Please indicate your gender:
Please specify your age in the box provided:
Please indicate your ethnicity in the box provided
Please indicate your marital status
If you do have children, how many and what are their ages?
How many people live in your household?
What is your primarly language?
What languages do you speak fluently?
How many years have you been employed in asbestos abatement?
Who was your asbestos training provider?
What language was your training provided in?
What language was medical exam administered in?
Do you use tobacco products? (i.e. ciggarettes, cigars, chewing tobacco, etc.)
How often do you use tobacco products?
How often do you think about contracting an asbestos related disease?
Do you think your asbestos work will hurt your family?
Put the following values in order, from most important to least important.
Health
-- Select -- 1 2 3 4 5 You
-- Select -- 1 2 3 4 5 Family
-- Select -- 1 2 3 4 5 Job
-- Select -- 1 2 3 4 5 Money
-- Select -- 1 2 3 4 5
How often do you perform respiratory seal checks?
I have been fit tested with the type and size of respirator I am wearing today.
My understanding of respirator care and use is:
Have you ever entered an active asbestos abatement work area without proper respiratory protection?
There is a known safe exposure level for asbestos.
I learned how to use a respirator from:
If I did not know how to use a respirator I would:
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