LORMA COLLEGES

College of Nursing
Carlatan, City of San Fernando, La Union


QUESTIONNAIRE

I. Profile of Tricycle Drivers
Instruction: Kindly complete the information by writing your answers beside the spaces
provided.
1. Age: _____
2. Age when Started Driving: _____
3. Number of Hours Driving in a Day: _____
4. Number of Days Driving in a Week: ___
II. Health Practices among Tricycle Drivers
Instruction: Please describe the extent to which you perform the following activities by
checking the appropriate column using the following scale:
3 Always (the activity is performed at all times)
2 Sometimes (the activity is performed once in a while)
1 Never (the activity is not performed at all)

EATING PATTERN 1 2 3
1. I eat meals on time.
a. breakfast (6am - 8am)
b. lunch (11am - 1pm)
c. dinner (6pm 8pm)
2. I eat 6-8 serving of fruits and vegetables
a. breakfast (1 serving of fruits and 1 serving vegetables)
b. lunch (1 serving of fruits and 1 serving vegetables)
c. dinner (1 serving of fruits and 1 serving vegetables)
3. I eat 3-6 cups of rice
a. breakfast (1-2 cup)
b. lunch (1-2 cup)
c. dinner (1-2 cup)
4. I add 3 servings of meat or meat alternatives (tofu) on my meals.
5. I eat snacks 2-3 times a day.
6. I bring packed food in my work.
7. I eat
a. street foods
b. canned goods
c. frozen foods
8. I drink 6-8 glasses of water every day, or more if necessary.




SAFETY PRECAUTION 1 2 3
1. I wear proper attire such rubber shoes, long sleeves and
sunglasses to protect my skin from the sun

2. I use raincoat during rainy seasons. .
3. I wear protective gears or equipment (mask, motorcycle gloves,
elbow and knee pads, etc.) during work.

4. I check the condition of my tricycle (gasoline, brakes, lights, tires,
etc.) before driving.

5. I make full use of the side-mirrors of my tricycle to check traffic
conditions and to signal properly in good time before changing lanes.

6. I avoid distractions when driving such as loud music and using a
hand-held mobile phone.

7. I obey, and understand the meaning and indication of traffic rules,
traffic light signals and traffic signs.

8. I know the hotlines (hospital, police, etc.) in case of emergency.
ELIMATION 1 2 3
1. I urinate whenever I have the urge.
2. I experience frequent urination during my work.
3. I move my bowel every day.
4. I urinate and defecate on a clean environment.
5. I use tissue, or soap and water after elimination.
6. I wash my hands after elimination.
7. I change my clothes when I sweat a lot.
8. I cover my mouth when I cough and sneeze.
LIFESTYLE 1 2 3
1. I smoke cigarette.
2. I drink
a. liquor
b. coffee
c. soft drinks
d. juice (tetra packs)
e. energy drink (sting, cobra, samurai, etc.)
3. I take vitamin supplements.
4. I go for annual check-up.
5. I do physical exercises for at least 30 minutes a day for 3-4x a
week.

6. I engage in recreational activities (watching TV, listening to the
radio, reading newspaper, playing cards, etc.), or sports activities
during my spare time at work.

7. I sleep between 6 and 8 hours every night and wake up feeling
rested.

8. I go to the doctor whenever I am not feeling well.
III. Common Health Problems among Tricycle Drivers
Instruction: Please check all those common health problems that you have experienced
since you started driving tricycle.

1. Bloated after meals
2. Nausea and vomiting
3. Gastric irritation
4. Watery stools
5. No regular bowel movement
6. Difficulty in urination
7. Urinary incontinence
8. Unusual discharge
9. Burning sensation when urinating
10. Dark-colored urine
11. Difficulty of breathing
12. Chest pain
13. Cough with secretions
14. Cough without secretions
15. Colds
16. Fracture
17. Head injury
18. Bruises
19. Disabilities
20. Blurred vision
21. Headache
22. Others (Please specify.)