IH IAQ Assessment

• Document No.

• Audit Title

• Conducted on

  Date

• Prepared by

• Complex

  Campbell

  Red Lake

  Balmer

  Cochenour

  Other

• Building

• Location
  Address

• Personnel Present

Concern

• Concern(s)

  Select IAQ Mould Temperature Unusual Smell Other

  • IAQ
  • Mould
  • Temperature
  • Unusual Smell
  • Other

• Complaint

General

• Odours?

  Yes

  No

  N/A

• Stuffy?

  Yes

  No

  N/A

• Overcrowding?

  Yes

  No

  N/A

• Unsanitary Conditions?

  Yes

  No

  N/A

• Garbage/Recycling Emptied Regularly?

  Yes

  No

  N/A

• Dust?

  Yes

  No

  N/A

• Moisture Problems? AC unit, condensation, etc...

  Yes

  No

  N/A

• Staining and discolouration of ceilings, tiles, walls, or carpets?

  Yes

  No

  N/A

• Visible Mould?

  Yes

  No

  N/A

• Are large amounts of paper stored, moved, or shredded?

  Yes

  No

  N/A

• Presence of chemical substances?

  Yes

  No

  N/A

• Very new or old furniture, fabrics, etc.?

  Yes

  No

  N/A

• Are any areas currently being, or have they recently been, remodelled, repaired, or redecorated?

  Yes

  No

  N/A

• Compare the original use of the complaint area and surrounding space with the present use.

• General Comments

• General Area Photos

  Media

Temperature

• Enter Temperature Reading

Temperature

• Location

• Temperature

• Any local sources of heating or cooling? Ex. Solar load or cold through windows, personal heaters, fans, AC units...

  Yes

  No

  N/A

• Thermal Gradient?

  Yes

  No

  N/A

• Floor-to-ceiling differential should not exceed 3 degrees C.

Humidity

• Ideal indoor humidity levels are 35% in the winter and 50% in the summer. ASHRAE specifies a range between 25-60%.

• Enter Relative Humidity Reading

RH

• Location

• Relative Humidity

• Condensation?

  Yes

  No

  N/A

• Humidifier Operation?

  Yes

  No

  N/A

• Chemical additives for water treatment?

  Yes

  No

  N/A

Ventilation/Air Flow

• ASHRAE recommends that average air movement not exceed 0.15 m/s for winter periods and 0.25 m/s for summer periods.

• Enter Air Flow Reading

Air Flow

• Location

• Air Flow

• Comments

• Balanced Air Distribution? Use of fans...

  Yes

  No

  N/A

• Obstruction of Airflow?

  Yes

  No

  N/A

• Are air diffusers located directly above people?

  Yes

  No

  N/A

• Are air intakes located near exhaust outlets, parking areas, smoking areas... Etc.?

  Yes

  No

  N/A

Air Samples

• Direct Reading Tube Sampling

Sample

• Substance

  Select CO NO2 Ammonia Styrene Formaldehyde Other

  • CO
  • NO2
  • Ammonia
  • Styrene
  • Formaldehyde
  • Other

• Reading

• Comments

• Pull Tube Photo

  Media

• Integrative Air Samples Required? If so list potential parameters and locations.

  Yes

  No

  N/A

• Are Dustrak readings required?

  Yes

  No

  N/A

• Dustrak Readings

Reading

• Reading

• Location

• Average particulate concentration found in buildings is 10 ug/m3 in a non-smoking environment, and can range from 30-100 ug/m3 in smoking areas.

Affected Employees

• Number of Employees Affected

• Affected Employees

Employee

• Employee Name

• Employee ID

• Symptoms

  Select Congestion Difficulty Breathing Dizziness Fatigue Headache Itchy Nausea Runny Nose Sneezing Watery Eyes Other

  • Congestion
  • Difficulty Breathing
  • Dizziness
  • Fatigue
  • Headache
  • Itchy
  • Nausea
  • Runny Nose
  • Sneezing
  • Watery Eyes
  • Other

• Other

• Suspected Cause(s)

Conclusion/Follow-Up

• Suspected Cause(s)

• Action Items

Action

• Action Item

• Assigned To

• Due