Your browser does not support JavaScript
Please enable JavaScript to make sure proper function of the application
Close
Modal Title
Close
Modal Title
English
Deutsch
X
1
2
3
4
5
6
7
8
i
Visit
Subject ID
Gender
M
F
Age
Date of Inclusion
Page
Date of data entry
Site
First Visit (Inclusion)
Version2_May2018 / Page 1
Socio-demographic data
1. Year of birth
2. Weight:
3. Height:
example: 1.65
Circumference hip
4. Ethnic origin
White
Caucasian
American Native
Mediterranean
North African
Black
Asian
Hawaiian
Other
Ethnic origin other
5. Skin phototype
I
I (pale white skin; blue/hazel eyes; blond/red hair; always burns; does not tan)
II
II (fair skin; blue eyes; burns easily; tans poorly)
III
III (darker white skin; tans after initial burn)
IV
IV (light brown skin; burns minimally; tans easily)
V
V (brown skin; rarely burns; tans dark easily)
VI
VI (dark brown or black skin; never burns; always tans dark)
6. Hair structure
Straight
Wavy
Curly
Unknown
7. Area of residence
Rural
City
8. Marital status
Single
Married/cohabitation
Divorced/separated
Widow/widower
9. Occupational status
Full time employment/Student
Full time employment/Student
On sick leave
On sick leave
On disability benefit
Rehabilitating
Rehabilitating
Retired
Unemployed
Unemployed
10. Educational level
Primary school 7-10 years
Vocational School
High School
College or university (less than 4 years)
College or university (4 or more years)
Next Page