Air Quality Survey
This survey aims to evaluate the current situation about indoor air quality issues on our buildings and offices. Your feedbacks are highly valuable to improve our indoor air quality. Please answer to the best of your ability.
Your Office Location
Please indicate if you regularly have any of the following indoor air quality issues in your building.
Too Cold
Too hot
Dusty
Noisy
Stuffy air
Draught
Moldy odors
Too humid
Drafty
Inadequate Lighting
No complaints
Other
Do you detect any unusual odor in your office?
Yes
No
Please specify
Since you have worked in this building, do you have diagnosed with any following health conditions? (You may select more than one box )
Chronic Cardiovascular Disease
Chronic Respiratory Disease
Allergies
Immune System Disorder
Neurological Disorder
None
Other
How would you rate the cleanliness of the building?
Poor
1
2
3
4
Good
5
1 is Poor, 5 is Good
Do you feel that there is an indoor air quality problem in your building/office?
Yes
No
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Is there a time of day you notice air quality issues? (You may select more than one box )
Morning
Afternoon
Evening
Is there a specific season air quality issues seem to be most notable?
Winter (December - February)
Spring (March - May)
Summer (June - August)
Fall (September - November)
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Are you currently a smoker?
Yes
No
Do you suffer any symptoms below frequently in the last 6 months;
Rows
Yes, all the time.
Sometimes
Not at all.
Shortness of Breathe
1
2
3
Eye Fever (Pink Eye)
4
5
6
Runny Nose
7
8
9
Watery Eyes
10
11
12
Nasal Burning
13
14
15
Migraines
16
17
18
Muscle aches
19
20
21
Sneezing
22
23
24
Do you feel that these symptoms are related to your work environment?
Definitely!
Yes, probably.
No, I don't think so.
Do these symptoms go away after leaving work?
No
They'll go away after 1 hour
They'll go away by the morning
They'll go away when I'm on vacation
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In daily, what percentage of your day do you usually work in your office?
25% or less
50% or less
75% or less
More than 75%
How would you describe the air quality in your office? (You may select more than one box)
Fresh
Odourless
Smelly
Stuffy
Dusty
Clean
How would you describe the air movement in your office?
Still
1
2
3
4
Draughty
5
1 is Still, 5 is Draughty
How would you describe the lighting in your office?
Too Bright
1
2
3
4
Too Dark
5
1 is Too Bright, 5 is Too Dark
How would you describe the air conditioning system in your office? (You may select more than one box)
Noisy
Quiet
Not working well.
Smelly
Working properly.
Has there been any following renovation occurred in or near your work environment?
New carpet
Painting
New Furniture
New Air Conditioner
Other
Have ever seen mold or any evidence of water leaks in your building? If yes, please describe by giving exact location.
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Your Full Name
First Name
Last Name
Gender
Male
Female
Please Pick Your Age Range
Please Select
under 30
30-40
41-50
over 50
Gender
Male
Female
Submit
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