IAQ Check List
Building: Sarah Adams Elementary School
Date: December 4, 2015
Building Inspection Performed by: Lyle Erstad
Report Compiled by: Lyle Erstad
Check List
IAQ Check List
True
False
N/A
1. Ground Level Indoor Inspection
a. Univents are on and air discharge grills are free of obstructions.
If false, send email to building principal and facilities director asking staff to be instructed to keep vents
clear at all times. Record locations here:
2. Ground Level Outdoor Inspection (weather permitting)
a. Univent air intakes are free of obstructions.
If false, record locations here:
b. Filters
i. Medium efficiency filters are installed in all univents.
If false, list locations and create work orders to initiate corrective action.
ii. High efficiency filters are installed in the air handling units.
If false, list locations and create work orders to initiate correction action.
iii. Filters are being changed every six months and the installed date is written on the outer filter casing.
If filter is older than 6 months, list locations and create work orders to initiate corrective action.
c. Insects, bird nests, or droppings are not evident near outdoor air intakes.
If false, indicate locations here:
d. Trash dumpsters are located away from doors, windows, and outdoor air intakes.
e. Potential sources of air contaminants do not exist near the building. (e.g. chimneys, stacks, industrial
plants, exhaust from nearby buildings)
f. Trucks and buses are not allowed to keep their engines idling near the building.
Page 1 of 9
Revised 3/7/2011 AMJ
Created 11/2010
IAQ Check List
Building: Sarah Adams Elementary School
Date: December 4, 2015
Building Inspection Performed by: Lyle Erstad
Report Compiled by: Lyle Erstad
Check List
g. No evidence of drainage problems exist. Water drains away from the building including roof
downspouts.
IAQ Check List
True
False
N/A
h. Sprinklers do not spray directly toward the building or into outdoor air intakes.
i.
Grass clippings from mowers are directed away from the building air intakes.
j.
Clean walk-off mats are present at exterior entrances.
3. Roof (Inspections conducted weather permitting)
a. Roofing consultant has not found any issues requiring immediate repair.
Most recent roofing inspection date/company: 5-year roofing plan completed 5/25/2010 with C. E.
Crowley & Associates.
b. There is no evidence of water ponding on the roof.
c. Intake ventilation units are operating properly and free of debris.
d. All exhaust fans are operating properly and free of debris.
5th Grade Hallway Exhaust and Restroom fans were off.
e. Air intake dampers are set to allow air flow even at minimum setting.
f. Insects, birds, animal nests or droppings are not evident near outdoor air intakes.
g. Plumbing stacks and exhaust vents are located away from air intakes.
4. Attic
a. There is no evidence of roof or plumbing leaks.
No Attic
Page 2 of 9
Revised 3/7/2011 AMJ
Created 11/2010
IAQ Check List
Building: Sarah Adams Elementary School
Date: December 4, 2015
Building Inspection Performed by: Lyle Erstad
Report Compiled by: Lyle Erstad
Check List
b. There is no evidence in attic of insects, birds, animals, or nests.
No Attic
5. General Considerations
a. Classrooms, offices and/or common areas appear recently cleaned.
If examples of poor housekeeping are found, record locations below:
IAQ Check List
True
False
N/A
b. Only vacuums with HEPA filters are being used.
c. All supply and exhaust ventilation units are working properly.
See comment on 3d.
d. Occupied space temperatures and relative humidity levels are within the standards listed below.
i. Temperature range:
 Winter temperatures 70-73 degrees.
 Summer temperatures 74-80 in air-conditioned spaces and 74-85 in non-air-conditioned
spaces.
Outdoor air temperature: 59.5; 48 degrees.
Highest temperature – Location: 4; 21; Reading of 78.4; 75.7 degrees.
Lowest temperature – Location: 110; 10; Reading of 74.8; 70.2 degrees.
ii. Relative humidity range is 30% to 60%.
 Non-air-conditioned spaces may be higher on rainy or humid summer humid days.
 All spaces may be less than 30% when the out-door air temperature is less than 32 degrees.
Outdoor relative humidity: 32.4; 30%
Highest relative humidity – Location: 4; 10; Reading of 25; 29.9%
Lowest relative humidity – Location: 110; 13;Reading of 23.3; 22.3%
Readings not within acceptable standards will result in the creation of a work order, requesting
maintenance to address. (Readings are noted on the attached test data sheet)
Page 3 of 9
Revised 3/7/2011 AMJ
Created 11/2010
IAQ Check List
Building: Sarah Adams Elementary School
Date: December 4, 2015
Building Inspection Performed by: Lyle Erstad
Report Compiled by: Lyle Erstad
Check List
e. Occupied space readings of carbon monoxide (CO) levels are less than 9.0 PPM.
Outdoor Air CO Reading: .6; .4
Highest CO Location: 109c; 10 Reading: .5; .5
Lowest CO Location: Several Locations; 21
Reading: 0; .1
IAQ Check List
True
False
N/A
If the CO level is greater than 9.0 PPM in any space as measured with a handheld device or “leave-in”
monitor, the space must be cleared of all occupants and steps taken to correct the problem. The issue
will be immediately addressed by maintenance and the Fire Department. (Readings are noted on the
attached test data sheet)
f. CO2 levels in any occupied space are below threshold limits.
i. Perform CO2 check with Gray Wolf or other portable device. Measure four times yearly or more
often if needed. Measure only in fully occupied rooms. Reading should be less than 700 PPM plus
outside air CO2 PPM.
700 PPM + 408; 500 PPM = 1108: 1200 PPM
Assume outside CO2 is 350 if temperature is below 41 degrees and air is not stagnant with no- wind.
Record all occupied space CO2 levels on forms provided. Provide the outdoor CO2 level as well as
the high and low CO2 extremes below:
Outdoor reading: 408: 500 PPM
Highest CO2 reading – Location: 10; 24; Reading of 1217; 844 PPM
Lowest CO2 reading – Location: 15; 13; Reading of 494; 587 PPM
ii. If reading is above threshold, check univent and air handling dampers to ensure a value is set to
provide at least 15 cfm of fresh air intake per student based on average space occupancies. If
reading is consistently elevated, then use data logging to monitor CO2 concentrations over time and
look for other sources of problems.
Page 4 of 9
Revised 3/7/2011 AMJ
Created 11/2010
IAQ Check List
Building: Sarah Adams Elementary School
Date: December 4, 2015
Building Inspection Performed by: Lyle Erstad
Report Compiled by: Lyle Erstad
Check List
iii. CO2 levels were checked three months ago.
IAQ Check List
True
False
N/A
iv. CO2 levels on “leave-in” devices, where present, where checked.
No leave-in devices
g. Offensive odors are not apparent.
If false, list problem areas: See Odor Work Order Report.
h. Water damage is not evident.
Check for roof leaks, pipe leaks, spills, stained ceiling tiles, etc, visually and with moisture meter. Look
for the source of any water leaks and schedule repairs. Discard porous items such as ceiling tiles if wet
for more than 24 hours. For carpeting, if less than 9 square feet of wet area, shampoo with germicide
and fan dry. For areas greater than 9 square feet, replace carpet with tile in reasonable timeframe. If
carpet is over ACM tile, replace during next unoccupied break time (winter break, spring break,
summer).
If false, record findings and locations here:
i. Mold or mildew growth is not evident.
If false, record findings and locations here:
j. All pest management issues are being handled by Integrated Pest Management.
See Pest Work Order Log
k. No other unresolved concerns or complaints by building personnel are known.
If false, list any pending issues not previously mentioned in this report here:
1. We need to resolve the temperature issue in Room 23 as it is warmer than other rooms
around it.
2. Also, we have to determine a permanent solution to the "rotten egg" smell coming from
the Nurse's office water.
l. There are no incomplete HVAC preventative maintenance (PM) work requests.
If false, list any incomplete HVAC work request here:
6. Bathrooms and General Plumbing
a. All locker or restroom exhaust fans are working.
Inoperable or malfunctioning fans are listed as follows:
Page 5 of 9
Revised 3/7/2011 AMJ
Created 11/2010
IAQ Check List
Building: Sarah Adams Elementary School
Date: December 4, 2015
Building Inspection Performed by: Lyle Erstad
Report Compiled by: Lyle Erstad
Check List
Location: 5 Grade Hallway Problem: Bathroom exhaust fans were off.
IAQ Check List
True
False
N/A
th
b. All of the following drain-trap maintenance procedures are being conducted according to the frequency
indicated.
If false, indicate all deviations and locations: The Custodial staff is reminded regularly on these
procedures.
i. Water is poured into floor drains once per week (approximately 1 quart of water) or water and a
teaspoon of cooking oil poured into the drain once a month.
ii. Water is poured into sinks at least once per week (about 2 cups of water).
iii. Toilets are flushed at least once per week.
7. Lab Chemicals & Maintenance Supplies
a. Lab chemicals are used with exhaust fans turned on.
b. Lab chemical storage areas have been inspected yearly by ROE and Fire Department.
Record last inspection dates below:
ROE: 10/2015
LZFD: Yet to be scheduled
c. Flammables are not stored with igniters.
d. All chemicals that may react or produce toxic or explosive by-products are separated and maintained in
approved containers stored in approved storage. (e.g. lockable, with appropriate ventilation).
e. Chemical disposal records for all lab chemicals are available for review.
Page 6 of 9
Revised 3/7/2011 AMJ
Created 11/2010
IAQ Check List
Building: Sarah Adams Elementary School
Date: December 4, 2015
Building Inspection Performed by: Lyle Erstad
Report Compiled by: Lyle Erstad
Check List
IAQ Check List
True
False
N/A
f. All cleaning products used in building contain no/low VOC.
List any exceptions:
g. Increased ventilation is considered when installing new carpets, cleaning upholstered furniture,
shampooing carpets, etc.
h. Exhaust ventilation systems in chemical and trash storage areas are turned on and functioning properly.
i.
Portable fuel containers are properly closed.
j.
Power equipment, like snow blowers and lawn mowers, have been serviced and maintained according to
manufacturers’ guidelines.
k. Oil based paints are stored in approved storage cabinets.
No oil based paint allowed in District.
l. Green Cleaning products and processes are used in this building.
8.
Combustion Appliances
a. Combustion analysis is performed at the start of the heating season on all boilers. Adjustments are
made to the burners to correct any abnormalities and improve efficiency.
This is scheduled for December.
b. In rooms that contain combustion appliances, there is no evidence of combustion gas or fuel odors.
If false, record locations here:
c. No leaks, disconnections, and/or deterioration were found on exhaust hoods.
d. Flue components are clean and free of soot.
Page 7 of 9
Revised 3/7/2011 AMJ
Created 11/2010
IAQ Check List
Building: Sarah Adams Elementary School
Date: December 4, 2015
Building Inspection Performed by: Lyle Erstad
Report Compiled by: Lyle Erstad
Check List
e. All combustion appliances have flues or exhaust hoods and vent NO2.
i. If false, inspect cooking hoods, chemical hoods. Assure that cooking stoves and appliances are
correctly installed, used, and maintained according to manufacturers’ specifications.
IAQ Check List
True
False
N/A
ii. If not vented, ensure that “leave-in” CO monitors are placed in room. Record locations here: NONE
iii. CO levels in rooms with combustion appliances are measured and recorded with an IAQ monitor. CO
readings outside of normal CO range will result in an immediate response by maintenance to reduce
CO level or vacating the room/building, if necessary.
Record locations here: Boiler Room
9. Other
a. Paint
No peeling and/or flaking paint found.
If planned building renovation will damage paint or if peeling paint is discovered, lead testing may be
necessary. If peeling paint is found, send email to the building Principal and the Facilities Director
alerting them of the problem. Staff and teachers need to pick up any flakes of paint to prevent
children from being exposed. The Facilities Director will advise the Facilities Coordinator (a Certified
Lead Paint Renovator) to test the paint for lead. Lead paint was discontinued in 1978. Buildings built
after 1978 are exempt from lead paint testing.
If lead is present, required repairs should be done immediately using lead-safe methods and, if
necessary, a licensed lead contractor.
Location(s) of known peeling paint in building:
b. The following preventive measures are being taken to reduce lead exposure.
i. Play areas and toys are cleaned nightly.
ii.
Floors are mopped nightly.
Page 8 of 9
Revised 3/7/2011 AMJ
Created 11/2010
IAQ Check List
Building: Sarah Adams Elementary School
Date: December 4, 2015
Building Inspection Performed by: Lyle Erstad
Report Compiled by: Lyle Erstad
Check List
IAQ Check List
True
False
N/A
iii. Dust at least weekly.
c. Radon testing is recommended by IEMA every 5 years. Last testing date listed below:
Date: 12/16 - 19/ 2011; Reading of (Highest) 2.8 pCi/L was recorded in Room 31.
National concern level is 4.0 pCi/L or higher.
d. The IAQ testing equipment used for this inspection was calibrated and is in good working order.
Equipment Used: Gray Wolf
Last date of calibration: 1/6/2015
Page 9 of 9
Revised 3/7/2011 AMJ
Created 11/2010
Sarah Adams Fall 2015 IAQ Data
Site
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Location
Date/Time
Outdoor Air 11/16/2015 10:19:18 AM
1 11/16/2015 11:42:02 AM
3 11/16/2015 11:54:43 AM
4 11/16/2015 11:59:08 AM
5 11/16/2015 12:20:03 PM
6 11/16/2015 12:10:26 PM
7 11/16/2015 12:04:01 PM
8 11/16/2015 12:05:19 PM
9 11/16/2015 12:06:53 PM
10 11/16/2015 12:08:42 PM
12 11/16/2015 12:13:31 PM
14 11/16/2015 12:16:07 PM
15
11/16/2015 1:00:24 PM
16 11/16/2015 12:59:00 PM
17
11/16/2015 1:02:30 PM
18 11/16/2015 11:31:17 AM
19 11/16/2015 11:29:47 AM
20 11/16/2015 11:27:16 AM
23 11/16/2015 12:56:22 PM
25 11/16/2015 12:54:23 PM
27 11/16/2015 11:07:56 AM
28 11/16/2015 11:24:57 AM
30 11/16/2015 11:09:22 AM
31 11/16/2015 11:18:16 AM
32 11/16/2015 11:11:13 AM
33 11/16/2015 11:19:50 AM
34 11/16/2015 11:12:31 AM
35 11/16/2015 11:13:56 AM
110 11/16/2015 11:33:50 AM
109A 11/16/2015 12:46:09 PM
109B 11/16/2015 12:47:49 PM
°F
59.9
76.6
77.7
78.4
76.7
77
78.1
77.8
77.9
77.8
75.7
75.6
76.1
76.5
75.7
77.5
77.5
77.3
75.6
77.1
77.4
76.3
76.9
78.3
77
77.6
77.3
77.8
74.8
76.9
76.2
% RH
32.4
28.4
25.2
25
27.1
25.6
25.9
26.2
25.3
27.5
22.3
22.9
24
25
25
25
25.1
26
24.3
25.1
26.4
24.2
26.2
26
27.9
26.4
28.5
30.8
23.3
25
25
CO ppm CO2 ppm Occupancy
0.6
408
0.2
932
1
0.1
584
19
0
632
20
0
823
15
0
635
12
0
672
18
0.1
753
25
0
748
23
0
1217
22
0
536
9
0.1
602
7
0.1
494
4
0
656
20
0
577
5
0
664
21
0
715
18
0
882
19
0.1
534
14
0.2
614
18
0
777
7
0.1
634
3
0.1
730
10
0.1
711
17
0.1
860
18
0.2
832
7
0.3
954
20
0.1
1106
19
0.1
593
20
0.1
713
1
0.1
729
2
Window
Note
Univent off
AC on
Yes
Yes
Yes
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109C
109D
1A
1B
1C
1D
Cafeteria
Gymnasium
Staff lounge
11/16/2015 12:49:19 PM
11/16/2015 12:50:41 PM
11/16/2015 11:48:12 AM
11/16/2015 11:46:58 AM
11/16/2015 11:42:52 AM
11/16/2015 11:45:33 AM
11/16/2015 11:35:39 AM
11/16/2015 11:37:33 AM
11/16/2015 12:24:16 PM
76
76
76.7
76.8
76.6
76.7
75.8
75.4
75.8
25.3
24.1
29.4
29.2
29
28.8
29.3
28.7
25.5
0.5
0.2
0
0.2
0.3
0.2
0
0.1
0
700
609
940
930
958
945
1068
982
819
4
2
1
1
1
1
55
20
13
48
70.2
72.7
75.7
75.1
73.3
73.9
30
29.9
22.3
25.5
23.8
28
26
0.4
0.5
0.4
0.1
0.3
0.3
0.2
500
840
587
631
683
844
830
22
2
13
3
4
2
CO2 Formula: 700 + 408 = 1108
Sarah Adams Outdoor Air
11/24/2015 12:17:09 PM
Sarah Adams
10 11/24/2015 12:29:08 PM
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13
11/24/2015 1:06:05 PM
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21 11/24/2015 12:49:48 PM
Sarah Adams
22 11/24/2015 12:57:42 PM
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24 11/24/2015 12:38:54 PM
Sarah Adams
26 11/24/2015 12:40:33 PM
CO2 Formula: 700 + 500 = 1200