Questionnaire Text

Questionnaire form view entire document: text image

30. At what location did this person work LAST WEEK? If this person worked at more than one location, print where he or she worked most last week

a) Address (Number and street name)_________________________________

If the exact address is not known, give a description of the location such as the building name or the nearest street or intersection.

b) Name of city, town, or post office _________________________________

c) Is the work location inside the limits of that city or town?

[ ] Yes
[ ] No, outside the city/town limits

d) Name of county _________________________________

e) Name of U.S. state or foreign country _________________________________

f) ZIP Code

[ ][ ][ ][ ][ ]

Questionnaire instructions view entire document: text image

24.Include the house or structure number; street name; street type (for example, St., Road, Ave.); and the street direction (if a direction such as "North" is part of the address). For example, print 1239 N. Main St. or 1239 Main St., N.W., not just 1239 Main.

If the only known address is a post office box, give a description of the work location. For example, print the name of the building or shopping center where the person works, the nearest intersection, or the nearest street where the workplace is located, etc. DO NOT GIVE A POST OFFICE BOX NUMBER.

If the person worked at a military installation or military base that has no street address, report the name of the military installation or base, and a description of the work location (such as building number, building name, nearest street or intersection).

If the person worked at several locations, but reported to the same location each day to begin work, print the street address of the location where he or she reported. If the person did not report to the same location each day to begin work, print the address of the location where he or she worked most of the time last week.

If the person's employer operates in more than one location (such as a grocery store chain or public school system), print the street address of the location or branch where the person worked. If the street address of a school is not known, print the name of the school, and a description of the location (such as nearest street or intersection).

If the person worked on a college or university campus and the street address of the workplace is not known, print the name of the building where he or she worked, and a description of the location (such as nearest street or intersection).

If the person worked in a foreign country or Puerto Rico, Guam, etc., print the name of the country on the state or foreign country line and then go to question 25.