CONTACT
INFORMATION
Name:
Address:
City:
State:
Choose one
Alabama
Alaska
Alberta
Arizona
Arkansas
British Columbia
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Labrador
Louisiana
Maine
Manitoba
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Brunswick
New Hampshire
New Jersey
New Mexico
New York
Newfoundland
North Carolina
North Dakota
Northwest Territory
Not in US or Canada
Nova Scotia
Ohio
Oklahoma
Ontario
Oregon
Pennsylvania
Prince Edward Island
Puerto Rico
Quebec
Rhode Island
Saskatchewan
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Yukon Territory
Zip:
Email:
Home Phone:
Area Code First
Alternate Phone:
Area Code First
Best time to call:
Morning
Afternoon
Evening
Survey Questions
1. On a scale of
1 – 10 (1=poor 10=excellant) how would you rate the indoor
air quality of your home or building?
Choose
1
2
3
4
5
6
7
8
9
10
2. Are there any
areas of the home or building that you believe might
have indoor air quality problems?
Choose
YES
NO
Unsure
3. What do you
think the cause of the problems could be?
4. Are there any
times when people are more prone to sickness or
experience more allergic reactions?
Choose
YES
NO
Unsure
5. Are any of the
home or building inhabitants experiencing upper
respiratory or allergic reactions?
Choose
YES
NO
Unsure
6. Are any of the
inhabitants experiencing itchy skin, watery eyes,
runny noses, coughing, sneezing, asthma or lung
problems?
Choose
YES
NO
Unsure
The EPA
estimates that seven out of ten homes and businesses
have bio contaminants that could contribute to health
problems for inhabitants. Most indoor air quality
problems are not visible to the naked eye. Mold
spores, pollen, pet dander and other bio contaminants
may be at very high levels in the air, yet
undetectable to the human eye. If these bio
contaminants can't be seen, how can we know if the air
we breathe is healthy or unhealthy? Environmental
consultants measure bio contaminants in the air by
taking air-o-cell and swab surface samples. An
air-o-cell is a small cassette with a filter medium in
the center. Attaching an air-o-cell cassette to an air
pump and drawing 15 liters of air per minute through
the cassette for five minutes is the proper procedure
for taking a standard air sample. The filter catches
spores, pollen, fibers and other allergenic
bio-contaminants as the air is pulled through the
medium. After five minutes the pump is turned off, and
then the cassette is sealed and sent to an independent
laboratory. A laboratory technician examines the
filter medium and counts the bio-contaminants captured
by the filter. The swab sample in turn is evaluated
for living contaminants. The technician then develops
a report that classifies the different
bio-contaminants found in the filter medium, and
records the quantities of the bio-contaminants found.
This report defines whether the air we breathe has
low, medium, or high levels of bio contaminants like
pollen, mold spores, dust and fibers that could be
making the inhabitants sick.
7. Do you believe
that poor air quality might be contributing to either
sickness or allergic reactions within your home or
building?
Choose
YES
NO
Unsure
Air and Surface sampling are the best testing methods
used to determine if the air in your home is healthy
or unhealthy.
8. Would
you like to have the air in your home or building
sampled using an air-o-cell cassette and a surface
swab for approximately $149.00, a fraction of what an
Environmental Consultant would charge?
Choose
YES
NO