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[p.188]

Section N - OCCUPATIONAL HEALTH

Section N1 - WORK HISTORY

In this part of the survey I will ask about your work experience, certain medical conditions and other health-related matters.


1a. First, I'll ask about the king of work you have done the longest, not counting work around the house. Thinking of all the jobs or businesses you have ever had, what kind of work did you do the longest? Include work done while in the Armed Forces.

Occupation ____
990 [] Never worked (Section N8, page 66)

b. When you were doing this kind of work, what were your most important activities or duties?

Duties ____


2a. How long did you do this kind of work?

00 [] Less than 1 year
Years ____


b. How old were you when you started doing this kind of work?

Age ____


3a. In what kind of business or industry did you do this kind of work the longest? For example, TV and radio manufacturing, retail shoe store, State Labor Department, farm.

Industry ____
932 [] Armed Forces - Civilian
942 [] Armed Forces - Active duty


g. In the industry where you worked the longest as a (entry in 1a) were you --
An employee of private company, -business, or individual for wages, salary or commission? .... P
A member of the armed forces? .... AF
A federal government employee? .... F
A state government employee? .... S
A local government employee? .... L
Self-employed in own business, professional practice or farm?
Ask: Is the business incorporated?
Yes .... I
No .... SE
Working without pay in family business or farm? ....WP

Class of worker
1 [] P
2 [] AF
3 [] F
4 [] S
5 [] L
6 [] I
7 [] SE
8 [] WP


Check item 1
Refer to HIS-1, C1.

1 [] Wa/Wb box marked in C1 (Check Item 5A, page 44)
2 [] Neither Wa nor Wb box marked in C1 (4)


4a. During the past 12 months, that is, since (12 month date) a year ago, did you work at any time at a job or business, not counting work around the house? (Include unpaid work in the family business or farm.)

1 [] Yes
2 [] No


b. How long has it been since you last worked at a job or business?
If less than 1 year (4c); If 1 year or more (8)

____
Number
1[] Weeks
2[] Months
3[] Years


c. For whom did you work at your last job or business? Enter name of company, business, organization or other employer

Employer ____

d. What kind of business or industry is this? For example, TV and radio manufacturing, retail shoe store, State Labor Department, farm.

Industry ____


e. What kind of work were you doing? For example, electrical engineer, stock clerk, typist, farmer.

Occupation ____

f. What were your most important activities or duties? For example, types, keeps account books, files, sells cars, operates printing press, finishes concrete.

Duties ____


Complete from entries in 4c-f. If not clear ask:
g. Were you --
An employee of private company, -business, or individual for wages, salary or commission? .... P
A member of the armed forces? .... AF
A federal government employee? .... F
A state government employee? .... S
A local government employee? .... L
Self-employed in own business, professional practice or farm?
Ask: Is the business incorporated?
Yes .... I
No .... SE
Working without pay in family business or farm? ....WP

Class of worker
1 [] P
2 [] AF
3 [] F
4 [] S
5 [] L
6 [] I
7 [] SE
8 [] WP

[p. 189]

Section N1 - WORK HISTORY - Continued


5. How long did you work as a (occupation in 4a) for (employer in 4c)?

____
Number
1[] Weeks
2[] Months
3[] Years


Check item 2
Refer to 4e and 1a.

1 [] Occupation in 4e is same as in 1a (8)
8 [] All others (6a)

6a. Considering all of your employers, for how many years altogether did you do this KIND of work?

00[] Less than 1 year
Years ____


b. How old were you when you started doing this kind of work?

Age ____


7a. In what kind of business or industry did you do this kind of work the longest? For example, TV and radio manufacturing, retail shoe store, State Labor Department, farm.

Industry ____
932 [] Armed Forces - Civilian
942 [] Armed Forces - Active duty


b. Were you --
An employee of private company, -business, or individual for wages, salary or commission? .... P
A member of the armed forces? .... AF
A federal government employee? .... F
A state government employee? .... S
A local government employee? .... L
Self-employed in own business, professional practice or farm?
Ask: Is the business incorporated?
Yes .... I
No .... SE
Working without pay in family business or farm? ....WP

Class of worker
1 [] P
2 [] AF
3 [] F
4 [] S
5 [] L
6 [] I
7 [] SE
8 [] WP


Hand Card N1, read list if telephone interview.

Card N1

1. Stopped working because of own illness, injury, disability or health problem that wsa job-related
2. Stopped working because of own illness, injury, disability, or other health problem that was not job-related
3. Retired
4. Child/family care
5. On layoff from a job
8. Some other reason (Specify)

8a. Which of these statements describe the reason or reasons you stopped working (entry in 4b) ago?
Mark all that apply.

1 [] Stopped working because of own illness, injury, disability or other health problem that was job-related.
2 [] Stopped working because of own illness, injury, disability or other health problem that was not job related.
3 [] Retired
4 [] Child/family care
5 [] On layoff from a job
8 [] Some other reason - Specify ____
9 [] DK


Check item 3
Refer to 8a.

1 [] Box 1 marked in 8a (8b)
8 [] All others (Check Item 4)

8b. Was a worker's compensation claim filed for your illness, injury, disability, or other health problem?

1 [] Yes
2 [] No (8d)


c. Have you received any money or other benefits from worker's compensation since you stopped working (entry in 4b) ago?

1 [] Yes
2 [] No


d. Was a claim filed for any other income or benefits because your health problem was job-related?

1 [] Yes
2 [] No

Check item 4
Refer to question 4. Mark first appropriate box.

1 [] "Armed Forces-Active Duty" in 4c (Section N7, page 62)
2 [] "Yes" in 4a (Check Item 7)
8 [] All others (Section N7, page 62)
[p.190]

Section N1 - WORK HISTORY - Continued


Check item 5A
Refer to HIS-1, pages 44 and 45.

1 [] Self respondent for questions 6b-g (Check Item 5B)
2 [] Proxy respondent for questions 6b-g (9)
8 [] All others (9)

Hand calendar
9a. Earlier I was told you had a job during the 2 weeks [outlines on that calendar/beginning Monday (date) and ending Sunday [(date)]. For whom did you work? Enter name of company, business, organization, or other employer.

Employer ____
932 [] Armed Forces - Civilian (9c)
942 [] Armed Forces - Active duty (9c)

b. What kind of business or industry is this? For example, TV and radio manufacturing, retail shoe store, State Labor Department, farm.

Industry ____


If "Active duty" in 9a, mark "AF" box without asking.
c. What kind of work was -- doing? For example, electrical engineer, stock clerk, typist, farmer.

Occupation ____
905 [] AF (Section N8, page 66)

d. What were your most important activities or duties at that job?
For example, types, keeps account books, files, sells cars, operates printing press, finishes concrete

Duties ____


Complete from entries in 9a-d. If not clear ask:
e. Were you -
An employee of private company, -business, or individual for wages, salary or commission? .... P
A member of the armed forces? .... AF
A federal government employee? .... F
A state government employee? .... S
A local government employee? .... L
Self-employed in own business, professional practice or farm?
Ask: Is the business incorporated?
Yes .... I
No .... SE
Working without pay in family business or farm? ....WP

Class of worker
1 [] P
2 [] AF (Section N8, page 66)
3 [] F
4 [] S
5 [] L
6 [] I
7 [] SE
8 [] WP

Check Item 5B
Refer to questions 9a and c or to HIS-1 pages 44--45.
Transcribe from questions 9a and c or from 6b/c and e on HIS-1.

Employer ____ (9f)
Occupation ____ (9f)

Hand calendar
9f. (You told me that during the 2 weeks (outlined on that calendar/beginning Monday (date) and ending Sunday (date)) you were employed as a (occupation in Check Item 5B) for (employer in Check Item 5B.)) How long have you worked as a (occupation in Check Item 5B) for (employer in Check Item 5B)?

____
Number
1[] Weeks
2[] Months
3[] Years


Check Item 6
Refer to Check item 5B and question 1a:

[] 1 Occupation in Check Item 5B is same as in 1a (Check Item 7)
[] 8 All others (9g)

9g. Considering all of your employers, for how many years altogether did you do this kind of work?

00[] Less than 1 year
Years ____


h. How old were you when you started doing this kind of work?

Age ____


i. In what kind of business or industry did you do this kind of work the longest? For example, TV and radio manufacturing, retail shoe store, State Labor Department, farm.

Industry ____
[] 932 Armed Forces -- Civilian
[] 942 Armed Forces -- Active duty


j. Were you --
An employee of private company, -business, or individual for wages, salary or commission? .... P
A member of the armed forces? .... AF
A federal government employee? .... F
A state government employee? .... S
A local government employee? .... L
Self-employed in own business, professional practice or farm?
Ask: Is the business incorporated?
Yes .... I
No .... SE
Working without pay in family business or farm? ....WP

Class of worker
1 [] P
2 [] AF
3 [] F
4 [] S
5 [] L
6 [] I
7 [] SE
8 [] WP

[p.191]

Section N1 -- Work History -- Continued

Check Item 7
Refer to Check Item 5B.

[] 1 Entry in Check Item 5B (Transcribe entries)
Employer ____ (10)
Occupation ____ (10)
[] 8 All other (Transcribe entries from 4c and e)
Employer ____ (10)
Occupation ____ (10)

These next questions are about your job as a (occupation in Check Item 7) for (employer in Check item 7).
10a. Did your job require you to do repeated strenuous physical activities such as lifting, pushing or pulling heavy objects?

1[] Yes
2[] No (11)


b. During a typical work day, how many minutes or hours altogether did you spend doing strenuous physical activities?

_____
Number
1[] Minutes
2[] Hours


11a. Did this job require you to do repeated bending, twisting or reaching?

1[] Yes
2[] No (12)


b. During a typical work day, how many minutes or hours altogether did you spend bending, twisting or reaching?

_____
Number
1[] Minutes
2[] Hours


12a. Did this job require you to bend or twist your hands or wrists many times an hour?

1[] Yes
2[] No (13)


b. During a typical workday, how many minutes or hours altogether did you spend bending or twisting your hands or wrists?

_____
Number
1[] Minutes
2[] Hours


13a. On this job, did you work with hand-held or hand-operated vibrating tools or machinery?

1[] Yes
2[] No (14)


b. During a typical work day, how many minutes or hours altogether did you spend working with hand-held or hand-operated vibrating machinery?

_____
Number
1[] Minutes
2[] Hours


14. I am going to read a list of substances that some people get on their skin at work. Tell me if you got any of these things on your hands or arms at your job as a (occupation in Check Item 7) for (employer in Check Item 7) during the past 12 months --


a. Did you get solvents or degreasers on your hands or arms?

1[] Yes
2[] No


b. Petroleum products other than solvents? For example, grease, oil, or fuel?

1[] Yes
2[] No


c. Soaps, detergents, or cleaning and disinfecting solutions used in performing your job?

1[] Yes
2[] No


d. Cutting oils, machine coolants, or metal working fluids?

1[] Yes
2[] No


e. Paints, varnishes, lacquers, or other coatings?

1[] Yes
2[] No


f. Glues, pastes, or other adhesives?

1[] Yes
2[] No


g. Acids or alkalies?

1[] Yes
2[] No


h. Pesticides, insecticides, herbicides, fungicides, or fumigants?

1[] Yes
2[] No


i. Foods or food products handled as part of your job duties?

1[] Yes
2[] No


j. Plants, trees, or shrubs handled as part of your job duties?

1[] Yes
2[] No


k. Did you get any other chemicals or substances on your hands or arms that could irritate the skin?

1[] Yes - Specify ____
2[] No
9[] DK

[p.192]

Section N2 -- Back Pain


These next questions are about back pain.

1a. At any time during the past 12 months, that is, since (12 month date) a year ago, did you have back pain every day for a week or more?

1[] Yes
2[] No (Section N3, page 49)
Check Item 8
Refer to sex and age.

1[] SP is female under 50 (1b)
8[] All others (2)

b. Did you have this back pain only at the tiem of your monthly periods?

1[] Yes (Section N3, page 49)
2[] No
3[] Don't menstruate


2a. (The remaining questions are about back pain other than menstrual pain.)
During the past 12 months, on about how many days altogether did you have back pain?

898[] Menstrual pain only (Section N3, page 49)
365[] Every day
Days ____


b. During the past 12 months, how many full days did you miss from work because of back pain?

000[] None
Days ____


3a. When you had this back pain, what part of your back bothered you the most -- the upper back, the middle back or the lower back?

1[] Upper
2[] Middle
3[] Lower


b. During the past 12 months, did the back pain ever spread to your:


buttocks?
1[] Yes
2[] No
9[] DK


thighs?
1[] Yes
2[] No
9[] DK


lower leg or foot?
1[] Yes
2[] No
9[] DK


4a. Did any of the back pain you had in the past 12 months result from a single accident or injury? Some examples are slipping, falling, twisting, lifting something, or being in a car accident.

1[] Yes
2[] No (5)


b. When did the accident or injury happen?

Month ____
Date ____
Year 19____


c. Were you at work at your job or business when the accident or injury happened?

1[] Yes
2[] No (5)


d. Was this at your job as a (occupation in Check Item 7) for (employer in Check Item 7)?

1[] Yes (5)
2[] No


e. For whom did you work when the accident or injury happened?
Enter name of company, business, organization, or other employer.

Employer ___
932[] Armed Forces -- Civilian (4g)
942[] Armed Forces -- Active duty (4g)

f. What kind of business or industry is this?
For example, TV and radio manufacturing, retail shoe store, State Labor Department, farm.

Industry ____


g. What kind of work did you do at that job?
For example, electrical engineer, stock clerk, typist, farmer.

Occupation ____

h. What were the most important activities or duties at that job?
For example, types, keeps account books, files, sells cars, operates printing press, finishes concrete.

Duties ____


Complete from entries in 4e--h. If not clear, ask:
i. Were you --
An employee of private company, -business, or individual for wages, salary or commission? .... P
A member of the armed forces? .... AF
A federal government employee? .... F
A state government employee? .... S
A local government employee? .... L
Self-employed in own business, professional practice or farm?
Ask: Is the business incorporated?
Yes .... I
No .... SE
Working without pay in family business or farm? ....WP

Class of worker
1 [] P (5)
2 [] AF (5)
3 [] F (5)
4 [] S (5)
5 [] L (5)
6 [] I (5)
7 [] SE (5)
8 [] WP (5)

[p. 193]

Section N2 -- Back Pain -- Continued


5a. Was any of the back pain you had in the past 12 months brought on by repeated activities such as lifting, pushing, pulling, bending, twisting, or reaching?

1[] Yes
2[] No (7)


b. Where did you perform the activities that brought on your back pain?
Mark only one box.

1[] At work (6)
2[] At home
3[] Recreational site (8)
8[] Other -- Specify ____ (8)


6a. Was this at your job as a (occupation in Check Item 7) for (employer in Check Item 7)?

1[] Yes (8)
2[] No


b. For whom did you work?
Enter name of company, business, organization, or other employer.

Employer ____
932[] Armed Forces -- Civilian (6d)
942[] Armed Forces -- Active duty (6d)

c. What kind of business or industry is this?
For example, TV and radio manufacturing, retail shoe store, State Labor Department, farm.

Industry ____


d. What kind of work did you do at that job?
For example, electrical engineer, stock clerk, typist, farmer.

Occupation ____

e. What were your most important activities or duties at that job?
For example, types, keeps account books, files, sells cars, operates printing press, finishes concrete.

Duties ____


Complete from entries in 6b--e. If not clear, ask:
f. Were you --
An employee of private company, -business, or individual for wages, salary or commission? .... P
A member of the armed forces? .... AF
A federal government employee? .... F
A state government employee? .... S
A local government employee? .... L
Self-employed in own business, professional practice or farm?
Ask: Is the business incorporated?
Yes .... I
No .... SE
Working without pay in family business or farm? ....WP

Class of worker
1 [] P (8)
2 [] AF (8)
3 [] F (8)
4 [] S (8)
5 [] L (8)
6 [] I (8)
7 [] SE (8)
8 [] WP (8)


If "Yes" in 5a, go to 8.
7. What caused your back pain? ________


8a. Has your back bothered you today?

1[] Yes (8c)
2[] No


b. How many days, weeks or months ago did you last have back pain?

____
Number
1[] Days
2[] Weeks
3[] Months


c. For how many consecutive days, weeks or months (did your back bother you that time/has your back been bothering you)?

____
Number
1[] Days
2[] Weeks
3[] Months
4[] Years

[p. 194]

Section N2 -- Back Pain -- Continued


9a. In what year did you first have an episode of back pain that lasted for a week or more?

87[] 1987 (9c)
88[] 1988 (9c)
89[] 1989 (9c)
[] Earlier year - Specify ____


b. Counting (year in 9a), in how many different years have you had episodes of back pain lasting for a week or more?

Years ____


Hand Card N2, read list if telephone interview

Card N2

0. Less than one month
1. 1 month, less than 3 months
2. 3 months, less than 6 months
3. 6 months, less than 12 months
4. 1 year, less than 5 years
5. 5 or more years

c. What was the longest period of time that you had back pain every day?

0[] Less than one month
1[] 1 month, less than 3 months
2[] 3 months, less than 6 months
3[] 6 months, less than 12 months
4[] 1 year, less than 5 years
5[] 5 or more years


10a. Have you ever stopped working at a job or changed jobs because of back pain?

1[] Yes (Section N3)
2[] No


b. Have you ever made a major change in your work activities because of back pain?

1[] Yes
2[] No

[p.195]

Section N3 -- Hand Discomfort

Now I will ask some questions about your hands and wrists.


1. Are you left handed, right handed or able to use both hands equally well?

1[] Left handed
2[] Right handed
3[] Able to use both hands equally well


2. Which hand do you use most at work?

1[] Left
2[] Right
3[] Use both hands equally


3. During the past 12 months, that is, since (12 month date) a year ago, have you had discomfort in your hands, wrists or fingers? Discomfort can mean pain, burning, stiffness, numbness, or tingling.

1[] Yes
2[] No (Section N4, page 52)


4. Was this discomfort due entirely to an injury, such as a cut, sprain or broken bone?

1[] Yes (Section N4, page 52)
2[] No
9[] DK


5a. During the past 12 months, on about how many days altogether did you have discomfort in your hands, wrists or fingers?

000[] Less than 5 days (section N4, page 52)
Days ____
365[] Every day (6)


b. During the past 12 months, did you have the discomfort every day for a week or more?

1[] Yes
2[] No


Check Item 9
Refer to 5a and 5b: Mark first appropriate box

1[] 20 or more in 5a (6)
2[] "Yes" in 5b (6)
8[] All others (section N4, page 52)

6. In which hand did you have this discomfort?

1[] Left
2[] Right
3[] Both


7. Was your discomfort worse when you were trying to sleep or did it awaken you from sleep?

1[] Yes
2[] No


8. In the past 12 months, did your hands or fingers often feel clumsy, that is, did you often have difficulty picking up or holding things?

1[] Yes
2[] No


9a. Has your hand(s) bothered you today?

1[] Yes (9c)
2[] No


b. How many days, weeks or months ago did you last have this discomfort?

____
Number
1[] Days ago
2[] Weeks ago
3[] Months ago


c. For how many consecutive days, weeks, or months did your hand(s) bother you that time/has your hand(s) been bothering you?

____
Number
1[] Days
2[] Weeks
3[] Months
4[] Years


10a. In what year did you first notice this hand discomfort?

87[] 1987 (11)
88[] 1988 (11)
89[] 1989 (11)
[] Earlier year- Specify ____


b. Counting (year in 10a), in how many different years has your hand(s) bothered you?

Years ____


11a. During the past 12 months, were you away from work for more than one week for any reason?

1[] Yes
2[] No (12)


b. When you were away from work for more than one week, did your hand discomfort increase, decrease, or stay the same?

1[] Increase
2[] Decrease
3[] Stay the same


12. During the past 12 months, did you miss at least a full day from work because of your hand discomfort?

1[] Yes
2[] No

[p.196]

Section N3 -- Hand Discomfort -- Continued


13a. Have you ever stopped working at a job or changed jobs because of your hand discomfort?

1[] Yes (14)
2[] No


b. Have you ever made a major change in your work activities because of your hand discomfort?

1[] Yes
2[] No


14a. How long has it been since you last saw or talked to a medical doctor, chiropractor, physical therapist or other medical person about your hand discomfort?

000[] Never saw medical person (15)

____
Number
1[] Days
2[] Weeks
3[] Months
4[] Years


b. What did the medical person call your hand discomfort? ____


15. Even if you have mentioned it before, please tell me if you have ever had any of the following conditions --


a. Arthritis of the hand, wrist or fingers?
1[] Yes
2[] No
9[] DK


b. A broken bone in your hand, wrist, or fingers?
1[] Yes
2[] No
9[] DK


c. A condition affecting the wrist and hand called carpal tunnel syndrome?
1[] Yes
2[] No
9[] DK

[p.197]

Section N4 -- Work Injuries


Now I will ask about on-the-job injuries in the past 12 months.
Hand Card N3

Card N3

To get medical attention or treatment other than first aid for minor injuries OR
To be unable to do some work activities OR
To lose consciousness OR
To transfer to another job

By "on-the-job injury" we mean an injury at work that resulted in at least one of the following:
an injury that required you to get medical attention or treatment, other than first aid for minor injuries; or to be unable to do some of your work activities; or to lose consciousness; or to transfer to another job.

1. During the past 12 months, that is, since (12 month date) a year ago, have you had any on-the-job injuries?

1[] Yes
2[] No (Section N5, page 58)


2. How many times have you been injured on the job during the past 12 months?

Number of times ____


3. On what date did your [(most recent) injury/injury before that] happen?
Enter each date in a separate column.

Month ____
Date ____
Year 19____

Complete question 4-21 as appropriate for the first injury before completing them for the next, etc.


4. At the time of your injury on (date in 3) were you working as a (occupation in Check Item 7) for (employer in Check Item 7)?

[] Injury 1
1[] Yes (6)
2[] No


5a. For whom did you work when the injury happened?
Enter name of company, business, organization, or other employer.

Employer ____
932[] Armed Forces -- civilian (5c)
942[] Armed Forces -- active duty (5c)

b. What kind of business or industry is this?
For example, TV and radio manufacturing, retail shoe store, State labor Department, farm.

Industry ____


c. What kind of work did you do at that job?
For example, electrical engineer, stock clerk, typist, farm.

Occupation ____

d. What were your most important activities or duties at that job?
For example, types, keeps account books, files, sells cars, operates printing press, finishes concrete.

Duties ____


Complete from entries in 5a--d. If not clear, ask:
e. Were you --
An employee of private company, -business, or individual for wages, salary or commission? .... P
A member of the armed forces? .... AF
A federal government employee? .... F
A state government employee? .... S
A local government employee? .... L
Self-employed in own business, professional practice or farm?
Ask: Is the business incorporated?
Yes .... I
No .... SE
Working without pay in family business or farm? ....WP

Class of worker
1 [] P
2 [] AF
3 [] F
4 [] S
5 [] L
6 [] I
7 [] SE
8 [] WP


6. At the time of this injury, what part of your body was hurt? What kind of injury was it? Anything else?

Part(s) of body ________
Kind of injury ____


7. Did you lose consciousness as a result of the injury?

1[] Yes
2[] No


8. What were you doing at the time of the injury? ____


9. How did the injury happen? ____

Go to 10 for this injury

[p.198]

Section N4 -- Work Injuries -- Continued


10. Was the activity you were doing at the time of the injury a new or unfamiliar job task?
Injury 1.

1[] Yes (12)
2[] No


11. Was the activity you were doing at the time of the injury part of your usual job tasks?

1[] Yes
2[] No


12. Did you see or talk to a medical doctor, nurse, chiropractor, physician's assistant, nurse practitioner or other medical person as a result of this injury?

1[] Yes
2[] No (check item 10)


13. Where did you first see or talk to a medical person about this injury?

[] 1 Work-site health unit
[] 2 Doctor's office (group practice or doctor's clinic)
[] 3 Emergency room
[] 4 Walk-in clinic
[] 5 Hospital outpatient clinic
[] 8 Other -- Specify ____


Check Item 10
Refer to question 6.

[] "Eye" in 6 (14)
8[] All others (15)

14a. Were you wearing eye protection equipment over your eyes at the time of the injury?

1[] Yes
2[] No (15)


b. What type of eye protection equipment were you wearing?

1[] Welding goggles
2[] Other goggles
3[] Glasses with side shields
4[] Glasses without side shields
5[] Welding helmet
6[] Face shield
8[] Other


15a. Did you miss more than half of the day from work on the day of the injury?

1[] Yes
2[] No


b. Other than the day of the injury, how many full days of scheduled work did you miss as a result of the injury?

Full days ____
000[] None


c. (Not counting the (number in 15b) full days), Did you miss any (other) scheduled time from work other than the day of the injury?

1[] Yes
2[] No (16)


d. (Again, not counting the (number in 15b) full days), How many days did you miss more than half the day from work as a result of the injury?

Days ____
000[] none


16a. Were you temporarily transferred to another job because of the injury?

1[] Yes (17)
2[] No


b. Were you temporarily assigned lighter work or excused from certain duties at work other than the day of the injury?

1[] Yes
2[] No


17a. Did you report this injury to your employer?

1[] Yes
2[] No


b. Was a worker's compensation claim filed as a result of this injury?

1[] Yes
2[] No


18a. Did you change employers as a result of the injury?

1[] Yes
2[] No (19)


b. Was your salary lower, higher or the same after your change of employers?

1[] Lower
2[] Higher
3[] Same


c. Were you as satisfied, less satisfied or more satisfied with your new employer as with your employer prior to the injury?

1[] As satisfied (19 for this injury)
2[] Less satisfied (19 for this injury)
3[] More satisfied (19 for this injury)

[p.199]

Section N4 -- Work Injuries -- Continued


19a. Did you change the kind of work you do as a result of the injury?
Injury 1

1[] Yes
2[] No (check item 11)


Mark box or ask:

0[] Yes in 18a (19c)

b. Was your salary lower, higher or the same after your job change?

1[] Lower
2[] Higher
3[] Same


c. Were you as satisfied, less satisfied or more satisfied with your new job as with your job prior to the injury?

1[] As satisfied
2[] Less satisfied
3[] More satisfied


Check Item 11
Refer to 18a and 19a.

1[] "Yes" in 18a or 19a (21)
8[] All others (20)

20. Did you make a permanent change in your work activities because of this injury?

1[] Yes
2[] No


21. Did you permanently change your off-the-job activities because of this injury?

1[] Yes
2[] No

Check Item 12
Refer to question 2, section N4.

1[] Additional injury (4 for next injury)
8[] All others (section N5)
[p. 200]

Section N5 -- Skin Conditions

Now I will ask about skin conditions.


1a. During the past 12 months, that is, since (12 month date) a year ago have you had dermatitis, eczema, or any other red, inflamed skin rash?

1[] Yes
2[] No (Section N6, page 60)


b. During the past 12 months, on about how many days altogether did you have a skin condition? Include days when you used treatment for the condition

365[] Every day
Days ____


2. What parts of your body were affected by this skin condition?
Mark all that apply.

1[] Hands
2[] Arms
3[] Head, face or neck
8[] Other body area -- Specify ____
9[] DK


3. During the past 12 months, did you miss at least a full day from work because of your skin condition?

1[] Yes
2[] No


4a. Did any skin condition you had in the past 12 months result from chemicals or other substances which got on your skin?

1[] Yes
2[] No (6)
9[] DK (6)


b. What chemicals or other substances were these? ____


c. Did you get these substances on your skin during the past 12 months?

1[] Yes
2[] No


d. Were you at work at your job or business when you got these substances on your skin?

1[] Yes
2[] No (6)
9[] DK (6)


5a. Was this at your job as a (occupation in Check Item 7) for (employer in Check Item 7)?

1[] Yes (6)
2[] No


b. For whom did you work when you got these substances on your skin?
Enter name of company, business, organization, or other employer.

Employer ____
932[] Armed Forces -- Civilian (5d)
942[] Armed Forces -- Active duty (5d)

c. What kind of business or industry is this?
For example, TV and radio manufacturing, retail shoe store, State Labor Department, farm.

Industry ____


d. What kind of work did you do at that job?
For example, electrical engineer, stock clerk, typist, farmer.

Occupation ____

e. What were your most important activities or duties at that job?
For example, types, keeps account books, files, sells cars, operates printing press, finishes concrete.

Duties ____


f. Were you --
An employee of private company, -business, or individual for wages, salary or commission? .... P
A member of the armed forces? .... AF
A federal government employee? .... F
A state government employee? .... S
A local government employee? .... L
Self-employed in own business, professional practice or farm?
Ask: Is the business incorporated?
Yes .... I
No .... SE
Working without pay in family business or farm? ....WP

Class of worker
1 [] P
2 [] AF
3 [] F
4 [] S
5 [] L
6 [] I
7 [] SE
8 [] WP


6a. During the past 12 months, did you use any prescription medications or other treatments prescribed by a doctor for your skin condition?

1[] Yes
2[] No


b. Did you use any over-the-counter or non-prescription medications or treatments for your skin condition?

1[] Yes
2[] No

[p.201]

Section N5 -- Skin Conditions -- Continued


7a. How long has it been since you last saw or talked to a dermatologist or skin specialist about your skin condition?

000[] Never

____ Number
1[] Days
2[] Weeks
3[] Months
4[] Years


b. How long has it been since you last saw or talked to any other type of medical person about your skin condition?

000[] Never

____ Number
1[] Days
2[] Weeks
3[] Months
4[] Years


8a. During the past 12 months, have you stopped working at a job or changed jobs because of your skin condition?

1[] Yes (Check item 13)
2[] No


b. During the past 12 months, did you make a major change in your work activities because of your skin condition?

1[] Yes
2[] No


Check Item 13
Refer to question 4d.

1[] "Yes" in 4d (9)
8[] All others (Section N6)

9. During the past 12 months, did you report your skin condition to your employer as a work-related illness or injury?

1[] Yes
2[] No


10. During the past 12 months, was a worker's compensation claim filed for your skin condition?

1[] Yes
2[] No

[p.202]

Section N6 -- Eye, Nose, Throat Irritation


Check Item 14
Refer to HIS-1, C1.

1[] Wa box marked (1)
8[] All others (Section N7, page 62)

These questions are about eye, nose and throat irritation.
Hand calendar
1a. During the past 2 weeks (outlined on that calendar/beginning Monday (date) and ending Sunday (date)), have you had any episodes of itchy, irritated or watery eyes?

1[] Yes
2[] No (4)


b. On how many days during the past 2 weeks did you have itchy, irritated or watery eyes?

Days ____


c. Were these symptoms due to a cold or flu, hay fever, other allergies, or something else?

1[] Cold or flu (4)
2[] Hay fever
3[] Other allergies
8[] Something else -- Specify ____


2a. Did you have these symptoms while you were at work?

1[] Yes
2[] No (3)


b. When you were away from work, did these symptoms increase, decrease, or stay the same?

1[] Increase
2[] Decrease
3[] Stay the same


3. During the past 2 weeks when you had these symptoms, did you also have a fever?

1[] Yes
2[] No


4a. Do you wear contact lenses?

1[] Yes
2[] No (5)


b. What type of contact lenses do you wear?
Mark all that apply.

1[] Hard lens(es) (include polycon)
2[] Soft lens(es), daily wear
3[] Soft lens(es), extended wear
4[] Intraocular lens(es)
8[] Other -- Specify ____
9[] DK


5a. During the past 2 weeks, have you had any episodes of stuffy, blocked, itchy or runny nose?

1[] Yes
2[] No (8)


b. On how many days during the past 2 weeks did you have stuffy, blocked, itchy or runny nose?

Days ____


c. Were these symptoms due to a cold or flu, hay fever, other allergies, or something else?

1[] Cold or flu (8)
2[] Hay fever
3[] Other allergies
8[] Something else -- Specify ____


6a. Did you have these symptoms while you were at work?

1[] Yes
2[] No (7)


b. When you were away from work, did these symptoms increase, decrease, or stay the same?

1[] Increase
2[] Decrease
3[] Stay the same


7. During the past 2 weeks when you had these symptoms, did you also have a fever?

1[] Yes
2[] No


8a. During the past 2 weeks, have you had any episodes of sore or dry throat?

1[] Yes
2[] No (Section N7, page 62)


b. On how many days during the past 2 weeks did you have sore or dry throat?

Days ____


c. Were these symptoms due to a cold or flu, hay fever, other allergies, or something else?

1[] Cold or flu (Section N7, page 62)
2[] Hay fever
3[] Other allergies
8[] Something else -- Specify ____

[p.203]

Section N6 -- Eye, Nose, Throat Irritation -- Continued


9a. Did you have these symptoms while you were at work?

1[] Yes
2[] No (10)


b. When you were away from work, did these symptoms increase, decrease or stay the same?

1[] Increase
2[] Decrease
3[] Stay the same


10. During the past 2 weeks when you had these symptoms, did you also have a fever?

1[] Yes
2[] No

[p. 204]

Section N7 - Conditions

I am going to read a list of medical conditions. Tell me if you have had any of these conditions even if you have mentioned them before.


1. During the past 12 months, that is, since (12 month date) a year ago, have you had --


a. Repeated trouble with neck, back or spine?
1[] Yes -- Specify ____
2[] No


b. A condition affecting the wrist and hand, called carpal tunnel syndrome?
1[] Yes
2[] No


c. A condition affecting the fingers and/or toes, called Raynaud's (Ra' nodes) phenomenon?
1[] Yes
2[] No


d. A condition affecting the tendons called tendonitis?
1[] Yes
2[] No


During the past 12 months have you had --


e. Hepatitis?
1[] Yes
2[] No


f. Skin cancer?
1[] Yes
2[] No


g. Lung cancer?
1[] Yes
2[] No


h. Asthma?
1[] Yes
2[] No


i. Chronic bronchitis?
1[] Yes
2[] No


j. Emphysema?
1[] Yes
2[] No


k. Any dust disease of the lungs, such as silicosis, asbestosis, brown lung, or black lung disease?
1[] Yes -- Specify ____
2[] No


2. Do you now have --


a. Deafness in one or both ears?
1[] Yes
2[] No


b. Any other trouble hearing in one or both ears?
1[] Yes
2[] No


Check Item 15
Refer to questions 1 and 2.

1[] "No" or "DK" in all of 1 and 2 (Section N8, page 66)
8[] "Yes" in any part of 1 or 2 (Fill a column for each condition)

[p. 205]

Section N7 -- Conditions -- Continued


Condition 1

Name of condition ____

3. Were you ever told by a doctor or other medical person that your (condition) was related to any job you ever had?

1[] Yes
2[] No


4. Was a worker's compensation claim ever filed for your (condition)?

1[] Yes (6)
2[] No


5. Did you ever report to your employer or to other company personnel that your (condition) was related to your job?

1[] Yes
2[] No


6. Did you ever tell a doctor or other medical person that your (condition) was related to any job you ever had?

1[] Yes
2[] No


Check Item 16
Refer to Check Item 7, page 45.

1[] Entries in Check Item 7 (7)
8[] All others (8)

7a. During the past 12 months, were you told by your doctor or employer to stay home from work temporarily because of your (condition)?

1[] Yes
2[] No


b. During the past 12 months, did your employer transfer you to another job, either temporarily or permanently, because of your (condition)?

1[] Yes (Check Item 17)
2[] No


c. During the past 12 months, did your employer give you lighter work or excuse you from certain duties at work because of your (condition)?

1[] Yes
2[] No

SEEM TO BE MISSING A QUESTION HERE, FOR INVAR 2944, 2963, 2982, 3001, 3020, 3039, 3058, 3077, 3096, 3115, 3134, 3153, 3172

Check Item 17
Refer to 3, 4, 5, 6:

1[] "Yes" in 3, 4, 5 or 6 (9)
8[] All others (NC)

9a. What kind of work did you do that was related to your (condition)?
For example, electrical engineer, stock clerk, typist, farmer.

Occupation____

b. What were your most important activities or duties at that job?
For example, types, keeps account books, files, sells cars, operates printing press, finishes concrete.

Duties ____


c. In what kind of business or industry did you work the longest as a (entry in 9a)?
For example, TV and radio manufacturing, retail shoe store, State Labor Department, farm.

Industry ____


d. In the industry where you worked the longest as a (entry in 9a) were you --
An employee of private company, -business, or individual for wages, salary or commission? .... P
A member of the armed forces? .... AF
A federal government employee? .... F
A state government employee? .... S
A local government employee? .... L
Self-employed in own business, professional practice or farm?
Ask: Is the business incorporated?
Yes .... I
No .... SE
Working without pay in family business or farm? ....WP

Class of worker
1 [] P (NC)
2 [] AF (NC)
3 [] F (NC)
4 [] S (NC)
5 [] L (NC)
6 [] I (NC)
7 [] SE (NC)
8 [] WP (NC)

[p. 206]

Section N8 -- Cigarette Smoking


These questions are about smoking cigarettes.
1. Have you smoked at least 100 cigarettes in your entire life?

1[] Yes
2[] No (6)


2. About how old were you when you first started smoking cigarettes fairly regularly?

00[] Never smoked regularly
Years ____


3. Do you smoke cigarettes now?

1[] Yes (5)
2[] No


Mark box or ask:
4. About how long has it been since you last smoked cigarettes fairly regularly?

000[] Never smoked regularly (6)

____ Number
1[] Days
2[] Weeks
3[] Months
4[] Years


5. On the average, about how many cigarettes a day (do/did) you smoke?

00[] Less than one cigarette per day
Cigarettes per day ____


6a. Do you live with anyone who smokes cigarettes?

1[] Yes
2[] No (check item 18)


b. Do they regularly smoke in the home?

1[] Yes
2[] No


Check Item 18
Refer to Check Item 5B on page 44.

1[] Entry in check item 5B (7)
2[] All others (occupational health addendum)

7a. Is smoking allowed in your place of work other than in designated areas?

1[] Yes
2[] No (Occupational health addendum)
3[] Works at home (occupational health addendum)


b. Do you find that cigarette smoke in the work place causes you no discomfort, some discomfort, moderate discomfort, or great discomfort?

1[] No discomfort
2[] Some discomfort
3[] Moderate discomfort
4[] Great discomfort

Section N -- Occupational Health Addendum


If Yes in question 17b, page 54/55, ask:
1. Was the worker's compensation claim for your injury on (date in 3, page 52/53) awarded, denied, or is it still in process?


[] Injury 1
1[] Awarded
2[] Denied
3[] In process
9[] DK


[] Injury 2
1[] Awarded
2[] Denied
3[] In process
9[] DK


[] Injury 3
1[] Awarded
2[] Denied
3[] In process
9[] DK


[] Injury 4
1[] Awarded
2[] Denied
3[] In process
9[] DK


[] Injury 5
1[] Awarded
2[] Denied
3[] In process
9[] DK


If Yes in question 10, page 59, ask:
2. Was the worker's compensation claim for your skin condition awarded, denied, or is it still in process?

1[] Awarded
2[] Denied
3[] In process
9[] DK


If Yes in question 4, page 64/65, ask:
3. Was the worker's compensation claim for your (condition) awarded, denied, or is it still in process?


[] Condition 1
1[] Awarded
2[] Denied
3[] In process
9[] DK


[] Condition 2
1[] Awarded
2[] Denied
3[] In process
9[] DK


[] Condition 3
1[] Awarded
2[] Denied
3[] In process
9[] DK


[] Condition 4
1[] Awarded
2[] Denied
3[] In process
9[] DK