English

Annex 3: QUESTIONNAIRES
A. – Questionnaire to workers
Identification of chemical risk
This questionnaire gives examples of questions that can be formulated (either orally
or in written form) to workers to find out more about their working situation and
conditions, their exposure to risk, and to ascertain the knowledge they have
regarding these issues.
These questions are a general guide. When developing the questionnaire,
consideration should be given to whether to shorten or enlarge the list, based on
the extent of information already available, the amount of time the workers have to
answer, and how predisposed they are to give answers.
Working area: ______________________________________________
Position: __________________________________________________
Gender: Woman Man
Special working conditions
Pregnant or breastfeeding women
Person sensible to certain products
Others
1. Do you use or are you exposed to chemical materials or
products in your work?
Yes
No
2. What are they used for and where do they come from? ____________________
____________________
3. Are the containers labelled? Yes No
4. Do you know the chemical names of products besides the
commercial names?
5. If it is a compost product (mix). Do you know the name of
each of the products (components)?
6. Do you have information about the effects or harm the
chemicals you use might cause to human health and the
environment?
Yes
Yes
Yes
No
No
No
7. How can these products penetrate your organism? Respiratory system
Ingestion
Through skin
8.a. Does the presence and manipulation of these products
create a risk situation that might cause an accident (splashing,
etc.)
Yes
No
8.b. Why does a risk exist? What are the reasons?
____________________
____________________
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