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ATLANTA AND CHICAGO DIAPERS

5.

1.During the 12-day study, you would be asked to complete a questionnaire after removing each diaper. You would need to return the used diapers (in bags provided) and paperwork to our agency during normal business hoursd. We are looking for Step/ size Newborn and Step / size 1. Do you have a child that wears one of these sizes and you can not have participated in a diaper study in the last 3 months.
2.Please complete the contact information below. (Required.)
3.Please supply us with a secondary contact number.

Murray Hill Center standard policy requires at least two contact numbers for each respondent.

If the secondary number you give us is not your own number but a friend, family member or co-worker please indicate as such.(Required.)
4.What is your gender?(Required.)
5.What is your current age? (Required.)
6.What is your ethnicity? (Required.)
7.What is your current work status?(Required.)
8.What is your Occupation-Job Title, Company you work for, and Industry?

(If you are Retired, Unemployed or a Homemaker Please tell us your previous employment information. If you are a full-time student please enter your Grade, School and Major)(Required.)
9.8. What is the highest level of education that you have completed?

(Required.)
10.9. What is your current marital status?
(Required.)
11.For this study, we are interested in speaking with people who work in certain occupations. For this reason, we need to know for what companies you or any other members of your household work.
12.Do you have a child at home currently wearing diapers?
13.Which type of diapers do you use for your child?
14.Would you please tell me the size of diapers that your child is currently using?
15.Do you anticipate that your child will be wearing a Step 1/Size 1 disposable diaper during the study dates of 6 – 18 February 2015?
16.What is your child’s current weight (approximately)?
17.Is your child in good general health?
18.. What brand of disposable diapers have you used most often during the past 30 days?
19.Is your baby a boy or a girl?
20.Does your baby have a chronic skin condition (eczema, psoriasis etc.)?
21.. Does your child have known allergies or skin sensitivities to disposable absorbent products or their materials/components, cosmetics or fragrance ingredients?
22.What type of daycare does your child attend, if any?
23.It would be your responsibility to instruct any of your child’s care givers on how to follow the same study procedures as we will ask of you. Would you be willing to instruct your child’s care provider of these procedures?
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