Question Grid

Name

qg_44_b_ii

Label

44 b(ii)

Question Text

Please give the following details about each accident starting with the earliest:-

DETAILS of how each ACCIDENT OCCURED (if burnt by fire say whether electric, gas, open fire, or oil stove) Where it occured (own home, school, street, etc.,)
Generic textGeneric textGeneric textGeneric text Generic textGeneric textGeneric textGeneric text
First Accident 1
Second 2

Usage

100 questions before...
Please give the following details about each accident starting with the earliest:-
Type of injury (enter as BURN, SCALD, BROKEN BONE, CUT, etc.) Part or parts injured Age when injured (in years and months) Treatment Hos.I.P, Hos.O.P, Nursing Home, Own Home If treated in own home, who gave treatment? (Doctor, Nurse, other) Details of remaining scarring, disability or deformity
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First Accident 1
Second 2
Please give the following details about each accident starting with the earliest:-
DETAILS of how each ACCIDENT OCCURED (if burnt by fire say whether electric, gas, open fire, or oil stove) Where it occured (own home, school, street, etc.,)
Generic textGeneric textGeneric textGeneric text Generic textGeneric textGeneric textGeneric text
First Accident 1
Second 2
Now here are some questions about the way you behave and feel, and act, after each question there is 'yes' a '?' and a 'no'. Try and decide, whether 'yes' or 'no' is how you usually feel and then circle the 'yes' or the 'no'. If you find it quite impossible to decide, then circle the '?'. However don't use the question-mark unless you feel you have to. Work quickly and don't spend too much time on any question, we want your first reaction.
-

1 - Yes

2 - ?

3 - No

Are you happiest when you get involved in some project that calls for rapid action?
Do you sometimes feel happy, sometimes depressed, without any apparent reason?
Does your mind often wander while you are trying to concentrate?
Do you usually take the initiative in making new friends?
Are you inclined to be quick and sure in your actions?
Are you frequently 'lost in thought' even when supposed to be taking part in a conversation?
Are you sometimes bubbling over with energy and sometimes very sluggish?
Would you rate yourself as a lively individual?
Would you be very unhappy if you were prevented from making numerous social contracts?
Are you inclined to be moody?
Do you have frequent ups and downs in mood, either with or without apparent cause?
Do you prefer action to planning for action?
3 questions after...
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Dimensions

Code Dimension

Type
Code List
Selection Style
SelectOne
Display Code
False
Display Label
True

Code Dimension

Display Code
False
Display Label
False

Response Options

Type
Text
Maximum Length
255
Rank
1
All Values
True
Rank
2
All Values
False
Specific Value
1
Type
Text
Maximum Length
255
Rank
1
All Values
True
Rank
2
All Values
False
Specific Value
2
Type
Text
Maximum Length
255
Rank
1
All Values
True
Rank
2
All Values
False
Specific Value
3
Type
Text
Maximum Length
255
Rank
1
All Values
True
Rank
2
All Values
False
Specific Value
4