INTERVIEWER: ENTERING SECTION 10: HEALTH.

Would your health keep you from working ON A JOB FOR PAY NOW?

(Are you/Would you be) limited in the KIND of work you (could) do on a job
for pay because of your health?

(Are you/Would you be) limited in the AMOUNT of work you (could) do because
of your health?

([Q10-3]=1) | ([Q10-4]=1)| ([Q10-5]=1)

COMMENT: Check if R has reported a health limitation.

([[resp.gender]]=1)

COMMENT: Is respondent male?

Are you currently pregnant?

Is your limitation ENTIRELY due to your current pregnancy?

Since what month and year have you had this limitation (other than your
pregnancy)?

INTERVIEWER: ENTER DATE FROM WHICH R HAS HAD THIS LIMITATION.

How much do you weigh?
(ENTER POUNDS)

INTERVIEWER: HAS RESPONDENT LOST ONE OR BOTH ARMS:
IF TELEPHONE INTERVIEW, DO NOT ASK RESPONDENT. SELECT TELEPHONE
INTERVIEW BELOW AND CONTINUE.

Were you born NATURALLY left-handed or right-handed?
(INTERVIEWER: IF NEITHER, RECORD EXPLANATION IN COMMENT SCREEN.)

Now, I would like to ask you a few questions about any injuries and
illnesses you might have received or gotten WHILE you were working on a
job.

First, since [lintdate], have you had an incident at any job we previously
discussed that resulted in an injury or illness to you?

COMMENT: What is the name of the employer you were working for when the MOST RECENT
incident that resulted in an injury or illness to you occurred?
(INTERVIEWER: MOVE OR TO THE EMPLOYER R HAS NAMED AND PRESS
<ENTER>. IF THERE IS NO MATCH, ASK R WHICH EMPLOYER LISTED IS THE SAME
AS THE ONE FOR WHICH R IS REPORTING A WORK-RELATED INJURY OR ILLNESS.) ORIGINAL MULTIPLE FIELDS QUESTION. BROKEN INTO SEPARATE QUESTIONS BY CONVERSION.

INTERVIEWER: YOU HAVE SELECTED THE EMPLOYER LISTED BELOW AS THE SAME ONE
R IS REPORTING A WORK-RELATED INJURY OR ILLNESS FOR. IF THIS
IS NOT CORRECT, RETURN TO THE PREVIOUS QUESTION BY PRESSING
THE <PAGE-UP> KEY AND SELECT THE CORRECT EMPLOYER.
EMPLOYER: ^[Q10-14].

INTERVIEWER: NO EMPLOYER MATCH WAS FOUND.
RECORD THE EMPLOYER FOR WHICH R IS REPORTING A WORK RELATED
ILLNESS.

In what month and year did the most recent incident occur that resulted in
an injury or illness to you?

(HAND CARD N) Which one category on this card best describes the activity
you were engaged in at the time of the incident? (CODE ONE ONLY).

Did the incident result in an injury or an illness?

What part of the body was hurt or affected?
(RECORD VERBATIM.)

(PROBE:) What other part of the body was hurt or affected?

INTERVIEWER: ENTER BELOW THE SECOND PART OF THE BODY THAT WAS HURT OR
AFFECTED.

(PROBE:) What other part of the body was hurt or affected?

INTERVIEWER: ENTER BELOW THE THIRD PART OF THE BODY THAT WAS HURT OR
AFFECTED.

(INTERVIEWER: FOR ([Q10-20]) ASK:) What kind of [Q10-19] was it?
(RECORD VERBATIM.)

[Q10-21]=1

COMMENT: is there another part of the body to ask about?

(INTERVIEWER: FOR ([Q10-22]) ASK:) What kind of [Q10-19] was it?
(RECORD VERBATIM.)

[Q10-23]=1

COMMENT: is there another part of the body to ask about?

(INTERVIEWER: FOR ([Q10-24]) ASK:) What kind of [Q10-19] was it?
(RECORD VERBATIM.)

Did the [Q10-19] cause you to miss one or more scheduled days of work,
not counting the day of the incident?

Not counting the day of the incident, how many days was this?

Did the [Q10-19] cause you ...
to be assigned to another job on a temporary basis?

Did the [Q10-19] cause you ...
to work at your regular job less than full time?

Did the [Q10-19] cause you ...
to work at your regular job, but be unable to perform all of the
normal duties of the job?

([Q10-32]=1)|([Q10-33]=1)|([Q10-34]=1)

COMMENT: check if any of the three preceeding q's contain a 'yes'

Not counting the day of the incident, how many days altogether was this?

Did the [Q10-19] (also) cause you...
to be laid off?

Did the [Q10-19] (also) cause you...
to quit?

Did the [Q10-19] (also) cause you...
to be fired?

Did the [Q10-19] (also) cause you...
to change occupations?

Did you lose any wages because of the [Q10-19]?

Did you or your employer fill out a worker's compensation form for this
[Q10-19]?

Have you collected any worker's compensation benefits for this [Q10-19]?

Is there a worker's compensation claim pending for this [Q10-19]?

Is the [Q10-19] we've just discussed the MOST SEVERE injury or illness that
you have received or gotten since [lintdate] while you were working at any
job we have already talked about?

COMMENT: What is the name of the employer you were working for when the MOST SEVERE
incident that resulted in an injury or illness to you occurred?
(INTERVIEWER: MOVE OR TO THE EMPLOYER R HAS NAMED AND PRESS
<ENTER>. IF THERE IS NO MATCH, ASK R WHICH EMPLOYER LISTED IS THE SAME
AS THE ONE FOR WHICH R IS REPORTING A WORK-RELATED INJURY OR ILLNESS.) ORIGINAL MULTIPLE FIELDS QUESTION. BROKEN INTO SEPARATE QUESTIONS BY CONVERSION.

INTERVIEWER: YOU HAVE SELECTED THE EMPLOYER LISTED BELOW AS THE SAME ONE
R IS REPORTING A WORK-RELATED INJURY OR ILLNESS FOR. IF THIS
IS NOT CORRECT, RETURN TO THE PREVIOUS QUESTION BY PRESSING
THE <PAGE-UP> KEY AND SELECT THE CORRECT EMPLOYER.
EMPLOYER: ^[Q10-47].

INTERVIEWER: NO EMPLOYER MATCH WAS FOUND.
RECORD THE EMPLOYER FOR WHICH R IS REPORTING A WORK RELATED
ILLNESS.

In what month and year did the incident occur that resulted in the most
severe injury or illness to you?

(HAND CARD N) Which one category on this card best describes the activity
you were engaged in at the time of the incident? (CODE ONE ONLY.)

Did the incident result in an injury or an illness?

What part of the body was hurt or affected?
(RECORD VERBATIM.)

(PROBE:) What other part of the body was hurt or affected?

INTERVIEWER: ENTER BELOW THE SECOND PART OF THE BODY THAT WAS HURT OR
AFFECTED.

(PROBE:) What other part of the body was hurt or affected?

INTERVIEWER: ENTER BELOW THE THIRD PART OF THE BODY THAT WAS HURT OR
AFFECTED.

(INTERVIEWER: FOR ([Q10-53]) ASK:) What kind of [Q10-52] was it?
(RECORD VERBATIM.)

([Q10-54]=1)

COMMENT: check if there is another part of the body to ask about.

(INTERVIEWER: FOR ([Q10-55]) ASK:) What kind of [Q10-52] was it?
(RECORD VERBATIM.)

([Q10-56]=1)

COMMENT: check if there is another part of the body to ask about.

(INTERVIEWER: FOR ([Q10-57]) ASK:) What kind of [Q10-52] was it?
(RECORD VERBATIM.)

Did the [Q10-52] cause you to miss one or more scheduled days of work,
not counting the day of the incident?

Not counting the day of the incident, how many days was this?

Did the [Q10-52] cause you ...
to be assigned to another job on a temporary basis?

Did the [Q10-52] cause you ...
to work at your regular job less than full time?

Did the [Q10-52] cause you ...
to work at your regular job, but be unable to perform all of the
normal duties of the job?

([Q10-65]=1)|([Q10-66]=1)|([Q10-67]=1)

COMMENT: check if any of the three preceeding q's are answered 'yes'

Not counting the day of the incident, how many days altogether was this?

Did the [Q10-52] (also) cause you...
to be laid off?

Did the [Q10-52] (also) cause you...
to quit?

Did the [Q10-52] (also) cause you...
to be fired?

Did the [Q10-52] (also) cause you...
to change occupations?

Did you lose any wages because of the [Q10-52]?

Did you or your employer fill out a worker's compensation form for this
[Q10-52]?

Have you collected any worker's compensation benefits for this [Q10-52]?

Is there a worker's compensation claim pending for this [Q10-52]?

Now we have a few questions about health care and hospitalization plans.

First, are you covered by any kind of private or governmental health or
hospitalization plans or health maintenance organization (HMO) plans?
(PROBE IF NECESSARY:) Examples of health and hospitalization insurance
plans include Blue Cross, Blue Shield, (Medicaid/Medi-Cal/Medical
Assistance/Welfare/Medical Services).

(HAND CARD O) What is the source of your health or hospitalization plan? Is
it from a policy from your current or previous employer, ...

... [a policy from your [husband/wife]'s current or previous employer],
a policy bought directly from a medical insurance company, is it (Medicaid/
Medi-Cal/Medical Assistance/Welfare/Medical Services), or is it from some
other source?
(READ CATEGORIES AS NECESSARY AND CODE ALL THAT APPLY.)

([[marcode]]=1) | ([[marcode]]=5)

COMMENT: check if current marital status is married and there is a spouse on the household roster

Is your [husband/wife] covered by any kind of private or governmental
health or hospitalization plans or health maintenance organization (HMO)
plans? (PROBE IF NECESSARY:) Examples of health and hospitalization
insurance plans include Blue Cross, Blue Shield, (Medicaid/Medi-Cal/Medical
Assistance/Welfare/Medical Services).

(HAND CARD O) What is the source of your [husband/wife]'s health or
hospitalization plan? (READ AS NECESSARY) Is it from a policy from your
current or previous employer, ...

... a policy from your [husband/wife]'s current or previous employer,
a policy bought directly from a medical insurance company, is it (Medicaid/
Medi-Cal/Medical Assistance/Welfare/Medical Services), or is it from some
other source?
(READ CATEGORIES AS NECESSARY AND CODE ALL THAT APPLY.)

([Q9-43]=1)|([Q9-43A]=1)|([Q9-43Aa]=1)|([Q9-43Ab]=1)|([Q9-43Ba]=1)|
([Q9-43Bb]=1)

COMMENT: Are any children in the respondent's household part- or full-time?

(Is/Are) your (child/children) covered by any kind of private or
governmental health or hospitalization plans or health maintenance
organization (HMO) plans? (PROBE IF NECESSARY:) Examples of health
and hospitalization insurance plans include Blue Cross, Blue Shield,
(Medicaid/Medi-Cal/Medical Assistance/Welfare/Medical Services).

(HAND CARD O) What is the source of your (child/children)'s health or
hospitalization plan? (READ AS NECESSARY) Is it from a policy from your
current or previous employer, ...

... [a policy from your [husband/wife]'s current or previous employer],
a policy bought directly from a medical insurance company, is it (Medicaid/
Medi-Cal/Medical Assistance/Welfare/Medical Services), or is it from some
other source?
(READ CATEGORIES AS NECESSARY AND CODE ALL THAT APPLY.)