From Glove Up! Protect yourselves and others while working with solvents
Solvents have different effects on different people. Some common symptoms of solvent exposure are:
Long term or high-level exposure can result in damage to the nervous system. Symptoms of this can include:
If you think you may be suffering from solvent exposure, complete the questionnaire and follow up with a visit to your doctor. Make sure when you visit your doctor you give him/her as much information as possible, i.e. take the completed questionnaire, tell them your occupation, how long you've been working in your industry and the solvents/carcinogen you may have been exposed to.
This questionnaire is used to help determine whether long-term overexposure to solvents has affected the central nervous system (brain).
Answer Yes or No to each question. After you finish, read the instructions to interpret the results.
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Questionnaire for long-term solvent-exposed workers
Do you have a bad memory?
Have your relatives told you that you have a bad memory?
Do you often have to make notes about what you must remember?
Do you often have to go back and check things you have done, such as turned off the stove, locked the door, etc.?
Do you generally find it hard to get the meaning from reading newspapers and books?
Do you have problems with concentrating?
Do you often feel irritated without any particular reason?
Do you often feel depressed without any particular reason?
Are you abnormally tired?
Are you less interested in sex than what you think is normal?
Do you have heart palpitations even when you don’t exert yourself?
Do you sometimes have a feeling of pressure in your chest?
Do you perspire without any particular reason?
Do you have a headache at least once a week?
Do you often have a painful tingling in some part of your body?
This questionnaire was developed based on clinical experience with workers who were exposed to solvent mixtures for many years. In general, if a solvent worker gives six or more Yes replies, it is advisable to get a medical evaluation. The questionnaire alone cannot prove that there was health damage due to solvents.
See a doctor if you are concerned about possible health effects of working with solvents. Note that some solvents affect other organs besides the brain. This questionnaire was designed to detect brain effects only. This questionnaire was adapted from the Swedish Q16 questionnaire, from the Textbook of Clinical Occupational and Environmental Medicine, Rosenstock and Cullen, W.B Saunders Company.
› Download the Questionnaire for long term solvent exposed workers (PDF)
Glove Up! Project yourselves and others while working with solvents
These web resources have been created by Annette and Tony Gibson to provide basic information on the dangers of using solvents in the workplace and how to protect yourself from exposure. The information is provided as a guideline only and not as a replacement for professional advice. If you have any questions, thoughts or comments you'd like to share with us please email us at gloveup@resene.co.nz.