Instructions:
(1) Your employer must allow you to answer this questionnaire during normal working hours, or at a time and place that is convenient to you. To maintain your confidentiality, your employer or supervisor must not look at or review your answers, and your employer must tell you how to deliver or send this questionnaire to the health care professional who will review it.
(2) Questions denoted with an asterisk ("*") require a response.

Question Title

* 1. Do you agree that your employer has allowed you to answer this questionnaire during normal working hours, or at a time and place that is convenient for you?

Question Title

* 2. Has your employer told you how to contact the health care professional who will review this questionnaire? If no, information will appear on the next page

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