Indoor Air Quality (IAQ) Concern

INSTRUCTIONS

This form is to serve as primary notification of an Indoor Air Quality concern to the WKU IAQ Manager. Use this form to report to any concerns you have related to the indoor air quality in your workplace. Indoor air quality concerns may include issues with temperature, humidity, ventilation, odors, or air pollutants that may be causing health or discomfort symptoms. Your observations are a critical component of resolving IAQ concerns. Please use the additional information section to specifically describe your concern. If you have questions, contact Anita Britt at 745-2333.

*REQUIRED FIELDS

GENERAL INFORMATION
*Name:	Title:	Department:
*Building/Room #:		Floor Level:
Phone Number:	Employment Status: FT - PT hrs/week
E-mail:

CONCERN INFORMATION
*What is the nature of the problem?
Where is the problem experienced (in one or more locations)?
*When was the problem first experienced?
*When does it occur or when is it the worst? (time of day, day of week, related to certain activities/events)?
What do you think is the cause of the IAQ concern?
Additional Information:
*What is the best time to reach you? We may need to contact you to discuss your concern.

Environment, Health and Safety

Indoor Air Quality (IAQ) Concern