6. Are there any diseases you risk contacting
from the above accidents
Listed in item 4? Yes No Don’t know
b. If yes, Please list them
(i)…………………………………………………………………
(ii)…………………………………………………………………
(iii)…………………………………………………………………
(iv)…………………………………………………………………
(v)…………………………………………………………………