Indoor Air Quality Complaint Form

Use this form to report problems related to indoor air quality. Indoor air quality problems can include, but are not limited to, concerns with temperature, humidity, ventilation,odours or air pollutants that may be causing adverse health effects or discomfort. Any personal information provided will remain confidential. If you are experiencing any medical issues you should submit an Accident/Incident/Occupational Disease Form in case there is a reason to file a disability.

Section A: General Information

Staff/FacultyStudentFiling this out on behalf of a visitor
Please select one option *

Section B: Actions Taken

Please indicate all that apply

YesNo
I have advised my supervisor
I have advised FCC (398-4555)
I have advised the building director
I have advised the Departmental Safety Committee
If you have advised FCC please provide the date of your call

Section C: Location and Description of Problem

IMPORTANT NOTE: Please use format 2016-06-30 (year-month-day)
Time of day or day of the week the problem is most pronounced
Please select your building
Is the problem localized in one area? If not, what other areas are affected?
YesNo
Are you experiencing any symptoms of health problems?