Appendix A. Online Risk Assessment Tool - AHRQ National ...

Environmental exposures# Question Prereq Options Script(s)Do you have well water at1 your home?Yes1 Do you have well water at your home?No1 Do you have well water at your home?Don't1a1a Has it been tested? If "Yes" to 1No1a Has it been tested? If "Yes" to 1Don't2knowIf "Yes"Has it been tested? to 1 YesWater Hazard, WellWaterWater Hazard, WellknowWaterHave you been exposed tolead? Yes Lead2 Have you been exposed to lead?No2 Have you been exposed to lead?Don't3know LeadDo you live near a toxicwaste site or ‘superfundsite’? Yes Soil Hazards3 Do you live near a toxic waste site or ‘superfund site’?No4Do you frequently drinkwater from plastic bottles?4 Do you frequently drink water from plastic bottles?No5Do you frequently eatfoods that come from metalcans that have a whiteplastic lining, like cannedsoup or vegetables?5 Do you frequently eat foods that come from metal cans that have a white plastic lining, like canned soup or vegetables?No5 Do you frequently eat foods that come from metal cans that have a white plastic lining, like canned soup or vegetables?Don't6YesYesWater Hazard, PlasticBottlesEnvironmentalHazard, Plastic LiningEnvironmentalknowHazard, Plastic LiningDo you ever clean a cat'slitter box? Yes Toxoplasmosis6 Do you ever clean a cat's litter box?No7Does your job or yourpartner’s job fall into any ofthe following categories?Check all that apply: Lab and clinical healthcare work Workplace ExposuresWorkplace ExposuresWorkplace Exposuresmaking or metal tempering Workplace ExposuresJobs that use: pesticides,herbicides, rodenticides, solvents(oil-based paints), heavy metals(lead), paint stripping agents, leadbasedpaints or non-latex-basedpaints that are solvent based andcontain metals for pigments Workplace Exposuresof the aboveknow7 Does your job or your partner’s job fall into any of the following categories? Check all that apply:Printing7 Does your job or your partner’s job fall into any of the following categories? Check all that apply:Dry-cleaning7 Does your job or your partner’s job fall into any of the following categories? Check all that apply:Jewelry7 Does your job or your partner’s job fall into any of the following categories? Check all that apply:7 Does your job or your partner’s job fall into any of the following categories? Check all that apply:None7 Does your job or your partner’s job fall into any of the following categories? Check all that apply:Don'tProgrammingNotesGo to Question1aSkip to Question2Skip to Question221