2 Occupational Exposure Qx (examples)

Attachment 4: Selected Job Modules (OccIDEAS) – Chemist and Janitor

Note- these are two examples of job modules. See Attachment 5 for complete set of job modules and time burden box for this part of the questionnaire

	CHEMIST (CH) MODULE
1	In this job, did you work in a lab?
	Yes
	No	[go to 2]
	DK	[go to 2]
1.1	How many hours per week did you do work in this area?
	< 2
	2 - 9
	10 - 19
	20 or more
	DK
2	Did you work in the production area of a plant?
	Yes
	No	[go to 3]
	DK	[go to 3]
2.1	How many hours per week did you do work in this area?
	< 2
	2 - 9
	10 - 19
	20 or more
	DK
2.2	Did you collect process samples in a production area?
	Yes
	No
	DK
3	Did you use chlorinated solvents?
	Yes
	No	[go to 4]
	DK	[go to 4]
3.1	How many hours per week did you do this?
	< 2
	2 - 9
	10 - 19
	20 or more
	DK
3.2	What chlorinated solvents did you use? Did you use…? (allow multiple)
	Trichloroethylene
	Dichloromethane
	Other chlorinated solvent
	DK
4	Did you use benzene?
	Yes
	No	[go to 5]
	DK	[go to 5]
4.1	How many hours per week did you do this?
	< 2
	2 - 9
	10 - 19
	20 or more
	DK
5	Did you use any other aromatic compounds, such as xylene or toluene?
	Yes
	No	[go to 6]
	DK	[go to 6]
5.1	How many hours per week did you do this?
	< 2
	2 - 9
	10 - 19
	20 or more
	DK
6	Did you use formaldehyde or a formaldehyde solution?
	Yes
	No	[go to 7]
	DK	[go to 7]
6.1	How many hours per week did you do this?
	< 2
	2 - 9
	10 - 19
	20 or more
	DK
7	Did you use dyes?
	Yes
	No	[go to 8]
	DK	[go to 8]
7.1	How many hours per week did you do this?
	< 2
	2 - 9
	10 - 19
	20 or more
	DK
7.2	Were these dyes usually in solid or liquid form?
	Solid	[go to 8]
	Liquid	[go to 7.2.1]
	Both	[go to 8]
	DK	[go to 8]
7.2.1	What did these dyes contain? Did they contain…? (allow multiple)
	Benzene
	Toluene or xylene
	Trichloroethylene
	Formaldehyde
	Something else
	DK
8	Were your hands ever immersed in a solvent, a solvent-based product, or fuel?
	Yes
	No
	DK
9	Did you wear gloves while using solvents or solvent-based products?
	Yes
	No
	Not applicable - did not use solvents
	DK
10	Did you clean your hands with a solvent, a solvent-based product or with fuel, such as gasoline?
	Yes
	No
	DK

	JANITOR (JA) MODULE
1	In this job, did you ever clean office areas?
	Yes
	No	[go to 2]
	DK	[go to 2]
1.1	How many hours per week did you do this?
	< 2
	2 - 9
	10 - 19
	20 or more
	DK
2	In this job, did you ever polish furniture with liquid cleaning chemicals?
	Yes
	No	[go to 3]
	DK	[go to 3]
2.1	How many hours per week did you do this?
	< 2
	2 - 9
	10 - 19
	20 or more
	DK
3	In this job, did you ever strip floors with liquid cleaning chemicals?
	Yes
	No	[go to 4]
	DK	[go to 4]
3.1	How many hours per week did you do this?
	< 2
	2 - 9
	10 - 19
	20 or more
	DK
4	In this job, did you ever clean in a production area of the plant?
	Yes
	No	[go to 5]
	DK	[go to 5]
4.1	How many hours per week did you do this?
	< 2
	2 - 9
	10 - 19
	20 or more
	DK
5	Did you ever work in an area where materials containing solvents, such as paints, varnishes, glues, or degreasers were used?
	Yes
	No	[go to 6]
	DK	[go to 6]
5.1	How many hours per week did other workers perform this task while you were working in this area?
	< 2
	2 - 9
	10 - 19
	20 or more
	DK
6	In this job, did you ever repair or maintain equipment or property?
	Yes
	No	[go to 7]
	DK	[go to 7]
6.1	How many hours per week did you do this?
	< 2
	2 - 9
	10 - 19
	20 or more
	DK
6.2	In this job, did you ever clean or degrease metal or plastic parts with chemicals?
	Yes
	No	[go to 6.3]
	DK	[go to 6.3]
6.2.1	How many hours per week did you do this?
	< 2
	2-9
	10-19
	20 or more
	DK
6.2.2	When you cleaned metal or plastic parts, what did you use? Did you use…? (allow multiple)
	Trichloroethylene
	Gasoline or other fuels
	Benzene, toluene, or xylene
	Mineral spirits, stoddard solvent, turpentine or naphtha
	Paint thinner
	Any other solvent
	Any other degreaser
	DK
6.2.3	Were the chemicals at room temperature or were they heated in a tank, vat, or vapor degreaser? (allow multiple)
	Room temperature
	Heated in vapor degreaser
	Heated in vat or tank
	Other
	DK
6.2.4	How did you clean the parts? Did you …? (allow multiple)
	Wipe with rag/cloth
	Wipe with brush
	Put in basket and manually dipped into tank
	Put in basket and dipped into tank using automated system
	Put into tank or bucket with hands
	Other
	DK
6.2.5	Was there a local exhaust system to remove the dust, fumes or vapors that was produced?
	Yes
	No
	DK
6.3	Did other workers clean or degrease parts in the area where you worked?
	Yes
	No	[go to 6.4]
	DK	[go to 6.4]
6.3.1	How many hours per week did other workers perform this task while you were working in this area?
	< 2
	2-9
	10-19
	20 or more
	DK
6.4	In this job, did you ever handle or pump fuel?
	Yes
	No	[go to 7]
	DK	[go to 7]
6.4.1	How many hours per week did you do this?
	< 2
	2-9
	10-19
	20 or more
	DK
7	Were your hands ever immersed in a solvent, a solvent-based product, or fuel?
	Yes
	No
	DK
8	Did you wear gloves while using solvents or solvent-based products?
	Yes
	No
	Not applicable - did not use solvents
	DK
9	Did you clean your hands with a solvent, a solvent-based product or with fuel, such as gasoline?
	Yes
	No
	DK

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