Participant ID: FW___ ___ ___Date: ___ ___ / ___ ___ / ___ ___Interviewer: _________________

24.If I had a little extra money I would spend it on:

Bills

Going out to eat with my family

Toys/games for my children

Save it for something big

Necessities for my family.

Other

2. If I had a lot of extra money I would spend it on:

3. Partner work family impact ( CONTACT _Con-34CF8B292 Diane Rohlman and Meagan Shaw)

There are all types of family arrangements. Sometimes only one parent works, sometimes both parents work and sometimes neither parent is able to work. We want to understand more what the impact on the family is when both parents are working throughout the year. Please answer each question thinking about your families current work situation. Remember there are no right or wrong answers the best answer is what is true for you.

1. In the past year has your spouse worked?

Yes

No (If N complete 2-4 and skip rest of questionnaire)

6. Would you like it if your spouse could work less or not working at all? Y N

8. My partner wishes that s/he did not have to work.

When my partner and I are both working…

15. I get less rest

My partner chooses to work because…

19. S/he has the extra time to work.

I wish my partner did not have to work because…

3. What type of payment arrangement do you have for your living quarters at your current home? If payment is only for utilities, consider it free. Do not read choice. Mark only one.

a) I Received free housing from my/my partners employer.

b) I pay for housing provided by my/partners employer.

c) I pay for housing provided by the government, a charity, or other non-work related institution.

d) Do not pay rent. (I or family member own the house or live for free with friends or relatives.

e) I rent from non-employer

f) Other:

4. At this location how much do you pay for housing (including housing for your family, if they live with you)?

a) Per wk, per mo, per day

b) Don’t know, taken out of my/partners paycheck

c) Don’t know/Don’t remember, but not taken out of my paycheck

d) Other

6. How much per hour (to nearest cent)?: _____________per hour

How much per piece:

How many Units can you complete in a day?

How many hours does that take you?

8. What was the amount your employer paid you on your last pay day?

-after taxes/before taxes

14. In the last 12 months, with your current employer, has anyone given you training or instructions in the safe use of pesticides (through video, audio, cassette, classroom lectures, written material, informal talks or by any other means)? Y/N/don’t work in agriculture

Now I’d like to ask you some questions about childcare. There are many places and persons that take care of children while parents work. Parents use childcare or a neighbor’s home; other times the kids stay at home with their mother, siblings or other relatives...

15. In general, how often have you used the following types of childcare for your child(ren) while you work (FW)?

16. In the last month how often have you used the different types of childcare for your children while you work?

a) MSHS

b) Spouse

c) Child’s older sibling(s).Age(s)?:

d) Other relatives’s older siblings)

e) Out of home

f) Friends / Neighbors

g) Take them to the field

h) I only work when my children are in school

i) Other : _______________

20. ...And the last time you used the health care provider, where did you go (what kind of place was it)?

21. And, ...the last time you used the health care provider, who paid the majority of the cost?

I paid the bill out of “my own pocket”

Medicaid/Medicare

Public clinic did not charge

Employer provided health Plan

Self or family bought individual health plan

Billed but not not pay

Worker’s compensation

Other:

Combination of:

22. When you NEED to get health care in the USA what are the main difficulties you face? [CHECK ALL THAT APPLY]

5.Work-to-Family and Family-to-Work Conflict

When we use the word “family” in this survey, we are speaking very broadly and are referring to all types of families, extended families, and family relationships. Please indicate your level of agreement or disagreement with each statement by circling the appropriate number. Check here if you have not worked in the last year () skip questionnaire

Answer: 1=never 2=rarely 3=sometimes 4=often 5=always or almost always

6. Job Content Questionnaire

Check here if you did not work in the last year () Skip to the next questionnaire

1=never 2=rarely 3=sometimes 4=often 5=always or almost always

44.a. Did you do something to change the unfair treatment? y/n

b. If no, why not? Feared retaliation, Didn’t know what to

If yes: 44c. How did you deal with the unfair treatment on the job? Talked to coworker, Talked to boss, Went to government agency, Went to community organization such as Legal Aid, Went to media outlet

d. Were your efforts to stop the unfair treatment successful? Y/n

9. Financial Stress Questionnaire

Think about how you feel about your family’s current economic situation. Indicate how often the following statements reflect your current situation.

1=not at all true 2=a little true 3=somewhat true 4=very true 5= completely true

67.Think back over the past year and tell us how much difficulty you had with paying your bills.

68.Think again over the past 12 months. Generally, at the end of each month do you end up with:

1. How long did it usually take for you to fall asleep during the past 4 weeks? (Circle One)

2. On the average, how many hours did you sleep each night during the past 4 weeks?

Write in number of hours per night:

How often during the past 4 weeks did you...

1=All of the Time 2=Most of the Time 3=A Good Bit of the Time 4=Some of the Time 5=A Little of the Time 6=None of the Time

69.Buxton Fat and Sugar

Think about your eating habits over the past 4 weeks. About how often did you eat or drink each of the following foods? Remember breakfast, lunch, dinner, snacks, and eating out. Blacken in only one bubble for each food.

1=never, 2=less than once, 3=1-3 times, 4=1-2 times per week, 5=3-4 times per week, 6=5-6 times per week, 7=once a day, 8=2 times per day 9=3-4 times per day 10=5 0r more times per day

Type of Food

13. Trouble with muscles and joints

Have you at any time during the last 12 months had trouble in:

9. One or both ankles feet: N Y

Have you at anytime during the last 12 months been prevented from doing your normal work because of the trouble?

18. One or both ankles feet: N Y

Have you had trouble at any time during the last 7 days?

1. In general, would you say your health is:

The following items are about activities you might do during a typical day. Does your health now limit you in these activities? If so, how much?

3. Climbing several flights of stairs

During the past 4 weeks, have you had any of the following problems with your work or other regular daily activities as a result of your physical health?

5. Were limited in the kind of work or other activities

During the past 4 weeks, have you had any of the following problems with your work or other regular daily activities as a result of any emotional problems ?

8. During the past 4 weeks, how much did pain interfere with your normal work (including both work outside the home and housework)?

These questions are about how you feel and how things have been with you during the past 4 weeks. For each question, please give the one answer that comes closest to the way you have been feeling. How much of the time during the past 4 weeks –

16. Dedobbeleer and Beland's Climate Measure

Check here if you have not worked in the last year () skip to the next questionnaire

Management's attitude toward safety practices:

1. How important do you think the workers' safety practices are to the management of your company? (Please check one answer)

Very Important

Somewhat Important

A little Important

Not at all Important

Managements attitude toward workers' safety:

2. How much do supervisors and other top management seem to care about your safety? (Please check one answer)

They do as much as possible to make the job safe

They are concerned about safety but they could do more than the are doing to make the job safe.

They are really only interested in getting the job done as fast and cheaply as possible.

Foremans's behavior

3. How much emphasis does the foreman place on safety practices on the job? (Please check one answer)

He regularly and frequently makes us aware of dangerous work practices and conditions.

He occasionally points out the most dangerous work practices and conditions

He seldom mentions danger or safety practices

He never mentions danger or safety practices

Safety instructions

4. When you were hired by your present employer, were you given instructions on the safety policy, safety requirements of the company? Yes No

Safety meetings

5. Are there regular job safety meetings at your present job site? Yes No

Proper equipment

7. How much control do you feel you have yourself over what happens to your safety on the job?

Almost no control

Almost total control

Primary control but luck is a factor

Little control, mostly a matter of luck

Perception of risk-taking

17. Multidimensional scale of perceived social support

1= never 2= rarely 3=sometime 4= fairly often 5= almost always

18. Perceived Stress Scale

1= never 2= rarely 3=sometime 4= fairly often 5= almost always

FW survey test