5 Occupational Job Exposure Modules - complete set

A multi-center international hospital-based case-control study of lymphoma in Asia (AsiaLymph) (NCI)

Attach 5 - Occupational_Job_Modules_-_complete_set revised 2-26-12

Patient Screener, Core & Occupational Exposure Questionnaires_AsiaLymph (Attachments 3, 4 & 5)

OMB: 0925-0654

Document [docx]
Download: docx | pdf

Attachment 5: Asia Lymph All Job Modules (OccIDEAS)*

OMB #: 0925-XXXX

Expiration date: XX/XX/20XX

Public reporting for this collection of information is estimated to average 45 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: NIH, Project Clearance Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, MD 20892-7974, ATTN: PRA (0925-XXXX). Do not return the completed form to this address.



Note – We estimate that 50% of subjects will not be asked any of these modules and that 50% of subjects will be asked 1-3 of these modules.




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





HEALTH PROFESSION (HP) MODULE


1

In this job, did you work in a room where instruments or other equipment was being sterilized?



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


1.2

How were these instruments and equipment sterilized? (allow multiple)



In a solution



In an autoclave or sterilizing unit



Something else



DK


1.3

What sterilizing agent was usually used in the solution? (allow multiple)



Formaldehyde



Phisohex



Something else



DK


2

In this job, did you use disinfectants or antiseptics?



Yes



No

[go to 3]


DK

[go to 3]

2.1

What disinfectant or antiseptic did you use? Did you use…? (allow multiple)



Formaldehyde



Phisohex



Something else



DK


3

In this job, did you clean dialysis machines?



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 clean endoscopes?



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

In this job, did you work in a lab?



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


5.2

Did you use dyes?



Yes



No

[go to 5.3]


DK

[go to 5.3]

5.2.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



DK


5.3

Did you use benzene?



Yes



No

[go to 5.4]


DK

[go to 5.4]

5.3.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



DK


5.4

Did you use trichloroethylene?



Yes



No

[go to 5.5]


DK

[go to 5.5]

5.4.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



DK


5.5

Did you use any formaldehyde or formalin?



Yes



No

[go to 6]


DK

[go to 6]

5.5.1

How many hours per week did you do this?



< 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

In this job, did you ever clean or degrease metal or plastic parts with chemicals?



Yes



No

[go to 6.2]


DK

[go to 6.2]

6.1.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



DK


6.1.2

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


6.1.3

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


6.1.4

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


6.1.5

Was there a local exhaust system to remove the dust, fumes or vapors that was produced?



Yes



No



DK


6.2

Did other workers clean or degrease parts in the area where you worked?


 

Yes


 

No

[go to 6.3]

 

DK

[go to 6.3]

6.2.1

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


6.3

In this job, did you ever use paint?



Yes



No

[go to 6.4]


DK

[go to 6.4]

6.3.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



DK


6.3.2

What did you usually use to apply the paint? (allow multiple)



Brush



Roller



Electrostatic gun



Spray gun



Dip item into paint



Other



DK


6.3.3

Did you paint indoors or inside a ship?



Yes



No

[go to 6.3.4]


DK

[go to 6.3.4]

6.3.3.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



DK


6.3.3.2

Was there a local exhaust system to remove the dust, fumes or vapors that was produced?



Yes



No



DK


6.3.3.3

Did you paint in a production area of a manufacturing plant?



Yes



No

[go to 6.3.4]


DK

[go to 6.3.4]

6.3.3.3.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



DK


6.3.4

Did you paint outdoors?



Yes



No

[go to 6.4]


DK

[go to 6.4]

6.3.4.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



DK


6.4

Did other workers use paints in the area where you worked?



Yes


No

[go to 6.5]


DK

[go to 6.5]

6.4.1

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


6.5

In this job, did you ever strip paint from metal or wood objects?



Yes,



No

[go to 6.6]


DK

[go to 6.6]

6.5.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



DK


6.5.2

To strip paint, what did you use? Did you use…? (allow multiple)



Methylene chloride



Acids, alkalis, or caustic solutions?



Any other chemical



Something else, such as a heat gun or scraper



DK


6.6

Did other workers strip paint from metal or wood objects in the area where you worked?



Yes



No

[go to 6.7]


DK

[go to 6.7]

6.6.1

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


6.7

In this job, did you ever use glues or adhesives?



Yes



No

[go to 6.8]


DK

[go to 6.8]

6.7.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



DK


6.7.2

What material were the things you were gluing made of? (allow multiple)



Wood



Metal



Plastic



Paper



Fabrics



Other



DK


6.7.3

Was there a local exhaust system to remove the dust, fumes or vapors that was produced?



Yes



No



DK


6.7.4

Did you use water-based glues or adhesives, for example, vinyl or acrylic resins?



Yes



No

[go to 6.7.5]


DK

[go to 6.7.5]

6.7.4.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



DK


6.7.5

Did you use glues or adhesives that you heated with a gun or other heated device?



Yes,



No

[go to 6.7.6]


DK

[go to 6.7.6]

6.7.5.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



DK


6.7.6

Did you use contact glues or adhesives where you apply the glue to both pieces being glued, let it dry for a short time, and then join the two pieces together?



Yes



No

[go to 6.7.7]


DK

[go to 6.7.7]

6.7.6.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



DK


6.7.7

Did you use glues or adhesives that require mixing two parts of the glue together before applying? (epoxy resins)



Yes


No

[go to 6.7.8]


DK

[go to 6.7.8]

6.7.7.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



DK


6.7.8

Did you use urea, phenol or melamine-based glues or adhesives?



Yes



No

[go to 6.8]


DK

[go to 6.8]

6.7.8.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



DK


6.8

Did other workers use glues or adhesives in the area where you worked?



Yes


No

[go to 6.9]


DK

[go to 6.9]

6.8.1

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


6.9

In this job, did you ever handle or use particle board, plywood, or veneered wood?



Yes



No

[go to 6.10]


DK

[go to 6.10]

6.9.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



DK


6.10

Did other workers work with particle board, plywood, or veneered wood in the area where you worked?



Yes



No

[go to 6.11]


DK

[go to 6.11]

6.10.1

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


6.11

In this job, did you ever handle or pump fuel?



Yes



No

[go to 7]


DK

[go to 7]

6.11.1

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





CHEMICAL INDUSTRY (CHI) MODULE


1

What did the employer make? (allow multiple)



Paints



Pesticides or fertilizers

[go to 1.1-1.2]


Drugs or pharmaceuticals

[go to 1.3-1.4]


Dyes or pigments

[go to 2]


Other chemicals

[go to 2]


DK

[go to 2]

1.1

Did the company make fumigants?



Yes



No



DK


1.2

Did the company make insecticides?



Yes

[go to 2]


No

[go to 2]


DK

[go to 2]

1.3

Did the company make vaccines?



Yes



No



DK


1.4

Did the company make antiseptics, germicides or antibacterials?



Yes



No



DK


2

How would you best describe your job at this employer?



Production (make, assemble, or process materials or parts into products or finished goods)

[go to 2.1-2.6]


Maintenance or Utilities (maintain or repair equipment, tools, property or utilities)

[go to 2.7-2.12]


Quality Control, Environmental Control, Engineering or Research

[go to 2.13-2.14]


Shipping, Receiving or Storage

[go to 2.15-2.18]


Administration

[go to 3]


DK

[go to 3]

2.1

Was the part of the plant where you worked making chemicals primarily indoors or outdoors?



Indoors



Outdoors



Both



DK


2.2

Did you spend time in a control room?



Yes

[go to 2.2.1]


No



DK


2.2.1

How many hours per week did you do work in this area?



< 2



2 - 9



10 - 19



20 or more



DK


2.3

Did you spend time in any production areas (other than a control room)?



Yes

[to go 2.3.1]


No



DK


2.3.1

How many hours per week did you do work in this area?



< 2



2 - 9



10 - 19



20 or more



DK


2.4

How would you describe most of the equipment that you ran or that was in the area where you worked?



Closed (meaning that the equipment had covers to them and pipes were used to transport most of the materials)



Open (no covers on the equipment and pipes were not used)



Both



DK


2.5

Did you add chemicals by any means (hand, scoop, shovel, or by emptying bags, drums, or other containers) into the equipment?



Yes

[go to 2.5.1]


No



DK


2.5.1

[Ask Vent Mini-module]


2.6

Did you pack or package chemicals?



Yes

[go to 2.6.1-2.6.2]


No

[go to 3]


DK

[go to 3]

2.6.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



DK


2.6.2

[Vent mini-module]

[go to 3]

2.7

[Degrease Mini-Module]


2.8

[Paint Mini-Module]


2.9

[Strip Mini-Module]


2.10

[Glue Mini-Module]


2.11

[Board Mini-Module]


2.12

[Fuel Mini-Module]

[go to 3]

2.13

Did you take samples from the process or production line for testing purposes?



Yes

[go to 2.13.1]


No



DK


2.13.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



DK


2.14

Did you perform chemical or physical tests on process or product samples?



Yes

[go to 2.14.1]


No

[go to 3]


DK

[go to 3]

2.14.1

How many hours per week did you do this?



< 2

[go to 3]


2 - 9

[go to 3]


10 - 19

[go to 3]


20 or more

[go to 3]


DK

[go to 3]

2.15

[Paint Mini-Module]


2.16

[Glue Mini-Module]


2.17

[Board Mini-Module]


2.18

[Fuel Mini-Module]


3

[Hands mini-module]





DRY CLEANING TEXTILE INDUSTRY MODULE


1

In this job, what best describes your work location?



A cleaning service where fabric and cloth items were washed or dry cleaned

[go to SECTION A]


A mill, factory, workshop or warehouse where yarn, textiles and clothing were made, packaged or shipped

[go to SECTION B]


None of the above

[go to SECTION D - SECTION J]

 

SECTION A [aDLI]

 

A.1

Did your employer wash clothes on the premises?



Yes



No



DK


A.2

Did your employer dry clean on the premises?



Yes

[go to A.2.1-A.2.3]


No



DK


A.2.1

Did you ever transfer dry cleaned fabric items from the washer to the dryer (please say no if the machines both washed and dried the fabric items in the same machine)?



Yes

[go to A.2.1.1]


No



DK


A.2.1.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



DK


A.2.2

Did you ever transfer dry cleaning fluid from a storage container to a dry cleaning machine, using a bucket or other type of container? (dry cleaning fluid is the chemical used to dry clean fabric items)



Yes

[go to A.2.2.1]


No



DK


A.2.2.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



DK


A.2.3

To dry clean, what chemicals were used? Did you use…? (allow multiple)



Perchloroethylene (perc) or tetrachloroethylene (tetra)?



Trichloroethylene (TCE)?



Trichloroethane (TCA)?



Carbon tetrachloride?



Stoddard solvent?



Gasoline?



Something else?



DK


A.3

Did you ever spot clean fabric items?



Yes

[go to A.3.1-A.3.2]


No



DK


A.3.1

About how many items did you spot clean?



15 items/week or less



15 to 100 items/week



more than 100 items/week



DK


A.3.2

To spot clean, what chemicals did you use? Did you use…? (allow multiple)



Perchloroethylene (perc) or tetrachloroethylene (tetra)?



Trichloroethylene (TCE)?



 Trichloroethane (TCA)?



Carbon tetrachloride?



Stoddard solvent?



A remover formulated to remove paint, grease or oils?



Gasoline?



Something else?



DK


A.4

In this job, did you ever repair or maintain equipment or property?



Yes

[go to A.4.1-A.4.7]


No



DK


A.4.1

Did you ever repair the dry cleaning equipment or maintain the dry cleaning fluid?



Yes

[go to A.4.1.1]


No



DK


A.4.1.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



DK


A.4.2

[Degrease Mini-Module]


A.4.3

[Paint Mini-Module]


A.4.4

[Strip Mini-Module]


A.4.5

[Glue Mini-Module]


A.4.6

[Board Mini-Module]


A.4.7

[Fuel Mini-Module]


A.5

[Hands mini-module]

[END]

 

SECTION B TEXTILE INDUSTRY MODULE

 

B.1

Was fabric, clothing or other cloth products, or both made at your employer?



Fabric



Clothing or other cloth products



Both



Something else



DK


B.2

Was the product made of leather, fur or hair?



Yes

[go to SECTION C]


No

[go to SECTION B.2.2]


DK

[go to SECTION B.2.3]

 

SECTION C LEATHER INDUSTRY MINI MODULE

 

C.1

Did your employer make leather, make a leather product, or do both?



Make leather



Make leather product



Both



DK


C.2

What color was the leather? (allow multiple)



Brown



Pale cream or white



Other



DK


C.3

How would you best describe your job at this employer?



Production (make, assemble, or process materials or parts into products or finished goods)

[go to C.3.1 - C.3.2]


Maintenance or Utilities (maintain or repair equipment, tools, property or utilities)

[go to C.3.3-C.3.8]


Quality Control, Environmental Control, Engineering or Research

[go to C.4]


Shipping, Receiving or Storage

[go to C.3.9-C.3.12]


Administration

[go to C.4]


DK

[go to C.4]

C.3.1

Was the leather or leather product from animal hides or skins, or was the leather synthetic or man-made?



Animal hide

[go to C.3.1.1-C.3.1.3]


Synthetic or man-made

[go to C.3.1.4-C.3.1.6]


Both

[go to C.3.1.7 - C.3.1.12]


Something else

[go to C.4]


DK

[go to C.4]

C.3.1.1

Was the leather already tanned or prepared, or did hides or skin come into the plant that had to have the hair and flesh removed and tanning done to the hides and skins?



Already tanned



Hair still on/needed tanning

[go to C.3.1.1.1-C.3.1.1.3]


Other



DK


C.3.1.1.1

Did you work in the area where the hide or skin was prepared for tanning ?



Yes

[go to C.3.1.1.1.1]


No



DK


C.3.1.1.1.1

How many hours per week did you do work in this area?



< 2



2 - 9



10 - 19



20 or more



DK


C.3.1.1.2

Did you work in the area where the hides and skins were tanned?



Yes

[go to C.3.1.1.2.1]


No



DK


C.3.1.1.2.1

How many hours per week did you do work in this area?



< 2



2 - 9



10 - 19



20 or more



DK


C.3.1.1.3

Did you work in the area where the tanned leather was stuffed or fat liquored?



Yes

[go to C3.1.1.3.1]


No



DK


C.3.1.1.3.1

Did you apply the chemicals to stuff or fat liquor the leather?



Yes

[go to C.3.1.1.3.1.1-C.3.1.1.3.1.2]


No



DK


C.3.1.1.3.1.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



DK


C.3.1.1.3.1.2

What chemicals did you use? (allow multiple)



Oils



TCE or trichloroethylene



Perchloroethylene (perc) or tetrachloroethylene (tetra)



Some other chemicals



DK


C.3.1.2

Did you apply a chemical to the leather?



Yes

[go to C.3.1.2.1]


No



DK


C.3.1.2.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



DK


C.3.1.3

Did you work in the area where the tanned leather was dried, set out, stretched and softened?



Yes

[go to C.3.1.3.1]


No



DK


C.3.1.3.1

How many hours per week did you do work in this area?



< 2



2 - 9



10 - 19



20 or more



DK


C.3.1.4

Did you work in the area where chemicals were mixed to make a leather-like resin or plastic?



Yes

[go to C.3.1.4.1]


No



DK


C.3.1.4.1

How many hours per week did you do work in this area?



< 2



2 - 9



10 - 19



20 or more



DK


C.3.1.5

Did you work in the area where chemicals were heated to make a leather-like resin or plastic?



Yes

[go to C.3.1.5.1]


No



DK


C.3.1.5.1

How many hours per week did you do work in this area?



< 2



2 - 9



10 - 19



20 or more



DK


C.3.1.6

Did you work in the area where chemicals were extruded to make a leather-like resin or plastic?



Yes

[go to C.3.1.6.1]


No



DK


C.3.1.6.1

How many hours per week did you do work in this area?



< 2



2 - 9



10 - 19



20 or more



DK


C.3.1.7

Was the leather already tanned or prepared, or did hides or skin come into the plant that had to have the hair and flesh removed and tanning done to the hides and skins?



Already tanned



Hair still on/needed tanning

[go to C.3.1.7.1-3.1.7.3]


Other



DK


C.3.1.7.1

Did you work in the area where the hide or skin was prepared for tanning?



Yes

[go to C.3.1.7.1.1]


No



DK


C.3.1.7.1.1

How many hours per week did you do work in this area?



< 2



2 - 9



10 - 19



20 or more



DK


C.3.1.7.2

Did you work in the area where the hides and skins were tanned?



Yes

[go to C.3.1.7.2.1]


No



DK


C.3.1.7.2.1

How many hours per week did you do work in this area?



< 2



2 - 9



10 - 19



20 or more



DK


C.3.1.7.3

Did you work in the area where the tanned leather was stuffed or fat liquored?



Yes

[go to C.3.1.7.3.1]


No



DK


C.3.1.7.3.1

Did you apply the chemicals to stuff or fat liquor the leather?



Yes

[go to C.3.1.7.3.1.1-C.3.1.7.3.1.2]


No



DK


C.3.1.7.3.1.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



DK


C.3.1.7.3.1.2

What chemicals did you use? (allow multiple)



Oils



TCE or trichloroethylene



Perchloroethylene (perc) or tetrachloroethylene (tetra)



Some other chemicals



DK


C.3.1.8

Did you apply a chemical to the leather?



Yes

[go to C.3.1.8.1]


No



DK


C.3.1.8.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



DK


C.3.1.9

Did you work in the area where the tanned leather was dried, set out, stretched and softened?



Yes

[go to C.3.1.9.1]


No



DK


C.3.1.9.1

How many hours per week did you do work in this area?



< 2



2 - 9



10 - 19



20 or more



DK


C.3.1.10

Did you work in the area where chemicals were mixed to make a leather-like resin or plastic?



Yes

[go to C.3.1.10.1]


No



DK


C.3.1.10.1

How many hours per week did you do work in this area?



< 2



2 - 9



10 - 19



20 or more



DK


C.3.1.11

Did you work in the area where chemicals were heated to make a leather-like resin or plastic?



Yes

[go to C.3.1.11.1]


No



DK


C.3.1.11.1

How many hours per week did you do work in this area?



< 2



2 - 9



10 - 19



20 or more



DK


C.3.1.12

Did you work in the area where chemicals were extruded to make a leather-like resin or plastic?



Yes

[go to C.3.1.12.1]


No



DK


C.3.1.12.1

How many hours per week did you do work in this area?



< 2



2 - 9



10 - 19



20 or more



DK


C.3.2

Did you work in the area where the leather pieces were glued together or glued to metal or plastic pieces?



Yes

[go to C.3.2.1 - C.3.2.2]


No



DK


C.3.2.1

How many hours per week did you do work in this area?



< 2



2 - 9



10 - 19



20 or more



DK


C.3.2.2

Did you do the gluing?



Yes

[go to C.3.2.2.1]


No



DK


C.3.2.2.1

How many hours per week did you do this?



< 2

[go to C.4]


2 - 9

[go to C.4]


10 - 19

[go to C.4]


20 or more

[go to C.4]


DK

[go to C.4]

C.3.3

[Degrease Mini-Module]


C.3.4

[Paint Mini-Module]


C.3.5

[Strip Mini-Module]


C.3.6

[Glue Mini-Module]


C.3.7

[Board Mini-Module]


C.3.8

[Fuel Mini-Module]

[go to C.4]

C.3.9

[Paint Mini-Module]


C.3.1

[Glue Mini-Module]


C.3.11

[Board Mini-Module]


C.3.12

[Fuel Mini-Module]


C.4

[Hands mini-module]

[END]

 

SECTION B.2.2 CONTINUE TEXTILE INDUSTRY MODULE

 

B.2.2

How would you best describe your job at this employer?



Production (make, assemble, or process materials or parts into products or finished goods)

[go to B.2.2.1 - 2.2.8]


Maintenance or Utilities (maintain or repair equipment, tools, property or utilities)

[go to B.2.2.9-B.2.2.15]


Quality Control, Environmental Control, Engineering or Research

[go to B.2.2.16-B.2.2.17]


Shipping, Receiving or Storage

[go to B.2.2.18-B.2.2.22]


Administration

[END]


DK

[END]

B.2.2.1

What was the product made of ? (allow multiple)



Cotton



Wool



Man-made or synthetic



Something else



DK


B.2.2.2

Did you work in the area where scouring or cleaning was done?



Yes

[go to 2.2.2.1-2.2.2.2]


No



DK


B.2.2.2.1

How many hours per week did you do work in this area?



< 2



2 - 9



10 - 19



20 or more



DK


B.2.2.2.2

Was perchloroethylene (perc) or tetrachloroethylene (tetra) used to scour or clean the products?



Yes



No



DK


B.2.2.3

Did you work in the area where dyeing was done?



Yes

[go to B.2.2.3.1]


No



DK


B.2.2.3.1

How many hours per week did you do work in this area?



< 2



2 - 9



10 - 19



20 or more



DK


B.2.2.4

Did you work in the area where printing was done?



Yes

[go to B.2.2.4.1]


No



DK


B.2.2.4.1

How many hours per week did you do work in this area?



< 2



2 - 9



10 - 19



20 or more



DK


B.2.2.5

Did you work in the area where trimming, cleaning, drying, or other finishing operations and inspecting of the products was done?



Yes

[go to B.2.2.5.1-B.2.2.5.2]


No



DK


B.2.2.5.1

How many hours per week did you do work in this area?



< 2



2 - 9



10 - 19



20 or more



DK


B.2.2.5.2

While working in this area, did you spot clean the fabrics or clothing?



Yes

[go to B.2.2.2.5.1-B.2.2.2.5.2]


No



DK


B.2.2.2.5.1

About how many items did you spot clean?



15 items/week or less



15 to 100 items/week



more than 100 items/week



DK


B.2.2.2.5.2

To spot clean, what chemicals did you use? Did you use…? (allow multiple)



Perchloroethylene (perc) or tetrachloroethylene (tetra)?



Trichloroethylene (TCE)?



Carbon tetrachloride?



Stoddard solvent?



A remover formulated to remove paint, grease or oils?



Gasoline?



Something else?



DK


B.2.2.6

Did you work in the area where fabric was made resistant to wrinkles, flame, stains, soil, shrinkage, water, moths, mildew, or something else?



Yes

[go to B.2.2.6.1-B.2.2.6.2]


No



DK


B.2.2.6.1

How many hours per week did you do work in this area?



< 2



2 - 9



10 - 19



20 or more



DK


B.2.2.6.2

What type of treatment was being done to the fabric? (allow multiple)



Wrinkle resistance or durable or permanent press



Flame resistance



Stain resistance



Soil resistance



Shrink resistance



Water resistance



Moth resistance



Mildew resistance



Other



DK


B.2.2.7

Did you clean the screens used to transfer color to the fabric?



Yes

[go to B.2.2.7.1]


No



DK


B.2.2.7.1

What chemicals did you use to do this? (allow multiple)



Carbon tetrachloride



Trichloroethylene



Trichloroethane



Chloroform



Perchloroethylene (perc) or tetrachloroethylene (tetra)



Some other chemical



DK


B.2.2.8

[Hands mini-module]

[END]

B.2.2.9

[Degrease Mini-Module]


B.2.2.10

[Paint Mini-Module]


B.2.2.11

[Strip Mini-Module]


B.2.2.12

[Glue Mini-Module]


B.2.2.13

[Board Mini-Module]


B.2.2.14

[Fuel Mini-Module]


B.2.2.15

[Hands mini-module]

[END]

B.2.2.16

Did you take samples from the process or production line for testing purposes?



Yes

[go to B.2.2.16.1]


No



DK


B.2.2.16.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



DK


B.2.2.17

Did you perform chemical or physical tests on process or product samples?



Yes

[go to B.2.2.17.1]


No

[END]


DK

[END]

B.2.2.17.1

How many hours per week did you do this?



< 2

[END]


2 - 9

[END]


10 - 19

[END]


20 or more

[END]


DK

[END]

B.2.2.18

[Paint Mini-Module]


B.2.2.19

[Glue Mini-Module]


B.2.2.20

[Board Mini-Module]


B.2.2.21

[Fuel Mini-Module]


B.2.2.22

[Hands mini-module]

[END]

 

SECTION B.2.3 CONTINUE TEXTILE INDUSTRY MODULE

 

B.2.3

How would you best describe your job at this employer?



Production (make, assemble, or process materials or parts into products or finished goods)

[go to B.2.3.1 - B.2.3.8]


Maintenance or Utilities (maintain or repair equipment, tools, property or utilities)

[go to B.2.3.9-B.2.3.15]


Quality Control, Environmental Control, Engineering or Research

[go to B.2.3.16-B.2.3.17]


Shipping, Receiving or Storage

[go to B.2.3.18-B.2.3.22]


Administration

[END]


DK

[END]

B.2.3.1

What was the product made of ? (allow multiple)



Cotton



Wool



Man-made or synthetic



Something else



DK


B.2.3.2

Did you work in the area where scouring or cleaning was done?



Yes

[go to B.2.3.2.1-B.2.3.2.2]


No



DK


B.2.3.2.1

How many hours per week did you do work in this area?



< 2



2 - 9



10 - 19



20 or more



DK


B.2.3.2.2

Was perchloroethylene (perc) or tetrachloroethylene (tetra) used to scour or clean the products?



Yes



No



DK


B.2.3.3

Did you work in the area where dyeing was done?



Yes

[go to B.2.3.3.1]


No



DK


B.2.3.3.1

How many hours per week did you do work in this area?



< 2



2 - 9



10 - 19



20 or more



DK


B.2.3.4

Did you work in the area where printing was done?



Yes

[go to B.2.3.4.1]


No



DK


B.2.3.4.1

How many hours per week did you do work in this area?



< 2



2 - 9



10 - 19



20 or more



DK


B.2.3.5

Did you work in the area where trimming, cleaning, drying, or other finishing operations and inspecting of the products was done?



Yes

[go to B.2.3.5.1-B.2.3.5.2]


No



DK


B.2.3.5.1

How many hours per week did you do work in this area?



< 2



2 - 9



10 - 19



20 or more



DK


B.2.3.5.2

While working in this area, did you spot clean the fabrics or clothing?



Yes

[go to B.2.3.5.2.1-B.2.3.5.2.2]


No



DK


B.2.3.5.2.1

About how many items did you spot clean?



15 items/week or less



15 to 100 items/week



More than 100 items/week



DK


B.2.3.5.2.2

To spot clean, what chemicals did you use? Did you use…? (allow multiple)



Perchloroethylene (perc) or tetrachloroethylene (tetra)?



Trichloroethylene (TCE)?



Carbon tetrachloride?



Stoddard solvent?



A remover formulated to remove paint, grease or oils?



Gasoline?



Something else?



DK


B.2.3.6

Did you work in the area where fabric was made resistant to wrinkles, flame, stains, soil, shrinkage, water, moths, mildew, or something else?



Yes

[go to B.2.3.6.1-B.2.3.6.2]


No



DK


B.2.3.6.1

How many hours per week did you do work in this area?



< 2



2 - 9



10 - 19



20 or more



DK


B.2.3.6.2

What type of treatment was being done to the fabric? (allow multiple)



Wrinkle resistance or durable or permanent press



Flame resistance



Stain resistance



Soil resistance



Shrink resistance



Water resistance



Moth resistance



Mildew resistance



Other



DK


B.2.3.7

Did you clean the screens used to transfer color to the fabric?



Yes

[go to B.2.3.7.1]


No



DK


B.2.3.7.1

What chemicals did you use to do this? (Allow multiple)



Carbon tetrachloride



Trichloroethylene



Trichloroethane



Chloroform



Perchloroethylene (perc) or tetrachloroethylene (tetra)



Some other chemical



DK


B.2.3.8

[Hands mini-module]

[END]

B.2.3.9

[Degrease Mini-Module]


B.2.3.10

[Paint Mini-Module]


B.2.3.11

[Strip Mini-Module]


B.2.3.12

[Glue Mini-Module]


B.2.3.13

[Board Mini-Module]


B.2.3.14

[Fuel Mini-Module]


B.2.3.15

[Hands mini-module]

[END]

B.2.3.16

Did you take samples from the process or production line for testing purposes?



Yes

[go to 2.3.16.1]


No



DK


B.2.3.16.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



DK


B.2.3.17

Did you perform chemical or physical tests on process or product samples?



Yes

[go to 2.3.17.1]


No

[END]


DK

[END]

B.2.3.17.1

How many hours per week did you do this?



< 2

[END]


2 - 9

[END]


10 - 19

[END]


20 or more

[END]


DK

[END]

B.2.3.18

[Paint Mini-Module]


B.2.3.19

[Glue Mini-Module]


B.2.3.20

[Board Mini-Module]


B.2.3.21

[Fuel Mini-Module]


B.2.3.22

[Hands mini-module]

[END]

SECTION D

[Degrease Mini-Module]

 

SECTION E

[Paint Mini-Module]

 

SECTION F

[Strip Mini-Module]

 

SECTION G

[Glue Mini-Module]

 

SECTION H

[Board Mini-Module]

 

SECTION I

[Fuel Mini-Module]

 

SECTION J

[Hands mini-module]

 


EMBALMER (EM) MODULE



1

Did you perform or assist with embalmings?




Yes

[go to 1.1-1.2]



No




DK



1.1

How many hours per week did you do this?




< 2




2 - 9




10 - 19




20 or more




DK



1.2

[Vent Mini-module]






FOUNDRY INDUSTRY (FOI) MODULE


1

How would you best describe your job at this employer?



Production (make, assemble, or process materials or parts into products or finished goods)

[go to 2]


Maintenance or Utilities (maintain or repair equipment, tools, property or utilities)

[go to 1.1-1.6]


Quality Control, Environmental Control, Engineering or Research

[go to 1.7-1.8]


Shipping, Receiving or Storage

[go to 1.9-1.12]


Administration

[go to 2]


DK

[go to 2]

1.1

[Degrease Mini-Module]


1.2

[Paint Mini-Module]


1.3

[Strip Mini-Module]


1.4

[Glue Mini-Module]


1.5

[Board Mini-Module]


1.6

[Fuel Mini-Module]

[go to 2]

1.7

Did you take samples from the process or production line for testing purposes?



Yes

[go to 1.7.1]


No



DK


1.7.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



DK


1.8

Did you perform chemical or physical tests on process or product samples?



Yes

[go to 1.8.1]


No

[go to 2]


DK

[go to 2]

1.8.1

How many hours per week did you do this?



< 2

[go to 2]


2 - 9

[go to 2]


10 - 19

[go to 2]


20 or more

[go to 2]


DK

[go to 2]

1.9

[Paint Mini-Module]


1.1

[Glue Mini-Module]


1.11

[Board Mini-Module]


1.12

[Fuel Mini-Module]

[go to 2]

2

Did you ever spend time in a production area of the plant, such as the core making, mold making, metal pouring, cooling, shakeout or fettling areas?



Yes

[go to 2.1-2.5]


No

[go to 3]


DK

[go to 3]

2.1

Did you ever spend time working in the core making area?



Yes

[go to 2.1.1-2.1.3]


No



DK


2.1.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



DK


2.1.2

Did the cores have to be heated in an oven or furnace before they set up, or were chemicals used to set up the core? By set up, I mean the process of hardening sand to form a core.



Heated in an oven or furnace



Chemicals were used



Both



Other



DK


2.1.3

Did you ever run a muller or other machine to mix sand and chemicals used to make the core ?



Yes

[go to 2.1.3.1 - 2.1.3.3]


No



DK


2.1.3.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



DK


2.1.3.2

What chemicals were used to make the core? Was it…? (allow multiple)



Epoxy resins



Phenolic resins



Urethane resins



Furan resins



Isocyanates



Formaldehyde



Something else



DK


2.1.3.3

[Vent Mini-module]


2.2

Did you ever spend time working in the mold making area?



Yes

[go to 2.2.1-2.2.5]


No



DK


2.2.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



DK


2.2.2

[Vent Mini-module]


2.2.3

Did the molds have to be heated in an oven or furnace before they set up, or were chemicals used to set up the molds? By set up, I mean the process of hardening sand to form a core.



Heated in an oven or furnace



Chemicals were used



Both



Other



DK


2.2.4

Did you ever add or mix chemicals or other materials to the sand?



Yes

[go to 2.2.4.1]


No



DK


2.2.4.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



DK


2.2.5

Did you dump the molds?



Yes

[go to 2.2.5.1]


No



DK


2.2.5.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



DK


2.3

Did you ever spend time working in the metal pouring area?



Yes

[go to 2.3.1]


No



DK


2.3.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



DK


2.4

Did you ever spend time working in the cooling area where the hot metal cooled?



Yes

[go to 2.4.1]


No



DK


2.4.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



DK


2.5

Did you ever spend time working in the shakeout or fettling area?



Yes

[go to 2.5.1]


No



DK


2.5.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



DK


3

[Hands mini-module]





FURNITURE INDUSTRY (FUI) MODULE


1

What type of furniture did your employer make? (allow multiple)



Plastic furniture?

[go to 1.1]


Wood furniture?

[go to 1.2]


Metal furniture?

[go to 2]


Kitchen or bathroom countertops?

[go to 1.3-1.6]


Another type of furniture?

[go to 2]


DK

[go to 2]

1.1

Did you personally make or mold the plastic, or did you assemble the furniture?



Make or mold plastic



Assembled furniture



Both



Neither



Something Else



DK


1.2

What type of wood product did you work with? (allow multiple)



Solid wood



Plywood, particleboard, or composite board



Veneered wood



Other wood



DK


1.3

Did you work in the chemical mixing area?



Yes

[go to 1.3.1-1.3.2]


No



DK


1.3.1

How many hours per week did you do work in this area?



< 2



2 - 9



10 - 19



20 or more



DK


1.3.2

What chemicals did you mix? (allow multiple)



Phenol



Formaldehyde



Something else



DK


1.4

Did you work in the area where sheets of paper were coated with chemicals?



Yes

[go to 1.4.1]


No



DK


1.4.1

How many hours per week did you do work in this area?



< 2



2 - 9



10 - 19



20 or more



DK


1.5

Did you work in the area where the sheets of coated papers were stacked?



Yes

[go to 1.5.1]


No



DK


1.5.1

How many hours per week did you do work in this area?



< 2



2 - 9



10 - 19



20 or more



DK


1.6

Did you work in the area where the coated stacks of paper were pressed together?



Yes

[go to 1.6.1-1.6.2]


No



DK


1.6.1

How many hours per week did you do work in this area?



< 2



2 - 9



10 - 19



20 or more



DK


1.6.2

Was the pressing of the paper done under heat?



Yes



No



DK


2

Did you ever work in the area where paints, stains, varnishes, lacquers, waxes, or other chemicals were applied?



Yes

[go to 2.1-2.6]


No



DK


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 ever degrease the furniture?



Yes

[ask 2.2.1-2.2.2]


No



DK


2.2.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



DK


2.2.2

How did you degrease the furniture? (allow multiple)



By hand



Some other way



DK


2.3

In this job, did you ever use paint?



Yes

[go to 2.3.1-2.3.3]


No



DK


2.3.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



DK


2.3.2

What did you usually use to apply the paint? (allow multiple)



Brush



Roller



Electrostatic gun



Spray gun



Dip item into paint



Other



DK


2.3.3

[Vent Mini-module]


2.3.4

Did other workers use paints in the area where you worked?



Yes

[go to 2.3.4.1]


No



DK


2.3.4.1

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


2.4

[Stain mini-module]


2.5

Did you ever lacquer the furniture?



Yes

[go to2.5.1-2.5.2]


No



DK


2.5.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



DK


2.5.2

How did you usually apply the lacquer? (allow multiple)



Brush



Rag



Spray gun



Electrostatic gun



Roller



Dipping



Other



DK


2.6

Did you ever apply wax to the furniture?



Yes

[go to 2.6.1]


No



DK


2.6.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



DK


3

Did you ever work in the area where paint, stains, varnishes, lacquers, or waxes were removed?



Yes

[go to 3.1-3.2]


No



DK


3.1

How many hours per week did you do work in this area?



< 2



2 - 9



10 - 19



20 or more



DK


3.2

How did you usually remove it? Was it with? (allow multiple)



Chemicals



A rag



A brush



Some other way



DK


4

Did you ever work in the area where a chemical or wax was drying on the furniture?



Yes

[go to 4.1-4.2]


No



DK


4.1

How many hours per week did you do work in this area?



< 2



2 - 9



10 - 19



20 or more



DK


4.2

Which chemicals were being dried on the furniture? Was it…? (allow multiple):



Paints



Stains



Varnishes



Lacquers



Waxes



Something else



DK


5

[Glue Mini-module]


6

In this job, did you ever repair or maintain equipment or property??



Yes

[go to 6.1-6.3]


No



DK


6.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



DK


6.2

[Degrease Mini-Module]


6.3

[ Fuel Mini-Module]


7

[Hands mini-module]





GENERAL FARMING - FOOD INDUSTRY MODULE (LONG)


1

In this job, what best describes your work location? (allow multiple)



A farm where crops were grown or livestock were raised

[go to SECTION A]


A factory, warehouse, or processing center where food products were processed or packaged

[go to SECTION B]


A restaurant or other food service location where food was prepared or sold

 


None of the above

[go to SECTION C - SECTION I]


SECTION A [aGF]


A.1

On the farms you worked, were crops raised to sell or to feed animals?



Yes

[go to A.1.1-A.1.4]


No



DK


A.1.1

In this job, did you ever apply any type of chemicals to kill weeds, bugs, fungus or molds, or rodents such as rats?



Yes

[go to A.1.1.1-A.1.1.5]


No



DK


A.1.1.1

Did you apply herbicides or weed killers?



Yes

[go to A.1.1.1.1-A.1.1.1.3]


No



DK


A.1.1.1.1

On average, how many times a year did you apply herbicides or weed killers?



[number 0-1000]



DK


A.1.1.1.2

Each time you did this, how many hours did it take?



[number 0-24]



DK


A.1.1.1.3

Did you add kerosene, diesel fuel, Stoddard solvent or oil to the weed killers or herbicides that you mixed?



Yes



No



DK


A.1.1.2

Did you apply insecticides or bug killers?



Yes

[go to A.1.1.2.1-A.1.1.2.3]


No



DK



A.1.1.2.1

On average, how many times a year did you apply insecticides or bug killers?



[number 0-1000]



DK


A.1.1.2.2

Each time you did this, how many hours did it take?



[number 0-24]



DK


A.1.1.2.3

Did you add kerosene, diesel fuel, Stoddard solvent or oil to the insecticides or bug killers that you mixed?



Yes



No



DK


A.1.1.3

Did you apply fumigants?



Yes

[go to A.1.1.3.1-A.1.1.3.3]


No



DK


A.1.1.3.1

On average, how many times a year did you apply fumigants?



[number 0-1000]



DK


A.1.1.3.2

Each time you did this, how many hours did it take?



[number 0-24]



DK


A.1.1.3.3

Did you add kerosene, diesel fuel, Stoddard solvent or oil to the fumigants that you mixed?



Yes



No



DK


A.1.1.4

Did you apply fungicides to kill mold or fungus?



Yes

[go to A.1.1.4.1-A.1.1.4.3]


No



DK


A.1.1.4.1

On average, how many times a year did you apply fungicides?



[number 0-1000]



DK


A.1.1.4.2

Each time you did this, how many hours did it take?



[number 0-24]



DK


A.1.1.4.3

Did you add kerosene, diesel fuel, Stoddard solvent or oil to the fungicides that you mixed?



Yes



No



DK


A.1.1.5

Did you apply rodenticides to kill rodents, such as rats?



Yes

[go to A.1.1.5.1-A.1.1.5.3]


No



DK


A.1.1.5.1

On average, how many times a year did you apply rodenticides?



[number 0-1000]



DK


A.1.1.5.2

Each time you did this, how many hours did it take?



[number 0-24]



DK


A.1.1.5.3

Did you add kerosene, diesel fuel, Stoddard solvent or oil to the rodenticides that you mixed?



Yes



No



DK


A.1.1.6

Did you work in an area where someone else applied any type of chemicals to kill weeds, bugs, fungus or molds, or rodents such as rats?



Yes

[go to A.1.1.6.1]


No



DK


A.1.1.6.1

What type of chemicals were used? (allow multiple)



Herbicides or weed killers



Insecticides or bug killers



Fumigants



Fungicides to kill mold or fungus



Rodenticides to kill rodents, such as rats



Something else



DK


A.1.1.7

Were your hands ever immersed in a solvent, a solvent-based product, or fuel?



Yes



No



DK


A.1.1.8

Did you wear gloves while using solvents or solvent-based products?



Yes



No



Not applicable - did not use solvents



DK


A.1.1.9

Did you clean your hands with a solvent, a solvent-based product or with fuel, such as gasoline?



Yes



No



DK


A.1.2

Did you apply a disinfectant or preservative to the crop? I don't mean a chemical used to kill weeds or bugs.



Yes

[go to A.1.2.1-A.1.2.3]


No



DK


A.1.2.1

On average, how many days a year did you apply it?



[number 0-365]



DK


A.1.2.2

On average, how many hours a day did you apply it?



[number 0-24]



DK


A.1.2.3

Did you add kerosene, diesel fuel, Stoddard solvent or oil to the weed killers you mixed?



Yes



No



DK


A.1.3

Did you apply fertilizer to the crop?



Yes

[go to A.1.3.1-A.1.3.3]


No



DK


A.1.3.1

On average, how many days a year did you apply it?



[number 0-365]



DK


A.1.3.2

On average, how many hours a day did you apply it?



[number 0-24]



DK


A.1.3.3

Did you add kerosene, diesel fuel, Stoddard solvent or oil to the fertilizer you mixed?



Yes



No



DK


A.1.4

Did you apply any chemical products into the soil to make the plants grow better? Please say no if you only added fertilizer.



Yes

[go to A.1.4.1-A.1.4.4]


No



DK


A.1.4.1

What did you add? (allow multiple)



Polystyrene flakes



Urea-formaldehyde resin



Phenolic resin foam



Polyurethane foam



Something else



DK


A.1.4.2

On average, how many days a year did you apply it?



[number 0-365]



DK


A.1.4.3

On average, how many hours a day did you apply it?



[number 0-24]



DK


A.1.4.4

Did you add kerosene, diesel fuel, Stoddard solvent or oil to the chemical products you mixed?



Yes



No



DK


A.2

On the farms you worked, were animals raised?



Yes

[go to A.2.1]


No



DK


A.2.1

Were the animals ever housed in a building?



Yes

[go to A.2.1.1]


No



DK


A.2.1.1

Did you or anyone else ever fumigate the area where the animals were housed?



Yes

[go to A.2.1.1.1]


No



DK


A.2.1.1.1

What fumigant was used?



Formaldehyde



Carbon tetrachloride



Phosphine



Other fumigant



DK


A.3

In this job, did you ever repair or maintain equipment or property??



Yes

[go to A.3.1-A.3.3]


No



DK


A.3.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



DK




A.3.2

In this job, did you ever clean or degrease metal or plastic parts with chemicals?



Yes

[go to A.3.2.1-A.3.2.5]


No



DK




A.3.2.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



DK


A.3.2.2

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


A.3.2.3

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


A.3.2.4

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


A.3.2.5

Was there a local exhaust system to remove the dust, fumes or vapors that was produced?



Yes



No



DK


A.3.2.6

Did other workers clean or degrease parts in the area where you worked?



Yes

[go to A.3.2.6.1]


No



DK


A.3.2.6.1

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


A.3.3

In this job, did you ever handle or pump fuel?



Yes

[go to A.3.3.1]


No



DK


A.3.3.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



DK


A.4

Were your hands ever immersed in a solvent, a solvent-based product, or fuel?



Yes



No



DK


A.5

Did you wear gloves while using solvents or solvent-based products?



Yes



No



Not applicable - did not use solvents



DK


A.6

Did you clean your hands with a solvent, a solvent-based product or with fuel, such as gasoline?



Yes



No



DK



SECTION B [aFDI]


B.1

How would you best describe your job at this employer?



Production (make, assemble, or process materials or parts into products or finished goods)



Maintenance or Utilities (maintain or repair equipment, tools, property or utilities)

[go to B.1.1-B.1.6]


Quality Control, Environmental Control, Engineering or Research



Shipping, Receiving or Storage

[go to B.1.7-B.1.10]


Administration



DK


B.1.1

In this job, did you ever clean or degrease metal or plastic parts with chemicals?



Yes

[go to B.1.1.1-B.1.1.5]


No



DK


B.1.1.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



DK


B.1.1.2

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


B.1.1.3

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


B.1.1.4

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




B.1.1.5

Was there a local exhaust system to remove the dust, fumes or vapors that was produced?



Yes



No



DK



B.1.1.6

Did other workers clean or degrease parts in the area where you worked?



Yes

[go to B.1.1.6.1]


No



DK


B.1.1.6.1

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


B.1.2

In this job, did you ever use paint?



Yes

[go to B.1.2.1-B.1.2.5]


No



DK


B.1.2.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



DK


B.1.2.2

What did you usually use to apply the paint? (allow multiple)



Brush



Roller



Electrostatic gun



Spray gun



Dip item into paint



Other



DK


B.1.2.3

Did you paint indoors or inside a ship?



Yes

[go to B.1.2.3.1-B.1.2.3.2]


No



DK


B.1.2.3.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



DK


B.1.2.3.2

Was there a local exhaust system to remove the dust, fumes or vapors that was produced?



Yes



No



DK


B.1.2.3.3

Did you paint in a production area of a manufacturing plant?



Yes

[go to B.1.2.3.3.1]


No



DK


B.1.2.3.3.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



DK


B.1.2.4

Did you paint outdoors?



Yes

[go to B.1.2.4.1]


No



DK


B.1.2.4.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



DK


B.1.2.5

Did other workers use paints in the area where you worked?



Yes

[go to B.1.2.5.1]


No



DK


B.1.2.5.1

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


B.1.3

In this job, did you ever strip paint from metal or wood objects?



Yes

[go to B.1.3.1-B.1.3.2]


No



DK


B.1.3.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



DK




B.1.3.2

To strip paint, what did you use? Did you use…? (allow multiple)



Methylene chloride



Acids, alkalis, or caustic solutions?



Any other chemical



Something else, such as a heat gun or scraper



DK


B.1.3.3

Did other workers strip paint from metal or wood objects in the area where you worked?



Yes

[go to B.1.3.3.1]


No



DK


B.1.3.3.1

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


B.1.4

In this job, did you ever use glues or adhesives?



Yes

[go to B.1.4.1-B.1.4.8]


No



DK


B.1.4.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



DK


B.1.4.2

What material were the things you were gluing made of? (allow multiple)



Wood



Metal



Plastic



Paper



Fabrics



Other



DK


B.1.4.3

Was there a local exhaust system to remove the dust, fumes or vapors that was produced?



Yes



No



DK


B.1.4.4

Did you use water-based glues or adhesives, for example, vinyl or acrylic resins?



Yes

[go to B.1.4.4.1]


No



DK


B.1.4.4.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



DK


B.1.4.5

Did you use glues or adhesives that you heated with a gun or other heated device?



Yes

[ go to B.1.4.5.1]


No



DK


B.1.4.5.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



DK


B.1.4.6

Did you use contact glues or adhesives where you apply the glue to both pieces being glued, let it dry for a short time, and then join the two pieces together?



Yes

[go to B.1.4.6.1]


No



DK


B.1.4.6.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



DK


B.1.4.7

Did you use glues or adhesives that require mixing two parts of the glue together before applying? (epoxy resins)



Yes

[go to B.1.4.7.1]


No



DK


B.1.4.7.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



DK


B.1.4.8

Did you use urea, phenol or melamine-based glues or adhesives?



Yes

[go to B.1.4.8.1]


No



DK


B.1.4.8.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



DK


B.1.4.9

Did other workers use glues or adhesives in the area where you worked?



Yes

[ask B.1.4.9.1]


No



DK


B.1.4.9.1

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


B.1.5

In this job, did you ever handle or use particle board, plywood, or veneered wood?



Yes

[go to B.1.5.1]


No



DK


B.1.5.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



DK


B.1.5.2

Did other workers work with particle board, plywood, or veneered wood in the area where you worked?



Yes

[go to B.1.5.2.1]


No



DK






B.1.5.2.1

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


B.1.6

In this job, did you ever handle or pump fuel?



Yes

[go to B.1.6.1]


No



DK


B.1.6.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



DK


B.1.7

In this job, did you ever use paint?



Yes

[go to B.1.7.1-B.1.7.4]


No



DK


B.1.7.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



DK


B.1.7.2

What did you usually use to apply the paint? (allow multiple)



Brush



Roller



Electrostatic gun



Spray gun



Dip item into paint



Other



DK


B.1.7.3

Did you paint indoors or inside a ship?



Yes

[go to B.1.7.3.1-B.1.7.3.2]


No



DK






B.1.7.3.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



DK


B.1.7.3.2

Was there a local exhaust system to remove the dust, fumes or vapors that was produced?



Yes



No



DK


B.1.7.3.3

Did you paint in a production area of a manufacturing plant?



Yes

[go to B.1.7.3.3.1]


No



DK


B.1.7.3.3.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



DK


B.1.7.4

Did you paint outdoors?



Yes

[go to B.1.7.1.4.1]


No



DK


B.1.7.4.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



DK


B.1.7.5

Did other workers use paints in the area where you worked?



Yes

[go to B.1.7.5.1]


No



DK


B.1.7.5.1

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


B.1.8

In this job, did you ever use glues or adhesives?



Yes

[go to B.1.8.1-B.1.8.8]


No



DK


B.1.8.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



DK


B.1.8.2

What material were the things you were gluing made of? (allow multiple)



Wood



Metal



Plastic



Paper



Fabrics



Other



DK


B.1.8.3

Was there a local exhaust system to remove the dust, fumes or vapors that was produced?



Yes



No



DK


B.1.8.4

Did you use water-based glues or adhesives, for example, vinyl or acrylic resins?



Yes

[go to B.1.8.4.1]


No



DK


B.1.8.4.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



DK


B.1.8.5

Did you use glues or adhesives that you heated with a gun or other heated device?



Yes

[ go to B.1.8.5.1]


No



DK






B.1.8.5.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



DK


B.1.8.6

Did you use contact glues or adhesives where you apply the glue to both pieces being glued, let it dry for a short time, and then join the two pieces together?



Yes

[go to B.1.8.6.1]


No



DK


B.1.8.6.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



DK


B.1.8.7

Did you use glues or adhesives that require mixing two parts of the glue together before applying? (epoxy resins)



Yes

[go to B.1.8.7.1]


No



DK


B.1.8.7.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



DK


B.1.8.8

Did you use urea, phenol or melamine-based glues or adhesives?



Yes

[go to B.1.8.8.1]


No



DK


B.1.8.8.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



DK






B.1.8.9

Did other workers use glues or adhesives in the area where you worked?



Yes

[ask B.1.8.9.1]


No



DK


B.1.8.9.1

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


B.1.9

In this job, did you ever handle or use particle board, plywood, or venered wood?



Yes

[go to B.1.9.1]


No



DK


B.1.9.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



DK


B.1.9.2

Did other workers work with particle board, plywood, or veneered wood in the area where you worked?



Yes

[go to B.1.9.2.1]


No



DK


B.1.9.2.1

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


B.1.10

In this job, did you ever handle or pump fuel?



Yes

[go to B.1.10.1]


No



DK







B.1.10.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



DK


B.2

Did you work in an area where preservatives were added to the food?



Yes

[go to B.2.1]


No



DK


B.2.1

How many hours per week did you do work in this area?



< 2



2 - 9



10 - 19



20 or more



DK


B.3

Did you work in an area where disinfectants were added to the food?



Yes

[go to B.3.1]


No



DK


B.3.1

How many hours per week did you do work in this area?



< 2



2 - 9



10 - 19



20 or more



DK


B.4

Did you work in an area where fumigants were used?



Yes

[go to B.4.1]


No



DK


B.4.1

How many hours per week did you do work in this area?



< 2



2 - 9



10 - 19



20 or more



DK


B.5

Were your hands ever immersed in a solvent, a solvent-based product, or fuel?



Yes



No



DK


B.6

Did you wear gloves while using solvents or solvent-based products?



Yes



No



Not applicable - did not use solvents



DK


B.7

Did you clean your hands with a solvent, a solvent-based product or with fuel, such as gasoline?



Yes



No



DK



SECTION C [Degrease Mini-Module]


C.1

In this job, did you ever clean or degrease metal or plastic parts with chemicals?



Yes

[go to C.1.1-C.1.5]


No



DK


C.1.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



DK


C.1.2

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


C.1.3

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



C.1.4

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


C.1.5

Was there a local exhaust system to remove the dust, fumes or vapors that was produced?



Yes



No



DK


C.2

Did other workers clean or degrease parts in the area where you worked?



Yes

[go to C.2.1]


No



DK


C.2.1

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



SECTION D [Paint Mini-Module]


D.1

In this job, did you ever use paint?



Yes

[go to D.1.1-D.1.5]


No



DK


D.1.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



DK


D.1.2

What did you usually use to apply the paint? (allow multiple)



Brush



Roller



Electrostatic gun



Spray gun



Dip item into paint



Other



DK


D.1.3

Did you paint indoors or inside a ship?



Yes

[go to D.1.3.1-D.1.3.2]


No



DK


D.1.3.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



DK


D.1.3.2

Was there a local exhaust system to remove the dust, fumes or vapors that was produced?



Yes



No



DK


D.1.3.3

Did you paint in a production area of a manufacturing plant?



Yes

[go to D.1.3.3.1]


No



DK


D.1.3.3.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



DK


D.1.4

Did you paint outdoors?



Yes

[go to D.1.4.1]


No



DK


D.1.4.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



DK


D.2

Did other workers use paints in the area where you worked?



Yes

[go to D.2.1]


No



DK


D.2.1

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



SECTION E [Strip Mini-Module]


E.1

In this job, did you ever strip paint from metal or wood objects?



Yes

[go to E.1.1-E.1.3]


No



DK


E.1.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



DK


E.1.2

To strip paint, what did you use? Did you use…? (allow multiple)



Methylene chloride



Acids, alkalis, or caustic solutions?



Any other chemical



Something else, such as a heat gun or scraper



DK


E.2

Did other workers strip paint from metal or wood objects in the area where you worked?



Yes

[go to E.2.1]


No



DK


E.2.1

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



SECTION F [Glue Mini-Module]


F.1

1. In this job, did you ever use glues or adhesives?



Yes

[go to F.1.1-F.1.8]


No



DK


F.1.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



DK


F.1.2

What material were the things you were gluing made of? (allow multiple)



Wood



Metal



Plastic



Paper



Fabrics



Other



DK


F.1.3

Was there a local exhaust system to remove the dust, fumes or vapors that was produced?



Yes



No



DK


F.1.4

Did you use water-based glues or adhesives, for example, vinyl or acrylic resins?



Yes

[go to F.1.4.1]


No



DK


F.1.4.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



DK


F.1.5

Did you use glues or adhesives that you heated with a gun or other heated device?



Yes

[ go to F.1.5.1]


No



DK


F.1.5.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



DK



F.1.6

Did you use contact glues or adhesives where you apply the glue to both pieces being glued, let it dry for a short time, and then join the two pieces together?



Yes

[go to F.1.6.1]


No



DK


F.1.6.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



DK


F.1.7

Did you use glues or adhesives that require mixing two parts of the glue together before applying? (epoxy resins)



Yes

[go to F.1.7.1]


No



DK


F.1.7.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



DK


F.1.8

Did you use urea, phenol or melamine-based glues or adhesives?



Yes

[go to F.1.8.1]


No



DK


F.1.8.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



DK


F.2

Did other workers use glues or adhesives in the area where you worked?



Yes

[ask F.2.1]


No



DK


F.2.1

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



SECTION G [Board Mini-Module]


G.1

In this job, did you ever handle or use particle board, plywood, or veneered wood?



Yes

[go to G.1.1]


No



DK


G.1.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



DK


G.2

Did other workers work with particle board, plywood, or veneered wood in the area where you worked?



Yes

[go to G.2.1]


No



DK


G.2.1

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



SECTION H [Fuel Mini-Module]


H.1

In this job, did you ever handle or pump fuel?



Yes

[go to H.1.1]


No



DK


H.1.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



DK



SECTION I [Hands mini-module]


I.1

Were your hands ever immersed in a solvent, a solvent-based product, or fuel?



Yes



No



DK


I.2

Did you wear gloves while using solvents or solvent-based products?



Yes



No



Not applicable - did not use solvents



DK


I.3

Did you clean your hands with a solvent, a solvent-based product or with fuel, such as gasoline?



Yes



No



DK





INDUSTRY SOLVENT (INSOL) MODULE


1

How would you best describe your job at this employer?



Production (make, assemble, or process materials or parts into products or finished goods)

[go to 2]


Maintenance or Utilities (maintain or repair equipment, tools, property or utilities)

[go to 1.1-1.6]


Quality Control, Environmental Control, Engineering or Research

[go to 1.7-1.8]


Shipping, Receiving or Storage

[go to 1.9-1.12]


Administration

[go to 2]


DK

[go to 2]

1.1

[Degrease Mini-Module]


1.2

[Paint Mini-Module]


1.3

[Strip Mini-Module]


1.4

[Glue Mini-Module]


1.5

[ Board Mini-Module]


1.6

[Fuel Mini-Module]

[go to 2]

1.7

Did you take samples from the process or production line for testing purposes?



Yes

[go to 1.7.1]


No



DK


1.7.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



DK


1.8

Did you perform chemical or physical tests on process or product samples?



Yes

[go to 1.8.1]


No

[go to 2]


DK

[go to 2]

1.8.1

How many hours per week did you do this?



< 2

[go to 2]


2 - 9

[go to 2]


10 - 19

[go to 2]


20 or more

[go to 2]


DK

[go to 2]

1.9

[Paint Mini-Module]


1.10

[Glue Mini-Module]


1.11

[Board Mini-Module]


1.12

[Fuel Mini-Module]


2

[Hands mini-module]



LEATHER INDUSTRY (LEI) MODULE


1

Did your employer make leather, make a leather product, or do both?



Make leather



Make leather product



Both



DK


2

What color was the leather? (allow multiple)



Brown



Pale cream or white



Other



DK


3

How would you best describe your job at this employer?



Production (make, assemble, or process materials or parts into products or finished goods)

[go to 3.1 - 3.2]


Maintenance or Utilities (maintain or repair equipment, tools, property or utilities)

[go to 3.3-3.8]


Quality Control, Environmental Control, Engineering or Research

[go to 4]


Shipping, Receiving or Storage

[go to 3.9-3.12]


Administration

[go to 4]


DK

[go to 4]

3.1

Was the leather or leather product from animal hides or skins, or was the leather synthetic or man-made?



Animal hide

[go to 3.1.1-3.1.3]


Synthetic or man-made

[go to 3.1.4-3.1.6]


Both

[go to 3.1.7 - 3.1.12]


Something else

[go to 4]


DK

[go to 4]

3.1.1

Was the leather already tanned or prepared, or did hides or skin come into the plant that had to have the hair and flesh removed and tanning done to the hides and skins?



Already tanned



Hair still on/needed tanning

[go to 3.1.1.1-3.1.1.3]


Other



DK


3.1.1.1

Did you work in the area where the hide or skin was prepared for tanning ?



Yes

[go to 3.1.1.1.1]


No



DK


3.1.1.1.1

How many hours per week did you do work in this area?



< 2



2 - 9



10 - 19



20 or more



DK


3.1.1.2

Did you work in the area where the hides and skins were tanned?



Yes

[go to 3.1.1.2.1]


No



DK


3.1.1.2.1

How many hours per week did you do work in this area?



< 2



2 - 9



10 - 19



20 or more



DK


3.1.1.3

Did you work in the area where the tanned leather was stuffed or fat liquored?



Yes

[go to 3.1.1.3.1]


No



DK


3.1.1.3.1

Did you apply the chemicals to stuff or fat liquor the leather?



Yes

[go to 3.1.1.3.1.1-3.1.1.3.1.2]


No



DK


3.1.1.3.1.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



DK


3.1.1.3.1.2

What chemicals did you use? (allow multiple)



Oils



TCE or trichloroethylene



Perchloroethylene (perc) or tetrachloroethylene (tetra)



Some other chemicals



DK


3.1.2

Did you apply a chemical to the leather?



Yes

[go to 3.1.2.1]


No



DK


3.1.2.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



DK


3.1.3

Did you work in the area where the tanned leather was dried, set out, stretched and softened?



Yes

[go to 3.1.3.1]


No



DK


3.1.3.1

How many hours per week did you do work in this area?



< 2



2 - 9



10 - 19



20 or more



DK


3.1.4

Did you work in the area where chemicals were mixed to make a leather-like resin or plastic?



Yes

[go to 3.1.4.1]


No



DK


3.1.4.1

How many hours per week did you do work in this area?



< 2



2 - 9



10 - 19



20 or more



DK


3.1.5

Did you work in the area where chemicals were heated to make a leather-like resin or plastic?



Yes

[go to 3.1.5.1]


No



DK


3.1.5.1

How many hours per week did you do work in this area?



< 2



2 - 9



10 - 19



20 or more



DK


3.1.6

Did you work in the area where chemicals were extruded to make a leather-like resin or plastic?



Yes

[go to 3.1.6.1]


No



DK


3.1.6.1

How many hours per week did you do work in this area?



< 2



2 - 9



10 - 19



20 or more



DK


3.1.7

Was the leather already tanned or prepared, or did hides or skin come into the plant that had to have the hair and flesh removed and tanning done to the hides and skins?



Already tanned



Hair still on/needed tanning

[go to 3.1.7.1-3.1.7.3]


Other



DK


3.1.7.1

Did you work in the area where the hide or skin was prepared for tanning?



Yes

[go to 3.1.1.7.1]


No



DK


3.1.7.1.1

How many hours per week did you do work in this area?



< 2



2 - 9



10 - 19



20 or more



DK


3.1.7.2

Did you work in the area where the hides and skins were tanned?



Yes

[go to 3.1.7.2.1]


No



DK


3.1.7.2.1

How many hours per week did you do work in this area?



< 2



2 - 9



10 - 19



20 or more



DK


3.1.7.3

Did you work in the area where the tanned leather was stuffed or fat liquored?



Yes

[go to 3.1.7.3.1]


No



DK


3.1.7.3.1

Did you apply the chemicals to stuff or fat liquor the leather?



Yes

[go to 3.1.7.3.1.1-3.1.7.3.1.2]


No



DK


3.1.7.3.1.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



DK


3.1.7.3.1.2

What chemicals did you use? (allow multiple)



Oils



TCE or trichloroethylene



Perchloroethylene (perc) or tetrachloroethylene (tetra)



Some other chemicals



DK


3.1.8

Did you apply a chemical to the leather?



Yes

[go to 3.1.8.1]


No



DK


3.1.8.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



DK


3.1.9

Did you work in the area where the tanned leather was dried, set out, stretched and softened?



Yes

[go to 3.1.9.1]


No



DK


3.1.9.1

How many hours per week did you do work in this area?



< 2



2 - 9



10 - 19



20 or more



DK


3.1.10

Did you work in the area where chemicals were mixed to make a leather-like resin or plastic?



Yes

[go to 3.1.10.1]


No



DK


3.1.10.1

How many hours per week did you do work in this area?



< 2



2 - 9



10 - 19



20 or more



DK


3.1.11

Did you work in the area where chemicals were heated to make a leather-like resin or plastic?



Yes

[go to 3.1.11.1]


No



DK


3.1.11.1

How many hours per week did you do work in this area?



< 2



2 - 9



10 - 19



20 or more



DK


3.1.12

Did you work in the area where chemicals were extruded to make a leather-like resin or plastic?



Yes

[go to 3.1.12.1]


No



DK


3.1.12.1

How many hours per week did you do work in this area?



< 2



2 - 9



10 - 19



20 or more



DK


3.2

Did you work in the area where the leather pieces were glued together or glued to metal or plastic pieces?



Yes

[go to 3.2.1 - 3.2.2]


No



DK


3.2.1

How many hours per week did you do work in this area?



< 2



2 - 9



10 - 19



20 or more



DK


3.2.2

Did you do the gluing?



Yes

[go to 3.2.2.1]


No



DK


3.2.2.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



DK


3.3

[Degrease Mini-Module]


3.4

[Paint Mini-Module]


3.5

[Strip Mini-Module]


3.6

[Glue Mini-Module]


3.7

[Board Mini-Module]


3.8

[Fuel Mini-Module]


3.9

[Paint Mini-Module]


3.10

[Glue Mini-Module]


3.11

[Board Mini-Module]


3.12

[Fuel Mini-Module]


4

[Hands mini-module]





LUMBER INDUSTRY (LUI) MODULE


1

What did the employer do? (allow multiple)



Cut trees

[go to 2]


Cut up logs in a sawmill

[go to 2]


Make plywood, particle board, or other type of composite board

[go to 1.1]


Make veneered wood

[go to 1.2]


Make cork

[go to 2]


Something else

[go to 2]


DK

[go to 2]

1.1

In the factory where plywood, particle board or other type of composite board were made, did you operate a machine?



Yes

[go to 1.1.1-1.1.3]


No



DK


1.1.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



DK


1.1.2

What did the machine do?



Saw



Coat or treat with chemicals



Heat press



Something else



DK


1.1.3

Did the machine have direct ventilation that removed the dust, fumes, or vapors from your area?



Yes



No



DK


1.2

In the factory where veneered wood was made, did you operate a machine?



Yes

[go to 1.2.1-1.2.3]


No



DK


1.2.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



DK


1.2.2

What did the machine do?



Saw



Coat or treat with chemicals



Heat press



Something else



DK


1.2.3

Did the machine have direct ventilation that removed the dust, fumes, or vapors from your area?



Yes



No



DK


2

In this job, did you ever repair or maintain equipment or property??



Yes

[go to 2.1-2.6]


No

[go to 3]


DK

[go to 3]

2.1

[Degrease Mini-Module]


2.2

[Paint Mini-Module]


2.3

[Stain Mini-Module]


2.4

[Strip Mini-Module]


2.5

[Glue Mini-Module]


2.6

[Fuel Mini-Module]


3

[Hands mini-module]





OIL REFINING INDUSTRY (ORI)


1

How would you best describe your job at this employer?



Production (make, assemble, or process materials or parts into products or finished goods)

[go to 2]


Maintenance or Utilities (maintain or repair equipment, tools, property or utilities)

[go to 1.1-1.6]


Quality Control, Environmental Control, Engineering or Research

[go to 1.7-1.8]


Shipping, Receiving or Storage

[go to 1.9-1.12]


Administration

[go to 2]


DK

[go to 2]

1.1

[Degrease Mini-Module]


1.2

[Paint Mini-Module]


1.3

[Strip Mini-Module]


1.4

[Glue Mini-Module]


1.5

[Board Mini-Module]


1.6

[Fuel Mini-Module]

[go to 2]

1.7

Did you take samples from the process or production line for testing purposes?



Yes

[go to 1.7.1]


No



DK


1.7.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



DK


1.8

Did you perform chemical or physical tests on process or product samples?



Yes

[go to 1.8.1]


No

[go to 2]


DK

[go to 2]

1.8.1

How many hours per week did you do this?



< 2

[go to 2]


2 - 9

[go to 2]


10 - 19

[go to 2]


20 or more

[go to 2]


DK

[go to 2]

1.9

[Paint Mini-Module]


1.10

[Glue Mini-Module]


1.11

[Board Mini-Module]


1.12

[Fuel Mini-Module]


2

Did you work in FRACTIONATION? (This is where the crude oil is processed to remove water, organic salts, and sulfur)



Yes

[go to 2.1]


No



DK


2.1

How many hours per week did you do work in this area?



< 2



2 - 9



10 - 19



20 or more



DK


3

Did you work in CRACKING? (This is where cracking occurs)



Yes

[go to 3.1]


No



DK


3.1

How many hours per week did you do work in this area?



< 2



2 - 9



10 - 19



20 or more



DK


4

Did you work in COKING? (very heavy residual oils formed into gasoline and diesel fuel, leaving petroleum coke as a residual product)



Yes

[go to 4.1]


No



DK


4.1

How many hours per week did you do work in this area?



< 2



2 - 9



10 - 19



20 or more



DK


5

Did you work in LIQUID FUEL BLENDING? (This is where fuels are blended)



Yes

[go to 5.1]


No



DK


5.1

How many hours per week did you do work in this area?



< 2



2 - 9



10 - 19



20 or more



DK


6

Did you work in an area where benzene or benzole was produced?



Yes

[go to 6.1]


No



DK


6.1

How many hours per week did you do work in this area?



< 2



2 - 9



10 - 19



20 or more



DK


7

Did you work in the TANK FARM? (This is where the products are stored)



Yes

[go to 7.1]


No



DK


7.1

How many hours per week did you do work in this area?



< 2



2 - 9



10 - 19



20 or more



DK


8

Did you work in LOADING? (This is where barges, trains, trucks were loaded)



Yes

[go to 8.1]


No



DK


8.1

How many hours per week did you do work in this area?



< 2



2 - 9



10 - 19



20 or more



DK


9

[Hands mini-module]





PESTICIDE (PE) MODULE


1

In this job, did you ever apply any type of chemicals to kill weeds, bugs, fungus or molds, or rodents such as rats?



Yes

[go to 1.1-1.5]


No

[go to 1.6]


DK

[go to 2]

1.1

Did you apply herbicides or weed killers?



Yes

[go to 1.1.1-1.1.3]


No



DK


1.1.1

On average, how many times a year did you apply herbicides or weed killers?



[number 0-1000]



DK


1.1.2

Each time you did this, how many hours did it take?



[number 0-24]



DK


1.1.3

Did you add kerosene, diesel fuel, Stoddard solvent or oil to the weed killers or herbicides that you mixed?



Yes



No



DK


1.2

Did you apply insecticides or bug killers?



Yes

[go to 1.2.1-1.2.3]


No



DK


1.2.1

On average, how many times a year did you apply insecticides or bug killers?



[number 0-1000]



DK


1.2.2

Each time you did this, how many hours did it take?



[number 0-24]



DK


1.2.3

Did you add kerosene, diesel fuel, Stoddard solvent or oil to the insecticides or bug killers that you mixed?



Yes



No



DK


1.3

Did you apply fumigants?



Yes

[go to 1.3.1-1.3.3]


No



DK




1.3.1

On average, how many times a year did you apply fumigants?



[number 0-1000]



DK


1.3.2

Each time you did this, how many hours did it take?



[number 0-24]



DK


1.3.3

Did you add kerosene, diesel fuel, Stoddard solvent or oil to the fumigants that you mixed?



Yes



No



DK


1.4

Did you apply fungicides to kill mold or fungus?



Yes

[go to 1.4.1-1.4.3]


No



DK


1.4.1

On average, how many times a year did you apply fungicides?



[number 0-1000]



DK


1.4.2

Each time you did this, how many hours did it take?



[number 0-24]



DK


1.4.3

Did you add kerosene, diesel fuel, Stoddard solvent or oil to the fungicides that you mixed?



Yes



No



DK


1.5

Did you apply rodenticides to kill rodents, such as rats?



Yes

[go to 1.5.1-1.5.3]


No



DK


1.5.1

On average, how many times a year did you apply rodenticides?



[number 0-1000]



DK


1.5.2

Each time you did this, how many hours did it take?



[number 0-24]



DK


1.5.3

Did you add kerosene, diesel fuel, Stoddard solvent or oil to the rodenticides that you mixed?



Yes



No



DK




1.6

Did you work in an area where someone else applied any type of chemicals to kill weeds, bugs, fungus or molds, or rodents such as rats?



Yes

[go to 1.6.1]


No



DK


1.6.1

What type of chemicals were used? (allow multiple)



Herbicides or weed killers



Insecticides or bug killers



Fumigants



Fungicides to kill mold or fungus



Rodenticides to kill rodents, such as rats



Something else



DK


2

[Hands mini-module ]





PHOTOGRAPHIC INDUSTRY (PHI) MODULE


1

Did your employer make photographic film?



Yes

[go to 1.1-1.4]


No

[go to 2]


DK

[go to 2]

1.1

How would you best describe your job at this employer?



Production (make, assemble, or process materials or parts into products or finished goods)

[go to 1.2]


Maintenance or Utilities (maintain or repair equipment, tools, property or utilities)

[go to 1.1.1-1.1.6]


Quality Control, Environmental Control, Engineering or Research

[go to 1.1.7-1.1.8]


Shipping, Receiving or Storage

[go to 1.1.9-1.1.12]


Administration

[go to 1.2]


DK

[go to 1.2]

1.1.1

[Degrease Mini-Module]


1.1.2

[Paint Mini-Module]


1.1.3

[Strip Mini-Module]


1.1.4

[Glue Mini-Module]


1.1.5

[Board Mini-Module]


1.1.6

[Fuel Mini-Module]

[go to 1.2]

1.1.7

Did you take samples from the process or production line for testing purposes?



Yes

[go to 1.1.7.1]


No



DK


1.1.7.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



DK


1.1.8

Did you perform chemical or physical tests on process or product samples?



Yes

[go to 1.1.8.1]


No

[go to 1.2]


DK

[go to 1.2]

1.1.8.1

How many hours per week did you do this?



< 2

[go to 1.2]


2 - 9

[go to 1.2]


10 - 19

[go to 1.2]


20 or more

[go to 1.2]


DK

[go to 1.2]

1.1.9

[Paint Mini-Module]


1.1.10

[Glue Mini-Module]


1.1.11

[Board Mini-Module]


1.1.12

[Fuel Mini-Module]


1.2

Did you work in the area where the film was made from chemicals?



Yes

[go to 1.2.1]


No



DK


1.2.1

How many hours per week did you do work in this area?



< 2



2 - 9



10 - 19



20 or more



DK


1.3

Did you work in the drying area?



Yes

[go to 1.3.1]


No



DK


1.3.1

How many hours per week did you do work in this area?



< 2



2 - 9



10 - 19



20 or more



DK


1.4

Did you work in the area where the film was rolled onto a canister?



Yes

[go to 1.4.1]


No



DK


1.4.1

How many hours per week did you do work in this area?



< 2



2 - 9



10 - 19



20 or more



DK


2

Did your employer develop photographic film?



Yes

[go to 2.1]


No



DK


2.1

Did you develop the film?



Yes

[go to 2.1.1]


No



DK


2.1.1

Did you use formaldehyde during the processing of the film?



Yes

[go to 2.1.1.1]


No



DK


2.1.1.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



DK


3

[Hands mini-module]





PLASTICS INDUSTRY (PLI) MODULE


1

How would you best describe your job at this employer?



Production (make, assemble, or process materials or parts into products or finished goods)

[go to 2]


Maintenance or Utilities (maintain or repair equipment, tools, property or utilities)

[go to 1.1-1.6]


Quality Control, Environmental Control, Engineering or Research

[go to 1.7-1.8]


Shipping, Receiving or Storage

[go to 1.9-1.12]


Administration

[go to 2]


DK

[go to 2]

1.1

[Degrease Mini-Module]


1.2

[Paint Mini-Module]


1.3

[Strip Mini-Module]


1.4

[Glue Mini-Module]


1.5

[Board Mini-Module]


1.6

[Fuel Mini-Module]

[go to 2]

1.7

Did you take samples from the process or production line for testing purposes?



Yes

[go to 1.7.1]


No



DK


1.7.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



DK


1.8

Did you perform chemical or physical tests on process or product samples?



Yes

[go to 1.8.1]


No

[go to 2]


DK

[go to 2]

1.8.1

How many hours per week did you do this?



< 2

[go to 2]


2 - 9

[go to 2]


10 - 19

[go to 2]


20 or more

[go to 2]


DK

[go to 2]

1.9

[Paint Mini-Module]


1.10

[Glue Mini-Module]


1.11

[Board Mini-Module]


1.12

[Fuel Mini-Module]


2

What type of plastics were being made by your employer? (allow multiple)



polystyrene



phenol-formaldehyde



polypropylene



urea-formaldehyde



polyester



melamine



Something else



DK


3

Did you work in the area where the plastic was being formed, either by a mold machine or a press?



Yes

[go to 3.1]


No



DK


3.1

How many hours per week did you do work in this area?



< 2



2 - 9



10 - 19



20 or more



DK


4

Did you work in the finishing or packing area?



Yes

[go to 4.1]


No



DK


4.1

How many hours per week did you do work in this area?



< 2



2 - 9



10 - 19



20 or more



DK


5

Did you work in some other area?



Yes

[go to 5.1]


No



DK


5.1

How many hours per week did you do work in this area?



< 2



2 - 9



10 - 19



20 or more



DK


6

[Hands mini-module]





PULP AND PAPER INDUSTRY (PPI) MODULE


1

How would you best describe your job at this employer?



Production (make, assemble, or process materials or parts into products or finished goods)

[go to 2]


Maintenance or Utilities (maintain or repair equipment, tools, property or utilities)

[go to 1.1-1.6]


Quality Control, Environmental Control, Engineering or Research

[go to 1.7-1.8]


Shipping, Receiving or Storage

[1.9-1.12]


Administration

[go to 2]


DK

[go to 2]

1.1

[Degrease Mini-Module]


1.2

[Paint Mini-Module]


1.3

[Strip Mini-Module]


1.4

[Glue Mini-Module]


1.5

[Board Mini-Module]


1.6

[Fuel Mini-Module]

[go to 2]

1.7

Did you take samples from the process or production line for testing purposes?



Yes

[go to 1.7.1]


No



DK


1.7.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



DK


1.8

Did you perform chemical or physical tests on process or product samples?



Yes

[go to 1.8.1]


No

[go to 2]


DK

[go to 2]

1.8.1

How many hours per week did you do this?



< 2

[go to 2]


2 - 9

[go to 2]


10 - 19

[go to 2]


20 or more

[go to 2]


DK

[go to 2]

1.9

[Paint Mini-Module]


1.10

[Glue Mini-Module]


1.11

[Board Mini-Module]


1.12

[Fuel Mini-Module]


2

Did you work in a paper mill?



Yes

[go to 2.1-2.4]


No



DK


2.1

Did you work in an area where recycled paper was prepared for the papermaking process?



Yes

[go to 2.1.1]


No



DK


2.1.1

Did you remove ink from waste paper?



Yes

[go to 2.1.1.1]


No



DK


2.1.1.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



DK


2.2

Did you work in the area where the paper machine was located?



Yes

[go to 2.2.1]


No



DK


2.2.1

How many hours per week did you do work in this area?



< 2



2 - 9



10 - 19



20 or more



DK


2.3

Did you work in the drying area?



Yes

[go to 2.3.1]


No



DK


2.3.1

How many hours per week did you do work in this area?



< 2



2 - 9



10 - 19



20 or more



DK


2.4

Did you work in the coating area?



Yes

[go to 2.4.1]


No



DK


2.4.1

How many hours per week did you do work in this area?



< 2



2 - 9



10 - 19



20 or more



DK


3

Did you work in a pulp mill?



Yes

[go to 3.1]


No



DK


3.1

How many hours per week did you do work in this area?



< 2



2 - 9



10 - 19



20 or more



DK


4

[Hands mini-module]





PRINTING INDUSTRY (PRI) MODULE


1

How would you best describe your job at this employer?



Production (make, assemble, or process materials or parts into products or finished goods)

[go to 2]


Maintenance or Utilities (maintain or repair equipment, tools, property or utilities)

[go to 1.1-1.6]


Quality Control, Environmental Control, Engineering or Research



Shipping, Receiving or Storage

[go to 1.7-1.10]


Administration

[go to 2]


DK

[go to 2]

1.1

[Degrease Mini-Module]


1.2

[Paint Mini-Module]


1.3

[Strip Mini-Module]


1.4

[Glue Mini-Module]


1.5

[Board Mini-Module]


1.6

[Fuel Mini-Module]

[go to 2]

1.7

[Paint Mini-Module]


1.8

[Glue Mini-Module]


1.9

[Board Mini-Module]


1.10

[Fuel Mini-Module]


2

Did you ever work in the plate making, plate engraving, or screen preparation area?



Yes

[go to 2.1-2.3]


No



DK


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 clean the printing plates?



Yes

[go to 2.2.1]


No



DK


2.2.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



DK



2.2.2

What chemicals did you use to clean the plates? (allow multiple)



Carbon tetrachloride



Trichloroethylene



Trichloroethane



Chloroform



Perchloroethylene (perc) or tetrachloroethylene (tetra)



Gasoline or other fuels



Some other chemical



DK


2.3

Did you wash or clean screens that are used in a silkscreen-like process?



Yes

[go to 2.3.1-2.3.2]


No



DK


2.3.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



DK


2.3.2

What chemicals did you use to clean the screens? (allow multiple)



Carbon tetrachloride



Trichloroethylene



Trichloroethane



Chloroform



Perchloroethylene (perc) or tetrachloroethylene (tetra)



Gasoline or other fuels



Some other chemical



DK


3

Did you ever work in the area where the ink was prepared?



Yes

[go to 3.1-3.2]


No



DK


3.1

How many hours per week did you do work in this area?



< 2



2 - 9



10 - 19



20 or more



DK


3.2

Did you prepare or mix the ink?



Yes

[go to 3.2.1-3.2.2]


No



DK


3.2.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



DK


3.2.2

Did you use solvents or chemicals other than water to dilute the ink?



Yes



No



DK


4

Did you ever work in the printing room or area?



Yes

[go to 4.1-4.2]


No



DK


4.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



DK


4.2

Did you run the press?



Yes

[go to 4.2.1]


No



DK


4.2.1

Did you wash or clean the plates or presses?



Yes

[go to 4.2.1.1-4.2.1.2]


No



DK


4.2.1.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



DK


4.2.1.2

What chemicals did you use to clean the plates or presses? (allow multiple)



Carbon tetrachloride



Trichloroethylene



Trichloroethane



Chloroform



Perchloroethylene (perc) or tetrachloroethylene (tetra)



Gasoline or other fuels



Some other chemical



DK


5

Did you ever work in the area where the ink was cured or the printing material was dried?



Yes

[go to 5.1-5.2]


No



DK


5.1

How many hours per week did you do work in this area?



< 2



2 - 9



10 - 19



20 or more



DK


5.2

[Vent Mini-module]


6

Did you ever work in the bookbinding area or an area where paper was folded, trimmed, glued, stapled, or stitched?



Yes

[go to 6.1-6.2]


No



DK


6.1

How many hours per week did you do work in this area?



< 2



2 - 9



10 - 19



20 or more



DK


6.2

Did you run the gluing machine?



Yes

[go to 6.2.1]


No



DK


6.2.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



DK


7

[Hands mini-module]





RUBBER INDUSTRY (RUI)


1

How would you best describe your job at this employer?



Production (make, assemble, or process materials or parts into products or finished goods)

[go to 2]


Maintenance or Utilities (maintain or repair equipment, tools, property or utilities)

[go to 1.1-1.5]


Quality Control, Environmental Control, Engineering or Research

[go to 1.6-1.7]


Shipping, Receiving or Storage

[go to 1.8-1.10]


Administration

[go to 2]


DK

[go to 2]

1.1

[Degrease Mini-Module]


1.2

[Paint Mini-Module]


1.3

[Strip Mini-Module]


1.4

[Board Mini-Module]


1.5

[Fuel Mini-Module]

[go to 2]

1.6

Did you take samples from the process or production line for testing purposes?



Yes

[go to 1.6.1]


No



DK


1.6.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



DK


1.7

Did you perform chemical or physical tests on process or product samples?



Yes

[go to 1.7.1]


No

[go to 2]


DK

[go to 2]

1.7.1

How many hours per week did you do this?



< 2

[go to 2]


2 - 9

[go to 2]


10 - 19

[go to 2]


20 or more

[go to 2]


DK

[go to 2]

1.8

[Paint Mini-Module]


1.9

[Board Mini-Module]


1.10

[Fuel Mini-Module]





2

Did you work in the weighing area?



Yes

[go to 2.1]


No



DK


2.1

How many hours per week did you do work in this area?



< 2



2 - 9



10 - 19



20 or more



DK


3

Did you work in the modeling area. (This is the area where rubber parts are glued or cemented together)?



Yes

[go to 3.1 - 3.3]


No



DK


3.1

How many hours per week did you do work in this area?



< 2



2 - 9



10 - 19



20 or more



DK


3.2

Did you make rubber cement by mixing rubber and solvents or gasoline together?



Yes



No



DK


3.3

Did you glue rubber and metal together to make rubber-to-metal bonds?



Yes

[go to 3.3.1]


No



DK


3.3.1

[Degrease mini-module]


4

Did you work in the curing area?



Yes

[go to 4.1]


No



DK


4.1

How many hours per week did you do work in this area?



< 2



2 - 9



10 - 19



20 or more



DK



5

Did you work in the finishing/ repair area?



Yes

[ask 5.1 - 5.2]


No



DK


5.1

How many hours per week did you do work in this area?



< 2



2 - 9



10 - 19



20 or more



DK


5.2

Did you use a solvent or gasoline to 'polish' the rubber?



Yes



No



DK


6

[Hands Mini-module]





SHOE MANUFACTURING INDUSTRY (SHI) (LONG)


1

How would you best describe your job at this employer?



Production (make, assemble, or process materials or parts into products or finished goods)

[go to 1.1 - 1.2]


Maintenance or Utilities (maintain or repair equipment, tools, property or utilities)

[go to 1.3-1.7]


Quality Control, Environmental Control, Engineering or Research



Shipping, Receiving or Storage

[go to 1.8-1.10]


Administration

[go to 2]


DK

[go to 2]

1.1

What type of shoes did you make? (allow multiple)



Leather shoes



Textile shoes



Rubber/plastic shoes or boots



Other



DK


1.2

In this job, what part of the shoe-making process did you do? Did you…? (allow multiple)



Cut the upper part of the shoe



Sew the upper part of the shoe



Use a model (or last) to shape the upper part of the shoe



Glue the upper part of the shoe to the sole



Finish or polish the assembled shoe



Something else



DK


1.3

In this job, did you ever clean or degrease metal or plastic parts with chemicals?



Yes

[go to 1.3.1-1.3.5]


No



DK


1.3.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



DK


1.3.2

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


1.3.3

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


1.3.4

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


1.3.5

Was there a local exhaust system to remove the dust, fumes or vapors that was produced?



Yes



No



DK


1.3.6

Did other workers clean or degrease parts in the area where you worked?



Yes

[go to 1.3.6.1]


No



DK


1.3.6.1

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


1.4

In this job, did you ever use paint?



Yes

[go to 1.4.1-1.4.5]


No



DK


1.4.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



DK


1.4.2

What did you usually use to apply the paint? (allow multiple)



Brush



Roller



Electrostatic gun



Spray gun



Dip item into paint



Other



DK


1.4.3

Did you paint indoors or inside a ship?



Yes

[go to 1.3.1-1.3.2]


No



DK


1.4.3.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



DK


1.4.3.2

Was there a local exhaust system to remove the dust, fumes or vapors that was produced?



Yes



No



DK


1.4.3.3

Did you paint in a production area of a manufacturing plant?



Yes

[go to 1.4.3.3.1]


No



DK


1.4.3.3.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



DK


1.4.4

Did you paint outdoors?



Yes

[go to 1.4.4.1]


No



DK


1.4.4.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



DK


1.4.5

Did other workers use paints in the area where you worked?



Yes

[go to 1.4.5.1]


No



DK


1.4.5.1

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


1.5

In this job, did you ever strip paint from metal or wood objects?



Yes,

[go to 1.5.1-1.5.3]


No



DK


1.5.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



DK


1.5.2

To strip paint, what did you use? Did you use…? (allow multiple)



Methylene chloride



Acids, alkalis, or caustic solutions?



Any other chemical



Something else, such as a heat gun or scraper



DK


1.5.3

Did other workers strip paint from metal or wood objects in the area where you worked?



Yes

[go to 1.5.3.1]


No



DK


1.5.3.1

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


1.6

In this job, did you ever handle or use particle board, plywood, or veneered wood?



Yes

[go to 1.6.1]


No



DK


1.6.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



DK


1.6.2

Did other workers work with particle board, plywood, or veneered wood in the area where you worked?



Yes,

[go to 1.6.2.1]


No



DK


1.6.2.1

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


1.7

In this job, did you ever handle or pump fuel?



Yes

[go to 1.7.1]


No



DK


1.7.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



DK


1.8

In this job, did you ever use paint?



Yes

[go to 1.8.1-1.8.5]


No



DK


1.8.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



DK


1.8.2

What did you usually use to apply the paint? (allow multiple)



Brush



Roller



Electrostatic gun



Spray gun



Dip item into paint



Other



DK


1.8.3

Did you paint indoors or inside a ship?



Yes

[go to 1.8.3.1-1.8.3.2]


No



DK


1.8.3.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



DK


1.8.3.2

Was there a local exhaust system to remove the dust, fumes or vapors that was produced?



Yes



No



DK


1.8.3.3

Did you paint in a production area of a manufacturing plant?



Yes

[go to 1.8.3.3.1]


No



DK


1.8.3.3.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



DK


1.8.4

Did you paint outdoors?



Yes

[go to 1.8.4.1]


No



DK


1.8.4.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



DK


1.8.5

Did other workers use paints in the area where you worked?



Yes

[go to 1.8.5.1]


No



DK


1.8.5.1

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


1.9

In this job, did you ever handle or use particle board, plywood, or veneered wood?



Yes

[go to 1.9.1]


No



DK


1.9.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



DK


1.9.2

Did other workers work with particle board, plywood, or veneered wood in the area where you worked?



Yes,

[go to 1.9.2.1]


No



DK


1.9.2.1

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


1.10

In this job, did you ever handle or pump fuel?



Yes

[go to 1.10.1]


No



DK


1.10.1

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 use glues or adhesives?



Yes,

[go to 2.1-2.3]


No



DK


2.1

Was there a local exhaust system to remove the dust, fumes or vapors that was produced?



Yes



No



DK


2.2

Did you use solvent-based glues or adhesives, for example, rubber cement?



Yes,

[go to 2.2.1]


No



DK


2.2.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



DK


2.3

Did you use water-based glues or adhesives, for example, vinyl or acrylic resins?



Yes

[go to 2.3.1]


No



DK


2.3.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



DK


3

In this job, did other workers use glues or adhesives in the area where you worked?



Yes

[go to 3.1]


No



DK


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


4

Were your hands ever immersed in a solvent, a solvent-based product, or fuel?



Yes



No



DK


5

Did you wear gloves while using solvents or solvent-based products?



Yes



No



Not applicable - did not use solvents



DK


6

Did you clean your hands with a solvent, a solvent-based product or with fuel, such as gasoline?



Yes



No



DK





Solvent (SOL) (LONG)


1

In this job, did you ever clean or degrease metal or plastic parts with chemicals?



Yes

[go to 1.1-1.5]


No



DK


1.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



DK


1.2

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


1.3

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


1.4

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


1.5

Was there a local exhaust system to remove the dust, fumes or vapors that was produced?



Yes



No



DK


1.6

Did other workers clean or degrease parts in the area where you worked?



Yes

[go to 1.6.1]


No



DK


1.6.1

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


2

In this job, did you ever use paint?



Yes

[go to 2.1-2.5]


No



DK


2.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



DK


2.2

What did you usually use to apply the paint? (allow multiple)



Brush



Roller



Electrostatic gun



Spray gun



Dip item into paint



Other



DK


2.3

Did you paint indoors or inside a ship?



Yes

[go to 2.3.1-2.3.2]


No



DK


2.3.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



DK





2.3.2

Was there a local exhaust system to remove the dust, fumes or vapors that was produced?



Yes



No



DK


2.3.3

Did you paint in a production area of a manufacturing plant?



Yes

[go to 2.3.3.1]


No



DK


2.3.3.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



DK


2.4

Did you paint outdoors?



Yes

[go to 2.4.1]


No



DK


2.4.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



DK


2.5

Did other workers use paints in the area where you worked?



Yes

[go to 2.5.1]


No



DK


2.5.1

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


3

In this job, did you use stains or varnishes?



Yes

[go to 3.1-3.3]


No



DK





3.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



DK


3.2

What type of stains or varnishes did you use? Did you use…? (allow multiple)



Water-based stains



Water-based varnishes



Oil-based stains



Oil-based varnishes



Something else



DK


3.3

Was there a local exhaust system to remove the dust, fumes or vapors that was produced?



Yes



No



DK


3.4

Did other workers use stains or varnishes in the area where you worked?



Yes

[go to 3.4.1]


No



DK


3.4.1

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


4

In this job, did you ever strip paint from metal or wood objects?



Yes,

[go to 4.1-4.3]


No



DK


4.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



DK





4.2

To strip paint, what did you use? Did you use…? (allow multiple)



Methylene chloride



Acids, alkalis, or caustic solutions?



Any other chemical



Something else, such as a heat gun or scraper



DK


4.3

Did other workers strip paint from metal or wood objects in the area where you worked?



Yes

[go to 4.3.1]


No



DK


4.3.1

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


5

In this job, did you ever use glues or adhesives?



Yes,

[go to 5.1-5.8]


No



DK


5.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



DK


5.2

What material were the things you were gluing made of? (allow multiple)



Wood



Metal



Plastic



Paper



Fabrics



Other



DK


5.3

Was there a local exhaust system to remove the dust, fumes or vapors that was produced?



Yes



No



DK


5.4

Did you use water-based glues or adhesives, for example, vinyl or acrylic resins?



Yes

[go to 5.4.1]


No



DK


5.4.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



DK


5.5

Did you use glues or adhesives that you heated with a gun or other heated device?



Yes,

[ go to 5.5.1]


No



DK


5.5.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



DK


5.6

Did you use contact glues or adhesives where you apply the glue to both pieces being glued, let it dry for a short time, and then join the two pieces together?



Yes

[go to 5.6.1]


No



DK


5.6.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



DK


5.7

Did you use glues or adhesives that require mixing two parts of the glue together before applying? (epoxy resins)



Yes

[go to 5.7.1]


No



DK


5.7.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



DK


5.8

Did you use urea, phenol or melamine-based glues or adhesives?



Yes

[go to 5.8.1]


No



DK


5.8.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



DK


5.9

Did other workers use glues or adhesives in the area where you worked?



Yes

[ask 5.9.1]


No



DK


5.9.1

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 handle or use particle board, plywood, or veneered wood?



Yes

[go to 6.1]


No



DK


6.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



DK


6.2

Did other workers work with particle board, plywood, or veneered wood in the area where you worked?



Yes,

[go to 6.2.1]


No



DK


6.2.1

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


7

In this job, did you ever handle or pump fuel?



Yes

[go to 7.1]


No



DK


7.1

How many hours per week did you do this?



< 2



2 - 9



10 - 19



20 or more



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





TEACHER (TE) MODULE



1

What grade level did you teach? (allow multiple)




Elementary or below




Junior high/middle school




High school




Vocational or technical school




College or university




Other




DK



2

What subjects did you teach? (allow multiple)




Art

[END]



Biology

[go to 2.1]



Chemistry

[go to 2.2]



Industrial shop

[go to 2.3-2.5]



Other

[END]



DK

[END]


2.1

Did you teach a lab component for this subject?




Yes

[go to 2.1.1]



No




DK



2.1.1

How many hours per week did you do this?




< 2




2 - 9




10 - 19




20 or more




DK



2.2

Did you teach a lab component for this subject?




Yes

[go to 2.2.1]



No




DK



2.2.1

How many hours per week did you do this?




< 2




2 - 9




10 - 19




20 or more




DK



2.3

[Degrease Mini-module]



2.4

[Paint Mini-Module]



2.5

[Hands mini-module]








*Note: The numbering in this document may not match the tablet exactly.

File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorRebecca Montalvan
File Modified0000-00-00
File Created2021-01-24

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