NYC 9/11 Public Portal Document
' VENTILATION SYSTEM EVALUATION FORM
guidance document
Please complete this form in accordance with instructions in the accompanying
Part 1.0 General Inf r ation
Date of evaluation: tI v I Building contact name and phone:
Evaluation team (list name and affiliation):
(Environmental professional)
ro — ru csT S (HVAC professional)
Building address: ype of Facility (check all that apply):
(Residential
~, c, Multi-use
Other_(describe)
Date of construction:
Number of residents units: Number of floors: `]
Prior inspection report/maintenance records available for review?:
I Other comments
Ventilation system types (check all that apply and indicate total no. of units)
Central ventilation system Mechanical exhaust system
Est. no. of units Est. no. of units
-
Mechanical make-up air system Passive shaft/duct
Est. no. of units Est. no. of units
Other (describe)
on this form
I certify that to the best of my knowledge, the information and observations recorded
including all attachments are a true and accurate representation of site conditions.
Ven ion y° *te . VAC) Evaluator Date .
1 03
2. Visual Inspection Forms
accordance with
Use the attached forms to document visual inspections. Complete the forms in
instructions in the accompanying guidance document.
NYC-WTC 000131909
OCR can misread numbers and units. Confirm readings against the page image before using them.