Respiratory questionnaire cotton industry

The questionnaire is intended to identify respiratory symptoms, medical history, and work exposures among non-textile workers in the cotton industry to help detect possible work-related respiratory problems. This tool is published as Appendix B-II to 1910.1043 and is designed to collect identification, occupational history, respiratory symptoms, allergy and smoking history, and other relevant information that can trigger further medical evaluation under 1910.1043.

The questionnaire should be given to non-textile workers in cotton industry workplaces whose exposures or job histories may put them at risk for cotton-dust-related respiratory problems. The form title and content make clear it is for "Non-Textile Workers for the Cotton Industry" as published in Appendix B-II to 1910.1043, and employers should use it where 1910.1043 medical surveillance or screening is appropriate.

The questionnaire collects identifying information (name, address, phone, birthdate, sex, ethnicity, height, weight, shift), current work area and percent time, specific job title, and appropriate industry category. The form structure and fields are shown in Appendix B-II to 1910.1043.

The questionnaire requires a complete occupational history listing each job from present back to initial employment, including tenure (from–to years), occupation, average days worked per week, specific work location, and whether hazardous exposures were present with a description if "Yes." The occupational history table format is contained in Appendix B-II to 1910.1043.

The questionnaire directly asks whether the worker usually coughs or brings up phlegm first thing in the morning or during the day/night and, if present, whether the symptom occurs for three months each year; affirmative answers trigger follow-up questions about duration and frequency. These branches and instructions are spelled out in the "COUGH" and "PHLEGM" sections in Appendix B-II to 1910.1043.

The questionnaire asks whether symptoms occur on particular days of the week and includes a specific set of questions about symptoms occurring on Mondays to detect patterns related to workplace exposure. Those timing questions and the Monday-focused items are contained in Appendix B-II to 1910.1043, which helps employers and clinicians assess possible work-relatedness of respiratory symptoms.

The questionnaire grades breathlessness by a stepwise series of questions about activity levels — e.g., shortness of breath when hurrying on level ground, walking with others at ordinary pace, having to stop for breath, and shortness of breath during washing or dressing — and assigns a dyspnea grade based on the first positive response in that sequence. The dyspnea grading sequence and instructions are provided in Appendix B-II to 1910.1043.

The form asks whether the worker has a heart condition under a doctor's care, whether they have ever had asthma (including age at onset and whether it preceded textile work), and whether they have had hay fever or other allergies. Those medical history items are listed in the "OTHER ILLNESSES AND ALLERGY HISTORY" section of Appendix B-II to 1910.1043.

The questionnaire records current smoking status (including regular smoker within the past month), ever-smoked history, years smoked by tobacco type (cigarettes, pipe, cigars), number of packs per day, and number of pack-years plus time since quitting for ex-smokers. These tobacco-use fields and options are included in Appendix B-II to 1910.1043.

The questionnaire lists specific industry categories such as Garnetting, Cottonseed Oil Mill, Cotton Warehouse, Utilization, Cotton Classification, and Cotton Ginning for the interviewer to check the appropriate industry. Those labeled industry choices appear in the header/industry selection area of Appendix B-II to 1910.1043.

The form includes an "Interviewer Code" field, indicating it is intended to be filled out by an interviewer (for example, an occupational-health professional or a trained interviewer), but the appendix itself does not prescribe specific professional qualifications. The interviewer field and form layout are shown in Appendix B-II to 1910.1043; employers should follow 1910.1043 and any local medical surveillance policies when choosing who performs interviews.

No, Appendix B-II itself does not specify the frequency for administering the questionnaire; it provides the standard screening form. Employers should follow the medical surveillance and timing requirements set out in 1910.1043 (the cotton-dust standard) and company medical policies to determine how often to screen workers.

If the questionnaire reveals symptoms that appear related to workplace timing or exposures (for example, symptoms that worsen on workdays or specific days like Mondays), the employer should arrange for further medical evaluation and investigate workplace exposures as described by Appendix B-II to 1910.1043 and take appropriate corrective actions under 1910.1043.

Yes — the questionnaire is designed to identify symptoms and exposure history that can indicate the need for further medical evaluation or action; employers should use the form responses as part of a medical surveillance process under 1910.1043 to determine whether a clinical exam, pulmonary function testing, or work restriction is warranted. Appendix B-II provides the screening content employers can use to trigger those next steps.

The occupational history table has columns to indicate whether hazardous exposures were present (Yes/No) and a space to describe the exposure; employers should record the type of exposure and length of exposure for each job entry as shown in Appendix B-II to 1910.1043.

No — this specific form is titled for non-textile workers in the cotton industry and is therefore intended for workers outside of textile mills but within cotton-related operations; the form title and content make that clear in Appendix B-II to 1910.1043.

For chronic cough or phlegm, the questionnaire asks whether the condition lasts for as much as three months a year and then asks how long the symptom has been present with duration categories (2 years or less; more than 2 to 9 years; 10–19 years; 20+ years), as shown in Appendix B-II to 1910.1043.

Yes — the occupational history section includes a question asking if the worker has ever worked with other dusts, fumes, or smoke and requests specification of the type and length of exposure; that field is provided in Appendix B-II to 1910.1043.

Yes — the questionnaire includes a note that certain wording (for example, "first thing in the morning") is intended for subjects who work at night, and the asterisked wording clarifies how to interpret timing for night workers as provided in Appendix B-II to 1910.1043.

The questionnaire directs the interviewer to grade dyspnea based on the sequence of activity-limited responses (e.g., shortness of breath when hurrying, walking with others, having to stop for breath, or during washing/dressing) and to record the Dyspnea Grade in the provided field; that grading procedure and the field for recording the grade are in Appendix B-II to 1910.1043.

No — Appendix B-II provides the screening form itself but does not prescribe record-retention periods or storage methods; employers should follow the recordkeeping and medical-surveillance retention requirements in 1910.1043 and applicable recordkeeping rules under 1910.