Occupational History

Question 1

Does your current job require you to sit, stand, walk, other?

Answer 1

Does your current job require you to sit, stand, walk, other?

Question 2

Does your current job require lifting and/or twisting?

Answer 2

Does your current job require lifting and/or twisting?

Question 3

Does your job involve jarring or jolting forces to the spine or extremities? Vibrating machinery?

Answer 3

Does your job involve jarring or jolting forces to the spine or extremities? Vibrating machinery?

Question 4

Does your job require your head or body to be bent forward, backward, to the side or twisted repeatedly or for extended periods?

Answer 4

Does your job require your head or body to be bent forward, backward, to the side or twisted repeatedly or for extended periods?

Question 5

Have you ever worked or lived somewhere where you were exposed to toxic metals, gases, fumes, dusts, radioactive material or chemicals?

Answer 5

Have you ever worked or lived somewhere where you were exposed to toxic metals, gases, fumes, dusts, radioactive material or chemicals?