Fart 1.0 'f eneral I fo
e Date of E$aluatiori : '' .• Building:contact naiveand.phone:
Team (list name and affiliation): ' r
Evaluation Teain
Tttva: +rl i:lytt (Environmental Professional)
(HVAC/Electrical Professional)
;- = . r c_ ° '' . - (Sheet Metal Professional)
Building Address: •Type of Facility (check all that apply)
p} .. — esidential:.
N4_ .,... Multi-use
Other (describe)
-. .. . Number ofresidentiai units: Number of floors
HVAC SYstelnTjrpes (t heck all that aPP1Y) =` . ti
Unit entiletor(single residence unit) fl \ValUwindow AC unit (single residence unit) . . '.:
Fan coil unit (single re idence unit)._ ,:,': ;Central N entilationsystem
Neat.pump unit (single residence Unit) Passive shaft/duct
Other (describe)
Location of outside air intake:
Outside air intake accessible for•irispection . •• Y . . 1\' (explain)
Part •2.0 Checklists
2.1 Ventilators, wall air conditioning units and window air conditioning`:nits in common spaces
Ventilation SystemJdentification: ' ' L.~: .~ '/S •i£ -= 5 &c • R ~qe y,~
Location: .
i w0
Access adequate for inspection of cononents
•DustfDirt/Debris Suspect WTC-Related Dust
System Component
Substrate Material
(sheet metal wrapped) Light Heavy
S}•stem Components (sheet metal lined) : None (<1/16 inch (t 1/16 inch -present? Estimate % of total dust
(fi erglass) depth) depth f' ) . loading
(flexible connector)
(double walled)
Outside air intake louvers, grates'
and/or screens "
Outside air duct
Outside air damper(s)
Return air grille '
Return air plenum ,. . -
Filter rack '
Filter media
Coils (evaporator) .
Blower assembly
Condensate drain pan
In-line electrical resistance strip
heaters (in supply ducts
connected to unit ventilators) • .
Fire dampers
Turning vanes
Supply air plenum or supply duct
Supply air plenum or supply duct -
liner
Supply air diffuser
21 Ventilators, wall air'cot litioning units and window ,air conditioning units in common spaces (cant.)
NYC-WTC 000115033
OCR can misread numbers and units. Confirm readings against the page image before using them.
NYC-WTC_000115033Source: NYC Law Department, mirrored locally