Secondhand Smoke Exposure Log

Date: 
05/17/2017
Document File: 
Document Text Version

Documenting your experience with secondhand smoke drifting into your rental unit can be valuable information to share with your property manager. For additional resources, visit SmokeFreeHomes.iowa.gov.

Secondhand Smoke Exposure Log

Experienced by Resident: ___________________________ Unit #_________

Date of Exposure                 *Record each incident

Time of Exposure                     *ex. 7am-8am, 9pm-10pm

Location                               *Where in the building or your unit are you being exposed? Where is smoke entering unit or building from?

Symptoms                               *How did the secondhand smoke affect you?

Action Taken/Notes                  *ex. Did you run a fan? Talk to the smoker? Talk to the manager? Seal off vent?

*This resource has been modified from Live Smoke Free.                                                                                              

February 2017

Printed from the website on December 01, 2020 at 8:39am.