In 2002, the National Research Council (NRC) completed an 18-month study entitled Biosolids Applied to Land: Advancing Standards and practices , which made an overarching recommendation to “establish a framework for an approach to implement human health investigations.” In response to this recommendation, the Water Environment Research Foundation (WERF) funded two projects. Phase I began in 2006 and WERF published the results in 2007. Phase I developed a draft five-step rapid response investigation protocol to collect data on reports of health effects from neighbors of land application sites. This project (Phase II) field tested and refined the Phase I draft protocol from May 2009 until November 2010, on 33 complaints from three states. The draft protocol included a health questionnaire to collect data on complaints of alleged health symptoms, nuisance odors, or quality of life effects from neighbors of land application sites of biosolids, manure and other materials, a generator questionnaire to characterize biosolids that were land applied and an applier questionnaire to document methods of application. The project team tested two site investigation reports which documented the location and described the land application site of concern. The project team also evaluated the health questionnaire using pre-testing, content expert reviews, and cognitive interviews during field testing, to determine if any biases existed within both the structure and organization of the questionnaire, the wording, and order of the questions, or within the methods of administration, such as measurement errors resulting from answers by respondents who misinterpreted or did not understand the meaning of questions. In addition, the project team evaluated the generator and applier questionnaires by pre-testing, content expert reviews, field testing, and by using a focus group of generators and appliers. The project team designed the protocol so that local or state public health departments and state biosolids regulators could apply it accurately, efficiently, and effectively as a component of a future standardized surveillance and “rapid response” investigation system throughout the country. The team of researchers also developed an outreach and implementation communication plan and a guidance document that suggested future research methods, based upon what the research team learned from this project. This title belongs to WERF Research Report Series . ISBN: 9781843396147 (eBook)