Title Page
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Prepared by
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Building/Room/Area
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Conducted on
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Location
Ground Level
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Ensured that ventilation units operate properly
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Ensured there are no obstructions blocking air intakes
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Checked for nests and droppings near outdoor air intakes
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Determined that dumpsters are located away from doors, windows, and outdoor air intakes
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Checked potential sources of air contaminants near the building (chimneys, stacks, industrial plants, exhaust from nearby buildings)
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Ensured that vehicles avoid idling near outdoor air intakes
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Minimized pesticide application
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Ensured that there is proper drainage away from the building (including roof downspouts)
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Ensured that sprinklers spray away from the building and outdoor air intakes
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Ensured that walk-off mats are used at exterior entrances and that they are cleaned regularly
Roof
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Ensured that the roof is in good condition
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Checked for evidence of water ponding
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Checked that ventilation units operate properly (air flows in)
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Ensured that exhaust fans operate properly (air flows out)
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Ensured that air intakes remain open, even at minimum setting
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Checked for nests and droppings near outdoor air intakes
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Ensured that air from plumbing stacks and exhaust outlets flows away from outdoor air intakes
Attic
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Checked for evidence of roof and plumbing leaks
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Checked for birds and animal nests
General Considerations
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Ensured that temperature and humidity are maintained within acceptable ranges
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Ensured that no obstructions exist in supply and exhaust vents
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Checked for odors
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Checked for signs of mold and mildew growth
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Checked for signs of water damage
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Checked for evidence of pests and obvious food sources
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Noted and reviewed all concerns from office occupants
Bathrooms and General Plumbing
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Ensured that bathrooms and restrooms have operating exhaust fans
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Ensured proper drain trap maintenance:
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Water is poured down floor drains once per week (approx. 1 quart of water)
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Water is poured into sinks at least once per week (about 2 cups of water)
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Toilets are flushed at least once per week
Maintenance Supplies
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Ensured that chemicals are used only with adequate ventilation and when building is unoccupied
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Ensured that vents in chemical and trash storage areas are operating properly
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Ensured that portable fuel containers are properly closed
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Ensured that power equipment, like snowblowers and lawn mowers, have been serviced and maintained according to manufacturers’ guidelines
Combustion Appliances
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Checked for combustion gas and fuel odors
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Ensured that combustion appliances have flues or exhaust hoods
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Checked for leaks, disconnections, and deterioration
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Ensured there is no soot on inside or outside of flue components
Other
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Checked for peeling and flaking paint (if the building was built before 1980, this could be a lead hazard)
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Determined date of last radon test
Sign off
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Signature of safety officer or inspector