NYC-WTC_000139960
Blank form template for recording building details, inspection teams, and ventilation system types.
1 shared topics · Same agency, volume and box · similarity 0.997
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Ventilation system evaluation form template, 2002
Machine-extracted title · confidence 100%Blank form for recording building details, facility type, and ventilation system characteristics during inspection.
NYC-WTC_000139934Folder label: “EPA HVAC ACTION PLAN (Indoor Clean up)”
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NYC 9/11 Public Portal Document
VENTILATION SYSTEM EVALUATION FORM Please complete this form in accordance with instructions in the accompanying guidance document Part 1.0 General Information Date of evaluation: Building contact name and phone:
Evaluation team (list name and affiliation): (Environmental professional) (HVAC professional) Building address: Type of Facility (check all that apply): 2] Residential _] Multi-use 22 Other (describe) Date of construction: Number of residential 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) I 1 Central ventilation system Q 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 CJ 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.
Ventilation System (HVAC) Evaluator Date
Part 2.0 Visual Inspection Forms Use the attached forms to document visual inspections. Complete the forms in accordance with instructions in the accompanying guidance document.
NYC-WTC_000139934
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NYC-WTC_000139934Source: NYC Law Department, mirrored locally
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