Female Questionnaire
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This section deals with exposure to specific potentially hazardous substances.


Secondhand smoke. Within the last 8 years, roughly how much time have you spent in smoke-filled environments? Heavy exposure is defined as being in a room with visible smoke/haze for more than 4 hours per day.
  • Don't know
  • None / minimal
  • 1-4 years of light exposure
  • 5-8 years of light exposure or 1-4 years heavy
  • 5-8 years of heavy exposure


Have you suffered exposure to diesel exhaust fumes (as opposed to exhaust fumes in general)? For example, diesel mechanics, truck drivers, working at a truck stop, etc.
  • No exposure / don't know
  • Light exposure for a short time
  • Light exposure for a long time
  • Heavy exposure for a short time
  • Heavy exposure for a long time


Have you been exposed to solvents or other carcinogens through lungs or skin, for example working with paints, glues, fuels or other chemicals?
  • No / don't know
  • Mild / short term, in the past only
  • Heavy / long term, in the past only
  • Moderate / short term current exposure
  • Heavy / long term current exposure


Have you had significant exposure to specific herbicides? Include short-term intense contact or long-term low-level exposure.
  • Don't know
  • No significant exposure
  • Phenoxy agents (2,4-D, agent orange, 2,4,5-T)
  • Glyphosates (roundup, touchdown...)
  • Yes, other


Have you done any dust-producing work in pre-1970 building(s)? Various hazardous substances were commonly used in the construction of these buildings, including asbestos and lead paint.
  • No / don't know
  • Yes, but didn't live there during the work
  • Yes, and lived there while the work was done
  • Yes, more than one job but did not live there
  • Yes, more than one job and lived there


Have you been exposed to treated lumber sawdust, for example as a carpenter?
  • No / don't know
  • Mild, in the past only
  • Heavy, in the past only
  • Moderate current exposure
  • Heavy current exposure


Are you regularly exposed to household mold or mildew? Mold prefers a damp, poorly-ventilated environment and can occur almost anywhere in the home, including walls, furniture and fabrics.
  • Don't know
  • No
  • There is a slight moldy/mildewy smell
  • Yes, it is a definite but manageable problem
  • There is a serious, uncontrollable mold problem