Coordinator's Guide for Indoor Air Quality: Appendix A

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.