Sample Memo for School Staff
                               Forest Lake School
        {Date]

        Dear Staff Member,
         SylAQproblemsthatmayarise.





                     which is attached.
            our school.
             Sincerely,
             {Name]
             rprincipal or Superintendent]

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Sample IVBemo for Parents
                                              '^^^'cfclyrespo
           I thought that





          n^ajnejiasao™-^


        Sincerely,

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Sample Memo for Contract Service Providers
                           ForestLakeSchool
       {Date]
Dear
          lNameofContractServiceProvider],

                        &~?***-
                                     activides may
                                             affect the air witfcn our
          Sincerely,
          {Name]
          lAQCoordinator

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Sample Memo for Local News Media
                                   take
              {Bate}
                                      School
                                                      '
         s'ncere;j,       '                   '         atlฐa
        /Name}

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Activating the IAQ Management Plan
  Use the checklist below to record and monitor the steps you have taken to activate the IAQ Management Plan.
Steps Token
1. IAQ Coordinator Selected
Name:
2. Guidance Read
3. Administrative Support Obtained
4. Requested Additional Information on Radon
5. Requested Additional Information on
Integrated Pest Management
6. Requested Additional Information on Lead
7. IAQ Checklist Intend Established
# of times each yean
Dates:
forte







Comments/Motes








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Activating the IAQ Management Plan (page 2])
Steps Takei
8. Emergency Response Prepared
Q Local health agency contacted
~ET1[AQ ptofessional(s) identified
and contacted
U Equipment arid supplies tor wet carpets
, ready or local professional cleaning firm
'ready
~ฃT"Local IAQ Service Providers form filled in
9. Committees and Groups Informed"
Q Health and safety committees)
Q Building committeeฎ
~U~PTA
Q Others:
10. IAQ Policies Prepared and Distributed ,
Q Smoking
Q P&t control
""QTVefltilation system operation
TTTPainting
~CT"dthers:
Dote














Comments/Notes















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IAQ Coordinator's Checklist
   WQtoonfmotor
                                     School
                                                                            DoteCnaptetsd
   Use the checklist below to record and monitor the steps you have taken to implement the IAQ Management Plan.
Steps Token
1. Start Action Pockets Log
Q All appropriate people have .received an
Action Packet
. Q Each Action Packet type has been
distributed
3. Receive and Summarize IAQ Checklists
Q Receive all IAQ Checklists
Q Review IAQ Checklists
Q Transfer data to Checklists Log
Q List things to review during walk-
through inspection
*• Penonn Wdkfhounh
wSmwdknrooghch^
5. Assess Radon Stabs
Q Testing completed . ,
Q Control system installed (if needed)
Q Control system properly operating
6. Assess Pest Control
7. Assess Lead Status
8. Identify Recent Changes
Q Flooding/water damage
Q Night or weekend classes
Q New staff
Q Other
Dote

















Comments/Notes











•*•






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IAQ Coordinator's Checklist (page 2)
       Steps Met                              Dote                   Comments/Motet
    9.  SelRepak and Upgrade Priorities      ~~
    Q  Make to-do list

    10. Gain Approval for Repairs and Upgrades
    12.
    13. Conduct Follow-up Inspections
    14. Develop Calendar of IAQ Events
    Q  Set next date for applying IAQ checklist
    Q  Note upcoming renovation and repairs
    Q  Note future addition of staff
    15. Assess Problem Solving Performance
    1.6. Btoolrsh'pnd Update IAQ Polities
  "17. DtstriiJfe final Report
    Q Students and staff
    Q Parents
    Q School administration
    18. Check Contacts list
    19. File Checklists, Reports, and Notes

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Jl.
         Checklists Log
           lAH Coordinator •
                                                                    School
           Use this log to keep track of who has received a Checklist, who has returned their Checklists), unresolved problem(s)
           identified in the Checklist^), who solved the problems, and when.

           This log can also be used to record distribution of information to parents, school board members, contract service
           providers, and local media.

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Local IAQ Service Providers List
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Consultant
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ADDRESS
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ADDRESS
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ADDRESS
ADDRESS
ADDRESS
ADDRESS
ADDRESS
ADDRESS

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Problem Solving Checklist
                                                                                  IAQ CoonSnater
                                                                                  School
Use this Checklist with the IAQ Problem Solving Wheel to resolve a. single IAQ
complaint, or several complaints occurring at the same time that seem related.
Mark a copy of the fire escape floorplan or use other means of recording and
reviewing information. Since this Checklist becomes a record of your activities in
resolving an IAQ complaint(s), date it and file it for future reference. Involve addi-
tional staff, such as engineers, during the problem solving process.
Complaint Data
Record complaints below at the beginning of your problem solving process. Interview the complainants) to get a
complete and accurate description of the complaint symptoms, times, and locations.
                             Dote
                                      Description of Complaint
                                     (symptoms or explanation)
  loartmKs) or      1$ Problem
Jtoom Humberts)     Ongoing?
                                                                                               Qavreixe
                                                                                             Datefc)&Time{s)
                                                                                QN
                                                                                Q-y
                                                                                QN
                                                                                Qy
                                                                                QN
                                                                                QN
                                                                                Q-Y"
                                                                                QN
                                                                                3Y-
                                                                                QN
                                                                                Qy-
                                                                                QN
                                                                                QY
                                                                                QN
                                                                                QN
   Problem Solving Steps
   Follow the directions on the IAQ Problem Solving Wheel to investigate potential causes of the symptoms recorded
   above. Use the steps below to help keep your investigation organized and documented.
                       Step
                                            Uote Completed
      Relate the symptoms from the complaint data
      box to a group of symptoms in the Notes
      column to the right
                                                        Q  Odors-
                                                        Q  Temperature or humidity problems (occupant
                                                           discomfort)
                                                        Q  Headache, lethargy, nausea, drowsiness, and
                                                           dizziness
                                                        Q  Swelling, itching, or irritated eyes, nose,
                                                           or throat; congestion  "
                                                        Q  Cough; congestion; chest tightness; shortness of
                                                           breath; fever, chills and/or fatigue
                                                        Q  Diagnosed infection or clusters of serious
                                                           health problems

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Step
Q Is this an emergency? Q Yes Q No
See the Wheel sectors "Identifying an emer-
gency" and "What to do in an emergency"
O Place a checkmark next to the potential causes in
* Step 4 below that are.shown at 2 on the Wheel.
Dote Completed

Notes
Actions Taken: Q Evacuation Q Notification 3 Other:
1  Each section below corresponds to a section of the IAQ Problem Solving Wheel. Use this area to record diagnostics
   you perform. Three spaces are provided below for each diagnostic step to allow you to record information for more
   than one location or piece of equipment. Make extra copies of this form as necessary. Please note that some of the steps
   may not apply to your building.
Step




Q Temperature & Humidity
• Is thermostat properly set?
• Is air flowing from the venc warm (for heat)
or cool (for air conditioning)?
• Are drafts or direct sunlight causing discom-
fort?
• Is humidity too high or low (best if between
30-60% rel. humidity)?
• Is condensation often present on windows or
other cold surfaces?
• Is there an objectionable odor?
Q Outdoor Air Supply
Is ventilation system turned on?
Is outdoor intake blocked?
Are supply ventfc) blocked?
Is air flowing from supply vent(s)?
Is air Sowing into outdoor intake?
Are outdoor air or supply ducts blocked?
Is outdoor air supply at least 15 cfm per person?
Is CO2 in the area higher than 1000 ppm?
Q Air Handling Unit
Is the system turned on?
Is the air flowing from vent(s)?
Is the fan operating?
Is the filters) clean & properly installed?
Are dampers operating properly?
Is there moisture, debris or microbial growth
in or around the unit?
Is the drain pun clftfln & draining?
Are the coils dean?
Is combustion equipment properly vented
(no flue leaks, spillage, or backdrafting)?
Dole completed (for each
location if mare than one
location or piece of
equipment b involved)
1
























.








2

































3

































Notes





































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                      Step
Q Local Exhaust
   Does exhaust turn on?
   Is the exhaust used when needed?
   Is ait flowing out the exhaust vent?
   Is exhaust duct work blocked?
   Is a sufficient amount of ait being exhausted?
   If everything works, but not enough air is
   being exhausted, can make up air easily enter
   the room (e.g., through spaces under doors)?
Q Biological Sources
•  Are animals or fungi (mold) present?
•  Is there an odor of mold or mildew in or near
   the complaint area?
•  Is there standing water near the complaint
   area or in the air handling unit?
•  Is condensation often present on window or
   cold surfaces?
•  Is indoor relative humidity above 60%?
•  Are contagious occupants present?

Q Housekeeping Sources
•  Do complaints occur during or just after
   housekeeping activities?
•  Do housekeeping activities take place near
   the complainants?
•  Are any new products in use?
•  Are housekeeping products being used
   according to directions?
*  Are products stored in sealed containers or in
   a vented room(s)?

Q Outdoor Sources
•  Are sources of odor or pollutants (e.g., vehicles,
   stored chemicals, trash, plumbing vents)
   located near outdoor air intakes?
•  Are there sources nearby or upwind:
   • Combustion byproducts from traffic, loading
     docks, or flue exhausts?
   • Industrial, agricultural, or lawn cane activity?
   • Construction activity?
•  Are pollen levels high?

Q Building Sources
•  Has there been recent painting^ooftng, or
   other remodeling or construction?
•  Were pesticides applied recently near the
   complaint area?
•  Are new furnishings or equipment in place?
•  Are drain traps dry?
•  Are chemicals stored in poorly sealed containers?
•  Is it overly dusty?
                                                locution if more than one
                                                  location or piece of
                                                 equipment is involved)
                                                  1

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Step
C Repeat all diagnostics for each potential cause in
all affected locations.
A If the diagnostics for the recommended potential
* causes did not identify the profalem(s), investi-
gate remaining potential causes in Step 4 until
the causes) of the complaints) are identified and
corrected.
7 If problem remains unidentified or uncorrected,
obtain professional assistance.
ft Provide notice if problem is not quickly resolved.
O Problem resolved and preventive measures taken.
.
1 Q Provide a final report.
11 To prevenc future problems implement an
* IAQ Management Plan.
1 *% . File this Qiecklist and related information.
Dote Completed








Notes


Company:
Person:
Phone:
Q Notice to Occupants
Q Notice to parents of minors
Describe solution:
Q Preventive measures taken:
Q Final report to occupants
Q Final report to parents of minors
3 Done

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