Air Quality Survey

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Please indicate whether you regularly experience any of the following indoor air quality issues in your building.

Do you detect any unusual odor in your office?

Yes No

Please specify

Since working in this building, have you been diagnosed with any of the following health conditions? (You may select more than one)

Do you feel there is an indoor air quality problem in your building/office?

Yes No

Is there a time of day when you notice air quality issues? (You may select more than one)

Morning Afternoon Evening No Set Pattern

Is there a specific season when air quality issues seem most noticeable?

Spring Summer Fall Winter

Are you currently a smoker?

Yes No

Do you feel these symptoms are related to your work environment?

Yes No

Do these symptoms go away after leaving work?

Yes No

Your Full Name

First Name

Last Name

Gender

Male Female

Please select your age range

Gender

Male Female

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