{"id":48,"date":"2019-03-06T10:56:19","date_gmt":"2019-03-06T15:56:19","guid":{"rendered":"https:\/\/sites.temple.edu\/ehrsforms\/?page_id=48"},"modified":"2019-03-07T14:53:00","modified_gmt":"2019-03-07T19:53:00","slug":"indoor-air-quality-occupant-questionnaire","status":"publish","type":"page","link":"https:\/\/sites.temple.edu\/ehrsforms\/indoor-air-quality-occupant-questionnaire\/","title":{"rendered":"Indoor Air Quality Occupant Questionnaire"},"content":{"rendered":"<h2>Indoor Air Quality Occupant Questionnaire<\/h2>\n<p>&nbsp;<\/p>\n<script>\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof InitializeEditor,callIfLoaded:function(o){return!(!gform.domLoaded||!gform.scriptsLoaded||!gform.themeScriptsLoaded&&!gform.isFormEditor()||(gform.isFormEditor()&&console.warn(\"The use of gform.initializeOnLoaded() is deprecated in the form editor context and will be removed in Gravity Forms 3.1.\"),o(),0))},initializeOnLoaded:function(o){gform.callIfLoaded(o)||(document.addEventListener(\"gform_main_scripts_loaded\",()=>{gform.scriptsLoaded=!0,gform.callIfLoaded(o)}),document.addEventListener(\"gform\/theme\/scripts_loaded\",()=>{gform.themeScriptsLoaded=!0,gform.callIfLoaded(o)}),window.addEventListener(\"DOMContentLoaded\",()=>{gform.domLoaded=!0,gform.callIfLoaded(o)}))},hooks:{action:{},filter:{}},addAction:function(o,r,e,t){gform.addHook(\"action\",o,r,e,t)},addFilter:function(o,r,e,t){gform.addHook(\"filter\",o,r,e,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,r){gform.removeHook(\"action\",o,r)},removeFilter:function(o,r,e){gform.removeHook(\"filter\",o,r,e)},addHook:function(o,r,e,t,n){null==gform.hooks[o][r]&&(gform.hooks[o][r]=[]);var d=gform.hooks[o][r];null==n&&(n=r+\"_\"+d.length),gform.hooks[o][r].push({tag:n,callable:e,priority:t=null==t?10:t})},doHook:function(r,o,e){var t;if(e=Array.prototype.slice.call(e,1),null!=gform.hooks[r][o]&&((o=gform.hooks[r][o]).sort(function(o,r){return o.priority-r.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==r?t.apply(null,e):e[0]=t.apply(null,e)})),\"filter\"==r)return e[0]},removeHook:function(o,r,t,n){var e;null!=gform.hooks[o][r]&&(e=(e=gform.hooks[o][r]).filter(function(o,r,e){return!!(null!=n&&n!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][r]=e)}});\n<\/script>\n\n                <div class='gf_browser_gecko gform_wrapper gform_legacy_markup_wrapper gform-theme--no-framework' data-form-theme='legacy' data-form-index='0' id='gform_wrapper_9' style='display:none'><form method='post' enctype='multipart\/form-data'  id='gform_9'  action='\/ehrsforms\/wp-json\/wp\/v2\/pages\/48' data-formid='9' novalidate>\n                        <div class='gform-body gform_body'><ul id='gform_fields_9' class='gform_fields top_label form_sublabel_below description_below validation_below'><li id=\"field_9_37\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><b>Any IAQ concern that poses an immediate danger to life and health should be reported to Campus Safety Services at 215-204-1234 (1-1234).<\/b><\/li><li id=\"field_9_10\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">Occupant Information<\/h2><\/li><li id=\"field_9_2\" class=\"gfield gfield--type-name gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >Occupant Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_9_2'>\n                            \n                            <span id='input_9_2_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_2.3' id='input_9_2_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_9_2_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_9_2_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_2.6' id='input_9_2_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_9_2_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/li><li id=\"field_9_3\" class=\"gfield gfield--type-phone gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_9_3'>Phone<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_3' id='input_9_3' type='tel' value='' class='medium'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_9_4\" class=\"gfield gfield--type-email gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_9_4'>Email<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_4' id='input_9_4' type='email' value='' class='medium'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/li><li id=\"field_9_6\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_9_6'>Building Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_6' id='input_9_6' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_9_7\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_9_7'>Room Number<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_7' id='input_9_7' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_9_11\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">Symptoms<\/h2><\/li><li id=\"field_9_12\" class=\"gfield gfield--type-textarea gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_9_12'>What is\/are your chief complaint(s)?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_12' id='input_9_12' class='textarea medium'     aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_9_13\" class=\"gfield gfield--type-textarea field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_9_13'>What symptoms or discomforts were experienced?<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_13' id='input_9_13' class='textarea medium'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_9_14\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Do you have any health conditions that may raise susceptibility to environmental problems?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_9_14'>\n\t\t\t<li class='gchoice gchoice_9_14_0'>\n\t\t\t\t<input name='input_14' type='radio' value='Yes'  id='choice_9_14_0'    \/>\n\t\t\t\t<label for='choice_9_14_0' id='label_9_14_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_9_14_1'>\n\t\t\t\t<input name='input_14' type='radio' value='No'  id='choice_9_14_1'    \/>\n\t\t\t\t<label for='choice_9_14_1' id='label_9_14_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_9_15\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Have you sought medical attention?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_9_15'>\n\t\t\t<li class='gchoice gchoice_9_15_0'>\n\t\t\t\t<input name='input_15' type='radio' value='Yes'  id='choice_9_15_0'    \/>\n\t\t\t\t<label for='choice_9_15_0' id='label_9_15_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_9_15_1'>\n\t\t\t\t<input name='input_15' type='radio' value='No'  id='choice_9_15_1'    \/>\n\t\t\t\t<label for='choice_9_15_1' id='label_9_15_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_9_16\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Do you smoke?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_9_16'>\n\t\t\t<li class='gchoice gchoice_9_16_0'>\n\t\t\t\t<input name='input_16' type='radio' value='Yes'  id='choice_9_16_0'    \/>\n\t\t\t\t<label for='choice_9_16_0' id='label_9_16_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_9_16_1'>\n\t\t\t\t<input name='input_16' type='radio' value='No'  id='choice_9_16_1'    \/>\n\t\t\t\t<label for='choice_9_16_1' id='label_9_16_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_9_17\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">Time<\/h2><\/li><li id=\"field_9_18\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_9_18'>When did the symptoms start?<\/label><div class='ginput_container ginput_container_text'><input name='input_18' id='input_9_18' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_9_19\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_9_19'>When are they the worst?<\/label><div class='ginput_container ginput_container_text'><input name='input_19' id='input_9_19' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_9_20\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Do they go away?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_9_20'>\n\t\t\t<li class='gchoice gchoice_9_20_0'>\n\t\t\t\t<input name='input_20' type='radio' value='Yes'  id='choice_9_20_0'    \/>\n\t\t\t\t<label for='choice_9_20_0' id='label_9_20_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_9_20_1'>\n\t\t\t\t<input name='input_20' type='radio' value='No'  id='choice_9_20_1'    \/>\n\t\t\t\t<label for='choice_9_20_1' id='label_9_20_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_9_21\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_9_21'>If yes, when?<\/label><div class='ginput_container ginput_container_text'><input name='input_21' id='input_9_21' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_9_33\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Have you noticed any other events (weather, temperature, humidity, construction) that could have contributed to the symptoms?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_9_33'>\n\t\t\t<li class='gchoice gchoice_9_33_0'>\n\t\t\t\t<input name='input_33' type='radio' value='Yes'  id='choice_9_33_0'    \/>\n\t\t\t\t<label for='choice_9_33_0' id='label_9_33_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_9_33_1'>\n\t\t\t\t<input name='input_33' type='radio' value='No'  id='choice_9_33_1'    \/>\n\t\t\t\t<label for='choice_9_33_1' id='label_9_33_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_9_22\" class=\"gfield gfield--type-textarea field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_9_22'>If yes, please list the events here.<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_22' id='input_9_22' class='textarea small'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_9_23\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">Location<\/h2><\/li><li id=\"field_9_24\" class=\"gfield gfield--type-textarea field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_9_24'>Where are you when symptoms are experienced?<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_24' id='input_9_24' class='textarea small'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_9_25\" class=\"gfield gfield--type-textarea field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_9_25'>Where do you spend most of the time in the building?<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_25' id='input_9_25' class='textarea small'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_9_26\" class=\"gfield gfield--type-textarea field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_9_26'>What do you think the possible cause(s) are or have you observed any building conditions that might need attention (e.g. temperature, humidity, drafts, or odors)?<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_26' id='input_9_26' class='textarea small'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_9_35\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Have there been any changes in your work space or nearby offices in the past 3 months (new carpeting, new furnitute, etc.)?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_9_35'>\n\t\t\t<li class='gchoice gchoice_9_35_0'>\n\t\t\t\t<input name='input_35' type='radio' value='Yes'  id='choice_9_35_0'    \/>\n\t\t\t\t<label for='choice_9_35_0' id='label_9_35_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_9_35_1'>\n\t\t\t\t<input name='input_35' type='radio' value='No'  id='choice_9_35_1'    \/>\n\t\t\t\t<label for='choice_9_35_1' id='label_9_35_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_9_27\" class=\"gfield gfield--type-textarea field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_9_27'>If yes, please list the changes here.<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_27' id='input_9_27' class='textarea small'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_9_28\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">Additional Information<\/h2><\/li><li id=\"field_9_30\" class=\"gfield gfield--type-checkbox gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >Some common problems are listed below. Please check any that apply to your situation:<\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_9_30'><li class='gchoice gchoice_9_30_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_30.1' type='checkbox'  value='Lack of fresh air'  id='choice_9_30_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_9_30_1' id='label_9_30_1' class='gform-field-label gform-field-label--type-inline'>Lack of fresh air<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_9_30_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_30.2' type='checkbox'  value='Natural gas'  id='choice_9_30_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_9_30_2' id='label_9_30_2' class='gform-field-label gform-field-label--type-inline'>Natural gas<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_9_30_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_30.3' type='checkbox'  value='Sewer gas smell'  id='choice_9_30_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_9_30_3' id='label_9_30_3' class='gform-field-label gform-field-label--type-inline'>Sewer gas smell<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_9_30_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_30.4' type='checkbox'  value='Dust in the air'  id='choice_9_30_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_9_30_4' id='label_9_30_4' class='gform-field-label gform-field-label--type-inline'>Dust in the air<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_9_30_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_30.5' type='checkbox'  value='Burning odor'  id='choice_9_30_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_9_30_5' id='label_9_30_5' class='gform-field-label gform-field-label--type-inline'>Burning odor<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_9_30_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_30.6' type='checkbox'  value='Chemical smell'  id='choice_9_30_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_9_30_6' id='label_9_30_6' class='gform-field-label gform-field-label--type-inline'>Chemical smell<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_9_30_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_30.7' type='checkbox'  value='Visible mold'  id='choice_9_30_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_9_30_7' id='label_9_30_7' class='gform-field-label gform-field-label--type-inline'>Visible mold<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_9_30_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_30.8' type='checkbox'  value='Moldy or musty odor'  id='choice_9_30_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_9_30_8' id='label_9_30_8' class='gform-field-label gform-field-label--type-inline'>Moldy or musty odor<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_9_30_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_30.9' type='checkbox'  value='Other'  id='choice_9_30_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_9_30_9' id='label_9_30_9' class='gform-field-label gform-field-label--type-inline'>Other<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_9_31\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_9_31'>Other<\/label><div class='ginput_container ginput_container_text'><input name='input_31' id='input_9_31' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_9_32\" class=\"gfield gfield--type-textarea field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_9_32'>Please provide any other comments or observations that may be helpful in determining the environmental condition of your workspace.<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_32' id='input_9_32' class='textarea small'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_9_36\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><p style=\"font-size:10px\">Environmental Health and Radiation Safety will only use the provided information to appropriately respond to your request. EHRS will not sell your information or use it for marketing purposes. Please contact us at 215-707-2520 or ehrs@temple.edu with any questions about how your information is used.<\/li><\/ul><\/div>\n        <div class='gform-footer gform_footer top_label'> <input type='submit' id='gform_submit_button_9' class='gform_button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='submit' value='Submit'  \/> \n            <input type='hidden' class='gform_hidden' name='gform_submission_method' data-js='gform_submission_method_9' value='postback' \/>\n            <input type='hidden' class='gform_hidden' name='gform_theme' data-js='gform_theme_9' id='gform_theme_9' value='legacy' \/>\n            <input type='hidden' class='gform_hidden' name='gform_style_settings' data-js='gform_style_settings_9' id='gform_style_settings_9' value='[]' \/>\n            <input type='hidden' class='gform_hidden' name='is_submit_9' value='1' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='9' \/>\n            \n            <input type='hidden' class='gform_hidden' name='gform_currency' data-currency='USD' value='\/o1IWJVe8zqQ8LEjf\/d4Rim44MOxnJdbTfMDfR3H5m9h3AH8\/LgmX34OpINxkZneMGvh+1nQKmxGU0myHxY62lvaaZKdMulWlIAyFezSTXwxfb4=' \/>\n            <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' \/>\n            <input type='hidden' class='gform_hidden' name='state_9' value='WyJbXSIsIjBlNGFmZDI1OTZmMDZlM2ZmYWYxN2RiODAwNjg0M2VkIl0=' \/>\n            <input type='hidden' autocomplete='off' class='gform_hidden' name='gform_target_page_number_9' id='gform_target_page_number_9' value='0' \/>\n            <input type='hidden' autocomplete='off' class='gform_hidden' name='gform_source_page_number_9' id='gform_source_page_number_9' value='1' \/>\n            <input type='hidden' name='gform_field_values' value='' \/>\n            \n        <\/div>\n                        <\/form>\n                        <\/div><script>\ngform.initializeOnLoaded( function() {gformInitSpinner( 9, 'https:\/\/sites.temple.edu\/ehrsforms\/wp-content\/plugins\/gravityforms\/images\/spinner.svg', true );jQuery('#gform_ajax_frame_9').on('load',function(){var contents = jQuery(this).contents().find('*').html();var is_postback = contents.indexOf('GF_AJAX_POSTBACK') >= 0;if(!is_postback){return;}var form_content = jQuery(this).contents().find('#gform_wrapper_9');var is_confirmation = jQuery(this).contents().find('#gform_confirmation_wrapper_9').length > 0;var is_redirect = contents.indexOf('gformRedirect(){') >= 0;var is_form = form_content.length > 0 && ! is_redirect && ! is_confirmation;var mt = parseInt(jQuery('html').css('margin-top'), 10) + parseInt(jQuery('body').css('margin-top'), 10) + 100;if(is_form){form_content.find('form').css('opacity', 0);jQuery('#gform_wrapper_9').html(form_content.html());if(form_content.hasClass('gform_validation_error')){jQuery('#gform_wrapper_9').addClass('gform_validation_error');} else {jQuery('#gform_wrapper_9').removeClass('gform_validation_error');}setTimeout( function() { \/* delay the scroll by 50 milliseconds to fix a bug in chrome *\/  }, 50 );if(window['gformInitDatepicker']) {gformInitDatepicker();}if(window['gformInitPriceFields']) {gformInitPriceFields();}var current_page = jQuery('#gform_source_page_number_9').val();gformInitSpinner( 9, 'https:\/\/sites.temple.edu\/ehrsforms\/wp-content\/plugins\/gravityforms\/images\/spinner.svg', true );jQuery(document).trigger('gform_page_loaded', [9, current_page]);window['gf_submitting_9'] = false;}else if(!is_redirect){var confirmation_content = jQuery(this).contents().find('.GF_AJAX_POSTBACK').html();if(!confirmation_content){confirmation_content = contents;}jQuery('#gform_wrapper_9').replaceWith(confirmation_content);jQuery(document).trigger('gform_confirmation_loaded', [9]);window['gf_submitting_9'] = false;wp.a11y.speak(jQuery('#gform_confirmation_message_9').text());}else{jQuery('#gform_9').append(contents);if(window['gformRedirect']) {gformRedirect();}}jQuery(document).trigger(\"gform_pre_post_render\", [{ formId: \"9\", currentPage: \"current_page\", abort: function() { this.preventDefault(); 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