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City Hall Heating & Air Conditioning Employee Survey

  1. 1. What department do you work in?

  2. 2. Where is your office located?

  3. 4. Do you associate any of the following conditions with your work environment?

  4. 5. In reference to question #4: How often do these conditions occur?

  5. 6. In reference to question #4: Please indicate the specific day(s) of the week.

  6. 7. In reference to question #4: Please indicate the specific month(s) of the year.

  7. 8. Please indicate your primary work area:

  8. 9. Do you have windows in close proximity to your primary work area?

  9. 10. Were any of the following items regularly used at or near your work area during the past year?

  10. 11. Have any of the following activities taken place near your work area recently?

  11. 12. DURING SUMMER MONTHS ONLY (June-September) - Is your workspace area:

  12. 13. Do any of your co-workers have similar problems that you are aware of?

  13. 14. DURING WINTER MONTHS ONLY (December-March) - Is your workspace area:

  14. 15. Do any of your co-workers have similar problems that you are aware of?

  15. 16. DURING SPRING/FALL MONTHS ONLY (April, May, October, November) - Is your workspace area:

  16. 17. Do any of your co-workers have similar problems that you are aware of?

  17. Leave This Blank:

  18. This field is not part of the form submission.