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EPA Building Air Quality Guide-1991

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Building Name: ____________________________________________ Address: __________________________________________ Completed by: ___________________________________________ Date: ______________ File Number: ___________________ HVAC Checklist - Short Form Indoor Air Quality Forms 194 OCCUPIED SPACE Thermostat types Zone/ Thermostat What Does Setpoints Measured Day/ Room Location Thermostat Temperature Time Control? Summer Winter (e.g., radiator, AHU-3) Humidistats/Dehumidistats type Zone/ Humidistat/ What Does It Setpoints Measured Day/ Room Dehumidistat Control? (%RH) Temperature Time Location ■ Potential problems (note location) ■ Thermal comfort or air circulation (drafts, obstructed airflow, stagnant air, overcrowding, poor thermostat location) ■ Malfunctioning equipment ■ Major sources of odors or contaminants (e.g., poor sanitation, incompatible uses of space) Page 4 of 4

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