Respirator Evaluation Questionnaire - Part A Section 2, Questions 7-9

Questions 7-9 include a question on medications, one about respirator use, and one about this survey.

7. Do you currently take medication for any of the following problems?
   1. Breathing or lung problems: Yes/No
   2. Heart trouble: Yes/No
   3. Blood pressure: Yes/No
   4. Seizures: Yes/No
8. If you've used a respirator, have you ever had any of the following problems? (If you've never used a respirator, check the following space and go to question 9:)
   1. Eye irritation: Yes/No
   2. Skin allergies or rashes: Yes/No
   3. Anxiety: Yes/No
   4. General weakness or fatigue: Yes/No
   5. Any other problem that interferes with your use of a respirator: Yes/No
Would you like to talk to the health care professional who will review this questionnaire about your answers to this questionnaire: Yes/No

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