HVAC Checklist - Short Form - US EPA

1 Building Name: _____ Address: _____Completed by: _____ Date: _____ File Number: _____HVAC Checklist - Short Form191 Indoor Air Quality FormsSections 2, 4 and 6 and Appendix B discuss the relationships between the hvac system and indoor air 1 of 4 MECHANICAL ROOMnClean and dry? Stored refuse or chemicals?nDescribe items in need of attentionMAJOR MECHANICAL EQUIPMENTnPreventive maintenance (PM) plan in use?Control SystemnTypenSystem operationnDate of last calibrationBoilersnRated Btu inputConditionnCombustion air: is there at least one square inch free area per 2,000 Btu input?nFuel or combustion odorsCooling TowernClean? no leaks or overflow?Slime or algae growth?nEliminator performancenBiocide treatment working?

2 (list type of biocide)nSpill containment plan implemented?Dirt separator working?ChillersnRefrigerant leaks?nEvidence of condensation problems?nWaste oil and refrigerant properly stored and disposed of?Building Name: _____ Address: _____Completed by: _____ Date: _____ File Number: _____HVAC Checklist - Short FormIndoor Air Quality Forms 192 Page 2 of 4 AIR HANDLING UNITnUnit identificationArea servedOutdoor Air Intake, Mixing Plenum, and DampernOutdoor air intake locationnNearby contaminant sources? (describe)nBird screen in place and unobstructed?nDesign total cfmoutdoor air ( ) cfmdate last tested and balancednMinimum % (damper setting) Minimum cfm =nCurrent damper setting (date, time, and hvac operating mode)nDamper control sequence (describe)nCondition of dampers and controls (note date)FansnControl sequencenCondition (note date)nIndicated temperaturessupply airmixed airreturn airoutdoor airnActual temperaturessupply airmixed airreturn airoutdoor airCoilsnHeating fluid discharge temperature Tcooling fluid discharge temperature TnControls (describe)nCondition (note date)HumidifiernTypeif biocide is used, note typenCondition (no overflow, drains trapped, all nozzles working?)

3 NNo slime, visible growth, or mineral deposits? (total cfm x minimum % )100 Building Name: _____ Address: _____Completed by: _____ Date: _____ File Number: _____HVAC Checklist - Short Form193 Indoor Air Quality FormsDISTRIBUTION SYSTEMS upply AirReturn Air Power ExhaustZone/Systemducted/cfm*ducted/cfm* cfm*controlservesRoomTypeunductedunducte d ( toilet)Condition of distribution system and terminal equipment (note locations of problems)nAdequate access for maintenance?nDucts and coils clean and obstructed?nAir paths unobstructed?supplyreturntransferexhaust make-upnNote locations of blocked air paths, diffusers, or grillesnAny unintentional openings into plenums?nControls operating properly?nAir volume correct?

4 NDrain pans clean? Any visible growth or odors?FiltersLocationType/RatingSizeDate Last ChangedCondition (give date)Page 3 of 4 Building Name: _____ Address: _____Completed by: _____ Date: _____ File Number: _____HVAC Checklist - Short FormIndoor Air Quality Forms 194 OCCUPIED SPACET hermostat typesZone/ThermostatWhat DoesSetpointsMeasuredDay/RoomLocationThe rmostatTemperatureTimeControl?SummerWint er( , radiator,AHU-3)Humidistats/Dehumidistats typeZone/Humidistat/What Does ItSetpointsMeasuredDay/RoomDehumidistatC ontrol?(%RH)TemperatureTimeLocationnPote ntial problems (note location)nThermal comfort or air circulation (drafts, obstructed airflow, stagnant air, overcrowding, poorthermostat location)nMalfunctioning equipmentnMajor sources of odors or contaminants ( , poor sanitation, incompatible uses of space)Page 4 of 4