Part 1. Exposure Survey
- Exposures
- Current and past exposure to metals, dust, fibers, fumes, chemicals, biologic hazards, radiation, noise, and/or vibration,
- Typical workday (job tasks, location, materials, and agents used),
- Changes in routines or processes, and
- Other employees or household members similarly affected.
- Health and Safety Practices at Work Site
- Ventilation,
- Medical and industrial hygiene surveillance,
- Employment exams,
- Personal protective equipment (e.g., respirators, gloves, and coveralls),
- Lockout devices, alarms, training, and drills,
- Personal habits (Smoke and/or eat in work area?),
- Wash hands with solvents?,
- Shower before leaving work?,
- Change shoes and clothing before leaving work?, and
- Launder work clothing at work?
Part 2. Work History
- Description of all previous jobs including short-term, seasonal, and part-time employment and military service, and
- Description of present jobs.
Part 3. Environmental History
- Present and previous home locations,
- Present and previous daycare/school settings (as applicable),
- Jobs of household members,
- Home insulating and heating and cooling system,
- Home cleaning agents,
- Pesticide exposure,
- Water supply (especially drinking water supply),
- Recent renovation/remodeling,
- Air pollution, indoor and outdoor,
- Hobbies and recreational activities (e.g., painting, photography, sculpting, welding, woodworking, piloting, restoring automobiles, shooting firearms, creating stained glass, creating ceramics, soldering, and gardening),
- Hazardous wastes/spill exposure,
- Home ventilation/moisture control/flooding, and
- Food source(s).