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ce

[p. 72]

CURRENTLY EMPLOYED PERSON PAGE

Person number ____

E1

1 [] Not SP (E2)
2 [] Eligible respondent avail. (E2)
3 [] Return call required (Next CE Page)


E2

Mark one box:

0 [] No work-loss days (2)
1 [] 1+ work-loss days (1)

Earlier it was reported that -- lost time from work during the past 2 weeks. (Hand Calendar)

1a. On which days during that 2-week period outlined in red did he lose time from work because of illness or injury or because he wasn't feeling well? (Circle all days reported in Table WL-1)

b. On which days did he lose time from work? (Circle all days reported in Table WL and reask 2a.)


[MK Note: On the survey, the question number for the following question appears to be "3," however; this appears to be a typo and should instead read "2", which is what is represented below.]


2a. (Besides this time) During the past 2 weeks, did he lose any (other) time from work to visit a doctor, dentist, or other medical person for himself?

1 [] Y
2 [] N (WL-1)

b. On which days did he lose time from work? (Circle all days reported in Talbe WL-1 and reask 2a.)

3a. (Besides this time) During the past 2 weeks, did he lose any (other time from work to visit a doctor, dentist, or other medical person form himself?

1 [] Y
2 [] N (WL-1)

b. On which days did he lose time from work for this reason? (Circle all days reported in Table WL-1 and reask 3a.)

WL-1
Days circled in WL-1?

[] Y
[] N (7)
TABLE WL-1

[MK Note: This table is difficult to represent; may need to refer to original survey instrument for clarification]

For EACH circled day, ask 4a and b

4a. How many hours did he lose from work on (day)?

1 [] Self employed (Ask 4a only)
Week Before
Mon ____ Hours
Tues ____ Hours
Wed ____ Hours
Thu ____ Hours
Fri ____ Hours
Sat ____ Hours
Sun ____ Hours
Last Week
Mon ____ Hours
Tues ____ Hours
Wed ____ Hours
Thu ____ Hours
Fri ____ Hours
Sat ____ Hours
Sun ____ Hours


b. Will his employer pay him in full, in part, or not at all for this time lost from work?

1 [] Full
2 [] Part
0 [] None


5a. (In addition to his employer) Did or will -- receive any income from loss of pay insurance or income from any other source for all or part of this time lost from work?

[] Y
0 [] N (6)

b. What source is this? (Specify) ____


If ONLY "Full" marked in 4b, go to 7; otherwise ask:

6. How much income did he lose BEFORE DEDUCTIONS because of this time lost from work?

Dollars $ ____
Cents ____
000 [] None

[p. 73]


7a. (Besides this time you have just told me about) During the past 2 weeks, did he lose any time from work because someone else was sick or to take someone else to a doctor, dentist, or for other health care?

1 [] Y
2 [] N (11)

b. On which days did he lose time from work for this reason? (Circle all days reported in Table WL-2.)

c. During the past 2 weeks did he lose any other time from work for this reason?

[] Y (Reask 7b)
[] N


TABLE WL-2

[MK Note: This table is difficult to represent; may need to refer to original survey instrument for clarification]


For EACH circled day, ask 8a and b
8a. How many hours did he lose from work on (day)?

1 [] Self employed (ask 8a only)
Week Before
Mon ____ Hours
Tues ____ Hours
Wed ____ Hours
Thu ____ Hours
Fri ____ Hours
Sat ____ Hours
Sun ____ Hours
Last Week
Mon ____ Hours
Tues ____ Hours
Wed ____ Hours
Thu ____ Hours
Fri ____ Hours
Sat ____ Hours
Sun ____ Hours


b. Will his employer pay him in full, in part, or not at all for this time lost from work?

1 [] Full
2 [] Part
0 [] None


9a. (In addition to his employer) Did or will -- receive any income from loss of pay insurance or income from any other source for all or part of this time lost from work?

[] Y
0 [] N (10)

b. What source is this? (Specify) ____


If ONLY "Full" marked in 8b, go to 11; otherwise ask:

10. How much income did he lose BEFORE DEDUCTIONS because of this time lost from work?

Dollars $ ____
Cents ____
0000 [] None


If days circled in Table WL-1 or WL-2 ask; otherwise go to 12.

11a. How many days per week does -- USUALLY work?

Days ____


b. How many hours per week does he USUALLY work?

Hours ____


c. When he works -- hours, how much does he earn per week BEFORE DEDUCTIONS?

Dollars $ ____
Cents ____


If "Self employed," go to next CE; otherwise ask:

12a. When -- is ill and loses time from work does he continue to receive any wages or salary directly from his employer?

1 [] Y
2 [] N (NP)


b. Under this arrangement is he entitled to a certain number of days sick leave each year?
[] Y
0 [] N (NP)


c. How many days of sick leave is he allowed each year?
Days ____