WHICH JOB TO REPORT ON]. In your own words, 

what do you think this instruction means?

Notes to interviewer:

These questions are the same as for the job at time of the incident. Continue to observe for issues to explore. 

Does R notice that this set of questions is about the current job? If R has more than one job, did R report on the correct 

one?

How do Q48 and Q49 function for determining that the current and former job are the same?

Debriefing questions for self-interview:

Recall and reference period

• How easy or difficult was it for you to answer questions about injuries/illnesses that occurred over the last 

year? 

• How sure are you that the injury/illness you told me about happened in the last year?

• Were there any questions that were particularly difficult to answer? Tell me more about that?

• If I asked you about injuries/illnesses that happened during the past year, how easy or hard would it be to 

answer the questions I asked you?

• When you signed up to do the survey, you may have seen a flyer or someone from NORC ask you about 

injuries and illnesses related to work that you may have had. Did you think about those injuries/illnesses you 

had, or did you do anything to get ready for the interview before you came? Tell me about that.

• Imagine that you didn’t know ahead of time that this survey was going to be about work-related injuries and 

illnesses. If someone called you or came to your door, and asked you whether you had ever had a work-related 

injury or illness, do you think you would have remembered? How hard would these questions in the survey be, 

if you didn’t know in advance what the survey was about?

Sensitivity
17 

• Were you worried/Would you be worried about telling your employer about an injury/illness? Was it/Would it 

be hard for you to tell your employer? Tell me more about that.

• Were you worried/Would you be worried about telling the government about an injury/illness? Why? Tell me 

more about that.

• Were you worried/Would you be worried about telling anyone else about a work-related injury/illness? Tell 

me more about that.

Review of selected items

• I’d like to ask you a little more about [QUESTION]. You said [FILL]. In your own words, what do you think 

that question was asking? How did you decide on your answer?

General debriefing

• What are your suggestions on how to improve the survey?

• What questions were the most difficult for you to answer?

• What questions were the easiest to answer?

Notes to interviewer:

Is reporting work-related injuries and illnesses to the employer a sensitive issue? Why or why not? Is telling others 

outside the workplace about these incidents sensitive? Why or why not?

What questions are the most and least difficult for Rs to answer? What answers are they uncertain about? Do they 

have suggestions for improving the survey?

Return to any questions that need further exploration. 

Debriefing questions for proxy respondents:

Proxy

• What is your relationship to [RESPONDENT NAME]?

• How much would you say you know about R’s job?

• How familiar would you say you are with R’s work-related injury/illness? Are you aware of the medical 

treatment he/she received when the injury/illness occurred? Are you aware of how this affected R’s job? How 

did you learn about R’s injury/illness? Who in your household besides R would be the best person to answer 

the kinds of questions I asked?

• What questions were the hardest for you to answer for R? Why? How much would you say you know about 

[QUESTION TOPIC]? How easy/hard is it to remember the information the question asked about? Tell me 

more.

• What questions were the easiest for you to answer for R? Why? How much would you say you know about 

[QUESTION TOPIC]? How easy/hard is it to remember the information the question asked about? Tell me 

more.

Sensitivity

• Were you worried/Would you be worried about telling anyone else about R’s work-related injury/illness? Tell 

me more about that.

Review of selected items

• I’d like to ask you a little more about [QUESTION]. You said [FILL]. In your own words, what do you think 

that question was asking? How did you decide on your answer?

General debriefing

• What are your suggestions on how to improve the survey?
18 

• What questions were the most difficult for you to answer?

• What questions were the easiest to answer?

Notes to interviewer:

Is proxy reporting of work-related injuries and illnesses a sensitive issue? Why or why not?

What questions are the most and least difficult for Rs to answer? What answers are they uncertain about? Do they 

have suggestions for improving the survey?

Return to any questions that need further exploration. 

Debriefing questions for those with no injury/illness to report:

Terms

How familiar are you with the following terms? Please tell in your own words what these terms mean to you?

Workers’ compensation, etc.

• Worker’s compensation

• Temporary disability

• Short-term disability

• Being kept on salary

• Sick leave

• Annual leave

• Personal time off

Medical professional/calendar days/work shifts

ASK R: In the last year, have you had any injury or illness that was serious enough that a medical professional was 

consulted? Please include any injury whether or not it was work-related.

• Who do you think of as a medical professional? Who would you include or not include? [IF NEEDED ASK 

IF THESE WOULD COUNT: medical doctor, nurse, physician’s assistant, chiropractor, paramedic]

• When you became injured or ill, how many calendar days were you unable to do your usual activities? 

• Did you miss any work shifts? How many?

• You said you were not able to do your usual activities for XX calendar days. How did you figure that out?

• You said you missed XX work shifts. How did you figure that out?

Unions/collective bargaining agreement

• Have you heard of unions? Have you heard of a collective bargaining agreement? Tell me what those words 

mean to you.

• Q39 (how many workers): Tell me how you figured out your answer to this question. Walk me through how 

you figured out that answer. How certain are you of your answer?

Understanding of terms

• Have you heard of the term “calendar days”? What does that term mean to you? What about the term “work 

shift”? What does that term mean to you? How are these terms the same? Different?

• Who do you think of as a medical professional? Who would you include or not include? [IF NEEDED ASK 

IF THESE WOULD COUNT: medical doctor, nurse, physician’s assistant, chiropractor, paramedic]

• Now I’d like to ask you about the term “medical diagnosis.” What does the term “medical diagnosis” mean to 

you? How do you get a medical diagnosis? Who gives you a medical diagnosis? Does a medical diagnosis 

have to come from a doctor or other health care professional?
19 

STEP 3: END OF INTERVIEW

Thank you for taking part in this survey.

□ STOP THE RECORDER.

RECRUITMENT QUESTION:

We are looking for additional respondents like you who would be interested in helping with the study. Do you know 

anyone who had a work-related injury or illness who might be interested in participating? If yes, would you mind if we 

gave you a flyer about the study and send you an email about the study that you could forward to them? 

INTERVIEWER: ANSWER ANY RESPONDENT QUESTIONS. 

This concludes the interview. I would be happy to answer any questions that you have. Thank you for your help with this 

study.

□ PAY THE RESPONDENT AND OBTAIN SIGNATURE ON RECEIPT.

MATERIALS TO TAKE AWAY FROM INTERVIEW

□ INTERVIEWER PROTOCOL BOOKLET (THIS BOOKLET)

□ SIGNED CONSENT FORM

□ SIGNED PAYMENT RECEIPT

□ DIGITAL RECORDER AND BATTERIES

□ NOTE PAPER, PENS, PENCILS
NORC | Designing a Household Survey of Injuries and Illnesses

FINAL REPORT

Appendix C: Cognitive Interview Round 2 Memo
1 

Memorandum

To: Elizabeth Rogers & Karen Shahpoori

From: NORC

Re: Household SOII Round 2 Cognitive Interviews

Date: 8/25/2016

Introduction

NORC is conducting cognitive testing on behalf of the Bureau of Labor Statistics (BLS) to inform the 

design of a Household Survey of Occupational Injuries and Illnesses (HSOII). The cognitive interviews 

will provide data to evaluate the HSOII survey questions for correct interpretation and to assess the ability 

of respondents to accurately answer the survey questions. The results of the interviews will be used to 

refine the HSOII questionnaire items and item order. 

Recruitment Strategy. The cognitive interview sample for Round 2 interviews was recruited via 

advertisements placed in Craigslist, Facebook, and on-site posting of flyers in locations in the Chicago 

and Northern Indiana areas. At the start of recruiting for Round 1, flyers were posted in nearly 30 venues. 

The recruiter followed up with contacts at the sites she visited. In Round 2, only 5 potential participants 

in total were recruited through flyers, with one of these completing an interview. Approximately 26 were 

recruited through Craigslist, with 18 of those completing an interview.

Sample Characteristics. We attempted to recruit a total of 45 persons for Round 2. Some of these recruits

were initially approached in Round 1 and recontacted in Round 2. Of those we attempted to recruit, 22 

completed interviews (21 main respondents and 1 proxy). Another four had scheduled interviews but did 

not keep their interview appointments and could not be rescheduled. 

One of the 22 recruited respondents (R) was a proxy who was invited for an interview primarily to discuss 

the work-related injuries and illnesses of another person recruited from his household. Another of the 22 

recruited respondents had also indicated that a proxy respondent was available, but repeated attempts to 

recruit that proxy were unsuccessful. An additional recruited respondent provided leads to other 

respondents who could serve as a respondent-proxy pair, but that pair ultimately declined to participate.
2 

Memorandum

In the respondent numbering presented in the discussion of findings, respondent pairs are given the same 

number. The letter “A” was assigned to the respondent who was recruited due to experience with a workrelated injury or illness. The letter “B” was assigned to the proxy who was recruited from the same 

household. During the cognitive interview, both the main respondent and the proxy participated in a selfinterview about their own experiences with workplace injuries and illnesses, and then participated in a 

proxy interview about the other member of the pair. Exhibit 1 displays demographic characteristics of the 

22 respondents who participated in an interview.

Exhibit 1: Respondent Characteristics 

Characteristic Category Number of 

Respondents

Q41 – Ethnicity (Spanish, Hispanic 

or Latino?)

Yes 1

No 21

Do not know 0

Refuse 0

Q42 - Race White 6

Black or African American 15

American Indian or Alaska Native 2

Asian 0

Native Hawaiian or Other Pacific Islander 0

Other (specify) 1

Do not know 0

Refuse 0

Q43-44 – Age categories Under 25 1

25-39 7

40-54 10

55-70 4

70 or older 0
3 

Memorandum

Exhibit 1 continued: Respondent Characteristics 

Characteristic Category Number of 

Respondents

Q45 - Marital Status Married – Spouse present 3

Married – Spouse absent 1

Widowed 0

Divorced 6

Separated 0

Never married 12

Do not know 0

Refuse 0

Q46 - Sex Male 10

Female 12

Q47 – Education level

High school diploma or less 8

Some college but no degree 4

Associate’s degree (any type) 5

Bachelor’s degree 5

Master’s, Professional, or Doctoral degree 0

Q48 – Current Employment Status

Full-Time 10

Part-Time 5

Not currently employed 7

Do not know 0

Refuse 0

Q52-Q59 – Description of 

occupation at the time of injury

Medical waste disposal driver 1

Maintenance 2

Personal care aide 2

Construction worker 3

Retail worker 3

Warehouse worker 1

Restaurant food service 4

Merchandiser 1

Office manager 1

Mail carrier 1

NA because proxy (no injury) 1

Security services 1

Cake decorator 1
4 

Memorandum

Interview. Of the 22 respondents, 15 were interviewed in person at NORC’s offices in Chicago, Illinois 

and Bethesda, Maryland and seven respondents were interviewed by phone. The interviews were 

conducted by four methodologists who are experienced in cognitive interviewing. Respondents 

participated in a cognitive interview lasting approximately one hour and were paid $40. 

Organization of this memo. The discussion of findings from the cognitive interviews focuses on the 

questionnaire items in which issues were observed during the cognitive interviews. Several revisions 

were made to the instrument based on findings in Round 1. In the course of Round 2 interviews, some 

changes to the Screener have already been incorporated in the Round 2B version of the instrument. 

NORC has presented additional suggestions in a document sent August 19th (HSOII Cognitive Protocol 

Round 2 v3 mockup 8-19-2016.docx). Upon feedback from BLS on the mock-up and the 

recommendations we present in this memo, we will incorporate additional improvements to the 

questionnaire.
5 

Memorandum

Screener

Questions 1 through 8: Screener
6 

Memorandum
7 

Memorandum
8 

Memorandum

The screener questions ask respondents whether they worked in the past year and whether they 

experienced any injuries or illnesses related to any job they had. As discussed in the Round 1 memo, 

respondents were able to understand the questions on whether they had worked in the last year (Q1), the 

injury/illness terms (Q4, Q5), and could discern the work-relatedness of their injuries/illnesses. The 

reference period of the survey was also generally understood by respondents.

For Round 2, several changes were made to the Screener questions:
9 

Memorandum

• Added phrasing “in the past year” at the beginning of several items. This change was suggested 

by BLS (Kaplan, BLS comments to Round 1 memo) to further emphasize for respondents the 

reference period of interest. 

• Added the follow-up question on recordability criteria for every injury/illness reported (Q3, Q4.1, 

Q5.1, and Q6.1). In Round 2, respondents were asked whether each injury/illness resulted in loss 

of consciousness, being unable to work for a day or more, etc.

• The cue “anxiety or depression” was added to the list of illnesses for Q5 to signal that this type of 

condition should be reported.

These changes worked well. Overall, in Round 2 few issues were observed with the Screener questions. 

A couple of issues that arose are noted below:

• R19: This R had not worked since a work-related injury in 2011. Based on his comprehension 

difficulties throughout the survey, the interviewer speculated that this respondent may have 

misunderstood the screener questions when screened for eligibility over the phone. 

• R17A (self-interview): R participated in a phone interview. He at first appeared not to 

understand the question. He thought the interviewer had said “worked for pain” when asking 

about working for pay. Once the misunderstanding was cleared up, R understood the question. 

This issue appears related to poor cell phone reception.

Understanding of screener questions on whether work-related injury/illness occurred

We observed no issues with respondent understanding that the injuries/illnesses of interest are those 

related to a job they held. Respondents reported injuries that, based on their descriptions, appeared to be 

related to their work. 

Transition from Q2/Q3 to Q4

We observed that many respondents miss the instruction “Other than the injury/illness you just 

mentioned” in Q4. After reporting an injury/illness in Q2, they interpreted Q4 as asking about the same 

incident and reported whether, during the incident they just reported in Q2, they also sustained any of the 

types of injury being cued in Q4. To address this issue, Q4 and Q5 were revised during Round 2 to 

further emphasize that the respondent should report injuries/illnesses other than those he/she has already 

reported.
10

Memorandum

Initial findings from the Round 2B versions of these questions suggest that the revised wording is helping 

respondents understand that Q4 and Q5 concern any additional injuries/illnesses they may have 

experienced. 

Conditions that develop over time

As noted in Round 1 interviews, some of the HSOII questions did not function well for conditions such as 

anxiety and stress, which may not be associated with an observable physical injury and, unlike physical 

injuries, are difficult to tie to a specific date. No conditions of this type were reported in Round 2 

interviews. We will continue to observe to determine how the questions are working for those with 

conditions that may not have a discrete starting point.

Recommendations 

• NORC presented several revisions to the Screener questions in the HSOII instrument in a mockup sent August 19th. Upon receiving feedback from BLS, we will revise and finalize revisions to 

the Screener section. Although the full set of recommendations is reflected in the mock-up, the 

key recommendations for this section include:

o Revise language to assure that for each succeeding question in the Screener section, 

respondents know that they are to report other injuries/illnesses, in addition to any 

previously reported.

o Collect month and year immediately after respondent report of each incident of 

injury/illness, instead of in Q8 after all incidents reported.

o Use the recordability criteria as cues to recall. Collect information on each recordability 

criteria when collecting characteristics of each injury/illness.
11

Memorandum

Injury or Illness: Description

Questions 10-13 – Illness or Injury: Description

Questions Q10 through Q13 are intended to capture the characteristics of the work-related injury or 

illness that the respondent experienced. For Round 2, these questions were revised to be more 

appropriately phrased for non-physical injuries, to improve question wording, and to clarify that the 

examples in the questions are to be read to all respondents.

The Round 1 versions of these questions were presented again in Round 2 during follow-up probing for

Q10 through Q13 (see Q10a-Q13a). Interviewers noted that Q10a-Q13a proved to be redundant and 

yielded little information of value. The additional loop through the questions during probing was 

frustrating for some respondents; Q10a-Q13a was subsequently dropped from the interview protocol.
12

Memorandum

Based on respondent narrative in response to the survey questions, we present a summary in Exhibit 2 of 

the nature, part of body, event, and source(s) for each injury/illness.

Exhibit 2: Characteristics of Reported Injury/Illness

R# Coding of nature, part of body, event, source(s)

18A

• Nature: Strained back

• Part of body: Back (R did not mention “back” in response to questions 10-13 but did state 

that this body part was affected when asked the screener question and 10a-13a.).

• Event: R was moving a heavy storage pod while going down a ramp and ended up pinned 

against the wall of the loading dock. (Further detail captured in 10a and 11a clarified that 

R that the storage pod had wheels and due to its heavy weight, R slid down the ramp and 

into the wall). 

• Source: Pod, wall, ramp.

19

• Nature: Respondent unable to describe nature. He mentioned the arm had pain and was 

swollen.

• Part of body: Arm and wrist.

• Event: Shelf with wax on it fell on R’s arm. Supervisor had hand on shelf just before 

shelf fell.

• Source: Wax, supervisor.

25

• Nature: Wrist has nerve damage, shooting pain in arm.

• Part of body: Wrist.

• Event: R walking up behind patient, patient was going up stairs and lost footing. R fell 

downstairs. Broke her fall with her arm.

• Source: Patient and stairs.

26

• Nature: Pulled back.

• Part of body: Back.

• Event: R was lifting a steel pillar off of a truck and collapsed.

• Source: Steel pillar. 
13

Memorandum

22

• Nature: Torn ligament, dislocated knee.

• Part of body: Leg, especially knee.

• Event: R reached up to grab a box of hangers on a shelf in a cabinet. The cabinet was 

tilted and fell on R’s left leg, especially her knee. [R provided further detail in 10a that she 

fell after the cabinet fell her on her leg and her knee twisted].

• Source: Metal cabinet [because it fell on R’s leg] and floor [because R said she twisted her 

knee after she fell].

28

• Nature: Cut on thumb.

• Part of body: Thumb.

• Event: R was using a slicing machine (for lettuce) and it cut her thumb

• Source: Slicing machine.

50

• Nature: 1) contusion and swelling of toe; 2) asthma, COPD in lungs

• Part of body: 1) toe; 2) lungs

• Event: 1) R was working in warehouse stacking boxes on skid (pallet), then something or 

someone pushed box and it fell and hit his foot; 2) R breathing dust, fumes and exhaust 

from the warehouse and trucks.

• Source: 1) Box, possibly person pushing box; 2) Dust, fumes, exhaust. 

41

• Nature: 1) Twisted ankle; 2) Tore fingernail back (nail fell off)

• Part of body: 1) Ankle; 2) finger (nail area)

• Event: 1) R slipped and fell on a water spot; 2) R was adding a key to a key chain and her 

finger got caught between the rings and tore back all the way. 

• Source: 1) Water and floor; 2) key chain and key.

55

• Nature: Broken toe

• Part of body: Toe

• Event: R was moving a rolling cart filled with flats of plants. One of the wheels on the cart 

broke and the cart landed on his toe.

• Source: Rolling cart.

49

• Nature: Sprain, bruising, and fractures in back and lumbar stenosis. (R’s response to 

screener question provided further detail – pelvis fractures and spinal cord fractures in L3 

and L4 vertebrae).

• Part of body: Back (possibly pelvis).

• Event: R was working with 14 ton steel concrete posts while standing on a flatbed semitrailer. A jack went through the floor of the trailer and R slipped off and landed pinned 

between two concrete posts.
14

Memorandum

• Source: Trailer truck, jack, concrete posts.

45

• Nature: Swollen ankle, slight fracture.

• Part of body: Ankle.

• Event: R was unloading boxes coming off a roller belt from a truck and had his foot 

positioned at the end of the truck belt when a box came down the belt and hit his ankle. 

• Source: Box.

40

• Nature: Sprained ankle and bruised back.

• Part of body: Ankle and back.

• Event: R was on an unsteady ladder, took a wrong step, and fell about 5ft backwards onto 

a palette with steel beams on it.

• Source: Palette and ladder.

52

• Nature: R lost consciousness, woke up in ER with terrible headache, stitches in head,

swollen neck, shoulder and elbow. 

• Part of body: Head, neck, shoulder, and arm on left side of body.

• Event: R slipped on a wet spot (or something slippery), fell back and hit head on floor. 

• Source: Slippery spot on floor (not sure if it was water or packaging from boxes he was 

unloading). 

42

• Nature: R mentioned lingering soreness in arm/elbow area, swollen ankle, and muscle 

spasms in back. (R responded to medical diagnosis question by stating contusion on her 

left side, bruised bones of back and arm, and sprained ankle). 

• Part of body: Back, arms, ankle.

• Event: R was using a step ladder to reach a box and fell off step ladder (about 15-20 ft.), 

landing on her side. 

• Source: Step ladder and floor.

47

• Nature: Sprain/strain of right ankle.

• Part of body: Right ankle.

• Event: R was loading heavy baskets of mail onto the back of her mail truck. She stepped 

onto the platform of the truck, twisted her foot in the process, then dropped the basket and 

fell.

• Source: Platform of truck, baskets of mail.

44

• Nature: Respondent unable to describe nature. She mentioned feeling tingly pain in her 

hand, sharp pain in elbow, and that her knee felt disconnected. (R’s response to 13a was 

that she sprained her hand/wrist and leg and also felt sharp pain in her elbow). 
15

Memorandum

• Part of body: Hand/wrist, elbow, and leg.

• Event: R slipped and fell down on a wet floor.

• Source: Wet floor.

54

• Nature: 1) Cut to hand requiring stitches; 2) 2nd degree burn on arm.

• Part of body: 1) Hand; 2) Arm

• Event: 1) R sliced the bottom of her hand with a sharp knife while cutting up an onion; 2) 

R was changing oil in deep fryer, removing fryer basket, and oil splattered and burned her 

arm.

• Source: 1) Knife, onion; 2) Oil, deep fryer, basket.

51

• Nature: Bulged disk in back.

• Part of body: Back.

• Event: R was carrying a heavy piece of wood and her back gave out and she fell.

• Source: Wood, ground.

57

• Nature: Strained back.

• Part of body: Back.

• Event: R slipped on wet floor and twisted his back (but did not actually fall down).

• Source: Water, floor.

43

• Nature: Slipped disc in back

• Part of body: Back

• Event: R slipped and fell on a wet floor.

• Source: Water, floor

17A

• Nature: Broken bone – wrist

• Part of body: Right wrist

• Event: R slipped and fell on a wet floor

• Source: Water, floor

Recommendations: 

We did not observe that respondents had issues with Q10-Q13 and the questions appear to provide 

sufficient information to determine the nature, part of body, event, and source(s) for each injury/illness.

NORC will continue to observe whether these questions are working as intended in Round 3. 
16

Memorandum

Injury or Illness: Medical Attention

Questions 14 - 17 – Medical Attention

This series of questions on medical attention asks respondents about the medical advice and treatment 

they received for their injury/illness. In collaboration with BLS, we implemented two changes to this 

section for Round 2:
17

Memorandum

• Incorporated the phrase “health care professional” to refer to the professionals who may provide 

medical attention to the respondent.

• Rephrased the question on being in the hospital to clarify that being “admitted” to the hospital is 

the focus of the question.

Series of questions on medical attention (Q15)

No issues were observed with the use of the term “health care professional.” However, for Q15, the series 

of questions on where the respondent got medical advice, treatment or follow-up care, there were a few 

instances in which respondent answers signaled misunderstanding of a question: 

• R28: Although this respondent appeared to have been transported in an ambulance, she answered 

“no” to this question. The respondent had difficulty explaining what she thought the question 

was asking. The interviewer’s best guess is that the R thought the question was asking whether 

someone else not involved in the incident called the ambulance. This was a rare 

misunderstanding of this item and likely not indicative of a problem with the item.

• R45: R went for a follow-up visit at the hospital. He responded “yes” to the question on whether 

he sought care at a doctor’s office but was unsure of his answer because it was the hospital, and

technically not a doctor’s office.

• R40: R counted a phone call to make a doctor’s appointment as getting care through a phone call 

to a health professional. 

Understanding of question on being admitted to the hospital (Q16)

Respondents generally understood what it meant to be admitted to the hospital. Examples of some 

respondent statements on what it means to be admitted to the hospital include:

• R47: It means that you are assigned to a room - have phone, privacy, TV, meals served.

• R51: So severe, major injury that requires being checked in and staying in the hospital a day or 

two or more.

• R50: To stay there overnight. 

• R22: ER visit is where they treat you, give you medicine to go and tell you to follow up with 

your main doctor. If it's serious they'll just keep you in the ER and transfer you to a hospital 

room.

However, a couple of respondents provided answers that suggested they did not fully understand what 

being admitted to the hospital means:
18

Memorandum

• R45: R was treated in the emergency room and was there for three hours. However, he stated he 

had been admitted to the hospital. He did indicate that he stayed zero nights.

• R54: R described sustaining a burn. She was in the ER and stayed there all night and did not 

consider herself to be admitted to the hospital. R understands hospital visit to “require more than 

one overnight stay and put in your own hospital room.” R seems to be correct that her being in 

the ER overnight does not count as being admitted to the hospital. However, her definition that a 

hospital stay requires more than one overnight stay seems incorrect.

Understanding of medical diagnosis (Q17)

In response to Q17, many respondents provide a lay description of the injury/illness they experienced. 

For example:

• R25: R said she had a sprain. She had described a sprained wrist due to fall down the stairs while 

helping a patients.

• R22: R had a torn ligament. R had described an accident in which she pulled a box from a 

cabinet; the cabinet tilted and fell on her left leg/knee.

• R45: R said his ankle was swollen, had slight fracture. He had his foot too close to the end of a 

roller coming off a truck. When a box came down the roller it hit his ankle at a high rate of speed.

• R40: R said injured disc in back. R had fallen off a ladder.

A couple of respondents provided answers that suggested they were unclear what a medical diagnosis 

was:

• R28: This R, who sustained a cut, indicated that he had not received a medical diagnosis. He 

answered “no” initially, thinking that getting a diagnosis means that something was wrong, “other 

than the cut, an infection or something that could be more serious.”

• R52: R thought he did not have a medical diagnosis because everything came back good; test 

results did not require him to stay longer at the hospital for treatment. However, this R did get 

stitches and had blacked out. It seems that the injury and blackout would have warranted a 

diagnosis.

In examining the content and flow of the entire series of questions on medical attention (Q14 through 

Q17), NORC interviewers observed that the question order and wording could be improved. For example, 

the questions on being treated at the emergency room and being admitted to the hospital are asked in two 

separate questions with other items intervening. These items may be best grouped together. Further, Q14 
19

Memorandum

asks whether a health care professional was consulted; however, the Q15 series addresses similar issues, 

suggesting that the questions should be combined into one series. Q15 also asks about emergency 

medical treatment but in an oddly phrased manner; respondents are asked about receiving care from an 

emergency vehicle rather than from emergency personnel. 

Recommendations:

As presented in the August 19th mock-up, we suggest revisions to the series of questions on medical 

attention. The mock-up presents a revised set of questions in which Q14-Q17 are reordered and revised 

to improve flow and clarity. Upon receiving feedback from BLS, we will revise and finalize revisions to 

the Screener section. Although the full set of recommendations is reflected in the mock-up, the key 

recommendations for this section include: 

• Combining Q14, Q15, Q16 and Q17 into one series of questions, with intent of improving 

question flow and removing redundancy.

• Clarifying meaning of being admitted to the hospital (with language referencing hospital stay and 

placing this question immediately after one on receiving treatment at the emergency room).

• Adding simplified language for medical diagnosis.

• Expanding on the information collected, to include recommended days off from work and 

whether the injury/illness caused the respondent to faint or pass out.
20

Memorandum

Injury or Illness: Effect on Work

Question 20 – Effect on Work

This series questions evaluates the effect the injury or illness had on the respondent’s work status. 

Relatively few changes were made to the questions in this section for Round 2. Items 20e and 20f were 

deleted. 

The question series worked well for respondents working full time who stayed with the same employer 

and did go back to work. For example:

• R18A: This R returned to the same employer after the injury. She got someone else to help with 

some duties (carrying bins) and also worked as dispatcher for a month before returning to work in 

the field. Her responses to the questions seemed accurate for her situation.
21

Memorandum

• R44: R seemed to correctly report that she did take time off, and then returned to work on a 

reduced schedule but could not do her normal duties.

However, some respondents displayed difficulties in answering Q20. A number of the items in Q20 do 

not apply to respondents who did not go back to work with the same employer or did not go back to work 

at all. Questions 20b, 20c, and 20d are particularly problematic as they presuppose that the R is working 

at their regular job. In other cases, respondents misinterpret the meaning of a question.

• R19: R did not return to the job. He said he was fired. Questions 20a through 20d in particular 

appear irrelevant since he was no longer at the job. 

• R28: R ended up quitting her job right after her injury. Some of the questions in the question 

series would not apply given that she no was no longer employed.

• R45: R was unable to work the next day and was off for 3 days. He responded “yes” to 20a 

(unable to work next day) and 20b (worked at regular job less than usual hours). However, after 

taking 3 days off, he did work his usual hours once he returned to work; it seems he should have 

answered “no” to 20b. Q20b make be confusing for those who take time off, since they may 

interpret taking days off to mean that they worked at their regular job less than their usual hours. 

• R40: R did not return to work. However, she answered “yes” to 20b because she is volunteering 

some hours from home to help transition an employee who is replacing her. Interviewer noted 

that Q20b, c and d seemed not to apply to this R, who did not officially return to work. Since it is 

unusual for an employee to volunteer to train his or her replacement, situations such as this one 

are unlikely to be a concern for the HSOII.

The question series also can be problematic for part-time workers:

• R25: This R had already indicated she had to take a couple of days off and was unable to work 

the next day, yet she said she did not lose wages. She did not answer yes/no to 20b but instead 

said took a day or two off. She was a part-time employee and did have to take days off due to the 

injury. Yet because she was able to schedule her work hours for later in the week, she did not 

lose wages.

Interpretation of some terms (occupations, laid off, wages) was also problematic for some respondents:

• R52: R switched to a different assignment with the same employer (switched from stocking to 

cashiering for 10 months). R said “yes” to 20j (changed occupations) however, he did not 

permanently take on a new line of work. 
22

Memorandum

• R17A: R thought he had been laid off, since he took time off from work while he healed from his 

broken wrist. However, it is not clear to the interviewer that taking time off due to injury counts 

as being laid off.

• R55 was confused by the term “wages” in 20k. He was compensated for the time he was off due 

to his injury, but it was not “wages” in the sense of “pay for work.” He responded “yes” that he 

lost wages but it appears he did receive full compensation, just from other sources rather than pay 

for work.

Question 21 and 22

These questions determine whether the respondent went back to work after the injury/illness and, if so, 

how many days after the injury/illness they began work again. Q21 is new to Round 2. Respondents 

generally did not have difficulty answering this new question but a couple of issues were noted during the 

interviews:
23

Memorandum

• R49: R answered “no” to Q21 but after probing about whether he could work again in any 

capacity, he said “yes.” 

• R17A: R said “yes” but then qualified his answer to indicate that he could work again after his 

injury healed. He appeared to convey that “yes” he would work again, but “no” not immediately 

after his injury. 

The issues noted suggest that Q21 could be interpreted in more than one way. It could be interpreted as 

asking whether the respondent was capable of working at all in any capacity, or to mean whether the 

respondent was able to perform normal job duties anymore.

Recommendation:

In the August 19th mock-up we presented suggested revisions for the section on Effect on Work. Key 

revisions that were made are summarized below:

• Two questions, Q18 and Q19, which ask about the employer’s knowledge of the injury/illness, 

are more closely tied to the questions on Workers’ Compensation and were moved to that section. 

• Questions 20 through Q22, addressing effects of in injury/illness on work and whether the 

respondent was able to work again, were reordered and revised. The questions should work better 

for those who did not return to work.

• Since some of the items in Q20 rely on knowing whether the respondent returned to work, Q21

was moved up to improve question flow and clarity. 

• Some items were revised to simplify language. For example, “change occupations” was revised 

to “change the kind of work you do...”
24

Memorandum

Injury or Illness: Workers’ Compensation

Question 26 - Grid of questions about what kinds of compensation the respondent received after 

their injury or illness

This grid of questions evaluates how and if workers were paid when they missed time at work due to their 

injury or illness. Based on findings from Round 1, the item on being “kept on salary” was revised (“Did 

your employer continue to pay your wages...”). In addition, revisions to the terms on sick leave, annual 

leave, and time off were revised to refer to “paid” leave or time off. As the responses below indicate, 

respondents are aware of whether they received pay while away from work recovering from their 

injury/illness. However, they can be unclear as to the source of the compensation.

• R18A: R paused and said “yes” to the question on whether the employer continue to pay your 

wages. However, she said the employer paid her a full two-week vacation, not wages. It seems 

that providing vacation pay could count as employer continuing to pay wages, but NORC is 

unsure.
25

Memorandum

• R55: R answered questions on workers’ compensation without issue. He received workers’ 

compensation for the days he missed and to cover his medical expenses. His employer made up 

the difference in pay that workers’ compensation did not cover. However, when asked if he used 

paid sick leave/annual leave/time off, he said “yes.” Probing revealed that he probably did not 

use paid time off. He was paid during his time off, but it appears it was not through paid days off 

that employees get; he got workers’ compensation and his employer compensated him for the 

difference in pay that was not covered by workers’ compensation. 

• R52: When asked about taking paid sick leave/annual leave/time off, R indicated yes and 

explained that he gets “injury time out” through his employer. He said this type of leave covers 2 

weeks to 8 months, so R is receiving pay while waiting for workers’ compensation. NORC is 

unclear as to whether this type of paid leave counts as paid sick leave/annual leave/time off or 

whether this is being kept on salary, with employer continuing to pay wages. R also answered 

“yes” to the question on employer continuing to pay wages. It is possible the R “double-counted” 

by answering “yes” to both types of paid time away from work.

• R47: R said “yes” that employer continued to pay her wages, but she called it sick leave. It is not 

clear whether she used sick leave, her employer paid her wages, or both occurred.

With two respondents, it became clear that Q26 does not apply when the respondent has left the 

employer:

• R19: R said he was let go from his job. Interviewer noted that some of the items in Q26 would 

not apply if the R was let go.

• R28: R quit immediately after the injury. Interviewer noted that some of the items in Q26 should 

be skipped in this case.

Further, a part-time employee found it difficult to determine whether she took leave without pay. One 

respondent seemed to simply misunderstand the question or the term “leave without pay”:

• R25: R had difficulty with the item on taking leave without pay. As a part-time employee, she 

took some days off but then reschedule her work days for later in the week. She did take leave 

and did not get paid, but made up her hours later in the week.
26

Memorandum

• R50: R said “no” to the question on taking leave without pay. However, in probing he indicated 

he did not get paid while away from work. He should have answered “yes” on taking leaving 

without pay.

Recommendations:

In the August 19th mock-up, several revisions that have been implemented should improve Q26:

• The skip patterns leading up to Q26 have been corrected and revised. 

• Skip patterns have been added to some items in Q26 to assure questions are directed at the 

appropriate group (such as those who filed for workers’ compensation or those who had not yet 

received workers’ compensation).

• Per BLS suggestion, the item on receiving wages and other compensation while unable to work 

was moved to the end of Q26. 

Respondent comments indicate that some do not know the source of the compensation they are receiving, 

whether it is employer paid, their own paid leave that they have accrued, or something else. NORC 

continues to consider how to revise the questions to yield the most accurate answers. However, data 

quality is likely to be an issue when respondents themselves are unsure of the sources of compensation 

they receive. 

Question 27 - Was there a claim filed for worker’s compensation?

Because this question occurs after a grid of several questions, respondents may have forgotten that the 

question refers to workers’ compensation by the time it is asked. One respondent expressed confusion; 
27

Memorandum

however, most seemed able to answer accurately as to whether there was an open workers’ compensation 

claim.

• R8 asked what kind of claim this was about when it was asked. It had to be clarified that it was a 

worker’s compensation claim.

Recommendations:

As detailed above, Q27 was incorporated into the Q26 series of questions. Since this question concerns 

whether there is an open workers’ compensation claim, it will now be asked as a follow-up to the question 

if the respondent indicates in Q26 that workers’ compensation was not received.

Occupation and Industry at Time of Injury or Illness

Q28 and Q29: Employed Full Time or Part Time and Hours Worked

These questions collect full-time vs. part-time employment status and hours worked in a typical week. 

Q28 was revised after Round 1 to clarify that it is the employer’s designation of the respondent as full- or 

part-time that is of interest. Respondents did not have difficulty answering these questions. No revisions 

are suggested for these items. 
28

Memorandum

Type of Employer

Q30: Type of employer

These questions ask about the type of employer the respondent works for. As a result of Round 1 testing, 

Q30 was simplified slightly to improve comprehension. Many answered the questions without issue. 

However, as the comments below indicate, respondents often have difficulty deciding the type of 

company they work for:

• R25: R worked for a home aide company and indicate it was private-for-profit. She seemed to 

give correct answer but said she really didn’t know.

• R22: R worked at a retail store but did not know which category to pick. R did not think it was 

any of the options listed.

• R28: R said “corporate” and works for a fast food company. How should such a response be 

coded? Should the R be prompted to pick a category or can “corporate” be coded as private-forprofit? 

• R41: R selected self-employed but said she was not sure. R works as a personal assistant for 

someone else, so this response appears correct. 
29

Memorandum

• R42: R worked for a major fast food chain, which is clearly for profit. However, R said not sure 

and picked government.

• R44: R works for a dollar store but did not know what to pick.

• R51: R works for her cousin’s business (cousin owns the business) but did not know what to 

pick. R picked family business but wasn’t sure if this was correct. 

Recommendations:

Respondents are sometimes unsure of the type of employer for whom they work. Although it may be 

possible to provide definitions of each type of employer to assist respondents in selecting the correct 

answer, it is possible that such definitions could be complex enough to be of little use. Since most 

respondents are willing to provide the name of the company they work for, it may be possible to code the 

type of company for those respondents who are not sure.

Employer Details

Q32: Name of respondent’s employer

This question was revised after Round 1 interviews to clarify that it is the name of the employer that is 

being requested. Respondents in Round 2 generally understood that Q32 was asking for the name of their 

employer. Most respondents had no concerns about providing that information. One set of respondents 

in which we interviewed both an injured respondent and a proxy (R17A and R17B) did not want to give 

the name of their employers. R17A felt that employer name was sensitive information and also indicated 

that the terms of the settlement require that he not disclose the name of the employer. 
30

Memorandum

Q40: Number of workers 

This question is about the relative size of the place where the respondent works. The question was revised 

based on the Round 1 finding that respondents who worked for larger employers with multiple locations 

sometimes thought the question referred to the number of employees across all employer locations. This 

particular issue did not arise, suggesting that the question revision successfully clarified that the employee 

should report on the number of employees at their work location. However, for some employees who are 

assigned to alternate work locations, it is still not clear how to respond:

• R18A: R drives a truck. She was not sure if the question referred to the people in the truck, two at 

most, or to the office. She decided the question referred to the entire office.

• R25: R is employed by a home health aide company. She works in client homes. When probed, 

she said she was unsure whether the question meant the number of people who work for the 

company in total. She stated she works in client homes and there is one client. Although 

respondent did not mention it explicitly, her comments suggest that she was the only aide in the 

client’s home.

• R55: R works for a contractor that supplies and maintains nursery products to large stores like 

Home Depot. R wasn’t sure whether to report a) how many people in total work at his particular 

job site (Home Depot) or how many people from his contracting company are placed at his 

particular job site. He reported a number based on the latter – how many people from the nursery 

contractor are assigned to work at his job site.

• R49: R worked for a large job placement company which connects thousands of people to work 

in a wide variety of industries. R wasn’t sure how many people work for the company but 

provided a rough estimate of 2000. 
31

Memorandum

Below we provide examples of how respondents arrived at answers. Although some respondents simply 

provide a guess and do not appear to have spent time constructing an answer, others explained how they 

provided their estimates:

• R50: R accounted for workers across various shifts. 

• R26: R added up three different work crews.

Recommendations:

For subcontractors and those assigned to different work locations, instructions should clarify for which

work location they should be reporting number of employees. Is it for the entire office or for the specific 

location to which they are assigned? If R is a contractor, do both the contract and non-contract employees 

at the location get included in the count?

Proxy Respondents

For one of the recruited respondents, another adult member of the respondent’s household was also 

invited to take part in an interview. We collected data on each member of the pair. We examined self- and 

proxy-reported answers to selected questions to assess the accuracy of proxy response. The data are 

presented in Exhibit 3. In this exhibit, the focal respondent is the person about whom the data are being 

collected. For each focal respondent, we compare the data from selected questions from the respondent’s 

self-interview and proxy interview (conducted with the respondent’s household member).

Respondent 17A had slipped and fell at work, breaking his wrist. He worked in a bakery department and 

slipped on liquid on the floor. He was out of work for nearly three months and received workers’ 

compensation during his time away from work. Respondent 17B, serving as proxy for 17A, did not 

report any workplace injuries or illnesses (17A also concurred that 17B did not have any injuries/illnesses 

to report). As Exhibit 2 shows, there is overall agreement between the respondent and the proxy on the 

injury that that 17A, details of the incident, effects on work, workers’ compensation received, as well as 

demographic information. 

Exhibit 3: Proxy Reporting

Question Focal 

Respondent

Self vs. Proxy Comparison
32

Memorandum

Screener 

(Q1 - Q8)

17A • Self (17A) and proxy (17B) both reported that the R had worked 

in the bakery department of a store, and had slipped and fallen. 

Both reported that R suffered a broken wrist.

• Both self and proxy agreed on the recordability characteristics 

(R did not lose consciousness, was unable to work for day or 

more, restricted work activities, did not transfer jobs, and got 

treatment beyond first aid).

• Both self and proxy reported injury occurred in December of 

2015, around Christmas.

17B • Self (17B) and proxy (17A) both reported that the R did not 

experience any work-related injuries or illnesses.

Injury or 

Illness (Q10 – 

Q13

17A • Both self and proxy described the event similarly, indicating that 

R slipped on floor and broke right wrist. Both mentioned liquid 

on the floor that caused the slip.

• In reporting other body parts or organs affected by the injury, 

17A reported not that he could remember, but bruising, swelling, 

abrasion on arms and legs. Proxy 17B thought 17A had scrapes 

on his face. This report of other associated injuries reflects a 

discrepancy between 17A and 17B.

17B • NA

Medical 

Attention 

(Q14)

17A • Both self and proxy agreed that 17A consulted a health care 

professional (both mentioned orthopedic surgeon), and that 17A 

was treated by an emergency vehicle and went to the emergency 

room.

• Regarding getting care through a phone call, 17A indicated he 

did not. 17B was not sure.

• Both agreed that 17A was not admitted to the hospital and that 

the medical diagnosis was a broken wrist.

17B • NA

Effect on 

Work—

Report to 

17A • Both 17A and 17B reported that the injury had been reported to 

the employer.

17B • NA
33

Memorandum

Employer 

(Q18)

Effect on 

Work—

Injury/Illness 

Caused... 

(Q20)

17A • Both 17A and 17B agreed in general on the effects of the injury 

on work. The main difference was that 17A said he was laid off, 

referring to the months he was unable to work. 17B indicated 

that 17A had not been laid off and that 17A had gotten workers’ 

compensation. Further, in discussing the effects of the injury on 

losing wages, 17A said he did not lose wages. However, 17B 

thought that 17A may not make as much as he used to.

17B • NA

Effect on 

Work—Days 

Missed (Q21 – 

Q22)

17A • Both 17A and 17B indicated that 17A was able to work again 

after the injury. 

• 17A indicated he took 2 1⁄2 to 3 months off, indicating 75 days 

when probed. 17B indicated it was 3 months off.

17B • NA

Effect on 

Work—

Workers’ 

Comp (Q23)

17A • Both 17A and 17B reported that 17A’s employer had filed for 

workers’ compensation and that it had been received. Except as 

noted below, they generally agreed on the details of the 

compensation received.

• 17A reported that he got paid his compensation in full, but 17B 

was not sure.

• Both agreed that 17A got short-term/temporary disability (but 

17A suggested he was unsure, “Got workers’ compensation, I 

guess, will say yes”).

• 17A said he got injury leave and time off (in response to Q on 

getting paid sick leaven, paid annual leave, or paid time off). 

17B thought that 17A had not gotten this paid leave.

17B • NA

Employment 

at Time of 

17A • Both 17A and 17B agreed that 17A was a full-time employee 

working 40 hours per week. They agreed on the type of 
34

Memorandum

Injury/Illness 

(Q28 – Q40)

company, job duties, that it was not a union job, and size of 

company, but refused to name the employer. 

17B • NA

Demographics 

(Q41 – Q47)

17A • Both 17A and 17B answered the demographics questions about 

17A similarly. 17B had to think for a while to recall 17A’s 

birthdate.

17B • For most questions, 17B and 17A provided the same 

demographic information for 17B. 17A paused to think about 

17B’s birthdate. Also, 17A thought 17B had some college but 

no degree, expressing uncertainty about 17B’s educational 

history. 17B self-reported that he has a BS degree.

Next Steps

In a memo delivered to BLS on July 28th (Round 2 preliminary findings.docx), NORC outlined key issues 

to address in the design of the HSOII questionnaire based on preliminary Round 2 findings. The present

memo has presented data concerning the issues that were observed in Round 2. Further, the August 19th

mock-up that NORC delivered to BLS presents a number of suggested item revisions and reordering of 

items, both of which should improve clarity and flow. Upon receiving feedback from BLS, NORC is 

prepared to conduct additional phone interviews to test the revised instrument and incorporate further 

updates to the HSOII instrument prior to launching Round 3. 
1 

HOUSEHOLD SURVEY OF OCCUPATIONAL INJURIES AND ILLNESSES

Cognitive interview protocol R2

MATERIALS NEEDED FOR INTERVIEW

□ INTERVIEWER PROTOCOL BOOKLET (THIS BOOKLET) AND SHOWCARDS

□ CONSENT FORM (TWO COPIES)

□ $40 CASH IN ENVELOPE

□ PAYMENT RECEIPT

□ FULLY CHARGED DIGITAL RECORDER AND EXTRA BATTERIES

□ NOTE PAPER, PENS AND PENCILS

STEP 1: INFORMED CONSENT

PROVIDE RESPONDENT WITH A COPY OF THE INFORMED CONSENT FORM. ASK THE RESPONDENT 

TO READ THE FORM, ANSWER ANY QUESTIONS, AND HAVE THE RESPONDENT SIGN THE FORM. 

LEAVE A SEPARATE COPY OF THE FORM WITH THE RESPONDENT.

□ SIGNED CONSENT FORM COLLECTED

□ COPY OF CONSENT FORM GIVEN TO RESPONDENT

□ IF THE RESPONDENT HAS CONSENTED TO RECORDING, START THE RECORDER.

STEP 2: COMPLETION OF THE QUESTIONNAIRE

BEGIN QUESTIONNAIRE. 

Interviewer probe bank (use as appropriate):

• “How did you come up with that answer?”

• “Can you tell me in your own words what you think the question is asking?”

• “Can you tell me more about that?”

If you pick up on a visual cue that suggests an issue or confusion: 

• “Tell me what you are thinking.”

• What does the word [term] in this question mean to you?

• You said [answer]. Can you tell me more about that?

If R is uncertain and asking for confirmation:

• There is not a right or wrong answer for this question. I am interested in hearing your thoughts on what 

the question is asking.

INTERVIEWER: If this interview is with a proxy respondent, please modify language accordingly. For example, instead 

of asking “Did you do ANY work for pay or profit?” ask “Did [your husband/wife/brother/he/she] do ANY work for pay 

or profit?”
2 

Survey Introduction

This survey is about work-related injuries and illnesses that you may have experienced. I would like to ask you questions 

about your work history and about the injuries and illnesses you may have had that are related to your job. The 

information that you provide in this survey is confidential. Your name and your answers to the questions will not be 

shared with anyone outside of NORC, the survey organization conducting this survey. I would be happy to answer any 

questions you may have about the survey. [ANSWER RESPONDENT QUESTIONS.] Let’s begin. 

Screener

1. In the past year, that is, since [CURRENT MONTH] of [LAST YEAR], did you do ANY work for pay or profit?

a. Yes  ELIGIBLE, CONTINUE

b. No  NOT ELIGIBLE, END INTERVIEW

c. DK

d. REF 

Any injury

2. In the past year, that is, since [CURRENT MONTH] of [LAST YEAR], have you experienced any injuries or 

illnesses related to any job you had?

a. Yes  COLLECT BRIEF DESCRIPTION, CONFIRM WORK-RELATED

b. No  SKIP TO Q4

c. DK

d. REF 

3. Did that injury/illness cause you to... 

Yes No DK REF

Lose consciousness? 

Be unable to work for a day or more?

Restrict your work activities?

Transfer jobs?

Get medical treatment other than first aid?

IF YES, COLLECT BRIEF DESCRIPTION AND CONFIRM WORK-RELATED.

4. [Other than the injury/illness you just mentioned], in the past year, that is, since [CURRENT MONTH] of [LAST 

YEAR], have you experienced any of the following injuries related to any job you had? I’m going to read a list of 

examples... CUES

a. Sprains, strains or tears

b. Soreness or pain

c. Bruises or contusions

d. Cuts, lacerations or punctures

e. Broken bones

f. Injury to muscles or joints

g. Open wounds

h. Burns 

i. Carpal tunnel syndrome

j. Any other injury? 

1) YES  COLLECT BRIEF DESCRIPTION, CONFIRM WORK-RELATED

2) NO SKIP TO Q5

3) DK SKIP TO Q5

4) REF SKIP TO Q5
3 

4.1 Did that injury/illness cause you to... 

Yes No DK REF

Lose consciousness? 

Be unable to work for a day or more?

Restrict your work activities?

Transfer jobs?

Get medical treatment other than first aid?

5. [Other than what you have already mentioned], in the past year, that is, since [CURRENT MONTH] of [LAST 

YEAR], have you experienced any of the following illnesses, related to any job you had? I’m going to read a list 

of examples... CUES: 

a. Skin disorders

b. Respiratory conditions

c. Poisonings,

d. Hearing loss

e. A disease or infection

f. Cancer 

g. Anxiety or depression

h. Any other illness? 

1) YES  COLLECT BRIEF DESCRIPTION, CONFIRM WORK-RELATED

2) NO SKIP TO Q6

3) DK SKIP TO Q6

4) REF SKIP TO Q6

5.1 Did that injury/illness cause you to...

Yes No DK REF

Lose consciousness? 

Be unable to work for a day or more?

Restrict your work activities?

Transfer jobs?

Get medical treatment other than first aid?

IF R HAS NOT REPORTED ANY INJURIES OR ILLNESSES ASK ABOUT INJURIES/ILLNESSES EVER

EXPERIENCED. ELSE GO TO Q7.]

6. Have you EVER experienced any injuries or illnesses related to any job you had?

a. YES  COLLECT BRIEF DESCRIPTION, CONFIRM WORK-RELATED

b. NO  GO TO PROBES AT END OF SCREENER SECTION THEN SKIP TO 

DEMOGRAPHICS

c. DK  GO TO PROBES AT END OF SCREENER SECTION THEN SKIP TO 

DEMOGRAPHICS

d. REF  GO TO PROBES AT END OF SCREENER SECTION THEN SKIP TO 

DEMOGRAPHICS
4 

6.1 Did that injury/illness cause you to...

Yes No DK REF

Lose consciousness? 

Be unable to work for a day or more?

Restrict your work activities?

Transfer jobs?

Get medical treatment other than first aid?

7. [IF YES TO ANY INJURIES OR ILLNESSES] How many total times [since CURRENT MONTH, ONE YEAR 

AGO], did you experience/have you ever experienced] an injury or illness related to any job you had? [THIS 

WILL CREATE THE LOOPS.] ________TIMES

8. [FOR EACH INJURY/ILLNESS] In what month and year did this injury/illness occur? 

MONTH/YEAR

ENTER MM/YYYY

DK

REF 

INTERVIEWER: CONFIRM NUMBER OF INCIDENTS AND BRIEF DESCRIPTION OF EACH. IF 

INJURY/ILLNESS EXPERIENCED WITHIN PAST YEAR, RESPONDENT WILL REPORT ON THOSE. 

OTHERWISE, IF NO INJURY/ILLNESS WITHIN PAST YEAR, RESPONDENT WILL REPORT ON 

INJURIES/ILLNESSES EVER EXPERIENCED.

Probes:

Screener

• I asked you this question: “In the past year, that is, since [CURRENT MONTH] of [LAST YEAR], have you 

experienced any injuries or illnesses related to any job you had?” In your own words, what is this question 

asking?

• In your own words, what would be a work-related injury or illness? Can you give me some examples of some 

things that would count as work-related injuries and illnesses? What would not count?

• Tell me about the kind of work you do. Tell me about other times when you got hurt or sick because of the 

work you do.

• [I asked you about whether you ever experienced any injury or illness, related to any job you had, that caused 

you to get medical treatment other than first aid]. What does “first aid” mean to you? What kind of treatment 

counts as first aid? What kind of treatment doesn’t count?

• The questions gave some examples of injuries and illnesses [SHOW R THE LISTS, READ THE LIST IF 

NECESSARY.] Are you familiar with [LIST]? Which ones have you heard of? Which ones had you not heard 

of? 

• How easy or hard was it to remember when the injury/illness happened? Can you tell me more about that? 

How did you figure out when the injury/illness happened?

Notes to interviewer:

The goal of the screener section is to enumerate all instances of work-related injuries and illnesses that occurred during 

the reference period. What issues do respondents have in reporting these incidents? Do they understand the types of 

injuries and illnesses to report? Can they accurately report only those that are work-related? How do they determine 

the boundary of the reference period and determine whether an incident occurred within the RP?

IF NO INCIDENTS OF WORK-RELATED INJURIES AND ILLNESSES, GO TO DEMOGRAPHICS SECTION.
5 

Injury or Illness

 

[FOR FIRST INJURY/ILLNESS START AT Q10] 

[FOR SECOND AND FOLLOWING INJURY/ILLNESS START AT Q9] 

9. [FOR SECOND/THIRD/ETC. LOOPS] How is this injury/illness related to the other injury/illness you 

mentioned? Is this related to [the other/another] injury/illness you already mentioned or is it a different 

injury/illness?

a. RELATED TO THE OTHER/ANOTHER INJURY/ILLNESS [GO TO NEXT LOOP]

b. THIS IS A DIFFERENT INJURY/ILLNESS [CONTINUE]

c. DK

d. REF 

“Now I am going to ask you more about [INJURY/ILLNESS #.... ].”

10. [WORKER ACTIVITY + some EVENT and SOURCE] [FOR EACH LOOP] Please 

describe how the injury, illness, or condition occurred, and what caused it. For example: 

“When ladder slipped on wet floor, I fell 20 feet”; “I was sprayed with chlorine when 

gasket broke during replacement”; “I developed soreness in wrist over time.” [OPEN 

ENDED]

11. [SOURCE] Were there any other objects, substances, or persons involved in the injury 

or illness that you didn’t mention? Please include equipment, chemicals, vehicles, or 

anything else.

12. [NATURE AND BODY PART] Please describe the injury, illness, or condition. How 

was [BODY PART, ORGAN] affected? You can use medical terms if you know them, 

or just talk about the symptoms you experienced. For example: “strained back”; 

“chemical burn on hand”; “carpal tunnel syndrome.”

13. [NATURE AND BODY PART] Were there any other parts of your body or organs

affected by the injury or illness that you may not have included in your description? How was [BODY PART, 

ORGAN] affected?

VERSION 2 OF Q10 THROUGH Q13:

Now I want to ask you a different set of questions about your injury/illness. These questions may sound similar to the 

ones I just asked you, but I am trying to find out which way of asking the questions works better. Please answer these 

questions as if we had not already talked about your injury/illness.

Now I am going to ask you more about (injury/illness):

CHECKLIST

1. Description or 

diagnosis for 

injury/illness (this is 

the OIICS nature) 

2. Part or parts of body 

affected, including 

body systems 

(OIICS part, 

obviously)

3. How the 

injury/illness/exposu

re happened (OIICS 

event) 

4. Vehicles, tools, 

chemicals, surfaces, 

or any other objects 

involved; this can be 

multiple objects; this 

can also just be the 

person’s body 

moved incorrectly 

(OIICS sources) 
6 

10a: [WORKER ACTIVITY + some EVENT and SOURCE] [FOR EACH LOOP] What happened? How did the 

injury or illness occur? For example: “When ladder slipped on wet floor, I fell 20 feet”; “I was sprayed with chlorine 

when gasket broke during replacement”; “I developed soreness in wrist over time.” [OPEN ENDED]

11a: [EVENT and SOURCE] [FOR EACH LOOP] What were you doing just before the incident occurred? Describe 

the activity as well as the tools, equipment, or material you were using. Be specific. For example: “climbing a ladder 

while carrying roofing materials”; “spraying chlorine from hand sprayer”; “daily computer key-entry.” 

a. DESCRIBE THE ACTIVITY.

DK

REF 

b. DESCRIBE THE TOOLS, EQUIPMENT, OR MATERIAL THAT YOU WERE USING.] [OPEN 

ENDED]

DK

REF 

12a: [SOURCE] [FOR EACH LOOP] What object or substance directly harmed you? For example: “concrete floor”; 

“chlorine”; “radial arm saw.” 

RECORD VERBATIM RESPONSE:

a. DK

b. REF 

13a: [NATURE and PART] [FOR EACH LOOP] [INTERVIEWER NOTE: R should be more specific than “hurt,” 

“pain,” or “sore.” For example: “strained back”; “chemical burn, hand”; “carpal tunnel syndrome.” 

a. How did this injury or illness happen?

RECORD VERBATIM RESPONSE:

a. DK

b. REF 

b. What part of your body was affected?

RECORD VERBATIM RESPONSE:

a. DK

b. REF 

c. How was it affected? What type of injury or illness affected your [PART OF BODY]?

RECORD VERBATIM RESPONSE:

a. DK

b. REF
7 

Probes:

Characteristics of incident

• [READ QUESTION] Can you tell me in your own words what you think this question is asking?

• [IF R DOES NOT INDICATE HOW INJURY/ILLNESS IS WORK-RELATED] Tell me more about how this 

injury/illness was related to your job. Where were you when this happened? What were you doing? What 

caused the injury/illness? Tell me more about the injury/illness. 

Notes to interviewer:

Questions 10 through 13 are intended to capture (event or exposure, source of the injury/illness, part of body affected, 

and nature of the injury/illness). Do the questions elicit the information needed? Are the response options adequate to 

capture the information Rs give? Use general probing to elicit more information about the incident. (For example, if R 

says “I cut myself” ask: What part of your body was injured? What did you get cut with? What were you doing at the 

time?

Medical attention

14. [FOR EACH LOOP] Was the injury/illness serious enough that a doctor, nurse, or other health care professional 

was consulted?

a. Yes  What type of health care professional did you see? (specify)___ ___________________

b. No 

c. DK

d. REF 

15. [FOR EACH LOOP] Did you get medical advice, treatment, or follow-up care for this injury/illness from...? 

Yes No Not 

needed

DK/REF

An emergency vehicle, such as an ambulance or fire truck

An emergency room

A doctor’s office or other health clinic 

Please include on-site offices or clinics at your place of employment

A phone call to a doctor, nurse, or other health care professional

Any place else? Specify

16. [FOR EACH LOOP] Were you admitted to the hospital? 

a. YES  How many nights were you in the hospital? _______ nights

b. NO

c. DK

d. REF 

17. Did you receive a medical diagnosis from a health care professional?

a. YES  What was your medical diagnosis?

b. NO

c. DK

d. REF 
8 

Probes:

Medical attention (tailor probes based on whether R reported receiving medical attention)

• Tell me more about the medical care you received after the injury/illness happened.

• Can you tell me in your own words what you think this question is asking?

• Who do you think of as a health care professional? Who would you include or not include? [IF NEEDED 

ASK IF THESE WOULD COUNT: medical doctor, nurse, physician’s assistant, chiropractor, paramedic]

• I asked you about whether you received a medical diagnosis. What does the term “medical diagnosis” mean to 

you? How do you get a medical diagnosis? Who gives you a medical diagnosis? Does a medical diagnosis 

have to come from a doctor or other health care professional?

• IF NEEDED] Did you go to a doctor, nurse, or other health care provider after [INCIDENT]? Did you go to 

the hospital or did paramedics come? 

• What does it mean to be admitted to the hospital? How is that different from an emergency room visit?

• Is/Was there a medical clinic at your place of employment? Did you see anyone at that clinic?

• Did you speak to a doctor, nurse, or another health care provider by phone after the incident? 

Effect on work

18. [FOR EACH LOOP] Did you report this injury/illness to your employer?

a. YES [SKIP TO Q20] 

b. NO

c. DK

d. REF 

19. [FOR EACH LOOP] IF NO TO REPORTING TO EMPLOYER: Why did you not report this injury/illness to 

your employer? 

a. Avoid being laid off YES NO DK REF 

b. Avoid loss of wages YES NO DK REF 

c. Avoid loss of promotion or advancement YES NO DK REF 

d. Avoid job transfer or restriction YES NO DK REF 

e. Employer would not recognize the injury/illness as 

work-related YES NO DK REF 

f. Employer wants to keep injury and illness rates low YES NO DK REF 

g. Realized the injury/illness was work-related after 

leaving the job YES NO DK REF 

h. Other (specify) YES NO DK REF 

Probes:

Effect on work

• [IF YES TO Q19] Tell me more about the reasons why you did not tell your employer about this injury/illness. 

Which was the main reason for not telling your employer? Tell me more about that.

Notes to interviewer:

Observe for signs of acquiescence bias in Q19. Are Rs saying “yes” because a reason sounds plausible or because it 

was a reason why R did not report an injury/illness? Ask for more detail and main reasons. How did R determine an 

answer to each item in Q19? Probe to explore understanding of terms, ability to accurately report on consequences of 

the injury/illness.
9 

20. [FOR EACH LOOP] Did the injury/illness cause you to...?

YES NO NA DK/REF

a. Be unable to work the next day, whether or not you were actually scheduled to 

work? [BE SURE TO ASK Q21]

b. Work at your regular job less than your usual number of hours?

c. Work at your regular job, but be unable to perform all of the normal duties of 

the job?

d. Be assigned to another job on a temporary basis?

e. (DELETED)

f. (DELETED)

g. Quit your job?

h. Be laid off?

i. Be fired?

j. Change occupations?

k. Lose any wages?

l. OTHER (SPECIFY)

IF NO WORK DAYS MISSED, GO THROUGH PROBES THEN SKIP TO INTRO AT Q23.

Probes:

Effect on work

• IF YES TO ANY ITEM IN Q20: Tell me more about [TEXT FILL]. [E.g., Tell me more about your normal 

job duties. What duties were you unable to perform? OR Tell me more about why you quit your job? When 

did you quit? How was that related to your injury/illness?] 

• What does the term [TEXT FILL] mean to you? Can you give me an example? [E.g., What does it mean to 

you to be assigned to another job on a temporary basis? What does it mean to be laid off? Fired?] 

• What kind of effect did the injury/illness have on your work schedule? Job duties? Ability to work? Ability to 

keep your job? The pay you received? 

21. Were you able to work again after the injury/illness?

a. YES

b. NO SKIP TO INTRO BEFORE Q23

c. DK SKIP TO INTRO BEFORE Q23

d. REF SKIP TO INTRO BEFORE Q23

22. [FOR EACH LOOP] How many days after the injury/illness were you able to start work again?

a. _____DAYS AFTER THE INJURY/ILLNESS

b. STILL OFF PAID WORK

c. EXPECTS NEVER TO DO PAID WORK AGAIN

d. BACK TO WORK SAME DAY

e. DK

f. REF 
10 

Probes:

Days after injury/illness able to start work again

• You said you were able to start work again XX days after the injury/illness. How did you figure that out?

• Walk me through the timeline of when you were injured and when you got back to work. 

• When you started work again were you able to resume all the duties you had before, or not?

• Did your doctor or another health care professional recommend that you take days off from work? How many 

days off did they recommend?

Notes to interviewer:

How does R determine days after injury/illness able to start work again? 

Workers’ compensation

Workers’ compensation is insurance that provides you with your lost wages and medical care when you become injured or 

ill due to your job. The next questions are about income you may have received from workers’ compensation.

23. [FOR EACH LOOP] Has anyone filed a workers’ compensation claim for this injury/illness?

a. YES

b. NO [SKIP TO Q25] 

c. DK

d. REF 

24. Who filed the workers’ compensation claim?

a. EMPLOYER

b. EMPLOYEE

c. FAMILY MEMBER OF EMPLOYEE

d. OTHER SPECIFY

e. DK

f. REF 

GO TO SKIP INSTRUCTION BEFORE Q26. 

25. [FOR EACH LOOP] IF NO ON QUESTION ABOUT WORKERS’ COMPENSATION: What was the main 

reason you or your employer did not file a workers’ compensation claim for this injury/illness?

a. Not eligible (did not meet waiting period)

b. Employer refused

c. Did not inform employer

d. Worker unaware of workers’ compensation coverage

e. Other reason, please specify

f. DK

g. REF 

SKIP INSTRUCTION: 

#1: IF YES TO Q20a—MISSED DAYS OF WORK, GO TO Q26. 

#2: ELSE IF WORKERS’ COMPENSATION CLAIM FILED (i.e., Q23=YES) SKIP TO Q27. 

#3: ELSE GO TO PROBES AT END OF SECTION THEN SKIP TO INTRO BEFORE Q28. 
11 

26. IF R MISSED DAYS OF WORK FOLLOWING THE INJURY/ILLNESS: MARK YES OR NO FOR EACH 

QUESTION

YES NO NA DK/REF

Did you receive workers’ compensation? 

READ IF NECESSARY: Workers compensation is 

insurance that provides you with your lost wages and 

medical care when you become injured or ill due to your 

job.

Did your employer continue to pay your wages and other 

compensation in full during the period you were unable to 

work? 

Short-term or temporary disability benefits provide you 

with a portion of your income if you are temporarily 

unable to work due to a medical condition. Did you 

receive short term (temporary) disability? 

Did you use paid sick leave, paid annual leave, or paid

time off?

Did you take leave without pay?

Other-specify _____________

Definitions:

Workers compensation is insurance that provides you with your lost wages and medical care when you become injured or 

ill due to your job.

Short-term or temporary disability benefits provide you with a portion of your income if you are temporarily unable to 

work due to a medical condition. 

27. [FOR EACH LOOP] IF FILED A WORKERS’ COMPENSATION CLAIM: Is there an open claim pending for 

this injury/illness?

a. YES

b. NO

c. DK

d. REF 

Probes:

Workers’ compensation

• ASK PROBES TAILORED TO THE REASONS R REPORTS ON WHY NO WC CLAIM 

WAS FILED BY EMPLOYER. EXAMPLES: Tell me more about the reasons why your 

employer did not file a workers’ compensation claim for this injury/illness? What did your 

employer say? Why did the employer refuse? How sure are you about whether or not your 

employer filed a claim?

• Can you tell me what it means to file a workers’ compensation claim? Tell me what you know 

about that process.

• Have you heard of [TEXT FILL]? Please tell me in your own words what you think [TEXT 

FILL] means: workers’ compensation, short-term or temporary disability, paid sick leave/paid 

annual leave/paid time off, leave without pay.

Notes to interviewer:

Do Rs know what workers’ compensation is? Do they know whether a WC form was filed? Are the 

terms in Q26 familiar to Rs and are the definitions helpful? 
12 

Occupation and Industry at Time of Injury or Illness

[FOR EACH LOOP] Thinking about the time of the injury/illness [TEXT FILL DESCRIPTION]. 

 

28. Were you considered by your employer to be a full time or part time employee? 

a. Full-time 

b. Part-time

c. DK

d. REF 

29. In a typical week, how many hours did you work? ______hours

IF NECESSARY: Was it greater than or equal to 35 hours per week?

DK

REF 

Probes:

Hours worked

• Do you work the same number of hours per week, or not? How did you determine how many hours per week 

you typically work? 

• How many hours a week would you consider to be full time employment? What does your employer consider 

to be full time employment? 

Notes to interviewer:

Does R have any difficulty recalling FT vs. PT work? How do Rs with irregular work schedules, seasonal employment, 

etc., answer the question? Does the number of hours per week typically worked accord with report of FT/PT status?

30. (Were/Was) (name/you) employed by government, by a private for-profit company, a nonprofit organization, selfemployed, or working in the family business? 

a. Government 

b. Private-for-profit company 

c. Non-profit organization including tax exempt and charitable organizations 

d. Self-employed 

e. Working in the family business 

31. Would that be the federal, state, or local government? 

a. Federal

b. State 

c. Local

32. What is the name of the (company, organization or agency) for whom you worked? [OPEN ENDED] 

DK

REF 

NOTE: IF GOVERNMENT EMPLOYER, TEXT FILL=AGENCY; IF NON-PROFIT, TEXT FILL=ORGANIZATION; 

ELSE TEXT FILL=COMPANY. 

33. What kind of business or industry was this? [OPEN ENDED] 

DK

REF 

34. DELETE 
13 

35. What did they make or do where you worked? [OPEN ENDED]

DK

REF 

36. In what state were you employed at this job?

DK

REF 

37. What kind of work did you do? (For example: registered nurse, personnel manager, supervisor of order 

department, secretary, accountant) [OPEN ENDED]

DK

REF 

38. What were your most important activities or duties? (For example: patient care, directing hiring policies, 

supervising order clerks, typing and filing, reconciling financial records) [OPEN ENDED]

DK

REF 

39. At this job, were you a member of a union or covered by a collective bargaining agreement?

a. YES

b. NO

c. DK

REF 

40. How many people work at your work location]? 

a. 1 to 10 workers

b. 11 to 49 workers

c. 50 to 249 workers

d. 250 to 999 workers

e. 1000 or more workers

f. DK

g. REF 

Probes:

Employment characteristics for job at time of injury/illness

• Q39 (union): Have you heard of unions? Have you heard of a collective bargaining 

agreement? Tell me what those words mean to you.

• Q39: Tell me how you decided on your answer. Tell me about the collective bargaining 

agreement. What union do/did you belong to?

• Q40 ON HOW MANY WORKERS: Tell me how you figured out your answer to this 

question. Walk me through how you figured out that answer. How certain are you of your 

answer?

Notes to interviewer:

Observe respondent ability to understand and respond to questions about employment at time of the 

injury/illness. Probe as needed to explore an issues with response. Are respondents able to accurately 

report answers for Q39 and Q40? Q40 should include total for R’s work location only, not the whole 

company/organization. 

IF R HAS ADDITIONAL INJURIES/ILLNESSES TO REPORT, GO BACK TO Q9. ELSE GO TO Q41. 
14 

Demographic Characteristics

Race/ethnicity

41. Are you Spanish, Hispanic, or Latino? 

a. YES 

b. NO

c. DK

d. REF 

42. [I am going to read you a list of five race categories.] Please choose one or more races that you consider yourself 

to be: 

a. White

b. Black or African American

c. American Indian or Alaska Native

d. Asian

e. Native Hawaiian or Other Pacific Islander

f. Other ________ 

g. DK

h. REF 

Age

43. What is your date of birth? Enter MM/DD/YYYY 

DK

REF 

44. As of last week, that would make you approximately (AGE) years old. Is that correct? 

[IF NECCESARY] Even though you don’t know your exact birthdate, what is your best guess as to how old 

you were on your last birthday? 

______ years

DK

REF 

Marital Type

45. Are you now married, widowed, divorced, separated or never married? 

a. MARRIED - SPOUSE PRESENT 

b. MARRIED - SPOUSE ABSENT 

c. WIDOWED 

d. DIVORCED 

e. SEPARATED 

f. NEVER MARRIED

g. DK

h. REF 

Gender

46. Are you male or female?

a. MALE

b. FEMALE
15 

Education

47. What is the highest level of school you have completed or the highest degree you have received? 

a. Less than 1st grade 

b. 1st, 2nd, 3rd or 4th grade 

c. 5th or 6th grade 

d. 7th or 8th grade 

e. 9th grade or 10th grade 

f. 11th grade 

g. 12th grade NO DIPLOMA 

h. High school graduate - high school diploma or the equivalent (For example: GED) 

i. Some college but no degree 

j. Associate degree in college - Occupational/vocational program 

k. Associate degree in college -- Academic program 

l. Bachelor's degree (For example: BA, AB, BS) 

m. Master's degree (For example: MA, MS, MEng, MEd, MSW, MBA) 

n. Professional School Degree (For example: MD,DDS,DVM,LLB,JD) 

o. Doctorate degree (For example: PhD, EdD)

47.1. In what country were you born?

___________________________ [OPEN-ENDED]

Current Industry and Occupation

The next questions are about your current job. If you have more than one job, please tell me about the job at which you 

usually work the most hours. If you work the same number of hours at two jobs, please tell me about the job where you 

were employed the longest.

48. What is your current employment status? Are you currently employed full-time, part-time, or are you not 

employed?

a. FULL-TIME 

b. PART-TIME 

c. NOT CURRENTLY EMPLOYED [SKIP TO END OF SURVEY]

d. DK

e. REF 

49. [IF CURRENTLY EMPLOYED] Is this job the same job with the same employer that you have already told me 

about?

a. Same job with same employer [FOLLOW SKIP BELOW at Q50] 

b. Different job, same employer [SKIP TO Q51] 

c. Different employer [SKIP TO Q51] 

d. DK

e. REF 

50. [IF YES AND ONLY ONE LOOP FOR INJURY/ILLNESS THEN SKIP TO END OF SURVEY. ELSE IF YES 

AND MORE THAN ONE REPORTED INJURY/ILLNESS AND EMPLOYER ASK:] Which job and employer 

is that? 

51. Currently, in a typical week, how many hours do you work? ______hours

IF NECESSARY: Was it greater than or equal to 35 hours per week?

DK 

REF 

 
16 

52. (Were/Was) (name/you) employed by government, by a private for-profit company, a nonprofit organization, 

self-employed, or working in the family business?

a. Government 

b. Private-for-profit company 

c. Non-profit organization including tax exempt and charitable organizations 

d. Self-employed 

e. Working in the family business 

53. Would that be the federal, state, or local government? 

d. Federal

e. State 

f. Local

54. What is the name of the (company, organization or agency) for whom you work? [OPEN ENDED] 

DK

REF 

55. What kind of business or industry is this? [OPEN ENDED]

DK

REF 

56. DELETE 

57. What do they make or do where you work? [OPEN ENDED]

DK

REF 

58. What kind of work do you do? (For example: registered nurse, personnel manager, supervisor of order 

department, secretary, accountant) [OPEN ENDED]

DK

REF 

59. What are your most important activities or duties? (For example: patient care, directing hiring policies, 

supervising order clerks, typing and filing, reconciling financial records) [OPEN ENDED]

DK

REF 

Probes:

Employment characteristics for current job

• Use general probes as needed to investigate issues with these questions.

• Is the job you reported your only job or do you have more than one job? 

• [REREAD THE ITALICIZED INSTRUCTION ON WHICH JOB TO REPORT ON]. In your own words, 

what do you think this instruction means?

Notes to interviewer:

These questions are the same as for the job at time of the incident. Continue to observe for issues to explore. 

Does R notice that this set of questions is about the current job? If R has more than one job, did R report on the correct 

one?

How do Q48 and Q49 function for determining that the current and former job are the same?
17 

Debriefing questions for self-interview:

Recall and reference period

• How easy or difficult was it for you to answer questions about injuries/illnesses that occurred over the last 

year? 

• How sure are you that the injury/illness you told me about happened in the last year?

• Were there any questions that were particularly difficult to answer? Tell me more about that?

• If I asked you about injuries/illnesses that happened during the past year, how easy or hard would it be to 

answer the questions I asked you?

• When you signed up to do the survey, you may have seen a flyer or someone from NORC ask you about 

injuries and illnesses related to work that you may have had. Did you think about those injuries/illnesses you 

had, or did you do anything to get ready for the interview before you came? Tell me about that.

• Imagine that you didn’t know ahead of time that this survey was going to be about work-related injuries and 

illnesses. If someone called you or came to your door, and asked you whether you had ever had a work-related 

injury or illness, do you think you would have remembered? How hard would these questions in the survey be, 

if you didn’t know in advance what the survey was about?

Sensitivity

• Were you worried/Would you be worried about telling your employer about an injury/illness? Was it/Would it 

be hard for you to tell your employer? Tell me more about that.

• Were you worried/Would you be worried about telling the government about an injury/illness? Why? Tell me 

more about that.

• Were you worried/Would you be worried about telling anyone else about a work-related injury/illness? Tell 

me more about that.

Review of selected items

• I’d like to ask you a little more about [QUESTION]. You said [FILL]. In your own words, what do you think 

that question was asking? How did you decide on your answer?

General debriefing

• What are your suggestions on how to improve the survey?

• What questions were the most difficult for you to answer?

• What questions were the easiest to answer?

Notes to interviewer:

Is reporting work-related injuries and illnesses to the employer a sensitive issue? Why or why not? Is telling others 

outside the workplace about these incidents sensitive? Why or why not?

What questions are the most and least difficult for Rs to answer? What answers are they uncertain about? Do they 

have suggestions for improving the survey?

Return to any questions that need further exploration. 
18 

Debriefing questions for proxy respondents:

Proxy

• What is your relationship to [RESPONDENT NAME]?

• How much would you say you know about R’s job?

• How familiar would you say you are with R’s work-related injury/illness? Are you aware of the medical 

treatment he/she received when the injury/illness occurred? Are you aware of how this affected R’s job? How 

did you learn about R’s injury/illness? Who in your household besides R would be the best person to answer 

the kinds of questions I asked?

• What questions were the hardest for you to answer for R? Why? How much would you say you know about 

[QUESTION TOPIC]? How easy/hard is it to remember the information the question asked about? Tell me 

more.

• What questions were the easiest for you to answer for R? Why? How much would you say you know about 

[QUESTION TOPIC]? How easy/hard is it to remember the information the question asked about? Tell me 

more.

Sensitivity

• Were you worried/Would you be worried about telling anyone else about R’s work-related injury/illness? Tell 

me more about that.

Review of selected items

• I’d like to ask you a little more about [QUESTION]. You said [FILL]. In your own words, what do you think 

that question was asking? How did you decide on your answer?

General debriefing

• What are your suggestions on how to improve the survey?

• What questions were the most difficult for you to answer?

• What questions were the easiest to answer?

Notes to interviewer:

Is proxy reporting of work-related injuries and illnesses a sensitive issue? Why or why not?

What questions are the most and least difficult for Rs to answer? What answers are they uncertain about? Do they 

have suggestions for improving the survey?

Return to any questions that need further exploration. 

Debriefing questions for those with no injury/illness to report:

Terms

How familiar are you with the following terms? Please tell in your own words what these terms mean to you?

Workers’ compensation, etc.

• Worker’s compensation

• Temporary disability

• Short-term disability

• Paid sick leave
19 

• Paid annual leave

• Paid time off

Health care professional/calendar days/work shifts

ASK R: In the last year, have you had any injury or illness that was serious enough that a health care professional was 

consulted? Please include any injury whether or not it was work-related.

• Who do you think of as a health care professional? Who would you include or not include? [IF NEEDED 

ASK IF THESE WOULD COUNT: medical doctor, nurse, physician’s assistant, chiropractor, paramedic]

• When you became injured or ill, how many days after the injury/illness were you able to start work again? How 

did you figure that out?

• You said you were not able to do your usual activities for XX calendar days. How did you figure that out?

Unions/collective bargaining agreement

• Have you heard of unions? Have you heard of a collective bargaining agreement? Tell me what those words 

mean to you.

• Q39 (how many workers): Tell me how you figured out your answer to this question. Walk me through how 

you figured out that answer. How certain are you of your answer?

Understanding of terms

• Who do you think of as a health care professional? Who would you include or not include? [IF NEEDED 

ASK IF THESE WOULD COUNT: medical doctor, nurse, physician’s assistant, chiropractor, paramedic]

• Now I’d like to ask you about the term “medical diagnosis.” What does the term “medical diagnosis” mean to 

you? How do you get a medical diagnosis? Who gives you a medical diagnosis? Does a medical diagnosis 

have to come from a doctor or other health care professional?

STEP 3: END OF INTERVIEW

Thank you for taking part in this survey.

□ STOP THE RECORDER.

RECRUITMENT QUESTION:

We are looking for additional respondents like you who would be interested in helping with the study. Do you know 

anyone who had a work-related injury or illness who might be interested in participating? If yes, would you mind if we 

gave you a flyer about the study and send you an email about the study that you could forward to them? 

INTERVIEWER: ANSWER ANY RESPONDENT QUESTIONS. 

This concludes the interview. I would be happy to answer any questions that you have. Thank you for your help with this 

study.

□ PAY THE RESPONDENT AND OBTAIN SIGNATURE ON RECEIPT.

MATERIALS TO TAKE AWAY FROM INTERVIEW

□ INTERVIEWER PROTOCOL BOOKLET (THIS BOOKLET)

□ SIGNED CONSENT FORM

□ SIGNED PAYMENT RECEIPT

□ DIGITAL RECORDER AND BATTERIES 

□ NOTE PAPER, PENS, PENCILS
NORC | Designing a Household Survey of Injuries and Illnesses

FINAL REPORT

Appendix D: Cognitive Interview Round 3 Memo
1 

Memorandum

To: Elizabeth Rogers & Karen Shahpoori

From: NORC

Re: Household SOII Round 3 Cognitive Interviews

Date: 9/30/2016

Introduction

NORC is conducting cognitive testing on behalf of the Bureau of Labor Statistics (BLS) to inform the 

design of a Household Survey of Occupational Injuries and Illnesses (HSOII). The cognitive interviews 

will provide data to evaluate the HSOII survey questions for correct interpretation and to assess the ability 

of respondents to accurately answer the survey questions. The results of the interviews will be used to 

refine the HSOII questionnaire items and item order. 

Recruitment Strategy. The cognitive interview sample for Round 3 interviews was recruited via 

advertisements placed in Craigslist, and on-site posting of flyers in locations in the Chicago and Northern 

Indiana areas, and via NORC’s AmeriSpeak panel. 

NORC paid to have two screening questions placed in the August Amerispeak Omnibus survey. A total of 

115 participants in this panel said they had a household member who had experienced an injury or illness 

in the last 12 months and were interested in participating. NORC followed up with all of these 

respondents and was able to secure and complete 19 interviews as a result of this recruitment strategy, 

including three proxy interviews with other household members. The rest of the interviews for Round 3 

were recruited through Craigslist postings. Since the mode for Round 3 was that of a phone interview, 

NORC was able to post in different locations and recruitment through this method was quite effective. 

NORC posted Craigslist ads in the following cities:

Tucson, AZ

Houston, TX

Louisville, KY

San Francisco, CA
2 

Memorandum

Oklahoma City, OK 

One respondent who was recruited in Round 2 but had not yet been scheduled was included in the pool 

for Round 3.

Sample Characteristics. We recruited a total of 30 persons for Round 3 (27 main respondents and 3 

proxy). Another two had scheduled interviews but did not keep their interview appointments and could 

not be rescheduled. 

Three of the 30 recruited respondents (R) were proxies who were invited for an interview primarily to 

discuss the work-related injuries and illnesses of another person recruited from his household. 

In the respondent numbering presented in the discussion of findings, respondent pairs are given the same 

number. The letter “A” was assigned to the respondent who was recruited due to experience with a workrelated injury or illness. The letter “B” was assigned to the proxy who was recruited from the same 

household. During the cognitive interview, both the main respondent and the proxy participated in a selfinterview about their own experiences with workplace injuries and illnesses, and then participated in a 

proxy interview about the other member of the pair. Exhibit 1 displays demographic characteristics of the 

30 respondents who participated in an interview; data are missing from one respondent for whom 

demographic data was not collected. 

Exhibit 1: Respondent Characteristics 

Characteristic Category Number of Respondents

Q41 – Ethnicity (Spanish, 

Hispanic or Latino?)

Yes 5

No 22

Do not know 2 

Refuse 0 

Q42 - Race White 14

Black or African American 10

American Indian or Alaska Native 3 

Asian 3 

Native Hawaiian or Other Pacific Islander 0 

Other (specify) 4 

Do not know 0 

Refuse 0 
3 

Memorandum

Q43-44 – Age categories Under 25 1

25-39 14

40-54 8

55-70 6

70 or older 0

Exhibit 1 continued: Respondent Characteristics 

Characteristic Category Number of Respondents

Q45 - Marital Status Married 13

Widowed 0

Divorced 3

Separated 0

Never married 13

Do not know 0

Refuse 0

Q46 - Sex Male 16

Female 13

Q47 – Education level

High school diploma or less 7

Some college but no degree 1

Associate’s degree (any type) 10

Bachelor’s degree or above 11

Q48 – Current 

Employment Status

Full-Time 17

Part-Time 6

Not currently employed 6

Do not know 0

Refuse 0

Q52-Q59 – Description 

of occupation at the time 

of injury

Oil field equipment operator 1

Firefighter 1

Mechanic 2

Casino tournament manager 1

Retail worker 3

Warehouse worker 3

Legal clerk 1

Maintenance 1

Landscaping 2
4 

Memorandum

Drain equipment production 1

Nursing 2

Data entry 2

Civil engineering 1

Medical staff associate 1

Electrical equipment installation 1

NA because proxy (no injury) 3

Projection equipment specialist 1

Welding 1

Quality control in oil refinery 1

Teaching 1

Interview. All interviews were conducted by phone. The interviews were conducted by three 

methodologists who are experienced in cognitive interviewing. Respondents participated in a cognitive 

interview lasting up to one hour and were paid $40. 

Timing of interviews: For the last 13 interviews in Round 3, cognitive interview protocols were modified 

so that all probing occurred at the end of the interviews. This was done in order to estimate the time of 

completion of the interviews. Based on the recordings of these interviews, the average completion time 

for an interview with one loop for an injury or illness was 27:51. The average additional time taken to 

complete each loop for each additional injury beyond this amount was 10:29.

Organization of this memo. The discussion of findings from the cognitive interviews focuses on the 

questionnaire items in which issues were observed during the cognitive interviews. 
5 

Memorandum

Screener

Questions A1 through A12: Screener
6 

Memorandum
7 

Memorandum
8 

Memorandum

The screener questions ask respondents whether they worked in the past year and whether they 

experienced any injuries or illnesses related to any job they had. As discussed in the Round 1 memo, 

respondents were able to understand the questions on whether they had worked in the last year (Q1), the 

injury/illness terms (Q4, Q5), and could discern the work-relatedness of their injuries/illnesses. The 

reference period of the survey was also generally understood by respondents.

For Round 3 (Version 1), several changes were made to the Screener questions:

• Revised language about the reference period. Consistent with other national surveys (such as the 

Current Population Survey and the National Crime Victimization Survey), we revised to present 

the dates of the reference period in an introductory statement. In the questions that follow, the 

reference period is then referred to as the “last 12 months.” Further, alternative language was 

scripted for respondents whose injuries/illnesses were chronic or were of gradual onset, making it 

difficult to tie the condition to a specific date.

• Moved question on dates of each injury/illness from end of screener. Previously, dates of all 

incidents were collected at the end of the screener. Respondents are now asked to provide

month/year of the injury/illness immediately after the screener question in which they report it. 

• The recordability criteria are no longer asked separately for each injury/illness reported. The 

information needed about each injury/illness is now collected later in the instrument. The 

recordability criteria are now used as additional cues to recall of incidents of injury and illness.

During Round 3, some additional modifications were made to the screener questions:

• The question on the total number of injuries/illnesses experienced has been revised. Instead of 

asking respondents to count up the incidents, the interviewer will enumerate them for respondent 

confirmation. This change will ease respondent burden.
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Memorandum

• In consultation with BLS, it was determined that when an injury/illness is chronic or gradual 

onset, respondents do not need to name the specific month/year in which they first noticed 

symptoms. In consultation with BLS (9/13 project meeting), NORC revised the questions on 

when the injury/illness occurred to indicate that when an injury or illness is chronic or of gradual 

onset, month and year does not need to be collected. Respondents with chronic or gradual onset 

injuries and illnesses will receive an alternate version of some of the questions on Effect on Work 

(Section D). These alternative questions are discussed in greater detail later in this memo.

The questions collecting month and year were revised to include guidance to interviewers and 

clarifying questions that can be asked to determine whether an injury or illness is chronic/gradual 

onset.

[IF ILLNESS/INJURY IS A CHRONIC/GRADUAL ONSET CONDITION, ASK 

ALTERNATIVE QUESTIONS AS NEEDED: Did this injury/illness occur on a specific day 

or did it develop over time? Did you experience symptoms related to this injury/illness in the 

last 12 months?

Understanding of screener questions on whether work-related injury/illness occurred

We observed no major issues with respondent understanding that the injuries/illnesses of interest are those 

related to a job they held. When reporting discrete events that led to injury/illness, respondent 

descriptions were clear that the incident was related to their work. With some injuries/illnesses that are 

chronic/gradual onset, such as carpal tunnel syndrome and back strain, it can be clear that the work 

activities they described, such as typing or heavy lifting, could result in the injury/illness they reported. 

With other chronic/gradual onset conditions, such as anxiety or depression, the link to work seems more 

difficult to determine.

Transition from Q2/Q3 to Q4

We observed in prior rounds of testing that many respondents miss the instruction “Other than the 

injury/illness you just mentioned” in Q4. After reporting an injury/illness in Q2, they interpreted Q4 as 

asking about the same incident and reported whether, during the incident they just reported in Q2, they 

also sustained any of the types of injury being cued in Q4. To address this issue, Q4 and Q5 were revised

during Round 2 to further emphasize that the respondent should report injuries/illnesses other than those 

he/she has already reported.
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Memorandum

Initial findings from the Round 2B versions of these questions suggest that the revised wording is helping 

respondents understand that Q4 and Q5 concern any additional injuries/illnesses they may have 

experienced. Further observation of this transition in Round 3 interviews confirmed that the revisions 

improved respondents’ understanding that subsequent screener questions are asking for reports of any 

additional injuries/illnesses experienced. However, a few respondents still interpreted these questions as 

asking about the same incident they already reported.

Conditions that develop over time

As noted prior interviews, some of the HSOII questions did not function well for conditions such as 

anxiety and stress, which may not be associated with an observable physical injury and, unlike physical 

injuries, are difficult to tie to a specific date. 

Question A8—Recordability criteria as cues to injury and illness

This question is generally well understood but does not produce many additional reports of injury/illness. 

Some of the reports are related to injuries/illnesses already reported in response to a previous screener 

question. Other reports do not appear to qualify. Some examples:

• R82: R reported that an injury to shoulder caused him to do less than his normal duties, but 

added that it was the same injury he already described.

• R158A: R said she felt like fainting but did not, reported being unable to work for a day or more 

but it was not a separate incident. Overall, R missed for this item that incidents “other” than 

those already reported were of interest.

• R158B: This R, who reported as a proxy for R158A, also made the mistake of reporting incidents 

that had already been mentioned in prior screener questions.

• R165: R works long hours and mentioned falling asleep at stop lights. Although the fatigue may 

be related to long work hours, falling asleep at a stop light did not result in injury/illness and was 

not directly tied to work duties.

Since A8 does not appear to be adding much new information, to reduce respondent burden, this question 

series could be removed from the screener.

Recommendations 

Overall the screener questions are working well. We provide a suggestion for reducing burden:
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Memorandum

• Consider removing A8, the screener question that uses recordability criteria to cue 

injuries/illnesses. It is lengthy and may not add much. It takes a couple of minutes to administer 

the question.

Further, A10 and A11 (questions on whether the respondent ever experienced an injury or illness) can be 

deleted. These questions were originally meant for cognitive interview respondents who may not have 

experienced injuries or illnesses in the last year and so are not needed for the next stage of pilot testing.

Injury or Illness: Description

Questions B1 through B5: Illness or Injury: Description
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Memorandum

Questions B1 through B5 are intended to capture the characteristics of the work-related injury or illness 

that the respondent experienced. In Round 2, these questions worked well to capture the characteristics of 

each injury/illness.

B1 is intended to be asked when the respondent reports more than one injury/illness and has not made it 

clear that the injuries/illnesses are separate events. However, during the screener the interviewer works 

with the respondent to clarify the number of distinct events. For this reason, B1 should be integrated into 

the screener. Interviewers will ask these questions as needed to determine the relatedness of and the total 

number of injuries/illnesses the R experienced. 

Exhibit 2 presents the characteristics of the injuries and illnesses that respondents reported.

Exhibit 2: Characteristics of Reported Injury/Illness

R# Coding of nature, part of body, event, source(s)

R64A

• Nature: Hematoma bruise on shin. Some associated swelling of the foot on that leg also 

occurred afterwards. 

• Part of body: 1) Shin 2) foot

• Event: R was swinging a sledgehammer and missed the intended target and hit himself in 

the shin. 

• Source: Sledgehammer, R’s own swing. 

R136A 

• Nature: Broke small bone in front part of ankle joint (bottom surface bone) and damaged 

inside joint. 
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Memorandum

• Part of body: Ankle

• Event: R was walking to a table and as he approached the table, someone stuck out their 

leg/foot so to avoid the person’s foot, R side stepped on his right leg and injured his ankle. 

• Source: Someone else’s leg/foot, the floor, and possibly poker table 

R126

• Nature: Sprain or strain of muscle in back, pulled muscle. 

• Part of body: 1) Back

• Event: R slipped down the stairs in an apartment after extinguishing a fire there. 

• Source: Stairs, the R’s body. 

R168 

Injury/Illness 1:

• Nature: Excruciating pain in left knee, R heard knee “pop and break” and knee was 

swollen, hurting, torn lateral meniscus

• Part of body: Left knee

• Event: R was working by himself and going too fast, walking around his truck looking for 

fluid leak, stumbled and fell on knee.

• Source: Ground (R did not explicitly state this.)

Injury/Illness 2:

• Nature: damaged, shattered, torn meniscus; fragmented knee

• Part of body: Right knee

• Event: R was climbing up on truck, working on a pump, the previously injured left knee 

locked up and R fell off truck. His knee hit steering box and shattered.

• Source: Steering box

R82 

• Nature: R described being in excruciating pain and that he wrenched his shoulder. R did 

not mention a diagnosis but that it was his rotator cuff.

• Part of body: Left shoulder (rotator cuff)

• Event: R was on a ladder to reach some doors that were stored on a top shelf for a 

customer. As he reached for one of the doors, it came out suddenly and R grabbed it and 

wrenched his shoulder. 

• Source: Doors, ladder, shelf, customer

158A

• Nature: Allergies (caused headaches, runny eyes, runny nose, sore throat, painful rashes, 

fatigue, difficulty waking up, and clogged nostrils). 

• Part of body: Head, including nose and throat, and skin since she reported rashes. 
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Memorandum

• Event: N/A – no specific incident, R did not specify a particular event that brought on the 

allergies. When probed about what caused the allergies, R stated “working in a law firm 

and handing old files.” 

• Source: R’s direct response to the screener and to Section B questions did not indicate 

source. Based on probing about what caused the allergies, R said it was due to handling 

boxes filled with old documents and working in an old building. R said she was allergic to 

multiple allergens.

R153

• Nature: Allergic reaction to outdoor work environment, including equipment and objects 

used for work

• Part of body: Everywhere b/c it was his skin but particularly skin on back and arms

• Event: N/A – no specific incident, just allergic reaction to things R touches or exposed to. 

• Source: R said he is allergic to everything

R135

• Nature: Broken coccyx and two herniated discs in her lower back that required surgery

• Part of body: Coccyx/tailbone and back

• Event: R was walking from in her employer’s parking lot and slipped on a patch of ice 

which caused her to fall on her tailbone. R noted that she was carrying a drink and a bag 

of food. 

• Source: Ice on parking lot, drink, bag of food 

R170 

• Nature: Cut on finger that required stitches

• Part of body: Finger

• Event: R was using a blade to cut a template for a drain and the template slipped and the 

blade cut his finger. 

• Source: Blade, template, drain.

R174

• Nature: Mild concussion syndrome

• Part of body: head

• Event: R was at work and went to sit on a chair but the chair legs were on an uneven 

surface so the chair flipped over and caused R to hit her head on the ground. 

• Source: Chair, floor. 

R60

• Nature: Tears in knee cartilage

• Part of body: 1) knee 2) back

• Event: R was lifting and twisting part of a car for his job, strained back and tore cartilage 

in knee. 

• Source: Lifting, movement of R’s own body. 
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Memorandum

R61

• Nature: Achilles Tendonitis

• Part of body: calves

• Event: Standing too long in bad shoes at job, gradual onset. 

• Source: Standing, poor shoes. 

R121 

• Nature: Anxiety or depression with symptoms of insomnia and an irregular heartbeat (R 

isn’t sure if the heartbeat issue was linked to the anxiety/depression). 

• Part of body: N/A

• Event: N/A – not a specific event but stressful work environment in which R was working 

too many hours under demanding supervisors/bosses and it was unacceptable to take days 

off. 

• Source: R’s bosses/supervisors and demanding work culture/environment

R165 

Injury/Illness 1:

• Nature: Strained back, painful

• Part of body: Back

• Event: R was lifting 100lb bag of concrete and “hurt her back”

• Source: Bag of concrete

Injury/Illness 2:

• Nature: Burn to both hands

• Part of body: Hands

• Event: R grabbed pans that were supposed to be on the hot rack but someone had 

mistakenly put them on the cold rack and the pans burned her hands. 

• Source: Pans, racks used to store pans, coworkers

R200 

(Lisa) 

Injury/Illness 1:

• Nature: Anxiety or depression, headaches. 

• Part of body: N/A 

• Event: N/A – Not a specific event but stressful work environment with long hours where 

R felt caught in the middle between the school administration and students she taught. 

Working in bridge program with GED students; felt that the program was designed to fail 

and she would have no job. 

Source: R’s bosses/supervisors in administration and students she taught.

Injury/Illness 2:

• Nature: Neck, back and shoulder pain, strained neck

• Part of body: Neck, back, shoulders
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Memorandum

• Event: NA – Developed over time due to carrying heavy books, use of computer

• Source: Books, computer

R202

• Nature: 3rd degree burn

• Part of body: 1) leg, hip

• Event: Machine press caught R’s leg, after it had been activated or turned on without 

anyone’s knowledge. R thinks someone else accidentally turned it on. 

• Source: Machinery. 

R137 

Injury/Illness 1:

• Nature: Sprained knee (swollen and bruised)

• Part of body: Knee

• Event: R tripped on a pothole in employer’s parking lot and she fell on her knee. 

• Source: Pothole, parking lot

Injury/Illness 2:

• Nature: Anxiety due to stressful work environment. Caused her to experience dizziness, 

high blood pressure, and trouble breathing on one occasion.

• Part of body: N/A

• Event: N/A – not a specific event but stressful work environment due to demanding 

supervisor/boss and being overworked.

• Source: R’s boss/supervisor and demanding work culture/environment

R204 

• Nature: Swollen eye

• Part of body: Eye

• Event: R was walking at her job site (a refinery) and someone was driving by her in a gocart. The go-cart caused some particle to fly up and hit R in the eye. R had safety glasses 

on but it got in under them.

• Source: Coworker, go-cart, particle/material

R164 

Injury/Illness 1:

• Nature: Sore back, abrasions on elbows and shoulders. R said he did not experience any 

issues related to hitting his head.

• Part of body: Head, back, shoulder, elbows

• Event: R fell 4 ft from a ladder when he overreached for a light fixture on the wall. Fell 

back and hit head (with helmet on) and back against the wall and then slid down the wall 

and landed on a fan.

• Source: ladder, light fixture, wall, fan
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Memorandum

Injury/Illness 2:

• Nature: Chipped a filling/crown

• Part of body: Mouth

• Event: Drilling a hole through concrete wall, drill bit jammed and the drill reversed back 

and hit R in the jaw. 

• Source: Drill, concrete wall

R163 

(Lisa) 

Injury/Illness 1:

• Nature: Arthritic collarbone, felt popping, grinding, pain

• Part of body: right collarbone, right shoulder, right hand

• Event: repetitive motion injury, reaching from right hand to left hand side of keyboard 

• Source: keyboard, typing

Injury/Illness 2:

• Nature: Carpal tunnel syndrome, sharp pain, soreness in forearm, numbness in fingers

• Part of body: forearm, ring and pinky fingers (R did not mention side of body)

• Event: typing

• Source: typing (R mentioned activity but did not mention keyboard or other source in 

description)

Injury/Illness 3:

• Nature: back strain, with pain and spasms

• Part of body: back

• Event: sitting in chairs 8-10 hours per day

• Source: chairs with no support

R208 

(David)

Injury/Illness 1:

• Nature: Broken foot and sprained ankle

• Part of body: Foot

• Event: R was at work and was moving boxes when a "tote" (type of forklift) ran over his 

foot. 

• Source: Tote (forklift), person driving the tote, boxes

Injury/Illness 2:

• Nature: R described injury as strained back, sharp pain in lower back, and felt like pins 

and needles. 

• Part of body: Lower back
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Memorandum

• Event: R was lifting packages and hurt his back

• Source: Packages

Injury/Illness 3:

• Nature: Cuts and bruises on arms and lower legs 

• Part of body: Arms and lower legs (knees to toes). 

• Event: R handles boxes coming off conveyer belt and sometimes the boxes hit R's hands 

or legs and sometimes the boxes scrape him when he picks them up. 

• Source: Packages, conveyer belt

R207 

• Nature: Spider bite, fractured finger, and sprained tendon

• Part of body: Hand 

• Event: R was at his job site taking down a plant basket and he was bit by a spider. The bite 

caused his hand to twitch which resulted in a fractured finger and sprained tendon. 

• Source: spider, plant basket, 

R209

Injury/Illness 1:

• Nature: Twisted lower back – inflamed and sore

• Part of body: Back

• Event: Construction at R’s work site during work hours and R twisted back while trying to 

avoid debris that was on the ground.

• Source: Debris (wall material) on the ground, construction work

 

Injury/Illness 2:

• Nature: Difficulty breathing

• Part of body: Lungs

• Event: Construction at R’s work site during work hours which caused dust and other 

materials in the air

Source: Dust in the air, construction work

R212 

• Nature: Eczema

• Part of body: Skin on hands and face

• Event: N/A – Developed over time due to allergens at work site and stress from R’s boss

• Source: Dust/allergens in the air at job site and stress caused by R’s boss

R210 

• Nature: Broken bone on left leg near ankle

• Part of body: Left leg
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Memorandum

• Event: R was standing in line to clock in for work and someone was operating a fork lift 

and backed it up and hit him and another coworker.

• Source: Fork lift, person operating the fork lift

R201

• Nature: Leg was bleeding and bruised and some skin had come off

• Part of body: Leg

• Event: R was on a riding lawnmower and went forward into a pole causing his leg to hit 

against the pole. 

• Source: Riding lawnmower, pole

R216 

Injury/Illness 1:

• Nature: 2nd degree burn to right arm

• Part of body: Right arm

• Event: R works in a chemical plant and a coworker mixed chemicals together that started 

a fire and burned R’s right arm.

• Source: Coworker, chemicals, fire

Injury/Illness 2:

• Nature: Bruises

• Part of body: Arm

• Event: Lifting too much due to other people in his shift not showing up

• Source: Heavy packages, R’s own body

Recommendations: 

We did not observe that respondents had issues with the questions on the characteristics of the 

injury/illness. In most cases, the questions appear to provide sufficient information to determine the 

nature, part of body, event, and source(s) for each injury/illness. 

We did note that on occasion, a respondent would comment that the examples in the questions did not 

apply to them. However, they could still report their own experience in response to the questions.

The presentation of B2 through B5 could be streamlined for those reporting more than one injury/illness. 

The full questions can be presented when collecting information on the first injury/illness. The examples 

could be omitted when collecting information on the second and additional injuries/illnesses. The 
20

Memorandum

examples will have already cued respondents to the type of response needed and repetition of the 

examples is not likely to be useful.

Injury or Illness: Medical Attention

Questions C1 – C4: Medical Attention
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Memorandum

This series of questions on medical attention asks respondents about the medical advice and treatment 

they received for their injury/illness. These questions were substantially revised for Round 3: 

• Reordered questions and revised skip patterns to improve flow. 

• Revised the question on being in the hospital to reduce error in reporting admission to the 

hospital. 

• Added questions on whether the health care professional recommended that the respondent take 

days off from work.

• Adding simplified language for the term “medical diagnosis” to be read by the interviewer if 

necessary.

The revised questions on medical attention worked well. However, in considering what we observed in 

prior rounds and this round of interviews, it has become clear that people do not realize that getting 

treatment from an outpatient office in a hospital is not the same as getting treatment at the hospital (that 

is, from the emergency room or as an admitted patient). 

• R168: This R received care from the urgent care clinic and offered this information in response to 

the question on whether he received care from a hospital.

• R136A: R received care at a doctor’s office at a VA medical center/hospital. This R had already 

mentioned receiving care from medical professionals. 

• R200: R did not respond “yes” or “no” on whether she received care at a hospital, but mentioned 

she saw a doctor at the health center at the hospital.

The evidence from the interviews suggests that respondents are not always precise about reporting the 

type of care they received. They often consider receiving outpatient care at the hospital to be the same as

getting care at the hospital. However, the follow-up questions on hospital care can help clarify the type of 

care received and allow for post-processing of the data to edit any incorrect responses. If respondents 

who report hospital care indicate that they did not receive care from the emergency room and were not 
22

Memorandum

admitted to the hospital, it would be possible to code them as having received care from a health care 

professional, but not from a hospital.

At times in response to the question on whether the R saw a health care professional, respondents answer 

with the type of professional they saw instead of providing a yes/no answer. They provide answers such 

as “PT” (physical therapy) or “urgent care.” These were taken as responses of “yes” to the question. If 

the respondent names a type of care that is not clearly relevant (which did not occur in the cognitive 

interviews), the interviewer would need to probe to determine whether the R did seek care from a health 

care professional.

We observed that some respondents (R165, R163) reported in C3 that the doctor recommended days off. 

However, the Rs volunteered that they did not take the days off. If it is necessary to capture that the R did 

not take days off as recommended, a response option should be added to C4 to capture this. 

Recommendations: 

The questions on medical attention worked well. We have no recommended revisions to these questions. 

Injury or Illness: Effect on Work

Question D1 – D11: Effect on Work
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Memorandum
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Memorandum

This series of questions evaluates the effect the injury or illness had on the respondent’s work status. Key 

revisions that were made for Round 3 (Version 1) include:

• Moving questions about the employer’s knowledge of the injury/illness to the section on

Workers’ Compensation, since they are more closely related to that series of questions.

• Reordering and revising the questions on whether the respondent returned to work, effects of an 

injury/illness on work, and whether the respondent was able to work again. The revisions are 

expected to improve flow, particularly for those who did not return to work.

• Revisions to simplify language. For example, “change occupations” was revised to include the 

phrase “change the kind of work you do...”
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Memorandum

Cognitive testing revealed that in some cases, respondents may not receive medical care or take time off 

for their injury/illness until well after it occurs. R168 received knee injuries for which he received care at 

an urgent care center immediately after the incidents. He did not take time off at that time but weeks later 

required surgery and took time off to recover. To accommodate situations in which medical care and 

effects on work do not occur until much later, we added two questions to Round 3, Version 3:

At any time after you went back to work, did you miss any (additional) days of work due to your 

injury/illness?

a. YES 

b. NO SKIP TO D19

c. DK SKIP TO D19

d. REF SKIP TO D19

About how many (additional) days of work did you miss?

_______ DAYS

Please explain what happened.

During Round 3, additional changes were made to this series of questions to accommodate respondents 

with chronic/gradual onset conditions. These questions were revised in both Versions 3 and 4 of the 

Round 3 protocol. Since respondents with these kinds of injuries/illnesses do not have a discrete 

reference point in time for answering the questions, questions on ability to work the next day, days off 

from work, and so on, needed to be revised. 

• Questions on whether the respondent was scheduled or able to work the next day were replaced 

by questions on whether symptoms of the injury/illness caused the respondent to miss work 

during the reference period.

Versions 3 and 4:

In the last 12 months, after you began experiencing symptoms due to TEXT FILL, did you 

miss any days of work, or not?

a. YES, MISSED DAYS OF WORK 
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Memorandum

b. NO, DID NOT MISS DAYS OF WORK 

c. DK

d. REF 

About how many days of work did you miss?

_______ DAYS

• The questions on working the usual number of hours, performing normal duties, and being 

assigned to a different job or tasks were revised slightly to remove reference to “when you went 

back to work.” References to the time point at which the respondent went back to work make 

sense for those who have a discrete start point that marks the beginning of the injury/illness. For 

those with gradual onset injuries/illnesses, there is often no discrete start point that they can 

identify.

Version 3:

When you worked...

Did you work your usual number of hours or not?

Were you able to perform all of the normal duties of your job or not?

Were you assigned to a different job or tasks than what you did prior to the onset of 

symptoms?

[IF YES] Was your assignment to a different job or tasks permanent or temporary?

Version 4:

In the last 12 months, did you ever work less than your usual number of hours because of 

symptoms of [TEXT FILL]? 

In the last 12 months, were you ever unable to perform all the normal duties of your job 

because of symptoms of [TEXT FILL]? 

In the last 12 months, were you ever assigned to a different job or tasks than what you did prior 

to the onset of symptoms of [TEXT FILL]? 
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Memorandum

[IF YES] Was your assignment to a different job or tasks permanent or temporary? 

Further, based on cognitive testing, it became apparent that D4, which asks whether the respondent 

returned to work after the injury/illness, was not necessary for those who had reported in previous 

questions that they were able to work the next day. We corrected the skip instructions to only ask D4 and 

D5 (which asks for number of days after injury/illness that respondent started work again) of those who 

were not able to work the next day. 

Recommendations: 

D6, D7 and D13 (Version 4 numbering) ask respondents if they worked usual hours, performed normal 

duties, or missed days of work. Although they worked well as written, we offer the following suggestion 

for minor revisions:

• Section D (D6, D7, D13): Consider removing the phrase “or not” that appears at the end of these 

questions on effect on work. Although the intent was to reduce acquiescence bias, for these items 

this is less of a concern. These questions on working usual hours, performing normal duties, and 

missing days of work ask for reports of behavior and may be less subject to acquiescence bias 

than questions, for example, on reasons for not wanting employer to know about injury/illness.

Further, for the question that asks respondents to explain what happened if they missed (additional) days 

of work (D12 in Version 4), we suggest a minor rewording to make the question more specific:

• What caused you to miss these (additional) days of work?

Injury or Illness: Effect on Pay

Questions E1 – E11: Effect on Pay
28

Memorandum
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30

Memorandum

This series of questions evaluates how and if workers were paid when they missed time at work due to 

their injury or illness. In prior interviews, we found that respondents are aware of whether they received 

pay or compensation for time off of work due to their injury/illness. However, they can be unsure of the 

source of the compensation.

Several revisions were implemented for Round 3 (Version 1): 
31

Memorandum

• Skip patterns have been corrected and revised to assure questions are directed at the appropriate 

group (such as those who filed for workers’ compensation or those who had not yet received 

workers’ compensation).

• Per BLS suggestion, the item on receiving wages and other compensation while unable to work 

was moved to the end of Q26. 

Although the questions on effect on pay generally worked well, we noted that for E2 respondents 

sometimes offered comments instead of responding to the specific options presented:

• R200: R answered the series of questions on why the employer did not know about the injury 

(E2). When reporting on the first injury (stress), she endorsed a number of items, such as 

avoiding loss of wages, loss of promotion and advancement, avoiding job transfer, etc. However, 

she interrupted at the beginning of E2 during reporting on the second injury (back strain). She 

said at that point that it did not occur to her to tell the employer. This R may have been 

demonstrating acquiescence bias in her responses.

• R163: During second pass through E2 for the second injury/illness (back strain), R interrupted 

and said she wanted to avoid being treated differently and she did not think it was reportable.

We observed that responses to E2 generally do not demonstrate acquiescence bias. We found that a

number of respondents (such as R208, R137, R163, R201) who said they did not inform their employers 

declined to endorse many of the offered options in E2. A comment by R163 illustrates this point.

• R163: R said in E2g that the employer wants to keep injury rates low, but that this was not the 

reason why her employer did not know about her injury.

We found that the formatting of E5 in the protocol resulted in an interviewer administering it on a few 

occasions as an open-ended question and from there coding the open-ended response to the one of the 

pre-determined categories, rather than reading the question along with the response categories to capture a 

response. Respondents’ open-ended answers to E5 were somewhat difficult to code, given that they did 

not always align well with the available categories. When the response options were read, the question 

worked well. However, some offered their own explanations, sometimes interrupting the presentation of 

the response category list: 
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Memorandum

• R136B did not wait for the interviewer to read the options in E5. This R was asked by his 

supervisor several times to file but the R did not think it was necessary and did not want to miss 

any days of work. 

• R200: For both the stress and back strain she experienced, R endorsed c (did not inform 

employer). R added a "couple reasons" to explain—she didn't feel she would win, stress with any 

position. 

• R137: For the fall she experienced, she picked c. R added she assumed that if she told her boss 

about the fall (in conversation) then she would look into it. But her boss never did anything with 

that information. For her anxiety, R also picked c (did not inform employer). She did not want 

her employer to know something was wrong related to anxiety and also because she thought 

worker's comp was for injury related issues and not things like anxiety.

As in prior rounds of interviewing, it is difficult to determine the accuracy of respondent reports on the 

sources of compensation for their wages and medical care received. Respondent situations vary widely. 

Some respondents seem fairly sure of their answers but others some seem uncertain about the source of 

their compensation or misinterpreted the compensation source. 

• R170: R received medical care for a cut he sustained. He was sent to a particular urgent care 

facility for care, which the employer covered. The employer also provided pay for the hours he 

missed after the cut occurred. R returned to work the next day. He did not think it was workers’ 

compensation but was not sure. This R was clear that his medical expenses and wages were 

covered, but not sure whether to count it as workers’ compensation.

• R126: R is a firefighter. His city of employment has the policy to pay people who are injured 

while they take time off to recover. He said it was through the city, not officially workers’ 

compensation.

• R207: R said he got workers’ compensation. For E10 (taking leave without pay) and E11 

(employer continued to pay wages), the R said that he did not know how to answer. He said he 

received workers’ compensation. In particular, in answering E11, he did not know if workers’ 

compensation he received is paid by the employer.

• R208: In reporting whether he took leave without pay (E10) R said “I guess so.” He was not 

getting paid by his employer but was receiving disability payments.
33

Memorandum

• R158A: R reported yes to E9 stating that she received paid time off. Upon probing, R was 

referring to “paid time off” as the bonus pay that she received twice a year because she 

considered her bonus pay to cover her pay for the days she missed work. R158B (proxy) 

indicated that R158A did not have any paid time off through her employer. 

Recommendations:

Some respondents may be uncertain about sources of compensation; for such respondents it is difficult to 

improve the accuracy of their data. However, the set of questions on effects on pay otherwise worked 

well. 

For respondents who have more than one injury or illness to report, E2 and E5 may seem especially 

lengthy. We have one suggestion to consider: 

• Consider changing E2 to have respondents select the main reason for not wanting the employer to 

know about the injury/illness. 

Finally, we have a suggestion for correcting what we believe is a typographical error in E2c:

• E2e: This option in the question on reasons for not informing the employer of the injury/illness 

reads: “Because you did not realize that the injury/illness was work-related until after leaving the 

job?” However, at this point in the instrument we have not asked whether the respondent is still at 

the job in question. We assume this is a typographical error and that “until after leaving the job” 

should be removed.

Occupation and Industry at Time of Injury or Illness 

In prior interviews it was observed that respondents who worked for a temporary agency and were 

contractors at the employment location were sometimes uncertain as to which company to report on. For 

Round 3, revisions were implemented to direct this group of respondents on how to answer questions on 

their employment. These revisions include:

• A new question asking whether the R worked for a temporary help agency or a temporary staffing 

agency.

• Instruction for those working for temporary agencies that they should answer the questions based 

on the place where they work on a day-to-day basis.
34

Memorandum

In addition, the question on type of employer the respondent works for (government, private-for-profit, 

etc.) was revised slightly. The question was revised to ask respondents which of the following groups 

best describes their employer. This new question structure helped to alert respondents prior to hearing the 

response options that the task was to select the best fitting category. Note that there is a minor 

typographical error that requires correction; the word “group” should have been plural (“groups”). 

Respondents understood the question on working for a temporary help agency without issue. R61 was the 

only respondent who indicated she worked for a temporary agency. 

• R61: This R was a nursing assistant who was employed through an agency and assigned to work 

at client homes. Although the respondent was instructed to report on the number of employees at

the work location to which she was assigned, she worked in multiple client homes and as a 

consequence this question did not work well for her situation. In reporting the number of 

employees at her work location, she reported the number of nurses at her employment agency. 
35

Memorandum

However, one respondent worked for a company that contracts to a hospital and is not a temporary help 

agency. He did experience some confusion in determining whether to answer the questions based on his 

actual employer or the hospital.

• R210: R provided the name of the hospital as the name of his employer. However, he is actually 

employed by a different company. He was not sure whether to describe his company, where he is 

responsible for shipping and receiving, or to describe the hospital for the series of questions on 

kind of employer and what the employer makes or does.

Respondents did not have issues with the new structure of the question on the type of employer they work 

for. As in past rounds, many answered the question without issue but a few answered incorrectly or were 

unsure of how to arrive at the correct answer: 

• R35: R answered “Family business.” R mistakenly thought this referred to working for a family 

owned business. R is not related to the employer so should not have picked this response. 

• R64A: R goes out in the field to various sites, so the number of people depends on how many are 

at the site that day. R considered the specific locations he went to, not the company as a whole.

• R126: R noted a difference between the total number of people assigned to his fire house (50) 

and the number there on any given day (around 13). R wasn’t sure which it was asking for. 

• R209: R was not sure whether to include part-time or only full-time staff in her count. She 

included part time and I classified the answer based on that response.

Recommendations:

Respondents who report more than one injury or illness may be employed with the same employer and in 

the same position for the multiple injuries/illnesses reported. In Section H, which collects information on 

the respondent’s current employment, a set of questions is asked to determine whether the respondent’s 

current employment is the same as at the time of the injury/illness. These questions, shown below, should 

be added to Section F to reduce respondent burden:
36

Memorandum

We also recommend that the question on whether the R worked for a temporary agency from Section F 

(F5) be added to the set of questions on current employment, after H7. Further, clarification should be 

provided for respondents who work for contractors on how to answer the questions on employment, that 

is, whether to report for the actual employer or for the work location where they are assigned.

Further, two minor typographical errors in Section F and in a related question in Section H should be 

fixed. F13 (“How many people work at your work location?”) should be phrased in past tense (“worked”) 

to be consistent the rest of the questions in this section. Further, in F3 and H6 (“Which of the following 

group best describes your CURRENT employer?”), the word “group” should be “groups.”
37

Memorandum

Proxy Respondents

For three of the recruited respondents, another adult member of the respondent’s household was also 

invited to take part in an interview. We collected data on each member of the pair. We examined self- and

proxy-reported answers to selected questions to assess the accuracy of proxy response. The data are 

presented in Exhibit 3. In this exhibit, the focal respondent is the person about whom the data are being 

collected. For each focal respondent, we compare the data from selected questions from the respondent’s 

self-interview and proxy interview (conducted with the respondent’s household member).

Exhibit 3: Proxy Reporting

Question Focal 

Respondent

Self vs. Proxy Comparison

Screener 

(Section A)

64A • Self (R64A) and proxy (R64B) both reported that R64A had hit 

himself in the shin with a hammer and that this occurred in July of 

2016.

• Self and proxy both reported that R64A also suffered hearing loss 

but they provided different accounts of when the hearing issue 

started. R64A reported two years ago and R64B reported that it 

was in 2015 but was not sure what month.

• R64B reported that R64A also had anxiety/depression that started 

in 2015 which was not included in R64A’s response to any of the 

screener questions.

136A • Self (R136A) and proxy (R136B) reported that R136A had only 

one injury in the last 12 months which they described similarly as 

R injured his right ankle while working a poker tournament. 

• Both self and proxy reported that the injury occurred in July 2016 

during the World Series of Poker event. 

158A • Self (R158A) and proxy (R158B) reported that R158A had 

allergies and back pain/spasms related to work. R158A also 

reported “cuts and bruises due to lifting heavy boxes at work” 

which was not reported by R158B. 
38

Memorandum

• Self and proxy had different responses when asked about 

month/year the injuries occurred. R158A said her allergies started 

4 years ago (2012) and worsened in Aug/Sept 2015. R158B did 

respond with month/year but reported that the back and allergy 

issues started up when his R158A started a new job. Based on 

probing, R158B said R158A’s job started in 2011. 

• Self and proxy had relatively similar responses for A12 (total 

times experienced an injury/illness in last 12 months). R158A 

could not remember specific counts because she had chronic pain 

conditions. R158B did not provide a numeric response but stated 

that R had constant pain due to back and allergies. 

Injury or 

Illness 

(Section B)

64A • Both R64A and R64B described the event similarly, indicating that 

R was using a sledgehammer and missed what he was trying to hit 

[which was a connector, according to R64A) and hit his shin 

instead. 

• In reporting how the shin was affected, self and proxy provided 

similar reports. R64A stated bruising and swelling and 64B stated 

bruising, but also provided a more technical term (hematoma) to 

describe the injury. As for other body parts that were affected, 

both self and proxy reported that R64A’s foot was bruised and 

swollen.

136A • Self (R136A) and proxy (R136B) provided similar accounts of the 

injury. Both described that R136A was supervising a poker 

tournament and injured his right ankle (broke small bone) because

as R136A was approaching one of the poker tables, he was forced 

to sidestep on his right foot to avoid someone else’s leg/foot. Both 

described the injury as a small broken bone at the front of the 

ankle and that a piece of the bone was still in R136A’s ankle. 

• R136A provided more specific detail and context regarding the 

event which was that the person who caused him to side step on 

his ankle was one of the masseuses who was giving a poker player 

a massage at the table. 
39

Memorandum

158A • Both R158A and R158Bprovided a similar description of the 

allergy condition; however, R158B provided more specific details 

about the source – stating that R158A was allergic to paper mites. 

R158A was less descript and just reported that the allergies were

due to handling old documents and working in an old building.

Medical 

Attention 

(Section C)

64A • Both R64A and R64B agreed that R64A consulted a health care 

professional; however, R64A reported seeing a doctor and R64B 

stated that R64A saw a physician’s assistant. 

• Both agreed that R64A was not admitted to the hospital but 

received treatment at a physician’s clinic (according to R64A) / 

physician assistant’s office (according to R64B) and that the 

medical diagnosis was a hematoma. R64B added that the diagnosis 

included deep tissue bruising.

• Both agreed that the healthcare professional recommended that 

R64A take 2 days off of work.

136A • R136A and R136B agreed on the medical attention R136A 

received for the injury. R136A was treated by a doctor at a health 

clinic as well as doctors at a hospital (Veterans hospital). 

• Both R136A and R136Bwere not sure the exact medical diagnosis. 

R136A reported that it was “damage to ankle bone” and R136B 

reported “a small bone in ankle broke off and is still there and 

possibly a strained ligament.”

• R136A provided more detail than the proxy on the various 

treatment options for the injury.

158A • Both R158A and R158B agreed that R158A consulted a doctor (an 

allergy specialist according to R158B), and that R158A was 

treated in a hospital. Upon probing, both confirmed that the 

treatment occurred in a health clinic that is located in a hospital

• R158A and R158B provided a similar response for medical 

diagnosis although R158B was more specific. R158A said she was 

allergic to multiple allergens and R158B said that an allergy prick 

test revealed that R158A was allergic to paper mites. Both agreed 
40

Memorandum

that the doctor did not recommend taking days off of work because 

of the condition. 

Effect on 

Work (Section 

D)

64A • Both R64A and R64B agreed in general on the effects of the injury 

on work. The main difference was that R64A reported that he went 

back to work 2 days after the injury whereas R64B reported it was 

3 days after the injury.

136A • R136A and R136B reported that the injury did not have a direct 

effect on R’s work. Both reported that 136A continued to work the 

same day the injury happened, did not miss any days of work, was 

able to work usual hours and perform usual duties and did not 

cause R136A to quit, be laid off, be fired, or change occupations.

158A • R158A and R158B reported that the allergy condition caused 

R158A to quit her job. 

• Interview probed about how many days R158A missed work due 

to the allergy condition. R158A reported that it was about 15 days 

in the last 5 years and 10 days were in the past 12 months. R158B 

did not know how many days R158A had missed but knows it was 

multiple days. [At the time of the interview, the protocol had not 

been revised to include alternate wording for chronic conditions 

but the interviewer modified the questions for Section D to better 

fit the chronic nature of the respondent’s condition.]

Effect on Pay 

and Workers 

Compensation 

(Section E)

64A • Both R64A and R64B reported that the injury had been reported to 

the employer and no one had filed a WC claim.

• Both R64A and R64B, in general, provided similar reports for why 

WC was not filed. R64A said the injury was not too serious and 

added that people get fired for filing WC. R64B stated that R64A 

would have gotten fired if he had filed WC and that he wanted to 

keep working.

• Both R64A and R64B agreed that R did not receive short-term 

disability, did not use paid sick leave/annual leave/time off, and 

was not compensated by employer for period unable to work.
41

Memorandum

• There was a discrepancy between R64A and R64B in regards to 

whether R64A took leave without pay as R64A said yes to this and 

R64B said no. The discrepancy appears to be explained by R64B’s 

response as he stated that R64A had worked so much overtime that 

he wasn’t eligible for paid leave, any time not at work beyond 40 

hours would just be time not spent at work not getting paid, 

therefore she did not consider it “leave without pay” since it was 

the equivalent of R working less overtime.

136A • No differences in responses between self and proxy on whether 

R136A’s employer knew about the injury and questions on WC. 

Both reported that R’s employer knew about the injury and asked 

R136A if he wanted to file for WC. 

• Both indicated that the reason a WC claim was not filed was 

because R136A did not feel it was necessary and wanted to 

continue working. 

158A • R158A and R158B reported that R158A’s employer knew about 

the injury and that no WC claim had been filed. Both reported that 

the reason for not filing a WC was because R158A was unaware of 

whether she qualified for WC.

• When asked if R158A used paid sick leave, paid annual leave, or 

paid time off, R158A reported yes whereas R158B reported no. It 

appears R158A misinterpreted paid time off and considered the 

holiday bonus she received as paying for the time she took off of 

work. 

Employment 

at Time of 

Injury/Illness 

(Section F)

64A • Both R64A and R64B agreed that R64A was a full-time employee; 

however, the main discrepancy is with the number of hours per 

week. R64A reported that he worked 140-168 hours per week 

(interviewer confirmed that this was his intended response) and 

R64B reported that R64A worked 80-90 hours per week. 

• They agreed on the type of company, job duties, that it was not a 

union job, and size of company, but refused to name the employer. 
42

Memorandum

136A • R136A initially did not report full or part-time employee but 

explained that he's an "on call employee" where he works year 

round but on a varied schedule. When probed about whether he 

considers his work full or part-time, R136A said “basically parttime but not technically. R136B reported that R136A was a parttime employee, adding that he is an “on call employee.” 

• When asked how many hours worked in a typical week, self and 

proxy reported the same range of hours (60-70 hours). 

158A • Self and proxy disagreed on full vs part-time status. R158A 

reported full-time employment whereas R158B reported part-time. 

However, both agreed that R worked 32 hours a week.

• R158B could not recall the exact name of the law firm that R was 

employed.

Demographics 

(Section G)

64A • Interviewer did not ask proxy demographic questions about R64A.

136A • No differences in responses between self and proxy.

158A • No differences in responses between self and proxy.

Respondents and proxies were fairly consistent in their reports. As the exhibit shows, the level 

of agreement in their reports was high. Minor issues were observed; some examples:

• Mismatch in reporting when a chronic condition occurred (R158A and R158B), and 

disagreement about full-time vs. part-time status occurred. They also did not agree on the 

use of paid sick leave, paid annual leave, or paid time off; R158A reported yes whereas R158B 

reported no.

• R64A and R64B disagreed about the number of hours worked, although both agreed it 

was full time work. They also disagreed about leave without pay. R64A said yes to this and 

R64B said no.

• R136A said he was an “on call employee” but R136B said it was part-time work. When 

employed, the R works 60-70 hours a week. 
43

Memorandum

The overall good match between respondents and proxies suggests that in a household 

administration of the SOII, the use of proxy respondents for the collection of data is a promising 

option. 

Conclusion

In the discussion above, we have presented our recommendations for final recommendations for revising 

and finalizing the HSOII questionnaire. In separate documents we present the questionnaire, which is the 

last version of the instrument that was tested in Round 3 (HSOII Questionnaire 9-30-2016.docx), and 

guidance for conducting the SOII Pilot (Recommendations for Pilot Test Procedures 9-30-2016.docx). 

Note that since the suggested revisions to the instrument discussed above have not yet been approved by 

BLS, they are not reflected in the final questionnaire document that accompanies this memo. 
1 

HOUSEHOLD SURVEY OF OCCUPATIONAL INJURIES AND ILLNESSES

Cognitive interview protocol R3 Version 1

8-31-2016

MATERIALS NEEDED FOR INTERVIEW

□ INTERVIEWER PROTOCOL BOOKLET (THIS BOOKLET) AND SHOWCARDS

□ CONSENT FORM

□ RESPONDENT PHONE NUMBER

□ FULLY CHARGED DIGITAL RECORDER AND EXTRA BATTERIES

□ NOTE PAPER, PENS AND PENCILS

STEP 1: INFORMED CONSENT

PROVIDE RESPONDENT WITH A COPY OF THE INFORMED CONSENT FORM. ASK THE RESPONDENT 

TO READ THE FORM, ANSWER ANY QUESTIONS, AND HAVE THE RESPONDENT SIGN THE FORM. 

LEAVE A SEPARATE COPY OF THE FORM WITH THE RESPONDENT.

□ COLLECT VERBAL CONSENT FROM RESPONDENT

□ IF THE RESPONDENT HAS CONSENTED TO RECORDING, START THE RECORDER.

STEP 2: COMPLETION OF THE QUESTIONNAIRE

BEGIN QUESTIONNAIRE. 

Interviewer probe bank (use as appropriate):

• “How did you come up with that answer?”

• “Can you tell me in your own words what you think the question is asking?”

• “Can you tell me more about that?”

If you pick up on a visual cue that suggests an issue or confusion: 

• “Tell me what you are thinking.”

• What does the word [term] in this question mean to you?

• You said [answer]. Can you tell me more about that?

If R is uncertain and asking for confirmation:

• There is not a right or wrong answer for this question. I am interested in hearing your thoughts on what 

the question is asking.

INTERVIEWER: If this interview is with a proxy respondent, please modify language accordingly. For example, instead 

of asking “Did you do ANY work for pay or profit?” ask “Did [your husband/wife/brother/he/she] do ANY work for pay 

or profit?”
2 

Survey Introduction

The information that you provide in this survey is confidential. Your name and your answers to the questions will not be 

shared with anyone outside of NORC, the survey organization conducting this survey. I would be happy to answer any 

questions you may have about the survey. [ANSWER RESPONDENT QUESTIONS.] Let’s begin. 

Screener

This survey is about work-related injuries and illnesses that you may have experienced. I will ask you questions about the 

injuries and illnesses you may have had that are related to any job you held in the last 12 months By the last 12 months, I 

mean since [CURRENT MONTH] of [LAST YEAR]. 

A1.In the last 12 months, did you do ANY work for pay or profit?

a. Yes  ELIGIBLE, CONTINUE

b. No  NOT ELIGIBLE, END INTERVIEW

c. DK

d. REF 

Any injury

A2.In the last 12 months, have you experienced any injuries or illnesses related to any job you held? 

a. Yes  COLLECT BRIEF DESCRIPTION, CONFIRM WORK-RELATED

b. No  SKIP TO A4 

c. DK

d. REF 

A3.In what month and year did this injury/illness occur? 

MONTH/YEAR

ENTER MM/YYYY

DK

REF 

INTERVIEWER NOTE: ASK ALTERNATIVE QUESTION IF NECESSARY FOR ILLNESS/INJURY WITH 

GRADUAL ONSET. “In what month and year did you first notice symptoms related to this injury/illness?”

A4.[Now I want to find out if you experienced any other work-related injuries other than the TEXT FILL INJURY

RESPONDENT REPORTED (e.g., concussion) you just told me about.] In the last 12 months, have you 

experienced any [other] injuries, such as the following, related to any job you held? 

a. Sprains, strains or tears

b. Soreness or pain

c. Bruises

d. Cuts or punctures

e. Broken bones

f. Injury to muscles or joints

g. Open wounds

h. Burns 

i. Carpal tunnel syndrome

j. Any other injury? 

1) YES  COLLECT BRIEF DESCRIPTION, CONFIRM WORK-RELATED
3 

2) NO SKIP TO A6

3) DK SKIP TO A6

4) REF SKIP TO A6

INTERVIEWER NOTE: READ DEFINITION IF NECESSARY. Carpal tunnel syndrome is a hand and arm condition 

that causes numbness, tingling and other symptoms. Carpal tunnel syndrome is caused by a pinched nerve in your wrist.

[http://www.mayoclinic.org/diseases-conditions/carpal-tunnel-syndrome/basics/definition/con-20030332]

A5. In what month and year did this injury occur? 

MONTH/YEAR

ENTER MM/YYYY

DK

REF 

INTERVIEWER NOTE: ASK ALTERNATIVE QUESTION IF NECESSARY FOR ILLNESS/INJURY WITH 

GRADUAL ONSET. “In what month and year did you first notice symptoms related to this injury/illness?”

A6. [Other than the TEXT FILL ILLNESS RESPONDENT REPORTED (e.g., asthma) you have already mentioned], 

in the last 12 months, have you experienced any [other] illnesses, such as the following, related to any job you 

held? 

a. Skin disorders

b. Respiratory conditions

c. Poisonings

d. Hearing loss

e. A disease or infection

f. Cancer 

g. Anxiety or depression

h. Any other illness? 

1) YES  COLLECT BRIEF DESCRIPTION, CONFIRM WORK-RELATED

2) NO SKIP TO A8

3) DK SKIP TO A8

4) REF SKIP TO A8

A7. In what month and year did this injury/illness occur? 

MONTH/YEAR

ENTER MM/YYYY

DK

REF 
4 

INTERVIEWER NOTE: ASK ALTERNATIVE QUESTION IF NECESSARY FOR ILLNESS/INJURY WITH 

GRADUAL ONSET. “In what month and year did you first notice symptoms related to this injury/illness?”

A8.[Other than the TEXT FILL INJURY/ILLNESS RESPONDENT REPORTED (e.g, concussion, asthma) you have 

already mentioned], in the last 12 months, have you experienced any [other] work-related injuries or illnesses that 

caused you to...

Yes No DK REF

a. Faint, pass out, or lose consciousness? 

b. Be unable to work for a day or more?

c. Do less than your normal work activities?

d. Be assigned to a different job or tasks at your 

place of work?

e. Get medical treatment other than what can be 

treated with a first aid kit?

IF YES, COLLECT BRIEF DESCRIPTION AND CONFIRM WORK-RELATED.

IF NO TO ALL ITEMS IN A8, SKIP TO A10.

READ IF NECESSARY: First aid refers to medical attention that is usually administered immediately after the injury 

occurs and at the location where it occurred. It often consists of a one-time, short-term treatment and requires little 

technology or training to administer. First aid can include cleaning minor cuts, scrapes, or scratches; treating a minor 

burn; applying bandages and dressings; the use of non-prescription medicine...

https://www.osha.gov/SLTC/medicalfirstaid/recognition.html

A9. In what month and year did this injury/illness occur? 

MONTH/YEAR

ENTER MM/YYYY

DK

REF 

INTERVIEWER NOTE: ASK ALTERNATIVE QUESTION IF NECESSARY FOR ILLNESS/INJURY WITH 

GRADUAL ONSET. “In what month and year did you first notice symptoms related to this injury/illness?”

IF R HAS NOT REPORTED ANY INJURIES OR ILLNESSES ASK ABOUT INJURIES/ILLNESSES EVER

EXPERIENCED. ELSE GO TO DEMOGRAPHICS.]

A10. Have you EVER experienced any injuries or illnesses related to any job you held? 

a. YES  COLLECT BRIEF DESCRIPTION, CONFIRM WORK-RELATED

b. NO  SKIP TO PROBES AT END OF SCREENER SECTION THEN SKIP TO DEMOGRAPHICS

c. DK  SKIP TO PROBES AT END OF SCREENER SECTION THEN SKIP TO DEMOGRAPHICS

d. REF  SKIP TO PROBES AT END OF SCREENER SECTION THEN SKIP TO DEMOGRAPHICS

A11. In what month and year did this injury/illness occur? 

MONTH/YEAR

ENTER MM/YYYY

DK

REF 
5 

A12. [IF YES TO ANY INJURIES OR ILLNESSES] How many total times in the last 12 months [did you 

experience/have you ever experienced] an injury or illness related to any job you held? [THIS WILL CREATE 

THE LOOPS.] ________TIMES

INTERVIEWER: CONFIRM NUMBER OF INCIDENTS AND BRIEF DESCRIPTION OF EACH. IF 

INJURY/ILLNESS EXPERIENCED WITHIN LAST YEAR, RESPONDENT WILL REPORT ON THOSE. 

OTHERWISE, IF NO INJURY/ILLNESS WITHIN LAST YEAR, RESPONDENT WILL REPORT ON 

INJURIES/ILLNESSES EVER EXPERIENCED.

Probes:

Screener

• I asked you this question: “In the last 12 months, have you experienced any injuries or illnesses related to any 

job you had?” In your own words, what is this question asking?

• In your own words, what would be a work-related injury or illness? Can you give me some examples of some 

things that would count as work-related injuries and illnesses? What would not count?

• Tell me about the kind of work you do. Tell me about other times when you got hurt or sick because of the 

work you do.

• [I asked you about whether you ever experienced any injury or illness, related to any job you had, that caused 

you to get medical treatment other than what could be treated with a first aid kit]. What does “first aid” mean 

to you? What kind of treatment counts as first aid? What kind of treatment doesn’t count?

• The questions gave some examples of injuries and illnesses [SHOW R THE LISTS, READ THE LIST IF 

NECESSARY.] Are you familiar with [LIST]? Which ones have you heard of? Which ones had you not heard 

of? 

• How easy or hard was it to remember when the injury/illness happened? Can you tell me more about that? 

How did you figure out when the injury/illness happened?

Notes to interviewer:

The goal of the screener section is to enumerate all instances of work-related injuries and illnesses that occurred during 

the reference period. What issues do respondents have in reporting these incidents? Do they understand the types of 

injuries and illnesses to report? Can they accurately report only those that are work-related? How do they determine 

the boundary of the reference period and determine whether an incident occurred within the RP?

IF NO INCIDENTS OF WORK-RELATED INJURIES AND ILLNESSES, GO TO DEMOGRAPHICS SECTION.

Injury or Illness

 

[FOR FIRST INJURY/ILLNESS START AT B2] 

[FOR SECOND AND FOLLOWING INJURY/ILLNESS START AT B1] 

B1. [FOR SECOND/THIRD/ETC. LOOPS] How is this injury/illness related to the other injury/illness you 

mentioned? Is this related to [the other/another] injury/illness you already mentioned or is it a different 

injury/illness?

a. RELATED TO THE OTHER/ANOTHER INJURY/ILLNESS [GO TO NEXT LOOP]

b. THIS IS A DIFFERENT INJURY/ILLNESS [CONTINUE] 

c. DK

d. REF 
6 

“Now I am going to ask you more about [INJURY/ILLNESS #....].”

B2. [WORKER ACTIVITY + some EVENT and SOURCE] [FOR EACH LOOP] Please 

describe how the injury, illness, or condition occurred, and what caused it. For example: 

“When ladder slipped on wet floor, I fell 20 feet”; “I developed soreness in wrist over 

time.” [OPEN ENDED]

B3. [SOURCE] Were there any other objects, substances, or persons involved in the injury 

or illness that you didn’t mention? Please include equipment, chemicals, vehicles, or 

anything else.

B4. [NATURE AND BODY PART] Please describe the injury, illness, or condition. How 

was [BODY PART, ORGAN] affected? You can use medical terms if you know them, 

or just talk about the symptoms you experienced. For example: “strained back”; 

“chemical burn on hand”; “fainted or passed out.” 

B5. [NATURE AND BODY PART] Were there any other parts of your body or organs

affected by the injury or illness that you may not have included in your description? 

How was [BODY PART, ORGAN] affected?

Probes:

Characteristics of incident

• [READ QUESTION] Can you tell me in your own words what you think this question is asking?

• [IF R DOES NOT INDICATE HOW INJURY/ILLNESS IS WORK-RELATED] Tell me more about how this 

injury/illness was related to your job. Where were you when this happened? What were you doing? What 

caused the injury/illness? Tell me more about the injury/illness. 

Notes to interviewer:

Questions B2 through B5 are intended to capture (event or exposure, source of the injury/illness, part of body affected, 

and nature of the injury/illness). Do the questions elicit the information needed? Are the response options adequate to 

capture the information Rs give? Use general probing to elicit more information about the incident. (For example, if R 

says “I cut myself” ask: What part of your body was injured? What did you get cut with? What were you doing at the 

time?

CHECKLIST

1. Description or 

diagnosis for 

injury/illness (this is 

the OIICS nature) 

2. Part or parts of body 

affected, including 

body systems 

(OIICS part, 

obviously)

3. How the 

injury/illness/exposu

re happened (OIICS 

event) 

4. Vehicles, tools, 

chemicals, surfaces, 

or any other objects 

involved; this can be 

multiple objects; this 

can also just be the 

person’s body 

moved incorrectly 

(OIICS sources) 
7 

Medical attention

C1. Did you get medical advice or treatment for this injury/illness from...

a. A doctor, nurse, or other healthcare professional?

[IF YES]: What type of health care professional 

did you see?

YES NO NA DK/REF

b. [UNLESS MENTIONED ABOVE] A 

paramedic, firefighter, or other emergency 

medical personnel?

C2. Did you get medical advice or treatment for this injury/illness at... 

a. A hospital? YES NO NA DK/REF

A1. [IF YES TO HOSPITAL] Did you 

receive treatment at the hospital emergency 

room (ER)?

A2.[IF YES TO HOSPITAL] Were you 

admitted for an overnight stay?

A3. [IF YES TO ADMITTED] How many 

nights were you in the hospital? _________ 

NIGHTS

b. A health clinic at your place of employment?

c. Any place else? Please specify.

[IF YES TO C1 OR C2, CONTINUE TO C3.] 

[OTHERWISE SKIP TO C5]

C3. [IF YES TO C1 OR C2]. Did you receive a medical diagnosis from a health care professional? ...

READ IF NECESSARY: Did a health care professional tell you the medical term for your injury/illness?

a. YES  What was your medical diagnosis? INTERVIEWER READ IF NECESSARY: What is the 

medical term the health care professional used to describe your injury/illness?

b. NO 

c. DK 

d. REF 

 

C4. [IF YES TO C1 OR C2]. Did your health care professional recommend that you take any days off from work due 

to your injury/illness? 

a. YES  How many days off did the health care professional recommend? _______ DAYS OFF

b. NO 

c. DK 

d. REF 
8 

Probes:

Medical attention (tailor probes based on whether R reported receiving medical attention)

• Tell me more about the medical care you received after the injury/illness happened.

• Can you tell me in your own words what you think this question is asking?

• Who do you think of as a health care professional? Who would you include or not include? [IF NEEDED 

ASK IF THESE WOULD COUNT: medical doctor, nurse, physician’s assistant, chiropractor, paramedic]

• I asked you about whether you received a medical diagnosis. What does the term “medical diagnosis” mean to 

you? How do you get a medical diagnosis? Who gives you a medical diagnosis? Does a medical diagnosis 

have to come from a doctor or other health care professional? (if asked) What did you think of when I asked 

you about the medical term the doctor/health care professional used to describe your injury/illness? What does 

“medical term” mean to you? 

• IF NEEDED] Did you go to a doctor, nurse, or other health care provider after [INCIDENT]? Did you go to 

the hospital or did paramedics come? 

• What does it mean to be admitted for an overnight stay in the hospital? How is that different from an 

emergency room visit?

• Is/Was there a medical clinic at your place of employment? Did you see anyone at that clinic?

• Did your doctor or another health care professional recommend that you take days off from work? How many 

days off did they recommend?

Effect on work

The next questions are about how the injury/illness affected your ability to work. 

D1.Were you scheduled to work the day after the injury/illness? 

a. YES

b. NO SKIP TO D3

c. DK SKIP TO D3

d. REF SKIP TO D3

D2.[IF SCHEDULED TO WORK NEXT DAY] Were you able to work the next day? 

a. YES  SKIP TO D4 

b. NO  SKIP TO D4

c. DK SKIP TO D4

d. REF SKIP TO D4

D3.[IF WAS NOT SCHEDULED TO WORK NEXT DAY] If you had been scheduled to work, would you have 

been able to work the next day? 

a. YES 

b. NO

c. DK

d. REF 

D4. Did you return to work after the injury/illness?

a. YES

b. YES, BACK TO WORK SAME DAYSKIP TO D6

c. NO SKIP TO D10

d. NO, STILL OFF PAID WORK BUT EXPECTS TO RETURNSKIP TO D10

e. NO, EXPECTS NEVER TO DO PAID WORK AGAINSKIP TO D10

f. DK SKIP TO D10

g. REF SKIP TO D10
9 

D5. [IF RETURNED TO WORK] How many days after the injury/illness did you start work again?

a. _____DAYS AFTER THE INJURY/ILLNESS

b. BACK TO WORK SAME DAY

c. BACK TO WORK NEXT DAY

d. DK

e. REF

INTERVIEWER NOTE: IF R INDICATES WENT BACK TO WORK ONE DAY AFTER INJURY/ILLNESS, 

CONFIRM THAT R MEANS THAT R WENT BACK TO WORK THE NEXT DAY, THAT IS, THE DAY AFTER 

INJURY/ILLNESS OCCURRED.

[IF R WENT BACK TO WORK (D4=YES), CONTINUE. ELSE IF R IS NOT WORKING, GO TO D10.]

D6. When you went back to work, did you work your usual number of hours or not?

a. YES 

b. NO 

c. DK

d. REF 

D7. When you went back to work, were you able to perform all of the normal duties of your job or not?

a. YES 

b. NO 

c. DK

d. REF 

D8. When you went back to work, were you assigned a different job or tasks than what you did prior to the 

injury/illness? 

a. YES 

b. NO SKIP TO D10

c. DK SKIP TO D10

d. REF SKIP TO D10

D9.[IF DIFFERENT, D8=YES] Was your assignment to a different job or tasks permanent or temporary? 

a. PERMANENT 

b. TEMPORARY 

c. DK

d. REF 

[TRANSITION STATEMENT FOR THOSE WHO RETURNED TO WORK: At any point after you returned to work, 

did the injury/illness affect your job in any of the following ways?]

D10. Did the injury/illness cause you to: 

YES NO NA DK/REF

a. Quit your job?

b. Be laid off?

c. Be fired?

d. Change the kind of work you do, that is, 

change your occupation?

D11. Did the injury/illness affect your ability to work in any other way?
10 

a. YES  Please specify.

b. NO 

c. DK

d. REF 

Probes:

Effect on work

• IF YES TO ANY ITEM D6-D11: Tell me more about [TEXT FILL]. [E.g., Tell me more about your normal 

job duties. What duties were you unable to perform? OR Tell me more about why you quit your job? When 

did you quit? How was that related to your injury/illness?] 

• What does the term [TEXT FILL] mean to you? Can you give me an example? [E.g., What does it mean to 

you to be assigned to another job on a permanent or temporary basis? What does it mean to be laid off? Fired?] 

• What kind of effect did the injury/illness have on your work schedule? Job duties? Ability to work? Ability to 

keep your job? The pay you received? 

Probes:

Days after injury/illness able to start work again

• You said you were able to start work again XX days after the injury/illness. How did you figure that out?

• Walk me through the timeline of when you were injured and when you got back to work. 

• When you started work again were you able to resume all the duties you had before, or not?

Notes to interviewer:

How does R determine days after injury/illness able to start work again? 

Effect on Pay

The next questions are about how the injury/illness affected your income or pay. 

E1. Did your employer know about this injury/illness?

a. YES SKIP TO E3

b. NO

c. DK

d. REF 

E2. [IF NO TO EMPLOYER KNOWING]: For what reasons did your employer not know about this injury/illness? 

Did you not want your employer to know about your injury/illness... 

YES NO NA DK/REF

a. To avoid being laid off?

b. To avoid loss of wages?

c. To avoid loss of promotion of 

advancement?

d. To avoid job transfer or restriction?
11 

e. Because you did not realize that the 

injury/illness was work-related until 

after leaving the job?

f. Because you felt your employer would 

not recognize the injury/illness as 

work-related?

g. Because your employer wants to keep 

injury and illness rates low?

h. Other (specify)?

The next questions are about workers’ compensation. Workers’ compensation is insurance that provides you with your 

lost wages and medical care when you become injured or ill due to your job. 

E3. Has anyone filed a workers’ compensation claim for this injury/illness?

a. YES

b. NO SKIP TO E5

c. DK

d. REF 

E4. Who filed the workers’ compensation claim?

a. EMPLOYER

b. EMPLOYEE

c. FAMILY MEMBER OF EMPLOYEE

d. OTHER SPECIFY

e. DK

f. REF 

ALL RESPONSES TO E4 GO TO SKIP INSTRUCTION BEFORE E6. 

E5. IF NO ON QUESTION ABOUT FILING WORKERS’ COMPENSATION: What was the main reason you or 

your employer did not file a workers’ compensation claim for this injury/illness?

a. You were not eligible because you did not meet waiting period

b. Your employer did not want to file a claim

c. You did not inform employer

d. You were unaware of workers’ compensation coverage

e. You chose not to pursue a claim even though you were eligible

f. Other reason, please specify

g. DK

h. REF 

SKIP INSTRUCTION: 

#1: WC FILED, CONTINUE TO E6. 

#2: ELSE IF NO WC FILED BUT MISSED DAYS OF WORK, SKIP TO E8. 

#3: ELSE [NO WC FILED AND DID NOT MISS DAYS OF WORK] SKIP TO PROBES AT END OF SECTION.

E6. IF R REPORTS WORKERS’ COMPENSATION CLAIM FILED: Did you receive workers’ compensation for 

this injury/illness? 

a. YES

b. NO

c. NA

d. DK

e. REF 
12 

READ IF NECESSARY: Workers compensation is insurance that provides you with your lost wages and medical 

care when you become injured or ill due to your job.

E7. IF R REPORTS WORKERS’ COMPENSATION NOT RECEIVED: Is there an open claim pending for this 

injury/illness?

a. YES

b. NO

c. NA

d. DK

e. REF 

E8. Short-term or temporary disability benefits provide you with a portion of your income if you are temporarily 

unable to work due to a medical condition. Did you receive short-term (temporary) disability for this 

injury/illness? 

a. YES

b. NO

c. NA

d. DK

e. REF 

E9. Did this injury/illness cause you to use paid sick leave, paid annual leave, or paid time off? 

a. YES

b. NO

c. NA

d. DK

e. REF 

E10. Did this injury/illness cause you to take leave without pay?

a. YES

b. NO

c. NA

d. DK

e. REF 

E11. Did your employer continue to pay your wages and other compensation in full during the period you were unable 

to work because of this injury/illness?

a. YES

b. NO

c. NA

d. DK

e. REF 

Probes:

Effect on work

• [IF YES TO E1] How did your employer know about the injury/illness?

• [IF NO TO E1] Tell me more about the reasons why your employer did not know about this injury/illness. 

What was the main reason your employer did not know? Tell me more about that.

• [IF DK TO E1] For what reasons are you not sure whether your employer knew about the injury/illness?

Notes to interviewer:
13 

Observe for signs of acquiescence bias in E1. Are Rs saying “yes” because a reason sounds plausible or because it was 

a reason why R’s employer did not the injury/illness? Ask for more detail and main reasons. Probe to explore 

understanding of terms, ability to accurately report on consequences of the injury/illness.

Probes:

Workers’ compensation

• ASK PROBES TAILORED TO THE REASONS R REPORTS ON WHY NO WC CLAIM WAS FILED BY 

EMPLOYER. EXAMPLES: Tell me more about the reasons why your employer did not file a workers’ 

compensation claim for this injury/illness? What did your employer say? Why did the employer refuse? How 

sure are you about whether or not your employer filed a claim?

• Can you tell me what it means to file a workers’ compensation claim? Tell me what you know about that 

process.

• Have you heard of [TEXT FILL]? Please tell me in your own words what you think [TEXT FILL] means: 

workers’ compensation, short-term or temporary disability, paid sick leave/paid annual leave/paid time off, 

leave without pay.

Notes to interviewer:

Do Rs know what workers’ compensation is? Do they know whether a WC form was filed? Are the terms in E6-E11 

familiar to Rs? Are the definitions helpful? 

Occupation and Industry at Time of Injury or Illness

The next questions are about your occupation and industry at the time of the injury/illness. Please think about the job you 

held at the time of the injury/illness [TEXT FILL DESCRIPTION]. 

F1. Were you considered by your employer to be a full time or part time employee?

a. FULL-TIME 

b. PART-TIME 

c. DK

d. REF 

F2. In a typical week, how many hours did you work? ______hours 

IF NECESSARY: Was it greater than or equal to 35 hours per week?

DK

REF 

Probes:

Hours worked

• Do you work the same number of hours per week, or not? How did you determine how many hours per week 

you typically work? 

• How many hours a week would you consider to be full time employment? What does your employer consider 

to be full time employment? 

Notes to interviewer:

Does R have any difficulty recalling FT vs. PT work? How do Rs with irregular work schedules, seasonal employment, 

etc., answer the question? Does the number of hours per week typically worked accord with report of FT/PT status?

F3. Which of the following group best describes your employer at the time of the injury/illness? 
14 

a. Government 

b. Private-for-profit company SKIP TO F5

c. Non-profit organization including tax exempt and charitable organizations  SKIP TO F5

d. Self-employed  SKIP TO F5

e. Working in the family business SKIP TO F5

F4. Would that be the federal, state, or local government? 

a. FEDERAL

b. STATE 

c. LOCAL

F5. Did you work for a temporary help agency or a temporary staffing agency? 

a. YES

b. NO

c. DK

d. REF 

INTERVIEWER NOTE: IF R IS A FARM LABOR CONTRACTOR, R IS NOT CONSIDERED 

TEMPORARY HELP/STAFFING AND RESPONSE TO THIS Q IS NO.

[IF F5 (TEMP HELP OR TEMP STAFFING AGENCY) =YES]: For the next questions, please answer based on the 

place where you were working on a day-to-day basis when the injury/illness occurred, not the temporary agency you 

worked for.

F6. What is the name of the (company, organization or agency) for whom you worked? [OPEN ENDED] 

DK

REF 

NOTE: IF GOVERNMENT EMPLOYER, TEXT FILL=AGENCY; IF NON-PROFIT, TEXT FILL=ORGANIZATION; 

ELSE TEXT FILL=COMPANY. 

F7. What kind of business or industry was this? [OPEN ENDED] 

DK

REF 

F8. What did they make or do where you worked? [OPEN ENDED] 

DK

REF 

F9. In what state were you employed at this job? [OPEN ENDED] 

DK

REF 

F10. What kind of work did you do? (For example: registered nurse, personnel manager, supervisor of order 

department, secretary, accountant) [OPEN ENDED]

DK

REF 

F11. What were your most important activities or duties? (For example: patient care, directing hiring policies, 

supervising order clerks, typing and filing, reconciling financial records) [OPEN ENDED]

DK

REF 
15 

F12. At this job, were you a member of a union or covered by a collective bargaining agreement?

a. YES

b. NO

c. DK

d. REF 

F13. How many people work at your work location?

e. 1 to 10 workers

a. 11 to 49 workers

b. 50 to 249 workers

c. 250 to 999 workers

d. 1000 or more workers

e. DK

f. REF 

Probes:

Employment characteristics for job at time of injury/illness

• F12 (union): Have you heard of unions? Have you heard of a collective bargaining 

agreement? Tell me what those words mean to you.

• F12: Tell me how you decided on your answer. Tell me about the collective bargaining 

agreement. What union do/did you belong to?

• F13 (how many workers): Tell me how you figured out your answer to this question. Walk 

me through how you figured out that answer. How certain are you of your answer?

Notes to interviewer:

Observe respondent ability to understand and respond to questions about employment at time of the 

injury/illness. Probe as needed to explore an issues with response. Are respondents able to accurately 

report answers for F12 and F13? F13 should include total for R’s work location only, not the whole 

company/organization. 

IF R HAS ADDITIONAL INJURIES/ILLNESSES TO REPORT, GO BACK TO SECTION B. ELSE GO TO G1. 

Demographic Characteristics

Race/ethnicity

G1. Are you Spanish, Hispanic, or Latino?

a. YES 

b. NO

c. DK

d. REF 

G2. [I am going to read you a list of five race categories.] Please choose one or more races that you consider yourself 

to be: 

a. White

b. Black or African American

c. American Indian or Alaska Native

d. Asian

e. Native Hawaiian or Other Pacific Islander

f. Other ________ 

g. DK

h. REF 
16 

Age

G3. What is your date of birth? Enter MM/DD/YYYY 

DK

REF 

G4. As of last week, that would make you approximately (AGE) years old. Is that correct?

[IF NECCESARY] Even though you don’t know your exact birthdate, what is your best guess as to how old 

you were on your last birthday? 

______ YEARS

DK

REF 

Marital Type

G5. Are you now married, widowed, divorced, separated or never married? 

a. MARRIED 

b. WIDOWED 

c. DIVORCED 

d. SEPARATED 

e. NEVER MARRIED

f. DK

g. REF 

Gender

G6. Are you male or female? 

a. MALE

b. FEMALE

Education

G7. What is the highest level of school you have completed or the highest degree you have received? 

a. Less than high school

b. High school or GED

c. Associate degree or some college

d. Bachelor’s degree or above

G8. In what country were you born? 

___________________________ [OPEN-ENDED]

Current Industry and Occupation

The next questions are about your current job. If you have more than one job, please tell me about the job at which you 

usually work the most hours. If you work the same number of hours at two jobs, please tell me about the job where you 

were employed the longest.

H1. What is your current employment status? Are you currently employed full-time, part-time, or are you not 

employed?

a. FULL-TIME 

b. PART-TIME 

c. NOT CURRENTLY EMPLOYED SKIP TO END OF SURVEY

d. DK

e. REF 
17 

H2. [IF CURRENTLY EMPLOYED] Is this job with the same employer you have already told me about? 

a. YES, SAME EMPLOYER  CONTINUE TO H3

b. NO, DIFFERENT EMPLOYER  SKIP TO H5

INTERVIEWER NOTE: 

• IF R HAS ONLY ONE INJURY/ILLNESS AND SAME EMPLOYER OR MULTIPLE INJURIES UNDER

SAME EMPLOYER, SKIP TO H4

• IF R HAS MULTIPLE INJURIES UNDER DIFFERENT EMPLOYERS, BUT CURRENT EMPLOYMENT IS 

WITH SAME EMPLOYER, CONTINUE TO H3

H3. [IF MULTIPLE INJURIES UNDER DIFFERENT EMPLOYERS BUT SAME AS CURRENT 

EMPLOYMENT] Which job and employer are you referring to? 

_________________

H4. [IF SAME EMPLOYER] Are you in the same position you were in at the time the injury/illness [TEXT FILL]?

a. YES SKIP TO PROBES AT END OF SECTION

b. NO

c. DK

d. REF 

INTERVIEWER NOTE: IF SAME EMPLOYER BUT DIFFERENT JOB, ASK H5 (HOW MANY HOURS 

WORKED), H11 (WHAT KIND OF WORK DO YOU DO), AND H12 (MOST IMPORTANT ACTIVITIES OR 

DUTIES). 

H5. [IF SAME EMPLOYER BUT DIFFERENT JOB OR DIFFERENT EMPLOYER THAN DURING INJURY 

ILLNESS] Currently, in a typical week, how many hours do you work? 

 ______hours

IF NECESSARY: Was it greater than or equal to 35 hours per week? 

DK 

REF 

INTERVIEWER NOTE: IF SAME EMPLOYER BUT DIFFERENT JOB, SKIP TO H11.

H6. [IF DIFFERENT EMPLOYER THAN DURING INJURY ILLNESS] Which of the following group best 

describes your CURRENT employer? 

a. Government 

b. Private-for-profit company SKIP TO H8

c. Non-profit organization including tax exempt and charitable organizations  SKIP TO H8

d. Self-employed  SKIP TO H8

e. Working in the family business SKIP TO H8

H7. [IF DIFFERENT EMPLOYER THAN HAD DURING INJURY/ILLNESS] Would that be the federal, state, or 

local government? 

a. FEDERAL

b. STATE 

c. LOCAL

H8. [IF DIFFERENT EMPLOYER THAN HAD DURING INJURY/ILLNESS] What is the name of the (company, 

organization or agency) for whom you work? [OPEN ENDED] 

DK

REF 
18 

H9. [IF DIFFERENT EMPLOYER THAN HAD DURING INJURY/ILLNESS] What kind of business or industry is 

this? [OPEN ENDED] 

DK

REF 

H10. [IF DIFFERENT EMPLOYER THAN HAD DURING INJURY/ILLNESS] What do they make or do where 

you work? [OPEN ENDED] 

DK

REF 

H11. [IF SAME EMPLOYER BUT DIFFERENT JOB OR DIFFERENT EMPLOYER THAN DURING INJURY 

ILLNESS] What kind of work do you do? (For example: registered nurse, personnel manager, supervisor of order 

department, secretary, accountant) [OPEN ENDED] 

DK

REF 

H12. [IF SAME EMPLOYER BUT DIFFERENT JOB OR DIFFERENT EMPLOYER THAN DURING INJURY 

ILLNESS] What are your most important activities or duties? (For example: patient care, directing hiring policies, 

supervising order clerks, typing and filing, reconciling financial records) [OPEN ENDED] 

DK

REF 

Probes:

Employment characteristics for current job

• Use general probes as needed to investigate issues with these questions.

• Is the job you reported your only job or do you have more than one job? 

• [REREAD THE ITALICIZED INSTRUCTION ON WHICH JOB TO REPORT ON]. In your own words, 

what do you think this instruction means?

Notes to interviewer:

These questions are the same as for the job at time of the incident. Continue to observe for issues to explore. 

Does R notice that this set of questions is about the current job? If R has more than one job, did R report on the correct 

one?

How do H2 and H3 function for determining that the current and former job are the same?

Debriefing questions for self-interview:

Recall and reference period

• How easy or difficult was it for you to answer questions about injuries/illnesses that occurred over the last 

year? 

• How sure are you that the injury/illness you told me about happened in the last year?

• Were there any questions that were particularly difficult to answer? Tell me more about that?

• If I asked you about injuries/illnesses that happened during the last 12 months, how easy or hard would it be to 

answer the questions I asked you?

• When you signed up to do the survey, you may have seen a flyer or someone from NORC ask you about 

injuries and illnesses related to work that you may have had. Did you think about those injuries/illnesses you 

had, or did you do anything to get ready for the interview before you came? Tell me about that.

• Imagine that you didn’t know ahead of time that this survey was going to be about work-related injuries and 

illnesses. If someone called you or came to your door, and asked you whether you had ever had a work-related 

injury or illness, do you think you would have remembered? How hard would these questions in the survey be, 

if you didn’t know in advance what the survey was about?
19 

Sensitivity

• Were you worried/Would you be worried about telling your employer about an injury/illness? Was it/Would it 

be hard for you to tell your employer? Tell me more about that.

• Were you worried/Would you be worried about telling the government about an injury/illness? Why? Tell me 

more about that.

• Were you worried/Would you be worried about telling anyone else about a work-related injury/illness? Tell 

me more about that.

Review of selected items

• I’d like to ask you a little more about [QUESTION]. You said [FILL]. In your own words, what do you think 

that question was asking? How did you decide on your answer?

General debriefing

• What are your suggestions on how to improve the survey?

• What questions were the most difficult for you to answer?

• What questions were the easiest to answer?

Notes to interviewer:

Is reporting work-related injuries and illnesses to the employer a sensitive issue? Why or why not? Is telling others 

outside the workplace about these incidents sensitive? Why or why not?

What questions are the most and least difficult for Rs to answer? What answers are they uncertain about? Do they 

have suggestions for improving the survey?

Return to any questions that need further exploration. 
20 

Debriefing questions for proxy respondents:

Proxy

• What is your relationship to [RESPONDENT NAME]?

• How much would you say you know about R’s job?

• How familiar would you say you are with R’s work-related injury/illness? Are you aware of the medical 

treatment he/she received when the injury/illness occurred? Are you aware of how this affected R’s job? How 

did you learn about R’s injury/illness? Who in your household besides R would be the best person to answer 

the kinds of questions I asked?

• What questions were the hardest for you to answer for R? Why? How much would you say you know about 

[QUESTION TOPIC]? How easy/hard is it to remember the information the question asked about? Tell me 

more.

• What questions were the easiest for you to answer for R? Why? How much would you say you know about 

[QUESTION TOPIC]? How easy/hard is it to remember the information the question asked about? Tell me 

more.

Sensitivity

• Were you worried/Would you be worried about telling anyone else about R’s work-related injury/illness? Tell 

me more about that.

Review of selected items

• I’d like to ask you a little more about [QUESTION]. You said [FILL]. In your own words, what do you think 

that question was asking? How did you decide on your answer?

General debriefing

• What are your suggestions on how to improve the survey?

• What questions were the most difficult for you to answer?

• What questions were the easiest to answer?

Notes to interviewer:

Is proxy reporting of work-related injuries and illnesses a sensitive issue? Why or why not?

What questions are the most and least difficult for Rs to answer? What answers are they uncertain about? Do they 

have suggestions for improving the survey?

Return to any questions that need further exploration. 

Debriefing questions for those with no injury/illness to report:

Terms

How familiar are you with the following terms? Please tell in your own words what these terms mean to you?

Workers’ compensation, etc.

• Worker’s compensation

• Temporary disability

• Short-term disability

• Paid sick leave

• Paid annual leave

• Paid time off
21 

Health care professional/calendar days/work shifts

ASK R: In the last year, have you had any injury or illness that was serious enough that a health care professional was 

consulted? Please include any injury whether or not it was work-related.

• Who do you think of as a health care professional? Who would you include or not include? [IF NEEDED 

ASK IF THESE WOULD COUNT: medical doctor, nurse, physician’s assistant, chiropractor, paramedic]

• When you became injured or ill, how many days after the injury/illness were you able to start work again? How 

did you figure that out?

• You said you were not able to do your usual activities for XX calendar days. How did you figure that out?

Unions/collective bargaining agreement

• Have you heard of unions? Have you heard of a collective bargaining agreement? Tell me what those words 

mean to you.

• Q39 (how many workers): Tell me how you figured out your answer to this question. Walk me through how 

you figured out that answer. How certain are you of your answer?

Understanding of terms

• Who do you think of as a health care professional? Who would you include or not include? [IF NEEDED 

ASK IF THESE WOULD COUNT: medical doctor, nurse, physician’s assistant, chiropractor, paramedic]

• Now I’d like to ask you about the term “medical diagnosis.” What does the term “medical diagnosis” mean to 

you? How do you get a medical diagnosis? Who gives you a medical diagnosis? Does a medical diagnosis 

have to come from a doctor or other health care professional?

STEP 3: END OF INTERVIEW

Thank you for taking part in this survey.

□ STOP THE RECORDER.

RECRUITMENT QUESTION:

We are looking for additional respondents like you who would be interested in helping with the study. Do you know 

anyone who had a work-related injury or illness who might be interested in participating? If yes, would you mind if we 

gave you a flyer about the study and send you an email about the study that you could forward to them? 

INTERVIEWER: ANSWER ANY RESPONDENT QUESTIONS. 

This concludes the interview. I would be happy to answer any questions that you have. Thank you for your help with this 

study.

□ MARK CASE AS COMPLETE IN RECRUITMENT DATABASE. 

MATERIALS TO TAKE AWAY FROM INTERVIEW

□ INTERVIEWER PROTOCOL BOOKLET (THIS BOOKLET)

□ DIGITAL RECORDER AND BATTERIES

□ NOTE PAPER, PENS, PENCILS
1 

HOUSEHOLD SURVEY OF OCCUPATIONAL INJURIES AND ILLNESSES

Cognitive interview protocol R3 Version 2

9-13-2016

MATERIALS NEEDED FOR INTERVIEW

□ INTERVIEWER PROTOCOL BOOKLET (THIS BOOKLET) AND SHOWCARDS

□ CONSENT FORM

□ RESPONDENT PHONE NUMBER

□ FULLY CHARGED DIGITAL RECORDER AND EXTRA BATTERIES

□ NOTE PAPER, PENS AND PENCILS

STEP 1: INFORMED CONSENT

PROVIDE RESPONDENT WITH A COPY OF THE INFORMED CONSENT FORM. ASK THE RESPONDENT 

TO READ THE FORM, ANSWER ANY QUESTIONS, AND HAVE THE RESPONDENT SIGN THE FORM. 

LEAVE A SEPARATE COPY OF THE FORM WITH THE RESPONDENT.

□ COLLECT VERBAL CONSENT FROM RESPONDENT

□ IF THE RESPONDENT HAS CONSENTED TO RECORDING, START THE RECORDER.

STEP 2: COMPLETION OF THE QUESTIONNAIRE

BEGIN QUESTIONNAIRE. 

Interviewer probe bank (use as appropriate):

• “How did you come up with that answer?”

• “Can you tell me in your own words what you think the question is asking?”

• “Can you tell me more about that?”

If you pick up on a visual cue that suggests an issue or confusion: 

• “Tell me what you are thinking.”

• What does the word [term] in this question mean to you?

• You said [answer]. Can you tell me more about that?

If R is uncertain and asking for confirmation:

• There is not a right or wrong answer for this question. I am interested in hearing your thoughts on what 

the question is asking.

INTERVIEWER: If this interview is with a proxy respondent, please modify language accordingly. For example, instead 

of asking “Did you do ANY work for pay or profit?” ask “Did [your husband/wife/brother/he/she] do ANY work for pay 

or profit?”
2 

Survey Introduction

The information that you provide in this survey is confidential. Your name and your answers to the questions will not be 

shared with anyone outside of NORC, the survey organization conducting this survey. I would be happy to answer any 

questions you may have about the survey. [ANSWER RESPONDENT QUESTIONS.] Let’s begin. 

Screener

This survey is about work-related injuries and illnesses that you may have experienced. I will ask you questions about the 

injuries and illnesses you may have had that are related to any job you held in the last 12 months By the last 12 months, I 

mean since [CURRENT MONTH] of [LAST YEAR]. 

A1.In the last 12 months, did you do ANY work for pay or profit?

a. Yes  ELIGIBLE, CONTINUE

b. No  NOT ELIGIBLE, END INTERVIEW

c. DK

d. REF 

Any injury

A2.In the last 12 months, have you experienced any injuries or illnesses related to any job you held? 

a. Yes  COLLECT BRIEF DESCRIPTION, CONFIRM WORK-RELATED

b. No  SKIP TO A4 

c. DK

d. REF 

A3.In what month and year did this injury/illness occur? 

MONTH/YEAR

ENTER MM/YYYY

NO SPECIFIC MONTH/YEAR DUE TO CHRONIC/GRADUAL ONSET CONDITION

DK

REF 

INTERVIEWER NOTE: IF ILLNESS/INJURY IS A CHRONIC/GRADUAL ONSET CONDITION FOR WHICH 

RESPONDENT IS UNABLE TO SPECIFY MONTH/YEAR OF OCCURRENT, MARK “NO SPECIFIC 

MONTH/YEAR”

A4.[Now I want to find out if you experienced any other work-related injuries other than the TEXT FILL INJURY

RESPONDENT REPORTED (e.g., concussion) you just told me about.] In the last 12 months, have you 

experienced any [other] injuries, such as the following, related to any job you held? 

a. Sprains, strains or tears

b. Soreness or pain

c. Bruises

d. Cuts or punctures

e. Broken bones

f. Injury to muscles or joints

g. Open wounds

h. Burns 

i. Carpal tunnel syndrome
3 

j. Any other injury? 

1) YES  COLLECT BRIEF DESCRIPTION, CONFIRM WORK-RELATED

2) NO SKIP TO A6

3) DK SKIP TO A6

4) REF SKIP TO A6

INTERVIEWER NOTE: READ DEFINITION IF NECESSARY. Carpal tunnel syndrome is a hand and arm condition 

that causes numbness, tingling and other symptoms. Carpal tunnel syndrome is caused by a pinched nerve in your wrist.

[http://www.mayoclinic.org/diseases-conditions/carpal-tunnel-syndrome/basics/definition/con-20030332]

A5. In what month and year did this injury occur? 

MONTH/YEAR

ENTER MM/YYYY

NO SPECIFIC MONTH/YEAR DUE TO CHRONIC/GRADUAL ONSET CONDITION

DK

REF 

A6. [Other than the TEXT FILL ILLNESS RESPONDENT REPORTED (e.g., asthma) you have already mentioned], 

in the last 12 months, have you experienced any [other] illnesses, such as the following, related to any job you 

held? 

a. Skin disorders

b. Respiratory conditions

c. Poisonings

d. Hearing loss

e. A disease or infection

f. Cancer 

g. Anxiety or depression

h. Any other illness? 

1) YES  COLLECT BRIEF DESCRIPTION, CONFIRM WORK-RELATED

2) NO SKIP TO A8

3) DK SKIP TO A8

4) REF SKIP TO A8

A7. In what month and year did this injury/illness occur? 

MONTH/YEAR

ENTER MM/YYYY

NO SPECIFIC MONTH/YEAR DUE TO CHRONIC/GRADUAL ONSET CONDITION

DK

REF 
4 

A8.[Other than the TEXT FILL INJURY/ILLNESS RESPONDENT REPORTED (e.g, concussion, asthma) you have 

already mentioned], in the last 12 months, have you experienced any [other] work-related injuries or illnesses that 

caused you to...

Yes No DK REF

a. Faint, pass out, or lose consciousness? 

b. Be unable to work for a day or more?

c. Do less than your normal work activities?

d. Be assigned to a different job or tasks at your 

place of work?

e. Get medical treatment other than what can be 

treated with a first aid kit?

IF YES, COLLECT BRIEF DESCRIPTION AND CONFIRM WORK-RELATED.

IF NO TO ALL ITEMS IN A8, SKIP TO A10.

READ IF NECESSARY: First aid refers to medical attention that is usually administered immediately after the injury 

occurs and at the location where it occurred. It often consists of a one-time, short-term treatment and requires little 

technology or training to administer. First aid can include cleaning minor cuts, scrapes, or scratches; treating a minor 

burn; applying bandages and dressings; the use of non-prescription medicine...

https://www.osha.gov/SLTC/medicalfirstaid/recognition.html

A9. In what month and year did this injury/illness occur? 

MONTH/YEAR

ENTER MM/YYYY

DK

REF 

IF R HAS NOT REPORTED ANY INJURIES OR ILLNESSES ASK ABOUT INJURIES/ILLNESSES EVER

EXPERIENCED. ELSE GO TO DEMOGRAPHICS.]

A10. Have you EVER experienced any injuries or illnesses related to any job you held? 

a. YES  COLLECT BRIEF DESCRIPTION, CONFIRM WORK-RELATED

b. NO  SKIP TO PROBES AT END OF SCREENER SECTION THEN SKIP TO DEMOGRAPHICS

c. DK  SKIP TO PROBES AT END OF SCREENER SECTION THEN SKIP TO DEMOGRAPHICS

d. REF  SKIP TO PROBES AT END OF SCREENER SECTION THEN SKIP TO DEMOGRAPHICS

A11. In what month and year did this injury/illness occur? 

MONTH/YEAR

ENTER MM/YYYY

DK

REF 

A12. [IF YES TO ANY INJURIES OR ILLNESSES] How many total times in the last 12 months [did you 

experience/have you ever experienced] an injury or illness related to any job you held? [THIS WILL CREATE 

THE LOOPS.] ________TIMES
5 

INTERVIEWER: CONFIRM NUMBER OF INCIDENTS AND BRIEF DESCRIPTION OF EACH. IF 

INJURY/ILLNESS EXPERIENCED WITHIN LAST YEAR, RESPONDENT WILL REPORT ON THOSE. 

OTHERWISE, IF NO INJURY/ILLNESS WITHIN LAST YEAR, RESPONDENT WILL REPORT ON 

INJURIES/ILLNESSES EVER EXPERIENCED.

Probes:

Screener

• I asked you this question: “In the last 12 months, have you experienced any injuries or illnesses related to any 

job you had?” In your own words, what is this question asking?

• In your own words, what would be a work-related injury or illness? Can you give me some examples of some 

things that would count as work-related injuries and illnesses? What would not count?

• Tell me about the kind of work you do. Tell me about other times when you got hurt or sick because of the 

work you do.

• [I asked you about whether you ever experienced any injury or illness, related to any job you had, that caused 

you to get medical treatment other than what could be treated with a first aid kit]. What does “first aid” mean 

to you? What kind of treatment counts as first aid? What kind of treatment doesn’t count?

• The questions gave some examples of injuries and illnesses [SHOW R THE LISTS, READ THE LIST IF 

NECESSARY.] Are you familiar with [LIST]? Which ones have you heard of? Which ones had you not heard 

of? 

• How easy or hard was it to remember when the injury/illness happened? Can you tell me more about that? 

How did you figure out when the injury/illness happened?

Notes to interviewer:

The goal of the screener section is to enumerate all instances of work-related injuries and illnesses that occurred during 

the reference period. What issues do respondents have in reporting these incidents? Do they understand the types of 

injuries and illnesses to report? Can they accurately report only those that are work-related? How do they determine 

the boundary of the reference period and determine whether an incident occurred within the RP?

IF NO INCIDENTS OF WORK-RELATED INJURIES AND ILLNESSES, GO TO DEMOGRAPHICS SECTION.

Injury or Illness

 

[FOR FIRST INJURY/ILLNESS START AT B2] 

[FOR SECOND AND FOLLOWING INJURY/ILLNESS START AT B1] 

B1. [FOR SECOND/THIRD/ETC. LOOPS] How is this injury/illness related to the other injury/illness you 

mentioned? Is this related to [the other/another] injury/illness you already mentioned or is it a different 

injury/illness?

a. RELATED TO THE OTHER/ANOTHER INJURY/ILLNESS [GO TO NEXT LOOP]

b. THIS IS A DIFFERENT INJURY/ILLNESS [CONTINUE]

c. DK

d. REF 
6 

“Now I am going to ask you more about [INJURY/ILLNESS #....].”

B2. [WORKER ACTIVITY + some EVENT and SOURCE] [FOR EACH LOOP] Please 

describe how the injury, illness, or condition occurred, and what caused it. For example: 

“When ladder slipped on wet floor, I fell 20 feet”; “I developed soreness in wrist over 

time.” [OPEN ENDED]

B3. [SOURCE] Were there any other objects, substances, or persons involved in the injury 

or illness that you didn’t mention? Please include equipment, chemicals, vehicles, or 

anything else.

B4. [NATURE AND BODY PART] Please describe the injury, illness, or condition. How 

was [BODY PART, ORGAN] affected? You can use medical terms if you know them, 

or just talk about the symptoms you experienced. For example: “strained back”; 

“chemical burn on hand”; “fainted or passed out.” 

B5. [NATURE AND BODY PART] Were there any other parts of your body or organs

affected by the injury or illness that you may not have included in your description? 

How was [BODY PART, ORGAN] affected?

Probes:

Characteristics of incident

• [READ QUESTION] Can you tell me in your own words what you think this question is asking?

• [IF R DOES NOT INDICATE HOW INJURY/ILLNESS IS WORK-RELATED] Tell me more about how this 

injury/illness was related to your job. Where were you when this happened? What were you doing? What 

caused the injury/illness? Tell me more about the injury/illness. 

Notes to interviewer:

Questions B2 through B5 are intended to capture (event or exposure, source of the injury/illness, part of body affected, 

and nature of the injury/illness). Do the questions elicit the information needed? Are the response options adequate to 

capture the information Rs give? Use general probing to elicit more information about the incident. (For example, if R 

says “I cut myself” ask: What part of your body was injured? What did you get cut with? What were you doing at the 

time?

CHECKLIST

1. Description or 

diagnosis for 

injury/illness (this is 

the OIICS nature) 

2. Part or parts of body 

affected, including 

body systems 

(OIICS part, 

obviously)

3. How the 

injury/illness/exposu

re happened (OIICS 

event) 

4. Vehicles, tools, 

chemicals, surfaces, 

or any other objects 

involved; this can be 

multiple objects; this 

can also just be the 

person’s body 

moved incorrectly 

(OIICS sources) 
7 

Medical attention

C1. Did you get medical advice or treatment for this injury/illness from...

a. A doctor, nurse, or other healthcare professional?

[IF YES]: What type of health care professional 

did you see?

YES NO NA DK/REF

b. [UNLESS MENTIONED ABOVE] A 

paramedic, firefighter, or other emergency 

medical personnel?

C2. Did you get medical advice or treatment for this injury/illness at... 

a. A hospital? YES NO NA DK/REF

A1. [IF YES TO HOSPITAL] Did you 

receive treatment at the hospital emergency 

room (ER)?

A2.[IF YES TO HOSPITAL] Were you 

admitted for an overnight stay?

A3. [IF YES TO ADMITTED] How many 

nights were you in the hospital? _________ 

NIGHTS

b. A health clinic at your place of employment?

c. Any place else? Please specify.

[IF YES TO C1 OR C2, CONTINUE TO C3.] 

[OTHERWISE SKIP TO C5]

C3. [IF YES TO C1 OR C2]. Did you receive a medical diagnosis from a health care professional? ...

READ IF NECESSARY: Did a health care professional tell you the medical term for your injury/illness?

a. YES  What was your medical diagnosis? INTERVIEWER READ IF NECESSARY: What is the 

medical term the health care professional used to describe your injury/illness?

b. NO 

c. DK 

d. REF 

 

C4. [IF YES TO C1 OR C2]. Did your health care professional recommend that you take any days off from work due 

to your injury/illness? 

a. YES  How many days off did the health care professional recommend? _______ DAYS OFF

b. NO 

c. DK 

d. REF 
8 

Probes:

Medical attention (tailor probes based on whether R reported receiving medical attention)

• Tell me more about the medical care you received after the injury/illness happened.

• Can you tell me in your own words what you think this question is asking?

• Who do you think of as a health care professional? Who would you include or not include? [IF NEEDED 

ASK IF THESE WOULD COUNT: medical doctor, nurse, physician’s assistant, chiropractor, paramedic]

• I asked you about whether you received a medical diagnosis. What does the term “medical diagnosis” mean to 

you? How do you get a medical diagnosis? Who gives you a medical diagnosis? Does a medical diagnosis 

have to come from a doctor or other health care professional? (if asked) What did you think of when I asked 

you about the medical term the doctor/health care professional used to describe your injury/illness? What does 

“medical term” mean to you? 

• IF NEEDED] Did you go to a doctor, nurse, or other health care provider after [INCIDENT]? Did you go to 

the hospital or did paramedics come? 

• What does it mean to be admitted for an overnight stay in the hospital? How is that different from an 

emergency room visit?

• Is/Was there a medical clinic at your place of employment? Did you see anyone at that clinic?

• Did your doctor or another health care professional recommend that you take days off from work? How many 

days off did they recommend?

Effect on work

The next questions are about how the injury/illness affected your ability to work. 

IF RESPONDENT HAS A CHRONIC/GRADUAL ONSET INJURY/ILLNESS, GO TO QUESTIONS AFTER D9.

D1.Were you scheduled to work the day after the injury/illness? 

a. YES

b. NO SKIP TO D3

c. DK SKIP TO D3

d. REF SKIP TO D3

D2.[IF SCHEDULED TO WORK NEXT DAY] Were you able to work the next day? 

a. YES  SKIP TO D6 

b. NO  SKIP TO D4

c. DK SKIP TO D4

d. REF SKIP TO D4

D3.[IF WAS NOT SCHEDULED TO WORK NEXT DAY] If you had been scheduled to work, would you have 

been able to work the next day? 

a. YES  SKIP TO D6

b. NO

c. DK

d. REF 

D4. Did you return to work after the injury/illness?

a. YES

b. YES, BACK TO WORK SAME DAYSKIP TO D6

c. NO SKIP TO D10

d. NO, STILL OFF PAID WORK BUT EXPECTS TO RETURNSKIP TO D10

e. NO, EXPECTS NEVER TO DO PAID WORK AGAINSKIP TO D10

f. DK SKIP TO D10

g. REF SKIP TO D10
9 

D5. [IF RETURNED TO WORK] How many days after the injury/illness did you start work again?

a. _____DAYS AFTER THE INJURY/ILLNESS

b. BACK TO WORK SAME DAY

c. BACK TO WORK NEXT DAY

d. DK

e. REF

INTERVIEWER NOTE: IF R INDICATES WENT BACK TO WORK ONE DAY AFTER INJURY/ILLNESS, 

CONFIRM THAT R MEANS THAT R WENT BACK TO WORK THE NEXT DAY, THAT IS, THE DAY AFTER 

INJURY/ILLNESS OCCURRED.

[IF R WENT BACK TO WORK (D4=YES), CONTINUE. ELSE IF R IS NOT WORKING, GO TO D10.]

D6. When you went back to work, did you work your usual number of hours or not?

a. YES 

b. NO 

c. DK

d. REF 

D7. When you went back to work, were you able to perform all of the normal duties of your job or not?

a. YES 

b. NO 

c. DK

d. REF 

D8. When you went back to work, were you assigned a different job or tasks than what you did prior to the 

injury/illness? 

a. YES 

b. NO SKIP TO D10

c. DK SKIP TO D10

d. REF SKIP TO D10

D9.[IF DIFFERENT, D8=YES] Was your assignment to a different job or tasks permanent or temporary? 

a. PERMANENT 

b. TEMPORARY 

c. DK

d. REF 

GO TO D10.

QUESTIONS ON EFFECT ON WORK FOR RESPONDENTS WITH CHRONIC/GRADUAL ONSET CONDITIONS:

In the last 12 months, after you began experiencing symptoms due to TEXT FILL,

1. Did you miss any days of work, or not?

2. [IF YES TO 1] about how many days of work did you miss? 

When you worked...

3. Did you work your usual number of hours or not?

4. Were you able to perform all of the normal duties of your job or not?
10 

5. Were you assigned to a different job or tasks than what you did prior to the onset of symptoms?

6. [IF YES TO 5] Was your assignment to a different job or tasks permanent or temporary?

[TRANSITION STATEMENT FOR THOSE WHO RETURNED TO WORK: At any point after you returned to work, 

did the injury/illness affect your job in any of the following ways?]

D10. Did the injury/illness cause you to: 

YES NO NA DK/REF

a. Quit your job?

b. Be laid off?

c. Be fired?

d. Change the kind of work you do, that is, 

change your occupation?

D11. Did the injury/illness affect your ability to work in any other way?

a. YES  Please specify.

b. NO 

c. DK

d. REF 

Probes:

Effect on work

• IF YES TO ANY ITEM D6-D11: Tell me more about [TEXT FILL]. [E.g., Tell me more about your normal 

job duties. What duties were you unable to perform? OR Tell me more about why you quit your job? When 

did you quit? How was that related to your injury/illness?] 

• What does the term [TEXT FILL] mean to you? Can you give me an example? [E.g., What does it mean to 

you to be assigned to another job on a permanent or temporary basis? What does it mean to be laid off? Fired?] 

• What kind of effect did the injury/illness have on your work schedule? Job duties? Ability to work? Ability to 

keep your job? The pay you received? 

Probes:

Days after injury/illness able to start work again

• You said you were able to start work again XX days after the injury/illness. How did you figure that out?

• Walk me through the timeline of when you were injured and when you got back to work. 

• When you started work again were you able to resume all the duties you had before, or not?

Notes to interviewer:

How does R determine days after injury/illness able to start work again? 

Effect on Pay

The next questions are about how the injury/illness affected your income or pay. 

E1. Did your employer know about this injury/illness?
11 

a. YES SKIP TO E3

b. NO

c. DK

d. REF 

E2. [IF NO TO EMPLOYER KNOWING]: For what reasons did your employer not know about this injury/illness? 

Did you not want your employer to know about your injury/illness... 

YES NO NA DK/REF

a. To avoid being laid off?

b. To avoid loss of wages?

c. To avoid loss of promotion of 

advancement?

d. To avoid job transfer or restriction?

e. Because you did not realize that the 

injury/illness was work-related until 

after leaving the job?

f. Because you felt your employer would 

not recognize the injury/illness as 

work-related?

g. Because your employer wants to keep 

injury and illness rates low?

h. Other (specify)?

The next questions are about workers’ compensation. Workers’ compensation is insurance that provides you with your 

lost wages and medical care when you become injured or ill due to your job. 

E3. Has anyone filed a workers’ compensation claim for this injury/illness?

a. YES

b. NO SKIP TO E5

c. DK

d. REF 

E4. Who filed the workers’ compensation claim?

a. EMPLOYER

b. EMPLOYEE

c. FAMILY MEMBER OF EMPLOYEE

d. OTHER SPECIFY

e. DK

f. REF 

ALL RESPONSES TO E4 GO TO SKIP INSTRUCTION BEFORE E6. 

E5. IF NO ON QUESTION ABOUT FILING WORKERS’ COMPENSATION: What was the main reason you or 

your employer did not file a workers’ compensation claim for this injury/illness?

a. You were not eligible because you did not meet waiting period

b. Your employer did not want to file a claim

c. You did not inform employer

d. You were unaware of workers’ compensation coverage

e. You chose not to pursue a claim even though you were eligible
12 

f. Other reason, please specify

g. DK

h. REF 

SKIP INSTRUCTION: 

#1: WC FILED, CONTINUE TO E6. 

#2: ELSE IF NO WC FILED BUT MISSED DAYS OF WORK, SKIP TO E8. 

#3: ELSE [NO WC FILED AND DID NOT MISS DAYS OF WORK] SKIP TO PROBES AT END OF SECTION.

E6. IF R REPORTS WORKERS’ COMPENSATION CLAIM FILED: Did you receive workers’ compensation for 

this injury/illness? 

a. YES

b. NO

c. NA

d. DK

e. REF 

READ IF NECESSARY: Workers compensation is insurance that provides you with your lost wages and medical 

care when you become injured or ill due to your job.

E7. IF R REPORTS WORKERS’ COMPENSATION NOT RECEIVED: Is there an open claim pending for this 

injury/illness?

a. YES

b. NO

c. NA

d. DK

e. REF 

E8. Short-term or temporary disability benefits provide you with a portion of your income if you are temporarily 

unable to work due to a medical condition. Did you receive short-term (temporary) disability for this 

injury/illness? 

a. YES

b. NO

c. NA

d. DK

e. REF 

E9. Did this injury/illness cause you to use paid sick leave, paid annual leave, or paid time off? 

a. YES

b. NO

c. NA

d. DK

e. REF 

E10. Did this injury/illness cause you to take leave without pay?

a. YES

b. NO

c. NA

d. DK

e. REF 
13 

E11. Did your employer continue to pay your wages and other compensation in full during the period you were unable 

to work because of this injury/illness?

a. YES

b. NO

c. NA

d. DK

e. REF 

Probes:

Effect on work

• [IF YES TO E1] How did your employer know about the injury/illness?

• [IF NO TO E1] Tell me more about the reasons why your employer did not know about this injury/illness. 

What was the main reason your employer did not know? Tell me more about that.

• [IF DK TO E1] For what reasons are you not sure whether your employer knew about the injury/illness?

Notes to interviewer: 

Observe for signs of acquiescence bias in E1. Are Rs saying “yes” because a reason sounds plausible or because it was 

a reason why R’s employer did not the injury/illness? Ask for more detail and main reasons. Probe to explore 

understanding of terms, ability to accurately report on consequences of the injury/illness.

Probes:

Workers’ compensation

• ASK PROBES TAILORED TO THE REASONS R REPORTS ON WHY NO WC CLAIM WAS FILED BY 

EMPLOYER. EXAMPLES: Tell me more about the reasons why your employer did not file a workers’ 

compensation claim for this injury/illness? What did your employer say? Why did the employer refuse? How 

sure are you about whether or not your employer filed a claim?

• Can you tell me what it means to file a workers’ compensation claim? Tell me what you know about that 

process.

• Have you heard of [TEXT FILL]? Please tell me in your own words what you think [TEXT FILL] means: 

workers’ compensation, short-term or temporary disability, paid sick leave/paid annual leave/paid time off, 

leave without pay.

Notes to interviewer:

Do Rs know what workers’ compensation is? Do they know whether a WC form was filed? Are the terms in E6-E11 

familiar to Rs? Are the definitions helpful? 

Occupation and Industry at Time of Injury or Illness

The next questions are about your occupation and industry at the time of the injury/illness. Please think about the job you 

held at the time of the injury/illness [TEXT FILL DESCRIPTION]. 

F1. Were you considered by your employer to be a full time or part time employee?

a. FULL-TIME 

b. PART-TIME 

c. DK

d. REF 

F2. In a typical week, how many hours did you work? ______hours 

IF NECESSARY: Was it greater than or equal to 35 hours per week?
14 

DK

REF 

Probes:

Hours worked

• Do you work the same number of hours per week, or not? How did you determine how many hours per week 

you typically work? 

• How many hours a week would you consider to be full time employment? What does your employer consider 

to be full time employment? 

Notes to interviewer:

Does R have any difficulty recalling FT vs. PT work? How do Rs with irregular work schedules, seasonal employment, 

etc., answer the question? Does the number of hours per week typically worked accord with report of FT/PT status?

F3. Which of the following group best describes your employer at the time of the injury/illness? 

a. Government 

b. Private-for-profit company SKIP TO F5

c. Non-profit organization including tax exempt and charitable organizations  SKIP TO F5

d. Self-employed  SKIP TO F5

e. Working in the family business SKIP TO F5

F4. Would that be the federal, state, or local government? 

a. FEDERAL

b. STATE 

c. LOCAL

F5. Did you work for a temporary help agency or a temporary staffing agency? 

a. YES

b. NO

c. DK

d. REF 

INTERVIEWER NOTE: IF R IS A FARM LABOR CONTRACTOR, R IS NOT CONSIDERED 

TEMPORARY HELP/STAFFING AND RESPONSE TO THIS Q IS NO.

[IF F5 (TEMP HELP OR TEMP STAFFING AGENCY) =YES]: For the next questions, please answer based on the 

place where you were working on a day-to-day basis when the injury/illness occurred, not the temporary agency you 

worked for.

F6. What is the name of the (company, organization or agency) for whom you worked? [OPEN ENDED] 

DK

REF 

NOTE: IF GOVERNMENT EMPLOYER, TEXT FILL=AGENCY; IF NON-PROFIT, TEXT FILL=ORGANIZATION; 

ELSE TEXT FILL=COMPANY. 

F7. What kind of business or industry was this? [OPEN ENDED] 

DK

REF 

F8. What did they make or do where you worked? [OPEN ENDED] 

DK
15 

REF 

F9. In what state were you employed at this job? [OPEN ENDED] 

DK

REF 

F10. What kind of work did you do? (For example: registered nurse, personnel manager, supervisor of order 

department, secretary, accountant) [OPEN ENDED]

DK

REF 

F11. What were your most important activities or duties? (For example: patient care, directing hiring policies, 

supervising order clerks, typing and filing, reconciling financial records) [OPEN ENDED]

DK

REF 

F12. At this job, were you a member of a union or covered by a collective bargaining agreement?

a. YES

b. NO

c. DK

d. REF 

F13. How many people work at your work location?

e. 1 to 10 workers

a. 11 to 49 workers

b. 50 to 249 workers

c. 250 to 999 workers

d. 1000 or more workers

e. DK

f. REF 

Probes:

Employment characteristics for job at time of injury/illness

• F12 (union): Have you heard of unions? Have you heard of a collective bargaining 

agreement? Tell me what those words mean to you.

• F12: Tell me how you decided on your answer. Tell me about the collective bargaining 

agreement. What union do/did you belong to?

• F13 (how many workers): Tell me how you figured out your answer to this question. Walk 

me through how you figured out that answer. How certain are you of your answer?

Notes to interviewer:

Observe respondent ability to understand and respond to questions about employment at time of the 

injury/illness. Probe as needed to explore an issues with response. Are respondents able to accurately 

report answers for F12 and F13? F13 should include total for R’s work location only, not the whole 

company/organization. 

IF R HAS ADDITIONAL INJURIES/ILLNESSES TO REPORT, GO BACK TO SECTION B. ELSE GO TO G1. 
16 

Demographic Characteristics

Race/ethnicity

G1. Are you Spanish, Hispanic, or Latino?

a. YES 

b. NO

c. DK

d. REF 

G2. [I am going to read you a list of five race categories.] Please choose one or more races that you consider yourself 

to be: 

a. White

b. Black or African American

c. American Indian or Alaska Native

d. Asian

e. Native Hawaiian or Other Pacific Islander

f. Other ________ 

g. DK

h. REF 

Age

G3. What is your date of birth? Enter MM/DD/YYYY 

DK

REF 

G4. As of last week, that would make you approximately (AGE) years old. Is that correct?

[IF NECCESARY] Even though you don’t know your exact birthdate, what is your best guess as to how old 

you were on your last birthday? 

______ YEARS

DK

REF 

Marital Type

G5. Are you now married, widowed, divorced, separated or never married? 

a. MARRIED 

b. WIDOWED 

c. DIVORCED 

d. SEPARATED 

e. NEVER MARRIED

f. DK

g. REF 

Gender

G6. Are you male or female? 

a. MALE

b. FEMALE

Education

G7. What is the highest level of school you have completed or the highest degree you have received? 

a. Less than high school

b. High school or GED

c. Associate degree or some college

d. Bachelor’s degree or above

G8. In what country were you born? 
17 

___________________________ [OPEN-ENDED]

Current Industry and Occupation

The next questions are about your current job. If you have more than one job, please tell me about the job at which you 

usually work the most hours. If you work the same number of hours at two jobs, please tell me about the job where you 

were employed the longest.

H1. What is your current employment status? Are you currently employed full-time, part-time, or are you not 

employed?

a. FULL-TIME 

b. PART-TIME 

c. NOT CURRENTLY EMPLOYED SKIP TO END OF SURVEY

d. DK

e. REF 

H2. [IF CURRENTLY EMPLOYED] Is this job with the same employer you have already told me about? 

a. YES, SAME EMPLOYER  CONTINUE TO H3

b. NO, DIFFERENT EMPLOYER  SKIP TO H5

INTERVIEWER NOTE: 

• IF R HAS ONLY ONE INJURY/ILLNESS AND SAME EMPLOYER OR MULTIPLE INJURIES UNDER

SAME EMPLOYER, SKIP TO H4

• IF R HAS MULTIPLE INJURIES UNDER DIFFERENT EMPLOYERS, BUT CURRENT EMPLOYMENT IS 

WITH SAME EMPLOYER, CONTINUE TO H3

H3. [IF MULTIPLE INJURIES UNDER DIFFERENT EMPLOYERS BUT SAME AS CURRENT 

EMPLOYMENT] Which job and employer are you referring to? 

_________________

H4. [IF SAME EMPLOYER] Are you in the same position you were in at the time the injury/illness [TEXT FILL]?

a. YES SKIP TO PROBES AT END OF SECTION

b. NO

c. DK

d. REF 

INTERVIEWER NOTE: IF SAME EMPLOYER BUT DIFFERENT JOB, ASK H5 (HOW MANY HOURS 

WORKED), H11 (WHAT KIND OF WORK DO YOU DO), AND H12 (MOST IMPORTANT ACTIVITIES OR 

DUTIES). 

H5. [IF SAME EMPLOYER BUT DIFFERENT JOB OR DIFFERENT EMPLOYER THAN DURING INJURY 

ILLNESS] Currently, in a typical week, how many hours do you work? 

 ______hours

IF NECESSARY: Was it greater than or equal to 35 hours per week? 

DK 

REF 

INTERVIEWER NOTE: IF SAME EMPLOYER BUT DIFFERENT JOB, SKIP TO H11.

H6. [IF DIFFERENT EMPLOYER THAN DURING INJURY ILLNESS] Which of the following group best 

describes your CURRENT employer? 

a. Government 
18 

b. Private-for-profit company SKIP TO H8

c. Non-profit organization including tax exempt and charitable organizations  SKIP TO H8

d. Self-employed  SKIP TO H8

e. Working in the family business SKIP TO H8

H7. [IF DIFFERENT EMPLOYER THAN HAD DURING INJURY/ILLNESS] Would that be the federal, state, or 

local government? 

a. FEDERAL

b. STATE 

c. LOCAL

H8. [IF DIFFERENT EMPLOYER THAN HAD DURING INJURY/ILLNESS] What is the name of the (company, 

organization or agency) for whom you work? [OPEN ENDED] 

DK

REF 

H9. [IF DIFFERENT EMPLOYER THAN HAD DURING INJURY/ILLNESS] What kind of business or industry is 

this? [OPEN ENDED] 

DK

REF 

H10. [IF DIFFERENT EMPLOYER THAN HAD DURING INJURY/ILLNESS] What do they make or do where 

you work? [OPEN ENDED] 

DK

REF 

H11. [IF SAME EMPLOYER BUT DIFFERENT JOB OR DIFFERENT EMPLOYER THAN DURING INJURY 

ILLNESS] What kind of work do you do? (For example: registered nurse, personnel manager, supervisor of order 

department, secretary, accountant) [OPEN ENDED] 

DK

REF 

H12. [IF SAME EMPLOYER BUT DIFFERENT JOB OR DIFFERENT EMPLOYER THAN DURING INJURY 

ILLNESS] What are your most important activities or duties? (For example: patient care, directing hiring policies, 

supervising order clerks, typing and filing, reconciling financial records) [OPEN ENDED] 

DK

REF 

Probes:

Employment characteristics for current job

• Use general probes as needed to investigate issues with these questions.

• Is the job you reported your only job or do you have more than one job? 

• [REREAD THE ITALICIZED INSTRUCTION ON WHICH JOB TO REPORT ON]. In your own words, 

what do you think this instruction means?

Notes to interviewer:

These questions are the same as for the job at time of the incident. Continue to observe for issues to explore. 

Does R notice that this set of questions is about the current job? If R has more than one job, did R report on the correct 

one?

How do H2 and H3 function for determining that the current and former job are the same?
19 

Debriefing questions for self-interview:

Recall and reference period

• How easy or difficult was it for you to answer questions about injuries/illnesses that occurred over the last 

year? 

• How sure are you that the injury/illness you told me about happened in the last year?

• Were there any questions that were particularly difficult to answer? Tell me more about that?

• If I asked you about injuries/illnesses that happened during the last 12 months, how easy or hard would it be to 

answer the questions I asked you?

• When you signed up to do the survey, you may have seen a flyer or someone from NORC ask you about 

injuries and illnesses related to work that you may have had. Did you think about those injuries/illnesses you 

had, or did you do anything to get ready for the interview before you came? Tell me about that.

• Imagine that you didn’t know ahead of time that this survey was going to be about work-related injuries and 

illnesses. If someone called you or came to your door, and asked you whether you had ever had a work-related 

injury or illness, do you think you would have remembered? How hard would these questions in the survey be, 

if you didn’t know in advance what the survey was about?

Sensitivity

• Were you worried/Would you be worried about telling your employer about an injury/illness? Was it/Would it 

be hard for you to tell your employer? Tell me more about that.

• Were you worried/Would you be worried about telling the government about an injury/illness? Why? Tell me 

more about that.

• Were you worried/Would you be worried about telling anyone else about a work-related injury/illness? Tell 

me more about that.

Review of selected items

• I’d like to ask you a little more about [QUESTION]. You said [FILL]. In your own words, what do you think 

that question was asking? How did you decide on your answer?

General debriefing

• What are your suggestions on how to improve the survey?

• What questions were the most difficult for you to answer?

• What questions were the easiest to answer?

Notes to interviewer:

Is reporting work-related injuries and illnesses to the employer a sensitive issue? Why or why not? Is telling others 

outside the workplace about these incidents sensitive? Why or why not?

What questions are the most and least difficult for Rs to answer? What answers are they uncertain about? Do they 

have suggestions for improving the survey?

Return to any questions that need further exploration. 
20 

Debriefing questions for proxy respondents:

Proxy

• What is your relationship to [RESPONDENT NAME]?

• How much would you say you know about R’s job?

• How familiar would you say you are with R’s work-related injury/illness? Are you aware of the medical 

treatment he/she received when the injury/illness occurred? Are you aware of how this affected R’s job? How 

did you learn about R’s injury/illness? Who in your household besides R would be the best person to answer 

the kinds of questions I asked?

• What questions were the hardest for you to answer for R? Why? How much would you say you know about 

[QUESTION TOPIC]? How easy/hard is it to remember the information the question asked about? Tell me 

more.

• What questions were the easiest for you to answer for R? Why? How much would you say you know about 

[QUESTION TOPIC]? How easy/hard is it to remember the information the question asked about? Tell me 

more.

Sensitivity

• Were you worried/Would you be worried about telling anyone else about R’s work-related injury/illness? Tell 

me more about that.

Review of selected items

• I’d like to ask you a little more about [QUESTION]. You said [FILL]. In your own words, what do you think 

that question was asking? How did you decide on your answer?

General debriefing

• What are your suggestions on how to improve the survey?

• What questions were the most difficult for you to answer?

• What questions were the easiest to answer?

Notes to interviewer:

Is proxy reporting of work-related injuries and illnesses a sensitive issue? Why or why not?

What questions are the most and least difficult for Rs to answer? What answers are they uncertain about? Do they 

have suggestions for improving the survey?

Return to any questions that need further exploration. 

Debriefing questions for those with no injury/illness to report:

Terms

How familiar are you with the following terms? Please tell in your own words what these terms mean to you?

Workers’ compensation, etc.

• Worker’s compensation

• Temporary disability

• Short-term disability

• Paid sick leave

• Paid annual leave

• Paid time off
21 

Health care professional/calendar days/work shifts

ASK R: In the last year, have you had any injury or illness that was serious enough that a health care professional was 

consulted? Please include any injury whether or not it was work-related.

• Who do you think of as a health care professional? Who would you include or not include? [IF NEEDED 

ASK IF THESE WOULD COUNT: medical doctor, nurse, physician’s assistant, chiropractor, paramedic]

• When you became injured or ill, how many days after the injury/illness were you able to start work again? How 

did you figure that out?

• You said you were not able to do your usual activities for XX calendar days. How did you figure that out?

Unions/collective bargaining agreement

• Have you heard of unions? Have you heard of a collective bargaining agreement? Tell me what those words 

mean to you.

• Q39 (how many workers): Tell me how you figured out your answer to this question. Walk me through how 

you figured out that answer. How certain are you of your answer?

Understanding of terms

• Who do you think of as a health care professional? Who would you include or not include? [IF NEEDED 

ASK IF THESE WOULD COUNT: medical doctor, nurse, physician’s assistant, chiropractor, paramedic]

• Now I’d like to ask you about the term “medical diagnosis.” What does the term “medical diagnosis” mean to 

you? How do you get a medical diagnosis? Who gives you a medical diagnosis? Does a medical diagnosis 

have to come from a doctor or other health care professional?

STEP 3: END OF INTERVIEW

Thank you for taking part in this survey.

□ STOP THE RECORDER.

RECRUITMENT QUESTION:

We are looking for additional respondents like you who would be interested in helping with the study. Do you know 

anyone who had a work-related injury or illness who might be interested in participating? If yes, would you mind if we 

gave you a flyer about the study and send you an email about the study that you could forward to them? 

INTERVIEWER: ANSWER ANY RESPONDENT QUESTIONS. 

This concludes the interview. I would be happy to answer any questions that you have. Thank you for your help with this 

study.

□ MARK CASE AS COMPLETE IN RECRUITMENT DATABASE. 

MATERIALS TO TAKE AWAY FROM INTERVIEW

□ INTERVIEWER PROTOCOL BOOKLET (THIS BOOKLET)

□ DIGITAL RECORDER AND BATTERIES

□ NOTE PAPER, PENS, PENCILS
1 

HOUSEHOLD SURVEY OF OCCUPATIONAL INJURIES AND ILLNESSES

Cognitive interview protocol R3 Version 3 

9-21-2016

MATERIALS NEEDED FOR INTERVIEW

□ INTERVIEWER PROTOCOL BOOKLET (THIS BOOKLET) AND SHOWCARDS

□ CONSENT FORM

□ RESPONDENT PHONE NUMBER

□ FULLY CHARGED DIGITAL RECORDER AND EXTRA BATTERIES

□ NOTE PAPER, PENS AND PENCILS

STEP 1: INFORMED CONSENT

PROVIDE RESPONDENT WITH A COPY OF THE INFORMED CONSENT FORM. ASK THE RESPONDENT 

TO READ THE FORM, ANSWER ANY QUESTIONS, AND HAVE THE RESPONDENT SIGN THE FORM. 

LEAVE A SEPARATE COPY OF THE FORM WITH THE RESPONDENT.

□ COLLECT VERBAL CONSENT FROM RESPONDENT

□ IF THE RESPONDENT HAS CONSENTED TO RECORDING, START THE RECORDER.

STEP 2: COMPLETION OF THE QUESTIONNAIRE

BEGIN QUESTIONNAIRE. 

Interviewer probe bank (use as appropriate):

• “How did you come up with that answer?”

• “Can you tell me in your own words what you think the question is asking?”

• “Can you tell me more about that?”

If you pick up on a visual cue that suggests an issue or confusion: 

• “Tell me what you are thinking.”

• What does the word [term] in this question mean to you?

• You said [answer]. Can you tell me more about that?

If R is uncertain and asking for confirmation:

• There is not a right or wrong answer for this question. I am interested in hearing your thoughts on what 

the question is asking.

INTERVIEWER: If this interview is with a proxy respondent, please modify language accordingly. For example, instead 

of asking “Did you do ANY work for pay or profit?” ask “Did [your husband/wife/brother/he/she] do ANY work for pay 

or profit?”
2 

Survey Introduction

The information that you provide in this survey is confidential. Your name and your answers to the questions will not be 

shared with anyone outside of NORC, the survey organization conducting this survey. I would be happy to answer any 

questions you may have about the survey. [ANSWER RESPONDENT QUESTIONS.] Let’s begin. 

Screener

This survey is about work-related injuries and illnesses that you may have experienced. I will ask you questions about the 

injuries and illnesses you may have had that are related to any job you held in the last 12 months By the last 12 months, I 

mean since [CURRENT MONTH] of [LAST YEAR]. 

A1.In the last 12 months, did you do ANY work for pay or profit?

a. Yes  ELIGIBLE, CONTINUE

b. No  NOT ELIGIBLE, END INTERVIEW

c. DK

d. REF 

Any injury

A2.In the last 12 months, have you experienced any injuries or illnesses related to any job you held? 

a. Yes  COLLECT BRIEF DESCRIPTION, CONFIRM WORK-RELATED

b. No  SKIP TO A4 

c. DK

d. REF 

A3.In what month and year did this injury/illness occur? 

MONTH/YEAR

ENTER MM/YYYY

NO SPECIFIC MONTH/YEAR DUE TO CHRONIC/GRADUAL ONSET CONDITION

DK

REF 

INTERVIEWER NOTE: IF ILLNESS/INJURY IS A CHRONIC/GRADUAL ONSET CONDITION FOR WHICH 

RESPONDENT IS UNABLE TO SPECIFY MONTH/YEAR OF OCCURRENT, MARK “NO SPECIFIC 

MONTH/YEAR”

A4.[Now I want to find out if you experienced any other work-related injuries other than the TEXT FILL INJURY

RESPONDENT REPORTED (e.g., concussion) you just told me about.] In the last 12 months, have you 

experienced any [other] injuries, such as the following, related to any job you held? 

a. Sprains, strains or tears

b. Soreness or pain

c. Bruises

d. Cuts or punctures

e. Broken bones

f. Injury to muscles or joints

g. Open wounds

h. Burns 

i. Carpal tunnel syndrome
3 

j. Any other injury? 

1) YES  COLLECT BRIEF DESCRIPTION, CONFIRM WORK-RELATED

2) NO SKIP TO A6

3) DK SKIP TO A6

4) REF SKIP TO A6

INTERVIEWER NOTE: READ DEFINITION IF NECESSARY. Carpal tunnel syndrome is a hand and arm condition 

that causes numbness, tingling and other symptoms. Carpal tunnel syndrome is caused by a pinched nerve in your wrist.

[http://www.mayoclinic.org/diseases-conditions/carpal-tunnel-syndrome/basics/definition/con-20030332]

A5. In what month and year did this injury occur? 

MONTH/YEAR

ENTER MM/YYYY

NO SPECIFIC MONTH/YEAR DUE TO CHRONIC/GRADUAL ONSET CONDITION

DK

REF 

A6. [Other than the TEXT FILL ILLNESS RESPONDENT REPORTED (e.g., asthma) you have already mentioned], 

in the last 12 months, have you experienced any [other] illnesses, such as the following, related to any job you 

held? 

a. Skin disorders

b. Respiratory conditions

c. Poisonings

d. Hearing loss

e. A disease or infection

f. Cancer 

g. Anxiety or depression

h. Any other illness? 

1) YES  COLLECT BRIEF DESCRIPTION, CONFIRM WORK-RELATED

2) NO SKIP TO A8

3) DK SKIP TO A8

4) REF SKIP TO A8

A7. In what month and year did this injury/illness occur? 

MONTH/YEAR

ENTER MM/YYYY

NO SPECIFIC MONTH/YEAR DUE TO CHRONIC/GRADUAL ONSET CONDITION

DK

REF 
4 

A8.[Other than the TEXT FILL INJURY/ILLNESS RESPONDENT REPORTED (e.g, concussion, asthma) you have 

already mentioned], in the last 12 months, have you experienced any [other] work-related injuries or illnesses that 

caused you to...

Yes No DK REF

a. Faint, pass out, or lose consciousness? 

b. Be unable to work for a day or more?

c. Do less than your normal work activities?

d. Be assigned to a different job or tasks at your 

place of work?

e. Get medical treatment other than what can be 

treated with a first aid kit?

IF YES, COLLECT BRIEF DESCRIPTION AND CONFIRM WORK-RELATED.

IF NO TO ALL ITEMS IN A8, SKIP TO A10.

READ IF NECESSARY: First aid refers to medical attention that is usually administered immediately after the injury 

occurs and at the location where it occurred. It often consists of a one-time, short-term treatment and requires little 

technology or training to administer. First aid can include cleaning minor cuts, scrapes, or scratches; treating a minor 

burn; applying bandages and dressings; the use of non-prescription medicine...

https://www.osha.gov/SLTC/medicalfirstaid/recognition.html

A9. In what month and year did this injury/illness occur? 

MONTH/YEAR

ENTER MM/YYYY

DK

REF 

IF R HAS NOT REPORTED ANY INJURIES OR ILLNESSES ASK ABOUT INJURIES/ILLNESSES EVER

EXPERIENCED. ELSE GO TO DEMOGRAPHICS.]

A10. Have you EVER experienced any injuries or illnesses related to any job you held? 

a. YES  COLLECT BRIEF DESCRIPTION, CONFIRM WORK-RELATED

b. NO  SKIP TO DEMOGRAPHICS

c. DK  SKIP TO DEMOGRAPHICS

d. REF  SKIP TO DEMOGRAPHICS

A11. In what month and year did this injury/illness occur? 

MONTH/YEAR

ENTER MM/YYYY

DK

REF 

A12. [IF YES TO ANY INJURIES OR ILLNESSES] You have told me about X work-related injuries and illnesses 

you have experienced in the last 12 months.

BRIEFLY LIST EACH INJURY/ILLNESS: TEXT FILL #1, TEXT FILL #2, TEXT FILL #3, ETC.
5 

Is that correct?

________TIMES

INTERVIEWER: CONFIRM NUMBER OF INCIDENTS AND BRIEF DESCRIPTION OF EACH. IF 

INJURY/ILLNESS EXPERIENCED WITHIN LAST YEAR, RESPONDENT WILL REPORT ON THOSE. 

OTHERWISE, IF NO INJURY/ILLNESS WITHIN LAST YEAR, RESPONDENT WILL REPORT ON 

INJURIES/ILLNESSES EVER EXPERIENCED.

IF NO INCIDENTS OF WORK-RELATED INJURIES AND ILLNESSES, GO TO DEMOGRAPHICS SECTION.

Notes to interviewer:

The goal of the screener section is to enumerate all instances of work-related injuries and illnesses that occurred during 

the reference period. What issues do respondents have in reporting these incidents? Do they understand the types of 

injuries and illnesses to report? Can they accurately report only those that are work-related? How do they determine the 

boundary of the reference period and determine whether an incident occurred within the RP?

Injury or Illness

 

[FOR FIRST INJURY/ILLNESS START AT B2] 

[FOR SECOND AND FOLLOWING INJURY/ILLNESS START AT B1] 

B1. [FOR SECOND/THIRD/ETC. LOOPS] How is this injury/illness related to the other injury/illness you 

mentioned? Is this related to [the other/another] injury/illness you already mentioned or is it a different 

injury/illness?

a. RELATED TO THE OTHER/ANOTHER INJURY/ILLNESS [GO TO NEXT LOOP]

b. THIS IS A DIFFERENT INJURY/ILLNESS [CONTINUE]

c. DK

d. REF 
6 

“Now I am going to ask you more about [INJURY/ILLNESS #....].”

B2. [WORKER ACTIVITY + some EVENT and SOURCE] [FOR EACH LOOP] Please 

describe how the injury, illness, or condition occurred, and what caused it. For example: 

“When ladder slipped on wet floor, I fell 20 feet”; “I developed soreness in wrist over 

time.” [OPEN ENDED]

B3. [SOURCE] Were there any other objects, substances, or persons involved in the injury 

or illness that you didn’t mention? Please include equipment, chemicals, vehicles, or 

anything else.

B4. [NATURE AND BODY PART] Please describe the injury, illness, or condition. How 

was [BODY PART, ORGAN] affected? You can use medical terms if you know them, 

or just talk about the symptoms you experienced. For example: “strained back”; 

“chemical burn on hand”; “fainted or passed out.” 

B5. [NATURE AND BODY PART] Were there any other parts of your body or organs

affected by the injury or illness that you may not have included in your description? 

How was [BODY PART, ORGAN] affected?

Notes to interviewer:

Questions B2 through B5 are intended to capture (event or exposure, source of the injury/illness, part of body affected, 

and nature of the injury/illness). Do the questions elicit the information needed? Are the response options adequate to 

capture the information Rs give? Use general probing to elicit more information about the incident. (For example, if R 

says “I cut myself” ask: What part of your body was injured? What did you get cut with? What were you doing at the 

time?

Medical attention

The next questions are about medical care you may have received for this injury/illness. Please think about the care you 

received immediately after the injury/illness occurred as well as follow-up care you received at a later time.

C1. Did you get medical advice or treatment for this injury/illness from...

a. A doctor, nurse, or other healthcare professional?

[IF YES]: What type of health care professional 

did you see?

YES NO NA DK/REF

b. [UNLESS MENTIONED ABOVE] A 

paramedic, firefighter, or other emergency 

medical personnel?

C2. Did you get medical advice or treatment for this injury/illness at... 

a. A hospital? YES NO NA DK/REF

A1. [IF YES TO HOSPITAL] Did you 

receive treatment at the hospital emergency 

room (ER)?

CHECKLIST

1. Description or 

diagnosis for 

injury/illness (this is 

the OIICS nature) 

2. Part or parts of body 

affected, including 

body systems 

(OIICS part, 

obviously)

3. How the 

injury/illness/exposu

re happened (OIICS 

event) 

4. Vehicles, tools, 

chemicals, surfaces, 

or any other objects 

involved; this can be 

multiple objects; this 

can also just be the 

person’s body 

moved incorrectly 

(OIICS sources) 
7 

A2.[IF YES TO HOSPITAL] Were you 

admitted for an overnight stay?

A3. [IF YES TO ADMITTED] How many 

nights were you in the hospital? _________ 

NIGHTS

b. A health clinic at your place of employment?

c. Any place else? Please specify.

[IF YES TO C1 OR C2, CONTINUE TO C3.] 

[OTHERWISE SKIP TO C5]

C3. [IF YES TO C1 OR C2]. Did you receive a medical diagnosis from a health care professional? ...

READ IF NECESSARY: Did a health care professional tell you the medical term for your injury/illness?

a. YES  What was your medical diagnosis? INTERVIEWER READ IF NECESSARY: What is the 

medical term the health care professional used to describe your injury/illness?

b. NO 

c. DK 

d. REF 

 

C4. [IF YES TO C1 OR C2]. Did your health care professional recommend that you take any days off from work due 

to your injury/illness? 

a. YES  How many days off did the health care professional recommend? _______ DAYS OFF

b. NO 

c. DK 

d. REF 

Effect on work

The next questions are about how the injury/illness affected your ability to work. 

IF RESPONDENT HAS A CHRONIC/GRADUAL ONSET INJURY/ILLNESS, GO TO D13. 

D1.Were you scheduled to work the day after the injury/illness? 

a. YES

b. NO SKIP TO D3

c. DK SKIP TO D3

d. REF SKIP TO D3

D2.[IF SCHEDULED TO WORK NEXT DAY] Were you able to work the next day? 

a. YES  SKIP TO D6 

b. NO  SKIP TO D4

c. DK SKIP TO D4

d. REF SKIP TO D4

D3.[IF WAS NOT SCHEDULED TO WORK NEXT DAY] If you had been scheduled to work, would you have 

been able to work the next day? 

a. YES  SKIP TO D6

b. NO

c. DK

d. REF 
8 

D4. Did you return to work after the injury/illness?

a. YES

b. YES, BACK TO WORK SAME DAYSKIP TO D6 

c. NO SKIP TO D19 

d. NO, STILL OFF PAID WORK BUT EXPECTS TO RETURNSKIP TO D19 

e. NO, EXPECTS NEVER TO DO PAID WORK AGAINSKIP TO D19 

f. DK SKIP TO D19 

g. REF SKIP TO D19 

D5. [IF RETURNED TO WORK] How many days after the injury/illness did you start work again?

a. _____DAYS AFTER THE INJURY/ILLNESS

b. BACK TO WORK SAME DAY

c. BACK TO WORK NEXT DAY

d. DK

e. REF

INTERVIEWER NOTE: IF R INDICATES WENT BACK TO WORK ONE DAY AFTER INJURY/ILLNESS, 

CONFIRM THAT R MEANS THAT R WENT BACK TO WORK THE NEXT DAY, THAT IS, THE DAY AFTER 

INJURY/ILLNESS OCCURRED.

[IF R WENT BACK TO WORK, CONTINUE. ELSE IF R IS NOT WORKING, GO TO D19.]

D6. When you went back to work, did you work your usual number of hours or not?

a. YES 

b. NO 

c. DK

d. REF 

D7. When you went back to work, were you able to perform all of the normal duties of your job or not?

a. YES 

b. NO 

c. DK

d. REF 

D8. When you went back to work, were you assigned a different job or tasks than what you did prior to the 

injury/illness? 

a. YES 

b. NO SKIP TO D10

c. DK SKIP TO D10

d. REF SKIP TO D10

D9.[IF DIFFERENT, D8=YES] Was your assignment to a different job or tasks permanent or temporary? 

a. PERMANENT 

b. TEMPORARY 

c. DK

d. REF 
9 

D10. At any time after you went back to work, did you miss any (additional) days of work due to your injury/illness? 

a. YES 

b. NO SKIP TO D19 

c. DK SKIP TO D19 

d. REF SKIP TO D19 

D11. About how many (additional) days of work did you miss? 

_______ DAYS

D12. Please explain what happened.

GO TO D19. 

QUESTIONS ON EFFECT ON WORK FOR RESPONDENTS WITH CHRONIC/GRADUAL ONSET CONDITIONS:

D13. In the last 12 months, after you began experiencing symptoms due to TEXT FILL, did you miss any days of 

work, or not?

a. YES, MISSED DAYS OF WORK 

b. NO, DID NOT MISS DAYS OF WORK 

c. DK

d. REF 

D14. About how many days of work did you miss?

_______ DAYS

When you worked...

D15. Did you work your usual number of hours or not?

D16. Were you able to perform all of the normal duties of your job or not?

D17. Were you assigned to a different job or tasks than what you did prior to the onset of symptoms?

D18. [IF YES TO D17] Was your assignment to a different job or tasks permanent or temporary?

[TRANSITION STATEMENT FOR THOSE WHO RETURNED TO WORK: At any point after you returned to work, 

did the injury/illness affect your job in any of the following ways?]

D19. Did the injury/illness cause you to: 

YES NO NA DK/REF

a. Quit your job?

b. Be laid off?

c. Be fired?

d. Change the kind of work you do, that is, 

change your occupation?

D20. Did the injury/illness affect your ability to work in any other way?

a. YES  Please specify.

b. NO 

c. DK

d. REF 
10 

Effect on Pay

The next questions are about how the injury/illness affected your income or pay. 

E1. Did your employer know about this injury/illness?

a. YES SKIP TO E3

b. NO

c. DK

d. REF 

E2. [IF NO TO EMPLOYER KNOWING]: For what reasons did your employer not know about this injury/illness? 

Did you not want your employer to know about your injury/illness... 

YES NO NA DK/REF

a. To avoid being laid off?

b. To avoid loss of wages?

c. To avoid loss of promotion of 

advancement?

d. To avoid job transfer or restriction?

e. Because you did not realize that the 

injury/illness was work-related until 

after leaving the job?

f. Because you felt your employer would 

not recognize the injury/illness as 

work-related?

g. Because your employer wants to keep 

injury and illness rates low?

h. Other (specify)?

The next questions are about workers’ compensation. Workers’ compensation is insurance that provides you with your 

lost wages and medical care when you become injured or ill due to your job. 

E3. Has anyone filed a workers’ compensation claim for this injury/illness?

a. YES

b. NO SKIP TO E5

c. DK

d. REF 

E4. Who filed the workers’ compensation claim?

a. EMPLOYER

b. EMPLOYEE

c. FAMILY MEMBER OF EMPLOYEE

d. OTHER SPECIFY

e. DK

f. REF 

ALL RESPONSES TO E4 GO TO SKIP INSTRUCTION BEFORE E6. 
11 

E5. IF NO ON QUESTION ABOUT FILING WORKERS’ COMPENSATION: What was the main reason you or 

your employer did not file a workers’ compensation claim for this injury/illness?

a. You were not eligible because you did not meet waiting period

b. Your employer did not want to file a claim

c. You did not inform employer

d. You were unaware of workers’ compensation coverage

e. You chose not to pursue a claim even though you were eligible

f. Other reason, please specify

g. DK

h. REF 

SKIP INSTRUCTION: 

#1: WC FILED, CONTINUE TO E6. 

#2: ELSE IF NO WC FILED BUT MISSED DAYS OF WORK, SKIP TO E8. 

#3: ELSE [NO WC FILED AND DID NOT MISS DAYS OF WORK] SKIP TO SECTION F. 

E6. IF R REPORTS WORKERS’ COMPENSATION CLAIM FILED: Did you receive workers’ compensation for 

this injury/illness? 

a. YES

b. NO

c. NA

d. DK

e. REF 

READ IF NECESSARY: Workers compensation is insurance that provides you with your lost wages and medical 

care when you become injured or ill due to your job.

E7. IF R REPORTS WORKERS’ COMPENSATION NOT RECEIVED: Is there an open claim pending for this 

injury/illness?

a. YES

b. NO

c. NA

d. DK

e. REF 

E8. Short-term or temporary disability benefits provide you with a portion of your income if you are temporarily 

unable to work due to a medical condition. Did you receive short-term (temporary) disability for this 

injury/illness? 

a. YES

b. NO

c. NA

d. DK

e. REF 

E9. Did this injury/illness cause you to use paid sick leave, paid annual leave, or paid time off? 

a. YES

b. NO

c. NA

d. DK

e. REF 

E10. Did this injury/illness cause you to take leave without pay?
12 

a. YES

b. NO

c. NA

d. DK

e. REF 

E11. Did your employer continue to pay your wages and other compensation in full during the period you were unable 

to work because of this injury/illness?

a. YES

b. NO

c. NA

d. DK

e. REF 

Notes to interviewer:

Do Rs know what workers’ compensation is? Do they know whether a WC form was filed? Are the terms in E6-E11 

familiar to Rs? Are the definitions helpful? 

Occupation and Industry at Time of Injury or Illness

The next questions are about your occupation and industry at the time of the injury/illness. Please think about the job you 

held at the time of the injury/illness [TEXT FILL DESCRIPTION]. 

F1. Were you considered by your employer to be a full time or part time employee?

a. FULL-TIME 

b. PART-TIME 

c. DK

d. REF 

F2. In a typical week, how many hours did you work? ______hours 

IF NECESSARY: Was it greater than or equal to 35 hours per week?

DK

REF 

F3. Which of the following groups best describes your employer at the time of the injury/illness? 

a. Government 

b. Private-for-profit company SKIP TO F5

c. Non-profit organization including tax exempt and charitable organizations  SKIP TO F5

d. Self-employed  SKIP TO F5

e. Working in the family business SKIP TO F5

F4. Would that be the federal, state, or local government? 

a. FEDERAL

b. STATE 

c. LOCAL

F5. Did you work for a temporary help agency or a temporary staffing agency? 

a. YES

b. NO

c. DK

d. REF 
13 

INTERVIEWER NOTE: IF R IS A FARM LABOR CONTRACTOR, R IS NOT CONSIDERED 

TEMPORARY HELP/STAFFING AND RESPONSE TO THIS Q IS NO.

[IF F5 (TEMP HELP OR TEMP STAFFING AGENCY) =YES]: For the next questions, please answer based on the 

place where you were working on a day-to-day basis when the injury/illness occurred, not the temporary agency you 

worked for.

F6. What is the name of the (company, organization or agency) for whom you worked? [OPEN ENDED] 

DK

REF 

NOTE: IF GOVERNMENT EMPLOYER, TEXT FILL=AGENCY; IF NON-PROFIT, TEXT FILL=ORGANIZATION; 

ELSE TEXT FILL=COMPANY. 

F7. What kind of business or industry was this? [OPEN ENDED] 

DK

REF 

F8. What did they make or do where you worked? [OPEN ENDED] 

DK

REF 

F9. In what state were you employed at this job? [OPEN ENDED] 

DK

REF 

F10. What kind of work did you do? (For example: registered nurse, personnel manager, supervisor of order 

department, secretary, accountant) [OPEN ENDED]

DK

REF 

F11. What were your most important activities or duties? (For example: patient care, directing hiring policies, 

supervising order clerks, typing and filing, reconciling financial records) [OPEN ENDED]

DK

REF 

F12. At this job, were you a member of a union or covered by a collective bargaining agreement?

a. YES

b. NO

c. DK

d. REF 

F13. How many people worked at your work location?

e. 1 to 10 workers

a. 11 to 49 workers

b. 50 to 249 workers

c. 250 to 999 workers

d. 1000 or more workers

e. DK

f. REF 
14 

IF R HAS ADDITIONAL INJURIES/ILLNESSES TO REPORT, GO BACK TO SECTION B. ELSE GO TO G1. 

Notes to interviewer:

Does R have any difficulty recalling FT vs. PT work? How do Rs with irregular work schedules, seasonal employment, 

etc., answer the question? Does the number of hours per week typically worked accord with report of FT/PT status?

Observe respondent ability to understand and respond to questions about employment at time of the injury/illness. Probe 

as needed to explore an issues with response. Are respondents able to accurately report answers for F12 and F13? F13 

should include total for R’s work location only, not the whole company/organization. 

Demographic Characteristics

Race/ethnicity

G1. Are you Spanish, Hispanic, or Latino?

a. YES 

b. NO

c. DK

d. REF 

G2. [I am going to read you a list of five race categories.] Please choose one or more races that you consider yourself 

to be: 

a. White

b. Black or African American

c. American Indian or Alaska Native

d. Asian

e. Native Hawaiian or Other Pacific Islander

f. Other ________ 

g. DK

h. REF 

Age

G3. What is your date of birth? Enter MM/DD/YYYY 

DK

REF 

G4. As of last week, that would make you approximately (AGE) years old. Is that correct?

[IF NECCESARY] Even though you don’t know your exact birthdate, what is your best guess as to how old 

you were on your last birthday? 

______ YEARS

DK

REF 

Marital Type

G5. Are you now married, widowed, divorced, separated or never married? 

a. MARRIED 

b. WIDOWED 

c. DIVORCED 

d. SEPARATED 

e. NEVER MARRIED

f. DK

g. REF 
15 

Gender

G6. Are you male or female? 

a. MALE

b. FEMALE

Education

G7. What is the highest level of school you have completed or the highest degree you have received? 

a. Less than high school

b. High school or GED

c. Associate degree or some college

d. Bachelor’s degree or above

G8. In what country were you born? 

___________________________ [OPEN-ENDED]

Current Industry and Occupation

The next questions are about your current job. If you have more than one job, please tell me about the job at which you 

usually work the most hours. If you work the same number of hours at two jobs, please tell me about the job where you 

were employed the longest.

H1. What is your current employment status? Are you currently employed full-time, part-time, or are you not 

employed?

a. FULL-TIME 

b. PART-TIME 

c. NOT CURRENTLY EMPLOYED SKIP TO END OF SURVEY

d. DK

e. REF 

H2. [IF CURRENTLY EMPLOYED] Is this job with the same employer you have already told me about? 

a. YES, SAME EMPLOYER  CONTINUE TO H3

b. NO, DIFFERENT EMPLOYER  SKIP TO H5

INTERVIEWER NOTE: 

• IF R HAS ONLY ONE INJURY/ILLNESS AND SAME EMPLOYER OR MULTIPLE INJURIES UNDER

SAME EMPLOYER, SKIP TO H4

• IF R HAS MULTIPLE INJURIES UNDER DIFFERENT EMPLOYERS, BUT CURRENT EMPLOYMENT IS 

WITH SAME EMPLOYER, CONTINUE TO H3

H3. [IF MULTIPLE INJURIES UNDER DIFFERENT EMPLOYERS BUT SAME AS CURRENT 

EMPLOYMENT] Which job and employer are you referring to? 

_________________

H4. [IF SAME EMPLOYER] Are you in the same position you were in at the time the injury/illness [TEXT FILL]?

a. YES SKIP TO PROBES AT END OF SECTION

b. NO

c. DK

d. REF 
16 

INTERVIEWER NOTE: IF SAME EMPLOYER BUT DIFFERENT JOB, ASK H5 (HOW MANY HOURS 

WORKED), H11 (WHAT KIND OF WORK DO YOU DO), AND H12 (MOST IMPORTANT ACTIVITIES OR 

DUTIES). 

H5. [IF SAME EMPLOYER BUT DIFFERENT JOB OR DIFFERENT EMPLOYER THAN DURING INJURY 

ILLNESS] Currently, in a typical week, how many hours do you work? 

 ______hours

IF NECESSARY: Was it greater than or equal to 35 hours per week? 

DK 

REF 

INTERVIEWER NOTE: IF SAME EMPLOYER BUT DIFFERENT JOB, SKIP TO H11.

H6. [IF DIFFERENT EMPLOYER THAN DURING INJURY ILLNESS] Which of the following groups best 

describes your CURRENT employer? 

a. Government 

b. Private-for-profit company SKIP TO H8

c. Non-profit organization including tax exempt and charitable organizations  SKIP TO H8

d. Self-employed  SKIP TO H8

e. Working in the family business SKIP TO H8

H7. [IF DIFFERENT EMPLOYER THAN HAD DURING INJURY/ILLNESS] Would that be the federal, state, or 

local government? 

a. FEDERAL

b. STATE 

c. LOCAL

H8. [IF DIFFERENT EMPLOYER THAN HAD DURING INJURY/ILLNESS] What is the name of the (company, 

organization or agency) for whom you work? [OPEN ENDED] 

DK

REF 

H9. [IF DIFFERENT EMPLOYER THAN HAD DURING INJURY/ILLNESS] What kind of business or industry is 

this? [OPEN ENDED] 

DK

REF 

H10. [IF DIFFERENT EMPLOYER THAN HAD DURING INJURY/ILLNESS] What do they make or do where 

you work? [OPEN ENDED] 

DK

REF 

H11. [IF SAME EMPLOYER BUT DIFFERENT JOB OR DIFFERENT EMPLOYER THAN DURING INJURY 

ILLNESS] What kind of work do you do? (For example: registered nurse, personnel manager, supervisor of order 

department, secretary, accountant) [OPEN ENDED] 

DK

REF 

H12. [IF SAME EMPLOYER BUT DIFFERENT JOB OR DIFFERENT EMPLOYER THAN DURING INJURY 

ILLNESS] What are your most important activities or duties? (For example: patient care, directing hiring policies, 

supervising order clerks, typing and filing, reconciling financial records) [OPEN ENDED] 
17 

DK

REF 

Debriefing questions for self-interview:

Review of screener section

• How easy or difficult was it for you to answer questions about injuries/illnesses that occurred over the last 

year? 

• How easy or hard was it to remember when the injury/illness happened? Can you tell me more about that? 

How did you figure out when the injury/illness happened?

• [IF CHRONIC/GRADUAL ONSET CONDITION AND PROVIDED DATE OF OCCURRENCE] How did 

you determine what month/year the injury/illness occurred?

Review of injury/illness section (Section B)

• [IF R DOES NOT PROVIDE ENOUGH INFO ABOUT THE INJURY/ILLNESS OR HOW IT IS WORKRELATED] Tell me more about how this injury/illness was related to your job. Where were you when this 

happened? What were you doing? What caused the injury/illness? What part of your body was injured or 

affected? Tell me more about the injury/illness. Tell me about the kind of work you do. 

Review of medical care section (Section C)

• Walk me through the medical attention you received immediately after the injury/illness occurred and any 

follow-up care that you experienced.

Review of effect on work section (Section D)

• [IF YES TO ANY ITEMS IN SECTION D] Tell me more about [TEXT FILL]. What kind of effect did the 

injury/illness have on your work schedule? Job duties? Ability to work? Ability to keep your job? Was the 

effect on [TEXT FILL] temporary or permanent?

• [IF MISSED WORK IMMEDIATELY AFTER INJURY/ILLNESS OCCURRED BUT RETURNED TO 

WORK] You said you were able to start work again XX days after the injury/illness. How did you figure that 

out? Walk me through the timeline of when you were injured and when you got back to work. You said you 

missed XX additional days of work due to this injury/illness. How did you figure that out? Please tell me more 

about what happened. 

• [IF MISSED ANY DAYS OF WORK DUE TO CHRONIC GRADUAL ONSET INJURY/ILLNESS] You 

said you missed XX days as a result of the injury/illness. How did you figure that out? When did you miss 

those days of work?

Review of effect on income or pay section (Section E)

• [IF NO TO E1] Tell me more about the reasons why your employer did not know about this injury/illness. 

What was the main reason your employer did not know? Tell me more about that.

• [IF NO TO E3] Tell me more about the reasons why you or your employer did not file a workers’ 

compensation claim for this injury/illness? 

• What kind of effect did the injury/illness have on your income or pay? 

• [IF YES TO ANY ITEM E8-E10] Tell me more about [TEXT FILL].

Review of selected questions (Return to any questions that need further exploration)

• I’d like to ask you a little more about [QUESTION]. You said [FILL]. In your own words, what do you think 

that question was asking? How did you decide on your answer?

General debriefing

• Were there any questions that were particularly difficult to answer? Tell me more about that?

• Were there any questions you felt uncomfortable answering?
18 

• What are your suggestions on how to improve the survey?

• Is there anything else that we should know about your injury/illness that we did not ask you about?

• Do you have any questions about the survey? 

Debriefing questions for proxy respondents:

Proxy

• What is your relationship to [RESPONDENT NAME]?

• How much would you say you know about R’s job?

• How familiar would you say you are with R’s work-related injury/illness? Are you aware of the medical 

treatment he/she received when the injury/illness occurred? Are you aware of how this affected R’s job? How 

did you learn about R’s injury/illness? Who in your household besides R would be the best person to answer 

the kinds of questions I asked?

• What questions were the hardest for you to answer for R? Why? How much would you say you know about 

[QUESTION TOPIC]? How easy/hard is it to remember the information the question asked about? Tell me 

more.

• What questions were the easiest for you to answer for R? Why? How much would you say you know about 

[QUESTION TOPIC]? How easy/hard is it to remember the information the question asked about? Tell me 

more.

Sensitivity

• Were you worried/Would you be worried about telling anyone else about R’s work-related injury/illness? Tell 

me more about that.

Review of selected items

• I’d like to ask you a little more about [QUESTION]. You said [FILL]. In your own words, what do you think 

that question was asking? How did you decide on your answer?

General debriefing

• What are your suggestions on how to improve the survey?

• What questions were the most difficult for you to answer?

• What questions were the easiest to answer?

Notes to interviewer:

Is proxy reporting of work-related injuries and illnesses a sensitive issue? Why or why not?

What questions are the most and least difficult for Rs to answer? What answers are they uncertain about? Do they 

have suggestions for improving the survey?

Return to any questions that need further exploration. 

STEP 3: END OF INTERVIEW

Thank you for taking part in this survey.

□ STOP THE RECORDER.
19 

RECRUITMENT QUESTION:

We are looking for additional respondents like you who would be interested in helping with the study. Do you know 

anyone who had a work-related injury or illness who might be interested in participating? If yes, would you mind if we 

gave you a flyer about the study and send you an email about the study that you could forward to them? 

INTERVIEWER: ANSWER ANY RESPONDENT QUESTIONS. 

This concludes the interview. I would be happy to answer any questions that you have. Thank you for your help with this 

study.

□ MARK CASE AS COMPLETE IN RECRUITMENT DATABASE. 

MATERIALS TO TAKE AWAY FROM INTERVIEW

□ INTERVIEWER PROTOCOL BOOKLET (THIS BOOKLET)

□ DIGITAL RECORDER AND BATTERIES

□ NOTE PAPER, PENS, PENCILS
1 

HOUSEHOLD SURVEY OF OCCUPATIONAL INJURIES AND ILLNESSES

Cognitive interview protocol R3 Version 4 

9-27-2016

MATERIALS NEEDED FOR INTERVIEW

□ INTERVIEWER PROTOCOL BOOKLET (THIS BOOKLET) AND SHOWCARDS

□ CONSENT FORM

□ RESPONDENT PHONE NUMBER

□ FULLY CHARGED DIGITAL RECORDER AND EXTRA BATTERIES

□ NOTE PAPER, PENS AND PENCILS

STEP 1: INFORMED CONSENT

PROVIDE RESPONDENT WITH A COPY OF THE INFORMED CONSENT FORM. ASK THE RESPONDENT 

TO READ THE FORM, ANSWER ANY QUESTIONS, AND HAVE THE RESPONDENT SIGN THE FORM. 

LEAVE A SEPARATE COPY OF THE FORM WITH THE RESPONDENT.

□ COLLECT VERBAL CONSENT FROM RESPONDENT

□ IF THE RESPONDENT HAS CONSENTED TO RECORDING, START THE RECORDER.

STEP 2: COMPLETION OF THE QUESTIONNAIRE

BEGIN QUESTIONNAIRE. 

Interviewer probe bank (use as appropriate):

• “How did you come up with that answer?”

• “Can you tell me in your own words what you think the question is asking?”

• “Can you tell me more about that?”

If you pick up on a visual cue that suggests an issue or confusion: 

• “Tell me what you are thinking.”

• What does the word [term] in this question mean to you?

• You said [answer]. Can you tell me more about that?

If R is uncertain and asking for confirmation:

• There is not a right or wrong answer for this question. I am interested in hearing your thoughts on what 

the question is asking.

INTERVIEWER: If this interview is with a proxy respondent, please modify language accordingly. For example, instead 

of asking “Did you do ANY work for pay or profit?” ask “Did [your husband/wife/brother/he/she] do ANY work for pay 

or profit?”
2 

Survey Introduction

The information that you provide in this survey is confidential. Your name and your answers to the questions will not be 

shared with anyone outside of NORC, the survey organization conducting this survey. I would be happy to answer any 

questions you may have about the survey. [ANSWER RESPONDENT QUESTIONS.] Let’s begin. 

Screener

This survey is about work-related injuries and illnesses that you may have experienced. I will ask you questions about the 

injuries and illnesses you may have had that are related to any job you held in the last 12 months By the last 12 months, I 

mean since [CURRENT MONTH] of [LAST YEAR]. 

A1.In the last 12 months, did you do ANY work for pay or profit?

a. Yes  ELIGIBLE, CONTINUE

b. No  NOT ELIGIBLE, END INTERVIEW

c. DK

d. REF 

Any injury

A2.In the last 12 months, have you experienced any injuries or illnesses related to any job you held? 

a. Yes  COLLECT BRIEF DESCRIPTION, CONFIRM WORK-RELATED

b. No  SKIP TO A4 

c. DK

d. REF 

A3.In what month and year did this injury/illness occur? [IF ILLNESS/INJURY IS A CHRONIC/GRADUAL 

ONSET CONDITION, ASK ALTERNATIVE QUESTIONS AS NEEDED: Did this injury/illness occur on a 

specific day or did it develop over time? Did you experience symptoms related to this injury/illness in the last 12 

months?

MONTH/YEAR

ENTER MM/YYYY

NO SPECIFIC MONTH/YEAR BUT SYMPTOMS EXPERIENCED IN LAST 12 MONTHS

DK

REF 

INTERVIEWER NOTE: IF INJURY/ILLNESS OCCURRED ON A SPECIFIC DAY, RESPONDENT SHOULD 

PROVIDE BEST ESTIMATE OF MONTH/YEAR. THE MONTH/YEAR REPORTED MUST BE IN REFERENCE 

PERIOD TO BE ELIGIBLE. IF DEVELOPED OVER TIME, CONFIRM THAT REPSPONDENT NOTICED 

SYMPTOMS DURING REFERENCE PERIOD TO BE ELIGIBLE.

A4.[Now I want to find out if you experienced any other work-related injuries other than the TEXT FILL INJURY

RESPONDENT REPORTED (e.g., concussion) you just told me about.] In the last 12 months, have you 

experienced any [other] injuries, such as the following, related to any job you held? 

a. Sprains, strains or tears

b. Soreness or pain

c. Bruises

d. Cuts or punctures

e. Broken bones

f. Injury to muscles or joints

g. Open wounds
3 

h. Burns 

i. Carpal tunnel syndrome

j. Any other injury? 

1) YES  COLLECT BRIEF DESCRIPTION, CONFIRM WORK-RELATED

2) NO SKIP TO A6

3) DK SKIP TO A6

4) REF SKIP TO A6

INTERVIEWER NOTE: READ DEFINITION IF NECESSARY. Carpal tunnel syndrome is a hand and arm condition 

that causes numbness, tingling and other symptoms. Carpal tunnel syndrome is caused by a pinched nerve in your wrist.

[http://www.mayoclinic.org/diseases-conditions/carpal-tunnel-syndrome/basics/definition/con-20030332]

A5. In what month and year did this injury occur? [IF ILLNESS/INJURY IS A CHRONIC/GRADUAL ONSET 

CONDITION, ASK ALTERNATIVE QUESTIONS AS NEEDED: Did this injury/illness occur on a specific day 

or did it develop over time? Did you experience symptoms related to this injury/illness in the last 12 months?

MONTH/YEAR

ENTER MM/YYYY

NO SPECIFIC MONTH/YEAR DUE TO CHRONIC/GRADUAL ONSET CONDITION

DK

REF 

A6. [Other than the TEXT FILL ILLNESS RESPONDENT REPORTED (e.g., asthma) you have already mentioned], 

in the last 12 months, have you experienced any [other] illnesses, such as the following, related to any job you 

held? 

a. Skin disorders

b. Respiratory conditions

c. Poisonings

d. Hearing loss

e. A disease or infection

f. Cancer 

g. Anxiety or depression

h. Any other illness? 

1) YES  COLLECT BRIEF DESCRIPTION, CONFIRM WORK-RELATED

2) NO SKIP TO A8

3) DK SKIP TO A8

4) REF SKIP TO A8

A7. In what month and year did this injury/illness occur? [IF ILLNESS/INJURY IS A CHRONIC/GRADUAL 

ONSET CONDITION, ASK ALTERNATIVE QUESTIONS AS NEEDED: Did this injury/illness occur on a 

specific day or did it develop over time? Did you experience symptoms related to this injury/illness in the last 12 

months?

MONTH/YEAR

ENTER MM/YYYY

NO SPECIFIC MONTH/YEAR DUE TO CHRONIC/GRADUAL ONSET CONDITION

DK

REF 
4 

A8.[Other than the TEXT FILL INJURY/ILLNESS RESPONDENT REPORTED (e.g, concussion, asthma) you have 

already mentioned], in the last 12 months, have you experienced any [other] work-related injuries or illnesses that 

caused you to...

Yes No DK REF

a. Faint, pass out, or lose consciousness? 

b. Be unable to work for a day or more?

c. Do less than your normal work activities?

d. Be assigned to a different job or tasks at your 

place of work?

e. Get medical treatment other than what can be 

treated with a first aid kit?

IF YES, COLLECT BRIEF DESCRIPTION AND CONFIRM WORK-RELATED.

IF NO TO ALL ITEMS IN A8, SKIP TO A10.

READ IF NECESSARY: First aid refers to medical attention that is usually administered immediately after the injury 

occurs and at the location where it occurred. It often consists of a one-time, short-term treatment and requires little 

technology or training to administer. First aid can include cleaning minor cuts, scrapes, or scratches; treating a minor 

burn; applying bandages and dressings; the use of non-prescription medicine...

https://www.osha.gov/SLTC/medicalfirstaid/recognition.html

A9. In what month and year did this injury/illness occur? [IF ILLNESS/INJURY IS A CHRONIC/GRADUAL 

ONSET CONDITION, ASK ALTERNATIVE QUESTIONS AS NEEDED: Did this injury/illness occur on a 

specific day or did it develop over time? Did you experience symptoms related to this injury/illness in the last 12 

months?

MONTH/YEAR

ENTER MM/YYYY

DK

REF 

IF R HAS NOT REPORTED ANY INJURIES OR ILLNESSES ASK ABOUT INJURIES/ILLNESSES EVER

EXPERIENCED. ELSE GO TO DEMOGRAPHICS.]

A10. Have you EVER experienced any injuries or illnesses related to any job you held? 

a. YES  COLLECT BRIEF DESCRIPTION, CONFIRM WORK-RELATED

b. NO  SKIP TO DEMOGRAPHICS

c. DK  SKIP TO DEMOGRAPHICS

d. REF  SKIP TO DEMOGRAPHICS

A11. In what month and year did this injury/illness occur? 

MONTH/YEAR

ENTER MM/YYYY

DK

REF 
5 

A12. [IF YES TO ANY INJURIES OR ILLNESSES] You have told me about X work-related injuries and illnesses 

you have experienced in the last 12 months.

BRIEFLY LIST EACH INJURY/ILLNESS: TEXT FILL #1, TEXT FILL #2, TEXT FILL #3, ETC.

Is that correct?

________TIMES

INTERVIEWER: CONFIRM NUMBER OF INCIDENTS AND BRIEF DESCRIPTION OF EACH. IF 

INJURY/ILLNESS EXPERIENCED WITHIN LAST YEAR, RESPONDENT WILL REPORT ON THOSE. 

OTHERWISE, IF NO INJURY/ILLNESS WITHIN LAST YEAR, RESPONDENT WILL REPORT ON 

INJURIES/ILLNESSES EVER EXPERIENCED.

IF NO INCIDENTS OF WORK-RELATED INJURIES AND ILLNESSES, GO TO DEMOGRAPHICS SECTION.

Notes to interviewer:

The goal of the screener section is to enumerate all instances of work-related injuries and illnesses that occurred during 

the reference period. What issues do respondents have in reporting these incidents? Do they understand the types of 

injuries and illnesses to report? Can they accurately report only those that are work-related? How do they determine the 

boundary of the reference period and determine whether an incident occurred within the RP?

Injury or Illness

 

[FOR FIRST INJURY/ILLNESS START AT B2] 

[FOR SECOND AND FOLLOWING INJURY/ILLNESS START AT B1] 

B1. [FOR SECOND/THIRD/ETC. LOOPS] How is this injury/illness related to the other injury/illness you 

mentioned? Is this related to [the other/another] injury/illness you already mentioned or is it a different 

injury/illness?

a. RELATED TO THE OTHER/ANOTHER INJURY/ILLNESS [GO TO NEXT LOOP]

b. THIS IS A DIFFERENT INJURY/ILLNESS [CONTINUE]

c. DK

d. REF 
6 

“Now I am going to ask you more about [INJURY/ILLNESS #....].”

B2. [WORKER ACTIVITY + some EVENT and SOURCE] [FOR EACH LOOP] Please 

describe how the injury, illness, or condition occurred, and what caused it. For example: 

“When ladder slipped on wet floor, I fell 20 feet”; “I developed soreness in wrist over 

time.” [OPEN ENDED]

B3. [SOURCE] Were there any other objects, substances, or persons involved in the injury 

or illness that you didn’t mention? Please include equipment, chemicals, vehicles, or 

anything else.

B4. [NATURE AND BODY PART] Please describe the injury, illness, or condition. How 

was [BODY PART, ORGAN] affected? You can use medical terms if you know them, 

or just talk about the symptoms you experienced. For example: “strained back”; 

“chemical burn on hand”; “fainted or passed out.” 

B5. [NATURE AND BODY PART] Were there any other parts of your body or organs

affected by the injury or illness that you may not have included in your description? 

How was [BODY PART, ORGAN] affected?

Notes to interviewer:

Questions B2 through B5 are intended to capture (event or exposure, source of the injury/illness, part of body affected, 

and nature of the injury/illness). Do the questions elicit the information needed? Are the response options adequate to 

capture the information Rs give? Use general probing to elicit more information about the incident. (For example, if R 

says “I cut myself” ask: What part of your body was injured? What did you get cut with? What were you doing at the 

time?

Medical attention

The next questions are about medical care you may have received for this injury/illness. Please think about the care you 

received immediately after the injury/illness occurred as well as follow-up care you received at a later time.

C1. Did you get medical advice or treatment for this injury/illness from...

a. A doctor, nurse, or other healthcare professional?

[IF YES]: What type of health care professional 

did you see?

YES NO NA DK/REF

b. [UNLESS MENTIONED ABOVE] A 

paramedic, firefighter, or other emergency 

medical personnel?

C2. Did you get medical advice or treatment for this injury/illness at... 

a. A hospital? YES NO NA DK/REF

CHECKLIST

1. Description or 

diagnosis for 

injury/illness (this is 

the OIICS nature) 

2. Part or parts of body 

affected, including 

body systems 

(OIICS part, 

obviously)

3. How the 

injury/illness/exposu

re happened (OIICS 

event) 

4. Vehicles, tools, 

chemicals, surfaces, 

or any other objects 

involved; this can be 

multiple objects; this 

can also just be the 

person’s body 

moved incorrectly 

(OIICS sources) 
7 

A1. [IF YES TO HOSPITAL] Did you 

receive treatment at the hospital emergency 

room (ER)?

A2.[IF YES TO HOSPITAL] Were you 

admitted for an overnight stay?

A3. [IF YES TO ADMITTED] How many 

nights were you in the hospital? _________ 

NIGHTS

b. A health clinic at your place of employment?

c. Any place else? Please specify.

[IF YES TO C1 OR C2, CONTINUE TO C3.] 

[OTHERWISE SKIP TO C5]

C3. [IF YES TO C1 OR C2]. Did you receive a medical diagnosis from a health care professional? ...

READ IF NECESSARY: Did a health care professional tell you the medical term for your injury/illness?

a. YES  What was your medical diagnosis? INTERVIEWER READ IF NECESSARY: What is the 

medical term the health care professional used to describe your injury/illness?

b. NO 

c. DK 

d. REF 

 

C4. [IF YES TO C1 OR C2]. Did your health care professional recommend that you take any days off from work due 

to your injury/illness? 

a. YES  How many days off did the health care professional recommend? _______ DAYS OFF

b. NO 

c. DK 

d. REF 

Effect on work

The next questions are about how the injury/illness affected your ability to work. 

IF RESPONDENT HAS A CHRONIC/GRADUAL ONSET INJURY/ILLNESS, GO TO D13. 

D1.Were you scheduled to work the day after the injury/illness? 

a. YES

b. NO SKIP TO D3

c. DK SKIP TO D3

d. REF SKIP TO D3

D2.[IF SCHEDULED TO WORK NEXT DAY] Were you able to work the next day? 

a. YES  SKIP TO D6 

b. NO  SKIP TO D4

c. DK SKIP TO D4

d. REF SKIP TO D4
8 

D3.[IF WAS NOT SCHEDULED TO WORK NEXT DAY] If you had been scheduled to work, would you have 

been able to work the next day? 

a. YES  SKIP TO D6

b. NO

c. DK

d. REF 

D4. Did you return to work after the injury/illness?

a. YES

b. YES, BACK TO WORK SAME DAYSKIP TO D6 

c. NO SKIP TO D19 

d. NO, STILL OFF PAID WORK BUT EXPECTS TO RETURNSKIP TO D19 

e. NO, EXPECTS NEVER TO DO PAID WORK AGAINSKIP TO D19 

f. DK SKIP TO D19 

g. REF SKIP TO D19 

D5. [IF RETURNED TO WORK] How many days after the injury/illness did you start work again?

a. _____DAYS AFTER THE INJURY/ILLNESS

b. BACK TO WORK SAME DAY

c. BACK TO WORK NEXT DAY

d. DK

e. REF

INTERVIEWER NOTE: IF R INDICATES WENT BACK TO WORK ONE DAY AFTER INJURY/ILLNESS, 

CONFIRM THAT R MEANS THAT R WENT BACK TO WORK THE NEXT DAY, THAT IS, THE DAY AFTER 

INJURY/ILLNESS OCCURRED.

[IF R WENT BACK TO WORK, CONTINUE. ELSE IF R IS NOT WORKING, GO TO D19.]

D6. When you went back to work, did you work your usual number of hours or not?

a. YES 

b. NO 

c. DK

d. REF 

D7. When you went back to work, were you able to perform all of the normal duties of your job or not?

a. YES 

b. NO 

c. DK

d. REF 

D8. When you went back to work, were you assigned a different job or tasks than what you did prior to the 

injury/illness? 

a. YES 

b. NO SKIP TO D10

c. DK SKIP TO D10

d. REF SKIP TO D10
9 

D9.[IF DIFFERENT, D8=YES] Was your assignment to a different job or tasks permanent or temporary? 

a. PERMANENT 

b. TEMPORARY 

c. DK

d. REF 

D10. At any time after you went back to work, did you miss any (additional) days of work due to your injury/illness? 

a. YES 

b. NO SKIP TO D19 

c. DK SKIP TO D19 

d. REF SKIP TO D19 

D11. About how many (additional) days of work did you miss? 

_______ DAYS

D12. Please explain what happened.

GO TO D19. 

QUESTIONS ON EFFECT ON WORK FOR RESPONDENTS WITH CHRONIC/GRADUAL ONSET CONDITIONS:

D13. In the last 12 months, after you began experiencing symptoms due to TEXT FILL, did you miss any days of 

work, or not?

a. YES, MISSED DAYS OF WORK 

b. NO, DID NOT MISS DAYS OF WORK 

c. DK

d. REF 

D14. About how many days of work did you miss? 

_______ DAYS

D15. In the last 12 months, did you ever work less than your usual number of hours because of symptoms of [TEXT 

FILL]? 

a. YES 

b. NO 

c. DK

d. REF 

D16. In the last 12 months, were you ever unable to perform all the normal duties of your job because of symptoms of 

[TEXT FILL]? 

a. YES 

b. NO 

c. DK

d. REF 
10 

D17. In the last 12 months, were you ever assigned to a different job or tasks than what you did prior to the onset of 

symptoms of [TEXT FILL]? 

a. YES 

b. NO SKIP TO D19

c. DK SKIP TO D19

d. REF SKIP TO D19

D18. Was your assignment to a different job or tasks permanent or temporary? 

a. PERMANENT 

b. TEMPORARY 

c. DK

d. REF 

[TRANSITION STATEMENT FOR THOSE WHO RETURNED TO WORK: At any point after you returned to work, 

did the injury/illness affect your job in any of the following ways?]

D19. Did the injury/illness cause you to: 

YES NO NA DK/REF

a. Quit your job?

b. Be laid off?

c. Be fired?

d. Change the kind of work you do, that is, 

change your occupation?

D20. Did the injury/illness affect your ability to work in any other way?

a. YES  Please specify.

b. NO 

c. DK

d. REF 

Effect on Pay

The next questions are about how the injury/illness affected your income or pay. 

E1. Did your employer know about this injury/illness?

a. YES SKIP TO E3

b. NO

c. DK

d. REF 

E2. [IF NO TO EMPLOYER KNOWING]: For what reasons did your employer not know about this injury/illness? 

Did you not want your employer to know about your injury/illness... 

YES NO NA DK/REF

a. To avoid being laid off?

b. To avoid loss of wages?

c. To avoid loss of promotion of 

advancement?
11 

d. To avoid job transfer or restriction?

e. Because you did not realize that the 

injury/illness was work-related until 

after leaving the job?

f. Because you felt your employer would 

not recognize the injury/illness as 

work-related?

g. Because your employer wants to keep 

injury and illness rates low?

h. Other (specify)?

The next questions are about workers’ compensation. Workers’ compensation is insurance that provides you with your 

lost wages and medical care when you become injured or ill due to your job. 

E3. Has anyone filed a workers’ compensation claim for this injury/illness?

a. YES

b. NO SKIP TO E5

c. DK

d. REF 

E4. Who filed the workers’ compensation claim?

a. EMPLOYER

b. EMPLOYEE

c. FAMILY MEMBER OF EMPLOYEE

d. OTHER SPECIFY

e. DK

f. REF 

ALL RESPONSES TO E4 GO TO SKIP INSTRUCTION BEFORE E6. 

E5. IF NO ON QUESTION ABOUT FILING WORKERS’ COMPENSATION: What was the main reason you or 

your employer did not file a workers’ compensation claim for this injury/illness?

a. You were not eligible because you did not meet waiting period

b. Your employer did not want to file a claim

c. You did not inform employer

d. You were unaware of workers’ compensation coverage

e. You chose not to pursue a claim even though you were eligible

f. Other reason, please specify

g. DK

h. REF 

SKIP INSTRUCTION: 

#1: WC FILED, CONTINUE TO E6. 

#2: ELSE IF NO WC FILED BUT MISSED DAYS OF WORK, SKIP TO E8. 

#3: ELSE [NO WC FILED AND DID NOT MISS DAYS OF WORK] SKIP TO SECTION F. 

E6. IF R REPORTS WORKERS’ COMPENSATION CLAIM FILED: Did you receive workers’ compensation for 

this injury/illness? 

a. YES

b. NO

c. NA
12 

d. DK

e. REF 

READ IF NECESSARY: Workers compensation is insurance that provides you with your lost wages and medical 

care when you become injured or ill due to your job.

E7. IF R REPORTS WORKERS’ COMPENSATION NOT RECEIVED: Is there an open claim pending for this 

injury/illness?

a. YES

b. NO

c. NA

d. DK

e. REF 

E8. Short-term or temporary disability benefits provide you with a portion of your income if you are temporarily 

unable to work due to a medical condition. Did you receive short-term (temporary) disability for this 

injury/illness? 

a. YES

b. NO

c. NA

d. DK

e. REF 

E9. Did this injury/illness cause you to use paid sick leave, paid annual leave, or paid time off? 

a. YES

b. NO

c. NA

d. DK

e. REF 

E10. Did this injury/illness cause you to take leave without pay?

a. YES

b. NO

c. NA

d. DK

e. REF 

E11. Did your employer continue to pay your wages and other compensation in full during the period you were unable 

to work because of this injury/illness?

a. YES

b. NO

c. NA

d. DK

e. REF 

Notes to interviewer:

Do Rs know what workers’ compensation is? Do they know whether a WC form was filed? Are the terms in E6-E11 

familiar to Rs? Are the definitions helpful? 
13 

Occupation and Industry at Time of Injury or Illness

The next questions are about your occupation and industry at the time of the injury/illness. Please think about the job you 

held at the time of the injury/illness [TEXT FILL DESCRIPTION]. 

F1. Were you considered by your employer to be a full time or part time employee?

a. FULL-TIME 

b. PART-TIME 

c. DK

d. REF 

F2. In a typical week, how many hours did you work? ______hours 

IF NECESSARY: Was it greater than or equal to 35 hours per week?

DK

REF 

F3. Which of the following groups best describes your employer at the time of the injury/illness? 

a. Government 

b. Private-for-profit company SKIP TO F5

c. Non-profit organization including tax exempt and charitable organizations  SKIP TO F5

d. Self-employed  SKIP TO F5

e. Working in the family business SKIP TO F5

F4. Would that be the federal, state, or local government? 

a. FEDERAL

b. STATE 

c. LOCAL

F5. Did you work for a temporary help agency or a temporary staffing agency? 

a. YES

b. NO

c. DK

d. REF 

INTERVIEWER NOTE: IF R IS A FARM LABOR CONTRACTOR, R IS NOT CONSIDERED 

TEMPORARY HELP/STAFFING AND RESPONSE TO THIS Q IS NO.

[IF F5 (TEMP HELP OR TEMP STAFFING AGENCY) =YES]: For the next questions, please answer based on the 

place where you were working on a day-to-day basis when the injury/illness occurred, not the temporary agency you 

worked for.

F6. What is the name of the (company, organization or agency) for whom you worked? [OPEN ENDED] 

DK

REF 

NOTE: IF GOVERNMENT EMPLOYER, TEXT FILL=AGENCY; IF NON-PROFIT, TEXT FILL=ORGANIZATION; 

ELSE TEXT FILL=COMPANY. 

F7. What kind of business or industry was this? [OPEN ENDED] 

DK

REF 

F8. What did they make or do where you worked? [OPEN ENDED] 
14 

DK

REF 

F9. In what state were you employed at this job? [OPEN ENDED] 

DK

REF 

F10. What kind of work did you do? (For example: registered nurse, personnel manager, supervisor of order 

department, secretary, accountant) [OPEN ENDED]

DK

REF 

F11. What were your most important activities or duties? (For example: patient care, directing hiring policies, 

supervising order clerks, typing and filing, reconciling financial records) [OPEN ENDED]

DK

REF 

F12. At this job, were you a member of a union or covered by a collective bargaining agreement?

a. YES

b. NO

c. DK

d. REF 

F13. How many people worked at your work location?

e. 1 to 10 workers

a. 11 to 49 workers

b. 50 to 249 workers

c. 250 to 999 workers

d. 1000 or more workers

e. DK

f. REF 

IF R HAS ADDITIONAL INJURIES/ILLNESSES TO REPORT, GO BACK TO SECTION B. ELSE GO TO G1. 

Notes to interviewer:

Does R have any difficulty recalling FT vs. PT work? How do Rs with irregular work schedules, seasonal employment, 

etc., answer the question? Does the number of hours per week typically worked accord with report of FT/PT status?

Observe respondent ability to understand and respond to questions about employment at time of the injury/illness. Probe 

as needed to explore an issues with response. Are respondents able to accurately report answers for F12 and F13? F13 

should include total for R’s work location only, not the whole company/organization. 

Demographic Characteristics

Race/ethnicity

G1. Are you Spanish, Hispanic, or Latino?

a. YES 

b. NO

c. DK

d. REF 
15 

G2. [I am going to read you a list of five race categories.] Please choose one or more races that you consider yourself 

to be: 

a. White

b. Black or African American

c. American Indian or Alaska Native

d. Asian

e. Native Hawaiian or Other Pacific Islander

f. Other ________ 

g. DK

h. REF 

Age

G3. What is your date of birth? Enter MM/DD/YYYY 

DK

REF 

G4. As of last week, that would make you approximately (AGE) years old. Is that correct?

[IF NECCESARY] Even though you don’t know your exact birthdate, what is your best guess as to how old 

you were on your last birthday? 

______ YEARS

DK

REF 

Marital Type

G5. Are you now married, widowed, divorced, separated or never married? 

a. MARRIED 

b. WIDOWED 

c. DIVORCED 

d. SEPARATED 

e. NEVER MARRIED

f. DK

g. REF 

Gender

G6. Are you male or female? 

a. MALE

b. FEMALE

Education

G7. What is the highest level of school you have completed or the highest degree you have received? 

a. Less than high school

b. High school or GED

c. Associate degree or some college

d. Bachelor’s degree or above

G8. In what country were you born? 

___________________________ [OPEN-ENDED]

Current Industry and Occupation
16 

The next questions are about your current job. If you have more than one job, please tell me about the job at which you 

usually work the most hours. If you work the same number of hours at two jobs, please tell me about the job where you 

were employed the longest.

H1. What is your current employment status? Are you currently employed full-time, part-time, or are you not 

employed?

a. FULL-TIME 

b. PART-TIME 

c. NOT CURRENTLY EMPLOYED SKIP TO END OF SURVEY

d. DK

e. REF 

H2. [IF CURRENTLY EMPLOYED] Is this job with the same employer you have already told me about? 

a. YES, SAME EMPLOYER  CONTINUE TO H3

b. NO, DIFFERENT EMPLOYER  SKIP TO H5

INTERVIEWER NOTE: 

• IF R HAS ONLY ONE INJURY/ILLNESS AND SAME EMPLOYER OR MULTIPLE INJURIES UNDER

SAME EMPLOYER, SKIP TO H4

• IF R HAS MULTIPLE INJURIES UNDER DIFFERENT EMPLOYERS, BUT CURRENT EMPLOYMENT IS 

WITH SAME EMPLOYER, CONTINUE TO H3

H3. [IF MULTIPLE INJURIES UNDER DIFFERENT EMPLOYERS BUT SAME AS CURRENT 

EMPLOYMENT] Which job and employer are you referring to? 

_________________

H4. [IF SAME EMPLOYER] Are you in the same position you were in at the time the injury/illness [TEXT FILL]?

a. YES SKIP TO PROBES AT END OF SECTION

b. NO

c. DK

d. REF 

INTERVIEWER NOTE: IF SAME EMPLOYER BUT DIFFERENT JOB, ASK H5 (HOW MANY HOURS 

WORKED), H11 (WHAT KIND OF WORK DO YOU DO), AND H12 (MOST IMPORTANT ACTIVITIES OR 

DUTIES). 

H5. [IF SAME EMPLOYER BUT DIFFERENT JOB OR DIFFERENT EMPLOYER THAN DURING INJURY 

ILLNESS] Currently, in a typical week, how many hours do you work? 

 ______hours

IF NECESSARY: Was it greater than or equal to 35 hours per week? 

DK 

REF 

INTERVIEWER NOTE: IF SAME EMPLOYER BUT DIFFERENT JOB, SKIP TO H11.

H6. [IF DIFFERENT EMPLOYER THAN DURING INJURY ILLNESS] Which of the following groups best 

describes your CURRENT employer? 

a. Government 

b. Private-for-profit company SKIP TO H8

c. Non-profit organization including tax exempt and charitable organizations  SKIP TO H8

d. Self-employed  SKIP TO H8

e. Working in the family business SKIP TO H8
17 

H7. [IF DIFFERENT EMPLOYER THAN HAD DURING INJURY/ILLNESS] Would that be the federal, state, or 

local government? 

a. FEDERAL

b. STATE 

c. LOCAL

H8. [IF DIFFERENT EMPLOYER THAN HAD DURING INJURY/ILLNESS] What is the name of the (company, 

organization or agency) for whom you work? [OPEN ENDED] 

DK

REF 

H9. [IF DIFFERENT EMPLOYER THAN HAD DURING INJURY/ILLNESS] What kind of business or industry is 

this? [OPEN ENDED] 

DK

REF 

H10. [IF DIFFERENT EMPLOYER THAN HAD DURING INJURY/ILLNESS] What do they make or do where 

you work? [OPEN ENDED] 

DK

REF 

H11. [IF SAME EMPLOYER BUT DIFFERENT JOB OR DIFFERENT EMPLOYER THAN DURING INJURY 

ILLNESS] What kind of work do you do? (For example: registered nurse, personnel manager, supervisor of order 

department, secretary, accountant) [OPEN ENDED] 

DK

REF 

H12. [IF SAME EMPLOYER BUT DIFFERENT JOB OR DIFFERENT EMPLOYER THAN DURING INJURY 

ILLNESS] What are your most important activities or duties? (For example: patient care, directing hiring policies, 

supervising order clerks, typing and filing, reconciling financial records) [OPEN ENDED] 

DK

REF 

Debriefing questions for self-interview:

Review of screener section

• How easy or difficult was it for you to answer questions about injuries/illnesses that occurred over the last 

year? 

• How easy or hard was it to remember when the injury/illness happened? Can you tell me more about that? 

How did you figure out when the injury/illness happened?

• [IF CHRONIC/GRADUAL ONSET CONDITION AND PROVIDED DATE OF OCCURRENCE] How did 

you determine what month/year the injury/illness occurred?

Review of injury/illness section (Section B)

• [IF R DOES NOT PROVIDE ENOUGH INFO ABOUT THE INJURY/ILLNESS OR HOW IT IS WORKRELATED] Tell me more about how this injury/illness was related to your job. Where were you when this 

happened? What were you doing? What caused the injury/illness? What part of your body was injured or 

affected? Tell me more about the injury/illness. Tell me about the kind of work you do. 
18 

Review of medical care section (Section C)

• Walk me through the medical attention you received immediately after the injury/illness occurred and any 

follow-up care that you experienced.

Review of effect on work section (Section D)

• [IF YES TO ANY ITEMS IN SECTION D] Tell me more about [TEXT FILL]. What kind of effect did the 

injury/illness have on your work schedule? Job duties? Ability to work? Ability to keep your job? Was the 

effect on [TEXT FILL] temporary or permanent?

• [IF MISSED WORK IMMEDIATELY AFTER INJURY/ILLNESS OCCURRED BUT RETURNED TO 

WORK] You said you were able to start work again XX days after the injury/illness. How did you figure that 

out? Walk me through the timeline of when you were injured and when you got back to work. You said you 

missed XX additional days of work due to this injury/illness. How did you figure that out? Please tell me more 

about what happened. 

• [IF MISSED ANY DAYS OF WORK DUE TO CHRONIC GRADUAL ONSET INJURY/ILLNESS] You 

said you missed XX days as a result of the injury/illness. How did you figure that out? When did you miss 

those days of work?

Review of effect on income or pay section (Section E)

• [IF NO TO E1] Tell me more about the reasons why your employer did not know about this injury/illness. 

What was the main reason your employer did not know? Tell me more about that.

• [IF NO TO E3] Tell me more about the reasons why you or your employer did not file a workers’ 

compensation claim for this injury/illness? 

• What kind of effect did the injury/illness have on your income or pay? 

• [IF YES TO ANY ITEM E8-E10] Tell me more about [TEXT FILL].

Review of selected questions (Return to any questions that need further exploration)

• I’d like to ask you a little more about [QUESTION]. You said [FILL]. In your own words, what do you think 

that question was asking? How did you decide on your answer?

General debriefing

• Were there any questions that were particularly difficult to answer? Tell me more about that?

• Were there any questions you felt uncomfortable answering?

• What are your suggestions on how to improve the survey?

• Is there anything else that we should know about your injury/illness that we did not ask you about?

• Do you have any questions about the survey? 

Debriefing questions for proxy respondents:

Proxy

• What is your relationship to [RESPONDENT NAME]?

• How much would you say you know about R’s job?

• How familiar would you say you are with R’s work-related injury/illness? Are you aware of the medical 

treatment he/she received when the injury/illness occurred? Are you aware of how this affected R’s job? How 

did you learn about R’s injury/illness? Who in your household besides R would be the best person to answer 

the kinds of questions I asked?

• What questions were the hardest for you to answer for R? Why? How much would you say you know about 

[QUESTION TOPIC]? How easy/hard is it to remember the information the question asked about? Tell me 

more.

• What questions were the easiest for you to answer for R? Why? How much would you say you know about 

[QUESTION TOPIC]? How easy/hard is it to remember the information the question asked about? Tell me 

more.
19 

Sensitivity

• Were you worried/Would you be worried about telling anyone else about R’s work-related injury/illness? Tell 

me more about that.

Review of selected items

• I’d like to ask you a little more about [QUESTION]. You said [FILL]. In your own words, what do you think 

that question was asking? How did you decide on your answer?

General debriefing

• What are your suggestions on how to improve the survey?

• What questions were the most difficult for you to answer?

• What questions were the easiest to answer?

Notes to interviewer:

Is proxy reporting of work-related injuries and illnesses a sensitive issue? Why or why not?

What questions are the most and least difficult for Rs to answer? What answers are they uncertain about? Do they 

have suggestions for improving the survey?

Return to any questions that need further exploration. 

STEP 3: END OF INTERVIEW

Thank you for taking part in this survey.

□ STOP THE RECORDER.

RECRUITMENT QUESTION:

We are looking for additional respondents like you who would be interested in helping with the study. Do you know 

anyone who had a work-related injury or illness who might be interested in participating? If yes, would you mind if we 

gave you a flyer about the study and send you an email about the study that you could forward to them? 

INTERVIEWER: ANSWER ANY RESPONDENT QUESTIONS. 

This concludes the interview. I would be happy to answer any questions that you have. Thank you for your help with this 

study.

□ MARK CASE AS COMPLETE IN RECRUITMENT DATABASE. 

MATERIALS TO TAKE AWAY FROM INTERVIEW

□ INTERVIEWER PROTOCOL BOOKLET (THIS BOOKLET)

□ DIGITAL RECORDER AND BATTERIES

□ NOTE PAPER, PENS, PENCILS
NORC | Designing a Household Survey of Injuries and Illnesses

FINAL REPORT

Appendix E: Presentation of Questionnaire 

Development Report 

(Deliverable #15)
Household SOII: 

Questionnaire 

Design

October 28, 2016

Lisa Lee
2

Designing a Household SOII

 Study goals

 To develop a survey design and questionnaire on non-fatal 

occupational injuries and illnesses that covers the population of 

workers and allows BLS to estimate injuries and illnesses by 

employment relationship, broad industry, and occupation at the 

national level.

 Designing the HSOII

 Cognitive testing methodology

 HSOII questionnaire

 Next steps

Presentation Overview
3

Study Goals

 SOII collects information from employers on nonfatal 

workplace injuries and illnesses

 Undercounting

 Effects of employer

 Effects of employee

 Reduce underreporting through household survey design

 Study design

 Questionnaire

Why do we need the HSOII?
4

Designing the HSOII

 Capture recordable workplace injuries and illnesses

 Days away from work

 Restricted work activity

 Transfer to another job

 Medical treatment beyond first aid

 Loss of consciousness

 Nature, part of body, source, event/exposure

 Industry/Occupation

 Employment relationship

 Demographic information

Measurement goals
5

Designing the HSOII

 Recall issues

 Remembering what happened

 Remembering when it happened

 Comprehension

 What counts as injury/illness

 Unfamiliar terms

 Sensitivity

 Proxy reporting

Challenges
6

Cognitive Testing Methodology

 3 rounds of iterative testing

 In-person interviews followed by phone interviews

 Concurrent probing followed by retrospective

 Proxy interviews

 Experienced cognitive interviewers

Overview
7

Cognitive Testing Methodology

 Flyers

 Craigslist

 AmeriSpeak omnibus survey

 Facebook

 Chicago Federation of Labor

Recruitment
8

Cognitive Testing Methodology

Recruitment flyer
9

Cognitive Testing Methodology

Facebook advertisements
10

Cognitive Testing Methodology

Recruitment

Method Number reached Number replied

Number 

interviewed

Flyer/personal 

contact Unknown 23 6

Craigslist Unknown 61 39

AmeriSpeak 115 44 19

Facebook Reach: 100,849

Clicks: 7,621 0 0

CFL Unknown 0 0
11

Cognitive Testing Methodology

 64 respondents interviewed across 3 rounds

 58 main respondents and 6 proxy respondents

 Respondents represent a wide range of demographic 

characteristics

 Cognitive interview lasting up to one hour

 $40 for participating

Respondent characteristics
12

HSOII Questionnaire

 Screener

 Injury or illness

 Medical attention

 Effect on work

 Effect on pay

 Occupation and industry

 Demographics

Questionnaire sections
13

HSOII Questionnaire

 Respondents generally understood what it means for an 

injury or illness to be work related

 Cues folded into Qs yielded additional reports of injuries 

and illnesses

 Respondents wanted to report the same injury/illness to 

multiple screener questions

 Respondents remembered dates of events

 Alternative questions and interviewer guidance for chronic 

and gradual onset conditions

 Anxiety, soreness, difficulty breathing

Screener
14

HSOII Questionnaire

Injury or illness

Characteristic Description

Nature Third degree burn

Part of Body Leg, hip

Event

Machine press caught R’s leg, after it had been activated or turned on 

without anyone’s knowledge. R thinks someone else accidentally 

turned it on.

Source Machinery

Characteristic Description

Nature Neck, back and shoulder pain, strained neck

Part of Body Neck, back, shoulder

Event Developed over time due to carrying heavy books, use of computer

Source Books, computer
15

HSOII Questionnaire

 Respondent confusion about what counts as being treated 

at or admitted to the hospital

 Urgent care, outpatient care=treated at hospital

 Being treated at the ER=admitted to hospital

 Most respondents understood “medical diagnosis”

Medical attention
16

HSOII Questionnaire

 Early versions of the questions included terms that were 

not clear

 Being assigned to another job on a temporary basis

 Being transferred

 Questions on ability to work next day, working usual hours

 Next day could be respondent’s day off work

 Respondent may have irregular work schedule

 Alternate set of questions for chronic/gradual onset 

conditions were created

Effect on work
17

HSOII Questionnaire

 Questions on whether the employer knew about the injury 

or illness and why employer didn’t know worked well

 Rs identified with the reasons on the list

 Respondents who received workers’ compensation were 

able to report this

 Some respondents uncertain about the source of 

compensation they received

Effect on pay
18

HSOII Questionnaire

 Some respondents did not know the sector they worked in

 Respondents who were contractors or temporary workers 

were unsure whether to answer questions for their 

employer or for the workplace to which they were 

assigned

 Some respondents did not want to provide the name of 

the employer

 Standard demographic questions worked well

Occupation and industry and demographics questions
19

Proxy Interviews

 6 pairs of proxy interviews were conducted

 4 husband-wife pairs

 1 pair of roommates

 2 brothers

 Accuracy of proxy reporting was high overall

Findings on accuracy of proxy reports
20

Interview Timing

 13 timing interviews

 Range from 20 to 48 minutes.

 Median 24:30 minutes.

 Average completion time for one loop was 27:51.

 Each additional loop averaged 10:29.

Round 3 timing interviews
21

Next Steps

 Implement final revisions to the questionnaire

 Recommendations for reducing interview length

 Remove A8

 Make E2 and E5 open-ended questions

 If an injury or illness does not meet the criterion for recordability, 

skip some or all of the questions on occupation and industry at 

time of injury/illness

 Add skip instructions to the section on occupation and industry at 

time of injury or illness

Finalizing the HSOII questionnaire
Thank You!
NORC | Designing a Household Survey of Injuries and Illnesses

FINAL REPORT

Appendix F: Final HSOII Questionnaire
1 

Household Survey of Occupational Injuries and Illnesses (HSOII) 

Updated 11-2-2016 

FINAL

Screener

This survey is about work-related injuries and illnesses that you may have experienced. I will ask you questions about the 

injuries and illnesses you may have had that are related to any job you held in the last 12 months By the last 12 months, I 

mean since [CURRENT MONTH] of [LAST YEAR]. 

A1.In the last 12 months, did you do ANY work for pay or profit?

a. Yes  ELIGIBLE, CONTINUE

b. No  NOT ELIGIBLE, END INTERVIEW

c. DK

d. REF 

Any injury

A2.In the last 12 months, have you experienced any injuries or illnesses related to any job you held? 

a. Yes  COLLECT BRIEF DESCRIPTION, CONFIRM WORK-RELATED

b. No  SKIP TO A4 

c. DK

d. REF 

A3.In what month and year did this injury/illness occur? [IF ILLNESS/INJURY IS A CHRONIC/GRADUAL 

ONSET CONDITION, ASK ALTERNATIVE QUESTIONS AS NEEDED: Did this injury/illness occur on a 

specific day or did it develop over time? Did you experience symptoms related to this injury/illness in the last 12 

months?

MONTH/YEAR

ENTER MM/YYYY

NO SPECIFIC MONTH/YEAR BUT SYMPTOMS EXPERIENCED IN LAST 12 MONTHS

DK

REF 

INTERVIEWER NOTE: IF INJURY/ILLNESS OCCURRED ON A SPECIFIC DAY, RESPONDENT SHOULD 

PROVIDE BEST ESTIMATE OF MONTH/YEAR. THE MONTH/YEAR REPORTED MUST BE IN REFERENCE 

PERIOD TO BE ELIGIBLE. IF DEVELOPED OVER TIME, CONFIRM THAT REPSPONDENT NOTICED 

SYMPTOMS DURING REFERENCE PERIOD TO BE ELIGIBLE.

A4.[Now I want to find out if you experienced any other work-related injuries other than the TEXT FILL INJURY

RESPONDENT REPORTED (e.g., concussion) you just told me about.] In the last 12 months, have you 

experienced any [other] injuries, such as the following, related to any job you held? 

a. Sprains, strains or tears

b. Soreness or pain

c. Bruises

d. Cuts or punctures

e. Broken bones

f. Injury to muscles or joints

g. Open wounds

h. Burns 
2 

i. Carpal tunnel syndrome

j. Any other injury? 

1) YES  COLLECT BRIEF DESCRIPTION, CONFIRM WORK-RELATED

2) NO SKIP TO A6

3) DK SKIP TO A6

4) REF SKIP TO A6

INTERVIEWER NOTE: READ DEFINITION IF NECESSARY. Carpal tunnel syndrome is a hand and arm condition 

that causes numbness, tingling and other symptoms. Carpal tunnel syndrome is caused by a pinched nerve in your wrist.

[http://www.mayoclinic.org/diseases-conditions/carpal-tunnel-syndrome/basics/definition/con-20030332]

A5. In what month and year did this injury occur? [IF ILLNESS/INJURY IS A CHRONIC/GRADUAL ONSET 

CONDITION, ASK ALTERNATIVE QUESTIONS AS NEEDED: Did this injury/illness occur on a specific day 

or did it develop over time? Did you experience symptoms related to this injury/illness in the last 12 months?

MONTH/YEAR

ENTER MM/YYYY

NO SPECIFIC MONTH/YEAR DUE TO CHRONIC/GRADUAL ONSET CONDITION

DK

REF 

INTERVIEWER NOTE: READ IF NECESSARY TO CLARIFY THAT THE INJURY/ILLNESS REPORTED IS A 

SEPARATE INCIDENT. Is this [injury/illness OR TEXTFILL] related to [the other/another injury/illness OR 

TEXTFILL] you already mentioned or is this a different injury/illness?

A6. [Other than the TEXT FILL ILLNESS RESPONDENT REPORTED (e.g., asthma) you have already mentioned], 

in the last 12 months, have you experienced any [other] illnesses, such as the following, related to any job you 

held? 

a. Skin disorders

b. Respiratory conditions

c. Poisonings

d. Hearing loss

e. A disease or infection

f. Cancer 

g. Anxiety or depression

h. Any other illness? 

1) YES  COLLECT BRIEF DESCRIPTION, CONFIRM WORK-RELATED

2) NO SKIP TO A8

3) DK SKIP TO A8

4) REF SKIP TO A8

A7. In what month and year did this injury/illness occur? [IF ILLNESS/INJURY IS A CHRONIC/GRADUAL 

ONSET CONDITION, ASK ALTERNATIVE QUESTIONS AS NEEDED: Did this injury/illness occur on a 

specific day or did it develop over time? Did you experience symptoms related to this injury/illness in the last 12 

months?

MONTH/YEAR
3 

ENTER MM/YYYY

NO SPECIFIC MONTH/YEAR DUE TO CHRONIC/GRADUAL ONSET CONDITION

DK

REF 

INTERVIEWER NOTE: READ IF NECESSARY TO CLARIFY THAT THE INJURY/ILLNESS REPORTED IS A 

SEPARATE INCIDENT. Is this [injury/illness OR TEXTFILL] related to [the other/another injury/illness OR 

TEXTFILL] you already mentioned or is this a different injury/illness?

A8. [IF YES TO ANY INJURIES OR ILLNESSES] You have told me about X work-related injuries and illnesses 

you have experienced in the last 12 months.

BRIEFLY LIST EACH INJURY/ILLNESS: TEXT FILL #1, TEXT FILL #2, TEXT FILL #3, ETC.

Is that correct?

________TIMES

INTERVIEWER: CONFIRM NUMBER OF INCIDENTS AND BRIEF DESCRIPTION OF EACH. IF 

INJURY/ILLNESS EXPERIENCED WITHIN LAST YEAR, RESPONDENT WILL REPORT ON THOSE. 

OTHERWISE, IF NO INJURY/ILLNESS WITHIN LAST YEAR, RESPONDENT WILL REPORT ON 

INJURIES/ILLNESSES EVER EXPERIENCED.

IF NO INCIDENTS OF WORK-RELATED INJURIES AND ILLNESSES, GO TO DEMOGRAPHICS SECTION.
4 

Injury or Illness

 

“Now I am going to ask you more about [INJURY/ILLNESS #....].”

B1. [WORKER ACTIVITY + some EVENT and SOURCE] [FOR EACH LOOP] Please 

describe how the injury, illness, or condition occurred, and what caused it. [OPEN 

ENDED]

INTERVIEWER NOTE: READ EXAMPLES IF NECESSARY. For example: When ladder 

slipped on wet floor, I fell 20 feet; I developed soreness in wrist over time.

B2. [SOURCE] Were there any other objects, substances, or persons involved in the injury 

or illness that you didn’t mention? Please include equipment, chemicals, vehicles, or 

anything else.

B3. [NATURE AND BODY PART] Please describe the injury, illness, or condition. How 

was [BODY PART, ORGAN] affected? You can use medical terms if you know them, 

or just talk about the symptoms you experienced. 

INTERVIEWER NOTE: READ EXAMPLES IF NECESSARY. For example: strained back; 

chemical burn on hand; fainted or passed out. 

B4. [NATURE AND BODY PART] Were there any other parts of your body or organs

affected by the injury or illness that you may not have included in your description? How was [BODY PART, 

ORGAN] affected?

Medical attention

The next questions are about medical care you may have received for this injury/illness. Please think about the care you 

received immediately after the injury/illness occurred as well as follow-up care you received at a later time.

C1. Did you get medical advice or treatment for this injury/illness from...

a. A doctor’s office, urgent care clinic, or outpatient 

clinic?

YES NO NA DK/REF

b. A health clinic at your place of employment?

c. A hospital?

d. [IF YES TO HOSPITAL] Did you receive 

treatment at the hospital emergency room or ER?

e. [IF YES TO HOSPITAL] Were you admitted for 

an overnight stay?

f. [IF ADMITTED] How many nights were you in 

the hospital? _________ NIGHTS

[Did you get medical advice or treatment for this 

injury/illness from...]

g. Emergency medical personnel, such as a 

paramedic or firefighter?

h. Anyplace else? Please specify

CHECKLIST

1. Description or 

diagnosis for 

injury/illness (this is 

the OIICS nature) 

2. Part or parts of body 

affected, including 

body systems 

(OIICS part, 

obviously)

3. How the 

injury/illness/exposu

re happened (OIICS 

event) 

4. Vehicles, tools, 

chemicals, surfaces, 

or any other objects 

involved; this can be 

multiple objects; this 

can also just be the 

person’s body 

moved incorrectly 

(OIICS sources) 
5 

[IF YES TO C1a, C1b, C1c, C1g, or C1h, CONTINUE TO C2.] 

[OTHERWISE SKIP TO NEXT SECTION] 

C2. [IF YES TO C1a, C1b, C1c, C1g, or C1h]. Did you receive a medical diagnosis from a health care professional? 

READ IF NECESSARY: Did a health care professional tell you the medical term for your injury/illness?

a. YES  What was your medical diagnosis? INTERVIEWER READ IF NECESSARY: What is the 

medical term the health care professional used to describe your injury/illness?

_____________________________DIAGNOSIS

b. NO 

c. DK 

d. REF 

 

C3. [IF YES TO C1a, C1b, C1c, C1g, or C1h]. Did your health care professional recommend that you take any days 

off from work due to your injury/illness? 

a. YES

b. NO SKIP TO NEXT SECTION

c. DK SKIP TO NEXT SECTION

d. REFSKIP TO NEXT SECTION

C4. How many days off did the health care professional recommend?

________DAYS

C5. Did you take [TEXT FILL C4 RESPONSE] days off?

a. YES

b. NO

c. I TOOK LESS THAN THE RECOMMENDED NUMBER OF DAYS OFF

d. I TOOK MORE THAN THE RECOMMENDED NUMBER OF DAYS OFF

e. DK

f. REF 

Effect on work

The next questions are about how the injury/illness affected your ability to work. 

IF RESPONDENT HAS A CHRONIC/GRADUAL ONSET INJURY/ILLNESS, GO TO D13. 

D1.Were you scheduled to work the day after the injury/illness? 

a. YES

b. NO SKIP TO D3

c. DK SKIP TO D3

d. REF SKIP TO D3

D2.[IF SCHEDULED TO WORK NEXT DAY] Were you able to work the next day? 

a. YES  SKIP TO D6 

b. NO  SKIP TO D4

c. DK SKIP TO D4

d. REF SKIP TO D4
6 

D3.[IF WAS NOT SCHEDULED TO WORK NEXT DAY] If you had been scheduled to work, would you have 

been able to work the next day? 

a. YES  SKIP TO D6

b. NO

c. DK

d. REF 

D4. Did you return to work after the injury/illness?

a. YES

b. NO SKIP TO D19 

c. NO, STILL OFF PAID WORK BUT EXPECTS TO RETURNSKIP TO D19 

d. NO, EXPECTS NEVER TO DO PAID WORK AGAINSKIP TO D19 

e. DK SKIP TO D19 

f. REF SKIP TO D19 

D5. [IF RETURNED TO WORK] How many days after the injury/illness did you start work again?

a. _____DAYS AFTER THE INJURY/ILLNESS

b. BACK TO WORK SAME DAY

c. BACK TO WORK NEXT DAY

d. DK

e. REF

INTERVIEWER NOTE: IF R INDICATES WENT BACK TO WORK ONE DAY AFTER INJURY/ILLNESS, 

CONFIRM THAT R MEANS THAT R WENT BACK TO WORK THE NEXT DAY, THAT IS, THE DAY AFTER 

INJURY/ILLNESS OCCURRED.

[IF R WENT BACK TO WORK, CONTINUE. ELSE IF R IS NOT WORKING, GO TO D19.]

D6. When you went back to work, did you work your usual number of hours or not?

a. YES 

b. NO 

c. DK

d. REF 

D7. When you went back to work, were you able to perform all of the normal duties of your job or not?

a. YES 

b. NO 

c. DK

d. REF 

D8. When you went back to work, were you assigned a different job or tasks than what you did prior to the 

injury/illness? 

a. YES 

b. NO SKIP TO D10

c. DK SKIP TO D10

d. REF SKIP TO D10
7 

D9.[IF DIFFERENT, D8=YES] Was your assignment to a different job or tasks permanent or temporary? 

a. PERMANENT 

b. TEMPORARY 

c. DK

d. REF 

D10. At any time after you went back to work, did you miss any (additional) days of work due to your injury/illness? 

a. YES 

b. NO SKIP TO D19 

c. DK SKIP TO D19 

d. REF SKIP TO D19 

D11. About how many (additional) days of work did you miss? 

_______ DAYS

D12.What caused you to miss these (additional) days of work?

GO TO D19. 

QUESTIONS ON EFFECT ON WORK FOR RESPONDENTS WITH CHRONIC/GRADUAL ONSET CONDITIONS:

D13. In the last 12 months, after you began experiencing symptoms due to TEXT FILL, did you miss any days of 

work, or not?

a. YES, MISSED DAYS OF WORK 

b. NO, DID NOT MISS DAYS OF WORK 

c. DK

d. REF 

D14. About how many days of work did you miss? 

_______ DAYS

D15. In the last 12 months, did you ever work less than your usual number of hours because of symptoms of [TEXT 

FILL]? 

a. YES 

b. NO 

c. DK

d. REF 

D16. In the last 12 months, were you ever unable to perform all the normal duties of your job because of symptoms of 

[TEXT FILL]? 

a. YES 

b. NO 

c. DK

d. REF 
8 

D17. In the last 12 months, were you ever assigned to a different job or tasks than what you did prior to the onset of 

symptoms of [TEXT FILL]? 

a. YES 

b. NO SKIP TO D19

c. DK SKIP TO D19

d. REF SKIP TO D19

D18. Was your assignment to a different job or tasks permanent or temporary? 

a. PERMANENT 

b. TEMPORARY 

c. DK

d. REF 

[TRANSITION STATEMENT FOR THOSE WHO RETURNED TO WORK: At any point after you returned to work, 

did the injury/illness affect your job in any of the following ways?]

D19. Did the injury/illness cause you to: 

YES NO NA DK/REF

a. Be laid off or fired? [IF YES, SKIP TO 

D19c]

b. Quit your job?

c. Change the kind of work you do, that is, 

change your occupation?

D20. Did the injury/illness affect your ability to work in any other way?

a. YES  Please specify.

b. NO 

c. DK

d. REF 

Effect on Pay

The next questions are about how the injury/illness affected your income or pay. 

E1. Did your employer know about this injury/illness?

a. YES SKIP TO E3

b. NO

c. DK

d. REF 

E2. [IF NO TO EMPLOYER KNOWING]: Why did your employer not know about this injury/illness? 

COLLECT BRIEF DESCRIPTION

The next questions are about workers’ compensation. Workers’ compensation is insurance that provides you with your 

lost wages and medical care when you become injured or ill due to your job. 

E3. Has anyone filed a workers’ compensation claim for this injury/illness?

a. YES

b. NO SKIP TO E5

c. DK

d. REF 
9 

E4. Who filed the workers’ compensation claim?

a. EMPLOYER

b. EMPLOYEE

c. FAMILY MEMBER OF EMPLOYEE

d. OTHER SPECIFY

e. DK

f. REF 

ALL RESPONSES TO E4 GO TO SKIP INSTRUCTION BEFORE E6. 

E5. IF NO ON QUESTION ABOUT FILING WORKERS’ COMPENSATION: What was the main reason you or 

your employer did not file a workers’ compensation claim for this injury/illness?

a. You were not eligible

b. You were eligible but decided not to pursue a claim

c. Your employer did not want you to file a claim

d. You were unaware of workers’ compensation coverage

e. Other reason, please specify

f. DK

g. REF 

SKIP INSTRUCTION: 

#1: WC FILED, CONTINUE TO E6. 

#2: ELSE IF NO WC FILED BUT MISSED DAYS OF WORK, SKIP TO E8. 

#3: ELSE [NO WC FILED AND DID NOT MISS DAYS OF WORK] SKIP TO SECTION F. 

E6. IF R REPORTS WORKERS’ COMPENSATION CLAIM FILED: Did you receive workers’ compensation for 

this injury/illness? 

a. YES

b. NO

c. NA

d. DK

e. REF 

READ IF NECESSARY: Workers compensation is insurance that provides you with your lost wages and medical 

care when you become injured or ill due to your job.

E7. IF R REPORTS WORKERS’ COMPENSATION NOT RECEIVED: Is there an open claim pending for this 

injury/illness?

a. YES

b. NO

c. NA

d. DK

e. REF 

E8. Short-term or temporary disability benefits provide you with a portion of your income if you are temporarily 

unable to work due to a medical condition. Did you receive short-term (temporary) disability for this 

injury/illness? 

a. YES

b. NO

c. NA

d. DK

e. REF 
10 

E9. Did this injury/illness cause you to use paid sick leave, paid annual leave, or paid time off? 

a. YES

b. NO

c. NA

d. DK

e. REF 

E10. Did this injury/illness cause you to take leave without pay?

a. YES

b. NO

c. NA

d. DK

e. REF 

E11. Did your employer continue to pay your wages and other compensation in full during the period you were unable 

to work because of this injury/illness?

a. YES

b. NO

c. NA

d. DK

e. REF 

Occupation and Industry at Time of Injury or Illness

The next questions are about your occupation and industry at the time of the injury/illness. Please think about the job you 

held at the time of the injury/illness [TEXT FILL DESCRIPTION]. 

INTERVIEWER NOTE: IF THIS IS SECOND OR SUBSEQUENT LOOP, GO TO F1. ELSE GO TO F4. 

F1. Is the job you held at the time of the [injury/illness TEXT FILL] with the same employer you have already told 

me about? 

a. YES, SAME EMPLOYER  SKIP TO INTERVIEWER INSTRUCTION

b. NO, DIFFERENT EMPLOYER  SKIP TO F4 

INTERVIEWER NOTE: 

• IF R HAS ONLY REPORTED ONE EMPLOYER, SKIP TO F3.

• IF R HAS REPORTED MULTIPLE EMPLOYERS, CONTINUE TO F2.

F2. [IF MULTIPLE EMPLOYERS ALREADY REPORTED] Which job and employer are you referring to? 

_________________

F3. [IF SAME EMPLOYER] Are you in the same position you were in at the time the injury/illness [TEXT FILL]?

a. YES SKIP TO NEXT SECTION

b. NO

c. DK

d. REF 

INTERVIEWER NOTE: IF SAME EMPLOYER BUT DIFFERENT POSITION, ASK F5 (HOW MANY HOURS 

WORKED), F13 (WHAT KIND OF WORK DO YOU DO), AND F14 (MOST IMPORTANT ACTIVITIES OR 
11 

DUTIES). THEN IF R HAS ADDITIONAL INJURIES/ILLNESSES TO REPORT, GO BACK TO SECTION B. ELSE 

GO TO G1.

F4. Were you considered by your employer to be a full time or part time employee?

a. FULL-TIME 

b. PART-TIME 

c. DK

d. REF 

F5. In a typical week, how many hours did you work? ______hours 

READ IF NECESSARY: Was it greater than or equal to 35 hours per week?

DK

REF 

F6. Which of the following groups best describes your employer at the time of the injury/illness? 

a. Government 

b. Private-for-profit company SKIP TO F8 

c. Non-profit organization including tax exempt and charitable organizations  SKIP TO F8 

d. Self-employed  SKIP TO F8 

e. Working in the family business SKIP TO F8 

F7. Would that be the federal, state, or local government? 

a. FEDERAL

b. STATE 

c. LOCAL

F8. Did you work for a temporary help agency, a temporary staffing agency, or a contractor? 

a. YES

b. NO

c. DK

d. REF 

INTERVIEWER NOTE: IF R IS A FARM LABOR CONTRACTOR, R IS NOT CONSIDERED 

TEMPORARY HELP/STAFFING AND RESPONSE TO THIS Q IS NO.

[IF F8 (TEMP HELP, TEMP STAFFING AGENCY, OR CONTRACTOR) =YES]: For the next questions, please 

answer based on the place where you were working on a day-to-day basis when the injury/illness occurred, not the 

temporary agency or contractor you worked for.

F9. What is the name of the (company, organization or agency) for whom you worked? [OPEN ENDED] 

DK

REF 

NOTE: IF GOVERNMENT EMPLOYER, TEXT FILL=AGENCY; IF NON-PROFIT, TEXT FILL=ORGANIZATION; 

ELSE TEXT FILL=COMPANY. 

F10. What kind of business or industry was this? [OPEN ENDED] 

DK

REF 

F11. What did they make or do where you worked? [OPEN ENDED] 

DK

REF 
12 

F12. In what state were you employed at this job? [OPEN ENDED] 

DK

REF 

F13. What kind of work did you do? (For example: registered nurse, personnel manager, supervisor of order 

department, secretary, accountant) [OPEN ENDED]

DK

REF 

F14. What were your most important activities or duties? (For example: patient care, directing hiring policies, 

supervising order clerks, typing and filing, reconciling financial records) [OPEN ENDED]

DK

REF 

F15. At this job, were you a member of a union or covered by a collective bargaining agreement?

a. YES

b. NO

c. DK

d. REF 

F16. How many people worked at your work location?

a. 1 to 10 workers

b. 11 to 49 workers

c. 50 to 249 workers

d. 250 to 999 workers

e. 1000 or more workers

f. DK

g. REF 

IF R HAS ADDITIONAL INJURIES/ILLNESSES TO REPORT, GO BACK TO SECTION B. ELSE GO TO G1. 

Demographic Characteristics

Race/ethnicity

G1. Are you Spanish, Hispanic, or Latino?

a. YES 

b. NO

c. DK

d. REF 

G2. [I am going to read you a list of five race categories.] Please choose one or more races that you consider yourself 

to be: 

a. White

b. Black or African American

c. American Indian or Alaska Native

d. Asian

e. Native Hawaiian or Other Pacific Islander

f. Other ________ 

g. DK

h. REF 
13 

Age

G3. What is your date of birth? Enter MM/DD/YYYY 

DK

REF 

G4. As of last week, that would make you approximately (AGE) years old. Is that correct?

[IF NECCESARY] Even though you don’t know your exact birthdate, what is your best guess as to how old 

you were on your last birthday? 

______ YEARS

DK

REF 

Marital Type

G5. Are you now married, widowed, divorced, separated or never married? 

a. MARRIED 

b. WIDOWED 

c. DIVORCED 

d. SEPARATED 

e. NEVER MARRIED

f. DK

g. REF 

Gender

G6. Are you male or female? 

a. MALE

b. FEMALE

Education

G7. What is the highest level of school you have completed or the highest degree you have received? 

a. Less than high school

b. High school or GED

c. Associate degree or some college

d. Bachelor’s degree or above

G8. In what country were you born? 

___________________________ [OPEN-ENDED]

Current Industry and Occupation

The next questions are about your current job. If you have more than one job, please tell me about the job at which you 

usually work the most hours. If you work the same number of hours at two jobs, please tell me about the job where you 

were employed the longest.

H1. What is your current employment status? Are you currently employed full-time, part-time, or are you not 

employed?

a. FULL-TIME 

b. PART-TIME 

c. NOT CURRENTLY EMPLOYED SKIP TO END OF SURVEY

d. DK

e. REF 
14 

H2. [IF CURRENTLY EMPLOYED] Is this job with the same employer you have already told me about? 

a. YES, SAME EMPLOYER  CONTINUE TO H3

b. NO, DIFFERENT EMPLOYER  SKIP TO H5

INTERVIEWER NOTE: 

• IF R HAS ONLY ONE INJURY/ILLNESS AND SAME EMPLOYER OR MULTIPLE INJURIES UNDER

SAME EMPLOYER, SKIP TO H4

• IF R HAS MULTIPLE INJURIES UNDER DIFFERENT EMPLOYERS, BUT CURRENT EMPLOYMENT IS 

WITH SAME EMPLOYER, CONTINUE TO H3

H3. [IF MULTIPLE INJURIES UNDER DIFFERENT EMPLOYERS BUT SAME AS CURRENT 

EMPLOYMENT] Which job and employer are you referring to? 

_________________

H4. [IF SAME EMPLOYER] Are you in the same position you were in at the time the injury/illness [TEXT FILL]?

a. YES SKIP TO PROBES AT END OF SECTION

b. NO

c. DK

d. REF 

INTERVIEWER NOTE: IF SAME EMPLOYER BUT DIFFERENT JOB, ASK H5 (HOW MANY HOURS 

WORKED), H12 (WHAT KIND OF WORK DO YOU DO), AND H13 (MOST IMPORTANT ACTIVITIES OR 

DUTIES). 

H5. [IF SAME EMPLOYER BUT DIFFERENT JOB OR DIFFERENT EMPLOYER THAN DURING INJURY 

ILLNESS] Currently, in a typical week, how many hours do you work? 

 ______hours

IF NECESSARY: Was it greater than or equal to 35 hours per week? 

DK 

REF 

INTERVIEWER NOTE: IF SAME EMPLOYER BUT DIFFERENT JOB, SKIP TO H12. 

H6. [IF DIFFERENT EMPLOYER THAN DURING INJURY ILLNESS] Which of the following groups best 

describes your CURRENT employer? 

a. Government 

b. Private-for-profit company SKIP TO H8 

c. Non-profit organization including tax exempt and charitable organizations  SKIP TO H8 

d. Self-employed  SKIP TO H8 

e. Working in the family business SKIP TO H8 

H7. [IF DIFFERENT EMPLOYER THAN HAD DURING INJURY/ILLNESS] Would that be the federal, state, or 

local government? 

a. FEDERAL

b. STATE 

c. LOCAL

H8. Did you work for a temporary help agency, a temporary staffing agency, or a contractor? 

a. YES

b. NO

c. DK

d. REF 
15 

INTERVIEWER NOTE: IF R IS A FARM LABOR CONTRACTOR, R IS NOT CONSIDERED

TEMPORARY HELP/STAFFING AND RESPONSE TO THIS Q IS NO.

[IF H8 (TEMP HELP, TEMP STAFFING AGENCY, OR CONTRACTOR) =YES]: For the next questions, please 

answer based on the place where you were working on a day-to-day basis when the injury/illness occurred, not the 

temporary agency or contractor you worked for.

H9. [IF DIFFERENT EMPLOYER THAN HAD DURING INJURY/ILLNESS] What is the name of the (company, 

organization or agency) for whom you work? [OPEN ENDED] 

DK

REF 

H10. [IF DIFFERENT EMPLOYER THAN HAD DURING INJURY/ILLNESS] What kind of business or industry is 

this? [OPEN ENDED] 

DK

REF 

H11. [IF DIFFERENT EMPLOYER THAN HAD DURING INJURY/ILLNESS] What do they make or do where 

you work? [OPEN ENDED] 

DK

REF 

H12. [IF SAME EMPLOYER BUT DIFFERENT JOB OR DIFFERENT EMPLOYER THAN DURING INJURY 

ILLNESS] What kind of work do you do? (For example: registered nurse, personnel manager, supervisor of order 

department, secretary, accountant) [OPEN ENDED] 

DK

REF 

H13. [IF SAME EMPLOYER BUT DIFFERENT JOB OR DIFFERENT EMPLOYER THAN DURING INJURY 

ILLNESS] What are your most important activities or duties? (For example: patient care, directing hiring policies, 

supervising order clerks, typing and filing, reconciling financial records) [OPEN ENDED] 

DK

REF