| N˚ | Questions | Codes | Answer |
| General information | |||
| Q1 | Record number |
| |_________| |
| Q2 | Date of registration | Date of registration in the study | |___|___|___| |
| Q3 | Personnel number | Give the participant’s registration number in the structure | |_________| |
| Q4 | Phone number | …………………………………………… ………… | |
| Socio-demographic characteristics | |||
| Q5 | Age (Years) | Number of years completed |
|_________| |
| Q6 | Sex | Female = 0; Male = 1 |
|_________| |
| Q7 | Nationality | Beninese = 0; Others = 1 (Specify.............) |
|_________| |
| Q8 | Marital status | Single = 0; Couple = 1; Divorced = 2; Widowed = 3 | |_________| |
| Q13 | Level of education | Never attended = 0; Literate = 1; Primary = 2; Secondary = 3; Higher = 4 | |_________| |
| Workplace information and associated respiratory risks | |||
| Q9 | How many years have you been working in the oil mill? | Specify the number of years of exercise; 999 if not applicable | |_________| |
| Q10 | What is your workstation | …………………...………………………. | |_________| |
| Q11 | The worker is involved in which area of the oil mill? | Administration = 0; Production = 1 | |_________| |
| Q12 | Is the worker exposed to inhalation of cotton dust? | No = 0; Yes = 1 | |_________| |
| Q13 | Is the worker exposed to hexane inhalation? | No = 0; Yes = 1 |
|
| History and use of drugs | |||
| Q14 | What is your smoking status? | Non-smoker = 0; Current smoker = 1; Ex smoker = 2; Passive smoker = 3 | |_________| |
| Q15 | Number of years of smoking (Current or former smoker) |
| |_________| |
| Q16 | Number of IPs (Current or Former Smoker) |
| |_________| |
| Q17 | Do you use other drugs such as cannabis or cocaine? | No = 0; Yes = 1 | |_________| |
| Complaints | |||
| Q18 | Do you have a frequent cough? | No = 0; Yes = 1 | |_________| |
| Q19 | What are the common characteristics of this cough? | Acute cough = 0; Chronic dry cough = 1; Chronic productive cough = 2; Not applicable = 9 | |_________| |
| Q20 | Do you have frequent Phlegm? | No = 0; Yes = 1 | |_________| |
| Q21 | Do you have frequent chest pain? | No = 0; Yes = 1 | |_________| |
| Q22 | Do you frequently experience breathing difficulties? | No = 0; Yes = 1 | |_________| |
| Q23 | Staging of dyspnea (Sadoul scale) | Stage0 = 0; StageI = 1; StageII = 2; StageIII = 3; StageIV = 4; StageV = 5; Unknown = 9 | |_________| |
| Q24 | Do you have frequent wheezing in your chest? | No = 0; Yes = 1 | |_________| |
| Q25 | Do you have frequent hemoptysis? | No = 0; Yes = 1 | |_________| |
| Q26 | How many years have you had these symptoms regularly? |
| |_________| |
| General review | |||
| Q27 | Weight (kgs) |
| |_________| |
| Q28 | Size (cm) |
| |_________| |
| Q29 | Body mass index (kg/m²) |
| |_________| |
| Q30 | Systolic blood pressure (mmHg) |
| |_________| |
| Q31 | Diastolic blood pressure (mmHg) |
| |_________| |
| Q32 | Heart rate (/ min) |
| |_________| |
| Q33 | Respiratory rate (/ min) |
| |_________| |
| Q34 | SaO2 |
| |_________| |
| Physical examination | |||
| Q34 | Pleuro-pulmonary examination | Normal = 0 ; Abnormal = 1 | |_________| |
| Q35 | Specify abnormality if abnormal pleuropulmonary examination | …………………………………………………………… …………………. | |
| Spirometry results | |||
| Q36 | Measured FEV1 (L) |
| |_________| |
| Q37 | LIN Theoretical FEV1 (L) |
| |_________| |
| Q38 | Measured FEV1/Theoretical FEV1 (%) |
| |_________| |
| Q39 | Measured FVC (L) |
| |_________| |
| Q40 | LIN Theoretical FVC (L) |
| |_________| |
| Q41 | FEV1/FVC measured (%) |
| |_________| |
| Q42 | FEV1/Theoretical FVC LIN (%) |
| |_________| |
| Q43 | Result of spirometry | Normal = 0; TVO = 1; TVR = 2; TVM = 3; Distal TVO = 4; Unknown = 9 | |_________| |