TITLE 77: PUBLIC HEALTH
CHAPTER I: DEPARTMENT OF PUBLIC HEALTH
SUBCHAPTER p: HAZARDOUS AND POISONOUS SUBSTANCE
PART 855 ASBESTOS ABATEMENT FOR PUBLIC AND PRIVATE SCHOOLS AND COMMERCIAL AND PUBLIC BUILDINGS IN ILLINOIS
SECTION 855.APPENDIX B ILLUSTRATIONS – INSPECTION AND MANAGEMENT PLAN FORMS



Section 855.APPENDIX B Illustrations Inspection and Management Plan Forms

 

Section 855.ILLUSTRATION B Inspection Report Form

 

Category

 

Sample Area I.D.

 

Inspection Date

 

School I.D. #

 

 

School Name

 

School Address

 

City

 

State

 

Zip

 

Room(s)

 

Sample Numbers

 

Inspector Name(s) and I.D. #(s)

 

Location of Area:

 

 

Description of Material Sampled:

 

 

Friability:

High

Moderate

Low

Area Estimate:

 

Ft.

Water Damage:

Yes

No

Pipe Diameter:

 

In.

Physical Damage:

Heavy

Moderate

Low

None

Type of Wall:

Smooth Concrete

Gypsum Board

Textured Concrete

Masonry

Other

 

Type of Floor:

Concrete

Carpet

Tile

Wood

Other

Type of Ceiling:

Acoustic Tile

Exposed Structure

Textured Plaster

Accessibility:

 

Height of friable material from floor:

 

Ft.

Existence of barriers:

Suspended Ceiling

Encapsulation

Other

Proximity to items requiring maintenance:

Electrical

 

 

Ventilation

Plumbing

Other

Less than 1 Ft.

More than 1 Ft.-Less than 5 Ft.

More than 5 Ft.

Ventilation Systems:

Vents near friable material:

Yes

No

Distance

 

Ft.

Return Grille

 

Supply Grille

 

 

Air Movement:

Heavy

Moderate

Low

Activity and Movement:

Use of Room:

 

Activity:

High

Moderate

Low

What is above the room?

 

What is adjacent to the room?

 

Comments: