Assessor
          Jeffrey Klenk
        Date
              Air Distribution and Terminal System (Assess 2-3 Locations per HVAC Zone)
| Check | OK | Comments | 
|---|---|---|
| Condition | ||
        No odors, noise or vibration
         
 | 
                      Yes 
         | 
                      |
        Clean, no obstructions
         
 | 
                      Yes 
         | 
                      |
        Free from signs of moisture/mold, insects or rodents?
         
 | 
                      Yes 
         | 
                      |
        No noticeable air leaks
         
 | 
                      Yes 
         | 
                      |
| Check | OK | Comments | 
|---|---|---|
| Ceiling Tiles | ||
        Tight seal on all tiles
         
 | 
                      Yes 
         | 
                      |
        No stained/damaged tiles indicating high RH or moisture problem
         
 | 
                      Yes 
         | 
                      |
| Check | OK | Comments | 
|---|---|---|
| Condition | ||
        No odors or unusual sounds
         
 | 
                      Yes 
         | 
                      |
        Clean, no excess dirt or moisture
         
 | 
                      No 
         | 
                      
        A couple of supply air diffusers had visible dust accumulation in room 31.  School custodial staff is to clean the diffuser.
         
 | 
                  
        No obstruction to air flow
         
 | 
                      Yes 
         | 
                      |
        No purposely placed obstruction indicating occupant distress
         
 | 
                      Yes 
         | 
                      |
| Location | ||
        No short circuiting between supply and return
         
 | 
                      Yes 
         | 
                      |
| Doors | ||
        Doors not tight or difficult to close indicating large pressure differential
         
 | 
                      Yes 
         | 
                      |
Building
| Check | OK | Comments | 
|---|---|---|
| Foundation | ||
        No moisture penetration or signs of mold?
         
 | 
                      Yes 
         | 
                      |
| Doors and Windows | ||
        Caulking and weather stripping in good condition
         
 | 
                      Yes 
         | 
                      |
| Check | OK | Comments | 
|---|---|---|
| Condition | ||
        Room is free of dust and clutter
         
 | 
                      No 
         | 
                      
        An air freshener was detected and observed within a cabinet of room D2.  School administration is to remind staff air fresheners are not permitted due to masking odors of concern and/or an irritant to others.  Remove the device from the building.
         
 | 
                  
        No stained or damage ceiling tiles
         
 | 
                      No 
         | 
                      
        Water stained ceiling tiles were observed in the restroom of room 36, hall outside gym office, and room D2.  If not already being addressed, school custodial staff is to submit a work order for Building Maintenance to evaluate, correct source, and replace ceiling  tile.
         
 | 
                  
        No visible mold present (walls, cabinets, under sinks, behind posters)
         
 | 
                      Yes 
         | 
                      |
| Relative Humidity | ||
        Not above 70%
         
 | 
                      Yes 
         | 
                      |
| Check | OK | Comments | 
|---|---|---|
| Condition | ||
        Clean
         
 | 
                      Yes 
         | 
                      |
        No unusual noise or odor
         
 | 
                      Yes 
         | 
                      |
        No mold growth on insulation
         
 | 
                      Yes 
         | 
                      |
        Traps contain water
         
 | 
                      Yes 
         | 
                      |
| Chemical Storage | ||
        Containers capped
         
 | 
                      Yes 
         | 
                      |
        No evidence of an active spill
         
 | 
                      Yes 
         | 
                      |
| Check | OK | Comments | 
|---|---|---|
| Condition | ||
        No odors, or unusual noise or vibration
         
 | 
                      Yes 
         | 
                      |