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EPA Building Air Quality Guide-1991

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Page 178 of 227

Indoor Air Quality Forms 169 This section of the document is a collec- tion of the forms that appear or are men- tioned in the text. Consider making copies of the forms, blocking out the page infor- mation at the bottom of the copies, and then reproducing these copies for use in your building. Some or all of them may require adaptation to meet your specific needs. Blank formatted sheets are included for preparing your own HVAC Checklist and Pollutant and Source Inventory. The forms appear in the following sequence: Management Checklist: (4 pages): for keeping track of the elements of the IAQ profile and IAQ management plan. Pollutant Pathway Record For IAQ Profiles: for identifying areas in which negative or positive pressures should be maintained. Zone/Room Record: for recording infor- mation on a room-by-room basis on the topics of room use, ventilation, and occu- pant population. Ventilation Worksheet: to be used in con- junction with the Zone/Room Record when calculating quantities of outdoor air that are being supplied to individual zones or rooms. IAQ Complaint Form: to be filled out by the complainant or by a staff person who receives information from the complainant. Incident Log: for keeping track of each IAQ complaint or problem and how it is handled. Occupant Interview (2 pages): for record- ing the observations of building occupants in relation to their symptoms and condi- tions in the building . Occupant Diary: for recording incidents of symptoms and associated observations as they occur. Log of Activities and System Operation: for recording activities and equipment operating schedules as they occur. HVAC Checklist - Short Form (4 pages): to be used as a short form for investigating an IAQ problem, or for periodic inspec- tions of the HVAC system. Duplicate pages 2 through 4 for each large air han- dling unit. HVAC Checklist - Long Form (14 pages, followed by one blank formatted sheet): to be used for detailed inspections of the HVAC system or as a long form for inves- tigating an IAQ problem. Duplicate pages 1 through 11 for each large air handling unit. Pollutant Pathway Form For Investigations: to be used in conjunction with a floor plan of the building. Pollutant and Source Inventory (6 pages, followed by one blank formatted sheet): to be used as a general checklist of poten- tial indoor and outdoor pollutant sources. Chemical Inventory: for recording information about chemicals stored or used within the building. Hypothesis Form: to be used for summarizing what has been learned during the building investigation, a tool to help the investigator collect his or her thoughts. Indoor Air Quality Forms

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