Questionnaire on Pesticide Apraying in Plantations

Name
Location
Personal Particulars
Sex:  Age:  Race: 
Marital Status: Occupation of Spouse: Length of Service:
No: of children:  Nature of work:  Salary: 

Are you a:
Permanent worker Contract worker Migrant Worker
Working Hours
Per day Per week Per month

Pesticide Use    
Are you a pesticide user?  Yes  No 
Date of last exposure to pesticide:   

1. What class of persticide used in the field?
Weedicide Insecticide Fungicides Others

2. What pesticide so you use?
Common name: Brand name:
What it is used for 
Do you spray throughout the year? Yes No
Is there a break given? Yes No
If there is a break, for how long?
What type of task are you assigned?
How long after spraying are you assigned to another task?   
Frequency in a month:   
No. of hours per spray:   

3. Equipment 
Method of spray (equipment used): 
What was the condition of the equipment? 
How is it stored? 
Was training provided on use? 

4. Protective clothing
Was protective clothing/equipment supplied? Yes No
If yes, what are they?
Cover-alls Gloves Eye and face protection
Aprons and coats Protective boots Respiratory equipment

5. Mixing of Pesticides
Do you mix the pesticidesbefore spraying? Yes No
If not, who mixes?  
What is the pesticide mixed with?
What are the quantities?
Do you mix it with other pesticides? Yes No
If yes, what are they?
What are the quantities?

6. Effects of the Pesticide
After spraying, do you suffer from:
Nausea Tremors 
Giddiness Lower abdominal pains 
Headache Vaginal pains  
Vomiting  Burning sensation during urination 
Difficulty in breathing  Fatigue/tiredness 
Tight feeling in chest  Back pains  
Itchiness/skin irrirtation   Discoloration of the nails/inflamation
and irritation
White patches on skin/red spots 
Bleeding through the nose  Swelling of the knee joints 
Vomiting  Others  
Blurred vision  
How have you  been exposed/come in contact with pesticides?
Through inhalation Yes No
On the skin Yes No
Accidentally consumed it Yes No

7. Medical
Who do you go when you have any effects of poisoning?  
What treatment is given?  
Types of medicine  Cream Drugs/tablets 
Liquid form
Do you go for regular check-ups?  
Where do you go for check-ups?  
Who conducts the medical examination?  
Is there a policy in the plantation on sending sprayers for regular check-ups?

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