Gender of the child
Bond with the child
Different bond with the child
How often does the child live at this address?
If the child also lives partly at a different address, is this other address located within the Singel of the city of Antwerp?
Name of the school
Address of the school
How long will the child live at the current address?
How long has the mother lived at the current address?
What is the child's country of birth?
What is the mother's country of birth?
What is the maternal grandmother's native country?
Today's Date
What is your relationship with the child participating in the study?
Which other person?
How many children aged 0-14 do you have in your household?
How many children aged 15-18 does your household consist of?
How many adults does your household consist of?
How many times have you been pregnant?
What is your highest degree?
What other diploma?
What is your nationality at birth: Belgian
What is your nationality at birth: Dutch
What is your nationality at birth: French
What is your nationality at birth: German
What is your nationality at birth: Italian
What is your nationality at birth: Spanish
What is your nationality at birth: Portuguese
What is your nationality at birth Polish
What is your nationality at birth: Turkish
What is your nationality at birth: Moroccan
What is your nationality at birth: I don't know
What is your nationality at birth: Other country
Which other country?
Current nationality : Belgian
Current nationality r: Dutch
Current nationality : French
Current nationality: German
Current nationality: Italian
Current nationality : Spanish
Current nationality : Portuguese
Current nationality : Polish
Current Nationality: Turkish
Current nationality : Moroccan
Current nationality : I don't know
Current nationality : Other country
Which other country
Do you have a partner who resides at the same address?
What profession do you currently practice?
What profession does your partner currently practice?
How easy or difficult is it to make ends meet with the total income of your household per month?
In which category does your family's total net monthly income fall? (wages, child benefit, benefits, etc. included)
What type of home do you live in?
Which floor?
What is the year of construction of the house?
Does the family own the house?
Have there been road or demolition works in the street where you live in the past 3 months?
Have you done or had renovation or embellishment work done in your house in the past year that released a lot of dust?
What floor covering do you have in the living room?  Tiles
What floor covering do you have in the living room? Carpet
What floor covering do you have in the living room? Loose carpets
What floor covering do you have in the living room? Parquet
What floor covering do you have in the living room? Plank floor
What floor covering do you have in the living room? Other (e.g. laminate, vinyl,...)
What floor covering do you have in the living room? Not applicable
What flooring do you have in the kitchen?  Tiles
What flooring do you have in the kitchen? Carpet
What flooring do you have in the kitchen? Loose carpets
What flooring do you have in the kitchen? Parquet
What flooring do you have in the kitchen? Plank floor
What flooring do you have in the kitchen? Other (e.g. laminate, vinyl,...)
What flooring do you have in the kitchen? Not applicable
What floor covering do you have in your bedroom?  Tiles
What floor covering do you have in your bedroom? Carpet
What floor covering do you have in your bedroom? Loose carpets
What floor covering do you have in your bedroom? Parquet
What floor covering do you have in your bedroom? Plank floor
What floor covering do you have in your bedroom? Other (e.g. laminate, vinyl,...)
What floor covering do you have in your bedroom? Not applicable
What floor covering do you have in your child's bedroom?  Tiles
What floor covering do you have in your child's bedroom? Carpet
What floor covering do you have in your child's bedroom? Loose carpets
What floor covering do you have in your child's bedroom? Parquet
What floor covering do you have in your child's bedroom? Plank floor
What floor covering do you have in your child's bedroom? Other (e.g. laminate, vinyl,...)
What floor covering do you have in your child's bedroom? N/A
How many times a week do you perform the following activities? Wipe off dust in the living room with a dry cloth
How many times a week do you perform the following activities? Wipe off dust in the living room with a damp cloth
How many times a week do you perform the following activities? Knock out the rug of the living room
How many times a week do you perform the following activities? Sweep or turn living room
How many times a week do you perform the following activities? Vacuuming living room
How many times a week do you perform the following activities? Mopping living room
How many times a week do you perform the following activities? Scrubbing the living room, cleaning the carpet with shampoo
How many times a week do you perform the following activities? Washing the windows of the living room
How many times a week do you perform the following activities? Kitchen cleaning
How many times a week do you perform the following activities? Bathroom cleaning
How many times a week do you perform the following activities? Cleaning bedrooms
How many times a week do you perform the following activities? Sweeping the terrace
How many times a week do you perform the following activities? Hose down the terrace
Do you use a stove (wood, gas, fuel oil, etc.) or a fireplace in your home?
What kind of stove do you use in your home? Wood pellet stove
What kind of stove do you use in your home? Oil heater/oil heater
What kind of stove do you use in your home? Gas heater (no decorative fireplaces)
What kind of stove do you use in your home? Wood stove
What kind of stove do you use in your home? Fireplace
What kind of stove do you use in your home? Coal stove
What kind of stove do you use in your home? Other
What other stove?
How often do you use this stove(s) or fireplace?  
Do you ever burn outside, e.g. an open fire or a fire pit? 
Has there been heating outside in the immediate vicinity of your home in the past 3 months? 
Is smoking allowed in the house?
In which rooms?
Do you smoke tobacco?
Are there pets inside your home?
Which pets are present in your home? Cat(s)
Which pets are present in your home? Dog(s)
Which pets are present in your home? Other animals with fur (e.g. rabbit, hamster, guinea pig, ...)
Which pets are present in your home? Birds
Which pets are present in your home? Other animals
What other animals?
How does the ventilation in your home take place? Manual
How does the ventilation in your home take place? Schedules
How does the ventilation in your home take place? Mechanical
How often is your home ventilated by opening windows and/or exterior doors? 
Are the following forms of moisture problems present in your home? A leaking roof
Are the following forms of moisture problems present in your home? Damp wall or floor 
Are the following forms of moisture problems present in your home? Rotting framework
Are the following forms of moisture problems present in your home? Condensation droplets on the inside of the windows
Are the following forms of moisture problems present in your home? No moisture problems
Are the following forms of moisture problems present in your home? Other
What other moisture problems?
Do you suffer from mold on walls, floors, ceilings, furniture or other places in your home?
Do you sometimes feel a draught in the house?
Where do you feel a draft? (exterior door, living room windows, kitchen windows, bedroom windows, ...) 
What material are the water pipes in the house made of? Plastic
What material are the water pipes in the house made of? Copper 
What material are the water pipes in the house made of? Lead
What material are the water pipes in the house made of? Other
What material are the water pipes in the house made of? I don't know
What other material?
Do you have a garden and/or terrace? 
What is present in your garden and/or terrace? Tiles, clinkers
What is present in your garden and/or terrace? Grass
What is present in your garden and/or terrace? Vegetable garden
What is present in your garden and/or terrace? Bare ground
What is present in your garden and/or terrace? Other
What else is present?
Do you have a groundwater well? 
How deep is this groundwater well?
What is/was the well water used for? Drink
What is/was the well water used for? Preparation of (hot) drinks such as tea, coffee, soup, ...
What is/was the well water used for? Food preparation (cooking, washing vegetables, ...
What is/was the well water used for? Dishwasher
What is/was the well water used for? Personal hygiene: bathing, use at the sink, brushing teeth
What is/was the well water used for? Watering the vegetable garden
What is/was the well water used for? Other
What else is/was the well water used for?
What footwear does your family mainly wear in the home?
Do the family members wipe their feet or shoes (on a doormat, among other things) when entering the house?
Do you wash all fruits and vegetables before use?
Do you have a vegetable garden? 
Is this vegetable garden part of your garden? 
What is the address of your vegetable garden?
Do you eat vegetables and/or fruit that come from your vegetable garden?
What types of fruit and/or vegetables? Potatoes
What types of fruit and/or vegetables? Leafy greens
What types of fruit and/or vegetables? Fruiting vegetables
What types of fruit and/or vegetables? Root and tuber vegetables
What types of fruit and/or vegetables? Cabbage
What types of fruit and/or vegetables? Onions
What types of fruit and/or vegetables? Stem crops
What types of fruit and/or vegetables? Legumes
What types of fruit and/or vegetables? Tree fruit
What types of fruit and/or vegetables? Small fruits
What types of fruit and/or vegetables? Nuts
Do you eat fruit and/or vegetables that you buy directly from or receive from a local grower (also family)? 
What is the address of the local grower?
What types of fruit and/or vegetables? Potatoes
What types of fruit and/or vegetables? Leafy greens
What types of fruit and/or vegetables? Fruiting vegetables
What types of fruit and/or vegetables? Root and tuber vegetables
What types of fruit and/or vegetables? Cabbage
What types of fruit and/or vegetables? Onions
What types of fruit and/or vegetables? Stem crops
What types of fruit and/or vegetables? Legumes
What types of fruit and/or vegetables? Tree fruit
What types of fruit and/or vegetables? Small fruits
What types of fruit and/or vegetables? Nuts
Do you sometimes eat eggs from your own chickens?  
Do you sometimes eat eggs that you buy directly from or receive from a local breeder (also family) within the Singel of Antwerp?
What kind of water do you drink? Water from the tap
What kind of water do you drink? Bottled water
What kind of water do you drink? Water from the groundwater well
Do you drink tea that was prepared in a traditional metal teapot?
Do you eat dishes that were prepared in ceramic pots or bowls (e.g. tagine, ...)?
How often do you eat organ meats (kidneys, liver, ...)? When filling in the form, think about the past 3 months.
How often do you eat game (pheasant, wild boar, ...)? When filling in the form, think about the past 3 months.
Has the doctor ever diagnosed you with an iron deficiency?
In which year approximately (last time if repeated)?
Are you currently taking dietary supplements? (e.g. vitamins, minerals (iron, zinc, ...), fish oil, omega-3 fatty acids, ...)
Which product and which brand?
Have the following tests been carried out at the current address in the past? Soil Test
Have the following tests been carried out at the current address in the past? Water test
Have the following tests been carried out at the current address in the past? Testing vegetables/fruit from your own garden
Have the following tests been carried out at the current address in the past? Other
Have the following tests been carried out at the current address in the past? None of the above
Have the following tests been carried out at the current address in the past? I don't know
What other tests?
May we contact you about this in the future?
Do you have any comments or suggestions about this questionnaire?
Today's Date
What was the gender of your child at birth?
Nationality of your child at birth: Belgian
Nationality of your child at birth: Dutch
Nationality of your child at birth: French
Nationality of your child at birth: German
Nationality of your child at birth: Italian
Nationality of your child at birth: Spanish
Nationality of your child at birth: Portuguese
Nationality of your child at birth: Polish
Nationality of your child at birth: Turkish
Nationality of your child at birth: Moroccan
Nationality of your child at birth: I don't know
Nationality of your child at birth: Other country
Which other country?
Current nationality of your child: Belgian
Current nationality of your child: Dutch
Current nationality of your child: French
Current nationality of your child: German
Current nationality of your child: Italian
Current nationality of your child: Spanish
Current nationality of your child: Portuguese
Current nationality of your child: Polish
Current nationality of your child: Turkish
Current nationality of your child: Moroccan
Current nationality of your child: I don't know
Current nationality of your child: Other country
Which other country?
What means of transport does your child use to go to school? On foot
What means of transport does your child use to go to school? Bicycle
What means of transport does your child use to go to school? Moped
What means of transport does your child use to go to school? Car
What means of transport does your child use to go to school? Bus
What means of transport does your child use to go to school? Train
What means of transport does your child use to go to school? Tram
What means of transport does your child use to go to school?  Other
What other means of transport?
How long does it take to travel to and from school on average? In total, so there and back.
How many hours a week is your child active on the computer/tablet/smartphone/game console?
How many hours a week does your child watch TV?
How often does your child come into a room where people smoke? Home
How often does your child come into a room where people smoke? In places other than home
How many times a week is your child actively involved in sports (such as football, cycling, etc.) so that he/she sweats or is out of breath?
How often does your child spend his/her free time outside in nature or on sites with fallow land (e.g. youth movement, sports, playing in the garden or on a playground, etc.)?
How often does your child do the following: wash hands
How often does your child do the following: brush teeth
How often does your child do the following: wash her
How often does your child do the following: take a bath or shower
How often does your child do the following: change clothes (full outfit)
Does your child sometimes bite his/her nails?
Do you have a vegetable garden?
Does your child eat vegetables and/or fruit that come from your vegetable garden?
What types of fruit and/or vegetables? Potatoes
What types of fruit and/or vegetables? Leafy greens
What types of fruit and/or vegetables? Fruiting vegetables
What types of fruit and/or vegetables? Root and tuber vegetables
What types of fruit and/or vegetables? Cabbage
What types of fruit and/or vegetables? Onions
What types of fruit and/or vegetables? Stem crops
What types of fruit and/or vegetables? Legumes
What types of fruit and/or vegetables? Tree fruit
What types of fruit and/or vegetables? Small fruits
What types of fruit and/or vegetables? Nuts
Does your child eat fruit and/or vegetables that you buy directly from or receive from a local grower (also family)?
What is the address?
What types of fruit and/or vegetables? Potatoes
What types of fruit and/or vegetables? Leafy greens
What types of fruit and/or vegetables? Fruiting vegetables
What types of fruit and/or vegetables? Root and tuber vegetables
What types of fruit and/or vegetables? Cabbage
What types of fruit and/or vegetables? Onions
What types of fruit and/or vegetables? Stem crops
What types of fruit and/or vegetables? Legumes
What types of fruit and/or vegetables? Tree fruit
What types of fruit and/or vegetables? Small fruits
What types of fruit and/or vegetables? Nuts
Does your child sometimes eat eggs from their own chickens?  
Does your child sometimes eat eggs that you buy directly from or get from a local breeder (also family)?
What kind of water does your child drink? Water from the tap
What kind of water does your child drink? Bottled water
What kind of water does your child drink? Water from the groundwater well
Does your child drink tea that was prepared in a traditional metal teapot?
Does your child eat dishes that were prepared in ceramic pots or bowls (e.g. tagine, etc.)?
How often does your child eat organ meats (kidneys, liver, etc.)? When filling in the form, think about the past 3 months.
How often does your child eat game (pheasant, wild boar, etc.)? When filling in the form, think about the past 3 months.
Is your child currently taking dietary supplements? (e.g. vitamins, minerals (iron, zinc, ...), fish oil, omega-3 fatty acids, ...)
Which product and which brand?
Was your child breastfed?
For how long was your child breastfed?
Do you have any comments or suggestions about this questionnaire?
Child examination date
Mother's examination date
Name of the child
Child's first name
Date of birth of the child
Year of birth of the child
Mother's name
Mother's first name
Date of birth of the mother
Street where the child lives
House number
Bus number
Postal code
Municipality
Mother's phone number
Mother's email
National register number of the child
National register number of the mother
What is your date of birth?
If you have previously given permission to send the personal results to the GP, please note the contact details below: name
If you have previously given permission to send the personal results to the GP, please note the contact details below:
Street + house number
If you have previously given permission to send the personal results to the GP, please note the contact details below:
House number
If you have previously given permission to send the personal results to the GP, please note the contact details below:
Name and address of the GP: postcode
If you have previously given permission to send the personal results to the GP, please note the contact details below:
Name and address of the general practitioner: municipality
What is the first name of the child participating in the study?
Your child's date of birth
Day of sampling
Average temperature of the day of sampling
Average humidity day of sampling
Average wind speed day of sampling
Average amount of precipitation on the day of sampling
Average temperature in the 14 days before sampling
Average humidity in the 14 days before sampling
Average amount of precipitation in the 14 days before sampling
Average wind speed in the 14 days before sampling
Number of days with average wind speed >5m/s in the 14 days before sampling
Number of days with average wind speed >7m/s in the 14 days before sampling
Average temperature in the 30 days before sampling
Average humidity in the 30 days before sampling
Average amount of precipitation in the 30 days before sampling
Average wind speed in the 30 days before sampling
Number of days with average wind speed >5m/s in the 30 days for sampling
Number of days with average wind speed >7m/s in the 30 days for sampling
Average temperature in the 90 days before sampling
Average humidity in the 90 days before sampling
Average amount of precipitation in the 90 days before sampling
Average wind speed in the 90 days before sampling
Number of days with average wind speed >5m/s in the 90 days before sampling
Number of days with average wind speed >7m/s in the 90 days before sampling