Coordinator's Guide for Indoor Air Quality: Appendix A
A Guide to Implementing an IAQ Program
Note: A PDF version of this publication is available.
Appendix A - IAQ Coordinator's Forms
Make copies of the checklists and forms in this section so that the originals will be available for future use. The checklists and forms may be copied or modified according to your specific needs. The IAQ Coordinator's forms in this appendix include:
- Sample Memo for School Staff
- Sample Memo for Parents
- Sample Memo for Contract Service Providers and,
- Sample Memo for Local News Media.
Additional forms available here in PDF:
- IAQ Management Plan Checklist (PDF)
- IAQ Coordinator's Checklist Log (PDF)
- Local IAQ Service Providers List (PDF)
- Problem Solving Checklist (PDF)
Sample Memo for School Staff
Forest Lake School
[Date]
Dear Staff Member,
This month, [Forest Lake] begins a new program to monitor and improve indoor air quality (IAQ) in our school. Enclosed is a copy of the IAQ Backgrounder, which is part of the U.S. Environmental Protection Agency (EPA) guidance that we are using in our school, and a checklist.
[Forest Lake] is proud to be taking a leadership role in providing a safe, comfortable, and productive environment for our students and staff so that we achieve our core mission—educating students. Our school will utilize EPA’s guidance to improve our IAQ by preventing as many IAQ problems as possible and responding to any IAQ issues that may arise.
Good air quality requires an ongoing commitment from everyone in our school. We all make daily decisions and perform activities that affect the quality of the air we breathe. You can make an important contribution to this IAQ improvement program by reading the background information and applying the simple, yet important, activities in your checklist (attached).
When you have read the IAQ Backgrounder and completed the checklist, return the checklist to our IAQ Coordinator, [name], so that [he or she] can follow up on any IAQ concerns. [Name] has agreed to administer the IAQ Management Plan, which includes taking a team leadership role, coordinating emergency response and serving as our information resource on IAQ. Contact [name] at [phone, e-mail address, and room number] with questions or concerns, and return the checklist to [him or her] by [date].
The school newsletter and Web site will provide progress reports as we implement our IAQ Plan.
Sincerely,
[Name]
[Principal or Superintendent]
Enclosures: IAQ Backgrounder, [Appropriate title] Checklist
Sample Memo for Parents
Forest Lake School
[Date]
Dear [Parent]:
This month, [Forest Lake] begins a new program to monitor and improve indoor air quality (IAQ) in our school. We are proud to be taking a leadership role in providing a safe, comfortable and productive environment for our students and staff so that we achieve our core mission -- educating students. Our school will utilize guidance provided by the U.S. Environmental Protection Agency to prevent IAQ problems and respond to any IAQ issues that may arise.
Enclosed is a copy of the IAQ Backgrounder, which is part of the EPA guidance that we are using in our school. Not only is this basic information useful to schools, you may also find it useful for application in your own home.
[Name] has agreed to administer the IAQ program in our school. If you have any questions or concerns, please do not hesitate to contact [name] at [phone, e-mail address and room number].
The school newsletter and Web site will carry progress reports as we learn more about IAQ in our school.
Sincerely,
[Name]
[Principal or Superintendent]
Enclosure: IAQ Backgrounder
Sample Memo for Contract Service Providers
Forest Lake School
Dear [Name of Contract Service Provider],
[Forest Lake] is proud to be taking a leadership role in providing a safe, comfortable and productive environment for our students and staff so that we achieve our core mission—educating students.
Therefore, [Forest Lake] is implementing a program to monitor and improve indoor air quality (IAQ) in our school. The work you perform in our school can have an impact on the quality of the school’s air. I have enclosed specific guidance provided by the U.S. Environmental Protection Agency that shows how you can help us make this effort a success.
Your involvement is important. Please read the enclosed IAQ Backgrounder and IAQ checklist.
If you have any questions or concerns, please do not hesitate to contact [name] at [phone, e-mail address and room number].
Sincerely,
[Name]
IAQ Coordinator
Enclosures: IAQ Backgrounder, [Appropriate title] Checklist
Sample Memo for Local News Media
Forest Lake School
[Date]
Dear [Local News Media Person]:
This month, [Forest Lake] begins a new program to monitor and improve indoor air quality (IAQ) in our school. We are proud to be taking a leadership role in providing a safe, comfortable and productive environment for our students and staff so that we achieve our core mission -- educating students. Our school will utilize guidance provided by the U.S. Environmental Protection Agency to improve IAQ, prevent IAQ problems and respond to any IAQ issues that may arise.
As a prominent source of information on events in our local area, you can be helpful in assuring that timely and accurate information regarding IAQ in our school reaches the parents of students and other concerned constituents. Enclosed is a copy of the IAQ Backgrounder, which is part of the EPA guidance that we are using in our school.
If you have any questions regarding IAQ in our school, please do not hesitate to contact our IAQ Coordinator [name]. [Name] has agreed to administer the IAQ Management Plan, which includes taking a team leadership role, coordinating emergency response and serving as our information resource on IAQ. [Name] can be contacted at [phone].
Sincerely,
[Name]
[Principal or Superintendent]
Enclosure: IAQ Backgrounder
For more information, see Indoor Air Quality.
Disclaimer
Any information gathered using this Action Kit is for the benefit and use of schools and school districts. EPA does not require retention or submission of any information gathered, and EPA has no regulatory or enforcement authority regarding general indoor air quality in schools. This Action Kit has been reviewed in accordance with EPA's policies. Information provides the current scientific and technical understanding of the issues presented. Following the advice given will not necessarily provide complete protection in all situations or against all hazards that may be caused by indoor air pollution.
Mention of any trade names or commercial products does not constitute endorsement or recommendation for use.
Warning
Please note the following as you prepare to use this Action Kit:
- This Action Kit is not intended as a substitute for appropriate emergency action in a hazardous situation that may be immediately threatening to life or safety.
- Modification of building functions, equipment, or structure to remedy air quality complaints may create other indoor air quality problems and may impact life-safety systems and energy use. A thorough understanding of all the factors that interact to create indoor air quality problems can help avoid this undesirable outcome. Consult with professionals as necessary.
- In the event that medical records are used while evaluating an IAQ problem, maintain confidentiality.
Reproduction
This Action Kit contains public information that may be produced or modified in whole or in part without permission. If the Action Kit or its contents are reproduced or modified, EPA would appreciate knowing how it is used. Please write to: IAQ Tools for Schools Program, Indoor Environments Division, U.S. Environmental Protection Agency, 1200 Pennsylvania Ave., NW, Mail Code 6609J, Washington, DC 20460
For more information, see Indoor Air Quality.
U.S. Environmental Protection Agency
Indoor Environments Division, 6609J
1200 Pennsylvania Ave., NW
Washington, DC 20460
(202) 343-9370
American Federation of Teachers
555 New Jersey Ave., N.W.
Washington, DC 20001
(202) 879-4400
Association of School Business Officials
11401 North Shore Drive
Reston, VA 22090
(703) 478-0405
National Education Association
1201 16th Street, N.W.
Washington, DC 20036-3290
(202) 833-4000
National Parent Teachers Association
330 North Wabash Avenue, Suite 2100
Chicago, IL 60611-3690
(312) 670-6782
American Lung Association
1740 Broadway
New York, NY 10019
(212) 315-8700