• VENTILATION SYSTEM EVALUATION FORM
Please complete this form in accordance with instructions in the accompanying guidance document
Part 1.0 General int- r ation
ate of evaluation: ,L y Building contact name and phone:
valuation team (list name and affili~
(Enviro:
2 (HVAC
Building address: Type of Facility (check all that apply):
Residential
Multi-use
Other (describe)
Date of construction:
Number of residents 1 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 Est. no. of units
Mechanical make-up air system Passive shaft/duct
Est. no. of units Est. no. of units 9
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.
Vent! ti S ( c Evaluator Date
Pa .0 lsual Inspection Forms
Use the attached forms to document visual inspections. Complete the forms in accordance with
instructions in the accompanying guidance document.
•
NYC-WTC 000133794
OCR can misread numbers and units. Confirm readings against the page image before using them.
NYC-WTC_000133794Source: NYC Law Department, mirrored locally
EPA correspondence transmitting the final HVAC system inspection checklist and implementation guidance for use by contractors in post-9/11 building cleanup and ventilation system…