Self submitted forms should ask very simple open-ended questions to prevent influencing the complainant. An example may be as follows:
Indoor Air Quality Complaint Form
Name:
___________________________________________________
Department:
___________________________________________________
Date:
___________________________________________________
Please use the space below to describe the air quality problem along with (1) any symptoms or discomfort you are experiencing, (2) any associated timing or location patterns, and (3) any potential causes or contributing factors that you suspect.