Title Page

  • Prepared by

  • Building/Room/Area

  • Conducted on

  • Location

Ground Level

  • Ensured that ventilation units operate properly

  • Ensured there are no obstructions blocking air intakes

  • Checked for nests and droppings near outdoor air intakes

  • Determined that dumpsters are located away from doors, windows, and outdoor air intakes

  • Checked potential sources of air contaminants near the building (chimneys, stacks, industrial plants, exhaust from nearby buildings)

  • Ensured that vehicles avoid idling near outdoor air intakes

  • Minimized pesticide application

  • Ensured that there is proper drainage away from the building (including roof downspouts)

  • Ensured that sprinklers spray away from the building and outdoor air intakes

  • Ensured that walk-off mats are used at exterior entrances and that they are cleaned regularly


  • Ensured that the roof is in good condition

  • Checked for evidence of water ponding

  • Checked that ventilation units operate properly (air flows in)

  • Ensured that exhaust fans operate properly (air flows out)

  • Ensured that air intakes remain open, even at minimum setting

  • Checked for nests and droppings near outdoor air intakes

  • Ensured that air from plumbing stacks and exhaust outlets flows away from outdoor air intakes


  • Checked for evidence of roof and plumbing leaks

  • Checked for birds and animal nests

General Considerations

  • Ensured that temperature and humidity are maintained within acceptable ranges

  • Ensured that no obstructions exist in supply and exhaust vents

  • Checked for odors

  • Checked for signs of mold and mildew growth

  • Checked for signs of water damage

  • Checked for evidence of pests and obvious food sources

  • Noted and reviewed all concerns from office occupants

Bathrooms and General Plumbing

  • Ensured that bathrooms and restrooms have operating exhaust fans

  • Ensured proper drain trap maintenance:

  • Water is poured down floor drains once per week (approx. 1 quart of water)

  • Water is poured into sinks at least once per week (about 2 cups of water)

  • Toilets are flushed at least once per week

Maintenance Supplies

  • Ensured that chemicals are used only with adequate ventilation and when building is unoccupied

  • Ensured that vents in chemical and trash storage areas are operating properly

  • Ensured that portable fuel containers are properly closed

  • Ensured that power equipment, like snowblowers and lawn mowers, have been serviced and maintained according to manufacturers’ guidelines

Combustion Appliances

  • Checked for combustion gas and fuel odors

  • Ensured that combustion appliances have flues or exhaust hoods

  • Checked for leaks, disconnections, and deterioration

  • Ensured there is no soot on inside or outside of flue components


  • Checked for peeling and flaking paint (if the building was built before 1980, this could be a lead hazard)

  • Determined date of last radon test

  • Sign off
  • Signature of safety officer or inspector

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