Air Quality Survey Template

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Air Quality Survey Preview

Use this air quality survey template to collect employees' observations about indoor conditions at work. Eight questions identify the locations, times, odors, and stuffiness people want the facilities team to investigate. Adapt the questionnaire in SurveyLegend to organize follow-up. Responses describe people's experience; they do not measure pollutant levels or establish whether a building is safe.

When to use this air quality survey

Use the survey for a defined building or area and a recent period, such as the last two weeks. Explain where urgent concerns should be reported instead of waiting for a survey review. Ask for enough location detail to investigate without requesting a respondent's medical history. This is a facilities-feedback questionnaire, not an environmental test, health assessment, or replacement for your existing incident-reporting process.

8 questions for your air quality survey

Start with these questions and adapt them to your audience. Every field is optional. Where answer choices are listed, respondents choose one.

Respondent introduction:
Please answer about the work area and the last two weeks. Share observations, not personal health details. Use your usual reporting route for urgent concerns; this survey is not an emergency channel. All questions are optional.

How to customize your air quality survey

List recognizable areas such as floors, meeting rooms, or work zones. Include an option for people who have not spent enough time there to answer. Keep the wording neutral: ask what someone noticed without suggesting a cause. State when facilities staff will review responses and provide a separate contact route for follow-up. You can combine choice fields and written details using SurveyLegend's survey and form features.

Printable air quality survey template

Use this printable air quality survey template for employees who prefer to record workplace observations on paper. Leave copies in an appropriate staff area and explain where completed forms should go. SurveyLegend supports an online option alongside the printed questionnaire.

AI prompt for an air quality survey

Create an air quality survey in SurveyLegend with questions about work areas, timing, odors, perceived stuffiness, and reporting routes.

The full prompt below includes all 8 questions and their response settings. Copy it, register for a free SurveyLegend account, and paste it into SurveyLegend's AI survey creation tool. Review and customize the result before sharing.

Create an air quality survey in SurveyLegend using the exact questionnaire below.

Purpose: Identify locations and times that need facilities follow-up.

Requirements:
- Include exactly 8 questions or fields, in the order shown. Preserve the wording, answer choices, choice order, field types, and optional settings verbatim.
- Use one selection for each Single choice field. Show all fields. Preserve instructions about leaving an irrelevant field blank; do not invent automatic branching.
- Do not add scoring, sample answers, claims of validation, or an anonymity promise.
- Keep the respondent introduction below. Any named event, advertisement, use case, review period, or organization referenced must be supplied by the survey creator before sharing. Do not invent these details.
- If a field, setting, or required supporting asset cannot be provided, explain the limitation. Do not silently substitute it or claim a working survey exists.

Respondent introduction:
Please answer about the work area and the last two weeks. Share observations, not personal health details. Use your usual reporting route for urgent concerns; this survey is not an emergency channel. All questions are optional.

Exact questionnaire:

1. Which work area are your observations about? Please use a room, floor, or zone name rather than a person's name.
Field type: Short text
Answer choices: none; respondent enters their own text.
Required: No

2. During the last two weeks, how often have you spent time in that area?
Field type: Single choice
Answer choices, in order:
- Most working days
- Several days
- Once or twice
- Not during this period
Required: No

3. During the last two weeks, how often did the air in that area feel stuffy to you?
Field type: Single choice
Answer choices, in order:
- Never
- Rarely
- Sometimes
- Often
- Every time I was there
- I did not spend enough time there to judge
Required: No

4. Did you notice an odor in that area that you wanted someone to investigate?
Field type: Single choice
Answer choices, in order:
- Yes
- No
- Not sure
- I was not in that area during this period
Required: No

5. If you noticed a concern, when did it occur? Include the approximate day or time if you remember.
Field type: Long text
Answer choices: none; respondent enters their own text.
Required: No

6. What did you observe, and what was happening nearby at the time? Please avoid personal health information.
Field type: Long text
Answer choices: none; respondent enters their own text.
Required: No

7. Do you know how to report a facilities concern about indoor air?
Field type: Single choice
Answer choices, in order:
- Yes
- No
- Not sure
Required: No

8. What would make it easier for you to report or follow up on this concern?
Field type: Long text
Answer choices: none; respondent enters their own text.
Required: No

Before finishing, compare every field with this specification. Report differences separately. Let the creator review and customize the private draft before sharing; do not publish it automatically.

Use prompt directly in SurveyLegend

Create a free account, then paste the copied prompt into SurveyLegend.

Already have an account? Sign in to create your air quality survey.

Organize air-condition observations for facilities follow-up

Group observations by location and time to find patterns that need investigation. Keep reports of odors separate from reports of stuffiness instead of combining them into a single air-quality score. Cross-check the circumstances with the facilities team and arrange appropriate investigation where needed. Neither a low complaint count nor a high satisfaction rating demonstrates safe air. Tell respondents how to raise a concern again if it continues.

Can a survey measure indoor air quality?

No. It can record people's observations and help identify where to look next. Measurements and a suitable investigation are needed to assess environmental conditions; a perception questionnaire cannot provide those results.

Should the survey ask about medical symptoms?

This starter deliberately avoids health-history and symptom questions. It focuses on locations, timing, and observable conditions that a facilities team can follow up. Use a separate appropriate process when a concern needs individual attention.

What if someone reports an urgent problem?

Make the existing urgent-reporting route clear before you distribute the survey. Explain that the questionnaire is reviewed on a schedule and is not monitored as an emergency channel.

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Air Quality Survey Template

When to use this air quality survey

8 questions for your air quality survey

A little feedback. A clearer picture.