The National Institute for Occupational Safety and Health (NIOSH) received a Health Hazard Evaluation request from the West Virginia Department of Health and Human Resources (WVDHHR) Director of Facilities regarding leased office space in the Webster Springs, West Virginia, district office. The request reported poor indoor air quality, new-carpet and other odors, water leaks, and inadequate heating, ventilation, and air-conditioning systems. The request reported respiratory, allergy, and sinus symptoms; eye, nose, and throat irritation; and skin irritation, including rashes and hives, among the employees. On September 11-12, 2003, we conducted a walkthrough of the building. Odors from cleaning supplies were apparent. We did not find obvious sources of mold or water incursion. Measurements made during the site visit found bioaerosol concentrations that were similar to outdoor concentrations, carbon dioxide concentrations that were elevated, and volatile organic compounds that are commonly found in office settings. Twenty-one (88%) of the employees completed a health questionnaire. Seven employees (33%) reported a physician diagnosis of asthma after occupying the building. We returned to the building on April 12-16, 2004 and performed a second building walkthrough, administered health questionnaires to employees, conducted lung function testing, and offered employees serial spirometry for assessment of work-related changes in lung function. During the 2004 walkthrough, we found water incursion, visible mold, and musty odors in the basement. Musty odors were noticeable in the entry area of the building, the elevator, and the south stairwell. It had been raining before and during the 2004 visit, but not during the 2003 visit. Odors from the restrooms were evident on the second floor. All 24 WVDHHR employees currently working in the building participated in the April 2004 medical testing and questionnaire. The employees were 4.6 and 2.6 times more likely to report having current asthma than the U.S. adult population and the West Virginia adult population, respectively. Five employees reported current asthma that was diagnosed after building occupancy. Twelve employees reported lower respiratory symptoms occurring in the last 12 months and improving when away from the building. Seven of the employees had some indication of abnormal lung function or exhaled nitric oxide levels suggestive of airways inflammation. Three of these seven employees had both some degree of bronchial hyperresponsiveness and exhaled nitric oxide levels suggestive of airways inflammation, consistent with poorly controlled asthma. Furthermore, one of these three employees had indications of a work-related pattern of lung function on serial spirometry. Our survey identified respiratory symptoms and conditions among employees that may be related to the workplace. The prevalences of physician-diagnosed and current asthma were high when compared to national and state prevalences, as were building-related symptoms. The building was found to have standing water, mold, and musty odors in the basement. Odors were also present in other parts of the building. The documented health effects and the environmental findings of water damage, standing water, and mold dictate continued remediation efforts to improve the conditions in the building as a means to protect the health of occupants and to prevent additional health effects. The NIOSH investigators determined that this building located in Webster Springs, West Virginia, was damp, as evidenced by water incursion and visible mold in the basement combined with musty odors in other areas of the building. While specific environmental exposures causing these health effects were not identified, current scientific evidence indicates that damp buildings are associated with the risk of nose and throat symptoms, cough, wheeze, asthma symptoms in sensitized persons, and hypersensitivity pneumonitis, lending credence to attributing excess employee symptoms and conditions to working in the building. The employee reports of respiratory symptoms and the objective lung function test results support the possibility of work-related respiratory conditions. NIOSH provided recommendations for correcting the dampness and conducting building maintenance to help reduce health risks for the building occupants.