WTC exposure survey form for four distinct populations, October 2006

NYC 9/11 Public Portal Document

Confidential For Internal Agency use Only

questions regarding the relevance or disclosure of any information collected in response to this survey, contact Cas Holloway ((212) 788-8235; [email protected]) for further assistance.

Information Requests

I. To the extent applicable, please provide the information requested for (i) City employees, (ii) contractors’ employees, (iii) volunteers, and (iv) any other agency clients and constituencies who were exposed to the WTC site.

Note: Responses should separately address each of the four populations listed above. If a particular population is not relevant to your agency, please indicate that in your response.

A. Please provide aggregate data showing how many employees, contractors’ employees, volunteers or other clients or constituencies were exposed to the WTC site, where the exposure occurred, for what period of time, and the tasks performed. To the extent available, the data should include:

(1) [For City employees only] How many employees remain active at the agency (or within City government), how many are retired and how many are deceased.

(a) Of active City employees, how many are on (i) sick leave or (ii) light duty or (iii) worker’s compensation or other disability in connection with a WTC-related injury or illness?

(b) Please provide aggregate data on the number of employees exposed who were covered by city-funded health insurance as of ' September 11, 2001, the coverage providers/plans, and any changes in coverage status, if available.

(2) [For clients or constituencies only] Please provide data explaining what the client or constituency group is and the basis for identifying the clients or constituency as an exposed group;

B. Since September 11, 2001, how has your agency tracked and/or monitored exposed City employees, contractors’ employees, volunteers and/or clients and other constituencies for WTC-related health issues or for any other WTC-related reason?

C. Since the completion of the rescue and recovery efforts, has your agency established any formal communications programs regarding WTC health issues for exposed City employees, contractors’ employees, volunteers and/or clients and other constituencies? What information is provided, and how frequently is such information conveyed?

2

NYC-WTC_000164528