7

Body mapping tool

Have last t (such numbn needle

Neck

Should

Elbows

Wrists/ hands

This section asks about musculoskeletal disorders, such as aches or pains, you may have had recently. Please use the tick boxes - □ - to answer each of the four questions for each part of the body shown in the picture on the right. The picture shows how the body has been divided. The areas of the body are not sharply defined and some parts overlap. You should decide for yourself which part (if any) is or has been affected. Please make sure you put one tick only for each question. For example, you could answer ‘Yes’ for the right elbow, or the left elbow, or both elbows.

you at any time during the hree months had trouble as ache, pain, discomfort, ess, tingling, or pins and s) in your:

Have you had this

trouble during the last seven days?

During the last three

months has this trouble prevented you

carrying out normal activities (e.g. job,

housework, hobbies)?

During the last three

months has this trouble been caused

or made worse by your job?

1 No Yes 1 2

2 No Yes 1 2

3 No Yes 1 2

4 No Yes 1 2 Caused 3 Made worse

ers 5 No Yes 1 2 Right only 3 Left only

4 Both

6 No Yes 1 2 Right only 3 Left only

4 Both

7 No Yes

8 No Yes 1 2 Caused 3 Made worse

9 No Yes 1 2 Right only 3 Left only

4 Both

10 No Yes 1 2 Right only 3 Left only

4 Both

11 No Yes 12 No Yes 1 2 Caused 3 Made worse

13 No Yes 1 2 Right only 3 Left only

4 Both

14 No Yes 1 2 Right only 3 Left only

4 Both

15 No Yes 1 2 Right only 3 Left only

4 Both

16 No Yes 1 2 Caused 3 Made worse

1 2 Right only 3 Left only

4 Both

1 2 Right only 3 Left only

4 Both

Upper back 17 No Yes

1 2 18 No Yes

1 2 19 No Yes

1 2 20 No Yes

1 2 Caused 3 Made worse

Lower back (small of back)

21 No Yes 1 2

22 No Yes 1 2

23 No Yes 1 2

24 No Yes 1 2 Caused 3 Made worse

Hips/ thighs/ buttocks

25 No Yes 1 2 Right only 3 Left only

4 Both

26 No Yes 1 2 Right only 3 Left only

4 Both

27 No Yes 1 2 Right only 3 Left only

4 Both

28 No Yes 1 2 Caused 3 Made worse

Knees 29 No Yes 1 2 Right only 3 Left only

4 Both

30 No Yes 1 2 Right only 3 Left only

4 Both

31 No Yes 1 2 Right only 3 Left only

4 Both

32 No Yes 1 2 Caused 3 Made worse

Ankles/ feet 33 No Yes 1 2 Right only 3 Left only

4 Both

34 No Yes 1 2 Right only 3 Left only

4 Both

35 No Yes 1 2 Right only 3 Left only

4 Both

36 No Yes 1 2 Caused 3 Made worse