INTERVIEWER: ENTERING SECTION 11: HEALTH.

Would your health keep you from working ON A JOB FOR PAY NOW?

(Are you/Would you be) limited in the KIND of work you (could) do on a job for pay because of your health?

(Are you/Would you be) limited in the AMOUNT of work you (could) do because of your health?

Is your limitation ENTIRELY due to your current pregnancy?

Since what month and year have you had this limitation (other than your pregnancy)?

INTERVIEWER: ENTER DATE FROM WHICH R HAS HAD THIS LIMITATION.

How much do you weigh?



(ENTER POUNDS)

Now, I would like to ask you a few questions about any injuries and illnesses you might have received or gotten WHILE you were working on a job.

First, since [!lintdate], have you had an incident at any job we previously discussed that resulted in an injury or illness to you?

What is the name of the employer you were working for when the MOST RECENT incident that resulted in an injury or illness to you occurred?

(INTERVIEWER: MOVE OR TO THE EMPLOYER R HAS NAMED AND PRESS <ENTER>. IF THERE IS NO MATCH, ASK R WHICH EMPLOYER LISTED IS THE SAME AS THE ONE FOR WHICH R IS REPORTING A WORK-RELATED INJURY OR ILLNESS.)

INTERVIEWER: YOU HAVE SELECTED THE EMPLOYER LISTED BELOW AS THE SAME ONE
R IS REPORTING A WORK-RELATED INJURY OR ILLNESS FOR. IF THIS
IS NOT CORRECT, RETURN TO THE PREVIOUS QUESTION BY PRESSING
THE <PAGE-UP> KEY AND SELECT THE CORRECT EMPLOYER.
EMPLOYER: [Employer for whom respondent was working when most recent incident resulting in illness/injury occurred (includes those for whom no match was made with employer worked for since last interview)].

INTERVIEWER: NO EMPLOYER MATCH WAS FOUND. RECORD THE EMPLOYER FOR WHICH R IS REPORTING A WORK RELATED ILLNESS.

In what month and year did the most recent incident occur that resulted in an injury or illness to you?

(HAND CARD DD) Which one category on this card best describes the activity you were engaged in at the time of the incident? (CODE ONE ONLY).

Did the incident result in an injury or an illness?

What part of the body was hurt or affected?


(RECORD VERBATIM.)

(PROBE:) What other part of the body was hurt or affected?

INTERVIEWER: ENTER BELOW THE SECOND PART OF THE BODY THAT WAS HURT OR
AFFECTED.

(PROBE:) What other part of the body was hurt or affected?

INTERVIEWER: ENTER BELOW THE THIRD PART OF THE BODY THAT WAS HURT OR
AFFECTED.

(INTERVIEWER: FOR ([First body part hurt or affected in most recent work-injury incident]) ASK:) What kind of [Did most recent work-injury incident result in illness or injury (text fill - "illness", "injury")] was it?


(RECORD VERBATIM.)

(INTERVIEWER: FOR ([Second body part hurt or affected in most recent work-injury incident]) ASK:) What kind of [Did most recent work-injury incident result in illness or injury (text fill - "illness", "injury")] was it?


(RECORD VERBATIM.)

(INTERVIEWER: FOR ([Third body part hurt or affected in most recent work-injury incident]) ASK:) What kind of [Did most recent work-injury incident result in illness or injury (text fill - "illness", "injury")] was it?


(RECORD VERBATIM.)

Did the [Did most recent work-injury incident result in illness or injury (text fill - "illness", "injury")] cause you to miss one or more scheduled days of work, not counting the day of the incident?

Not counting the day of the incident, how many days was this?

Did the [Did most recent work-injury incident result in illness or injury (text fill - "illness", "injury")] cause you ...

to be assigned to another job on a temporary basis?

Did the [Did most recent work-injury incident result in illness or injury (text fill - "illness", "injury")] cause you ...

to work at your regular job less than full time?

Did the [Did most recent work-injury incident result in illness or injury (text fill - "illness", "injury")] cause you ...

to work at your regular job, but be unable to perform all of the
normal duties of the job?

Not counting the day of the incident, how many days altogether was this?

Did the [Did most recent work-injury incident result in illness or injury (text fill - "illness", "injury")] (also) cause you...

to be laid off?

Did the [Did most recent work-injury incident result in illness or injury (text fill - "illness", "injury")] (also) cause you...

to quit?

Did the [Did most recent work-injury incident result in illness or injury (text fill - "illness", "injury")] (also) cause you...

to be fired?

Did the [Did most recent work-injury incident result in illness or injury (text fill - "illness", "injury")] (also) cause you...

to change occupations?

Did you lose any wages because of the [Did most recent work-injury incident result in illness or injury (text fill - "illness", "injury")]?

Did you or your employer fill out a worker's compensation form for this [Did most recent work-injury incident result in illness or injury (text fill - "illness", "injury")]?

Have you collected any worker's compensation benefits for this [Did most recent work-injury incident result in illness or injury (text fill - "illness", "injury")]?

Is there a worker's compensation claim pending for this [Did most recent work-injury incident result in illness or injury (text fill - "illness", "injury")]?

Is the [Did most recent work-injury incident result in illness or injury (text fill - "illness", "injury")] we've just discussed the MOST SEVERE injury or illness that you have received or gotten since [!lintdate] while you were working at any job we have already talked about?

What is the name of the employer you were working for when the MOST SEVERE incident that resulted in an injury or illness to you occurred?

(INTERVIEWER: MOVE OR TO THE EMPLOYER R HAS NAMED AND PRESS <ENTER>. IF THERE IS NO MATCH, ASK R WHICH EMPLOYER LISTED IS THE SAME AS THE ONE FOR WHICH R IS REPORTING A WORK-RELATED INJURY OR ILLNESS.)

INTERVIEWER: YOU HAVE SELECTED THE EMPLOYER LISTED BELOW AS THE SAME ONE
R IS REPORTING A WORK-RELATED INJURY OR ILLNESS FOR. IF THIS
IS NOT CORRECT, RETURN TO THE PREVIOUS QUESTION BY PRESSING
THE <PAGE-UP> KEY AND SELECT THE CORRECT EMPLOYER.
EMPLOYER: [Employer for whom respondent was working when most severe incident resulting in illness/injury occurred (includes those for whom no match was made with employer worked for since last interview)].

INTERVIEWER: NO EMPLOYER MATCH WAS FOUND. RECORD THE EMPLOYER FOR WHICH R IS REPORTING A WORK RELATED ILLNESS.

In what month and year did the incident occur that resulted in the most severe injury or illness to you?

(HAND CARD DD) Which one category on this card best describes the activity you were engaged in at the time of the incident? (CODE ONE ONLY.)

Did the incident result in an injury or an illness?

What part of the body was hurt or affected?


(RECORD VERBATIM.)

(PROBE:) What other part of the body was hurt or affected?

INTERVIEWER: ENTER BELOW THE SECOND PART OF THE BODY THAT WAS HURT OR
AFFECTED.

(PROBE:) What other part of the body was hurt or affected?

INTERVIEWER: ENTER BELOW THE THIRD PART OF THE BODY THAT WAS HURT OR
AFFECTED.

(INTERVIEWER: FOR ([First body part hurt or affected in most severe work-injury incident]) ASK:) What kind of [Did most severe work-injury incident result in illness of injury (text fill - "illness", "injury")] was it?


(RECORD VERBATIM.)

(INTERVIEWER: FOR ([Second body part hurt or affected in most severe work-injury incident]) ASK:) What kind of [Did most severe work-injury incident result in illness of injury (text fill - "illness", "injury")] was it?


(RECORD VERBATIM.)

(INTERVIEWER: FOR ([Third body part hurt or affected in most severe work-injury incident]) ASK:) What kind of [Did most severe work-injury incident result in illness of injury (text fill - "illness", "injury")] was it?


(RECORD VERBATIM.)

Did the [Did most severe work-injury incident result in illness of injury (text fill - "illness", "injury")] cause you to miss one or more scheduled days of work, not counting the day of the incident?

Not counting the day of the incident, how many days was this?

Did the [Did most severe work-injury incident result in illness of injury (text fill - "illness", "injury")] cause you ...

to be assigned to another job on a temporary basis?

Did the [Did most severe work-injury incident result in illness of injury (text fill - "illness", "injury")] cause you ...

to work at your regular job less than full time?

Did the [Did most severe work-injury incident result in illness of injury (text fill - "illness", "injury")] cause you ...

to work at your regular job, but be unable to perform all of the
normal duties of the job?

Not counting the day of the incident, how many days altogether was this?

Did the [Did most severe work-injury incident result in illness of injury (text fill - "illness", "injury")] (also) cause you...

to be laid off?

Did the [Did most severe work-injury incident result in illness of injury (text fill - "illness", "injury")] (also) cause you...

to quit?

Did the [Did most severe work-injury incident result in illness of injury (text fill - "illness", "injury")] (also) cause you...

to be fired?

Did the [Did most severe work-injury incident result in illness of injury (text fill - "illness", "injury")] (also) cause you...

to change occupations?

Did you lose any wages because of the [Did most severe work-injury incident result in illness of injury (text fill - "illness", "injury")]?

Did you or your employer fill out a worker's compensation form for this [Did most severe work-injury incident result in illness of injury (text fill - "illness", "injury")]?

Have you collected any worker's compensation benefits for this [Did most severe work-injury incident result in illness of injury (text fill - "illness", "injury")]?

Is there a worker's compensation claim pending for this [Did most severe work-injury incident result in illness of injury (text fill - "illness", "injury")]?

Now we have a few questions about health care and hospitalization plans.

First, are you covered by any kind of private or governmental health or hospitalization plans or health maintenance organization (HMO) plans? (PROBE IF NECESSARY:) Examples of health and hospitalization insurance plans include Blue Cross, Blue Shield, (Medicaid/Medi-Cal/Medical
Assistance/Welfare/Medical Services).

(HAND CARD EE) What is the source of your health or hospitalization plan? Is it from a policy from your current or previous employer, ...

... [a policy from (your) [Spouse/partner's name]'s current or previous employer], a policy bought directly from a medical insurance company, is it (Medicaid/Medi-Cal/Medical Assistance/Welfare/Medical Services), or is it from some other source?

(READ CATEGORIES AS NECESSARY AND CODE ALL THAT APPLY.)

In 1995, were there any months when you were NOT covered by health insurance?

Which months?

(MARK ALL THAT APPLY)
(ENTER MONTHS IN 1996 ON NEXT SCREEN)

(Which months?)

(MARK ALL THAT APPLY)
(ENTER MONTHS IN 1996 BELOW)

When was the most recent time you were covered by insurance?

(When was the most recent time you were covered by insurance?)

(ENTER MONTH AND YEAR)

Can you tell me how long ago the most recent time you were covered by insurance was?


(ENTER AMOUNT BELOW AND TIME UNIT - "WEEKS", "MONTHS", ETC. IN NEXT SCREEN.)

(Can you tell me how long ago the most recent time you were covered by insurance was?)


(ENTER TIME UNIT BELOW)

Is [Spouse/partner's name] covered by any kind of private or governmental health or hospitalization plans or health maintenance organization (HMO) plans? (PROBE IF NECESSARY:) Examples of health and hospitalization insurance plans include Blue Cross, Blue Shield, (Medicaid/Medi-Cal/Medical
Assistance/Welfare/Medical Services).

(HAND CARD EE) What is the source of [Spouse/partner's name]'s health or hospitalization plan? (READ AS NECESSARY) Is it from a policy from your current or previous employer, ...

... a policy from [Spouse/partner's name]'s current or previous employer, a policy bought directly from a medical insurance company, is it (Medicaid/Medi-Cal/Medical Assistance/Welfare/Medical Services), or is it from some other source?

(READ CATEGORIES AS NECESSARY AND CODE ALL THAT APPLY.)

(Is/Are) your (child/children) covered by any kind of private or governmental health or hospitalization plans or health maintenance organization (HMO) plans? (PROBE IF NECESSARY:) Examples of health and hospitalization insurance plans include Blue Cross, Blue Shield, Medicaid/Medi-Cal/Medical Assistance/Welfare/Medical Services).

(HAND CARD EE) What is the source of your (child/children)'s health or hospitalization plan? (READ AS NECESSARY) Is it from a policy from your current or previous employer, ...

... [a policy from (your) [Spouse/partner's name]'s current or previous employer], a policy bought directly from a medical insurance company, is it (Medicaid/Medi-Cal/Medical Assistance/Welfare/Medical Services), or is it from some other source?

(READ CATEGORIES AS NECESSARY AND CODE ALL THAT APPLY.)