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  1. About NIOSH (National Institute for Occupational Safety and Health) and the Respirator Use Questionnaire: About NIOSH-Approved Disposable N95 Respirators; Respirator Use Questionnaire, New Orleans, Louisiana
    Source: National Institute for Occupational Safety and Health [Centers for Disease Control and Prevention] (CDC NIOSH)
    Date Published: 2015
    Format: Text
    Annotation: The National Institute for Occupational Safety and Health (NIOSH) is working with people on behalf of the State of Louisiana to encourage and explore public use of masks and respirators. This survey targets those who have experienced hurricanes living in New Orleans. Questions relate to disaster experience, health, visual evaluation, and demographics. NIOSH aims to promote cautionary tools such as masks among certain populations to minimize public inhalation of mold and other contaminants. This resource was identified by the NIH Disaster Research Response Program (DR2) for researchers looking for pre- and post-disaster data collection instruments.

    Ease of Use in Disaster Setting: Easy
    Flesch-Kincaid Reading Level: 6.1
    Population: High Risk/Special/Unique Populations
    Length: 23 questions
    Administered by: Lay Interviewer
    Language(s): English    ...[See more] [See less]
    URL: https://www.nlm.nih.gov/dimrc/Respirator_Use_Questionnaire_New_Orleans.doc
    Type: Guideline/Assessment Tool
    Access Notes: Contact information:
    Centers for Disease Control and Prevention, 800-CDC-INFO.
    Includes Research Tools: Yes.
    ID: 11420. From: Disaster Lit®a database of the U.S. National Library of Medicine.
  2. Proximity to Natural Gas Wells and Reported Health Status: Results of a Household Survey in Washington County, Pennsylvania
    Source: National Institute of Environmental Health Sciences [National Institutes of Health] (NIEHS)
    Date Published: 8/2014
    Format: PDF
    Annotation: This Community Assessment for Public Health Emergency Response (CASPER) questionnaire was used in a community near natural gas wells in Pennsylvania. This assessment of reported health symptoms and health status is based on questions drawn from publicly available surveys. Symptom questions, covering a range of organ systems that had been mentioned in published reports, asked respondents whether they or any household members had experienced each condition during the past year. The health assessment also asked a number of general yes/no questions about concerns of environmental hazards in the community, such as whether respondents were satisfied with air quality, water quality, soil quality, environmental noise, odors, and traffic, but did not specifically mention natural gas wells, hydraulic fracturing, or other natural gas extraction activities. The survey was pretested with focus groups in the study area in collaboration with a community-based group and revised to ensure comprehensibility of questions. This resource was identified by the NIH Disaster Research Response Program (DR2) for researchers looking for pre- and post-disaster data collection instruments.

    Ease of Use in Disaster Setting: Easy
    Flesch-Kincaid Reading Level: 5.7
    Population: Residential/Workplace
    Length: 78 questions
    Administered by: Lay Interviewer
    Language(s): English    ...[See more] [See less]
    URL: https://ehp.niehs.nih.gov/doi/10.1289/ehp.1307732
    Type: Guideline/Assessment Tool
    Access Notes: Free/Publicly Available

    Citation(s):
    Rabinowitz PM, Slizovskiy IB, Lamers V, Trufan SJ, Holford TR, Dziura JD, Peduzzi PN, Kane MJ, Reif JS, Weiss TR, Stowe MH. Proximity to natural gas wells and reported health status: results of a household survey in Washington County, Pennsylvania. Environ Health Perspect. 2015 Jan;123(1):21-6. PubMed PMID: 25204871. https://www.ncbi.nlm.nih.gov/pubmed/25204871. Subscription not required.

    Contact information:

    Contact person: P.M. Rabinowitz
    Institution: University of Washington School of Public Health, Department of Environmental and Occupational Health
    Address: 1959 NE Pacific St., F551 Health Sciences Center, Box 357234, Seattle, WA 98195
    Phone: 206-685-2654
    E-mail: peterr7@uw.edu
    Includes Research Tools: Yes.
    ID: 12943. From: Disaster Lit®a database of the U.S. National Library of Medicine.
  3. Community Health Assessment Following Mercaptan Spill: Appendices A, B, C, and D
    Source: Centers for Disease Control and Prevention, National Center for Environmental Health (CDC NCEH)
    Date Published: 11/30/2012
    Format: PDF
    Annotation: This Community Assessment for Public Health Emergency Response (CASPER) questionnaire was used in a community following a Mercaptan spill in Alabama. Prior to each interview, the teams completed a tracking form (Appendix A) to record the outcome of every interview attempt. This information served as the basis for calculating the response rates. In the event that field teams encountered a household with urgent needs that presented an immediate threat to life or health, they were to encourage or assist the household to call emergency services (911). In the event that calling 911 was not appropriate, the teams would complete a confidential referral form (Appendix B). After gaining verbal consent (Appendix C), one eligible household member (18 years of age or older) from the family was selected to speak for all household members when responding to the questionnaire (Appendix D). Appendices A, B, C, and D can be found on pages 28 to 41 of the resource. This resource was identified by the NIH Disaster Research Response Program (DR2) for researchers looking for pre- and post-disaster data collection instruments.

    Ease of Use in Disaster Setting: Easy
    Flesch-Kincaid Reading Level: 6.8
    Population: Residential/Workplace
    Length: 28 questions
    Administered by: Lay Interviewer
    Language(s): English    ...[See more] [See less]
    URL: http://www.adph.org/tox/assets/Eight_Mile_Mercaptan.pdf
    Type: Guideline/Assessment Tool
    Access Notes: Free/Publicly Available

    Citation(s):
    Behbod MB, Parker EM, Jones EA, Bayleyegn T, Guarisco J, Morrison M, McIntyre MG, Knight M. Eichold B and Yip F. Community health assessment following mercaptan spill: Eight Mile, Mobile County, Alabama, September 2012, J Public Health Management Practice, 2014, 20(6), 632-639. PubMed PMID: 24253404. https://www.ncbi.nlm.nih.gov/pubmed/24253404. Subscription not required.

    Contact information:

    Organization: Alabama Department of Public Health, Division of Infectious Diseases and Outbreaks, Bureau of Communicable Disease
    Address: RSA Tower, 201 Monroe Street, Suite 1450, Montgomery, AL 36104
    Phone: 334-206-5971; After hours (24/7): 1-800-338-8374
    Fax: 334-206-3734

    Link to Appendix D:

    Appendix D: Household Questionnaire, MS Word
    PDF

    Includes Research Tools: Yes.
    ID: 12942. From: Disaster Lit®a database of the U.S. National Library of Medicine.
  4. NIOSH (National Institute for Occupational Safety and Health) Alert: Preventing Occupational Respiratory Disease from Exposures Caused by Dampness in Office Buildings, Schools, and Other Nonindustrial Buildings
    Source: National Institute for Occupational Safety and Health [Centers for Disease Control and Prevention] (CDC NIOSH)
    Date Published: 11/2012
    Format: PDF
    Annotation: This 28-page document describes the respiratory problems that occupants may experience from exposures in damp buildings, presents summary information on outbreaks of building-related respiratory disease, and provides recommendations on how to identify, respond to, and prevent building dampness and related respiratory symptoms and disease....[See more] [See less]
    URL: https://www.cdc.gov/niosh/docs/2013-102/
    Type: Guideline/Assessment Tool
    Access Notes: Direct link to document: https://www.cdc.gov/niosh/docs/2013-102/pdfs/2013-102.pdf
    ID: 11378. From: Disaster Lit®a database of the U.S. National Library of Medicine.
  5. NIOSH (National Institute for Occupational Safety and Health) Alert: Preventing Occupational Respiratory Disease from Exposures Caused by Dampness in Office Buildings, Schools, and Other Nonindustrial Buildings: Appendix A: Building Inspection Checklist
    Source: National Institute for Occupational Safety and Health [Centers for Disease Control and Prevention] (CDC NIOSH)
    Date Published: 11/2012
    Format: PDF
    Annotation: Research studies show that exposures to building dampness and mold are associated with respiratory symptoms such as asthma, hypersensitivity, and other health impacts. These subsequent illnesses occur in part from a lack of knowledge and understanding of the nature and severity resulting from dampness and mold in buildings. This checklist, located in Appendix A, pages 19-21, describes methods for identifying evidence of leaks or dampness that can be addressed before extensive damage occurs. This resource was identified by the NIH Disaster Research Response Program (DR2) for researchers looking for pre- and post-disaster data collection instruments.


    Ease of Use in Disaster Setting: Moderate
    Flesch-Kincaid Reading Level: n/a
    Population: Adults only
    Length: 34 questions
    Administered by: Specialist/Doctor/Expert
    Language(s): English    ...[See more] [See less]
    URL: https://www.cdc.gov/niosh/docs/2013-102/
    Type: Guideline/Assessment Tool
    Access Notes: Free/Publicly Available

    Citation:

    U.S. Environmental Protection Agency. Indoor Air Quality: Tools for Schools: Action Kit. Washington, DC; Reston, VA; Chicago, IL; New York, N.Y. 1995. No subscription required.

    Contact information:

    Institution: Centers for Disease Control and Prevention
    Phone: 800-CDC-INFO
    Includes Research Tools: Yes.
    ID: 11428. From: Disaster Lit®a database of the U.S. National Library of Medicine.
  6. PILOT Study: Dampness and Mold Assessment Tool Instructions Packet
    Source: National Institute for Occupational Safety and Health [Centers for Disease Control and Prevention] (CDC NIOSH)
    Date Published: 2011
    Format: PDF
    Annotation: This observational assessment tool was developed by the National Institute for Occupational Safety and Health (NIOSH) to gauge signs of dampness, water damage, mold growth, and musty odors in rooms and areas throughout a building. The information collected aims to provide valuable data for motivating remediation, prioritizing intervention, and evaluating remediation effectiveness. This packet describes step-by-step instructions to identify and record areas of dampness or mold, trigger early repair, create awareness of potential problem areas, and track or monitor past and present areas of focus. This resource was identified by the NIH Disaster Research Response Program (DR2) for researchers looking for pre- and post-disaster data collection instruments.

    Ease of Use in Disaster Setting: Easy
    Flesch-Kincaid Reading Level: 3.6
    Population: Residential/Workplace, All/Anyone
    Length:
    Administered by: Self Administered/Self Report
    Language(s): English    ...[See more] [See less]
    URL: https://maineindoorair.org/Assessment%20Tool%20Instructions%20Packet%2011-3-11.pdf
    Type: Guideline/Assessment Tool
    Access Notes: Free/Publicly Available

    Citations:
    Park JH, Schleiff PL, Attfield MD, Cox Ganser JM, Kreiss K. Building-related respiratory symptoms can be predicted with semi-quantitative indices of exposure to dampness and mold. Indoor Air. 2004; 14:425 - 433. PubMed PMID: 15500636. https://www.ncbi.nlm.nih.gov/pubmed/15500636. Subscription required.

    Cox-Ganser JM, Rao CY, Park JH, Schumpert JC, Kreiss K. Asthma and respiratory symptoms in hospital workers related to dampness and biological contaminants. Indoor Air. 2009; 19(4):280-290. PubMed PMID: 19500175. https://www.ncbi.nlm.nih.gov/pubmed/19500175. Subscription required.

    Contact information:

    Contact person: Michelle Martin
    Institution: NIOSH
    Phone: 304-285-5734

    Institution: Centers for Disease Control and Prevention
    Email: moldsheet#1@cdc.gov

    This link is no longer available. 3/14/2018.
    Includes Research Tools: Yes.
    ID: 11427. From: Disaster Lit®a database of the U.S. National Library of Medicine.
  7. Neurotoxin Questionnaire (Autonomic Nervous System)
    Source: National Integrated Health Associates (NIHA)
    Date Published: 2009
    Format: PDF
    Annotation: The Neurotoxin Questionnaire is a dysautonomia questionnaire approved for use in a Food and Drug Administration study on mercury toxicity, developed by Dr. Dietrich Klinghardt and Dr. Paula Bickel. This screening instrument highlights the wide range of symptoms and organs that can be affected by heavy metal toxicity, toxic chemicals, chronic infections, and anything else that affects the functional nervous system. This resource was identified by the NIH Disaster Research Response Program (DR2) for researchers looking for pre- and post-disaster data collection instruments.

    Ease of Use in Disaster Setting: Easy
    Population: Adults only
    Length: 18 questions
    Administered by: Self Administered/Self Report
    Language(s): English    ...[See more] [See less]
    URL: https://www.nihadc.com/library/detox-for-life-class-2-addit-resources/56-7-neurotoxin-questionnaire/file.html?accept_license=1
    Type: Guideline/Assessment Tool
    Access Notes: Free/Publicly Available

    Citation(s):
    Thordardottir EB, Valdimarsdottir UA, Hansdottir I, Resnick H, Shipherd JC, Gudmundsdottir B. Post-traumatic stress and other health consequences of catastrophic avalanches: A 16-year follow-up of survivors. J Anxiety Disord. 2015 May;32:103-11. doi: 10.1016/j.janxdis.2015.03.005. Epub 2015 May 4. PubMed PMID: 25935315. https://www.ncbi.nlm.nih.gov/pubmed/25935315. Subscription required.

    Contact information:

    Institution: National Integrated Health Associates
    Address: 5225 Wisconsin Ave., Suite 402, Washington DC, 20015
    Phone: 202-237-7000
    Web: https://www.nihadc.com
    Includes Research Tools: Yes.
    ID: 12922. From: Disaster Lit®a database of the U.S. National Library of Medicine.
  8. Appendix D: Recognition and Management of Mold-Related Illness: Table B: Questions for Patients with Common Symptoms; Table C: Environmental Questionnaire; Table D: Current Symptoms
    Source: U Conn Health
    Format: PDF
    Annotation: University of Connecticut Health Center, Division of Occupational and Environmental Medicine, Center for Indoor Environments and Health has mold questionnaires in Tables B, C, and D of Appendix D (page D-1) of "Guidance for Clinicians on the Recognition and Management of Health Effects related to Mold Exposure and Moisture Indoors." Questionnaires in the tables consist of a general health history, items pertaining to possible symptoms, work/residence settings and locations for the respondent, potential exposures, and diagnostic assessment. Table B: Questions for Patients with Common Symptoms is on page D-3. Table C: Environmental Questionnaire is on page D-4. Table D: Current Symptoms: History and Relationship to Home, Work, or School (For Patients in which a Potential Exposure to Mold Exists) is on page D-6. This resource was identified by the NIH Disaster Research Response Program (DR2) for researchers looking for pre- and post-disaster data collection instruments.

    Ease of Use in Disaster Setting: Moderate
    Population: Residential/Workplace
    Length: 50 questions
    Administered by: Self Administered/Self Report
    Language(s): English    ...[See more] [See less]
    URL: https://health.uconn.edu/occupational-environmental/wp-content/uploads/sites/25/2015/12/mold_guide.pdf
    Type: Guideline/Assessment Tool
    Access Notes: Free/Publicly Available

    Citation(s):
    Storey E, Dangman KH, Schenck P. Guidance for clinicians on the recognition and management of health effects related to mold exposure and moisture indoors. Farmington, CT: University of Connecticut Health Center, Division of Occupational and Environmental Medicine, Center for Indoor Environments and Health. 2004.
    http://doem.uchc.edu/consultation_outreach/indoor_environments/pdfs/mold_guide.pdf

    Contact information:

    Institution: University of Connecticut Health Center
    Center for Indoor Environments and Health
    Address: 263 Farmington Avenue
    Farmington, CT 06030-6210
    Web: http://doem.uchc.edu/consultation_outreach/indoor_environments/

    Tables B, C, and D of Appendix D (page D-1) of "Guidance for Clinicians on the Recognition and Management of Health Effects related to Mold Exposure and Moisture Indoors."

    MS Word
    PDF

    Includes Research Tools: Yes.
    ID: 7815. From: Disaster Lit®a database of the U.S. National Library of Medicine.
  9. QEESI (Quick Environmental Exposure and Sensitivity Inventory)
    Source: University of Texas McGovern Medical School
    Format: PDF
    Annotation: This validated questionnaire, the Quick Environmental Exposure and Sensitivity Inventory, or QEESI©, also known as the "TILT Test," helps researchers, doctors, and their patients identify individuals with multiple chemical intolerances. The QEESI was developed as a screening questionnaire for multiple chemical intolerances (MCI). The instrument has four scales: Symptom Severity, Chemical Intolerances, Other Intolerances, and Life Impact. It can be used to assess the onset of new or intensified symptoms following an event. This resource was identified by the NIH Disaster Research Response Program (DR2) for researchers looking for pre- and post-disaster data collection instruments.

    Ease of Use in Disaster Setting: Moderate
    Population: Adults Only
    Length: 50 questions
    Administered by: Self Administered/Self Report
    Language(s): English, German, Danish, Swedish, Japanese, French, and Korean    ...[See more] [See less]
    URL: http://drclaudiamiller.com/wp-content/uploads/2012/01/qeesi.pdf
    Type: Guideline/Assessment Tool
    Access Notes: Permission/Request required

    Citation(s):
    Miller CS, Prihoda TJ. The Environmental Exposure and Sensitivity Inventory (EESI): a standardized approach for measuring chemical intolerances for research and clinical applications. Toxicol Ind Health. 1999 Apr-Jun;15(3-4):370-85. PubMed PMID: 10416289. https://www.ncbi.nlm.nih.gov/pubmed/10416289. Subscription required.

    Hojo S, Kumano H, Yoshino H, Kakuta K, Ishikawa S. Application of Quick Environment Exposure Sensitivity Inventory (QEESI) for Japanese population: study of reliability and validity of the questionnaire. Toxicol Ind Health. 2003 Jul;19(2-6):41-9. PubMed PMID: 15697173. https://www.ncbi.nlm.nih.gov/pubmed/15697173. Subscription required.

    Nordin S, Andersson L. Evaluation of a Swedish version of the Quick Environmental Exposure and Sensitivity Inventory. Int Arch Occup Environ Health. 2010 Jan;83(1):95-104. doi: 10.1007/s00420-009-0427-4. Epub 2009 May 26. PubMed PMID: 19468745.
    https://www.ncbi.nlm.nih.gov/pubmed/19468745. Subscription required.

    Skovbjerg S, Berg ND, Elberling J, Christensen KB. Evaluation of the quick environmental exposure and sensitivity inventory in a Danish population. J Environ Public Health. 2012;2012:304314. doi: 10.1155/2012/304314. Epub 2012 Jan PubMed PMID: 22529872; PubMed Central PMCID: PMC3317206. https://www.ncbi.nlm.nih.gov/pubmed/22529872. Subscription not required.

    QEESI is free of charge, but researchers must contact Dr. Claudia Miller for permission to use the QEESI© in their studies.

    Contact information:
    Contact person: Dr. Claudia Miller, Professor
    Institution: University of Texas School of Medicine at San Antonio
    Department of Family and Community Medicine
    Address: 7703 Floyd Curl Drive
    San Antonio, TX 78229-3900
    Phone: 210-562-6550
    Fax: 210-562-6552
    Email: MillerCS@uthscsa.edu
    Web: http://drclaudiamiller.com/
    Includes Research Tools: Yes.
    ID: 7816. From: Disaster Lit®a database of the U.S. National Library of Medicine.
  10. Appendix E. NHEXAS (National Human Exposure Assessment Survey) Questionnaires
    Source: U.S. Environmental Protection Agency (EPA)
    Format: PDF
    Annotation: The Environmental Protection Agency (EPA) National Human Exposure Assessment Survey (NHEXAS) is conducted as four projects by researchers in the academic, private, and governmental areas of science collaborating to coordinate studies that share a common questionnaire on activity and sociodemographics, examine the same exposure sources, and send samples for analysis to the same laboratory. The studies are unique in the degree of characterization of exposures of individuals. Multiple chemicals, chemical classes, and exposure pathways and routes are examined for each individual for each study. Studies measure pollutant concentrations in air, water, soil, dust, food, blood, urine, and hair, and on surfaces and human skin using various sampling and analytical techniques; determine direct exposure using personal exposure monitors; and estimate human activity patterns using a series of questionnaires and diaries listed below. This resource was identified by the NIH Disaster Research Response Program (DR2) for researchers looking for pre- and post-disaster data collection instruments.

    Ease of Use in Disaster Setting: Difficult
    Flesch-Kincaid Reading Level: Grade 5.4
    Population: Residential/Workplace
    Length: 118 multi-part questions. Six sections within questionnaire: Descriptive (10 questions), Baseline (44 questions), Time Diary and Activity (28 questions), Technician Walk-Through (11 questions), Followup (11 questions), and 24-Hour Food Diary (14 questions)
    Administered by: Trained Lay Examiner/Interviewer Administration
    Language(s): English    ...[See more] [See less]
    URL: https://nepis.epa.gov/Exe/ZyPURL.cgi?Dockey=P1007PCS.TXT
    Type: Guideline/Assessment Tool
    Access Notes: Free/Publicly Available

    Citation(s):
    Pellizzari E, Lioy P, Quackenboss J, Whitmore R, Clayton A, Freeman N, Waldman J, Thomas K, Rodes C, Wilcosky T. Population-based exposure measurements in EPA region 5: a phase I field study in support of the National Human Exposure Assessment Survey. J Expo Anal Environ Epidemiol. 1995 Jul-Sep;5(3):327-58. Erratum in: J Expo Anal Environ Epidemiol 1995 Oct-Dec;5(4):583. PubMed PMID: 8814775.
    https://www.ncbi.nlm.nih.gov/pubmed/8814775. Print only.

    Clayton CA, Pellizzari ED, Whitmore RW, Perritt RL, Quackenboss JJ. National Human Exposure Assessment Survey (NHEXAS): distributions and associations of lead, arsenic and volatile organic compounds in EPA region 5. J Expo Anal Environ Epidemiol. 1999 Sep-Oct;9(5):381-92. PubMed PMID: 10554141.
    https://www.ncbi.nlm.nih.gov/pubmed/10554141. Print only.

    National Human Exposure Assessment Survey (NHEXAS) Data Analysis Work Group
    U.S. Environmental Protection Agency
    https://nepis.epa.gov/Exe/ZyPURL.cgi?Dockey=P1007PCS.TXT

    Contact information:

    U.S. Environmental Protection Agency
    Phone: 703-347-8561
    Fax: 703-347-8691
    Email: nceadc.comment@epa.gov This link is no longer available. 8/10/2015.
    Includes Research Tools: Yes.
    ID: 7818. From: Disaster Lit®a database of the U.S. National Library of Medicine.
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