Questionnaire Text

Questionnaire form view entire document:  text  image
14. Is he (she), for the reason of his (her) disability or disease, wholly or to a high degree limited in main activities relevant to his (her) age (professional activities, studies, household keeping, etc.; in the case of small children: playing games, etc.)?

[] 0 Not
[] 1 Yes, wholly
[] 2 Yes, to a high degree
Questionnaire instructions view entire document:  text  image
Main tasks relevant for the given age shall be understood as:
a) For children in the pre-school age (0-6 year old) ability to fully engage in all forms of entertainment and games, and in the case of the youngest children (those around 1 year old) ability to properly reply to both internal and external stimuli (crying, smiling, performing proper gestures, etc.)
Whole limitation the said limitation level shall be indicated for severely disabled individual and for those with nervous system significantly damaged. Limitation to a high degree if the general health condition makes it impossible for the said individual to perform the abovementioned tasks.
b) Children in the school and pre-reproduction age (7-17 year old) attending school in a normal manner and ability to take active part in all the lessons (excluding PE).
Whole limitation the said level shall be indicated if the given individual is unable to attend any school, even a special one.
Limitation to a high degree if the said individual attends special school (or class), special education facility (for example, for bling or mentally disabled children), as well as if he or she attends a traditional school, but due to acute disability or disease - he or she is unable to fully engage in the organized non-sport activities.
Note: In the case of some children with certain task performance limitations, especially in the case of those provided for by parents working in socialized agricultural companies, there is the 500 PLN family allowance provided. Such children shall be considered to be limited (wholly or to a high degree).
c) Individuals in the production age (men 18-64 year old, women 18-59 year old) professional work, managing the household by women (especially those above 25), attending a high school or a university.
Whole limitation such inability shall be indicated if the said person is completely unable to perform the activities mentioned before or had to stop them due to the disability and now cannot return to performing the aforementioned tasks.
Limitation to a high degree shall be understood as ability to perform certain basic tasks at the workplace that have always been executed as the part of the job, as well as capability to partially manage the household. This answer shall be also indicated if the surveyed individual has had to limit the time of performing the said activities (working part-time or having to take a leave), completely stop their performance by changing the scope of responsibilities (for example, by changing the workplace, changing a school for a special one, abandoning certain house chores, etc.), or take advantage of special tools and equipment making the execution of the said tasks notably easier.
d) Individuals in the post-production age (men 65 year old and more, women 60 year old and more) ability to care about oneself by, for example, preparing basic meals, making shopping, cleaning the premises, taking a bath.
Whole limitation shall be indicated for the individuals who, due to a severe illness or disability, had to abandon the performance of the abovementioned tasks or have to be constantly supervised by other individuals in order to make it possible for them to do so.
Limitation to a high degree concerns the individuals who must be supervised or supported while executing certain of the abovementioned tasks, as well as those who had to abandon the performance of only some of the tasks enumerated above.