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EPA Building Air Quality Guide-1991

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Building Name: ___________________________________________ Address: ____________________________________ Completed by: ____________________________________ Date: _______________ File Number: ___________________ Indoor Air Quality Forms 215 Pollutant and Source Inventory Using the list of potential source categories below, record any indications of contamination or suspected pollutants that may require further investigation or treatment. Sources of contamination may be constant or intermittent or may be linked to single, unrepeated events. For intermittent sources, try to indicate the time of peak activity or contaminant production, including correlations with weather (e.g., wind direction). Page 3 of 6 Source Category Checked Needs Attention Location Comments HUMAN ACTIVITIES Personal Activities Smoking Cosmetics (odors) Housekeeping Activities Cleaning materials Cleaning procedures (e.g., dust from sweeping, vacuuming) Stored supplies Stored refuse Maintenance Activities Use of materials with volatile compunds (e.g., paint, caulk, adhesives) Stored supplies with volatile compounds Use of pesticides

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