Fill and Sign the Shc107 Form

Pollutant Pathway Form For Investigations Building Name: _____________________________________________ File Number : ___________________________ Address: _____________________________________________ Completed by: ________________________________ This form should be used in combination with a floor plan such as a fire evacuation plan. Building areas that appear isolated from each other may be connected by airflow passages such as air distribution zones, utility tunnels or chases, party walls, spaces above suspended ceilings (whether or not those spaces are serving as air plenums), elevator shafts, and crawl spaces. Describe the complaint area in the space below and mark it on your floor plan. Then list rooms or zones connected to the complaint area by airflow pathways. Use the form to record the direction of air flow between the complaint area and the connected rooms/zones, including the date and time. (Airflow patterns generally change overtime). Mark the floor plan with arrows or plus (+) and minus (-) signs to map out the airflow patterns you observe, using chemical smoke or a micromanometer. The "comments" column can be used to note pollutant sources that merit further attention. Rooms or zones included in the complaint area: ____________________________________________________________ ______________________________________________________________________________________________________________________________________ Sections 2, 4 and 6 discuss pollutant pathways and driving forces. Rooms or Zones Connected to the Complaint Area By Pathways Pressure Relative to Complaint Area Use Comments (e.g., potential pollutant sources) +/- date/time