Consent to participate in an Employee Stress Assessment and Management Process

Please read this Informed Consent document (you will have to scroll down) and select the appropriate button at the bottom of the page before proceeding.

The TeamAgility assessment (TA) is primarily a group stress assessment questionnaire being offered to employee work groups. It is a tool developed and distributed by Working Well Limited of the United Kingdom. The TA is designed to identify the primary sources of stress in a work group to help identify appropriate intervention strategies to help reduce that stress or minimize its impact on both the individual and the work group. The reason Dow is offering this questionnaire is that it is recognized that undue stress and pressure impact employee health and performance as well as work group performance, and contributes to job dissatisfaction. Therefore, offering this questionnaire is an investment in helping to understand the sources of undue stress and pressure on work groups, and in identifying appropriate support strategies to reduce stress.

The TA is administered upon request from a work group leader. This may be a small work group, a department or even a site. The TA is only administered electronically.  Once a group has decided to administer the TA, an email will be sent to all eligible participants, inviting them to complete the questionnaire. The email will provide the participant with a personal identification number only known by Working Well Resource Systems. Once the participant completes the questionnaire and hits the [Your Results] button, they will be able to instantly review their results.

How the data will be used by Dow:

Once the administration period for the TA is up, a group report (without any personal identifiable information) will be generated and sent to the group leader, along with the appropriate Dow Regional Health Director and the Dow Human Performance Leader. For U.S. participants only, individual participant's Dow medical data will be correlated with that person's individual responses to identify possible sources of stress that are correlated to higher health care costs. At no time will the medical claims of that individual be shared with anyone within Dow. The group report will then be reviewed and action steps identified to address areas needing improvement. Group reports may be customized to view appropriate subgroups (such as job type or gender). However, no subgroup will be able to be created unless there are a minimum of 15 participants in each group. For instance, in order to view possible gender differences, there must be a minimum of 15 males and 15 females. The group results and identified action steps will then be shared with all eligible employees in that group.

How you may use your personal data:
You are free to discuss your results with a Dow Health Services Professional. It will be up to you to initiate the contact. You may also contact your local Employee Assistance Program office. Your personal report will include a Dow Resources document that provides you with contact information for a variety of resources.

This process has been approved by the Dow Human Studies Review Board, which is a sanctioned Board made up of Dow and community professionals, whose purpose is to insure high ethical standards are met and/or exceeded.

At no time will anyone at Dow be able to view your personal responses or your personal report. The supplier that is analyzing the questionnaires, Working Well Limited, also meets the strict requirements for ensuring confidentiality that are set by the European Union (which meets and, in most cases, exceeds the standards established in the US).

Voluntary Nature of Participation:
Your participation in taking the TA is strictly voluntary. However, in order for the group results to be valid and useful for determining group level interventions, the goal is to get a minimum of 60% participation among eligible employees.

Participation in the TA poses no physical risk. The individual personal profile you will receive will guide you to look at how you are doing in each area and to focus on what you can do to improve. The recommendations provided are very general and written in a positive manner so as not to cause any undue emotional stress. Any personal results discussed by the employee with the Dow Health Services Professional are handled in a manner consistent with the Dow Health Services practices for handling medical records.


Where to get Further Information:
If significant new knowledge is obtained during the course of this research, which may relate to your willingness to continue participation, you will be informed of this knowledge. Also, for any questions or concerns regarding this process, your confidentiality, anonymity or privacy rights you feel may be related to this study, you may contact any of the following (Each name is a link so that you can send a question electronically if you wish):

For any questions or concerns regarding this process, your confidentiality, anonymity or privacy rights you feel may be related to this study, you may contact any of the following (Each name is a link so that you can send a question electronically if you wish):

Principal Investigators:
Catherine Baase, Director, Global Health Services - 989-636-6542

WorkingWell - Liza Hutton – 00-44-207-427-0020
Dow (U.S.) Ethics Hotline - 800-803-6862

Dow Ethics website

Or, your Regional Health Director:
United States - Midland Region  Dr. Cathy Bodnar
989 638 7857
United States - Delaware Valley Region  Dr. Eileen Bonner
215 785 7061
United States - Texas Region  Dr. Stan Miller
979 238 1110
United States - Louisiana Region  Dr. Marcia Lee
989 636 3690
LA Central Region  Dr. Lucio Ribeiro
55 13 3358 8293
Hispanic Region  Dr. Sergio Salomon
54 2914 591520
India, Middle East & Africa/Pacific Region  Dr. Murray Coombs
27 836 539 859
Northern Asia Pacific Region  Dr. Fiona Bao
86 21 385 12467
Western Germany Region  Dr. Bernhard Schumacher
49 4146 912444
Dow Central Germany Region  Dr. Frank Sladeczek
49 3461 492513
Terneuzen Region  Dr. Murray Coombs
27 836 539 859

I have read (or been informed of) the information given above. I understand the meaning of this information. I have been offered the opportunity to ask and have all of my questions concerning my participation in this process answered.

Copyright WorkingWell Limited 2019. 80 Fleet Street, London, EC4Y 1ET.