Respirator Evaluation Questionnaire - Part A Section 2, Question 4

Question 4 also requires a yes or no answer. Its specific language is as follows:

4. Do you currently have any of the following symptoms of pulmonary or lung illness?
   1. Shortness of breath: Yes/No
   2. Shortness of breath when walking fast on level ground or walking up a slight hill or incline: Yes/No
   3. Shortness of breath when walking with other people at an ordinary pace on level ground: Yes/No
   4. Have to stop for breath when walking at your own pace on level ground: Yes/No
   5. Shortness of breath when washing or dressing yourself: Yes/No
   6. Shortness of breath that interferes with your job: Yes/No
   7. Coughing that produces phlegm (thick sputum): Yes/No
   8. Coughing that wakes you early in the morning: Yes/No
   9. Coughing that occurs mostly when you are lying down: Yes/No
   10. Coughing up blood in the last month: Yes/No
   11. Wheezing: Yes/No
   12. Wheezing that interferes with your job: Yes/No
   13. Chest pain when you breathe deeply: Yes/No
   14. Any other symptoms that you think may be related to lung problems: Yes/No

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