Attachment 4 Occupational Job Modules examples

Attachment 4: Selected Job Modules (OccIDEAS) – Chemist and Janitor
Note- these are two examples of job modules. See Attachment 5 for complete set of job modules and
time burden box for this part of the questionnaire
CHEMIST (CH) MODULE
1 In this job, did you work in a lab?

1.1

2

2.1

2.2

3

3.1

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

1

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3.2 What chlorinated solvents did you use? Did you use…? (allow
multiple)
Trichloroethylene
Dichloromethane
Other chlorinated solvent
DK
4 Did you use benzene?

4.1

5

5.1

6

6.1

7

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
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

2

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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
DK

3

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1

1.1

2

2.1

3

3.1

4

4.1

JANITOR (JA) MODULE
In this job, did you ever clean office areas?
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 polish furniture with liquid cleaning
chemicals?
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 strip floors with liquid cleaning chemicals?
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 clean in a production area of the plant?
Yes
No
DK
How many hours per week did you do this?
<2
2-9
10 - 19
20 or more
DK

4

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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
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6.2.3 Were the chemicals at room temperature or were they heated in a
tank, vat, or vapor degreaser? (allow multiple)
Room temperature
Heated in vapor degreaser
Heated in vat or tank
Other
DK
6.2.4 How did you clean the parts? Did you …? (allow multiple)
Wipe with rag/cloth
Wipe with brush
Put in basket and manually
dipped into tank
Put in basket and dipped into
tank using automated system
Put into tank or bucket with
hands
Other
DK
6.2.5 Was there a local exhaust system to remove the dust, fumes or
vapors that was produced?
Yes
No
DK
6.3 Did other workers clean or degrease parts in the area where you
worked?
Yes
No
DK
6.3.1 How many hours per week did other workers perform this task
while you were working in this area?
<2
2-9
10-19
20 or more
DK
6.4 In this job, did you ever handle or pump fuel?
Yes
No
DK
6.4.1 How many hours per week did you do this?
<2
2-9
10-19
20 or more
DK
6

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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