About The Area Being Diagnosed For Mold
Is the building located next to: Highways or Airports A waste dump site A parking garage
Industrial Plants Commercial Business None of the above
Have any recent changes been made to the building (painting, weatherization, remodeling, new furniture, etc.)? Yes No
Have you recently acquired new items containing particleboard, paneling, or pressed wood? Yes No
Do you frequently see insects in your building? Yes No
Are insecticides or pesticides frequently applied inside the building? Yes No
Do you currently have pets? Yes No
If you have pets are they allowed in the bedrooms? Yes No
Do you have indoor houseplants? Yes No
If you have an attached garage, do you warm up your car inside it in the winter time? Yes No
Does any member of the building work around animals, furs, feathers, chemicals or dust ? Yes No
Does the building have a carbon monoxide detector? Yes No
Do more than one member of the building have the same or similar symptoms? Yes No
Are any of the members sensitive to smells such as perfume, hair spray or chemicals? Yes No
Has there been any flood, roof leak, broken water pipe, or any other moisture problem in the building? Yes No
Please give details to the water infiltration to the structure
Is there any area that has a foul smell? Yes No Location?
Is there any area that smells like an old building? Yes No Location?
Is there any area that smells like dirty socks, a locker room or dirty laundry? Yes No Location?
Is there any area that has a damp earthy odor? Yes No Location?
Is there any area that has a musty or mildew odor? Yes No Location?
Do your towels get a musty or moldy smell within a week? Yes No
How often do you have to dust to stay dust free?
Do you get dust bunnies on your hard surface floors within a week? Yes No
Have you ever seen mold or mildew in any place in the building? Yes No Location?
Give the location where you have smelled the odor or mildew in the building.
What room is the odor of mold or mildew the strongest?