National Agriculture Workers Survey (NAWS)

[REV. Aug 5, 2013]

S:\4. Questionnaire\2014\2014NEWQUESTIONS\ENGLISHNEWQUESTIONS\InjuryScreen&Supl07Aug2013.wpd

SCREENING FOR INJURY SUPPLEMENT
[INTERVIEWER: ...ONLY IF THE RESPONDENT SEEMS HESITANT TO TALK ABOUT INJURIES (e.g., BECAUSE
HE/SHE IS FEARFUL, SHOULD YOU REMIND THE RESPONDENT THAT ALL THE INFORMATION HE/SHE SHARES
WITH YOU IS CONFIDENTIAL. USE YOUR JUDGMENT ABOUT REMINDING THE INTERVIEWER ABOUT
CONFIDENTIALITY AT ANY POINT WHILE ADMINISTERING THIS SUPPLEMENT].

“I would like to ask you some questions about injuries or accidents that you might have had in the United
States in the last 12 months while doing farm work (“FW”), and also while doing non-farm work (“NF”)
like construction, landscaping, working at a hotel or restaurant, or any other job. They could be things
like:...
...injuries from a car accident traveling to and from work;
...cutting yourself with a sharp tool or knife;
...hurting yourself lifting heavy objects, such as crates;
...hurting yourself by falling, for example falling off a ladder or crate, or tripping in the field; or
...getting sick from working too long in the hot sun, being bitten or stung by an insect, or breathing
pesticides while working in the fields.”
...In the past 12 months, have you had any injury or accident that made you...
NLS01

...unable to work for at least 4 hours?
90
91

NLS02

NLS03

NO
YES

...use any type of first aid, such as a bandage
to stop bleeding or antiseptic to clean a wound
(or ice packs for a bruise, etc.) or seek medical
treatment at a clinic or from a nurse or doctor?
90
91

...unable to work as hard as you normally
do for at least 4 hours? [or were assigned a
different job (or different task) that was easier
because the injury prevented you from doing
the first job (or task)]

NLS04

NO
YES

...take strong medicine, except aspirin (or

Tylenol or Ibuprofen), to allow you to keep
working?

9 0 NO
9 1 YES

90
91

NO
YES

INTERVIEWER:...
...IF THE RESPONDENT ANSWERED “NO”
TO ALL OF THE PREVIOUS QUESTIONS
(NLS01 TO NLS04), SKIP TO NEXT SECTION
(“XX", PAGE XX).
NL1E

...IF THE RESPONDENT ANSWERED “YES”
TO ANY OF THE PREVIOUS QUESTIONS
(NLS01 TO NLS04), ASK NL1E

HOW MANY OF THESE TYPES OF INJURIES HAVE YOU HAD?
FW:

NF:

[INTERVIEWER: Write here any spontaneous response related to an injury or injuries (e.g., type of
injuries and dates) so you can refer to it when completing the “Injury Supplement”]:

CONTINUE WITH NEXT SECTION (“NP1f”) UNTIL COMPLETION OF QUESTIONNAIRE, THEN
COMPLETE “INJURY / ACCIDENT -SUPPLEMENT QUESTIONNAIRE”!!!

1

NAME OF WORKER:____________________________

SUPPLEMENT ONLY FOR WORKERS WHO SAID “YES” TO ANY OF NL QUESTIONS (NAWS page XX)
– SECTION NL - INJURIES/ACCIDENTS -

[NL3 CODES FOR “INJURY LIST”] IN THE LAST 12 MONTHS, HAVE YOU HAD ANY: ...
9a
9b
9c
9d

scrape/abrasion?
bruise/contusion?
amputation/loss of body part?
sprain/strain/torn ligament/
traumatic rupture?

9e
9f
9g
9h

broken or fractured bone/ crushed/ mangled?
dislocation?
cut/laceration/puncture/ stab/ jab?
burn/blister/scald?

9i

insect bite/ sting/ bitten by animal?

9j

otro?:

Please describe, how did you get injured? What happened when you where injured?
[INTERVIEWER: If there is more than one injury, write first the number corresponding to the incident (i.e., for the first incident
write number 1) in the “Injury Grid” (next page). Use the following grids for the other incidents and number each one of them. If
you need more grids, use “extras” from other unused supplements. In each grid, ask and write answers for questions NL3 to
NL20]
IN THE NEXT GRIDS, WRITE IN DETAIL ALL NARRATIVE RESPONSES TO PROMPT QUESTIONS FROM NL3 TO NL20. AS YOU
ASK EACH QUESTION, MARK RESPONSES; AND WHERE REQUIRED, MARK ITS CORRESPONDING BOX TO ENSURE THAT
ALL QUESTIONS ARE ASKED (i.e., What happened?; What were you doing?; Where did it happen?; What caused the
injury/accident?; What tools or machineries were you using when it happened?; etc.)
[USE A SEPARATE GRID FOR EACH INJURY/ACCIDENT]
CODES FOR NL13:
1. COMMUNITY HEALTH CENTER
2. PRIVATE MEDICAL DOCTOR’S OFFICE/PRIVATE
CLINIC
3. HOSPITAL
4. EMERGENCY ROOM

5. MIGRANT HEALTH CLINIC
6. CHIROPRACTOR OR
NATUROPATH
7. DENTIST

8.
9.
10.
88.

FIRST AID ON SITE
WENT TO HOME (ANOTHER) COUNTRY
NO MEDICAL TREATMENT
OTHER:

CODES FOR NL14:
1
2
3
4

PAID OUT OF MY OWN POCKET
MEDICAID/MEDICARE
NO CHARGE
EMPLOYER PROVIDED HEALTHPLAN

5 SELF OR FAMILY INSURANCE HEALTH
PLAN
8 BILLED, BUT DID NOT PAY
9 “WORKER’S COMPENSATION”
10 EMPLOYER PAID “OUT-OF-POCKET”

2

11 DO NOT REMEMBER WHO PAID FOR IT
6 OTHER:
7 COMBINATION OF:

INJURIES/ACCIDENTS

[REV. Aug 5, 2013]

INCIDENT # = FW?:
NL3

NF?:

S:\4. Questionnaire\2014\2014NEWQUESTIONS\ENGLISHNEWQUESTIONS\InjuryScreen&Supl07Aug2013.wpd

[INTW: THIS GRID IS FOR THE FIRST INJURY/ACCIDENT MENTIONED BY THE RESPONDENT]

The following questions are about this injury/accident incident. What part(s) of your body was (were) injured and what type(s) of injury(-ies) did you
have in this incident? [INTW: ASK FOR BODY-PARTS INJURIES, FROM THIS INCIDENT, FOR EACH BODY PART, WRITE ANSWER(S) AND CHECK
ALL CODES THAT APPLY (SEE CODES - FIRST PAGE NL3).
[BODY PARTS:
CODES FOR TYPE OF INJURY LISTED ON PREVIOUS PAGE (IN NL3). READ AND MARK ALL THAT APPLY]:

PART 1

a. 9

b. 9

c. 9

d. 9

e.

9

f.

9

g. 9

h. 9

i. 9

j. 9

PART 2

a. 9

b. 9

c. 9

d. 9

e.

9

f.

9

g. 9

h. 9

i. 9

j. 9

PART 3

a. 9

b. 9

c. 9

d. 9

e.

9

f.

9

g. 9

h. 9

i. 9

j. 9

[NARRATIVE SECTION (IF YOU NEED MORE SPACE, USE BACK PAGE). AFTER ASKING EACH PROMPT-QUESTION, MARK CORRESPONDING BOX]:
9 WHAT HAPPENED? 9 WHAT WERE YOU DOING? 9 WHERE DID IT HAPPEN? 9 WHAT CAUSED IT? 9 DETAILS? 9 NAMES OF MACHINES AND/OR TOOLS?
[IF IT IS “NF”: ASK “OCCUPATION AND INDUSTRY”:]

NL4

Where?:

9 1 “field”

NL5
When? [MONTH AND
YEAR]:

9 2 “labor camp”
NL6
With current employer?:
9 0 NO

/
NL11
Not able to work
normally >4 hours?:
9 0 No
9 1 Yes

9 3 farm building
NL8
Crop?

9 4 ranch roadway
NL9a
Task / Activity?:

9 1 YES

9 5 public street

NL7a
During working hours?:
9 0 NO

NL12
NL21
# of days not able to work # of days DID NOT WORK
normally?:
because of
injury?:

NL13
Where treated? [ENTER ALL, USE
Codes]:

3

9 8 other:

NL14
How was it paid for?
[Codes]:

9 1 YES
NL20
Did you receive
first aid?
9 0 NO 9 1 Yes

INJURIES/ACCIDENTS

[REV. Aug 5, 2013]

INCIDENT # = FW?:
NL3

NF?:

S:\4. Questionnaire\2014\2014NEWQUESTIONS\ENGLISHNEWQUESTIONS\InjuryScreen&Supl07Aug2013.wpd

[INTW: THIS GRID IS FOR THE SECOND INCIDENT (INJURY/ACCIDENT) MENTIONED BY THE INTERVIEWER. IF HE
MENTIONS MORE THAN TWO INCIDENTES (INJURIES/ACCIDENTS), USE BLANK FORMS FROM OTHER SUPPLEMENTS]

The following questions are about this injury/accident incident. What part(s) of your body was (were) injured and what type(s) of injury(-ies) did you
have in this incident? [INTW: ASK FOR BODY-PARTS INJURIES, FROM THIS INCIDENT, FOR EACH BODY PART, WRITE ANSWER(S) AND CHECK
ALL CODES THAT APPLY (SEE CODES - FIRST PAGE NL3).
[BODY PARTS:
CODES FOR TYPE OF INJURY LISTED ON PREVIOUS PAGE (IN NL1). READ AND MARK ALL THAT APPLY]:

PART 1

a. 9

b. 9

c. 9

d. 9

e.

9

f.

9

g. 9

h. 9

i. 9

j. 9

PART 2

a. 9

b. 9

c. 9

d. 9

e.

9

f.

9

g. 9

h. 9

i. 9

j. 9

PART 3

a. 9

b. 9

c. 9

d. 9

e.

9

f.

9

g. 9

h. 9

i. 9

j. 9

[NARRATIVE SECTION (IF YOU NEED MORE SPACE, USE BACK PAGE). AFTER ASKING EACH PROMPT-QUESTION, MARK CORRESPONDING BOX]:
9 WHAT HAPPENED? 9 WHAT WERE YOU DOING? 9 WHERE DID IT HAPPEN? 9 WHAT CAUSED IT? 9 DETAILS? 9 NAMES OF MACHINES AND/OR TOOLS?
[IF IT IS “NF”: ASK “OCCUPATION AND INDUSTRY”:]

NL4

Where?

9 1 “field”

9 2 “labor camp”

NL5

When?: [MONTH/YEAR]
/
NL11

9 3 farm building

NL6

NL8

With current employer?:
9 0 NO
NL12

9 4 ranch roadway

Crop?

9 5 public street

9 8 other:

NL9a

Task / Activity?:

9 1 YES

NL7a

During working hours?:
9 0 NO

NL21

NL13

NL14

9 1 YES
NL20

Not able to work normally # of days not able to work # of days DID NOT WORK Where treated? [ENTER ALL, USE How was it paid for? Did you receive first
because of
Codes]:
>4 hours?:
normally?:
aid?
[Codes]:
injury?:
9 0 No
9 1 Yes
9 0 NO 9 1 Yes
4

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