Indoor Air Quality Survey

This optional survey is being provided to ETFO members at your school site to help us learn more about Indoor Air Quality (IAQ) concerns through your personal experiences and knowledge of the work environment.  If you choose to complete this survey, your identity and individual responses will be kept confidential.  Please complete this survey as soon as possible.  ETFO will prepare a summary report about IAQ concerns at the school as a whole and present this report to your principal and the school board.  No individuals wil be identified in the survey report.  All respondents will receive a copy of the report.

Name of school:

Question Title

* 1. Name of school:

How long have you worked at this worksite?

Question Title

* 2. How long have you worked at this worksite?

How long have you worked at this worksite?

Question Title

* 3. How long have you worked at this worksite?

For questions matrix, in the last year, did you experience any of the following health symptoms that lasted two days or more?
If you answered NO to all of the above questions, please stop here.  If you answered YES to any of the questions, please continue.
In the last year, did you experience any of the following health symptoms that lasted two days or more?

Question Title

* 19. In the last year, did you experience any of the following health symptoms that lasted two days or more?

  Frequently Sometimes Occasionally Never
Headache
Nausea
Dizziness
Tiredness and/or fatigue
Irritation of eyes, nose, and/or throat
Breathing problems
Stuffy and/or runny nose
Sinus congestion
Coughing
Sneezing
Wheezing
Shortness of breath
Blurred vision
Difficulty concentrating

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