TE-H.2.15.1 Dampness and Mold Visual Assessment Worksheet.pdf

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Attached to
Ft Carson BASOPS (Base Operations Services)
Solicitation number
W5168W-24-R-0009
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This document is a Dampness and Mold Visual Assessment (VSA) Worksheet (TE-H.2.15.1) used to evaluate the presence of dampness and mold in a room or housing unit. The worksheet collects information on the ambient air temperature, dew point, relative humidity, and identifies the components inspected such as the ceiling, walls, floor, windows, furnishings, HVAC systems, and belongings. It provides a scoring system to assess the level of dampness and mold observed, ranging from 0 (none) to 3 (combined area greater than 100 square feet). The worksheet also captures notes and observations related to the assessment.

The related federal contract opportunity is for Base Operations Support Services at U.S. Army Fort Carson, Colorado. The Mission and Installation Contracting Command-Fort Carson is issuing this solicitation for a contractor to provide personnel, equipment, supplies, tools, materials, and other services for facility maintenance, grounds keeping, pavement clearance, HVAC, and wastewater services. This is an acquisition for Common Level of Services across several functional areas.

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Dampness and Mold Visual Assessment (VSA) Worksheet TE-H.2.15.1

MVA

1 Jan 2025

label:
unitAddress: Home Address:
housingRepName: Housing Representative Name:
roomArea: Room/Area (additional copies for each room):
odorSource: Describe source of musty or damp odors:
ambientAirTemperature: Ambient air temperature:
dewPoint: Dew point measurement:
assessmentDate: Date:
scoring: 0 - none; 1 - combined area 10 square feet or less; 2 - combined area between 10 and 100 square feet; 3 - combined area greater than 100 square feet; U - uncertain if mold was identified.
relativeHumidity: Relative humidity measurement:
component:
ceiling:
ceilingTile: Ceiling Tile
plaster: Plaster
concrete: Concrete
sheetRock: Sheet rock
metal: Metal
wood: Wood
walls:
sheetRock: Sheet rock
plaster: Plaster
concrete: Concrete
block: Block
brick: Brick
tile: Tile
wood: Wood
floor:
wood: Wood
carpet: Carpet
vinyl: Vinyl
ceramic: Ceramic
concrete: Concrete
windows:
exterior: Exterior
interior: Interior
skylight: Skylight
furnishings:
furniture: Furniture
mechanical: Mechanical
sink: Sink
toilet: Toilet
copier: Copier
hvacSystems:
radiator: Radiator
forcedAir: Forced-air
fan: Fan
unitVentilator: Unit ventilator
windowUnit: Window unit
belongings:
books: Books
boxes: Boxes
equipment: Equipment
pipes:
insulatedPlumbing: Insulated Plumbing
insulatedGas: Insulated Gas
assessment:
ceiling:
peelingPaint: Peeling Paint
rust: Rust
walls:
peelingPaint: Peeling Paint
efflorescence: Efflorescence
windows:
peelingPaint: Peeling Paint
condensation: Condensation
furnishings:
peelingPaint: Peeling Paint
rust: Rust
hvacSystems:
peelingPaint: Peeling Paint
rust: Rust
belongings:
wrinkledPaper: Wrinkled Paper
crumpledBoxes: Crumpled boxes
pipes:
peelingPaint: Peeling Paint
rust: Rust
wet: Wet
stained: Stained
floor:
buckling: Buckling
other:
ceiling: Other:
walls: Other:
floor: Other:
windows: Other:
furnishings: Other:
hvacSystems: Other:
belongings: Other:
pipes: Other:
windows: Windows
furnishings: Furnishings
hvacSystems: HVAC Systems
belongings: Belongings
roomOdor: Upon entering room/area, check for musty or damp odor:
none:
roomOdor: None
mild:
roomOdor: Mild
moderate:
roomOdor: Moderate
strong:
roomOdor: Strong
pageNumber: Page #
ofPages: of
ceiling: Ceiling
walls: Walls
floor: Floor
pipes: Pipes
notes: Notes:
documentId:
unitAddress:
assessmentDate:
housingRepName:
roomArea:
odorSource:
relativeHumidity:
ambientAirTemperature:
dewPoint:
ceiling:
damageStain: [ ]
visibleMold: [ ]
wetDamp: [ ]
room: Off
nothingFound: Off
damageExterior: Off
visibleMoldExterior: Off
wetDampExterior: Off
component:
ceiling:
ceilingTile: Off
plaster: Off
concrete: Off
sheetRock: Off
metal: Off
wood: Off
walls:
sheetRock: Off
plaster: Off
concrete: Off
block: Off
brick: Off
tile: Off
wood: Off
floor:
wood: Off
carpet: Off
vinyl: Off
ceramic: Off
concrete: Off
windows:
exterior: Off
interior: Off
skylight: Off
furnishings:
furniture: Off
mechanical: Off
sink: Off
toilet: Off
copier: Off
hvacSystems:
radiator: Off
forcedAir: Off
fan: Off
unitVentilator: Off
windowUnit: Off
belongings:
books: Off
boxes: Off
equipment: Off
pipes:
insulatedPlumbing: Off
insulatedGas: Off
assessment:
ceiling:
peelingPaint: Off
rust: Off
walls:
peelingPaint: Off
efflorescence: Off
windows:
peelingPaint: Off
condensation: Off
floor:
buckling: Off
furnishings:
peelingPaint: Off
rust: Off
hvacSystems:
peelingPaint: Off
rust: Off
belongings:
wrinkledPaper: Off
crumpledBoxes: Off
pipes:
peelingPaint: Off
rust: Off
wet: Off
stained: Off
other:
ceiling:
walls:
floor:
windows:
furnishings:
hvacSystems:
belongings:
pipes:
walls:
damageStain: [ ]
visibleMold: [ ]
wetDamp: [ ]
room: Off
nothingFound: Off
damageExterior: Off
visibleMoldExterior: Off
wetDampExterior: Off
floor:
damageStain: [ ]
visibleMold: [ ]
wetDamp: [ ]
room: Off
nothingFound: Off
damageExterior: Off
visibleMoldExterior: Off
wetDampExterior: Off
windows:
damageStain: [ ]
visibleMold: [ ]
wetDamp: [ ]
room: Off
nothingFound: Off
damageExterior: Off
visibleMoldExterior: Off
wetDampExterior: Off
furnishings:
damageStain: [ ]
visibleMold: [ ]
wetDamp: [ ]
room: Off
nothingFound: Off
damageExterior: Off
visibleMoldExterior: Off
wetDampExterior: Off
hvacSystems:
damageStain: [ ]
visibleMold: [ ]
wetDamp: [ ]
room: Off
nothingFound: Off
damageExterior: Off
visibleMoldExterior: Off
wetDampExterior: Off
belongings:
damageStain: [ ]
visibleMold: [ ]
wetDamp: [ ]
room: Off
nothingFound: Off
damageExterior: Off
visibleMoldExterior: Off
wetDampExterior: Off
pipes:
damageStain: [ ]
visibleMold: [ ]
wetDamp: [ ]
room: Off
nothingFound: Off
damageExterior: Off
visibleMoldExterior: Off
wetDampExterior: Off
roomOdor: Off
pageNumber:
ofPages:
notes:

File details come from the government source that posted it. Updated .