Occupancy Questionnaire

Institution: De La Salle University Medical Center Building address: Congressional Ave., Dasmarias City, Cavite Date:_________________ Time:________________ Introduction We are conducting an evaluation of your building to assess ho ell it !erforms for those ho occu!y it. "his information ill be used to assess areas that need im!rovement, !rovide feedbac# for similar buildings and !ro$ects and to hel! us better manage the environment. Gender Male% 'Please tick(

&emale

Occupation: 'Please tick most relevant or state in other( Administrative staff Medical staff Maintenance Medical )e!resentative *ther% +++.. Time in building a. ,o long do you s!end in the building during the day'Please tick(
,ours ./ /01 203 405 607 .7

Location 8n an average ee# ho much time do you s!end in the follo ing ty!es of s!acea% *ffice 'Please tick(
,ours 904 50/9 //0/4 /5019 1/014 15029 2/024 .24

b% :mergency de!artment 'Please tick(

,ours 904 50/9 //0/4 /5019 1/014 15029 2/024 .24

c% Laboratory 'Please tick(

,ours 904 50/9 //0/4 /5019 1/014 15029 2/024 .24

d% Clinic 'Please tick(

,ours 904 50/9 //0/4 /5019 1/014 15029 2/024 .24

e% ;harmacy 'Please tick(

,ours 904 50/9 //0/4 /5019 1/014 15029 2/024 .24

f% *ther 'Please state(

+++++++++++++++. ,ours 904 50/9 //0/4 /5019 1/014 15029 2/024 .24

Please rate the overall uality o! the !ollo"ing areas: 'Please tick(
a% *ffice b% :mergency de!artment c% Laboratory d% Clinic e% ;harmacy ;oor ;oor / / 1 1 2 2 3 3 4 4 5 5 6 6 :<cellent :<cellent

;oor ;oor ;oor

/ / /

1 1 1

2 2 2

3 3 3

4 4 4

5 5 5

6 6 6

:<cellent :<cellent :<cellent

f% *ther 'Please state(% ++++++++++++

;oor / 1 2 3 4 5 6 :<cellent

Building Generally Does the design of the building su!!ort the needs of !atients;oor / 1 2 3 4 5 6 :<cellent

,o

can you describe the organi=ation of s!aces 'rooms(/ 1 2 3 4 5 6 :<cellent

;oor

#ecurity and #a!ety a. ;ersonal safety% ,o safe do you feel in the building- 'Please tick(
Unsafe / 1 2 3 4 5 6 >ery safe

b. What as!ects of the environment contribute to feeling safei(. >isibility of security guards 'Please tick(
?ot significant / 1 2 3 4 5 6 >ery significant

ii(.Lighting
?ot significant / 1 2 3 4 5 6 >ery significant

iii( S!atial configuration 'i.e. relatively large uncluttered s!aces(

?ot significant / 1 2 3 4 5 6 >ery significant

Does the fire emergency systems ade@uate- '&ire e<tinguisher, fire alarm, fire e<it(
?ot ade@uate / 1 2 3 4 5 6 Ade@uate

$ccessibility %can you get into it& can you get around the building ' campus easily( a(. ,o accessible is the building from the street i.e. to the rece!tion door- 'Please tick(
/ 1 2 3 4 5 6 >ery accessible

?ot accessible

b(. ,o

easy is vertical circulation/ 1 2 3 4 5 6 >ery easy

>ery difficult

c(. ,o

easy is hori=ontal circulation/ 1 2 3 4 5 6 >ery easy

>ery difficult

d(. Are there enough signage for locating rooms and s!aces?ot ade@uate / 1 2 3 4 5 6 Ade@uate

)leanliness ,o clean is the building'Please tick(

Dirty / 1 2 3 4 5 6 Clean

$ir uality a(. Does the @uality of the air in this !art of the building have a negative effect on your !erformance-'Please tick(
?ot significant / 1 2 3 4 5 6

or#

>ery significant

b(. 8s the air fresh- 'Please tick(

/ 1 2 3 4 5 6 &resh

d(. Does the air smell-'Please tick(

Smelly / 1 2 3 4 5 6 ?o smell

e( 8s there air movement- 'Please tick(

Still / 1 2 3 4 5 6 Aood circulation

Temperature a(. Does the tem!erature in this !art of the building have a negative effect on your or# !erformance'Please tick(
?ot significant / 1 2 3 4 5 6 >ery significant

c( 8s the tem!erature during the summer too cold or too arm-'Please tick(
"oo cold / 1 2 3 4 5 6 "oo hot

*oise a(. Does the distraction from noise in this !art of the building have a negative effect on your !erformance- 'Please tick(
?ot significant / 1 2 3 4 5 6 >ery significant

or#

b( 8s there significant distraction from noise outside the s!ace'Please tick(

?ot significant / 1 2 3 4 5 6 >ery significant

c( 8s there significant distraction from bac#ground noise-'Please tick(

?ot significant

>ery significant

Lighting b( 8s there too much or too little natural light- 'Please tick(
"oo little / 1 2 3 4 5 6 "oo much

d( 8s there too much or too little artificial light 'Please tick(

"oo little / 1 2 3 4 5 6 "oo much

f( Are the blinds B shutters effective in bloc#ing out natural light'Please tick(
?ot effective / 1 2 3 4 5 6 >ery effective

)omments 8f you have any additional comments that you ould li#e to ma#e about any as!ect of your or# environment !lease note them here. 8f relevant to a !articular @uestion !lease give the @uestion number.

"his @uestionnaire ill be collected on +.. "han# you very much for s!aring the time to com!lete this @uestionnaire.