Introduction
| An exposure history form has three components: Exposure Survey, Work History, and Environmental History. The main aspects of an exposure history (summarized in Table 3) will be elicited through the exposure history form.
Although a positive response to any question on the form indicates the need for further inquiry, a negative response to all questions does not necessarily rule out a toxic exposure etiology or significant previous exposure. All patients should complete exposure history forms, although the form does not need extensive evaluation in every clinical situation. As in all data-gathering activities, sound clinical judgment must be exercised.
| Table 3. Components of an Exposure History |
Part 1. Exposure Survey
- Exposures
- current and past exposure to metals, dust, fibers, fumes, chemicals, biologic hazards, radiation, noise, and/or vibration
- typical workday (job tasks, location, materials, and agents used)
- changes in routines or processes
- other employees or household members similarly affected
- Health and Safety Practices at Work Site
- ventilation
- medical and industrial hygiene surveillance
- employment exams
- personal protective equipment (e.g., respirators, gloves, and coveralls)
- lockout devices, alarms, training, and drills
- personal habits (Smoke and/or eat in work area? Wash hands with solvents?)
Part 2. Work History
- description of all previous jobs including short-term, seasonal, and part-time employment and military service
- description of present jobs
Part 3. Environmental History
- present and previous home locations
- jobs of household members
- home insulating and heating and cooling system
- home cleaning agents
- pesticide exposure
- water supply
- recent renovation/remodeling
- air pollution, indoor and outdoor
- hobbies (e.g., painting, photography, sculpting, welding, woodworking, piloting, restoring automobiles, shooting firearms, creating stained glass, creating ceramics, and gardening)
- hazardous wastes/spill exposure
- home ventilation/moisture control/flooding
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