ࡱ>  @ k,bjbj5*5* W@W@;$/fffffff4&`&`&`h`:a|tch(hhhi0iisssssss$tHtl6xkL6xlffff6xfl@i"jl'j;jiiiss^! bAk^!bAPEOSH Indoor Air Quality Standard Inspection Checklist Location: Inspection #: Inspector: Date: COMPLIANCE PROGRAM - GENERAL REQUIREMENTSYNN/AN.J.A.C. 12:100-13.3(a)Has a designated person been identified to handle the implementation and documentation of the ӣƵ indoor air quality standard? Name/Title/Phone #: ____________________________________________________ ____________________________________________________ FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX 13.3(a)Has the employer ensured that the designated person is familiar with all the requirements of the standard? FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX 13.3(a)1Is there an established, operating and documented preventive maintenance schedule for the heating, ventilation and air conditioning (HVAC) system in accordance with the manufacturer's recommendations or accepted practice for the HVAC system? FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX 13.3(a)1Does the HVAC preventive maintenance schedule include: checking and/or changing air filters, checking and/or changing belts, lubrication of equipment parts, checking the functioning of motors and confirming that all equipment is in operating order?  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX 13.3(a)1Are damaged or inoperable components of the HVAC system replaced or repaired as appropriate? FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX 13.3(a)1Are parts of the HVAC system with standing water checked visually for microbial growth? FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX 13.3(a)2Is general or local exhaust ventilation used where housekeeping and maintenance activities could reasonably be expected to result in exposure to hazardous substances above applicable exposure limits? FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX 13.3(a)3When the carbon dioxide level exceeds 1,000 parts per million, is the HVAC system checked and repaired as necessary to ensure the system is operating properly? FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX 13.3(a)4In office buildings/schools, when the temperature is outside of the range of 68 to 79 degrees Fahrenheit, is the HVAC system checked and repaired as necessary to ensure the system is operating properly? FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX 13.3(a)5When a contaminant is identified in the make-up air supply, is the source of the contaminant eliminated or the make-up inlets and/or exhaust air outlets relocated to avoid entry of the contaminant into the air system?  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX 13.3(a)6If buildings do not have mechanical ventilation, are windows, doors, vents, stacks, and other portals used for natural ventilation operating properly? FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX 13.3(a)7Are complaints promptly investigated that involve signs or symptoms that may be associated with Building-Related Illness or Sick Building Syndrome? FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX 13.3(a)8Does the employer have a written plan that meets the requirements of the subchapter? FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX 13.3(a)9Is the written compliance plan reviewed and updated annually to reflect new or updated procedures? FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  PEOSH Indoor Air Quality Standard Inspection Checklist (cont.) CONTROLS OF SPECIFIC CONTAMINANTSYNN/A13.4(a)When point sources generate airborne levels of contaminants above applicable limits, is local exhaust ventilation or substitution used to reduce the exposure levels to below the limits? FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX 13.4(b)Does the employer control microbial contamination by promptly repairing water intrusion that can promote growth of biologic agents? FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX 13.4(c)Does the employer remediate damp or wet materials by drying, replacing, removing, or cleaning same within 48 hours of discovery and continue remediation until water intrusion is eliminated? FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX 13.4(d)Are visible microbial contaminants removed from ductwork, humidifiers, dehumidifiers, condensate drip pans, heat exchange components, and other HVAC and building system components, or on building surfaces, such as carpeting and ceiling tiles, when found during regular or emergency maintenance activities or during visual inspection? FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX RENOVATION/REMODELINGYNN/A13.5(a)During renovation work and/or new construction, are local ventilation or other protective devices used to safeguard employees and students from dust, stone and other small particles, toxic gases or other harmful substances in quantities hazardous to health? FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX 13.5(a)Are renovation areas in occupied buildings isolated so that air contaminants, dust, and debris are confined to the renovation or construction area by use of measures such as physical barriers, pressure differentials, and/or performing work during periods of minimal occupancy? FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX 13.5(a)(1)Are work areas cleaned and aired out as necessary prior to re-occupancy? FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX 13.5(a)(2)Is hazard information used to select products and to determine necessary measures to be taken? FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX 13.5(b)Before selection and use, are product labels and MSDS sheets checked or is information obtained on whether the use of paints, adhesives, sealants, solvents or installation of insulation, particle board, plywood, floor coverings, carpet backing, textiles or other materials contain volatile organic compounds such as solvents, formaldehyde, or Isocyanates that could be emitted during regular use? FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX 13.5(c)Are employees notified at least 24 hours in advance, or promptly in emergency situations, of work to be performed on the building that may introduce air contaminants into their work area? FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  PEOSH Indoor Air Quality Standard Inspection Checklist (cont.) RECORDKEEPINGYNN/A13.6(a)Is the maintenance schedule updated to show all maintenance performed on the building systems? FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX 13.6(a)Does the maintenance schedule include the dates that the building systems maintenance was performed and the names of the persons or companies performing the work? FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX 13.6(b)Are maintenance schedules with the information required by the indoor air quality standard retained for at least three years? FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX 13.6(c)Are the records required to be maintained by this section available for inspection by PEOSH? FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX 13.6(d)Are the records required to be maintained by this section available for inspection by employees and employee representatives for examination and copying within 10 working days of request? FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX EMPLOYERS RESPONSE TO A SIGNED COMPLAINTYNN/A13.7(a)If the employer receives a complaint notification from the PEOSH Program about an indoor air quality problem, is a written response sent back to PEOSH within 15 working days? FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX 13.7(a)Do the employers written responses to complaint notifications received from the PEOSH Program about an indoor air quality problem include any combination of the following: 1) A statement that the complaint is unfounded; 2) A description of any remedial action already taken; 3) An outline of any remedial measures planned but not yet taken with a timetable for completion; and/or 4) A statement that a study of the problem, with a timetable for completion of the study, has been initiated? FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX 13.7(b)If the employer plans remedial measures or a study initiated in response to a complaint notification received from the PEOSH Program, is a written report describing the remedial measures implemented and/or a copy of a study's report submitted to the PEOSH Program within 15 working days of completion? FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX 13.7(c)If remedial work is initiated in response to a complaint notification from the PEOSH Program, are permits obtained and work performed as required by N.J.A.C. 5:23 (the ӣƵ Uniform Construction Code)? FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX 13.8(a)If available, are the following documents provided to the PEOSH Program when requested in response to an employee complaint: 1) As-built construction documents; 2) HVAC system commissioning reports; 3) HVAC systems testing, adjusting and balancing reports; 4) Operations and maintenance manuals; 5) Water treatment logs; and 6) Operator training materials? FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  PAGE 3 of  NUMPAGES 3 Jun 2008 6AB[\df ޴ާzogoXM;XMXM#jh+6hGCJUaJh+6hGCJaJjh+6hGCJUaJhGCJaJh+6hGCJaJh+hG\h+hG5\ h@hGCJOJQJ^JaJh@hG5\h@hGOJQJ^J#hhG5CJ OJQJ^JaJ .HHhFhG5CJ OJQJ^JaJ hG5CJ OJQJ^JaJ #h@hG5CJ OJQJ^JaJ "7BQefe$d$1$Ifa$gdGl'd$1$IfgdGl'  `'X@ZgdG `'gdGK `'C$EƀFgdG$a$gdG;,j,$d$Ifa$gdGl'/$d$1$Ifa$gdGlkd$$Ifl\#%(*H$ ```` t(0P+44 lap(8  $$1$Ifa$gdGl$$Ifa$gdGl$1$IfgdGl    ӰӋygӰU#jh+6hGCJUaJ#jh+6hGCJUaJ#jwh+6hGCJUaJ#jh+6hGCJUaJh+6hGCJaJh+hG\ h@hGCJOJQJ^JaJ#jh+6hGCJUaJh+6hGCJaJjh+6hGCJUaJ#jhh+6hGCJUaJ!   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t+6,,5555=5/ a4tDeCheck4tDeCheck5tDeCheck6$$If4!vh5555=5#v#v#v#v=#v:Vl t+6,,5555=5/ a4tDeCheck4tDeCheck5tDeCheck6$$If4!vh5555=5#v#v#v#v=#v:Vl9 t+6,,5555=5/ a4$$If4!vh5#55=5#v##v#v=#v:Vlp ```` t(+6,5#55=5/ a4p(tDeCheck4tDeCheck5tDeCheck6$$If4!vh5555=5#v#v#v#v=#v:Vlf t+6,,5555=5/ a4tDeCheck4tDeCheck5tDeCheck6$$If4!vh5555=5#v#v#v#v=#v:VlQ t+6,,5555=5/ a4tDeCheck4tDeCheck5tDeCheck6$$If4!vh5555=5#v#v#v#v=#v:Vl, t+6,,5555=5/ a4tDeCheck4tDeCheck5tDeCheck6$$If4!vh5555=5#v#v#v#v=#v:Vlx t+6,,5555=5/ a4tDeCheck4tDeCheck5tDeCheck6$$If4!vh5555=5#v#v#v#v=#v:Vl t+6,,5555=5/ a4@@@ GNormalCJ_HaJmH sH tH DA@D Default Paragraph FontVi@V  Table Normal :V 44 la (k(No List < @< GFooter  !CJaJ@ G Table Grid<:V0a1$7$8$H$OJQJ^J_H.)@. 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