Indoor Air Quality Complaint Or Request

OKALOOSA COUNTY SCHOOL DISTRICT FACILITIES Indoor Air Quality Complaint or Request

It is the intent of the Facilities Department to maintain a safe and healthy environment for the students and employees of the Okaloosa County School District. Please assist us in this effort by using this form to report any complaint related to indoor air quality including concerns with temperature control, ventilation or air pollutants. Simply select the appropriate school or facility from the drop down list below and complete the remaining fields. Use the Description field to provide a brief narrative explaining the nature of the indoor air quality issue being reported and any known possible causes.

Elementary Middle High/Combo Other Building Room Description:

Reported By: Reviewed By:

(Principal/Director) Date: Date:

Please print after completing the form and have the Principal/Director sign. The form should then be returned to Linda Castleman or Tom Cox by fax at (850) 833-4205 or (850) 689-7410. If you have questions they may be reached at [email protected] (850) 833-3455 and [email protected] (850) 689-2048. Please ensure that the form has been signed by the Principal/Director prior to submitting to the Facilities Department.

Received By: Date: Action Taken: Date Action By: Completed: Follow-Up Signature: