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Date first worked at the World Trade Center site:
Date last worked at the World Trade Center site:
What was your job/role in the recovery and/or cleanup effort?
Did you experience any of the following symptoms during or after working at the WTC site? Asthmatic Attacks Excessive Coughing and Wheezing Shortness of Breath Bronchitis Pulmonary Inflammation Skin Irritation Heart Attack Stroke Nervous Disorder Other None (just concerned)
After September 11, 2001, did a doctor ever diagnose you with any of the following: WTC Cough Pulmonary Inflammation Lung Disease Asthma Bronchitis Silicosis Cancer Kidney Disease Mesothelioma Heart Attack Heart Disease Stroke Brain Damage Nervous Disorder Other
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