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010 <br /> 5. To what extent are you bothered by someone else smoking at work? <br /> a. Not at all <br /> b. Slightly <br /> c. Considerably <br /> d. It constitutes a health hazard for me <br /> 6. How often are you bothered by someone else smoking at work? <br /> a. Always <br /> b. Frequently <br /> c. Occasionally <br /> _ d. Seldom <br /> e. Never <br /> 7 . In what ways are you bothered by smoking? (Check as many as <br /> apply. ) <br /> a. Not at all <br /> b. Eye irritation <br /> c. Coughing <br /> d. Headaches <br /> e. Interferes with work performance (ex. must move to a <br /> smoke- free area to work) <br /> f. Concerned about long-term health effects <br /> g. Clothing and hair smell <br /> h. Allergy <br /> i. Asthma <br /> j . All of the above <br /> k. Some of the above <br /> 1. Other (specify) <br /> m. Odor <br /> 8. What is your opinion of a County smoking policy? Please rank the <br /> following on a scale of 1 to 6 with 1. being most acceptable and <br /> 6. being least acceptable. <br /> a. There should be no restrictions. <br /> b. There should be a total ban on smoking by employees and <br /> public alike in all County facilities. <br /> c. There should be a total ban on smoking by employees with <br /> public restricted to smoking in designated areas. <br /> d. There should be designated smoking and non-smoking areas <br /> for employees and public alike. <br /> 1) If smoking is allowed, smokeless ashtrays purchased <br /> at personal expense of smokers required Yes ^ No <br /> e. Smoking should be allowed in work areas if all co- <br /> workers agree, except in areas restricted for safety <br /> (elevators, around flammable or explosive materials, <br /> etc. ) , otherwise smoking prohibited. <br /> 1) If smoking is allowed, smokeless ashtrays purchased <br /> at personal expense of smokers required __ Yes — No <br /> (Question 8 is continued on the next page. ) <br /> Page 2 of 6 <br />