RECA questionnaire- we want to hear from you

We want to hear from you

The Center for Public Integrity wants to learn more about people who were exposed to uranium while working in the uranium industry in the United States during the 20th century.
Please fill out this questionnaire if one of these descriptions fits you:
You’re a uranium miner, mill worker, or ore transporter who worked in the uranium industry in or after 1941 OR are a relative of such a worker.

We will not share or publish any of your personal information without permission. You can submit this form online by hitting submit at the end of the questionnaire. If you complete a print version of this form, please scan a copy and send to Phil Harrison at philharrisonjr@hotmail.com or mail a copy to P.O. Box 661, Shiprock, New Mexico, 87420. Call 505-635-5212 with any questions.

Print or scanned versions can also be sent to reporter Yvette Cabrera at ycabrera@publicintegrity.org or mailed to The Center for Public Integrity, 910 17th Street NW, Suite 1030, Washington DC 20006.

The Center for Public Integrity is a nonprofit newsroom that reports on issues of inequality. We are collecting this data in partnership with the Navajo Uranium Radiation Victims Committee (established in the 1970s) and the committee’s senior consultant Phil Harrison, a member of the Navajo Nation. Public Integrity is gathering the information for stories on this topic, and the Navajo Uranium Radiation Victims Committee seeks to create a database of Navajo miners/workers and other indigenous miners/workers in the U.S. uranium industry. We may use non-identifying responses to aid with our reporting. Both organizations will have access to the data collected.
The information I am submitting is about:*

MeA relative
Your name *

First NameLast Name
Name of uranium worker (If you're the uranium worker, write your name) *

First NameLast Name
Date of birth of miner

MonthDayYear
Date
Relation to the uranium worker

SelfSpouseSiblingChildParentOther
Agency affiliation if Navajo (N/A if not).
Chapter affiliation if Navajo (N/A if not).
Mailing address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Email
example@example.com
Name of employer *
List all in chronological order. Separate with comma.
Name of mine*
List all in chronological order. Separate with a comma.
Name of mining area*
List all in chronological order. Separate with a comma.
County of mine *
List all in chronological order. Separate with a comma.
State of mine *
Start date of work *
(Month/Year- List all start dates in chronological order. Separate with a comma.)
End date of work *
(Month/Year- List all end dates in chronological order. Separate with a comma.)
Occupation or activity in mine (select all that apply)

Underground uranium minerSurface uranium minerOre TransporterMill workerOther
Have you or your relative (if you're filling out this form about their work) qualified for RECA compensation?

YesNoI don't know
Did you or your relative experience any health complications that you believe are related to working in the uranium industry? Check all that apply

Lung cancerFibrosis of the lungPulmonary fibrosisSilicosisPneumoconiosis or corpulmonale related to lung fibrosisprimary renal cancerchronic renal diseaseOther
Do you have records or relevant documents you can share? Please attach them here.

Cancelof
Are you or your impacted relative a veteran*

YesNo
Can a reporter contact you for further information? (If a reporter decides to contact you, you can ask to keep the conversation confidential.)*

YesNo
What is your preferred method of contact (select all that apply)*

Phone callEmailTextWhatsAppOther
How can Public Integrity use this information you shared?*

Anonymously, just for background informationPublic Integrity can quote my answers, anonymouslyPublic Integrity can quote my answers and attribute them to meOther
Should be Empty:

We want to hear from you