Document 5d6gj8EeXQ7v4YbB94n1Lvb0

CT'* ' '*& " ' ' ^ ^HEALTH RESEAR 3rROUP 2000 P Street, N.W. WaahiHgton, D.C. 20036. 202/872-0320 ; DSjW- QUESTIONNAIRE TO PLANT PHYSICIANS The Health Research Group is a public interest group funded by Public Citizen, Inc. The purpose of this questionnaire la to gather informa tion for a report about the efficacy of occupational health services in this country. All surveyed plants will be listed in the final report and non-respondents will be listed as such. Feel free to comment or add any clarification that you feel necessary in response to the questions. Please return the questionnaire by August 10. 1974. (A copy of the final report will be mailed to cooperating physicians upon request.) Your participation is greatly appreciated. Name of physician: ^ Title: ____________________________________________ Years of employment (by present company): Are you employed full-time or part-time?" Number of hours employed per week: Name of company: _______________________________ YOur mailing address:___________________ ___ Name and local number of union at plant: ___________ Where were you employed prior to your present job? How long were you employed there? 1. Please indicate your academic training and background by circling the appropriate answer or supplying the requested information. a. Date graduated from medical school: . b. Academlo Residency in occupational medicine: None 1 year 2 years c. "In-plant" residency in a Board approved program: Yes No d. Certification by American Board of Preventive Medicine in Occupational Medicine: Yes No e. Please list other areas of residency training and indicate those in which you are Board-certified. f. Please list any other relevant training. 2. Do you think that there Is enough attention given to occu pational health in medical school? (Please circle answ rs) Yes No 0003491 --over-- '<1- 1 .<_v~ 3. Hav you ever taught occupational health In a medical school, or a school of public health? If yes, where, and for how many hours per year? Yea No 4. At your plant are you responsible for insuring that new data on occupational health hazards is included in your: a. Medical surveillance program? Yes No b. Industrial hygiene program? Yes No If either of these is your responsibility, please send written materials relevant to the program. If either of these is not your responsibility, please list the title or position of the person who is responsible: a. _______________________________________________________________________ b. , 5. Have you ever met with all employees to inform them of the health hazards they will encounter at work and the pre cautionary measures that need to be taken? Yes No If yes, how often do you regularly meet with the employees to discuss occupational health? 6. Have you ever distributed to the employees any written in formation on occupational health hazards? Yes No If yes, please include samples. 7. Are the workers in your plant given a list of all the chemical names of substances to which they are exposed? Yes No 8. Do you ask the employees to report all health problems to you, even if they aren't sure that the problems are occupationally-related? Yes No 9. Do you tour the plant to observe work practices and working conditions? Yes No If yes, how often? 10. Do you check to make sure that the employees are ac tually taking the proper precautions, including the correct use of appropriate protective equipment? Yes No If no, who (position) does? __ ____________________ . 11. At the plant where you are employed, Is there ample op portunity for all employees who seek your services to do so during their work shift? Yes No 12. Do you treat all employees who report to you with medical problems, including those which are nonoccupationally-related? Yes No If no, how is it decided what health needs qualify for treatment by the company physician? ASI-PR 0003492 13. Please indicate -tp .whom you regularly report significant . .. occupationally-related medical findings and the num rtcal:, order in which you report them: __ Patient (a.) J_. :> __ Employees' private physicians __ Dept, of Labor __ Employees-----1----------------) __ Union )__ Assumingconfidentiality __ Management ) ofworkers' names __ Other companies--------- ) 14. Are workers given all results of their own medical surveillance tests? Yes No 15. Has there been a routine reporting of collective results of medical surveillance tests to the union in the plant? Yes No To the workers in the plant? Yes No 16. In the past year what is the average number of hours per week that you spent doing the following: Activity Hours per week Pre-employment exams............................... ........................ Periodic exams (non-executive).... Executive physical exams.............................................. Back-to-work exams following absence for health reasons............ ........................ On-the-job accidents............................... ........................ Treating illnesses............................................................ Educational sessions for workers.. Personal counseling................................. ........................ Administrative............................................. ........................ Research.................................................................................... Business and Travel.......................................................... Industrial hygiene............................................................ Other................................................................... ........................ Total hours per week employed.................................. 17. Is there a Joint (labor and management) health and safety committee in your plant? Ye3 No If yes, do you participate In meetings of this Joint health and safety committee? Yes No 18. If you are employed part-time, who is in charge when you are not present? 19- Is a nurse employed by the medical department in your plant? Yes No If yes, what are the nurse's responsibilities? 20. Does your plant medical program have (check answers): __ Tuberculosis skin testing? __ Pre-employment chest x-rays? An industrial hygienist? __ Full time __ Part time __ A consultant dermatologist? __ A consultant psychiatrist? __ Biochemical laboratory screening for executive physical exams? __ Biochemical laboratory screening for non executive physical exams? 21. Do you think that the size of your budget limits the effec tiveness of the medical program for workers in your plant? Yes No ASI-PR 0003493 --over--  -4- .22 Has there ever been an occupational health hazard In the plant at which you are employed? Yes No If yes, please list the hazards, being as specific as possible. For each hazard, list any adverse effects observed In the workers, the date the effects were first observed, the medical surveillance procedures now employed and the frequency of their application. Per example: HAZARD ADVERSE HEALTH EFFECTS OBSERVED MEDICAL DATE SURVEILLANCE Noise Hearing loss 1964 Annual audiometry Beta-naphthylamine Bladder cancer 1957 Annual cystoscopy; urine cytology - every 6 months --(use additional pages if necessary) List the dates of any investigations or studies that have been undertaken by you or your company on the hazards you have re ported in question #22.. (If a study was done, list the dates under the appropriate heading). Hazard Animal study-' dates______ Human studydates ASI-PR 0003494  " < -jSX. -5' 24. If there have been any company-sponsored, animal studies on the hazards listed In question #22 which have been published in the scientific literature, please give a complete reference (author, title. Journal and date): 25* If there have been any case reports or epidemiological studies on health hazards and the workers in your plant which have been published in the scientific literature, please give a complete reference (author, title, journal and date). Please include all studies on workers in your plant even if no adverse health effects were found: ASI-PR 0003495 --uver-- -6- 26. When were workers at your plant first notified of the hazards and adverse health effects you listed In question #22? HAZARD DATE OF FIRST NOTIFICATION 27. In respcnae to the adverse health effects noted in question #22, have you ever recommended any changes to minimize worker exposure to a particular hazard? Yes No If yes, was management responsive to your suggestions? Yes No 28. Are you aware of any incidents involving the suppression of occupational health data? Yes No 29. Have you ever testified at a workman's compensation case hearing involving a worker employed at any company where you were a physician? Yes No 30. Do you, as a physician, see any conflict in having to repres nt the company in a workman's compensation case? Yes No "l. Are you in any way, other than salary, economically affiliated with the company that employs you? Yes No Does the company offer you stock options? Yes No Do you own stock in the company by which you are employed? Yes No 32. Have you read the series "Annals of Industry--Casualties of the Workplace," by Paul Brodeur, which appeared in the New Yorker Magazine beginning on October 29, 1973? If yes, how many of the serial articles did you read? What was your impression of this series? Yes No * PLEASE RETfjRN ALL QUESTIONNAIRES BY AUGUST 10. 1974 TO THE HEALTH RESEARCH GROUP H# ASI-PR 0003496