Borang IAQ HIE 2/2007

DEPARTMENT OF OCCUPATIONAL SAFETY AND HEALTH

(INDUSTRIAL HYGIENE & ERGONOMICS DIVISION)

CHECKLIST OF DOCUMENTS TO BE ATTACHED WITH REPORT

(INDOOR AIR QUALITY MONITORING & ASSESSMENT)
These documents should be attached together with report on indoor air quality monitoring &
assessment:1.

Process flowchart, if applicable

2.

Photocopy of calibration certificate for equipment and calibrator

3.

Monitoring Data sheet and calculation

4.

Workplace layout plan (location of area & workers selected for monitoring)

5.

Photocopy of laboratory analysis certificate

6.

Form A Verification from employer that report has been presented

7.

Photocopy of IAQ Assessor competency certificate

8.

Others, if any

Form A (IAQ)
Date

..............................

Workplace

...................................................................
...................................................................
...................................................................
...................................................................

Contact Person:

Ref:

...................................................................

INDOOR AIR QUALITY (IAQ) ASSESSMENT REPORT

This is to certify that IAQ assessment for the above premise has been
conducted and explained to the top management and Safety & Health
Committee members on the ...
2.
Indoor Air Quality Assessor shall furnish the employer with the report of
the assessment within one (1) month of the completion of the assessment.
3.
The employer has to take action to control exposure if the assessment
report indicates significant risk within one (1) month after receiving the
assessment report.
4.
The employer shall inform to local DOSH state office on the action
taken within 30 days.

.......................................................
Signature of IAQ Assessor
Registration No.: JKKP HIE 127/171-4 (

Date of Assessment : From to

IAQ Assessment Report Received by:

Name

: ............................................................................

Designation

: ............................................................................

Date of report received

: ............................................................................

Signature

: ............................................................................