VENTILATION SYSTEM EVALUATION FORM
Please complete this form in accordance with instructions in the accompanying guidance document
Part 1.0 General Inf r ation
Date of evaluation: y O Building contact name and phone:
ivaluation team (list name and affiliation):
(Environmental professional)
- :J u i 1 (HVAC rofessional)
To '/
Buildig address: Type of Facility (check all that apply):
50 ln1 AflJ J i Residential
Multi-use
Other (describe)
Date of construction:
Number of residents units: Number of floors:
Prior inspection report/maintenance records available for review?:
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 I Est. no. of units
Mechanical make-up air system Passive shaft/duct
Est. no. of units Est. no. of units O
Other (describe)
I certify that to the best of my knowledge, the information and observations recorded on this form
including all attachments are a true and accurate representation of site conditions.
Vents ti S• i( C) Evaluator Date
Pa .0 isual Inspection Forms
Use the attached forms to document visual inspections. Complete the forms in accordance with
instructions in the accompanying guidance document.
NYC-WTC 000133630
OCR can misread numbers and units. Confirm readings against the page image before using them.
NYC-WTC_000133630Source: NYC Law Department, mirrored locally
An HVAC inspection report from Cole Consulting Corporation dated February 13, 2003, recommending cleaning of units at 275 Greenwich Street due to WTC dust.