Taking an Occupational and Environmental Health History
Screening Questionnaires:
Initial History and Physical: THE BIG THREE should be integrated into your
entry level baseline history for all new patients. These questions were narrowed
down to three by the consensus of occupational physicians gathered at the
annual meeting of the Association of Occupational and Environmental Clinics.
What to do with the information generated by the patient's responses? You will
find resources at the end of the questionnaire on health hazards by occupation,
occupational activity and substances.
1. (Occupation) Describe what you do for work currently and in the past.
2. (Activities) Are there any physical activities that you do at work or away
from work now or in the past that you feel are harmful to you?
3. (Substances/Physical Hazards) Are you currently or were previously
exposed to chemicals, fumes, dusts, noise, and/or high heat at your work
or away from work? Do you think these are harming you?
Episodic Illness Visits: The same three topics should also we explored for
present illness visits (PI) as well as questions about whether others are similarly
affected:
1. Do your symptoms come on while you are- at work, at home, outside the
home? (location related)
2. Are there any activities at work, at home, in your community that
aggravates your current illness? (activity related)
3. Are there any new environmental substances at work, at home or in your
community that aggravate your present illness? (substance)
4. Do you have any colleagues (in your workplace, home or community)
complaining of the same problem?
Step Two
In Depth Questionnaire:
The CH2OPD2: This mnemonic was originally developed by The Ontario College
of Family Physicians1 and includes questions on Community - Home - Hobbies Personal - Diet - Drugs. It is more comprehensive and combines the most
prominent occupational and environmental health history models to include:
1. Recognition and Management of Pesticide Poisonings, 5th ed. by J. Routt
Reigart, and James R. Roberts. Published by the Environmental
Protection Agency, Office of Prevention, Pesticides, and Toxic
Substances. 1999, pages 18-19.
2. I PREPARE Environmental Exposure History ATSDR
3. WHACS
4. C ommunity, H ome ,H obby, O ccupation, P ersonal, D iet
D rugs. Environmental Health Clinic, Sunnybrook & Women’s College
Health Sciences Centre, Ontario College of Family Physicians compiled
by Dr. L. M. Marshall Peer Reviewed Article:
Lynn Marshall, Erica Weir, Alan Abelsohn, Margaret D. Sanborn,
Canadian Medical Association Journal 2002;166(8):1049-55
5. Pediatric Environmental History (0-18 Years of Age) The Screening
Environmental History, National Environmental Education Training
Foundation The Screening Environmental History is taken in part from
the following sources:http://www.neetf.org/Health/PEHI.htm
6. Exposure History Form ATSDR
7. Mosby’s Guide To Physical Examination,6th ed.
Step Three
Exposure History Questionnaire For Agricultural Workers:
If your patient is an agriculture worker these are important questions to ask
about exposure. Each question is attached to information about why the question
and exposure is important. You can use these for anticipatory guidance.
1
Marshall, L. Taking an Exposure History. Ontario College of Family Physicians.
http://www.cfpc.ca/english/ocfp/communications/publications/default.asp?s=1#EnvironmentHealth