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Approved HCW Consent

Approved HCW Consent

Covid-19 information

Health Care Worker COVID-19 Survey

Informed Consent



Title: Health Care Worker COVID-19 Survey

Investigator: Dr. David Michaels, Department of Environmental and Occupational Health, The George Washington University School of Public Health

Why is this research being done? Health care workers are at the core of the response to the COVID-19 pandemic: their work is uniquely important in the efforts to save lives and reduce further transmission of the virus. In this study, we hope to:

  • Gather basic information about COVID-19 exposures and cases among health care workers in the US.
  • Identify situations, practices and policies that increase the risk of infection.
  • Highlight opportunities to improve worker safety and workplace infection control in health care settings.

Who will take part in this research study? All health care workers who have been exposed to or infected with COVID-19 are invited to complete the survey. Family members may also complete the survey for health care workers who cannot complete it for themselves.

What will we do with the data? We will compile the data we collect and post it on the web, providing a web interface for researchers and the public to view de-identified data.

What happens if I agree to be in this research study? If you agree to participate you will be asked to complete a brief survey that will take 5 to10 minutes to complete. You can complete the survey once for yourself or a family member, and complete additional surveys for any other family members who cannot complete the survey for themselves. Once you have completed the survey your participation in the study is complete.

Do I have to take part in this research study? Participation in this research study is voluntary. It is your choice whether or not you want to take part. You can agree to take part and later change your mind. If you choose not to take part or choose to stop taking part at any time, there will be no penalty to you. Your employment status will not be affected in any way should you choose not to take part or to withdraw at any time.

Is there any way being in this study could be bad for me? Although we are not collecting names or contact information of cases or other participants in the study, there is always a risk of breach of privacy or confidentiality. You may find some questions in the survey to be personal or upsetting. There is a possible risk to employability or reputation, given the nature of some of the questions asked on the survey. The risks and discomforts associated with participation in this study are not expected to be greater than those ordinarily encountered in daily life.

Will being in this study help me in any way? You will not receive any direct benefits from participating in this research.

What happens to my information collected for the research? Every effort will be made to keep your information confidential, however, this cannot be guaranteed. All data will be stored securely on a HIPPA compliant server, which is only accessible to the research team. De-identified results will be made publicly available online at:

Will I be paid for my participation in this research study? Participants will not be paid for their participation in this research study.

What if I have questions or concerns? The person in charge of this study is Dr. David Michaels. If you have questions, suggestions, or concerns regarding this study, his contact information is :; 202-994-1102. This research is being overseen by an Institutional Review Board (“IRB”). You may contact them at 202-994- 2715 or via email at if:

  • You have questions, concerns, or complaints that are not being answered by the research team or if you wish to talk to someone independent of the research team.
  • You have questions about your rights as a research subject.




I have read and understand the consent formand agree to participate in this study



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Thank you.