1 Survey

Appendix A A.2.3.a–1

OMB #: _______________

Expiration Date: ________

How To Prepare for Your Appointment

You are scheduled for a home visit on (date of visit) at (time of visit).

Because we will be collecting dust and air samples, we would like to ask that before our visit you:

• Do NOT vacuum, dust, or sweep your floors for at least 3 days before the visit.

• Do NOT do any seasonal cleaning of any wood, pellet, or coal stoves or fireplaces that you may have.

If you use any pesticide products for insects, please gather the containers for all of the pesticide products you have used in the past 6 months. Our staff would like to look at the labels during the visit.

Our data collectors would also like to look at the labels for any prescription and non-prescription medicines, and any vitamins, minerals, herbals, and other dietary supplements you have taken during the past 30 days. Please gather the containers and have them available during the visit.

For a few of the measures, the data collector will need access to your shoulder and upper back area.

• If you own one, please wear a sleeveless, loose-fitting shirt.

The data collector will be measuring your waist and hip circumferences. The hip measurement will be made over your clothing.

• We ask that you wear thin pants (e.g. spandex leggings, thin cotton, or jersey pants with no pockets and no zippers) so the data collector can feel the correct point at which to place the measuring device.

If you have any further questions about how to prepare for this Study visit, you may contact your Study Center at xxx-xxx-xxxx.

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