| 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 | |_________| | ||
| Work center information | |||||
| Q14 | How many years have you been working in the milling factory of Dantokpa market? | Specify the number of years of exercise; 999 if not applicable | |_________| | ||
| Q15 | What is your professional status? | Mill owner = 0 Serving a leader = 1 | |_________| | ||
| Q16 | How many hours do you work a day? | 1-2 years = 0 More than 2 years = 1 | |_________| | ||
| Q17 | Noise level measurement at the station | Inf 85 dB = 0 85 - 90 dB = 1 Sup 90 dB = 2 | |_________| | ||
| Q18 | Do you have personal protective equipment (PPE) against noise? | No = 0; Yes = 1 |
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| Q19 | If yes, name them and show them |
| |_________| | ||
| Q20 | Does your job require you to be in constant noise all day? | No = 0; Yes = 1 |
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| Q21 | Do you take a break at your workstation? | No = 0; Yes = 1 |
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| Q22 | If so, what do you do during the break? | You stay at the station = 1 |
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| You are leaving the position = 2 Other to be specified = 3 |
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| Q23 | Do you have any activities outside of milling that expose you to noise? | No = 0; Yes = 1 | |_________| | ||
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| Background |
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| Q24 | What is your smoking status? | Non-smoker = 0; Current smoker = 1; Ex-smoker = 2; Passive smoker = 3 | |_________| | ||
| Q25 | Do you have an ENT history before starting to work in the milling industry? (otitis, tympanic perforation, trauma) | No = 0; Yes = 1 | |_________| | ||
| Complaints |
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| Q26 | Do you speak normally at work to make yourself heard? | No = 0; Yes = 1 | |_________| | ||
| Q27 | Do you know the health effects of noise? | Acute cough = 0; Chronic dry cough = 1; Chronic productive cough = 2; Not applicable = 9 | |_________| | ||
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| After 8 hours of work do you experience the following symptoms? | No = 0; Yes = 1 | |_________| | ||
| Q28 | Headaches | No = 0; Yes = 1 | |_________| | ||
| Q29 | Ringing/whistling in the ears | No = 0; Yes = 1 | |_________| | ||
| Q30 | Sensation of hearing loss | No = 0; Yes = 1 | |_________| | ||
| Q31 | Fatigue | No = 0; Yes = 1 | |_________| | ||
| Q32 | Perceived stress (visual stress scale reading) | No = 0; Yes = 1 | |_________| | ||
| Q33 | Irritability | No = 0; Yes = 1 | |_________| | ||
| Q34 | Sleep disorder | No = 0; Yes = 1 | |_________| | ||
| Q35 | Dizziness | No = 0; Yes = 1 | |_________| | ||
| Q36 | Palpitation | No = 0; Yes = 1 | |_________| | ||
| Q37 | Anxiety | No = 0; Yes = 1 | |_________| | ||
| Q38 | Concentration problems | No = 0; Yes = 1 | |_________| | ||
| General review |
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| Q39 | Weight (kgs) |
| |_________| | ||
| Q40 | Size (cm) |
| |_________| | ||
| Q41 | Body mass index (kg/m²) |
| |_________| | ||
| Q42 | Systolic blood pressure (mmHg) |
| |_________| | ||
| Q43 | Diastolic blood pressure (mmHg) |
| |_________| | ||
| Physical examination |
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| Q44 | Otoscopic examination | Normal = 0 ; Abnormal = 1 (discharge, inflamed EAC, AOM, perforated eardrum) | |_________| | ||
| Audiometric results |
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