Complaint Form- Self Submitted

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.

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