ID

27735

Descrição

The occupational health check provides information about possibly unhealthy or hazardous working conditions. In this way it can aid in the improvement of work places, the reduction of risks as well as in the early detection and prevention of work-related health problems. The aim is to ensure employability and occupational health protection. https://www.medituev.de/de/arbeitsmedizin/vorsorge/ TÜV Nord MEDITUEV. Provided by Dr. med. Rudolf Richter.

Link

https://www.medituev.de/de/arbeitsmedizin/vorsorge/

Palavras-chave

  1. 25/11/2017 25/11/2017 -
  2. 27/11/2017 27/11/2017 -
Titular dos direitos

TÜV Nord MEDITUEV

Transferido a

27 de novembro de 2017

DOI

Para um pedido faça login.

Licença

Creative Commons BY-NC 3.0

Comentários do modelo :

Aqui pode comentar o modelo. Pode comentá-lo especificamente através dos balões de texto nos grupos de itens e itens.

Comentários do grupo de itens para :

Comentários do item para :

Para descarregar formulários, precisa de ter uma sessão iniciada. Por favor faça login ou registe-se gratuitamente.

MEDITUEV Occupational health check

MEDITUEV Occupational health check

Personal data
Descrição

Personal data

Name
Descrição

Name

Tipo de dados

text

Alias
UMLS CUI [1]
C0027365
First Name
Descrição

First Name

Tipo de dados

text

Alias
UMLS CUI [1]
C1443235
Date of birth
Descrição

Date of birth

Tipo de dados

date

Alias
UMLS CUI [1]
C0421451
Birth name
Descrição

birth name

Tipo de dados

text

Alias
UMLS CUI [1]
C1549652
Street address (street/number)
Descrição

street address

Tipo de dados

text

Alias
UMLS CUI [1,1]
C1301826
UMLS CUI [1,2]
C0421449
Postal code code/place of residence
Descrição

postal code code and place of residence

Tipo de dados

text

Telephone number
Descrição

telephone number

Tipo de dados

text

Alias
UMLS CUI [1]
C1515258
Sex
Descrição

sex

Tipo de dados

text

Alias
UMLS CUI [1]
C0150831
Date of employment (month/year)
Descrição

Date of employment

Tipo de dados

text

Nationality
Descrição

Nationality

Tipo de dados

text

Alias
UMLS CUI [1]
C0027473
Employer
Descrição

Employer

Tipo de dados

text

Alias
UMLS CUI [1]
C1274022
Health insurance
Descrição

Health insurance

Tipo de dados

text

Alias
UMLS CUI [1]
C0021682
General practitioner
Descrição

General practitioner

Tipo de dados

text

Alias
UMLS CUI [1]
C0017319
Work history
Descrição

Work history

1. Profession you were trained in?
Descrição

Professional training

Tipo de dados

text

Alias
UMLS CUI [1]
C2698884
Comments of physician
Descrição

Comments of physician

Tipo de dados

text

Alias
UMLS CUI [1]
C0947611
Former occupations
Descrição

Former occupations

2. Please state any former occupations (incl. military service) that you pursued for more than one year.
Descrição

Previous occupations

Tipo de dados

text

Alias
UMLS CUI [1]
C0028811
2. Beginning (year)
Descrição

Beginning year

Tipo de dados

integer

Alias
UMLS CUI [1]
C0439659
2. End (year)
Descrição

End year

Tipo de dados

integer

Alias
UMLS CUI [1]
C0806020
Comments of physician
Descrição

Comments of physician

Tipo de dados

text

Alias
UMLS CUI [1,1]
C0947611
UMLS CUI [1,2]
C0031831
Current occupation
Descrição

Current occupation

3. Which occupation/function are you supposed to take up?
Descrição

Current occupation

Tipo de dados

text

Alias
UMLS CUI [1]
C0421456
3. Since when? (year)
Descrição

Beginning year

Tipo de dados

integer

Alias
UMLS CUI [1]
C0439659
Comments of physician
Descrição

Comments of physician

Tipo de dados

text

Alias
UMLS CUI [1]
C0947611
Working conditions
Descrição

Working conditions

4. What is your usual work place (e.g. office, workshop, warehouse, vehicle fleet, forge, foundry)?
Descrição

Workplace

Tipo de dados

text

Alias
UMLS CUI [1]
C0162579
5. Which kind of materials do you work with regularly? (e.g. metal, cement, paint, thinner, gases or other)
Descrição

Working material

Tipo de dados

text

Alias
UMLS CUI [1,1]
C0520510
UMLS CUI [1,2]
C0520510
6. Which work equipment do you use? (e.g. tools, screen, vehicle or other)
Descrição

Work equipment

Tipo de dados

text

Alias
UMLS CUI [1]
C0220824
7. Which means of protection do you use (e.g. protective helmet, ear protection, safety shoes, protective clothing)?
Descrição

Protection

Tipo de dados

text

Alias
UMLS CUI [1]
C0262668
8. Working hours
Descrição

Working hours

Tipo de dados

integer

Alias
UMLS CUI [1]
C2135639
9. Do you do shift work?
Descrição

shift work

Tipo de dados

integer

Alias
UMLS CUI [1]
C1658633
Comments of physician
Descrição

Comments of physician

Tipo de dados

text

Alias
UMLS CUI [1]
C0947611
Working capacity
Descrição

Working capacity

10. Have you ever been incapable to work for more than 14 consecutive days within the last 12 months?
Descrição

Incapacity to work

Tipo de dados

boolean

Alias
UMLS CUI [1]
C2984044
11. Do you receive a pension?
Descrição

Pension

Tipo de dados

integer

Alias
UMLS CUI [1]
C0425022
14. Do you have a certificate of disability?
Descrição

certificate of disability

Tipo de dados

integer

Alias
UMLS CUI [1]
C0018576
14. If yes, what is your degree of disability?
Descrição

degree of disability

Tipo de dados

integer

Unidades de medida
  • %
Alias
UMLS CUI [1]
C0231170
%
15. Did you change your workplace due to health-related reasons?
Descrição

health-related change of workplace

Tipo de dados

boolean

Alias
UMLS CUI [1]
C0162579
Comments of physician
Descrição

Comments of physician

Tipo de dados

text

Alias
UMLS CUI [1]
C0947611
Medical examinations
Descrição

Medical examinations

16. Did you ever undergo an occupational health check?
Descrição

Occupational health check

Tipo de dados

boolean

Alias
UMLS CUI [1]
C2973270
16. If yes, where?
Descrição

place of occupational health check

Tipo de dados

text

Alias
UMLS CUI [1,1]
C2973270
UMLS CUI [1,2]
C2986042
17. Have you been X-rayed in recent years?
Descrição

X-ray

Tipo de dados

boolean

Alias
UMLS CUI [1]
C0043309
17. If yes, which body parts?
Descrição

X-ray body part

Tipo de dados

text

Alias
UMLS CUI [1,1]
C0043309
UMLS CUI [1,2]
C0229962
Comments of physician
Descrição

Comments of physician

Tipo de dados

text

Alias
UMLS CUI [1]
C0947611
18. Which stress factors are/were you exposed to?
Descrição

18. Which stress factors are/were you exposed to?

1 Heat
Descrição

heat

Tipo de dados

text

Alias
UMLS CUI [1]
C0018837
2 Cold, wetness, moisture
Descrição

cold, wetness, moisture

Tipo de dados

text

Alias
UMLS CUI [1]
C0009264
UMLS CUI [2]
C1830752
UMLS CUI [3]
C0868994
3 Gas, fumes, dust, smell
Descrição

gas, fumes, dust, smell

Tipo de dados

text

Alias
UMLS CUI [1]
C3173714
4 Noise [more than 85 dB(A)]
Descrição

noise

Tipo de dados

text

Alias
UMLS CUI [1]
C3257923
5 Solvent
Descrição

solvent

Tipo de dados

text

Alias
UMLS CUI [1]
C0037638
6 Cooling lubricant
Descrição

Cutting oil

Tipo de dados

text

Alias
UMLS CUI [1]
C0301020
8 Pressure of time
Descrição

Pressure of time

Tipo de dados

text

Alias
UMLS CUI [1]
C0807481
9 Bad posture
Descrição

bad posture

Tipo de dados

text

Alias
UMLS CUI [1]
C1262869
10 Hard work
Descrição

hard work

Tipo de dados

text

Alias
UMLS CUI [1]
C2987222
Comments of physician
Descrição

Comments of physician

Tipo de dados

text

Alias
UMLS CUI [1]
C0947611
Work-related sources of irritation
Descrição

Work-related sources of irritation

19 Are there factors that irritate you at your workplace?
Descrição

source of irritation

Tipo de dados

text

Alias
UMLS CUI [1]
C1706307
Comments of physician
Descrição

Comments of physician

Tipo de dados

text

Alias
UMLS CUI [1]
C0947611
Please answer the following questions about your personal living conditions
Descrição

Please answer the following questions about your personal living conditions

20. Do you live together with other people?
Descrição

living with other people

Tipo de dados

integer

Alias
UMLS CUI [1]
C2135569
21. How many children do you have that live with you?
Descrição

Number of children

Tipo de dados

integer

Alias
UMLS CUI [1]
C2229974
21. Age (years)
Descrição

Please state the age of each child.

Tipo de dados

text

Alias
UMLS CUI [1,1]
C0008059
UMLS CUI [1,2]
C0001779
22. Do you smoke?
Descrição

Smoking

Tipo de dados

integer

Alias
UMLS CUI [1]
C0543414
23. Do you consume alcohol?
Descrição

Alcohol consumption

Tipo de dados

integer

Alias
UMLS CUI [1]
C0001948
24. Do you do sports?
Descrição

sports

Tipo de dados

integer

Alias
UMLS CUI [1]
C0038039
25. What do you do to benefit your health?
Descrição

actions to benefit health

Tipo de dados

text

Alias
UMLS CUI [1]
C0814225
26. Do you go to cancer screenings?
Descrição

cancer screening

Tipo de dados

boolean

Alias
UMLS CUI [1]
C0199230
26. When was the last time?
Descrição

year

Tipo de dados

integer

Alias
UMLS CUI [1]
C0199230
27.Have you ever undergone a treatment at a health resort?
Descrição

Treatment at a health resort

Tipo de dados

boolean

Alias
UMLS CUI [1]
C0018740
27. When was the last time?
Descrição

year

Tipo de dados

integer

Alias
UMLS CUI [1,1]
C0018740
UMLS CUI [1,2]
C0087111
Comments of physician
Descrição

Comments of physician

Tipo de dados

text

Alias
UMLS CUI [1]
C0947611
Are/were there any diseases in your family?
Descrição

Are/were there any diseases in your family?

Diabetes
Descrição

Diabetes

Tipo de dados

boolean

Alias
UMLS CUI [1]
C0011849
Hypertension
Descrição

Hypertension

Tipo de dados

boolean

Alias
UMLS CUI [1]
C0020538
Stroke
Descrição

Stroke

Tipo de dados

boolean

Alias
UMLS CUI [1]
C0038454
Myocardial infarction
Descrição

Myocardial infarction

Tipo de dados

boolean

Alias
UMLS CUI [1]
C0027051
Allergies/Hypersensitivity to substances, food, etc.
Descrição

Allergies

Tipo de dados

boolean

Alias
UMLS CUI [1]
C0020517
Respiratory diseases
Descrição

Respiratory diseases

Tipo de dados

boolean

Alias
UMLS CUI [1]
C0035204
Gout
Descrição

Gout

Tipo de dados

boolean

Alias
UMLS CUI [1]
C0018099
Deformities
Descrição

Deformities

Tipo de dados

boolean

Alias
UMLS CUI [1]
C0302142
Cancer
Descrição

cancer

Tipo de dados

boolean

Alias
UMLS CUI [1]
C0006826
Other diseases
Descrição

Other disease

Tipo de dados

boolean

Alias
UMLS CUI [1]
C2359476
Comments of physician
Descrição

Comments of physician

Tipo de dados

text

Alias
UMLS CUI [1,1]
C0947611
UMLS CUI [1,2]
C0031831
Please answer the following questions about your diseases and health problems
Descrição

Please answer the following questions about your diseases and health problems

1 Do you suffer from headaches frequently?
Descrição

heachaches

Tipo de dados

boolean

Alias
UMLS CUI [1]
C0018681
2 Do you suffer from lack of appetite?
Descrição

Lack of appetite

Tipo de dados

boolean

Alias
UMLS CUI [1]
C0003618
3 Do you suffer from increased thirst?
Descrição

thirst

Tipo de dados

boolean

Alias
UMLS CUI [1]
C0039971
4 Do you have sleep disturbances?
Descrição

sleep disturbances

Tipo de dados

boolean

Alias
UMLS CUI [1]
C0037317
4 If yes, do you have difficulties falling asleep?
Descrição

difficulty falling asleep

Tipo de dados

boolean

Alias
UMLS CUI [1]
C0150079
4 If yes, do you wake during the night?
Descrição

waking during the night

Tipo de dados

boolean

Alias
UMLS CUI [1]
C3175860
5 Do you have irregular bowel movements?
Descrição

irregular bowel movements

Tipo de dados

boolean

Alias
UMLS CUI [1]
C0426642
6 Do you wear glasses/contact lenses?
Descrição

glasses/contact lenses

Tipo de dados

boolean

Alias
UMLS CUI [1]
C3843284
7 Do you have an eye complaint?
Descrição

Eye complaint

Tipo de dados

boolean

Alias
UMLS CUI [1]
C0848690
8 Is your hearing impaired?
Descrição

impaired hearing

Tipo de dados

boolean

Alias
UMLS CUI [1]
C1384666
9 Do you have ear problems?
Descrição

Ear problems

Tipo de dados

boolean

Alias
UMLS CUI [1]
C0013443
12 Are you prone to diseases of the frontal sinus and the maxillary sinus of the throat?
Descrição

diseases of frontal sinus and maxillary sinus, throat

Tipo de dados

boolean

Alias
UMLS CUI [1]
C0016734
UMLS CUI [2]
C0024957
13 Do/did you have a common cold multiple times a year?
Descrição

common cold

Tipo de dados

boolean

Alias
UMLS CUI [1]
C0009443
14 Do you cough frequently (regularly every day)?
Descrição

Cough

Tipo de dados

boolean

Alias
UMLS CUI [1]
C0010200
15 Are you prone to bronchial asthma/bronchitis?
Descrição

bronchial asthma/bronchitis

Tipo de dados

boolean

Alias
UMLS CUI [1]
C0004096
17 Did you ever have pneumonia/pleurisy/tuberculosis?
Descrição

pneumonia, pleurisy, tuberculosis

Tipo de dados

boolean

Alias
UMLS CUI [1]
C0041296
UMLS CUI [2]
C0032285
UMLS CUI [3]
C0032231
18 Have you ever been diagnosed with hypertension?
Descrição

Hypertension

Tipo de dados

boolean

Alias
UMLS CUI [1]
C0020538
19 Do you suffer from dyspnea?
Descrição

dyspnea

Tipo de dados

boolean

Alias
UMLS CUI [1]
C0013404
20 Do you feel a tightness in the chest (chest pain) during physical stress?
Descrição

Chest tightness

Tipo de dados

boolean

Alias
UMLS CUI [1]
C0232292
21 Did you ever have a myocardial infarction?
Descrição

myocardial infarction

Tipo de dados

boolean

Alias
UMLS CUI [1]
C0027051
22 Do you have other cardiovascular problems?
Descrição

other cardiovascular problems

Tipo de dados

boolean

Alias
UMLS CUI [1]
C1273828
23 Are you prone to dizziness/disturbed balance?
Descrição

dizziness, disturbed balance

Tipo de dados

boolean

Alias
UMLS CUI [1]
C0012833
UMLS CUI [2]
C0575090
24 Have you been diagnosed with diabetes?
Descrição

Diabetes

Tipo de dados

boolean

Alias
UMLS CUI [1]
C0011849
25 Were your blood lipid levels ever found to be elevated?
Descrição

elevated blood lipid levels

Tipo de dados

boolean

Alias
UMLS CUI [1]
C0020473
26 Were your uric acid levels ever found to be elevated (gout)?
Descrição

elevated uric acid levels

Tipo de dados

boolean

Alias
UMLS CUI [1]
C0041980
27 Have you ever been diagnosed with a thyroid disease?
Descrição

thyroid disease

Tipo de dados

boolean

Alias
UMLS CUI [1]
C0040128
28 Do you have gastro-intestinal problems/heartburn?
Descrição

gastro-intestinal problems, heartburn

Tipo de dados

boolean

Alias
UMLS CUI [1]
C4023588
30 Do you have bilious complaints?
Descrição

biliary complaints

Tipo de dados

boolean

Alias
UMLS CUI [1,1]
C0009566
UMLS CUI [1,2]
C0521378
31 Did you ever have jaundice?
Descrição

jaundice

Tipo de dados

boolean

Alias
UMLS CUI [1]
C0022346
32 Have you been diagnosed with a liver disease?
Descrição

liver disease

Tipo de dados

boolean

Alias
UMLS CUI [1]
C0023895
33 Are you prone to uropathies (kidney, bladder)?
Descrição

uropathy

Tipo de dados

boolean

Alias
UMLS CUI [1]
C0178879
34 Do you have problems when urinating?
Descrição

problems when urinating

Tipo de dados

boolean

Alias
UMLS CUI [1]
C0013428
35 Do you have hemorrhoids?
Descrição

hemorrhoids

Tipo de dados

boolean

Alias
UMLS CUI [1]
C0019112
36 Dou you have varices?
Descrição

varices

Tipo de dados

boolean

Alias
UMLS CUI [1]
C0042345
37 Do you have back pain?
Descrição

back pain

Tipo de dados

boolean

Alias
UMLS CUI [1]
C0004604
37 If yes, where? - 1 cervical spine/neck
Descrição

cervical spine or neck pain

Tipo de dados

text

Alias
UMLS CUI [1]
C0007859
37 If yes, where? - 2 thoracic spine
Descrição

thoracic spine pain

Tipo de dados

text

Alias
UMLS CUI [1]
C0423673
37 If yes, where? - 3 lumbar spine/lower back
Descrição

lumbar spine or lower back pain

Tipo de dados

text

Alias
UMLS CUI [1]
C0024091
38 Do you suffer from lumbago (sciatica)?
Descrição

lumbago

Tipo de dados

boolean

Alias
UMLS CUI [1]
C0948852
39 Did you have a herniated disk?
Descrição

herniated disk

Tipo de dados

boolean

Alias
UMLS CUI [1]
C0021818
40 Do you have pain in any joints or limbs?
Descrição

joint pain/limb pain

Tipo de dados

boolean

Alias
UMLS CUI [1]
C0003862
41 Do you have a seizure disorder?
Descrição

seizure disorder

Tipo de dados

boolean

Alias
UMLS CUI [1]
C0014544
42 Do you have a neurological/psychiatric disease?
Descrição

neurological/psychiatric disease

Tipo de dados

boolean

Alias
UMLS CUI [1]
C0027765
43 Are you prone to dermatoses?
Descrição

dermatosis

Tipo de dados

boolean

Alias
UMLS CUI [1]
C0037274
44 Do you suffer from allergies?
Descrição

Allergies

Tipo de dados

boolean

Alias
UMLS CUI [1]
C0020517
45 Do you have hay fever?
Descrição

hay fever

Tipo de dados

boolean

Alias
UMLS CUI [1]
C0018621
46 Did you have any bone fractures?
Descrição

bone fractures

Tipo de dados

boolean

Alias
UMLS CUI [1]
C0016663
47 Did you have an accident that led to any permanent damage?
Descrição

permanent damage due to accident

Tipo de dados

boolean

Alias
UMLS CUI [1]
C3640792
Comments of physician
Descrição

Comments of physician

Tipo de dados

text

Alias
UMLS CUI [1]
C0947611
Surgeries
Descrição

Surgeries

48. Did you ever undergo surgery?
Descrição

Surgery

Tipo de dados

boolean

Alias
UMLS CUI [1]
C0543467
1 Heart
Descrição

Heart surgery

Tipo de dados

boolean

Alias
UMLS CUI [1]
C0018821
2 Kidney
Descrição

Kidney surgery

Tipo de dados

boolean

Alias
UMLS CUI [1]
C0194053
3 Gallbladder
Descrição

Gallbladder surgery

Tipo de dados

boolean

Alias
UMLS CUI [1]
C0744263
4 Hernia
Descrição

hernia surgery

Tipo de dados

boolean

Alias
UMLS CUI [1]
C0019270
5 Stomach
Descrição

stomach surgery

Tipo de dados

boolean

Alias
UMLS CUI [1]
C0198482
7 Bone
Descrição

bone surgery

Tipo de dados

boolean

Alias
UMLS CUI [1]
C0262950
8 Other surgery
Descrição

other surgery

Tipo de dados

boolean

Alias
UMLS CUI [1]
C0543467
Comments of physician
Descrição

Comments of physician

Tipo de dados

text

Alias
UMLS CUI [1]
C0947611
Dental/medical treatment
Descrição

Dental/medical treatment

49. Are you currently under dental/medical treatment?
Descrição

dental/medical treatment

Tipo de dados

boolean

Alias
UMLS CUI [1]
C0011331
49. If yes, why?
Descrição

dental/medical treatment reason

Tipo de dados

text

Alias
UMLS CUI [1,1]
C0011331
UMLS CUI [1,2]
C0392360
Comments of physician
Descrição

Comments of physician

Tipo de dados

text

Alias
UMLS CUI [1]
C0947611
Vaccination
Descrição

Vaccination

50. Are you vaccinated against tetanus?
Descrição

tetanus vaccination

Tipo de dados

boolean

Alias
UMLS CUI [1]
C0199807
50. When?
Descrição

year

Tipo de dados

integer

Alias
UMLS CUI [1]
C0199807
Comments of physician
Descrição

Comments of physician

Tipo de dados

text

Alias
UMLS CUI [1]
C0947611
Current medication
Descrição

Current medication

51. Are you taking any medication of at least one of the following types (mutiple selections possible)?
Descrição

Current medication

Tipo de dados

boolean

Alias
UMLS CUI [1]
C1553892
1 Medication for headache
Descrição

medication for headache

Tipo de dados

boolean

Alias
UMLS CUI [1,1]
C0018681
UMLS CUI [1,2]
C0013227
2 Pain medication
Descrição

pain medication

Tipo de dados

boolean

Alias
UMLS CUI [1]
C0002771
3 Cardiovascular agents
Descrição

Cardiovascular agents

Tipo de dados

boolean

Alias
UMLS CUI [1]
C0007220
4 Laxatives
Descrição

laxatives

Tipo de dados

boolean

Alias
UMLS CUI [1]
C0282090
5 Tranquilizer
Descrição

Tranquilizer

Tipo de dados

boolean

Alias
UMLS CUI [1]
C0040614
6 Sleeping pills
Descrição

sleeping pills

Tipo de dados

boolean

Alias
UMLS CUI [1]
C0599396
7 Stomachic
Descrição

stomachic

Tipo de dados

boolean

Alias
UMLS CUI [1]
C0013227
8 Bronchial medication
Descrição

Bronchial medication

Tipo de dados

boolean

Alias
UMLS CUI [1]
C0205039
9 Other medication
Descrição

other medication

Tipo de dados

boolean

Alias
UMLS CUI [1]
C0013227
9 Which other medication?
Descrição

other medicaton specification

Tipo de dados

text

Alias
UMLS CUI [1]
C0013227
Comments of physician
Descrição

Comments of physician

Tipo de dados

text

Alias
UMLS CUI [1]
C0947611
Miscellaneous
Descrição

Miscellaneous

52. Other complaints
Descrição

Other complaints

Tipo de dados

text

Alias
UMLS CUI [1]
C0871764
53. Are you pregnant?
Descrição

Pregnancy

Tipo de dados

boolean

Alias
UMLS CUI [1]
C0032961
54. Do you undergo gynecological screenings regularly?
Descrição

Gynecological screening

Tipo de dados

boolean

Alias
UMLS CUI [1]
C0200044
Comments of physician
Descrição

Comments of physician

Tipo de dados

text

Alias
UMLS CUI [1]
C0947611
General comments
Descrição

General comments

Tipo de dados

text

Alias
UMLS CUI [1]
C0947611

Similar models

MEDITUEV Occupational health check

Name
Tipo
Description | Question | Decode (Coded Value)
Tipo de dados
Alias
Item Group
Personal data
Name
Item
Name
text
C0027365 (UMLS CUI [1])
First Name
Item
First Name
text
C1443235 (UMLS CUI [1])
Date of birth
Item
Date of birth
date
C0421451 (UMLS CUI [1])
birth name
Item
Birth name
text
C1549652 (UMLS CUI [1])
street address
Item
Street address (street/number)
text
C1301826 (UMLS CUI [1,1])
C0421449 (UMLS CUI [1,2])
postal code code and place of residence
Item
Postal code code/place of residence
text
telephone number
Item
Telephone number
text
C1515258 (UMLS CUI [1])
Item
Sex
text
C0150831 (UMLS CUI [1])
Code List
Sex
CL Item
female (female)
(Comment:en)
CL Item
male (male)
(Comment:en)
Date of employment
Item
Date of employment (month/year)
text
Nationality
Item
Nationality
text
C0027473 (UMLS CUI [1])
Employer
Item
Employer
text
C1274022 (UMLS CUI [1])
Health insurance
Item
Health insurance
text
C0021682 (UMLS CUI [1])
General practitioner
Item
General practitioner
text
C0017319 (UMLS CUI [1])
Item Group
Work history
Professional training
Item
1. Profession you were trained in?
text
C2698884 (UMLS CUI [1])
Comments of physician
Item
Comments of physician
text
C0947611 (UMLS CUI [1])
Item Group
Former occupations
Previous occupations
Item
2. Please state any former occupations (incl. military service) that you pursued for more than one year.
text
C0028811 (UMLS CUI [1])
Beginning year
Item
2. Beginning (year)
integer
C0439659 (UMLS CUI [1])
End year
Item
2. End (year)
integer
C0806020 (UMLS CUI [1])
Comments of physician
Item
Comments of physician
text
C0947611 (UMLS CUI [1,1])
C0031831 (UMLS CUI [1,2])
Item Group
Current occupation
Current occupation
Item
3. Which occupation/function are you supposed to take up?
text
C0421456 (UMLS CUI [1])
Beginning year
Item
3. Since when? (year)
integer
C0439659 (UMLS CUI [1])
Comments of physician
Item
Comments of physician
text
C0947611 (UMLS CUI [1])
Item Group
Working conditions
Workplace
Item
4. What is your usual work place (e.g. office, workshop, warehouse, vehicle fleet, forge, foundry)?
text
C0162579 (UMLS CUI [1])
Working material
Item
5. Which kind of materials do you work with regularly? (e.g. metal, cement, paint, thinner, gases or other)
text
C0520510 (UMLS CUI [1,1])
C0520510 (UMLS CUI [1,2])
Work equipment
Item
6. Which work equipment do you use? (e.g. tools, screen, vehicle or other)
text
C0220824 (UMLS CUI [1])
Protection
Item
7. Which means of protection do you use (e.g. protective helmet, ear protection, safety shoes, protective clothing)?
text
C0262668 (UMLS CUI [1])
Item
8. Working hours
integer
C2135639 (UMLS CUI [1])
Code List
8. Working hours
CL Item
normal (1)
CL Item
part-time (2)
CL Item
often overtime (3)
CL Item
hours per week (4)
Item
9. Do you do shift work?
integer
C1658633 (UMLS CUI [1])
Code List
9. Do you do shift work?
CL Item
no (1)
C1298908 (UMLS CUI-1)
(Comment:de)
CL Item
early shift and late shift (2)
C0425104 (UMLS CUI-1)
(Comment:de)
CL Item
alternate shift incl. night shift (3)
C1660631 (UMLS CUI-1)
(Comment:de)
CL Item
night shift only (4)
C1660631 (UMLS CUI-1)
(Comment:de)
Comments of physician
Item
Comments of physician
text
C0947611 (UMLS CUI [1])
Item Group
Working capacity
Incapacity to work
Item
10. Have you ever been incapable to work for more than 14 consecutive days within the last 12 months?
boolean
C2984044 (UMLS CUI [1])
Item
11. Do you receive a pension?
integer
C0425022 (UMLS CUI [1])
Code List
11. Do you receive a pension?
CL Item
no (1)
CL Item
yes (2)
CL Item
requested (3)
Item
14. Do you have a certificate of disability?
integer
C0018576 (UMLS CUI [1])
Code List
14. Do you have a certificate of disability?
CL Item
no (1)
CL Item
yes (2)
CL Item
requested (3)
degree of disability
Item
14. If yes, what is your degree of disability?
integer
C0231170 (UMLS CUI [1])
health-related change of workplace
Item
15. Did you change your workplace due to health-related reasons?
boolean
C0162579 (UMLS CUI [1])
Comments of physician
Item
Comments of physician
text
C0947611 (UMLS CUI [1])
Item Group
Medical examinations
Occupational health check
Item
16. Did you ever undergo an occupational health check?
boolean
C2973270 (UMLS CUI [1])
place of occupational health check
Item
16. If yes, where?
text
C2973270 (UMLS CUI [1,1])
C2986042 (UMLS CUI [1,2])
X-ray
Item
17. Have you been X-rayed in recent years?
boolean
C0043309 (UMLS CUI [1])
X-ray body part
Item
17. If yes, which body parts?
text
C0043309 (UMLS CUI [1,1])
C0229962 (UMLS CUI [1,2])
Comments of physician
Item
Comments of physician
text
C0947611 (UMLS CUI [1])
Item Group
18. Which stress factors are/were you exposed to?
Item
1 Heat
text
C0018837 (UMLS CUI [1])
Code List
1 Heat
CL Item
no (no)
CL Item
sometimes (sometimes)
CL Item
constantly (constantly)
Item
2 Cold, wetness, moisture
text
C0009264 (UMLS CUI [1])
C1830752 (UMLS CUI [2])
C0868994 (UMLS CUI [3])
Code List
2 Cold, wetness, moisture
CL Item
no (no)
CL Item
sometimes (sometimes)
CL Item
constantly (constantly)
Item
3 Gas, fumes, dust, smell
text
C3173714 (UMLS CUI [1])
Code List
3 Gas, fumes, dust, smell
CL Item
no (no)
CL Item
sometimes (sometimes)
CL Item
constantly (constantly)
Item
4 Noise [more than 85 dB(A)]
text
C3257923 (UMLS CUI [1])
Code List
4 Noise [more than 85 dB(A)]
CL Item
no (no)
CL Item
sometimes (sometimes)
CL Item
constantly (constantly)
Item
5 Solvent
text
C0037638 (UMLS CUI [1])
Code List
5 Solvent
CL Item
no (no)
CL Item
sometimes (sometimes)
CL Item
constantly (constantly)
Item
6 Cooling lubricant
text
C0301020 (UMLS CUI [1])
Code List
6 Cooling lubricant
CL Item
no (no)
CL Item
sometimes (sometimes)
CL Item
constantly (constantly)
Item
8 Pressure of time
text
C0807481 (UMLS CUI [1])
Code List
8 Pressure of time
CL Item
no (no)
CL Item
sometimes (sometimes)
CL Item
constantly (constantly)
Item
9 Bad posture
text
C1262869 (UMLS CUI [1])
Code List
9 Bad posture
CL Item
no (no)
CL Item
sometimes (sometimes)
CL Item
constantly (constantly)
Item
10 Hard work
text
C2987222 (UMLS CUI [1])
Code List
10 Hard work
CL Item
no (no)
CL Item
sometimes (sometimes)
CL Item
constantly (constantly)
Comments of physician
Item
Comments of physician
text
C0947611 (UMLS CUI [1])
Item Group
Work-related sources of irritation
source of irritation
Item
19 Are there factors that irritate you at your workplace?
text
C1706307 (UMLS CUI [1])
Comments of physician
Item
text
C0947611 (UMLS CUI [1])
Item Group
Please answer the following questions about your personal living conditions
Item
20. Do you live together with other people?
integer
C2135569 (UMLS CUI [1])
Code List
20. Do you live together with other people?
CL Item
living in a familiy/community (1)
C0557130 (UMLS CUI-1)
(Comment:de)
CL Item
living alone (2)
C0439044 (UMLS CUI-1)
(Comment:de)
CL Item
Answer refused (3)
C0947611 (UMLS CUI-1)
(Comment:de)
Number of children
Item
21. How many children do you have that live with you?
integer
C2229974 (UMLS CUI [1])
Age of children
Item
21. Age (years)
text
C0008059 (UMLS CUI [1,1])
C0001779 (UMLS CUI [1,2])
Item
22. Do you smoke?
integer
C0543414 (UMLS CUI [1])
Code List
22. Do you smoke?
CL Item
no (1)
CL Item
yes (2)
CL Item
not anymore (3)
Item
23. Do you consume alcohol?
integer
C0001948 (UMLS CUI [1])
Code List
23. Do you consume alcohol?
CL Item
no (1)
CL Item
yes (2)
CL Item
sometimes (3)
CL Item
daily (4)
Item
24. Do you do sports?
integer
C0038039 (UMLS CUI [1])
Code List
24. Do you do sports?
CL Item
no (1)
CL Item
regularly (2)
CL Item
irregularly (3)
actions to benefit health
Item
25. What do you do to benefit your health?
text
C0814225 (UMLS CUI [1])
cancer screening
Item
26. Do you go to cancer screenings?
boolean
C0199230 (UMLS CUI [1])
latest cancer screening
Item
26. When was the last time?
integer
C0199230 (UMLS CUI [1])
Treatment at a health resort
Item
27.Have you ever undergone a treatment at a health resort?
boolean
C0018740 (UMLS CUI [1])
latest treatment at a health resort
Item
27. When was the last time?
integer
C0018740 (UMLS CUI [1,1])
C0087111 (UMLS CUI [1,2])
Comments of physician
Item
Comments of physician
text
C0947611 (UMLS CUI [1])
Item Group
Are/were there any diseases in your family?
Diabetes
Item
Diabetes
boolean
C0011849 (UMLS CUI [1])
Hypertension
Item
Hypertension
boolean
C0020538 (UMLS CUI [1])
Stroke
Item
Stroke
boolean
C0038454 (UMLS CUI [1])
Myocardial infarction
Item
Myocardial infarction
boolean
C0027051 (UMLS CUI [1])
Allergies
Item
Allergies/Hypersensitivity to substances, food, etc.
boolean
C0020517 (UMLS CUI [1])
Respiratory diseases
Item
Respiratory diseases
boolean
C0035204 (UMLS CUI [1])
Gout
Item
Gout
boolean
C0018099 (UMLS CUI [1])
Deformities
Item
Deformities
boolean
C0302142 (UMLS CUI [1])
cancer
Item
Cancer
boolean
C0006826 (UMLS CUI [1])
Other disease
Item
Other diseases
boolean
C2359476 (UMLS CUI [1])
Comments of physician
Item
Comments of physician
text
C0947611 (UMLS CUI [1,1])
C0031831 (UMLS CUI [1,2])
Item Group
Please answer the following questions about your diseases and health problems
heachaches
Item
1 Do you suffer from headaches frequently?
boolean
C0018681 (UMLS CUI [1])
Lack of appetite
Item
2 Do you suffer from lack of appetite?
boolean
C0003618 (UMLS CUI [1])
thirst
Item
3 Do you suffer from increased thirst?
boolean
C0039971 (UMLS CUI [1])
sleep disturbances
Item
4 Do you have sleep disturbances?
boolean
C0037317 (UMLS CUI [1])
difficulty falling asleep
Item
4 If yes, do you have difficulties falling asleep?
boolean
C0150079 (UMLS CUI [1])
waking during the night
Item
4 If yes, do you wake during the night?
boolean
C3175860 (UMLS CUI [1])
irregular bowel movements
Item
5 Do you have irregular bowel movements?
boolean
C0426642 (UMLS CUI [1])
glasses/contact lenses
Item
6 Do you wear glasses/contact lenses?
boolean
C3843284 (UMLS CUI [1])
Eye complaint
Item
7 Do you have an eye complaint?
boolean
C0848690 (UMLS CUI [1])
impaired hearing
Item
8 Is your hearing impaired?
boolean
C1384666 (UMLS CUI [1])
Ear problems
Item
9 Do you have ear problems?
boolean
C0013443 (UMLS CUI [1])
diseases of frontal sinus and maxillary sinus, throat
Item
12 Are you prone to diseases of the frontal sinus and the maxillary sinus of the throat?
boolean
C0016734 (UMLS CUI [1])
C0024957 (UMLS CUI [2])
common cold
Item
13 Do/did you have a common cold multiple times a year?
boolean
C0009443 (UMLS CUI [1])
Cough
Item
14 Do you cough frequently (regularly every day)?
boolean
C0010200 (UMLS CUI [1])
bronchial asthma/bronchitis
Item
15 Are you prone to bronchial asthma/bronchitis?
boolean
C0004096 (UMLS CUI [1])
pneumonia, pleurisy, tuberculosis
Item
17 Did you ever have pneumonia/pleurisy/tuberculosis?
boolean
C0041296 (UMLS CUI [1])
C0032285 (UMLS CUI [2])
C0032231 (UMLS CUI [3])
Hypertension
Item
18 Have you ever been diagnosed with hypertension?
boolean
C0020538 (UMLS CUI [1])
dyspnea
Item
19 Do you suffer from dyspnea?
boolean
C0013404 (UMLS CUI [1])
Chest tightness
Item
20 Do you feel a tightness in the chest (chest pain) during physical stress?
boolean
C0232292 (UMLS CUI [1])
myocardial infarction
Item
21 Did you ever have a myocardial infarction?
boolean
C0027051 (UMLS CUI [1])
other cardiovascular problems
Item
22 Do you have other cardiovascular problems?
boolean
C1273828 (UMLS CUI [1])
dizziness, disturbed balance
Item
23 Are you prone to dizziness/disturbed balance?
boolean
C0012833 (UMLS CUI [1])
C0575090 (UMLS CUI [2])
Diabetes
Item
24 Have you been diagnosed with diabetes?
boolean
C0011849 (UMLS CUI [1])
elevated blood lipid levels
Item
25 Were your blood lipid levels ever found to be elevated?
boolean
C0020473 (UMLS CUI [1])
elevated uric acid levels
Item
26 Were your uric acid levels ever found to be elevated (gout)?
boolean
C0041980 (UMLS CUI [1])
thyroid disease
Item
27 Have you ever been diagnosed with a thyroid disease?
boolean
C0040128 (UMLS CUI [1])
gastro-intestinal problems, heartburn
Item
28 Do you have gastro-intestinal problems/heartburn?
boolean
C4023588 (UMLS CUI [1])
biliary complaints
Item
30 Do you have bilious complaints?
boolean
C0009566 (UMLS CUI [1,1])
C0521378 (UMLS CUI [1,2])
jaundice
Item
31 Did you ever have jaundice?
boolean
C0022346 (UMLS CUI [1])
liver disease
Item
32 Have you been diagnosed with a liver disease?
boolean
C0023895 (UMLS CUI [1])
uropathy
Item
33 Are you prone to uropathies (kidney, bladder)?
boolean
C0178879 (UMLS CUI [1])
problems when urinating
Item
34 Do you have problems when urinating?
boolean
C0013428 (UMLS CUI [1])
hemorrhoids
Item
35 Do you have hemorrhoids?
boolean
C0019112 (UMLS CUI [1])
varices
Item
36 Dou you have varices?
boolean
C0042345 (UMLS CUI [1])
back pain
Item
37 Do you have back pain?
boolean
C0004604 (UMLS CUI [1])
Item
37 If yes, where? - 1 cervical spine/neck
text
C0007859 (UMLS CUI [1])
Code List
37 If yes, where? - 1 cervical spine/neck
CL Item
sometimes  (sometimes)
CL Item
frequently  (frequently)
CL Item
daily  (daily)
Item
37 If yes, where? - 2 thoracic spine
text
C0423673 (UMLS CUI [1])
Code List
37 If yes, where? - 2 thoracic spine
CL Item
sometimes  (sometimes)
CL Item
frequently  (frequently)
CL Item
daily  (daily)
Item
37 If yes, where? - 3 lumbar spine/lower back
text
C0024091 (UMLS CUI [1])
Code List
37 If yes, where? - 3 lumbar spine/lower back
CL Item
sometimes  (sometimes)
CL Item
frequently  (frequently)
CL Item
daily  (daily)
lumbago
Item
38 Do you suffer from lumbago (sciatica)?
boolean
C0948852 (UMLS CUI [1])
herniated disk
Item
39 Did you have a herniated disk?
boolean
C0021818 (UMLS CUI [1])
joint pain/limb pain
Item
40 Do you have pain in any joints or limbs?
boolean
C0003862 (UMLS CUI [1])
seizure disorder
Item
41 Do you have a seizure disorder?
boolean
C0014544 (UMLS CUI [1])
neurological/psychiatric disease
Item
42 Do you have a neurological/psychiatric disease?
boolean
C0027765 (UMLS CUI [1])
dermatosis
Item
43 Are you prone to dermatoses?
boolean
C0037274 (UMLS CUI [1])
Allergies
Item
44 Do you suffer from allergies?
boolean
C0020517 (UMLS CUI [1])
hay fever
Item
45 Do you have hay fever?
boolean
C0018621 (UMLS CUI [1])
bone fractures
Item
46 Did you have any bone fractures?
boolean
C0016663 (UMLS CUI [1])
permanent damage due to accident
Item
47 Did you have an accident that led to any permanent damage?
boolean
C3640792 (UMLS CUI [1])
Comments of physician
Item
Comments of physician
text
C0947611 (UMLS CUI [1])
Item Group
Surgeries
Surgery
Item
48. Did you ever undergo surgery?
boolean
C0543467 (UMLS CUI [1])
Heart surgery
Item
1 Heart
boolean
C0018821 (UMLS CUI [1])
Kidney surgery
Item
2 Kidney
boolean
C0194053 (UMLS CUI [1])
Gallbladder surgery
Item
3 Gallbladder
boolean
C0744263 (UMLS CUI [1])
hernia surgery
Item
4 Hernia
boolean
C0019270 (UMLS CUI [1])
stomach surgery
Item
5 Stomach
boolean
C0198482 (UMLS CUI [1])
bone surgery
Item
7 Bone
boolean
C0262950 (UMLS CUI [1])
other surgery
Item
8 Other surgery
boolean
C0543467 (UMLS CUI [1])
Comments of physician
Item
Comments of physician
text
C0947611 (UMLS CUI [1])
Item Group
Dental/medical treatment
dental/medical treatment
Item
49. Are you currently under dental/medical treatment?
boolean
C0011331 (UMLS CUI [1])
dental/medical treatment reason
Item
49. If yes, why?
text
C0011331 (UMLS CUI [1,1])
C0392360 (UMLS CUI [1,2])
Comments of physician
Item
Comments of physician
text
C0947611 (UMLS CUI [1])
Item Group
Vaccination
tetanus vaccination
Item
50. Are you vaccinated against tetanus?
boolean
C0199807 (UMLS CUI [1])
time of tetanus vaccination
Item
50. When?
integer
C0199807 (UMLS CUI [1])
Comments of physician
Item
Comments of physician
text
C0947611 (UMLS CUI [1])
Item Group
Current medication
Current medication
Item
51. Are you taking any medication of at least one of the following types (mutiple selections possible)?
boolean
C1553892 (UMLS CUI [1])
medication for headache
Item
1 Medication for headache
boolean
C0018681 (UMLS CUI [1,1])
C0013227 (UMLS CUI [1,2])
pain medication
Item
2 Pain medication
boolean
C0002771 (UMLS CUI [1])
Cardiovascular agents
Item
3 Cardiovascular agents
boolean
C0007220 (UMLS CUI [1])
laxatives
Item
4 Laxatives
boolean
C0282090 (UMLS CUI [1])
Tranquilizer
Item
5 Tranquilizer
boolean
C0040614 (UMLS CUI [1])
sleeping pills
Item
6 Sleeping pills
boolean
C0599396 (UMLS CUI [1])
stomachic
Item
7 Stomachic
boolean
C0013227 (UMLS CUI [1])
Bronchial medication
Item
8 Bronchial medication
boolean
C0205039 (UMLS CUI [1])
other medication
Item
9 Other medication
boolean
C0013227 (UMLS CUI [1])
other medicaton specification
Item
9 Which other medication?
text
C0013227 (UMLS CUI [1])
Comments of physician
Item
Comments of physician
text
C0947611 (UMLS CUI [1])
Item Group
Miscellaneous
Other complaints
Item
52. Other complaints
text
C0871764 (UMLS CUI [1])
Pregnancy
Item
53. Are you pregnant?
boolean
C0032961 (UMLS CUI [1])
Gynecological screening
Item
54. Do you undergo gynecological screenings regularly?
boolean
C0200044 (UMLS CUI [1])
Comments of physician
Item
Comments of physician
text
C0947611 (UMLS CUI [1])
General comments
Item
General comments
text
C0947611 (UMLS CUI [1])

Use este formulário para feedback, perguntas e sugestões de aperfeiçoamento.

Campos marcados com * são obrigatórios.

Do you need help on how to use the search function? Please watch the corresponding tutorial video for more details and learn how to use the search function most efficiently.

Watch Tutorial