| No. | Item | None (0) | Very Weak (1) | Slightly Weak(2) | Moderate(3) | Slightly Strong(4) | Very Strong(5) |
|---|---|---|---|---|---|---|---|
| Subjective irritation - Subject | |||||||
| 1 | Itching | □ 0 | □ 1 | □ 2 | □ 3 | □ 4 | □ 5 |
| 2 | Prickling | □ 0 | □ 1 | □ 2 | □ 3 | □ 4 | □ 5 |
| 3 | Burning | □ 0 | □ 1 | □ 2 | □ 3 | □ 4 | □ 5 |
| 4 | Stinging | □ 0 | □ 1 | □ 2 | □ 3 | □ 4 | □ 5 |
| 5 | etc. | □ 0 | □ 1 | □ 2 | □ 3 | □ 4 | □ 5 |
| Objective irritation - Investigator | |||||||
| 1 | Erythema | □ 0 | □ 1 | □ 2 | □ 3 | □ 4 | □ 5 |
| 2 | Edema | □ 0 | □ 1 | □ 2 | □ 3 | □ 4 | □ 5 |
| 3 | Papule | □ 0 | □ 1 | □ 2 | □ 3 | □ 4 | □ 5 |
| 4 | Scale | □ 0 | □ 1 | □ 2 | □ 3 | □ 4 | □ 5 |
| 5 | etc. | □ 0 | □ 1 | □ 2 | □ 3 | □ 4 | □ 5 |