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.