Skip to Main Content

Report an Indoor Environmental Quality Concern

This questionnaire was developed to collect information that may help us solve your IEQ 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 due to the number of reports received, investigations may not occur the same day.
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?
CAPTCHA