Advanced Purification: Survey


 

Is The Air In Your Home Safe to Breathe?

According to the EPA: “In the last several years, a growing body of scientific evidence has indicated that the air within homes and other buildings can be more seriously polluted than the outdoor air in even the largest and most industrialized cities. Other research indicates that people spend approximately 90 percent of their time indoors. Thus, for many people, the risks to health may be greater due to exposure to air pollution indoors than outdoors. In addition, people who may be exposed to indoor air pollutants for the longest periods of time are often those most susceptible to the effects of indoor air pollution. Such groups include the young, the elderly, and the chronically ill, especially those suffering from respiratory or cardiovascular disease. While pollutant levels from individual sources may not pose a significant health risk by themselves, most homes have more than one source that contributes to indoor air pollution. There can be a serious risk from the cumulative effects of these sources. Health effects from indoor air pollutants may be experienced soon after exposure or, possibly, years later. The likelihood of immediate reactions to indoor air pollutants depends on several factors. Age and preexisting medical conditions are two important influences. In other cases, whether a person reacts to a pollutant depends on individual sensitivity, which varies tremendously from person to person.” According to the American College of Allergy, Asthma & Immunology, “50% of all illness is aggravated or caused by polluted indoor air.”
 

Indoor Air Quality Health Questions

1) Does anyone in the household suffer from any of the following symptoms?

Symptoms
Y
N
Y
N

Asthma

Headaches
Allergies Depression
Sneezing Loss of Memory
Sinus Congestion Flu-Like Symptoms
Bronchial Constriction Unexplained Irritability
Trouble Breathing Fatigue or Drowsiness
Skin Rashes or Itchy Skin Equilibrium or Balance Loss
Eye, Nose, or Throat Irritation Arthritic-Like Aches
Bloody Nose Restlessness
Dry Cough Nausea
 
Did these symptoms appear after you moved to a new or different home?
Do the symptoms disappear when you go to school or the office or go away on a trip, and return when you come back?

Indoor Air Quality Odor Questions

Y
N
2) Are there any smokers in this house?

a. What do they smoke?

b. Where do they smoke?

3) Do you use air fresheners (sprays or plug-ins)?

a. How frequently?

4) Do you shampoo your carpets?

a. How frequently?

5) Do you have any indoor pets?
Dogs
Cats
Other
Number
Sm/Med/Lg
Sm Med
Lg
Sm Med
Lg
Sm Med
Lg
Indoor/Outdoor
In Out
In Out
In Out
Spade/Neutered
Y N
Y N
Y N
House Trained
Y N
Y N
Y N
Identify Accident Area(s)
Shedding?
Y N
Y N
Y N
Fleas?
Y N
Y N
Y N
6) Do you cook in the house?

a. Are there any lingering cooking odors?

7) Are there any other odor problem areas?

a. Please describe location and source:

Indoor Air Quality Mold/Mildew Questions

The EPA informs us that 6 out of 10 homes and buildings are "sick," meaning they are hazardous to your health to occupy as a result of airborne pollutants.

Y
N
8) Do you have visible signs of mold/mildew?

a. Are there any odors associated with this mold / mildew?

b. Have you located the source of moisture?

c. Where is this mold located?

d. How long has mold / mildew been a problem?

 

9) What is the approximate square footage?

Name*
Email*
Street
City
State
Zip
Phone
Cell
Best Time to Call



*required information

We do not provide any information we gather or develop about
our visitors to any third parties for any purpose.

For more information on the health risks from indoor air pollution,
see the following websites:

Consumer Products Safety Commission:
http://www.cpsc.gov/cpscpub/pubs/425.html
US Environmental Protection Agency:
http://www.epa.gov/iaq/pubs/insidest.html
American Lung Association:
http://www.lungusa.org/site/apps/s/content.asp?c=dvLUK9O0E&b=34706&ct=67135

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