Indoor Air Quality Program

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1 Indoor Air Quality Program Purpose This written Indoor Air Quality Program is instituted by Company Name to maintain acceptable indoor air quality. The program is accessible to all interested persons, including employees and enforcing agencies. The information here will facilitate implementation of measures necessary to prevent degradation of indoor air quality. This program is based on the proposed Indoor Air Quality Rule that appeared in the Federal Register on April 5, Administrative Duties Who is designated to assure implementation of your Indoor Air Quality Program? (Enter name/title.), our company s Indoor Air Quality Program Administrator, is responsible for establishing and implementing the written program. This person has full authority to make necessary decisions to ensure the success of this program. Who is designated to assure implementation of your Indoor Air Quality Program? (Enter name/title.) is also qualified by appropriate training and experience that is commensurate with the complexity of the program to administer or oversee our program and conduct the required evaluations of program effectiveness. Copies of the written Indoor Air Quality Program may be obtained from Who is designated to assure implementation of your Indoor Air Quality Program? (Enter name/title.) in Where is the written program kept? (Building, office, trailer, etc.). If after reading this program, you find that improvements can be made, please contact Who is designated to assure implementation of your Indoor Air Quality Program? (Enter name/title.). We encourage all suggestions because we are committed to the success of our written Indoor Air Quality Program. We strive for a comprehensive, integrated prevention system that obtains clear understanding, safe behavior, and involvement in the program from every level of the company. Building Description A general building description is essential information of a building profile which is necessary for a basic understanding of the building systems and which is necessary to set the foundation for the operations and maintenance information found later in this written program. The following list gives our building information: Building Name: What is the name of one of your buildings? (If you only have one building, the name may be the name of your company. You will have the ability to add the names of other buildings later in the program.) Address: What is the address of this building? Building Work Activity: What are your building work activities? (Describe activities for one building. You will have the ability to add information for other buildings later in the program.) Building Coordinator: Who is your building's coordinator and what are his/her work and home (if appropriate) telephone numbers? (Specify information for one building. You will have the ability to add information for other buildings later in the program.) Alternate Building Coordinator: Who is your company's alternate building coordinator and what are his/her work and home (if appropriate) telephone numbers? (Specify information for one building. You will have the ability to add information for other buildings later in the program.)

2 Number of Employees/Visitors to Building: How many employees and visitors do you have in your building? (Specify information for one building.) Hours of Operation: What are the hours of operation for the building? (Specify information for one building.) Weekend Use: What is the weekend use of the building? (Describe. Specify information for one building.) Tenant Requirements: What are the tenant requirements, if any, of the building? (Specify information for one building.) Known Air Contaminants Released: What known air contaminants, if any, have been released in the building? (List. Specify information for one building.) What other information do you want to add? (Specify information for one building.) List the same kind of information as you did for the first building above? (Use the more information button to copy the bullets.) We have attached a building map to this written program. Building System Information What are your facility building systems? (Describe them.) See the attached Which have you attached: single-line schematics or as-built construction documents (enter one or the other) to this written program? (In order to locate major building system equipment and the areas they serve, one or the other should be attached.) which locate major building system equipment and the areas that they serve. Building use patterns are as follows: What are your building use patterns? Personal Protective Equipment (PPE) Who is responsible for ensuring that all personal protective equipment (PPE) provisions are met? is responsible for ensuring that the following provisions are met. All personal protective equipment used at this company by employees performing work on building systems will be provided without cost to employees. PPE will be chosen based on anticipated hazards and provided to employees in the following manner: How will personal protective equipment be provided to employees? (i.e., who is responsible for distribution?) Here is the PPE we require: Task: Personal protective equipment required:

3 Who is responsible for ensuring that all personal protective equipment (PPE) provisions are met? shall ensure that appropriate PPE in the appropriate sizes is readily accessible at the workplace or is issued without cost to employees. All PPE will be cleaned, laundered, and disposed of by Company Name at no cost to employees. PPE is cleaned and disinfected at the following intervals: Personal protective equipment type: Is cleaned and disinfected at the following interval: In order to assure the continued reliability of PPE, it must be inspected on a regular basis. The frequency of inspection is related to the frequency of use. Here are our frequencies for inspection: Personal protective equipment type: Inspection: Frequency: PPE that fails an inspection or is otherwise found to be defective is removed from service, and is discarded or repaired or adjusted in accordance with the following procedures: How is personal protective equipment discarded or repaired or adjusted? (List procedures.) What do you want to add to the section? Operating Procedures Daily operating and management of facility building systems can directly affect indoor air quality. Normal operating procedures for building systems are as follows: What are your normal operating procedures for building systems? (See more information button.) Special procedures for building systems are as follows: What are your company's special procedures for building systems? (Describe.) Operating performance criteria for building systems summarize and translate design assumptions and intent. In this way, building occupants, whose expectations regarding their environment may exceed what is deliverable by the building systems, may understand what is, in fact, deliverable. Here are our operating performance criteria: What are your operating performance criteria? (List.) Maintenance Procedures There appears to be consensus among HVAC maintenance personnel that the most successful maintenance programs, gauged in terms of system performance and life-cycle economics, are proactive rather than reactive. Consequently, we promote preventive maintenance for our building system components that affect indoor air quality. Company Name maintains the following equipment that affects indoor air quality:

4 Make, model, and serial number: Type: Quantity: Purpose and location: For this equipment we have implemented the following maintenance procedures: What are your maintenance procedures for building systems? (List them.) Inspections How often does your designated Indoor Air Quality Program Administrator inspect building systems? (Weekly, monthly, semiannually, etc. and whenever employee complaints regarding indoor air quality are made), Who is designated to assure implementation of your Indoor Air Quality Program? (Enter name/title.) or a trained employee under the supervision of Who is designated to assure implementation of your Indoor Air Quality Program? (Enter name/title.), visually inspects our building systems. These inspections focus on those building system components whose failure, degradation, or misuse would adversely impact indoor air quality. Here is our inspection checklist: What does your company inspect? (List items or attach your inspection checklist to this written program. If you attach a checklist, state, See our attached inspection checklist," in the answer field.) Operator Training Under no circumstances may an employee operate or maintain a building system until he/she has successfully completed this company s building system training program. This includes all new employees, regardless of claimed previous experience. Individuals in the following departments receive training: Which departments receive training under this written program? (List them.) The Indoor Air Quality Administrator, Who is designated to assure implementation of your Indoor Air Quality Program? (Enter name/title.), will identify trainees in each set of new employees and make arrangements with department management to schedule training. The Administrator will also identify those existing employees who need retraining. Who is responsible for conducting training? (Enter name/title.) is responsible for conducting training. His/Her/Their qualifications include What are the qualifications of your trainer(s)?. Training is done in-house. See the attached copy of the current training material and the course outline. The company training program includes: What type of instruction does your training program include? Through training we ensure that employees in the departments listed above are knowledgeable in: In what topics are your employees trained? (List topics.

5 Training Certification After an employee has completed the training program, the instructor will determine whether the employee can safely perform the operations or maintenance of building systems. Who is responsible for keeping training certification records? (Enter name/title.) is responsible for keeping records certifying each employee who has successfully completed training. Each certificate includes the name of the employee, the date(s) of the training, and the signature of the person who did the training and evaluation. Performance Evaluation Each trained employee is evaluated How often does your company evaluate performance? to verify that the employee has retained and uses the knowledge and skills needed to operate safely. This evaluation is done by Who is responsible for performing performance evaluations? (Enter name/title.). If the evaluation shows that the employee is lacking the appropriate skills and knowledge, the employee is retrained by our instructor(s). When some unsafe operating or maintenance procedure is identified, we do retraining. Current Trained Operators Under no circumstances may an employee operate or maintain a building system until he/she has successfully completed this company's training program. The following table lists employees who are currently trained employees at this company: Department or work area: Employee name/title: All employees have a general obligation to work safely. What do you want to add to the section? Contractor Employers There are times when we may have an outside contractor For what activity(ies) does your company use outside contractors?. For these situations we have implemented the following procedures: What are your contractor procedures? (List them.) What do you want to add to the section?

6 Recordkeeping Company Name encourages indoor air quality feedback good or bad. We record all employee complaints of building-related illnesses. Our company believes these records are necessary to expedite review and evaluation of the system and to support implementation and operation of an adequate indoor air quality program. Use of our Indoor Air Quality Complaint Form for employee complaints is recommended. See the attached Indoor Air Quality Complaint Form attached to this written program. Other records maintained by the company to assist in potential indoor air quality evaluations include: What other indoor air quality records does your company maintain? All records are maintained bywho maintains these records? (Enter name/title.) in Where are these records maintained? for three years; however, maintenance records may be disposed of in less than three years if they are rendered obsolete by establishment and replacement of more recent records or rendered irrelevant due to HVAC system replacement or redesign. Smoking Policy What is your smoking policy? (Describe.) Other Requirements What other requirements do you want to add to this written program? Program Evaluation It is inherent that problems may occasionally arise in this Indoor Air Quality Program. Although we may not be able to eliminate all problems, we try to eliminate as many problems as possible to improve employee protection. By having our program administrator, Who is designated to assure implementation of your Indoor Air Quality Program? (Enter name/title.), thoroughly evaluate and, as necessary, revise our Indoor Air Quality Program, we can eliminate problems effectively. At this company, program evaluation, performed How often does your program administrator evaluate the program? (i.e., weekly, monthly, semiannually, annually, etc.) by our program administrator, involves the following: What is involved with evaluating the program? What do you want to add to the section? Appendices Our company has attached the following appendices to this written program: What appendices have you attached to this written program?

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