Energy Conservation Services, Inc.
188 Broadway, P.O Box 116, Port Ewen, NY 12466
info@ecshv.com
(845) 338-3864
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Air Quality Assessment
Each day, we breathe 35 lbs of air. Why not make sure the air you breathe is healthy and safe.
First Name
Last Name
Address
Email
Phone
Indicate if you frequently have any of the following complaints concerning the indoor air quality of your building?
Temperature too hot/cold
Stuffy air
Moldy odors
Poor lighting
Dusty
Noisy
Too dry
Too humid or too much moisture
Drafty
Vibration
Crowded work area/Health concerns
Indicate if any of the following apply to apply:
Wear contact lenses
Operate video display terminals at least one hour/average day
Use any chemical substance such as cleaners
Use tobacco products
Since spending time in the building, have you experienced:
Allergies
Asthma
Sinusitis
Laryngitis
Other respiratory conditions
Have you noticed any of the following after spending time in the building?
Frequent cough or wheezing
Fatigue/Drowsiness
Burning, itchy or watery eyes
Sneezing attacks or nasal congestion
Sore throat or hoarse voice
Headaches or migraines
Feeling like your "always" sick
"Brain fog"
Do you rely on any of the following to help you through the times you feel poorly?
Pain relievers
Decongestants
Antihistimines
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