Question Grid

Name

qg_A3

Label

A3

Question Text

What jobs have you had since the study child was 5 that involved exposure to chemicals or machines? Include part-time and voluntary work. If you have not had a job that involved chemicals or machines write 'None'.

Job Materials/chemicals/machines used Date started (month-year) Date stopped (month-year)
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Usage

9 questions before...
In the last 12 months, how often have you done the following:
-

1 - Every day

2 - Most days

3 - Once or twice a week

4 - Less than once a week

5 - Not at all

gardening
hairdressing
farm work
hospital work
shift work
What jobs have you had since the study child was 5 that involved exposure to chemicals or machines? Include part-time and voluntary work. If you have not had a job that involved chemicals or machines write 'None'.
Job Materials/chemicals/machines used Date started (month-year) Date stopped (month-year)
Generic textGeneric textGeneric dateGeneric dateGeneric textGeneric dateGeneric dateGeneric textGeneric dateGeneric textGeneric dateGeneric textGeneric dateGeneric textGeneric textGeneric date Generic textGeneric textGeneric dateGeneric dateGeneric textGeneric dateGeneric dateGeneric textGeneric dateGeneric textGeneric dateGeneric textGeneric dateGeneric textGeneric textGeneric date Generic textGeneric textGeneric dateGeneric dateGeneric textGeneric dateGeneric dateGeneric textGeneric dateGeneric textGeneric dateGeneric textGeneric dateGeneric textGeneric textGeneric date Generic textGeneric textGeneric dateGeneric dateGeneric textGeneric dateGeneric dateGeneric textGeneric dateGeneric textGeneric dateGeneric textGeneric dateGeneric textGeneric textGeneric date
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13
If there is not enough space please continue on the back cover or on a separate sheet.
86 questions after...
View the complete questionnaire

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