Appendix 1: Office work environment survey questionnaire

Part 1: Demographic information

Name: (please leave blank if preferred)

Building/Floor/Room: (as appropriate)

Job type:

Smoking habits:

Hours per day spend in building:

Office equipment used:

Part 2: Subjective evaluation of working environment

Do you experience the following conditions in your working environment?

	Always	Often	Sometimes	ever
Too little air
Too much air
Too dry
Too moist
Too hot
Too cold
Too bright
Too dim
Glare on surfaces
Too noisy
Too quiet
Smoky
Stuffy
Unpleasant odours

Part 3: Health-impaired symptoms

Do you experience any of the following complaints in your workplace? Also, please indicate if the problem is consistently more common in the afternoon than in the morning.

	Always	Often	Sometimes	Never	More common in the afternoon
Dry or sore throat
Skin dryness
Skin rashes
Eye irritation
Contact lens
problem
Runny nose
Stuffy nose
Difficulty in
breathing
Chest tightness
Flu-like symptoms
Headache
Dizziness
Nausea
Drowsiness
Lethargy
Aches in arms
Chest pain
Backache
Menstrual problems
Impotence

Part 4: Degree of control over environment

	None	A little	Some	Mostly	Complete
Temperature
Ventilation
Humidity
Lighting
Noise

Please add any additional comments:

Sick Building Syndrome: causes, effects and control - Appendix 1
© 1990 London Hazards Centre, Interchange Studios, Hampstead Town Hall Centre, 213 Haverstock Hill, London NW3 4QP, UK

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