Appendix 1: Worker Questionnaire QUESTIONS FOR DERMATOLOGIST REGARDING FACTORS CONTRIBUTING TO THE DEVELOPMENT OF OCCUPATIONAL CONTACT DERMATITIS Atopy Has atopy played a role in this Yes condition? No patient’s N/A (not atopic) If yes, how? Immediate i.e. contact urticaria ICD in an atopic Other: Occupational exposures Hard-to-Avoid Known (unavoidable) allergen Yes exposure No (skip to Question 5) List unavoidable allergens Which environmental factors are Sweating relevant? (circle all that apply) Dust/fibres Heat Friction or vibration Not applicable Unavoidable irritant exposure Frequent wet work (circle all that apply) Prolonged glove use Unable to wear gloves e.g. fine work, machinery etc Other: Avoidable/inappropriate Known (avoidable) allergen Yes exposure No (skip to Question 9) List avoidable allergens Is there avoidable (inappropriate) Yes exposure to wet work/other No irritants? Was there an accidental Yes exposure e.g. chemical spill? No Engineering controls Are engineering controls Yes adequate (as assessed by Dr)? No Specify details Not applicable Personal Protective Equipment (PPE) Is the PPE adequate? Specify Yes (skip to Question 14)
Appendix 1: Worker Questionnaire QUESTIONS FOR DERMATOLOGIST REGARDING FACTORS CONTRIBUTING TO THE DEVELOPMENT OF OCCUPATIONAL CONTACT DERMATITIS Atopy Has atopy played a role in this patient’s condition? Yes No N/A (not atopic) If yes, how? Immediate i.e. contact urticaria ICD in an atopic Other: Occupational exposures Hard-to-Avoid Known (unavoidable) allergen exposure Yes No (skip to Question 5) List unavoidable allergens Which environmental factors are relevant? (circle all that apply) Sweating Dust/fibres Heat Friction or vibration Not applicable Unavoidable irritant exposure (circle all that apply) Frequent wet work Prolonged glove use Unable to wear gloves e.g. fine work, machinery etc Other: Avoidable/inappropriate Known (avoidable) allergen exposure Yes No (skip to Question 9) List avoidable allergens Is there avoidable (inappropriate) exposure to wet work/other irritants? Yes No Was there an accidental exposure e.g. chemical spill? Yes No Engineering controls Are engineering controls adequate (as assessed by Dr)? Specify details Yes No Not applicable Personal Protective Equipment (PPE) Is the PPE adequate? Specify Yes (skip to Question 14)
factors-contributing-contact-dermatitis.docx