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Nursing Health, & Environment: Strengthening the Relationship to Improve the Public's Health
Styrene
Trinitrotoluene
Talc
Vibration
Toluene
Vinyl chloride
TDI or MDI
Welding fumes
Trichloroethylene
X rays
If you have answered ''yes" to any of the above, please describe your exposure on a separate sheet of paper.
Environmental Exposure
Do you live in the central city or in a rural, urban, or suburban area?
Have you ever changed your residence or home because of a health problem? If so, describe:
Do you live in the immediate vicinity of a refinery, smelter, factory, battery recycling plant, hazardous waste site, or other potential pollution source?
Do you (and your child) live in or regularly visit a building with peeling or chipped lead paint (e.g., built before 1960)? Has there been recent, ongoing, or planned renovation or remodeling of this structure(s)?
Do any members of your household have contact with dusts or chemicals in the workplace that are then brought into the home?
Do you have a hobby that you do at home? If so, describe:
Do you fumigate your home or use pesticides in and around your home and on a pet? Do you use mothballs?
What cleaning agents and solvents are used in your home?
