Haw. Code R. tit. 11, subtit. 1, ch. 501, fig. 2 - Air Cleaning Device Inspection Checklist June 1, 1998
1. Air cleaning
device designation or number ______________
2. Date of inspection (mm/dd/yy)
______________
3. Time of
inspection (a.m./p.m.) ______________
4. Air cleaning device operating properly
(y/n) ______________
5. Tears,
holes or abrasions in fabric filter (y/n) ______________
6. Dust on clean side of fabric filters (y/n)
______________
7. Other signs of
malfunctions or potential malfunctions (y/n) ______________
8. Describe other malfunctions or signs of
potential malfunctions ______________
__________________________________________________________
9. Describe corrective action(s) taken
___________________________________
__________________________________________________________
10. Date and time corrective action taken
______________
11. Inspected by:
_______________ ______________ ______________ ________
Print/type name Title Signature Date
_______________ ______________ ______________ ________
Print/type name Title Signature Date
Notes
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