The form I downloaded from SCNM's website included two tables, one for my
residence history, one for my job history. Given that I am 59 and have literally
lived in nearly three dozen different locations, with at least as many different
jobs, it didn't seem to me that the form would be adequate. So I mimicked both
online.
| Location |
Dates |
City, Suburb, Rural |
Amount of Traffic |
Age of Building |
Type of Residence |
Known Exposures |
Moved for Health Reasons? |
Styertowne Apartments
Styertowne, NJ |
1951-1952 |
|
|
|
Apt |
The apartment above ours caught fire. Mom smoked. |
N |
MacArthur Avenue
Garfield, NJ |
1952-1958 |
City |
Moderate |
N/A |
Converted factory |
Building had been a rubber tool factory. Mom
smoked. Mothballs. |
N |
River Road
Victory, VT |
1958-1961 |
Rural |
Almost none |
100 years |
Farmhouse |
Lived in house through remodeling (new wood, drywall,
paint, shingles); kerosene oil lamps (I cleaned and filled them;
kerosene stored in back room tank). Lead pipes.
Mom smoked. I played with liquid mercury (fun to smear it on fingers).
Oil heat, gas heat. Wood stove, oil stove, gas stove. Gas refrigerator.
Mothballs. |
N |
Val's Motel
Concord, VT |
Winters 1959, 1960 |
Rural |
Little |
N/A |
Efficiency Apt |
Mom smoked. |
N |
St. George Street
St. Augustine, FL |
1961-1963 |
City |
Little |
50 years |
House |
My room was a remodeled porch, work done when we
moved in.
Mom, Grandma, and Grandpa all smoked. Mothballs. |
N |
B Street
St. Augustine Beach, FL |
1963-1968 |
Suburb |
Almost none |
0 years (new house) |
House |
Nightly visits by mosquito control truck all summer;
we used to run after the truck and let it spray us.
Mom, Grandma, and Grandpa all smoked. Mom sprayed Lysol liberally,
409, etc. |
N |
Sevilla St.
St. Augustine, FL |
1968-1971 |
City |
Little |
40 years? |
House |
Brand-new sofa bed; I did woodworking in school and
built some furniture. Mom and Grandpa all smoked. Mom sprayed Lysol
liberally. |
N |
Laurel St.
Palatka, FL |
1972 |
City |
Moderate |
N/A |
Garage apartment (but no cars stored while we were
there) |
|
N |
Breezy Brae Trailer Park
Wildwood Dr.
St. Augustine, FL |
1972 |
Rural |
Almost none |
5 years? |
Mobile home |
|
N |
San Sebastian Av.
St. Augustine, FL |
1972 |
City |
Just off highway |
N/A |
Apt in converted house |
|
N |
| Ft. Lauderdale, FL |
1973-1974 |
City |
Moderate |
N/A |
Garden Apt |
|
N |
Great Lakes NTC
Illinois |
1974-1975 |
|
Moderate |
Old |
House |
Various shots, chemicals, tools, etc. |
N |
| USS Yosemite |
1975 |
Ship |
|
|
Ship |
All kinds of fuels, smells, solvents, etc. |
N |
| Bakersfield, FL |
1976-1977 |
Rural |
Little, but what there was, was diesel equipment |
40 years ? |
House |
Insect repellent (lots). Gas heat. |
N |
W 15th St
Panama City, FL |
1977 |
City (Park) |
Some diesel equipment exposure |
40 years ? |
House |
Gas heat. |
N |
| Pensacola, FL |
1978-1979 |
City |
Little |
7 years ? |
Mobile home |
|
N |
| Manassas, VA |
1979-1980 |
City |
Little |
N/A |
Townhouse |
New foam mattress. |
N |
| Omaha, NE |
1980-1981 |
City |
Moderate |
N/A |
Apt |
|
N |
| Blair, NE |
1981-1982 |
Town |
Moderate |
ancient |
House |
Mold. |
N |
| Elkton, FL |
1982 |
Rural |
Almost none |
7 years ? |
Mobile home |
Insect repellent. |
N |
| Silver Spring, MD |
1983 |
Suburb |
Moderate |
N//A |
Apt |
|
N |
Inlet Court
Reston, VA |
1983-1985 |
Suburb |
Moderate |
N/A |
Townhouse |
Waterbed. |
N |
Bluefish Lane
Fort Myers, FL |
1986 |
City |
Moderate |
N/A |
Townhouse |
Waterbed. |
N |
Winterthur Apartments
Winterthur Ln
Reston, VA |
1987 |
Suburb |
Moderate |
N/A |
Apt |
Chlorinated pool.
Waterbed. |
N |
Deep Wood
Reston, VA |
1988-1989 |
Suburb |
Moderate |
N/A |
Townhouse |
Waterbed. Fireplace (rarely used). |
N |
| various places in Florida |
1990 |
Suburb |
Moderate |
N/A |
Apt |
Several new apartments; chlorinated pools. Waterbed. |
N |
Countryside Village
Village Circle Way
Manchester, NH 03102 |
1991-1992 |
Outskirts |
Little |
N/A |
Apt |
When my mother stayed with me, frequent and liberal
use of Lysol. Waterbed. |
N |
Eagle Nest Way
Manchester, NH |
1992-1997 |
Hilltop |
Little (but adjacent to highway) |
10 years? |
Townhouse |
Waterbed. |
N |
| Snowflake, AZ |
Sep-Dec 1997 |
Rural |
None |
ancient |
Mobile home |
Beneath mobile home, piles of rat feces. Gas stove.
Gas refrigerator. |
N |
Miller Trail Road
Snowflake, AZ |
1998-1999 |
Rural |
Almost none |
10 years? |
Manufactured home |
|
N |
Greenbrian Rd
Peoria, AZ 85382 |
1999-2001 |
City |
Moderate |
N/A |
House |
Mom's Lysol. Glade plug-ins air freshener. Febreze.
Commercial pest control treatments. |
N |
N 90th Lane
Peoria, AZ 85381 |
2001-2005 |
City |
Little |
N/A |
House |
Mom's Lysol. Pets sprayed for fleas; flea collars.
Glade plug-ins air freshener. Febreze. Commercial pest control
treatments. |
N |
E Lobo Ave
Mesa, AZ 85209 |
2005-2009 |
Suburb |
Little |
4 years |
House |
Pets sprayed for fleas; flea collars. Glade plug-ins
air freshener. Febreze. Commercial pest control treatments. |
N |
E Natal Ave
Mesa, AZ 85209 |
2009- |
Suburb |
Little |
10 years |
House |
On golf course, with pool. Pets have flea collars.
Glade plug-ins air freshener. Febreze. Commercial pest control
treatments. |
N |
| Workplace |
Dates |
Full-Time (Y/N) |
Type of Industry |
Job Duties |
Known Exposures |
Protective Equipment |
Missed Work for Health Reasons? |
| Stanley Chair Company |
10/1969 - 12/1969 |
Y |
Furniture Manufacturer |
Cushion-Stuffer |
Foam rubber, Polyurethane foam, formaldehyde, dust |
None |
N |
| Sears |
1/1970 - 3/1970 |
Y |
Auto Parts Department |
Inventory |
Oils, cleaners |
None |
N |
| Hungry Pelican |
2/1972 - 3/1972 |
N |
Fast Food Restaurant |
Cook, Cashier |
Cooking oils, degreasers |
None |
N |
| Palm Coast |
4/1972 - 5/1972 |
Y |
Real Estate |
Tour Guide |
|
None |
N |
| WAOC |
6/1972 - 12/1972 |
Y |
Radio Station |
Disc Jockey |
|
None |
N |
| Hollywood Elevator Cab Company |
1 week in January, 1973 |
Y |
Manufacturing |
Various |
Spray laminate |
Goggles |
N |
| King Pest Control |
4/1973 - 3/1974 |
Y |
Pest Control |
Technician |
Various insecticides |
None |
N |
| security company |
5-1974 - 7/1974 |
Y |
Security Guard |
Watch railroad car in woods to make sure no one stole
it |
An incident in which I accidentally Maced myself |
None |
N |
| US Navy |
8/1974 - 12/1975 |
Y |
Electronics Technician |
Recruit, Trainee, then repaired electronic equipment |
Shipboard environment: Diesel fumes, solvents, etc.
Once got seriously shocked by electricity. |
None |
N |
| Florida State Division of Forestry |
1976 - 1977 |
Y |
Fire Control Dispatcher |
Climb fire tower, spot fires, radio rangers to put
them out |
Insecticide to kill wasps in tower; diesel fumes;
once or twice exposed to forest fire smoke |
None |
Y (Kidney Stone) |
| Student / Environmental Protection Agency |
1978 - 1979 |
Y |
Computer Programmer |
Designed and wrote computer programs |
|
None |
N |
| Self-Employed |
1979 - 1985 |
Y |
Computer Programmer |
Designed and wrote computer programs |
|
None |
Y (Kidney Stone) |
| GBSI |
1986 |
Y |
Computer Programmer |
Designed and wrote computer programs |
Worked in a factory-like environment, with various
chemicals and exposure to paper dust and cigarette smoke |
None |
N |
| Self-Employed |
1987 - 1993 |
Y |
Computer Programmer |
Designed and wrote computer programs |
|
None |
N |
| Self-Employed |
1993 - 2001 |
Y |
Corporate Instructor |
Taught one-week programming courses all
over US, plus Canada, Mexico and Germany |
Various environments including factories,
offices, weekly air travel |
None |
N |
| Schneider National Carriers |
2002 - 2003 |
Y |
Truck Driver |
Drove a "big rig" up and down west coast |
Diesel fumes, plus one incident of
spraying diesel on myself (got in eyes, nose, mouth) |
None |
Y (Got a double hernia on the job) |
| Self-Employed |
2003 - 2004 |
Y |
Computer Programmer |
Designed and wrote computer programs |
|
None |
Y (Developed cellulitis, spent week in
hospital) |
| Self-Employed |
2005 |
Y |
Computer Programmer |
Designed and wrote computer programs |
Building had moldy smell |
None |
N (But developed severe red eye that
never really went away) |
| Self-Employed |
2006 - present |
Y |
Computer Programmer |
Designed and wrote computer programs |
|
None |
N (and everyone else in my building is
constantly sick) (I do usually sneeze in the building though) |