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Indoor Air Quality Safety Questionnaire Mobile App

Use the Indoor Air Quality Safety Questionnaire mobile app to help insure that your home and businesses air quality is not putting you, your family or employees at risk. You can build one Simple List screen and repeat it as many times as you need to when using GoCanvas on your mobile device.

  • Lendlease
  • The Cooperative
  • PG&E
  • Red Bull
  • Mirvac

Want to learn more about GoCanvas?

Request a Demo

Take a peek inside the Indoor Air Quality Safety Questionnaire Mobile App

Included Features

Our App Builder gives you the power to easily add and remove the ones you want. {{controller.show_all ? 'See included features.' : 'See more features.'}}

  • {{data.title}}

Included Fields

Customize to add, remove, or edit any of the fields below.

  • Ico textbox

    Name:

  • Ico date

    Date:

  • Ico multiline

    Address:

  • Ico dropdown

    Do you have mold or mildew problems during the winter or experience high humidity at any time of ...

  • Ico dropdown

    Is your clothes dryer vented indoors at any time?

  • Ico dropdown

    Do you dry clothes inside your home (not in the dryer)?

  • Ico dropdown

    Is the basement or crawlspace below your home frequently damp or wet?

  • Ico dropdown

    Do your bathrooms have working exhaust fans?

  • Ico dropdown

    Do you have and use your kitchen exhaust fan (not recirculating type) when using the stove or oven?

  • Ico date

    When was the last time the grease filter was cleaned?

  • Ico dropdown

    Are any of the following items typically stored or used inside your home?

  • Ico dropdown

    Do you use a wood stove, fireplace or unvented space heater(s) during the winter?

  • Ico dropdown

    Does your wood stove or fireplace ever back draft or is the draft weak, even after the first few ...

  • Ico dropdown

    Do you (or a neighbor) regularly warm up a car or truck very close to your house or inside an att...

  • Ico dropdown

    Is anyone in your household experiencing any of the following symptoms?

  • Ico dropdown

    Are any of these symptoms reported by more than one member of the household?

  • Ico dropdown

    Are these symptoms more severe in those who spend the most time indoors at home?

  • Ico dropdown

    Are the symptoms most severe in household members younger than 4 or older than 60 years of age?

  • Ico dropdown

    Are these symptoms worse in winter or during a particular season?

  • Ico dropdown

    Do these symptoms become less severe when away from the house?

  • Ico decimal

    About how many hours seem to make a difference?

  • Ico dropdown

    Does anyone smoke inside your home?

  • Ico dropdown

    Have any of the following things been added or done to your home recently?

  • Ico dropdown

    Changes to your heating system?

  • Ico dropdown

    Is there evidence of rodents or rodent droppings in or around your home, attic, basement, crawlsp...

  • Ico dropdown

    Is there anything else in or around your home that you suspect may contribute to poor indoor air ...

  • Ico multiline

    Please explain in the space below

  • Ico dropdown

    Do you use a humidifier during the winter (free-standing or furnace-mounted)?

  • ...and More!

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