Form 1 Attachment 5 Occupational Job Modules

Attachment 5: Asia Lymph All Job Modules (OccIDEAS)*
OMB #: 0925-0654
Expiration date:
10/31/2015 Public reporting for this collection of information is estimated to average 35 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 (0925-0654). 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. We estimate that 15 minutes
will be needed on average to complete this portion of the interview.

CHEMIST (CH) MODULE
1 In this job, did you work in a lab?

1.1

2

2.1

2.2

Yes
No
DK
How many hours per week did you do work in this area?
<2
2-9
10 - 19
20 or more
DK
Did you work in the production area of a plant?
Yes
No
DK
How many hours per week did you do work in this area?
<2
2-9
10 - 19
20 or more
DK
Did you collect process samples in a production area?
Yes
No
DK

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

[go to 2]
[go to 2]

[go to 3]
[go to 3]

3 Did you use chlorinated solvents?

3.1

3.2

4

4.1

5

5.1

6

Yes
No
DK
How many hours per week did you do this?
<2
2-9
10 - 19
20 or more
DK
What chlorinated solvents did you use? Did you use…? (allow
multiple)
Trichloroethylene
Dichloromethane
Other chlorinated solvent
DK
Did you use benzene?
Yes
No
DK
How many hours per week did you do this?
<2
2-9
10 - 19
20 or more
DK
Did you use any other aromatic compounds, such as xylene or
toluene?
Yes
No
DK
How many hours per week did you do this?
<2
2-9
10 - 19
20 or more
DK
Did you use formaldehyde or a formaldehyde solution?
Yes
No
DK
2

[go to 4]
[go to 4]

[go to 5]
[go to 5]

[go to 6]
[go to 6]

[go to 7]
[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
DK
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
Liquid
Both
DK
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
3

[go to 8]
[go to 8]

[go to 8]
[go to 7.2.1]
[go to 8]
[go to 8]

DK
JANITOR (JA) MODULE
1 In this job, did you ever clean office areas?
Yes
No
DK
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
DK
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
DK
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
DK
4.1 How many hours per week did you do this?
<2
2-9
10 - 19
20 or more
DK
4

[go to 2]
[go to 2]

[go to 3]
[go to 3]

[go to 4]
[go to 4]

[go to 5]
[go to 5]

5 Did you ever work in an area where materials containing solvents,
such as paints, varnishes, glues, or degreasers were used?
Yes
No
DK
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
DK
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
DK
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
5

[go to 6]
[go to 6]

[go to 7]
[go to 7]

[go to 6.3]
[go to 6.3]

6.2.3 Were the chemicals at room temperature or were they heated in a
tank, vat, or vapor degreaser? (allow multiple)

6.2.4

6.2.5

6.3

6.3.1

Room temperature
Heated in vapor degreaser
Heated in vat or tank
Other
DK
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
Was there a local exhaust system to remove the dust, fumes or
vapors that was produced?
Yes
No
DK
Did other workers clean or degrease parts in the area where you
worked?
Yes
No
DK
How many hours per week did other workers perform this task
while you were working in this area?

[go to 6.4]
[go to 6.4]

<2
2-9
10-19
20 or more
DK
6.4 In this job, did you ever handle or pump fuel?
Yes
No
DK
6.4.1 How many hours per week did you do this?
<2
2-9
10-19
20 or more
DK
6

[go to 7]
[go to 7]

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

7

1

1.1

1.2

1.3

2

2.1

3

3.1

HEALTH PROFESSION (HP) MODULE
In this job, did you work in a room where instruments or other
equipment was being sterilized?
Yes
No
DK
How many hours per week did you do work in this area?
<2
2-9
10 - 19
20 or more
DK
How were these instruments and equipment sterilized? (allow
multiple)
In a solution
In an autoclave or sterilizing unit
Something else
DK
What sterilizing agent was usually used in the solution? (allow
multiple)
Formaldehyde
Phisohex
Something else
DK
In this job, did you use disinfectants or antiseptics?
Yes
No
DK
What disinfectant or antiseptic did you use? Did you use…? (allow
multiple)
Formaldehyde
Phisohex
Something else
DK
In this job, did you clean dialysis machines?
Yes
No
DK
How many hours per week did you do this?
<2
2-9
10 - 19
20 or more
DK
8

[go to 2]
[go to 2]

[go to 3]
[go to 3]

[go to 4]
[go to 4]

4 In this job, did you clean endoscopes?
Yes
No
DK
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?

5.1

5.2

5.2.1

5.3

5.3.1

Yes
No
DK
How many hours per week did you do this?
<2
2-9
10 - 19
20 or more
DK
Did you use dyes?
Yes
No
DK
How many hours per week did you do this?
<2
2-9
10 - 19
20 or more
DK
Did you use benzene?
Yes
No
DK
How many hours per week did you do this?
<2
2-9
10 - 19
20 or more
DK

9

[go to 5]
[go to 5]

[go to 6]
[go to 6]

[go to 5.3]
[go to 5.3]

[go to 5.4]
[go to 5.4]

5.4 Did you use trichloroethylene?

5.4.1

5.5

5.5.1

6

6.1

6.1.1

6.1.2

Yes
No
DK
How many hours per week did you do this?
<2
2-9
10 - 19
20 or more
DK
Did you use any formaldehyde or formalin?
Yes
No
DK
How many hours per week did you do this?
<2
2-9
10 - 19
20 or more
DK
In this job, did you ever repair or maintain equipment or property?
Yes
No
DK
In this job, did you ever clean or degrease metal or plastic parts
with chemicals?
Yes
No
DK
How many hours per week did you do this?
<2
2-9
10 - 19
20 or more
DK
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
10

[go to 5.5]
[go to 5.5]

[go to 6]
[go to 6]

[go to 7]
[go to 7]

[go to 6.2]
[go to 6.2]

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

6.1.5

6.2

6.2.1

6.3

6.3.1

Other
DK
Was there a local exhaust system to remove the dust, fumes or
vapors that was produced?
Yes
No
DK
Did other workers clean or degrease parts in the area where you
worked?
Yes
No
DK
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
In this job, did you ever use paint?
Yes
No
DK
How many hours per week did you do this?
<2
2-9
10 - 19
20 or more
DK

11

[go to 6.3]
[go to 6.3]

[go to 6.4]
[go to 6.4]

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

6.3.3

6.3.3.1

6.3.3.2

6.3.3.3

6.3.3.3.1

6.3.4

6.3.4.1

Brush
Roller
Electrostatic gun
Spray gun
Dip item into paint
Other
DK
Did you paint indoors or inside a ship?
Yes
No
DK
How many hours per week did you do this?
<2
2-9
10 - 19
20 or more
DK
Was there a local exhaust system to remove the dust, fumes or
vapors that was produced?
Yes
No
DK
Did you paint in a production area of a manufacturing plant?
Yes
No
DK
How many hours per week did you do this?
<2
2-9
10 - 19
20 or more
DK
Did you paint outdoors?
Yes
No
DK
How many hours per week did you do this?
<2
2-9
10 - 19
20 or more
DK
12

[go to 6.3.4]
[go to 6.3.4]

[go to 6.3.4]
[go to 6.3.4]

[go to 6.4]
[go to 6.4]

6.4 Did other workers use paints in the area where you worked?
Yes
No
DK
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
DK
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
DK
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
DK

13

[go to 6.5]
[go to 6.5]

[go to 6.6]
[go to 6.6]

[go to 6.7]
[go to 6.7]

[go to 6.8]
[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
DK
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
DK
6.7.5.1 How many hours per week did you do this?
<2
2-9
10 - 19
20 or more
DK
14

[go to 6.7.5]
[go to 6.7.5]

[go to 6.7.6]
[go to 6.7.6]

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
DK
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
DK
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
DK
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
DK
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
15

[go to 6.7.7]
[go to 6.7.7]

[go to 6.7.8]
[go to 6.7.8]

[go to 6.8]
[go to 6.8]

[go to 6.9]
[go to 6.9]

6.9 In this job, did you ever handle or use particle board, plywood, or
veneered wood?
Yes
No
DK
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
DK
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
DK
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
16

[go to 6.10]
[go to 6.10]

[go to 6.11]
[go to 6.11]

[go to 7]
[go to 7]

9 Did you clean your hands with a solvent, a solvent-based product or
with fuel, such as gasoline?
Yes
No
DK

17

1

1.1

1.2

1.3

1.4

2

2.1

2.2

CHEMICAL INDUSTRY (CHI) MODULE
What did the employer make? (allow multiple)
Paints
Pesticides or fertilizers
Drugs or pharmaceuticals
Dyes or pigments
Other chemicals
DK
Did the company make fumigants?
Yes
No
DK
Did the company make insecticides?
Yes
No
DK
Did the company make vaccines?
Yes
No
DK
Did the company make antiseptics, germicides or antibacterials?
Yes
No
DK
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)
Quality Control, Environmental Control, Engineering or
Research
Shipping, Receiving or Storage
Administration
DK
Was the part of the plant where you worked making chemicals
primarily indoors or outdoors?
Indoors
Outdoors
Both
DK
Did you spend time in a control room?
Yes
No
DK
18

[go to 1.1-1.2]
[go to 1.3-1.4]
[go to 2]
[go to 2]
[go to 2]

[go to 2]
[go to 2]
[go to 2]

[go to 2.1-2.6]
[go to 2.7-2.12]
[go to 2.13-2.14]
[go to 2.15-2.18]
[go to 3]
[go to 3]

[go to 2.2.1]

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
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
No
DK
2.5.1 [Ask Vent Mini-module]
2.6 Did you pack or package chemicals?
Yes
No
DK
2.6.1 How many hours per week did you do this?
<2
2-9
10 - 19
20 or more
DK
19

[to go 2.3.1]

[go to 2.5.1]

[go to 2.6.1-2.6.2]
[go to 3]
[go to 3]

2.6.2
2.7
2.8
2.9
2.10
2.11
2.12
2.13

2.13.1

2.14

2.14.1

2.15
2.16
2.17
2.18
3

[Vent mini-module]
[Degrease Mini-Module]
[Paint Mini-Module]
[Strip Mini-Module]
[Glue Mini-Module]
[Board Mini-Module]
[Fuel Mini-Module]
Did you take samples from the process or production line for
testing purposes?
Yes
No
DK
How many hours per week did you do this?
<2
2-9
10 - 19
20 or more
DK
Did you perform chemical or physical tests on process or product
samples?
Yes
No
DK
How many hours per week did you do this?
<2
2-9
10 - 19
20 or more
DK
[Paint Mini-Module]
[Glue Mini-Module]
[Board Mini-Module]
[Fuel Mini-Module]
[Hands mini-module]

20

[go to 3]

[go to 3]

[go to 2.13.1]

[go to 2.14.1]
[go to 3]
[go to 3]
[go to 3]
[go to 3]
[go to 3]
[go to 3]
[go to 3]

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
A mill, factory, workshop or warehouse where yarn,
textiles and clothing were made, packaged or
shipped
None of the above

A.1

A.2

A.2.1

A.2.1.1

A.2.2

A.2.2.1

A.2.3

SECTION A [aDLI]
Did your employer wash clothes on the premises?
Yes
No
DK
Did your employer dry clean on the premises?
Yes
No
DK
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
No
DK
How many hours per week did you do this?
<2
2-9
10 - 19
20 or more
DK
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
No
DK
How many hours per week did you do this?
<2
2-9
10 - 19
20 or more
DK
To dry clean, what chemicals were used? Did you use…? (allow
21

[go to SECTION A]
[go to SECTION B]

[go to SECTION D SECTION J]

[go to A.2.1-A.2.3]

[go to A.2.1.1]

[go to A.2.2.1]

multiple)

A.3

A.3.1

A.3.2

A.4

A.4.1

A.4.1.1

Perchloroethylene (perc) or tetrachloroethylene (tetra)?
Trichloroethylene (TCE)?
Trichloroethane (TCA)?
Carbon tetrachloride?
Stoddard solvent?
Gasoline?
Something else?
DK
Did you ever spot clean fabric items?
Yes
No
DK
About how many items did you spot clean?
15 items/week or less
15 to 100 items/week
more than 100 items/week
DK
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
In this job, did you ever repair or maintain equipment or
property?
Yes
No
DK
Did you ever repair the dry cleaning equipment or maintain the
dry cleaning fluid?
Yes
No
DK
How many hours per week did you do this?
<2
2-9
10 - 19
20 or more
DK
22

[go to A.3.1-A.3.2]

[go to A.4.1-A.4.7]

[go to A.4.1.1]

A.4.2
A.4.3
A.4.4
A.4.5
A.4.6
A.4.7
A.5

[Degrease Mini-Module]
[Paint Mini-Module]
[Strip Mini-Module]
[Glue Mini-Module]
[Board Mini-Module]
[Fuel Mini-Module]
[Hands mini-module]
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
No
DK
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)
Maintenance or Utilities (maintain or repair equipment,
tools, property or utilities)
Quality Control, Environmental Control, Engineering or
Research
Shipping, Receiving or Storage
Administration
DK

C.3.1 Was the leather or leather product from animal hides or skins, or
was the leather synthetic or man-made?
23

[END]

[go to SECTION C]
[go to SECTION B.2.2]
[go to SECTION B.2.3]

[go to C.3.1 - C.3.2]
[go to C.3.3-C.3.8]
[go to C.4]
[go to C.3.9-C.3.12]
[go to C.4]
[go to C.4]

C.3.1.1

C.3.1.1.1

C.3.1.1.1.1

C.3.1.1.2

C.3.1.1.2.1

C.3.1.1.3

C.3.1.1.3.1

Animal hide
Synthetic or man-made
Both
Something else
DK
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
Other
DK
Did you work in the area where the hide or skin was prepared for
tanning ?
Yes
No
DK
How many hours per week did you do work in this area?
<2
2-9
10 - 19
20 or more
DK
Did you work in the area where the hides and skins were tanned?
Yes
No
DK
How many hours per week did you do work in this area?
<2
2-9
10 - 19
20 or more
DK
Did you work in the area where the tanned leather was stuffed or
fat liquored?
Yes
No
DK
Did you apply the chemicals to stuff or fat liquor the leather?
Yes
No
DK

24

[go to C.3.1.1-C.3.1.3]
[go to C.3.1.4-C.3.1.6]
[go to C.3.1.7 - C.3.1.12]
[go to C.4]
[go to C.4]

[go to C.3.1.1.1-C.3.1.1.3]

[go to C.3.1.1.1.1]

[go to C.3.1.1.2.1]

[go to C3.1.1.3.1]

[go to C.3.1.1.3.1.1C.3.1.1.3.1.2]

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
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
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
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
25

[go to C.3.1.2.1]

[go to C.3.1.3.1]

[go to C.3.1.4.1]

C.3.1.5 Did you work in the area where chemicals were heated to make a
leather-like resin or plastic?
Yes
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
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
Other
DK
C.3.1.7.1 Did you work in the area where the hide or skin was prepared for
tanning?
Yes
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
No
26

[go to C.3.1.5.1]

[go to C.3.1.6.1]

[go to C.3.1.7.1-3.1.7.3]

[go to C.3.1.7.1.1]

[go to C.3.1.7.2.1]

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
No
DK
C.3.1.7.3.1 Did you apply the chemicals to stuff or fat liquor the leather?
Yes

C.3.1.7.3.1.1

C.3.1.7.3.1.2

C.3.1.8

C.3.1.8.1

C.3.1.9

No
DK
How many hours per week did you do this?
<2
2-9
10 - 19
20 or more
DK
What chemicals did you use? (allow multiple)
Oils
TCE or trichloroethylene
Perchloroethylene (perc) or tetrachloroethylene (tetra)
Some other chemicals
DK
Did you apply a chemical to the leather?
Yes
No
DK
How many hours per week did you do this?
<2
2-9
10 - 19
20 or more
DK
Did you work in the area where the tanned leather was dried, set
out, stretched and softened?
Yes
No
DK
27

[go to C.3.1.7.3.1]

[go to C.3.1.7.3.1.1C.3.1.7.3.1.2]

[go to C.3.1.8.1]

[go to C.3.1.9.1]

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
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
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
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
No
DK
28

[go to C.3.1.10.1]

[go to C.3.1.11.1]

[go to C.3.1.12.1]

[go to C.3.2.1 - C.3.2.2]

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
No
DK
C.3.2.2.1 How many hours per week did you do this?
<2
2-9
10 - 19
20 or more
DK
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]
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]
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)
Maintenance or Utilities (maintain or repair equipment,
tools, property or utilities)
Quality Control, Environmental Control, Engineering or
Research
Shipping, Receiving or Storage
Administration
DK
B.2.2.1 What was the product made of ? (allow multiple)
Cotton
Wool
Man-made or synthetic
Something else
DK
29

[go to C.3.2.2.1]

[go to C.4]
[go to C.4]
[go to C.4]
[go to C.4]
[go to C.4]

[go to C.4]

[END]

[go to B.2.2.1 - 2.2.8]
[go to B.2.2.9-B.2.2.15]
[go to B.2.2.16-B.2.2.17]
[go to B.2.2.18-B.2.2.22]
[END]
[END]

B.2.2.2 Did you work in the area where scouring or cleaning was done?
Yes
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
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
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
No
DK

30

[go to 2.2.2.1-2.2.2.2]

[go to B.2.2.3.1]

[go to B.2.2.4.1]

[go to B.2.2.5.1-B.2.2.5.2]

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

B.2.2.2.5.1

B.2.2.2.5.2

B.2.2.6

B.2.2.6.1

B.2.2.6.2

No
DK
About how many items did you spot clean?
15 items/week or less
15 to 100 items/week
more than 100 items/week
DK
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
Did you work in the area where fabric was made resistant to
wrinkles, flame, stains, soil, shrinkage, water, moths, mildew, or
something else?
Yes
No
DK
How many hours per week did you do work in this area?
<2
2-9
10 - 19
20 or more
DK
What type of treatment was being done to the fabric? (allow
multiple)
Wrinkle resistance or durable or permanent press
Flame resistance
Stain resistance
31

[go to B.2.2.2.5.1B.2.2.2.5.2]

[go to B.2.2.6.1-B.2.2.6.2]

B.2.2.7

B.2.2.7.1

B.2.2.8
B.2.2.9
B.2.2.10
B.2.2.11
B.2.2.12
B.2.2.13
B.2.2.14
B.2.2.15
B.2.2.16

B.2.2.16.1

B.2.2.17

Soil resistance
Shrink resistance
Water resistance
Moth resistance
Mildew resistance
Other
DK
Did you clean the screens used to transfer color to the fabric?
Yes
No
DK
What chemicals did you use to do this? (allow multiple)
Carbon tetrachloride
Trichloroethylene
Trichloroethane
Chloroform
Perchloroethylene (perc) or tetrachloroethylene (tetra)
Some other chemical
DK
[Hands mini-module]
[Degrease Mini-Module]
[Paint Mini-Module]
[Strip Mini-Module]
[Glue Mini-Module]
[Board Mini-Module]
[Fuel Mini-Module]
[Hands mini-module]
Did you take samples from the process or production line for
testing purposes?
Yes
No
DK
How many hours per week did you do this?
<2
2-9
10 - 19
20 or more
DK
Did you perform chemical or physical tests on process or product
samples?
Yes
No
DK
32

[go to B.2.2.7.1]

[END]

[END]

[go to B.2.2.16.1]

[go to B.2.2.17.1]
[END]
[END]

B.2.2.17.1 How many hours per week did you do this?
<2
2-9
10 - 19
20 or more
DK
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]
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)
Maintenance or Utilities (maintain or repair equipment,
tools, property or utilities)
Quality Control, Environmental Control, Engineering or
Research
Shipping, Receiving or Storage
Administration
DK
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
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
33

[END]
[END]
[END]
[END]
[END]

[END]

[go to B.2.3.1 - B.2.3.8]
[go to B.2.3.9-B.2.3.15]
[go to B.2.3.16-B.2.3.17]
[go to B.2.3.18-B.2.3.22]
[END]
[END]

[go to B.2.3.2.1-B.2.3.2.2]

B.2.3.3 Did you work in the area where dyeing was done?
Yes
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
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
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
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
34

[go to B.2.3.3.1]

[go to B.2.3.4.1]

[go to B.2.3.5.1-B.2.3.5.2]

[go to B.2.3.5.2.1B.2.3.5.2.2]

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
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
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
35

[go to B.2.3.6.1-B.2.3.6.2]

[go to B.2.3.7.1]

B.2.3.8
B.2.3.9
B.2.3.10
B.2.3.11
B.2.3.12
B.2.3.13
B.2.3.14
B.2.3.15
B.2.3.16

B.2.3.16.1

B.2.3.17

B.2.3.17.1

B.2.3.18
B.2.3.19
B.2.3.20
B.2.3.21
B.2.3.22
SECTION D
SECTION E
SECTION F
SECTION G
SECTION H
SECTION I
SECTION J

[Hands mini-module]
[Degrease Mini-Module]
[Paint Mini-Module]
[Strip Mini-Module]
[Glue Mini-Module]
[Board Mini-Module]
[Fuel Mini-Module]
[Hands mini-module]
Did you take samples from the process or production line for
testing purposes?
Yes
No
DK
How many hours per week did you do this?
<2
2-9
10 - 19
20 or more
DK
Did you perform chemical or physical tests on process or product
samples?
Yes
No
DK
How many hours per week did you do this?
<2
2-9
10 - 19
20 or more
DK
[Paint Mini-Module]
[Glue Mini-Module]
[Board Mini-Module]
[Fuel Mini-Module]
[Hands mini-module]
[Degrease Mini-Module]
[Paint Mini-Module]
[Strip Mini-Module]
[Glue Mini-Module]
[Board Mini-Module]
[Fuel Mini-Module]
[Hands mini-module]
36

[END]

[END]

[go to 2.3.16.1]

[go to 2.3.17.1]
[END]
[END]
[END]
[END]
[END]
[END]
[END]

[END]

EMBALMER (EM) MODULE
1 Did you perform or assist with embalmings?
Yes
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]

37

[go to 1.1-1.2]

1

1.1
1.2
1.3
1.4
1.5
1.6
1.7

1.7.1

1.8

1.8.1

1.9
1.1
1.11
1.12

FOUNDRY INDUSTRY (FOI) MODULE
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)
Quality Control, Environmental Control, Engineering or
Research
Shipping, Receiving or Storage
Administration
DK
[Degrease Mini-Module]
[Paint Mini-Module]
[Strip Mini-Module]
[Glue Mini-Module]
[Board Mini-Module]
[Fuel Mini-Module]
Did you take samples from the process or production line for
testing purposes?
Yes
No
DK
How many hours per week did you do this?
<2
2-9
10 - 19
20 or more
DK
Did you perform chemical or physical tests on process or product
samples?
Yes
No
DK
How many hours per week did you do this?
<2
2-9
10 - 19
20 or more
DK
[Paint Mini-Module]
[Glue Mini-Module]
[Board Mini-Module]
[Fuel Mini-Module]
38

[go to 2]
[go to 1.1-1.6]
[go to 1.7-1.8]
[go to 1.9-1.12]
[go to 2]
[go to 2]

[go to 2]

[go to 1.7.1]

[go to 1.8.1]
[go to 2]
[go to 2]
[go to 2]
[go to 2]
[go to 2]
[go to 2]
[go to 2]

[go to 2]

2

2.1

2.1.1

2.1.2

2.1.3

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
No
DK
Did you ever spend time working in the core making area?
Yes
No
DK
How many hours per week did you do this?
<2
2-9
10 - 19
20 or more
DK
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
Did you ever run a muller or other machine to mix sand and
chemicals used to make the core ?
Yes

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
39

[go to 2.1-2.5]
[go to 3]
[go to 3]
[go to 2.1.1-2.1.3]

[go to 2.1.3.1 2.1.3.3]

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
40

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

41

[go to 2.3.1]

[go to 2.4.1]

[go to 2.5.1]

1

1.1

1.2

1.3

1.3.1

1.3.2

1.4

FURNITURE INDUSTRY (FUI) MODULE
What type of furniture did your employer make? (allow multiple)
Plastic furniture?
Wood furniture?
Metal furniture?
Kitchen or bathroom countertops?
Another type of furniture?
DK
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
What type of wood product did you work with? (allow multiple)
Solid wood
Plywood, particleboard, or composite board
Veneered wood
Other wood
DK
Did you work in the chemical mixing area?
Yes
No
DK
How many hours per week did you do work in this area?
<2
2-9
10 - 19
20 or more
DK
What chemicals did you mix? (allow multiple)
Phenol
Formaldehyde
Something else
DK
Did you work in the area where sheets of paper were coated with
chemicals?
Yes
No
DK

42

[go to 1.1]
[go to 1.2]
[go to 2]
[go to 1.3-1.6]
[go to 2]
[go to 2]

[go to 1.3.1-1.3.2]

[go to 1.4.1]

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
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
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
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
43

[go to 1.5.1]

[go to 1.6.1-1.6.2]

[go to 2.1-2.6]

2.2 Did you ever degrease the furniture?

2.2.1

2.2.2

2.3

2.3.1

2.3.2

2.3.3
2.3.4

2.3.4.1

Yes
No
DK
How many hours per week did you do this?
<2
2-9
10 - 19
20 or more
DK
How did you degrease the furniture? (allow multiple)
By hand
Some other way
DK
In this job, did you ever use paint?
Yes
No
DK
How many hours per week did you do this?
<2
2-9
10 - 19
20 or more
DK
What did you usually use to apply the paint? (allow multiple)
Brush
Roller
Electrostatic gun
Spray gun
Dip item into paint
Other
DK
[Vent Mini-module]
Did other workers use paints in the area where you worked?
Yes
No
DK
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
44

[ask 2.2.1-2.2.2]

[go to 2.3.1-2.3.3]

[go to 2.3.4.1]

2.4 [Stain mini-module]
2.5 Did you ever lacquer the furniture?

2.5.1

2.5.2

2.6

2.6.1

3

3.1

Yes
No
DK
How many hours per week did you do this?
<2
2-9
10 - 19
20 or more
DK
How did you usually apply the lacquer? (allow multiple)
Brush
Rag
Spray gun
Electrostatic gun
Roller
Dipping
Other
DK
Did you ever apply wax to the furniture?
Yes
No
DK
How many hours per week did you do this?
<2
2-9
10 - 19
20 or more
DK
Did you ever work in the area where paint, stains, varnishes,
lacquers, or waxes were removed?
Yes
No
DK
How many hours per week did you do work in this area?
<2
2-9
10 - 19
20 or more
DK

45

[go to2.5.1-2.5.2]

[go to 2.6.1]

[go to 3.1-3.2]

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
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
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]

46

[go to 4.1-4.2]

[go to 6.1-6.3]

1

A.1

A.1.1

A.1.1.1

A.1.1.1.1

A.1.1.1.2

A.1.1.1.3

A.1.1.2

GENERAL FARMING - FOOD INDUSTRY MODULE (LONG)
In this job, what best describes your work location? (allow
multiple)
A farm where crops were grown or livestock were raised
A factory, warehouse, or processing center where food
products were processed or packaged
A restaurant or other food service location where food
was prepared or sold
None of the above
SECTION A [aGF]
On the farms you worked, were crops raised to sell or to feed
animals?
Yes
No
DK
In this job, did you ever apply any type of chemicals to kill weeds,
bugs, fungus or molds, or rodents such as rats?
Yes
No
DK
Did you apply herbicides or weed killers?
Yes
No
DK
On average, how many times a year did you apply herbicides or
weed killers?
[number 0-1000]
DK
Each time you did this, how many hours did it take?
[number 0-24]
DK
Did you add kerosene, diesel fuel, Stoddard solvent or oil to the
weed killers or herbicides that you mixed?
Yes
No
DK
Did you apply insecticides or bug killers?
Yes
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
47

[go to SECTION A]
[go to SECTION B]

[go to SECTION C SECTION I]

[go to A.1.1-A.1.4]

[go to A.1.1.1-A.1.1.5]

[go to A.1.1.1.1-A.1.1.1.3]

[go to A.1.1.2.1-A.1.1.2.3]

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
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
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
No
DK
A.1.1.5.1 On average, how many times a year did you apply rodenticides?
[number 0-1000]
48

[go to A.1.1.3.1-A.1.1.3.3]

[go to A.1.1.4.1-A.1.1.4.3]

[go to A.1.1.5.1-A.1.1.5.3]

A.1.1.5.2

A.1.1.5.3

A.1.1.6

A.1.1.6.1

A.1.1.7

A.1.1.8

A.1.1.9

A.1.2

DK
Each time you did this, how many hours did it take?
[number 0-24]
DK
Did you add kerosene, diesel fuel, Stoddard solvent or oil to the
rodenticides that you mixed?
Yes
No
DK
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
No
DK
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
Were your hands ever immersed in a solvent, a solvent-based
product, or fuel?
Yes
No
DK
Did you wear gloves while using solvents or solvent-based
products?
Yes
No
Not applicable - did not use
solvents
DK
Did you clean your hands with a solvent, a solvent-based product
or with fuel, such as gasoline?
Yes
No
DK
Did you apply a disinfectant or preservative to the crop? I don't
mean a chemical used to kill weeds or bugs.
Yes
No
DK
49

[go to A.1.1.6.1]

[go to A.1.2.1-A.1.2.3]

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
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
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
50

[go to A.1.3.1-A.1.3.3]

[go to A.1.4.1-A.1.4.4]

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
No
DK
A.2.1 Were the animals ever housed in a building?
Yes
No
DK
A.2.1.1 Did you or anyone else ever fumigate the area where the animals
were housed?
Yes
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
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
No
DK

51

[go to A.2.1]

[go to A.2.1.1]

[go to A.2.1.1.1]

[go to A.3.1-A.3.3]

[go to A.3.2.1-A.3.2.5]

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
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
52

[go to A.3.2.6.1]

A.3.3

A.3.3.1

A.4

A.5

A.6

B.1

B.1.1

20 or more
DK
In this job, did you ever handle or pump fuel?
Yes
No
DK
How many hours per week did you do this?
<2
2-9
10 - 19
20 or more
DK
Were your hands ever immersed in a solvent, a solvent-based
product, or fuel?
Yes
No
DK
Did you wear gloves while using solvents or solvent-based
products?
Yes
No
Not applicable - did not use
solvents
DK
Did you clean your hands with a solvent, a solvent-based product
or with fuel, such as gasoline?
Yes
No
DK
SECTION B [aFDI]
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)
Quality Control, Environmental Control, Engineering or
Research
Shipping, Receiving or Storage
Administration
DK
In this job, did you ever clean or degrease metal or plastic parts
with chemicals?
Yes
No
DK
53

[go to A.3.3.1]

[go to B.1.1-B.1.6]

[go to B.1.7-B.1.10]

[go to B.1.1.1-B.1.1.5]

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

54

B.1.1.6 Did other workers clean or degrease parts in the area where you
worked?
Yes
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
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
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
55

[go to B.1.1.6.1]

[go to B.1.2.1-B.1.2.5]

[go to B.1.2.3.1-B.1.2.3.2]

B.1.2.3.3 Did you paint in a production area of a manufacturing plant?
Yes
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
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
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
No
DK
B.1.3.1 How many hours per week did you do this?
<2
2-9
10 - 19
20 or more
DK

56

[go to B.1.2.3.3.1]

[go to B.1.2.4.1]

[go to B.1.2.5.1]

[go to B.1.3.1-B.1.3.2]

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
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
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
57

[go to B.1.3.3.1]

[go to B.1.4.1-B.1.4.8]

B.1.4.4 Did you use water-based glues or adhesives, for example, vinyl or
acrylic resins?
Yes
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
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
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
No
DK
B.1.4.7.1 How many hours per week did you do this?
<2
2-9
10 - 19
58

[go to B.1.4.4.1]

[ go to B.1.4.5.1]

[go to B.1.4.6.1]

[go to B.1.4.7.1]

B.1.4.8

B.1.4.8.1

B.1.4.9

B.1.4.9.1

B.1.5

B.1.5.1

B.1.5.2

20 or more
DK
Did you use urea, phenol or melamine-based glues or adhesives?
Yes
No
DK
How many hours per week did you do this?
<2
2-9
10 - 19
20 or more
DK
Did other workers use glues or adhesives in the area where you
worked?
Yes
No
DK
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
In this job, did you ever handle or use particle board, plywood, or
veneered wood?
Yes
No
DK
How many hours per week did you do this?
<2
2-9
10 - 19
20 or more
DK
Did other workers work with particle board, plywood, or
veneered wood in the area where you worked?
Yes
No
DK

59

[go to B.1.4.8.1]

[ask B.1.4.9.1]

[go to B.1.5.1]

[go to B.1.5.2.1]

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
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
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
No
DK

60

[go to B.1.6.1]

[go to B.1.7.1-B.1.7.4]

[go to B.1.7.3.1-B.1.7.3.2]

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
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
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
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
61

[go to B.1.7.3.3.1]

[go to B.1.7.1.4.1]

[go to B.1.7.5.1]

B.1.8 In this job, did you ever use glues or adhesives?
Yes
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
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
No
DK

62

[go to B.1.8.1-B.1.8.8]

[go to B.1.8.4.1]

[ go to B.1.8.5.1]

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
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
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
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

63

[go to B.1.8.6.1]

[go to B.1.8.7.1]

[go to B.1.8.8.1]

B.1.8.9 Did other workers use glues or adhesives in the area where you
worked?
Yes
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
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
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
No
DK

64

[ask B.1.8.9.1]

[go to B.1.9.1]

[go to B.1.9.2.1]

[go to B.1.10.1]

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
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
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
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
65

[go to B.2.1]

[go to B.3.1]

[go to B.4.1]

B.6

B.7

C.1

C.1.1

C.1.2

C.1.3

Did you wear gloves while using solvents or solvent-based
products?
Yes
No
Not applicable - did not use
solvents
DK
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]
In this job, did you ever clean or degrease metal or plastic parts
with chemicals?
Yes
No
DK
How many hours per week did you do this?
<2
2-9
10 - 19
20 or more
DK
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
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

66

[go to C.1.1-C.1.5]

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
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
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
67

[go to C.2.1]

[go to D.1.1-D.1.5]

D.1.3

D.1.3.1

D.1.3.2

D.1.3.3

D.1.3.3.1

D.1.4

D.1.4.1

D.2

Spray gun
Dip item into paint
Other
DK
Did you paint indoors or inside a ship?
Yes
No
DK
How many hours per week did you do this?
<2
2-9
10 - 19
20 or more
DK
Was there a local exhaust system to remove the dust, fumes or
vapors that was produced?
Yes
No
DK
Did you paint in a production area of a manufacturing plant?
Yes
No
DK
How many hours per week did you do this?
<2
2-9
10 - 19
20 or more
DK
Did you paint outdoors?
Yes
No
DK
How many hours per week did you do this?
<2
2-9
10 - 19
20 or more
DK
Did other workers use paints in the area where you worked?
Yes
No
DK
68

[go to D.1.3.1-D.1.3.2]

[go to D.1.3.3.1]

[go to D.1.4.1]

[go to D.2.1]

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
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
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
No
DK
69

[go to E.1.1-E.1.3]

[go to E.2.1]

[go to F.1.1-F.1.8]

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
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
No
DK
F.1.5.1 How many hours per week did you do this?
<2
2-9
10 - 19
20 or more
DK

70

[go to F.1.4.1]

[ go to F.1.5.1]

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
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
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
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
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
71

[go to F.1.6.1]

[go to F.1.7.1]

[go to F.1.8.1]

[ask F.2.1]

20 or more
DK
G.1

G.1.1

G.2

G.2.1

H.1

H.1.1

I.1

SECTION G [Board Mini-Module]
In this job, did you ever handle or use particle board, plywood, or
veneered wood?
Yes
No
DK
How many hours per week did you do this?
<2
2-9
10 - 19
20 or more
DK
Did other workers work with particle board, plywood, or
veneered wood in the area where you worked?
Yes
No
DK
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]
In this job, did you ever handle or pump fuel?
Yes
No
DK
How many hours per week did you do this?
<2
2-9
10 - 19
20 or more
DK
SECTION I [Hands mini-module]
Were your hands ever immersed in a solvent, a solvent-based
product, or fuel?
Yes
No
DK
72

[go to G.1.1]

[go to G.2.1]

[go to H.1.1]

I.2

I.3

Did you wear gloves while using solvents or solvent-based
products?
Yes
No
Not applicable - did not use
solvents
DK
Did you clean your hands with a solvent, a solvent-based product
or with fuel, such as gasoline?
Yes
No
DK

73

1

1.1
1.2
1.3
1.4
1.5
1.6
1.7

1.7.1

1.8

1.8.1

1.9
1.10
1.11
1.12
2

INDUSTRY SOLVENT (INSOL) MODULE
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)
Quality Control, Environmental Control, Engineering or
Research
Shipping, Receiving or Storage
Administration
DK
[Degrease Mini-Module]
[Paint Mini-Module]
[Strip Mini-Module]
[Glue Mini-Module]
[ Board Mini-Module]
[Fuel Mini-Module]
Did you take samples from the process or production line for
testing purposes?
Yes
No
DK
How many hours per week did you do this?
<2
2-9
10 - 19
20 or more
DK
Did you perform chemical or physical tests on process or product
samples?
Yes
No
DK
How many hours per week did you do this?
<2
2-9
10 - 19
20 or more
DK
[Paint Mini-Module]
[Glue Mini-Module]
[Board Mini-Module]
[Fuel Mini-Module]
[Hands mini-module]
74

[go to 2]
[go to 1.1-1.6]
[go to 1.7-1.8]
[go to 1.9-1.12]
[go to 2]
[go to 2]

[go to 2]

[go to 1.7.1]

[go to 1.8.1]
[go to 2]
[go to 2]
[go to 2]
[go to 2]
[go to 2]
[go to 2]
[go to 2]

1

2

3

3.1

3.1.1

3.1.1.1

3.1.1.1.1

LEATHER INDUSTRY (LEI) MODULE
Did your employer make leather, make a leather product, or do
both?
Make leather
Make leather product
Both
DK
What color was the leather? (allow multiple)
Brown
Pale cream or white
Other
DK
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)
Quality Control, Environmental Control, Engineering or
Research
Shipping, Receiving or Storage
Administration
DK
Was the leather or leather product from animal hides or skins, or
was the leather synthetic or man-made?
Animal hide
Synthetic or man-made
Both
Something else
DK
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
Other
DK
Did you work in the area where the hide or skin was prepared for
tanning ?
Yes
No
DK
How many hours per week did you do work in this area?
<2
2-9
75

[go to 3.1 - 3.2]
[go to 3.3-3.8]
[go to 4]
[go to 3.9-3.12]
[go to 4]
[go to 4]

[go to 3.1.1-3.1.3]
[go to 3.1.4-3.1.6]
[go to 3.1.7 - 3.1.12]
[go to 4]
[go to 4]

[go to 3.1.1.1-3.1.1.3]

[go to 3.1.1.1.1]

3.1.1.2

3.1.1.2.1

3.1.1.3

3.1.1.3.1

3.1.1.3.1.1

3.1.1.3.1.2

3.1.2

3.1.2.1

10 - 19
20 or more
DK
Did you work in the area where the hides and skins were tanned?
Yes
[go to 3.1.1.2.1]
No
DK
How many hours per week did you do work in this area?
<2
2-9
10 - 19
20 or more
DK
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
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
How many hours per week did you do this?
<2
2-9
10 - 19
20 or more
DK
What chemicals did you use? (allow multiple)
Oils
TCE or trichloroethylene
Perchloroethylene (perc) or tetrachloroethylene (tetra)
Some other chemicals
DK
Did you apply a chemical to the leather?
Yes
[go to 3.1.2.1]
No
DK
How many hours per week did you do this?
<2
2-9
10 - 19
20 or more
DK
76

3.1.3 Did you work in the area where the tanned leather was dried, set
out, stretched and softened?
Yes
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
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
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
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
77

[go to 3.1.3.1]

[go to 3.1.4.1]

[go to 3.1.5.1]

[go to 3.1.6.1]

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
Other
DK
3.1.7.1 Did you work in the area where the hide or skin was prepared for
tanning?
Yes
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
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
No
DK
3.1.7.3.1 Did you apply the chemicals to stuff or fat liquor the leather?
Yes
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
78

[go to 3.1.7.1-3.1.7.3]

[go to 3.1.1.7.1]

[go to 3.1.7.2.1]

[go to 3.1.7.3.1]

[go to 3.1.7.3.1.13.1.7.3.1.2]

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
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
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
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
No
DK
79

[go to 3.1.8.1]

[go to 3.1.9.1]

[go to 3.1.10.1]

[go to 3.1.11.1]

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
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
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
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]
80

[go to 3.1.12.1]

[go to 3.2.1 - 3.2.2]

[go to 3.2.2.1]

3.8
3.9
3.10
3.11
3.12
4

[Fuel Mini-Module]
[Paint Mini-Module]
[Glue Mini-Module]
[Board Mini-Module]
[Fuel Mini-Module]
[Hands mini-module]

81

1

1.1

1.1.1

1.1.2

1.1.3

1.2

1.2.1

LUMBER INDUSTRY (LUI) MODULE
What did the employer do? (allow multiple)
Cut trees
Cut up logs in a sawmill
Make plywood, particle board, or other type of composite
board
Make veneered wood
Make cork
Something else
DK
In the factory where plywood, particle board or other type of
composite board were made, did you operate a machine?
Yes
No
DK
How many hours per week did you do this?
<2
2-9
10 - 19
20 or more
DK
What did the machine do?
Saw
Coat or treat with chemicals
Heat press
Something else
DK
Did the machine have direct ventilation that removed the dust,
fumes, or vapors from your area?
Yes
No
DK
In the factory where veneered wood was made, did you operate
a machine?
Yes
No
DK
How many hours per week did you do this?
<2
2-9
10 - 19
20 or more
DK
82

[go to 2]
[go to 2]
[go to 1.1]
[go to 1.2]
[go to 2]
[go to 2]
[go to 2]

[go to 1.1.1-1.1.3]

[go to 1.2.1-1.2.3]

1.2.2 What did the machine do?

1.2.3

2

2.1
2.2
2.3
2.4
2.5
2.6
3

Saw
Coat or treat with chemicals
Heat press
Something else
DK
Did the machine have direct ventilation that removed the dust,
fumes, or vapors from your area?
Yes
No
DK
In this job, did you ever repair or maintain equipment or
property??
Yes
No
DK
[Degrease Mini-Module]
[Paint Mini-Module]
[Stain Mini-Module]
[Strip Mini-Module]
[Glue Mini-Module]
[Fuel Mini-Module]
[Hands mini-module]

83

[go to 2.1-2.6]
[go to 3]
[go to 3]

1

1.1
1.2
1.3
1.4
1.5
1.6
1.7

1.7.1

1.8

1.8.1

1.9
1.10
1.11
1.12

OIL REFINING INDUSTRY (ORI)
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)
Quality Control, Environmental Control, Engineering or
Research
Shipping, Receiving or Storage
Administration
DK
[Degrease Mini-Module]
[Paint Mini-Module]
[Strip Mini-Module]
[Glue Mini-Module]
[Board Mini-Module]
[Fuel Mini-Module]
Did you take samples from the process or production line for
testing purposes?
Yes
No
DK
How many hours per week did you do this?
<2
2-9
10 - 19
20 or more
DK
Did you perform chemical or physical tests on process or product
samples?
Yes
No
DK
How many hours per week did you do this?
<2
2-9
10 - 19
20 or more
DK
[Paint Mini-Module]
[Glue Mini-Module]
[Board Mini-Module]
[Fuel Mini-Module]
84

[go to 2]
[go to 1.1-1.6]
[go to 1.7-1.8]
[go to 1.9-1.12]
[go to 2]
[go to 2]

[go to 2]

[go to 1.7.1]

[go to 1.8.1]
[go to 2]
[go to 2]
[go to 2]
[go to 2]
[go to 2]
[go to 2]
[go to 2]

2

2.1

3

3.1

4

4.1

5

5.1

Did you work in FRACTIONATION? (This is where the crude oil is
processed to remove water, organic salts, and sulfur)
Yes
No
DK
How many hours per week did you do work in this area?
<2
2-9
10 - 19
20 or more
DK
Did you work in CRACKING? (This is where cracking occurs)
Yes
No
DK
How many hours per week did you do work in this area?
<2
2-9
10 - 19
20 or more
DK
Did you work in COKING? (very heavy residual oils formed into
gasoline and diesel fuel, leaving petroleum coke as a residual
product)
Yes
No
DK
How many hours per week did you do work in this area?
<2
2-9
10 - 19
20 or more
DK
Did you work in LIQUID FUEL BLENDING? (This is where fuels are
blended)
Yes
No
DK
How many hours per week did you do work in this area?
<2
2-9
10 - 19
20 or more
DK
85

[go to 2.1]

[go to 3.1]

[go to 4.1]

[go to 5.1]

6

6.1

7

7.1

8

8.1

9

Did you work in an area where benzene or benzole was
produced?
Yes
No
DK
How many hours per week did you do work in this area?
<2
2-9
10 - 19
20 or more
DK
Did you work in the TANK FARM? (This is where the products are
stored)
Yes
No
DK
How many hours per week did you do work in this area?
<2
2-9
10 - 19
20 or more
DK
Did you work in LOADING? (This is where barges, trains, trucks
were loaded)
Yes
No
DK
How many hours per week did you do work in this area?
<2
2-9
10 - 19
20 or more
DK
[Hands mini-module]

86

[go to 6.1]

[go to 7.1]

[go to 8.1]

1

1.1

1.1.1

1.1.2

1.1.3

1.2

1.2.1

1.2.2

1.2.3

1.3

PESTICIDE (PE) MODULE
In this job, did you ever apply any type of chemicals to kill weeds,
bugs, fungus or molds, or rodents such as rats?
Yes
No
DK
Did you apply herbicides or weed killers?
Yes
No
DK
On average, how many times a year did you apply herbicides or
weed killers?
[number 0-1000]
DK
Each time you did this, how many hours did it take?
[number 0-24]
DK
Did you add kerosene, diesel fuel, Stoddard solvent or oil to the
weed killers or herbicides that you mixed?
Yes
No
DK
Did you apply insecticides or bug killers?
Yes
No
DK
On average, how many times a year did you apply insecticides or
bug killers?
[number 0-1000]
DK
Each time you did this, how many hours did it take?
[number 0-24]
DK
Did you add kerosene, diesel fuel, Stoddard solvent or oil to the
insecticides or bug killers that you mixed?
Yes
No
DK
Did you apply fumigants?
Yes
No
DK

87

[go to 1.1-1.5]
[go to 1.6]
[go to 2]
[go to 1.1.1-1.1.3]

[go to 1.2.1-1.2.3]

[go to 1.3.1-1.3.3]

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
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
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

88

[go to 1.4.1-1.4.3]

[go to 1.5.1-1.5.3]

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
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 ]

89

[go to 1.6.1]

1

1.1

1.1.1
1.1.2
1.1.3
1.1.4
1.1.5
1.1.6
1.1.7

1.1.7.1

1.1.8

1.1.8.1

PHOTOGRAPHIC INDUSTRY (PHI) MODULE
Did your employer make photographic film?
Yes
No
DK
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)
Quality Control, Environmental Control, Engineering or
Research
Shipping, Receiving or Storage
Administration
DK
[Degrease Mini-Module]
[Paint Mini-Module]
[Strip Mini-Module]
[Glue Mini-Module]
[Board Mini-Module]
[Fuel Mini-Module]
Did you take samples from the process or production line for
testing purposes?
Yes
No
DK
How many hours per week did you do this?
<2
2-9
10 - 19
20 or more
DK
Did you perform chemical or physical tests on process or product
samples?
Yes
No
DK
How many hours per week did you do this?
<2
2-9
10 - 19
20 or more
DK

90

[go to 1.1-1.4]
[go to 2]
[go to 2]
[go to 1.2]
[go to 1.1.1-1.1.6]
[go to 1.1.7-1.1.8]
[go to 1.1.9-1.1.12]
[go to 1.2]
[go to 1.2]

[go to 1.2]

[go to 1.1.7.1]

[go to 1.1.8.1]
[go to 1.2]
[go to 1.2]
[go to 1.2]
[go to 1.2]
[go to 1.2]
[go to 1.2]
[go to 1.2]

1.1.9
1.1.10
1.1.11
1.1.12
1.2

1.2.1

1.3

1.3.1

1.4

1.4.1

2

2.1

[Paint Mini-Module]
[Glue Mini-Module]
[Board Mini-Module]
[Fuel Mini-Module]
Did you work in the area where the film was made from
chemicals?
Yes
No
DK
How many hours per week did you do work in this area?
<2
2-9
10 - 19
20 or more
DK
Did you work in the drying area?
Yes
No
DK
How many hours per week did you do work in this area?
<2
2-9
10 - 19
20 or more
DK
Did you work in the area where the film was rolled onto a
canister?
Yes
No
DK
How many hours per week did you do work in this area?
<2
2-9
10 - 19
20 or more
DK
Did your employer develop photographic film?
Yes
No
DK
Did you develop the film?
Yes
No
DK
91

[go to 1.2.1]

[go to 1.3.1]

[go to 1.4.1]

[go to 2.1]

[go to 2.1.1]

2.1.1 Did you use formaldehyde during the processing of the film?
Yes
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]

92

[go to 2.1.1.1]

1

1.1
1.2
1.3
1.4
1.5
1.6
1.7

1.7.1

1.8

1.8.1

1.9
1.10
1.11
1.12

PLASTICS INDUSTRY (PLI) MODULE
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)
Quality Control, Environmental Control, Engineering or
Research
Shipping, Receiving or Storage
Administration
DK
[Degrease Mini-Module]
[Paint Mini-Module]
[Strip Mini-Module]
[Glue Mini-Module]
[Board Mini-Module]
[Fuel Mini-Module]
Did you take samples from the process or production line for
testing purposes?
Yes
No
DK
How many hours per week did you do this?
<2
2-9
10 - 19
20 or more
DK
Did you perform chemical or physical tests on process or product
samples?
Yes
No
DK
How many hours per week did you do this?
<2
2-9
10 - 19
20 or more
DK
[Paint Mini-Module]
[Glue Mini-Module]
[Board Mini-Module]
[Fuel Mini-Module]
93

[go to 2]
[go to 1.1-1.6]
[go to 1.7-1.8]
[go to 1.9-1.12]
[go to 2]
[go to 2]

[go to 2]

[go to 1.7.1]

[go to 1.8.1]
[go to 2]
[go to 2]
[go to 2]
[go to 2]
[go to 2]
[go to 2]
[go to 2]

2

3

3.1

4

4.1

5

5.1

6

What type of plastics were being made by your employer? (allow
multiple)
polystyrene
phenol-formaldehyde
polypropylene
urea-formaldehyde
polyester
melamine
Something else
DK
Did you work in the area where the plastic was being formed,
either by a mold machine or a press?
Yes
No
DK
How many hours per week did you do work in this area?
<2
2-9
10 - 19
20 or more
DK
Did you work in the finishing or packing area?
Yes
No
DK
How many hours per week did you do work in this area?
<2
2-9
10 - 19
20 or more
DK
Did you work in some other area?
Yes
No
DK
How many hours per week did you do work in this area?
<2
2-9
10 - 19
20 or more
DK
[Hands mini-module]

94

[go to 3.1]

[go to 4.1]

[go to 5.1]

1

1.1
1.2
1.3
1.4
1.5
1.6
1.7

1.7.1

1.8

1.8.1

1.9
1.10
1.11
1.12

PULP AND PAPER INDUSTRY (PPI) MODULE
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)
Quality Control, Environmental Control, Engineering or
Research
Shipping, Receiving or Storage
Administration
DK
[Degrease Mini-Module]
[Paint Mini-Module]
[Strip Mini-Module]
[Glue Mini-Module]
[Board Mini-Module]
[Fuel Mini-Module]
Did you take samples from the process or production line for
testing purposes?
Yes
No
DK
How many hours per week did you do this?
<2
2-9
10 - 19
20 or more
DK
Did you perform chemical or physical tests on process or product
samples?
Yes
No
DK
How many hours per week did you do this?
<2
2-9
10 - 19
20 or more
DK
[Paint Mini-Module]
[Glue Mini-Module]
[Board Mini-Module]
[Fuel Mini-Module]
95

[go to 2]
[go to 1.1-1.6]
[go to 1.7-1.8]
[1.9-1.12]
[go to 2]
[go to 2]

[go to 2]

[go to 1.7.1]

[go to 1.8.1]
[go to 2]
[go to 2]
[go to 2]
[go to 2]
[go to 2]
[go to 2]
[go to 2]

2

2.1

2.1.1

2.1.1.1

2.2

2.2.1

2.3

2.3.1

2.4

Did you work in a paper mill?
Yes
No
DK
Did you work in an area where recycled paper was prepared for
the papermaking process?
Yes
No
DK
Did you remove ink from waste paper?
Yes
No
DK
How many hours per week did you do this?
<2
2-9
10 - 19
20 or more
DK
Did you work in the area where the paper machine was located?
Yes
No
DK
How many hours per week did you do work in this area?
<2
2-9
10 - 19
20 or more
DK
Did you work in the drying area?
Yes
No
DK
How many hours per week did you do work in this area?
<2
2-9
10 - 19
20 or more
DK
Did you work in the coating area?
Yes
No
DK
96

[go to 2.1-2.4]

[go to 2.1.1]

[go to 2.1.1.1]

[go to 2.2.1]

[go to 2.3.1]

[go to 2.4.1]

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
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]

97

[go to 3.1]

1

1.1
1.2
1.3
1.4
1.5
1.6
1.7
1.8
1.9
1.10
2

2.1

2.2

2.2.1

PRINTING INDUSTRY (PRI) MODULE
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)
Quality Control, Environmental Control, Engineering or
Research
Shipping, Receiving or Storage
Administration
DK
[Degrease Mini-Module]
[Paint Mini-Module]
[Strip Mini-Module]
[Glue Mini-Module]
[Board Mini-Module]
[Fuel Mini-Module]
[Paint Mini-Module]
[Glue Mini-Module]
[Board Mini-Module]
[Fuel Mini-Module]
Did you ever work in the plate making, plate engraving, or screen
preparation area?
Yes
No
DK
How many hours per week did you do work in this area?
<2
2-9
10 - 19
20 or more
DK
Did you clean the printing plates?
Yes
No
DK
How many hours per week did you do this?
<2
2-9
10 - 19
20 or more
DK

98

[go to 2]
[go to 1.1-1.6]

[go to 1.7-1.10]
[go to 2]
[go to 2]

[go to 2]

[go to 2.1-2.3]

[go to 2.2.1]

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
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
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
No
DK
99

[go to 2.3.1-2.3.2]

[go to 3.1-3.2]

[go to 3.2.1-3.2.2]

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
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
No
DK
4.2.1 Did you wash or clean the plates or presses?
Yes
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
100

[go to 4.1-4.2]

[go to 4.2.1]

[go to 4.2.1.1-4.2.1.2]

5

5.1

5.2
6

6.1

6.2

6.2.1

7

Did you ever work in the area where the ink was cured or the
printing material was dried?
Yes
No
DK
How many hours per week did you do work in this area?
<2
2-9
10 - 19
20 or more
DK
[Vent Mini-module]
Did you ever work in the bookbinding area or an area where
paper was folded, trimmed, glued, stapled, or stitched?
Yes
No
DK
How many hours per week did you do work in this area?
<2
2-9
10 - 19
20 or more
DK
Did you run the gluing machine?
Yes
No
DK
How many hours per week did you do this?
<2
2-9
10 - 19
20 or more
DK
[Hands mini-module]

101

[go to 5.1-5.2]

[go to 6.1-6.2]

[go to 6.2.1]

1

1.1
1.2
1.3
1.4
1.5
1.6

1.6.1

1.7

1.7.1

1.8
1.9
1.10

RUBBER INDUSTRY (RUI)
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)
Quality Control, Environmental Control, Engineering or
Research
Shipping, Receiving or Storage
Administration
DK
[Degrease Mini-Module]
[Paint Mini-Module]
[Strip Mini-Module]
[Board Mini-Module]
[Fuel Mini-Module]
Did you take samples from the process or production line for
testing purposes?
Yes
No
DK
How many hours per week did you do this?
<2
2-9
10 - 19
20 or more
DK
Did you perform chemical or physical tests on process or product
samples?
Yes
No
DK
How many hours per week did you do this?
<2
2-9
10 - 19
20 or more
DK
[Paint Mini-Module]
[Board Mini-Module]
[Fuel Mini-Module]

102

[go to 2]
[go to 1.1-1.5]
[go to 1.6-1.7]
[go to 1.8-1.10]
[go to 2]
[go to 2]

[go to 2]

[go to 1.6.1]

[go to 1.7.1]
[go to 2]
[go to 2]
[go to 2]
[go to 2]
[go to 2]
[go to 2]
[go to 2]

2

2.1

3

3.1

3.2

3.3

3.3.1
4

4.1

Did you work in the weighing area?
Yes
No
DK
How many hours per week did you do work in this area?
<2
2-9
10 - 19
20 or more
DK
Did you work in the modeling area. (This is the area where rubber
parts are glued or cemented together)?
Yes
No
DK
How many hours per week did you do work in this area?
<2
2-9
10 - 19
20 or more
DK
Did you make rubber cement by mixing rubber and solvents or
gasoline together?
Yes
No
DK
Did you glue rubber and metal together to make rubber-to-metal
bonds?
Yes
No
DK
[Degrease mini-module]
Did you work in the curing area?
Yes
No
DK
How many hours per week did you do work in this area?
<2
2-9
10 - 19
20 or more
DK

103

[go to 2.1]

[go to 3.1 - 3.3]

[go to 3.3.1]

[go to 4.1]

5

Did you work in the finishing/ repair area?
Yes
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]

104

[ask 5.1 - 5.2]

1

1.1

1.2

1.3

1.3.1

1.3.2

SHOE MANUFACTURING INDUSTRY (SHI) (LONG)
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)
Quality Control, Environmental Control, Engineering or
Research
Shipping, Receiving or Storage
Administration
DK
What type of shoes did you make? (allow multiple)
Leather shoes
Textile shoes
Rubber/plastic shoes or boots
Other
DK
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
In this job, did you ever clean or degrease metal or plastic parts
with chemicals?
Yes
No
DK
How many hours per week did you do this?
<2
2-9
10 - 19
20 or more
DK
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
105

[go to 1.1 - 1.2]
[go to 1.3-1.7]

[go to 1.8-1.10]
[go to 2]
[go to 2]

[go to 1.3.1-1.3.5]

1.3.3

1.3.4

1.3.5

1.3.6

1.3.6.1

1.4

1.4.1

Paint thinner
Any other solvent
Any other degreaser
DK
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
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
Was there a local exhaust system to remove the dust, fumes or
vapors that was produced?
Yes
No
DK
Did other workers clean or degrease parts in the area where you
worked?
Yes
No
DK
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
In this job, did you ever use paint?
Yes
No
DK
How many hours per week did you do this?
<2
2-9
106

[go to 1.3.6.1]

[go to 1.4.1-1.4.5]

1.4.2

1.4.3

1.4.3.1

1.4.3.2

1.4.3.3

1.4.3.3.1

1.4.4

1.4.4.1

10 - 19
20 or more
DK
What did you usually use to apply the paint? (allow multiple)
Brush
Roller
Electrostatic gun
Spray gun
Dip item into paint
Other
DK
Did you paint indoors or inside a ship?
Yes
No
DK
How many hours per week did you do this?
<2
2-9
10 - 19
20 or more
DK
Was there a local exhaust system to remove the dust, fumes or
vapors that was produced?
Yes
No
DK
Did you paint in a production area of a manufacturing plant?
Yes
No
DK
How many hours per week did you do this?
<2
2-9
10 - 19
20 or more
DK
Did you paint outdoors?
Yes
No
DK
How many hours per week did you do this?
<2
2-9
10 - 19
20 or more
DK
107

[go to 1.3.1-1.3.2]

[go to 1.4.3.3.1]

[go to 1.4.4.1]

1.4.5 Did other workers use paints in the area where you worked?
Yes
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,
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
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
No
DK
108

[go to 1.4.5.1]

[go to 1.5.1-1.5.3]

[go to 1.5.3.1]

[go to 1.6.1]

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,
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
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
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
109

[go to 1.6.2.1]

[go to 1.7.1]

[go to 1.8.1-1.8.5]

Dip item into paint
Other
DK
1.8.3 Did you paint indoors or inside a ship?
Yes

1.8.3.1

1.8.3.2

1.8.3.3

1.8.3.3.1

1.8.4

1.8.4.1

1.8.5

No
DK
How many hours per week did you do this?
<2
2-9
10 - 19
20 or more
DK
Was there a local exhaust system to remove the dust, fumes or
vapors that was produced?
Yes
No
DK
Did you paint in a production area of a manufacturing plant?
Yes
No
DK
How many hours per week did you do this?
<2
2-9
10 - 19
20 or more
DK
Did you paint outdoors?
Yes
No
DK
How many hours per week did you do this?
<2
2-9
10 - 19
20 or more
DK
Did other workers use paints in the area where you worked?
Yes
No
DK
110

[go to 1.8.3.11.8.3.2]

[go to 1.8.3.3.1]

[go to 1.8.4.1]

[go to 1.8.5.1]

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
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,
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
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,
No
DK
111

[go to 1.9.1]

[go to 1.9.2.1]

[go to 1.10.1]

[go to 2.1-2.3]

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,
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
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
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
112

[go to 2.2.1]

[go to 2.3.1]

[go to 3.1]

5

6

Did you wear gloves while using solvents or solvent-based
products?
Yes
No
Not applicable - did not use
solvents
DK
Did you clean your hands with a solvent, a solvent-based product
or with fuel, such as gasoline?
Yes
No
DK

113

1

1.1

1.2

1.3

1.4

1.5

Solvent (SOL) (LONG)
In this job, did you ever clean or degrease metal or plastic parts
with chemicals?
Yes
No
DK
How many hours per week did you do this?
<2
2-9
10 - 19
20 or more
DK
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
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
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
Was there a local exhaust system to remove the dust, fumes or
vapors that was produced?
Yes
No
DK

114

[go to 1.1-1.5]

1.6 Did other workers clean or degrease parts in the area where you
worked?
Yes
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
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
No
DK
2.3.1 How many hours per week did you do this?
<2
2-9
10 - 19
20 or more
DK

115

[go to 1.6.1]

[go to 2.1-2.5]

[go to 2.3.1-2.3.2]

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
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
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
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
No
DK

116

[go to 2.3.3.1]

[go to 2.4.1]

[go to 2.5.1]

[go to 3.1-3.3]

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
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,
No
DK
4.1 How many hours per week did you do this?
<2
2-9
10 - 19
20 or more
DK

117

[go to 3.4.1]

[go to 4.1-4.3]

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
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,
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
118

[go to 4.3.1]

[go to 5.1-5.8]

acrylic resins?

5.4.1

5.5

5.5.1

5.6

5.6.1

5.7

5.7.1

Yes
No
DK
How many hours per week did you do this?
<2
2-9
10 - 19
20 or more
DK
Did you use glues or adhesives that you heated with a gun or
other heated device?
Yes,
No
DK
How many hours per week did you do this?
<2
2-9
10 - 19
20 or more
DK
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
DK
How many hours per week did you do this?
<2
2-9
10 - 19
20 or more
DK
Did you use glues or adhesives that require mixing two parts of
the glue together before applying? (epoxy resins)
Yes
No
DK
How many hours per week did you do this?
<2
2-9
10 - 19
20 or more
DK
119

[go to 5.4.1]

[ go to 5.5.1]

[go to 5.6.1]

[go to 5.7.1]

5.8 Did you use urea, phenol or melamine-based glues or adhesives?
Yes
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
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
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,
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
120

[go to 5.8.1]

[ask 5.9.1]

[go to 6.1]

[go to 6.2.1]

7

7.1

8

9

10

In this job, did you ever handle or pump fuel?
Yes
No
DK
How many hours per week did you do this?
<2
2-9
10 - 19
20 or more
DK
Were your hands ever immersed in a solvent, a solvent-based
product, or fuel?
Yes
No
DK
Did you wear gloves while using solvents or solvent-based
products?
Yes
No
Not applicable - did not use
solvents
DK
Did you clean your hands with a solvent, a solvent-based product
or with fuel, such as gasoline?
Yes
No
DK

121

[go to 7.1]

1

2

2.1

2.1.1

2.2

2.2.1

2.3
2.4
2.5

TEACHER (TE) MODULE
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
What subjects did you teach? (allow multiple)
Art
Biology
Chemistry
Industrial shop
Other
DK
Did you teach a lab component for this subject?
Yes
No
DK
How many hours per week did you do this?
<2
2-9
10 - 19
20 or more
DK
Did you teach a lab component for this subject?
Yes
No
DK
How many hours per week did you do this?
<2
2-9
10 - 19
20 or more
DK
[Degrease Mini-module]
[Paint Mini-Module]
[Hands mini-module]

122

[END]
[go to 2.1]
[go to 2.2]
[go to 2.3-2.5]
[END]
[END]
[go to 2.1.1]

[go to 2.2.1]