Synthetic Turf Field Facility Owner/Manager Questionnair

Form Approved

OMB No. 0923-XXXX

Exp. Date xx/xx/20xx xxxxxx/xx/xx/20xx

Attachment 4h. Synthetic Turf Field Facility Owner Manager Questionnaire

Interviewer: In this interview, I would like to ask you some general questions about your role and responsibilities at this facility and about the operation, maintenance, and use of the synthetic turf fields with crumb rubber infill at your facility.

A1. Who owns the facility?

Private

School

City

County

State

Military/Federal

(enter other if necessary)

A1.a What type of organization owns the facility?

A2. What is your profession and relationship to this facility?

(owner or manager)

A3. How long have you operated this facility?

yrs

months

A4. May I have your phone number and E-mail address for future contact?

Phone

ATSDR estimates the average public reporting burden for this collection of information as 30 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Reports Clearance Officer; 1600 Clifton Road, MS D-74, Atlanta, GA 30333, ATTN: PRA (0923-XXXX).

E-Mail

A8. How many days per week are the synthetic fields open at this facility during each season?

Days per Week Spring 0

Days per Week Summer 0

Days per Week Fall 0

Days per Week Winter 0

A9. What is average number of hours per day that people use the synthetic fields at this facility during the four seasons?

Hours per Day Spring 0

Hours per Day Summer 0

Hours per Day Fall 0

Hours per Day Winter 0

A10a. On average, how many people per day use the synthetic fields at this facility during Spring?

A10b. On average, how many people per day use the synthetic fields at this facility during Summer?

A10c. On average, how many people per day use the synthetic fields at this facility during Fall?

A10d. On average, how many people per day use the synthetic fields at this facility during Winter?

A11. For each of the different age groups, what sports or other activities are played on the synthetic turf fields at this facility during which seasons (check all that apply)?

				Spring	Summer	Fall	Winter
	< 6		Soccer
			Football
			Field Hockey
			Baseball
			Softball
			Rugby
			Ultimate Frisbee
			Physical Training (PT)
			Physical Education (PE)
			Other:
			Other:
	6 - 11		Soccer
			Football
			Field Hockey
			Baseball
			Softball
			Rugby
			Ultimate Frisbee
			Physical Training (PT)
			Physical Education (PE)
			Other:
			Other:

A11. For each of the different age groups, what sports or other activities are played on the synthetic turf fields at this facility during which seasons (check all that apply)? (continued)

				Spring	Summer	Fall	Winter
	12 - 18		Soccer
			Football
			Field Hockey
			Baseball
			Softball
			Rugby
			Ultimate Frisbee
			Physical Training (PT)
			Physical Education (PE)
			Other:
			Other:
				Spring	Summer	Fall	Winter
	18 +		Soccer
			Football
			Field Hockey
			Baseball
			Softball
			Rugby
			Ultimate Frisbee
			Physical Training (PT)
			Physical Education (PE)
			Other:
			Other:

Facility Information

A12. Do you have any standard practices in place to reduce tire crumb exposure to people using the synthetic fields?

Outdoor Fields Only

A13. Are there outdoor fields at this facility?

A14. When was each outdoor synthetic field installed at this facility?

Field Month Year

A15. Which company or companies installed these fields?

A16. Do you ever replace all of the tire crumb infill on the outdoor synthetic turf field(s) at your facility?

Yes

No

Don’t Know

Refused

If yes, how often do you replace all of the tire crumb infill on the synthetic turf fields?

A17. Do you ever refresh or add tire crumb infill to your outdoor synthetic turf field(s) at your facility?

Yes

No

Don’t Know

Refused

If yes, how often do you refresh or add tire crumb infill to your synthetic turf fields?

A18. What was the date of the most recent replacement/refreshment?

A19. Which company or companies provides crumb rubber infill material for replacement/refreshment?

A20. Are the following routine field maintenance activities performed on the outdoor synthetic field(s) at this facility?

	Activity	Times	per
	Sweeping		Day/week/month/year
	Brushing		Day/week/month/year
	Redistribution/leveling		Day/week/month/year
	Aerating		Day/week/month/year
	Magnet sweep		Day/week/month/year
	Rejuvenation		Day/week/month/year
	Deep Cleaning		Day/week/month/year

A21. Has the outdoor synthetic field(s) ever been treated with biocides, herbicides, insecticides, fungicides, or other agents?

Yes

No

Don’t know

Refused

A22. Have any of the following chemicals been used on the field? (check all that apply) and how often?

	Chemical	Times	per
	Algae Died B		Day/week/month/year
	Qualgex		Day/week/month/year
	Steri-maX		Day/week/month/year
	Other (specify)		Day/week/month/year
	Unknown Biocide			Daily/weekly/ monthly/annually

Indoor Fields Only

A23. Are there indoor fields at this facility?

A24. When was each indoor synthetic field installed at this facility?

Field Month Year

A25. Which company or companies installed these fields?

A26. Do you ever replace all of the tire crumb infill on the indoor synthetic turf field(s) at your facility?

Yes

No

Don’t Know

Refused

If yes, how often do you replace all of the tire crumb infill on the synthetic turf fields?

A27. Do you ever refresh or add tire crumb infill to your indoor synthetic turf field(s) at your facility?

Yes

No

Don’t Know

Refused

If yes, how often do you refresh or add tire crumb infill to your synthetic turf fields?

A28. What was the date of the most recent replacement/refreshment?

A29. What company or companies provides crumb rubber infill material for replacement/refreshment?

A30. Are the following routine field maintenance activities performed on the indoor synthetic field(s) at this facility?

	Activity	Times	per
	Sweeping		Day/week/month/year
	Brushing		Day/week/month/year
	Redistribution/leveling		Day/week/month/year
	Aerating		Day/week/month/year
	Magnet sweep		Day/week/month/year
	Rejuvenation		Day/week/month/year
	Deep Cleaning		Day/week/month/year

A31. Has the outdoor synthetic field(s) ever been treated with biocides, herbicides, insecticides, fungicides, or other agents?

Yes

No

Don’t Know

Refused

A32. Have any of the following chemicals been used on the field? (check all that apply) and how often?

	Algae Died B		Daily/weekly/ monthly/annually
	Qualgex		Daily/weekly/ monthly/annually
	Steri-maX		Daily/weekly/ monthly/annually
	Other (specify)		Daily/weekly/ monthly/annually
	Unknown Biocide		Daily/weekly/ monthly/annually

A33. Do you know the outdoor air fraction ventilation rates for this facility during each season?

If yes (please specify):

Spring		(cfm)
Summer		(cfm)
Fall		(cfm)
Winter		(cfm)

If you do not know, can you identify a person, including their phone number, who can provide us with your facility ventilation rates?

(full name) (phone number)

Thank you so much for your time. I know that your time is valuable. If you have any questions or concerns, please, refer to the contact sheet for information on who to contact.