1 - ESDS

Questionnaire Re f
Question No
Q2(A)
Q2(A)
Q2(B)
Q3
Coding Sheet
Reference
Q2Aii
22Aiii
)26 2
,
No of
Boxes/
Characters
2
2
Coding Instructions/Remarks
Sight problems ...........38
Skin problems ............39
Speech impediment ........40
Stomach problems/digestive
tract .....-..............41
Thyroid gland ............42
Ulcers (internal) ........43
Ulcerations jabcasses
(external) ..............44
Varicose veins ...........45
Other ....................46
Try to fit into the abOve
categories before referring
to supervisor
Values -3-46
Type of illness/disability -
second
Code as per first illness
(2Ai)
Values -3-46
rype of illness/disability -
third
Code as per first illness
(2Ai )
Ialues -3-02
>oes it limit
~ay?
you in any
lAw of the illnesses)
res ......................01
{0 .......................02
ralues -3-02
:ut down activities in
;WO weeks because of
.llness?
ast
:es ................... ..01
10.. . .. .. . .. .. . . . . .. .. .. ..02
~..
Ldtl