Lists of conditions or complaints characteristic of sick buildings or SBS: Sick Building Syndrome.

This article series explains sick building syndrome or SBS and links to a sick building questionnaire form helpful in tracking down building-related indoor air quality and health complaints that may be related to building conditions.

Checklist for symptoms for SBS - Sick Building Syndrome

Mail or give this questionnaire to your building investigator or consultant

Question: Is there a checklist for symptoms for SBS - Sick Building Syndrome

2018/12/28, a reader asked:

Would it be possible to get a checklist of symptoms for SBS [Sick Building Syndrome]?

I would also like to know if and where some test kits can be bought.

I want to cover and check all bases before i even think about talking to landlord .

I live in apt complex and at least 5 people are all experiencing symtoms of SBS. I haven't asked others yet. thank you and any info you give me will be appreciated. - Anonymous by private email

Reply:

Your question is a reasonable one and I understand why you would ask.

While we do offer a SICK HOUSE IAQ QUESTIONNAIRE that collects basic diagnostic information, no simple SBS symptom nor SBS cause checklist can be complete and as I will explain below, reliance on any checklist is dangerous.

Similarly, no test kit for SBS Sick Building Syndrome can be complete and no comprehensive SBS checklist fits all situations.

However experts have given general lists of the characteristics of a "sick building" based on the nature of occupant complaints, and the most-common "causes" of sick buildings can also be listed in general terms.

Checklist of Evidence of a Sick Building Syndrome (SBS) Complaints or Symptoms

The most basic Sick Building Syndrome individual symptom that comes to mind is that the individual's health complaint or indoor air quality IAQ-like complaint is noticeably more severe when an individual spends time or has spent time in a particular building or in an area in the building.

The most-common SBS comlaints include respiratory complaints, asthma or allergic reactions to an environment, skin or dermatitis complaints, dizziness, faintness, and tiredness or exhaustion.

Watch out: some illnesses and health complaints may linger long after a person has left a building whose indoor conditions either caused or agravated their complaint, and other illnesses or health complaints may occur long-enough after an exposure to their cause that the building or environment at fault is not obvious.

Absence of evidence is not evidence of absence of a problem cause.

For an example showing how long and varied are illnesses related to even a single class of contaminants,

see MOLD RELATED ILLNESS GUIDE

The US EPA lists the following indicators of a "sick building" that may result in SBS complaints:

• Building occupants complain of symptoms associated with acute discomfort, e.g., headache; eye, nose, or throat irritation; dry cough; dry or itchy skin; dizziness and nausea; difficulty in concentrating; fatigue; and sensitivity to odors.  
• The cause of the symptoms is not known.
• Most of the complainants report relief soon after leaving the building.
• Building occupants complain of symptoms such as cough; chest tightness; fever, chills; and muscle aches.
• The symptoms can be clinically defined and have clearly identifiable causes.
• Complainants may require prolonged recovery times after leaving the building.
  

The EPA notes

It is important to note that complaints may result from other causes. These may include an illness contracted outside the building, acute sensitivity (e.g., allergies), job related stress or dissatisfaction, and other psychosocial factors.

Nevertheless, studies show that symptoms may be caused or exacerbated by indoor air quality problems. - U.S. EPA 1991 cited below.  

Checklist of Sick Building Syndrome SBS Causes

In the same EPA basic guidance document we quoted above, the agency describes the following common causes of SBS.

• Biological contaminants, such as animal allergens, high levels of dust mite fecals, mold, pollen, bacteria and viruses in building reservoirs, exacerbated when distributed through a building's HVAC system.
  
  Physical symptoms related to biological contamination include cough, chest tightness, fever, chills, muscle aches, and allergic responses such as mucous membrane irritation and upper respiratory congestion. - EPA op. cit.
• Chemical contaminants indoors from indoor sources, covering a very wide range including common chemicals from adhesives, carpets, some wood products, cleaners, VOCs, mold.
• Inadequate building ventilation. ASHRAE (American Society of Heating, Refrigerating, and Air-Conditioning Engineers) [I'm a member] recommends a that building ventilation provide at least 15 cubic feet per minute (CFM) of outdoor air per person, and in office spaces, 20 CFM/min. (ASHRAE Standard 62-1989). ]
  
  Really? Well yes in general but in my opinion it's always best if we can find and remove the source of indoor contaminants. For example fresh air ventilation is not a suitable nor adequate response to a significant indoor mold contamination problem.
• Excluded from SBS but still important in some buildings are contaminants whose long-term exposure can lead to health problems, such as asbestos contamination or radon gas exposure at high levels. These contaminants are therefore often included in SBS surveys even though they are not likely to explain short term SBS IAQ complaints.

Dangers of Relying on any SBS Symptom or Cause Checklist

Watch out: In my opinion there is no single, simple comprehensive checklist for sick building syndrome causes nor cures nor symptoms.

The range of causes of SBS complaints is quite broad and includes the presence of harmful or irritating particles (dust or particulates), chemicals, gases, and present or past use of or presence of chemicals or other irritating materials in or around a building.

The American Industrial Hygiene Association [I'm a member] provides a 6-inch thick binder of procedures and things to check when investigating building indoor air or environments for contaminants and irritants.

It's also the case that inspecting to a checklist virtually always is going to misdirect the inspector away from things that should be observed and considered.

That's because of the normal human tendency to inspect to the checklist instead of doing what is actually needed. Inspecting the building.

It is particularly the beginners in any inspection field who really wish they had a checklist. Their list its useful to remind them not to forget to look at something.

But as I'm trying to explain, since no list can be complete, relying on one is misdirecting.

The inspector ultimately only looks for the things on her list. And even then may not recognize Clues suggesting that something on the list is actually present but the clue wasn't included in the list.

What's needed is first a thorough occupant interview to understand the complaints of occupants as well as individual special Health vulnerabilities.

That's added to a complete taking of the building history of things that could contribute to or cause irritating or unsafe environmental conditions such as leaks, paints, use of pesticides or sprays or other chemicals, prior history of such uses, visual evidence of such uses, such as pesticide application drill marks, and occupancies of the building so just various industrial or business or hobby applications.

With that background an experienced inspector then makes a very thorough inspection of the building inside and out for visual evidence of obvious contaminants or problems.

An inspector might make limited use of specific tests to look for targets suggested by the combination of occupant complaints building history and visual inspection.

And in some cases and inspector might choose areas of greatest risk of a hidden contaminant to make modest test openings to inspect or test building wall ceiling or floor cavities.

But again since there's no simple technical test that would be all comprehensive relying on tests without the accompanying interviews and inspections I have described would be a worse mistake than trying to rely on a checklist.

There are some checklist-like procedures that can help focus a building investigation.

Steve Bliss has offered this

INDOOR AIR HAZARDS TABLE

I've given some examples in our discussion of odor complaints in which we've suggested that the log keeping track of when the complaints are apparent can help relate and odor to its source.

See this ODOR DIAGNOSIS CHECKLIST in print format

We have a similar approach to tracking down noise and sound complaints. For example it's sometimes useful to notice time of day, weather conditions, and similar factors.

See NOISE SOURCE DATA LOG

SBS Sick Building Syndrome References & Research

• SICK HOUSE IAQ QUESTIONNAIRE - a simple form that assists building owners or occupants in giving helpful investigation to an environmental professional who is investigating SBS or Sick Building Syndrdome complaints at any structure.
• American Lung Association, EPA, CPSC, AMA, INDOOR AIR POLLUTION Introduction for Health Professionals [PDF] American Lung Association, 1740 Broadway New York, NY 10019 USA Tel: 212/315-8700, AMA American Medical Association, Department of Preventive Medicine and Public Health, 515 North State Street Chicago, IL 60610 USA, Tel:
  312/464-4541 and CPSC and EPA, retrieved 2019/01/01 original source: https://www.epa.gov/sites/production/files/2015-01/documents/indoor_air_pollution.pdf
• CDC, NIOSH & EPA, BUILDING AIR QUALITY, Guide for Building Owners & Facilities Managers [PDF] ISBN 0-16--035919-8 (1991) retrieved 2019/01/01 original source: https://www.cdc.gov/niosh/docs/91-114/pdfs/91-114.pdf
• EPA, INDOOR AIR QUALITY TOOLS for SCHOOLS REFERENCE GUIDE, EPA et als, [PDF] 2009, retrieved 2019/01/01 original source: https://www.epa.gov/sites/production/files/2014-08/documents/reference_guide.pdf
  
  Excerpt: Poor IAQ can lead to a large variety of health problems and potentially affect comfort, concentration, and staff/ student performance. In recognition of tight school budgets, this guidance is designed to present practical and often low-cost actions you can take to identify and address existing or potential air quality problems.
  
  You can accomplish this using current school staff to perform a limited and well-defined set of basic operations and maintenance activities. However, some actions may require specialized expertise.
• US EPA, HEALTHY BUILDINGS, HEALTHY PEOPLE [PDF] (2001), EPA 402-K-01-003, retrieved 2019/01/01 original source: https://www.epa.gov/sites/production/files/2014-08/documents/hbhp_report.pdf
• US EPA, INDOOR AIR QUALITY TOOLS for SCHOOLS (Tfs) EVALUATION [PDF] (2007), retrieved 2019/01/01 original source: https://www.epa.gov/sites/production/files/2015-09/documents/eval-tools-for-schools.pdf
• US EPA, SICK BUILDING SYNDROME, Indoor Air Facts No. 4 (1991) [PDF] U.S. Environmental Protection Agency (EPA), R&D, retrieved 2019/01/01 original source: https://www.epa.gov/sites/production/files/2014-08/documents/sick_building_factsheet.pdf
  
  Excerpt: The term "sick building syndrome" (SBS) is used to describe situations in which building occupants experience acute health and comfort effects that appear to be linked to time spent in a building, but no specific illness or cause can be identified.
  
  The complaints may be localized in a particular room or zone, or may be widespread throughout the building.
  
  In contrast, the term "building related illness" (BRI) is used when symptoms of diagnosable illness are identified and can be attributed directly to airborne building contaminants.
  
  A 1984 World Health Organization Committee report suggested that up to 30 percent of new and remodeled buildings worldwide may be the subject of excessive complaints related to indoor air quality (IAQ).
  
  Often this condition is temporary, but some buildings have long-term problems. Frequently, problems result when a building is operated or maintained in a manner that is inconsistent with its original design or prescribed operating procedures. Sometimes indoor air problems are a result of poor building design or occupant activities.

...

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