Is My Building Sick?
Indoor Air Quality Problem Fact Sheet
| Click here for an electronic Word document you can fill out and print. | |
| Your name:__________________________________________________ | Date:______________ |
| Your work location:____________________________________________ | Phone:______________ |
| If you have recently experienced symptoms or discomfort related to the quality of the air in this building, please describe them in this space: | |
| Where are you when you experience the symptoms or discomfort? | |
| Where do you spend most of your time in the building? | |
| When did these symptoms or discomfort start? | |
| When are they generally worst? | |
| Do they go away? If so, when? | |
| Who else has these symptoms? | |
| What events (weather, activities inside or outside the building, etc.) or conditions (temperature, humidity, drafts, stagnant air, odors, etc.) tend to occur at about the same time as your symptoms? Please describe in this space: | |
| Is there anything else we should know about this problem? Please describe in this space: | |
| Thanks for your help! | |
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