ID#__________

Hand Usage Questionnaire

Please indicate below which hand you ordinarily use for each activity.

With which hand do you (circle one for each activity):

1) draw?                                                                                     1. Left        2. Right        3. Either

2) write?                                                                                    1. Left        2. Right        3. Either

3) use a bottle opener?                                                               1. Left        2. Right        3. Either

4) throw a snowball to hit a tree?                                              1. Left        2. Right        3. Either

5) use a hammer?                                                                       1. Left        2. Right        3. Either

6) use a toothbrush?                                                                   1. Left        2. Right        3. Either

7) use a screwdriver?                                                                1. Left        2. Right        3. Either

8) use an eraser on paper?                                                         1. Left        2. Right        3. Either

9) use a tennis racket?                                                               1. Left        2. Right        3. Either

10) use a scissors?                                                                    1. Left        2. Right        3. Either

11) hold a match when striking it?                                            1. Left        2. Right        3. Either

12) stir a can of paint?                                                              1. Left        2. Right        3. Either

13) On which shoulder do you rest a bat before swinging?      1. Left        2. Right        3. Either

14) At any point in your life, were you forced to switch
      from your dominant hand to your less dominant hand ?       1. Yes        2. No

       14a) If YES, was this a switch from (circle one):
                      1. Left hand to right hand?                    2. Right hand to left hand?

                       Why were you forced to switch?______________________________________

                        _______________________________________________________________

15) Are any of your parents or brothers or sisters or any other blood relatives left-handed ?
                                                                                                   1.Yes             2. No

15a) If YES, circle the numbers below to indicate which family members are left-handed.

              1. Father                            2. Mother                           3.Brother(s) How many?____
                      4. Sister(s) How Many?___                       5. Other blood relatives