Indoor Air Quality Questionnaire Indoor Air Quality Questionnaire Name * Email * Phone Street Address * City * State * AKALARAZCACOCTDCDEFLGAHIIAIDILINKSKYLAMAMDMEMIMNMOMSMTNCNDNENHNJNMNVNYOHOKORPARISCSDTNTXUTVAVTWAWIWVWY Is there any suspect visible mold growth in your home or office? * Yes No When did you first notice the issue? * Please describe the issue you are experiencing * Are there any odors that may be described as weird or strange? * Yes No Where is the odor the strongest? * Are there any environmental factors that influence the smell ? (time of day, season, weather, etc) * What is the location of the odor? Please describe NSEW orientation of the odor. * What type of heating/cooling is in the space? Hot water/forced hot air, etc) * Are there any health issues associated with your issues? * Yes No What symptoms are you experiencing and have you seen a doctor? * Please describe the room or areas that you avoid due to reactions. * What is the age of the structure, how long have you lived/worked here? * If condo or townhome, please describe your location (middle, end, ground floor, etc) * What type of flooring is in the space? * Have any repairs or renovations been completed inside or outside? * Yes No If so, please describe Who occupies the property with you? (kids, grandkids, co workers, etc) * Do you have any engineering controls in place (ex. Sump Pump, Dehumidifier, Ventilator, French Drain, etc)? * Yes No If so, please describe (french drains, dehumidifiers, sump pumps, etc) Has any recent landscaping work been completed on your property? (Pool, Patio, etc) Any further information you would like to share? * Please attach any previous lab results, Investigative reports, or photos. Photos / Video Drop a file here or click to upload Choose File Maximum file size: 52.43MB Reports (pdf, doc, docx) Drop a file here or click to upload Choose File Maximum file size: 52.43MB Lab Results (pdf, doc, docx) Drop a file here or click to upload Choose File Maximum file size: 52.43MB Submit If you are human, leave this field blank. Δ