2.7
other
____ 2.7.1 bites
____ 2.7.2 loss of hearing
____ 2.7.3 penetration of skin by short pet
hairs
2.8
When do you experience these symptoms?
2.9
Do they get better when you are not at work?
2.10
Are you under medical care?
2.11
What was the diagnosis?
2.12
Any other problems you would like to report?
2.13 Any prior pesticide poisoning?
Yes______ NO _______
If yes, explain_________________________________________
2.14 Any prior allergies before your employment as a groomer?
Yes _________ NO__________
If yes, explain ________________________________________
