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