nres questionnaire

7/25/2019 Nres Questionnaire

1/5

PART 1: Demographic Profle

DIRECTIONS:

How old are you? Ilang taon ka na?

18-25 years old 26-35 years old 36-45 years old 45 years or older

What is your sex? Ano ang iyong kasarian?

ale !e"ale

#i$il status

%ingle

arried &i$or'ed

Widowed

Where do you 'urrently li$e?

ontal(an arikina

)thers* +lease s+e'i,y.............

How long ha$e you (een li$ing there?

/ess than 5 years

6-10 years 11-20 years ore than 21 years

All "y li,e

Whi'h o, the ,ollowing (est des'ri(es the area you li$e in?

r(an %u(ur(an ural

du'ational Attain"ent

ndergraduate raduate ost-graduate

!a"ily onthly In'o"e in hili++ine +eso

nder 5000


2/5

6000-10000 11000-15000 16000 and a(o$e

How long ha$e you (een working as a shoe"aker?

2-5 years 6-10 years 11-20 years 21 years and a(o$e

Whi'h o, the ,ollowing 'ategories (est des'ri(es your +ri"arily area o, e"+loy"ent

regardless o, your a'tual +osition7?

o

Whi'h o, the ,ollowing (est des'ri(es your role in industry?

o

How would you des'ri(e your work s'hedule?

o egularo Irregularo otating

How "any days in a week do you work?

o 3 days and (elowo 4 days

o 5 dayso 6 dayso days

How "any hours do you esti"ate you s+end +er day in your work?

o 3 hours and (elowo 4-8 hourso 9-12 hourso 13 hours and "ore

&o you s"oke 'igarettes?

#urrently x-s"oker )nly s"oked a ,ew ti"es :e$er

Ha$e you e$er in your li,e s"oked 'igarettes on a daily (asis?

;es


3/5

:o

How "any years* in total* did you s"oke 'igarettes on a daily (asis?

....... ;A% %)


4/5

x'ellent ery good ood !air oor

1 2 3 4 5

DIRECTIONS:

Buestions 1 2 3 4 5In general* how would you rate

your o$erall health now?In general* how would you rate

your o$erall "ental health now?

&o you ha$e any o, the ,ollowing 'onditions? I, your answer is ;%* "ark whether

you ne$er* +re$iously* or 'urrently re'ei$e +ro,essional treat"ent@ ro,essionaltreat"ent is any treat"ent su+er$ised (y a health +ro,essional@7

:)* I donCt

ha$e this

'ondition

;%* (ut I

ne$er re'ei$ed

+ro,essionaltreat"ent

;%* I

+re$iously

re'ei$ed (utdonCt 'urrently

re'ei$e7

+ro,essionaltreat"ent

;%* and I

'urrently

re'ei$e+ro,essional

treat"ent

#ough?

#ough with+hleg"?%hortness o,

(reath?#olds?ye irritation?Heada'he?!eeling diDDy?

>rou(le

slee+ing?

&o you ha$e any disease or health +ro(le"s (e,ore working as a shoe"aker?

;es :o

I, yes* +lease indi'ate...............


5/5

#urrent sy"+to"s ark any o, the ,ollowing sy"+to"s you ha$e ex+erien'edwithin the last2-4 "onths

!atigue

>rou(le slee+ing Heada'he

=a'k +ain #ough

#olds %ore throat !e$er &iarrhea #onsti+ation :ausea and o"iting &iDDiness :one o, these sy"+to"s

In a ty+i'al week* on how "any days do you do any "oderate a'ti$ities that 'ausess"all in'reases in (reathing or heartrate ,or at least 30 "inutes?

3 days and (elow 4- days I donEt ty+i'ally do any "oderate exer'ise

In a ty+i'al week* on how "any days do you do any $igorous a'ti$ities that 'ausess"all in'reases in (reathing or heartrate ,or at least 30 "inutes?

3 days and (elow 4- days

I donEt ty+i'ally do any $igorous exer'ise

&o you get at least 8 hours o, slee+ at night

;es :o

Work days "issed due to illness in the +ast years?

15 or less days

20 or "ore days

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