Industrial Hygiene

Report an Indoor Air Quality (IAQ) Concern

This questionnaire was developed to collect information that may help us solve your IAQ concern. Personal medical information will not be seen or shared with anyone other than the EH&S staff investigating the issue. Please fill out the questionnaire as completely and accurately as possible. For questions or comments please call the EH&S Industrial Hygiene Program at 805.893.8787 or 805.893.3743.

All items marked with an asterisk (*) are required.

Occupant Information
General Information
Personal Health Information (Optional)
Additional Information