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EPA Building Air Quality Guide-1991

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Page 193 of 227

Building Name: ____________________________________________ Address: __________________________________________ Completed by: ___________________________________________ Date: ______________ File Number: ___________________ HVAC Checklist - Short Form 191 Indoor Air Quality Forms Sections 2, 4 and 6 and Appendix B discuss the relationships between the HVAC system and indoor air quality. Page 1 of 4 MECHANICAL ROOM ■ Clean and dry? Stored refuse or chemicals? ■ Describe items in need of attention MAJOR MECHANICAL EQUIPMENT ■ Preventive maintenance (PM) plan in use? Control System ■ Type ■ System operation ■ Date of last calibration Boilers ■ Rated Btu input Condition ■ Combustion air: is there at least one square inch free area per 2,000 Btu input? ■ Fuel or combustion odors Cooling Tower ■ Clean? no leaks or overflow? Slime or algae growth? ■ Eliminator performance ■ Biocide treatment working? (list type of biocide) ■ Spill containment plan implemented? Dirt separator working? Chillers ■ Refrigerant leaks? ■ Evidence of condensation problems? ■ Waste oil and refrigerant properly stored and disposed of?

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