Indoor Air Quality Questionnaire

 


 

Please fill this form out and click "Submit" at the bottom of the page, or fax it to:
(413) 542-5789
Attn: Richard Mears
Environmental Health and Safety
Amherst College Facilities

Symptom Patterns
Are you aware of other people with similar symptoms or concerns? *
Do you have any health conditions that may make you particularly susceptible to environmental problems?
Timing Patterns
(This could include weather events, temperature/humidity changes, or activities in the building)
Spatial Patterns
Additional Information
(e.g. temperature, humidity, drafts, stagnant air, and odors)
Have you sought out medical attention for your symptoms? *
Validation
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