Indoor Air Quality Reporting Form
*Name
*E-Mail
*Phone Extension
*Building
*Date Feb 9, 2012
*Area with complaints
No. of occupants with problem
*When did the problem first occur? Feb 9, 2012
*Symptoms described
Which of the following may have contributed? Water damage
Remodeling
Stuffy air
Pesticide spraying
Odors
Carpet aged/moldy
Paint
Equipment cleaning
Dry drain traps
Furniture aged/moldy
Air intake
New material
Repeat problem
Temp. problem
Visible mold
Other
Additional Comments
 
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