Environmental Engineering Reference
In-Depth Information
4. Do any of the following apply to you?
___ Wear contact lenses
___ Operate video display terminals at least 10% of the workday
___ Operate photocopier machines at least 10% of the workday
___ Use or operate other special office machines or equipment
(Specify) _________________________________________________
5. Do you smoke? Yes ____ No ____
6. Do others in your immediate work area smoke? Yes ___ No ___
7. Your office or suite number is __________________________________
8. What is your job title or position? _______________________________
9. Briefly describe your primary job tasks. _________________________
_____________________________________________________________
_____________________________________________________________
10. Can you offer any other comments or observations concerning your
office environment? (Optional)
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
11. Your name? (Optional) ________________________________________
12. Your office phone number? (Optional) ___________________________
Source:
From Gorman, R.W. and Wallingford, K.M., in
Design and Protocol for
Monitoring Indoor Air Quality
, ASTM STP 1002, Nagda, N.L. and Harper, J.P.,
Eds., American Society for Testing and Materials, Philadelphia, 1989, 63. With
permission.
