Report an Indoor Air Quality Concern

This questionnaire was developed to collect information that may help us solve your IAQ concern. Personal medical information will not be seen or shared with anyone other than the EH&S staff investigating the issue. Please fill out the questionnaire as completely and accurately as possible. For questions or comments please email the EH&S Industrial Hygiene Program indhyg@ehs.ucla.edu.

Please note that investigations may not occur the day of based on amount of reports coming in.
Your Information
General Information
Are you experiencing health symptoms or discomfort?
Please enter the date and approximate time of when you first noticed the issue.
Is there a time of day or year the issue is better or worse?
Personal Health Information
Do you have known health conditions or allergies that may make you particularly sensitive to environmental factors?
Have you sought medical attention for your symptoms?