Workplace Air Quality Assessment Form
Workplace Air Quality Assessment Form
This form is designed to assess the air quality in your workplace. It helps to identify potential air quality issues and ensure compliance with health and safety standards.
|
Date of Assessment: |
[MONTH DAY, YEAR] |
|
Assessed By: |
General Information
Room/Area Description:
|
Open-plan office space on the second floor, near the eastern wing of the building. |
Number of Employees Working in the Area:
Type of Work Performed in the Area:
Ventilation System Description:
Temperature and Humidity Levels:
Air Movement:
Odor Identification:
Dust and Particulate Matter:
Potential Contaminants
Chemical Substances:
Biological Agents:
Other Pollutants:
Employee Feedback
Symptoms Reported by Employees:
Concerns Raised by Employees:
Action Plan
Immediate Actions Taken:
Recommendations for Improvement:
Assessor's Signature:
Kathleen joy
[JOB TITLE]
[15/12/2050]
