[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.
990 [] Never worked (Section N8, page 66)
b. When you were doing this kind of work, what were your most important activities or duties?
2a. How long did you do this kind of work?
Years ____
b. How old were you when you started doing this kind of work?
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.
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
2 [] AF
3 [] F
4 [] S
5 [] L
6 [] I
7 [] SE
8 [] WP
Check item 1
Refer to HIS-1, C1.
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.)
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
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
d. What kind of business or industry is this? For example, TV and radio manufacturing, retail shoe store, State Labor Department, farm.
e. What kind of work were you doing? For example, electrical engineer, stock clerk, typist, farmer.
f. What were your most important activities or duties? For example, types, keeps account books, files, sells cars, operates printing press, finishes concrete.
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
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
2[] Months
3[] Years
Check item 2
Refer to 4e and 1a.
8 [] All others (6a)
6a. Considering all of your employers, for how many years altogether did you do this KIND of work?
Years ____
b. How old were you when you started doing this kind of work?
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.
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
2 [] AF
3 [] F
4 [] S
5 [] L
6 [] I
7 [] SE
8 [] WP
Hand Card N1, read list if telephone interview.
Card N1
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.
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
8 [] All others (Check Item 4)
8b. Was a worker's compensation claim filed for your illness, injury, disability, or other health problem?
2 [] No (8d)
c. Have you received any money or other benefits from worker's compensation since you stopped working (entry in 4b) ago?
2 [] No
d. Was a claim filed for any other income or benefits because your health problem was job-related?
2 [] No
Check item 4
Refer to question 4. Mark first appropriate box.
2 [] "Yes" in 4a (Check Item 7)
8 [] All others (Section N7, page 62)
Section N1 - WORK HISTORY - Continued
Check item 5A
Refer to HIS-1, pages 44 and 45.
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.
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.
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.
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
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
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.
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
2[] Months
3[] Years
Check Item 6
Refer to Check item 5B and question 1a:
[] 8 All others (9g)
9g. Considering all of your employers, for how many years altogether did you do this kind of work?
Years ____
h. How old were you when you started doing this kind of work?
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.
[] 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
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.
Occupation ____ (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?
2[] No (11)
b. During a typical work day, how many minutes or hours altogether did you spend doing strenuous physical activities?
Number
2[] Hours
11a. Did this job require you to do repeated bending, twisting or reaching?
2[] No (12)
b. During a typical work day, how many minutes or hours altogether did you spend bending, twisting or reaching?
Number
2[] Hours
12a. Did this job require you to bend or twist your hands or wrists many times an hour?
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
2[] Hours
13a. On this job, did you work with hand-held or hand-operated vibrating tools or machinery?
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
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?
2[] No
b. Petroleum products other than solvents? For example, grease, oil, or fuel?
2[] No
c. Soaps, detergents, or cleaning and disinfecting solutions used in performing your job?
2[] No
d. Cutting oils, machine coolants, or metal working fluids?
2[] No
e. Paints, varnishes, lacquers, or other coatings?
2[] No
f. Glues, pastes, or other adhesives?
2[] No
2[] No
h. Pesticides, insecticides, herbicides, fungicides, or fumigants?
2[] No
i. Foods or food products handled as part of your job duties?
2[] No
j. Plants, trees, or shrubs handled as part of your job duties?
2[] No
k. Did you get any other chemicals or substances on your hands or arms that could irritate the skin?
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?
2[] No (Section N3, page 49)
Refer to sex and age.
8[] All others (2)
b. Did you have this back pain only at the tiem of your monthly periods?
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?
365[] Every day
Days ____
b. During the past 12 months, how many full days did you miss from work because of back pain?
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?
2[] Middle
3[] Lower
b. During the past 12 months, did the back pain ever spread to your:
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.
2[] No (5)
b. When did the accident or injury happen?
Date ____
Year 19____
c. Were you at work at your job or business when the accident or injury happened?
2[] No (5)
d. Was this at your job as a (occupation in Check Item 7) for (employer in Check Item 7)?
2[] No
e. For whom did you work when the accident or injury happened?
Enter name of company, business, organization, or other 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.
g. What kind of work did you do at that job?
For example, electrical engineer, stock clerk, typist, farmer.
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.
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
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?
2[] No (7)
b. Where did you perform the activities that brought on your back pain?
Mark only one box.
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)?
2[] No
b. For whom did you work?
Enter name of company, business, organization, or other 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.
d. What kind of work did you do at that job?
For example, electrical engineer, stock clerk, typist, farmer.
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.
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
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?
2[] No
b. How many days, weeks or months ago did you last have back pain?
Number
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
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?
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?
Hand Card N2, read list if telephone interview
Card N2
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?
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?
2[] No
b. Have you ever made a major change in your work activities because of back pain?
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?
2[] Right handed
3[] Able to use both hands equally well
2. Which hand do you use most at work?
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.
2[] No (Section N4, page 52)
4. Was this discomfort due entirely to an injury, such as a cut, sprain or broken bone?
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?
Days ____
365[] Every day (6)
b. During the past 12 months, did you have the discomfort every day for a week or more?
2[] No
Check Item 9
Refer to 5a and 5b: Mark first appropriate box
2[] "Yes" in 5b (6)
8[] All others (section N4, page 52)
6. In which hand did you have this discomfort?
2[] Right
3[] Both
7. Was your discomfort worse when you were trying to sleep or did it awaken you from sleep?
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?
2[] No
9a. Has your hand(s) bothered you today?
2[] No
b. How many days, weeks or months ago did you last have this discomfort?
Number
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
2[] Weeks
3[] Months
4[] Years
10a. In what year did you first notice this hand discomfort?
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?
11a. During the past 12 months, were you away from work for more than one week for any reason?
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?
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?
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?
2[] No
b. Have you ever made a major change in your work activities because of your hand discomfort?
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?
____
Number
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 --
2[] No
9[] DK
2[] No
9[] DK
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 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?
2[] No (Section N5, page 58)
2. How many times have you been injured on the job during the past 12 months?
3. On what date did your [(most recent) injury/injury before that] happen?
Enter each date in a separate column.
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)?
1[] Yes (6)
2[] No
5a. For whom did you work when the injury happened?
Enter name of company, business, organization, or other 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.
c. What kind of work did you do at that job?
For example, electrical engineer, stock clerk, typist, farm.
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.
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
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?
Kind of injury ____
7. Did you lose consciousness as a result of the injury?
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.
2[] No
11. Was the activity you were doing at the time of the injury part of your usual job tasks?
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?
2[] No (check item 10)
13. Where did you first see or talk to a medical person about this injury?
[] 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.
8[] All others (15)
14a. Were you wearing eye protection equipment over your eyes at the time of the injury?
2[] No (15)
b. What type of eye protection equipment were you wearing?
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?
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?
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?
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?
000[] none
16a. Were you temporarily transferred to another job because of the injury?
2[] No
b. Were you temporarily assigned lighter work or excused from certain duties at work other than the day of the injury?
2[] No
17a. Did you report this injury to your employer?
2[] No
b. Was a worker's compensation claim filed as a result of this injury?
2[] No
18a. Did you change employers as a result of the injury?
2[] No (19)
b. Was your salary lower, higher or the same after your change of employers?
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?
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
2[] No (check item 11)
b. Was your salary lower, higher or the same after your job change?
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?
2[] Less satisfied
3[] More satisfied
Check Item 11
Refer to 18a and 19a.
8[] All others (20)
20. Did you make a permanent change in your work activities because of this injury?
2[] No
21. Did you permanently change your off-the-job activities because of this injury?
2[] No
Check Item 12
Refer to question 2, section N4.
8[] All others (section N5)
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?
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
Days ____
2. What parts of your body were affected by this skin condition?
Mark all that apply.
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?
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?
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?
2[] No
d. Were you at work at your job or business when you got these substances on your skin?
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)?
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.
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.
d. What kind of work did you do at that job?
For example, electrical engineer, stock clerk, typist, farmer.
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.
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
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?
2[] No
b. Did you use any over-the-counter or non-prescription medications or treatments for your skin condition?
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?
____ Number
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?
____ Number
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?
2[] No
b. During the past 12 months, did you make a major change in your work activities because of your skin condition?
2[] No
Check Item 13
Refer to question 4d.
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?
2[] No
10. During the past 12 months, was a worker's compensation claim filed for your skin condition?
2[] No
[p.202]
Section N6 -- Eye, Nose, Throat Irritation
Check Item 14
Refer to HIS-1, C1.
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?
2[] No (4)
b. On how many days during the past 2 weeks did you have itchy, irritated or watery eyes?
c. Were these symptoms due to a cold or flu, hay fever, other allergies, or something else?
2[] Hay fever
3[] Other allergies
8[] Something else -- Specify ____
2a. Did you have these symptoms while you were at work?
2[] No (3)
b. When you were away from work, did these symptoms increase, decrease, or stay the same?
2[] Decrease
3[] Stay the same
3. During the past 2 weeks when you had these symptoms, did you also have a fever?
2[] No
4a. Do you wear contact lenses?
2[] No (5)
b. What type of contact lenses do you wear?
Mark all that apply.
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?
2[] No (8)
b. On how many days during the past 2 weeks did you have stuffy, blocked, itchy or runny nose?
c. Were these symptoms due to a cold or flu, hay fever, other allergies, or something else?
2[] Hay fever
3[] Other allergies
8[] Something else -- Specify ____
6a. Did you have these symptoms while you were at work?
2[] No (7)
b. When you were away from work, did these symptoms increase, decrease, or stay the same?
2[] Decrease
3[] Stay the same
7. During the past 2 weeks when you had these symptoms, did you also have a fever?
2[] No
8a. During the past 2 weeks, have you had any episodes of sore or dry throat?
2[] No (Section N7, page 62)
b. On how many days during the past 2 weeks did you have sore or dry throat?
c. Were these symptoms due to a cold or flu, hay fever, other allergies, or something else?
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?
2[] No (10)
b. When you were away from work, did these symptoms increase, decrease or stay the same?
2[] Decrease
3[] Stay the same
10. During the past 2 weeks when you had these symptoms, did you also have a fever?
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 --
2[] No
2[] No
2[] No
2[] No
During the past 12 months have you had --
2[] No
2[] No
2[] No
2[] No
Check Item 15
Refer to questions 1 and 2.
8[] "Yes" in any part of 1 or 2 (Fill a column for each condition)
[p. 205]
Section N7 -- Conditions -- Continued
3. Were you ever told by a doctor or other medical person that your (condition) was related to any job you ever had?
Condition 1
2[] No
4. Was a worker's compensation claim ever filed for your (condition)?
2[] No
5. Did you ever report to your employer or to other company personnel that your (condition) was related to your job?
2[] No
6. Did you ever tell a doctor or other medical person that your (condition) was related to any job you ever had?
2[] No
Check Item 16
Refer to Check Item 7, page 45.
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)?
2[] No
b. During the past 12 months, did your employer transfer you to another job, either temporarily or permanently, because of your (condition)?
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)?
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:
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.
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.
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.
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
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?
2[] No (6)
2. About how old were you when you first started smoking cigarettes fairly regularly?
Years ____
3. Do you smoke cigarettes now?
2[] No
Mark box or ask:
4. About how long has it been since you last smoked cigarettes fairly regularly?
____ Number
2[] Weeks
3[] Months
4[] Years
5. On the average, about how many cigarettes a day (do/did) you smoke?
Cigarettes per day ____
6a. Do you live with anyone who smokes cigarettes?
2[] No (check item 18)
b. Do they regularly smoke in the home?
2[] No
Check Item 18
Refer to Check Item 5B on page 44.
2[] All others (occupational health addendum)
7a. Is smoking allowed in your place of work other than in designated areas?
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?
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?
2[] Denied
3[] In process
9[] DK
2[] Denied
3[] In process
9[] DK
2[] Denied
3[] In process
9[] DK
2[] Denied
3[] In process
9[] DK
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?
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?
2[] Denied
3[] In process
9[] DK
2[] Denied
3[] In process
9[] DK
2[] Denied
3[] In process
9[] DK
2[] Denied
3[] In process
9[] DK