Welcome to the Agricultural Self-Report Survey

We invite you to participate in a research study being conducted by investigators from The University of Iowa. The purpose of this study is to test a self-report system for non-fatal injuries and near misses among agricultural workers, and to test whether an online safety and health community encourages participation in a self-report program.

In order to participate in this study, you must be 18 years of age or older and work in agricultural production or a related industry.

If you agree to participate, we would like you to complete a survey. You are free to skip any questions that you prefer not to answer. It will take approximately 10 minutes.

If you agree to participate in this study your data will only be identified by a random, non-sequential participant number. We will not collect your name or any identifying information about you. It will not be possible to link you to your responses on the survey. When we have collected 300 surveys, the surveys will be made available in an online database. All reports will be screened before they are added to the database. The online database is intended to allow workers, equipment manufactures, and safety and health professionals to benefit from the information collected during this study. We hope that making this data available to others will lead to innovations that will ultimately reduce the rates of injuries and fatalities among agricultural workers.

Taking part in this research study is completely voluntary. If you do not wish to participate in this study, simply click exit at the bottom of the screen at any time. You may end your participation at any time using the exit button.

If you have questions about the study, please contact Nicole Becklinger, Department of Mechanical and Industrial Engineering, 2403 Seamans Center for the Engineering Arts and Sciences, Iowa City, IA, 52245; Phone: 319-554-5564; or e-mail nbecklin@engineering.uiowa.edu

If you have any questions about the rights of research subjects, please contact the Human Subjects Office, 105 Hardin Library for the Health Sciences, 600 Newton Rd, The University of Iowa, Iowa City, IA 52241-1098, (319)335-6564 or e-mail irb@uiowa.edu

Thank you very much for your consideration of this research study