QID Respondent Reference Sheet

P PTID ACROS REFERENCE SHEET DATE:___/___/___

Respondent Answers

Requirements and Features

Was PPE [CORRECT]?

R 17. Verified Product: YES NO/DK/REF

R19. Location:

On your farm Other: _________­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­_______________________________________

In your nursery DK/REF

In your orchard

In your greenhouse

HEADWEAR

R28_30_33. Headwear Worn:

Bandana, scarf, or t-shirt

Cap or short-brimmed hat

Wide-brimmed hat

Hood

Hooded respirator

Helmet/helmet respirator

No

DK/REF

“Cover over your…”

DK, None

[HEADWEAR]:_________________________________________

_____________________________________________________

_____________________________________________________

[HFEATURES]:

_____ Hat with wide brim all the way around, hood, hooded

respirator, helmet, or helmet respirator

_____ The headwear, or a cover over the headwear, in the

specified material

_____ No special features

YES

NO

DK

N/A

EYEWEAR

R39_41. Eyewear Worn:

Glasses

Goggles

Face shield

Full-face respirator

Helmet respirator with face

shield

No

DK/REF

DK, None

[EYEWEAR]: __________________________________

_____________________________________________________

_____________________________________________________

[EFEATURES]:

_____ Glasses with side and brow protection

_____Goggles

_____Splash-proof goggles (shielded openings)

_____Face shield

_____Full-face respirator or helmet respirator with face shield

_____Any of the above checked items

_____No special features

YES

NO

DK

N/A

CLOTHING

R49_56_57. CLOTHING WORN:

Outer Under- layer neath
	Short sleeve shirt Long sleeve shirt Shorts or short pants Long pants Jacket Coveralls Set of jacket and pants NONE/No DK/REF

DK, None

[CLOTHING]: __________________________________

_____________________________________________________

_____________________________________________________

[CFEATURES]:

_____Coveralls or its equivalent

_____Coveralls, or its equivalent, in the specified material

_____No special features

YES

NO

DK

N/A

RSCREEN1. Pesticide 1: ___________________________________________________________________________

RSCREEN2. Pesticide 2: ___________________________________________________________________________

RSCREEN3. Pesticide 3: ___________________________________________________________________________

RSCREEN4. Focus Pesticide: _______________________________________________________________________

FOOTWEAR FOOTWEAR	R63_70. FOOTWEAR WORN: Sandals or other open toe or open heel shoes Shoes Boots NONE DK/REF “Covers over your…”	DK, None [FOOTWEAR]: __________________________________ _____________________________________________________ _____________________________________________________ [FFEATURES]: _____Closed toe and closed heel shoes, overshoes, boots or overboots _____Shoes, boots, or shoe or boot covers, in the specified material _____Socks _____No special features	YES NO DK N/A
GLOVES	R76. GLOVES WORN: Yes No DK/REF R78. MORE THAN ONE GLOVE ON EITHER HAND? Yes No DK/REF CHEMICAL RESISTANT GLOVES? R81. (OUTER) R90. INNER Yes Yes No No DK/REF DK/REF/NA R87. REUSED (OUTER) GLOVES? Yes No/DK/REF	DK, None [GLOVES]: _____________________________________ _____________________________________________________ _____________________________________________________ [GFEATURES]: _____Gloves in the specified material _____No special features	YES NO DK N/A
RESPIRATORS	R105_107. RESPIRATOR WORN: Piece of cloth or bandana Filtering facepiece respirator Air-purifying respirator (non- powered) Powered air-purifying respirator (PAPR) Supplied air respirator (SAR) Self-contained breathing apparatus (SCBA) No DK/REF	DK, None [RESPIRATOR/FILTER]:____________________________ _____________________________________________________ _____________________________________________________ _____________________________________________________ [RFEATURES]: _____Filtering facepiece respirator _____Air-purifying respirator (non-powered) or powered air- purifying respirator (PAPR) with a [TYPE BELOW] filter, cartridge, or canister ____ Particulate ____ Organic Vapor ____ Particulate and Organic Vapor _____Self-contained breathing apparatus (SCBA) _____Supplied-air respirator (SAR) _____Any of the above checked items _____No special features	YES NO DK N/A
	R 125. EVER READ LABEL FOR… (PPE/CLOTHING)... FROM SAME PRODUCT?: YES NO/DK/REF
	R 132. ABLE TO FIND INFORMATION ON PRODUCT LABEL ABOUT…(PPE/CLOTHING)?: YES NO/DK/REF/NA