The Occupational and Environmental History

Abstract

The occupational and environmental history is fundamentally important to making the correct and timely diagnosis of any illness that may have resulted from a toxic exposure in the workplace, the household, or the general environment. In interviewing the patient with a potential occupational or occupational illness, it is important for the physician to ask questions that efficiently lead the patient into providing useful information about possible associations between the presenting illness and potential toxic exposures. A particularly useful and efficient construct for interviewing a patient about his or her occupational and environmental history is contained in the easy-to-remember mnemonic “WHACOS.” The components of the “WHACOS” mnemonic are as follows:

W—What do you do? H—How do you do it? A—Are the symptoms acute or chronic in nature? C—Are any coworkers, family members, or friends sick with the same illness? O—Do you have any hobbies, pets, or travel outside of work? S—Are you satisfied with your job? These simple questions can efficiently lead the patient into a useful dialog with the physician about occupational and environmental factors that can provide important clues about the etiology of an illness that may be related to a toxic exposure.

Appendix: Occupational and Environmental Exposure History

Patient Name: _______________ Medical Record Number: _______________

Date of Form Completion: ___________ Date of Birth: ___________

A. Current Occupational History

Are you currently employed?

Yes _____ No _____

If yes, what was your approximate date of hire? _________

Please fill out the following regarding your current job:

Name of Employer	Job Title	Job Description

Describe your typical work shifts in a week (e.g. Monday 8AM-5PM, Tuesday 12noon-8PM etc.):

Monday________________

Tuesday________________

Wednesday________________

Thursday________________

Friday________________

Saturday________________

Sunday ________________

Can you smell the chemicals or materials that you work with?

Yes _____ No _____

Have you ever worked in a dusty environment?

Yes _____ No _____

Have you ever worked in a moldy or musty environment?

Yes _____ No _____

Do you ever get material from work on your clothes or skin?

Yes _____ No _____

Do you wash your hands with solvents in the workplace?

Yes _____ No _____

Do your work clothes get laundered at home?

Yes _____ No _____

Do you shower regularly at work?

Yes _____ No _____

Do you use protective equipment such as gloves, masks, respirators or hearing protectors at work?

Yes _____ No _____

Have you ever been advised to use protective equipment?

Yes _____ No _____

Have you been instructed in the use of protective equipment?

Yes _____ No _____

Is there smoke at the workplace?

Yes _____ No _____

Do you smoke in the workplace?

Yes _____ No _____

Do you eat at the work place?

Yes _____ No _____

Have you ever been off work for more than 1 day because of an illness related to work?

Yes _____ No _____

Have you ever changed jobs or work assignments because of health problems or injuries?

Yes _____ No _____

Has your work routine changed recently?

Yes _____ No _____

Is the ventilation system at your workplace adequate and working properly?

Yes _____ No _____

B. Hazardous Exposures at Work or Home (circle all that apply)

Animals	Extreme Heat/Cold	Nickel
Arsenic	Fertilizers	Paints/Varnishes
Asbestos	Fumes	Pesticides
Benzene	Glues/Adhesives	Petroleum Products/Gasoline
Beryllium	Grain Dust	Phosphates
Biological Hazards	Isocyanates	Power Tools
Cadmium	Latex	Sand/Stone Dust
Chromates	Lead	Silica
Cigarette Smoke	Lifting	Smoke
Coal Dust	Loud Noise	Solvents
Cobalt	Mercury	Vanadium
Cutting Oils	Metal-Grinding Dust	Vibration
Dust	Metal-Working Fluid	Wood Dust/Saw Dust
Other:______________________________________________________________________

Are any co-workers exposed to any of the hazardous exposures listed above?

Yes _____ No _____

Are there any co-workers with symptoms similar to those that you are experiencing?

Yes _____ No _____

Is anyone in your home exposed to any of the hazardous exposures listed above?

Yes _____ No _____

Are there any family members with symptoms similar to those that you are experiencing?

Yes _____ No _____

C. Previous Occupational History

Please fill out the following table regarding past jobs, including temporary, seasonal, part-time and military employment

Employer	Date Started/Ended	Job Title/Description	Known Hazards

D. Environmental History

Community Environment:

Do you live close to any of the following? Check all that apply.

Heavy Traffic	Industrial Plant	Power Plant
Waste Dump	Superfund Site	Construction Site

Home Environment:

In approximately what year was your house built? ___________

Circle all that apply to your home.

Septic system	Central heating	Fireplace/Wood Stove
Air humidifier	Central air conditioner	Gas stove
Well water	Window air conditioner	Water leaks
City water	Gas space heater	Other:_______________

Do you have a basement?

Yes _____ No _____

If yes, please answer the following questions:

Does your basement have a musty or moldy odor?

Yes _____ No _____

Does your basement have a water problem?

Yes _____ No _____

Has your basement ever flooded?

Yes _____ No _____

Is your kitchen stove exhausted to the outside from a range hood?

Yes _____ No _____

Is air from your bathroom(s) exhausted to the outside?

Yes _____ No _____

Is there mold growth on any of your bathroom walls?

Yes _____ No _____

Is there mold growth on any of your shower curtains?

Yes _____ No _____

Hobbies:

Circle all that apply.

Auto Body Repair/Restoration	Hunting	Photography
Auto Mechanics	Leather Working	Sculpture
Ceramics/Pottery	Masonry	Stone Work
Electronics	Metal Working	Taxidermy
Fishing	Model Making	Woodworking
Gardening	Painting	Other:

Do you use any solvents in any of your hobbies?

Yes _____ No _____

Do you do any soldering in any of your hobbies?

Yes _____ No _____

Do you have any pets?

Yes _____ No _____ If yes, what kind of pets? ____________________________

Have you ever kept birds as pets?

Yes _____ No _____If yes, what kind of bird(s)? ___________________________

Personal Exposures:

Do you currently smoke?

Yes _____ No _____

If yes, ________ packs/day for _________ years

Is there someone else in your household that smokes?

Yes _____ No _____

If yes, ________ packs/day for _________ years

Approximately how many drinks of alcohol do you have per week? __________________

Do you take any prescription drugs?

Yes _____ No _____

If yes, please list each drug that you take, the dose of each drug and how often you take each drug.

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Do you take any herbal or vitamin supplements?

Yes _____ No _____

If yes, what do you take and how often do you take it?

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Do you use recreational drugs?

Yes _____ No _____

If yes, what do you use and how often do you use it?

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