Attachment 5 Workstation 5.doc

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Professional Engineer for Dust Collector
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N4215822QA001
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N4215822QA001.pdf PDF

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VENTILATION SURVEY FORM

COMMAND/SHOP INFO
INSTRUMENT DATA

COMMAND:________________________________

SHOP:_____________________________________

DATE:_____________________________________

LOCATION:________________________________

VENTILATION TYPE:________________________

PROBE TYPE:________________________________

TYPE USED:_________________________________

RANGE:_________________________________FPM

SERIAL NUMBER:____________________________

CALIBRATION DATE:_________________________

DIAGRAM OF SYSTEM AND VENTILATION DATA:

Baseline (Year: )

ACGIH Recommendations

Last Year’s Reading

Continuous Flow Indicator Present?
Y or N (If Yes – type: )

Reading: (Acceptable reading: )

Vent Used For

Vent Acceptable?
Y or N

Based on: ACGIH; Low samples at these flowrates;

Other:

COMMENTS: Manometer: Off _______ On________ Pre-Filter __________ HEPA Filter: __________

INDUSTRIAL HYGIENIST

Ventilation

Slot Size

Slot Size

(FPM)

12” ________

24” ________

36” ________

48” ________

60” ________

LEFT

(FPM)

12” ________

24” ________

36” ________

48” ________

60” ________

72” ________

84” ________

96” ________

108” ________

120” ________

132” ________

RIGHT

50”

142 ”

Workstation #5

Sewing Machine Table

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