RAH IN-Feb 2011

Short Term Radon Test and Radon Mitigation System Inspection

RAH Job #: / Address: / Block / Lot
Test ID: / City: / State: / Zip:

PERSON CONDUCTING TEST / INSPECTION:

Name: / Cell Phone:
Nat Cert# / Exp: / State Cert#: / Exp:

RADON SYSTEM INSPECTION: System Installed by: ______

For Passing Inspection – All items within this box to be marked “Yes” – “CNBI” = Cannot be Inspected or “NA” = Not Applicable
Radon System noted on Breaker? / Yes __ No __ / Slab Block-Outs Filled? / Yes __ No __ CNBI ___
Radon Fan Operational? / Yes __ No __ / Slab Caulked & Tooled? / Yes __ No __ NA __
Fan Discharge Properly Located? / Yes __ No __ CNBI ___ / (perimeter & joints) / CNBI ___
Radon Fan Vertical? / Yes __ No __ CNBI ___ / Water in Floor Drains? / Yes __ No __
Fan supports Above & Below Fan? / Yes __ No __ CNBI ___ / Sump Lid in Place and Sealed? / Yes __ No __ NA __
Screen in Fan Discharge? / Yes __ No __ CNBI ___ / Label on Sump? / Yes __ No __ NA __
Visible Portions of Pipe Braced? / Yes __ No __ CNBI ___ / Membrane in Crawl Space? / Yes __ No __ NA __
Pipe Labels? (basement, attic) / Yes __ No __ CNBI ___ / Membrane Edges / Seams Sealed? / Yes __ No __ NA __
U Tube in Place and Zeroed Out? / Yes __ No __ / Crawl Membrane Label? / Yes __ No __ NA __
U Tube Marked / Labeled? / Yes __ No __
System Label Complete & Near U Tube? / Yes __ No __ / Closed House Conditions? / Yes __ No __
U Tube Reading: (in. W.C.) / ______
At Arrival: Door hanger? Yes ___ No___ / HVAC System On? Yes __ No __ / Basement Finished? Yes __ No
SYSTEM FAILED INSPECTION
System Failure communicated to superintendent and Failure Form provided to RAH personnel
Inspector Signature: ______Date: ______
SYSTEM PASSED INSPECTION
To the extent the radon system can be accessed and visually inspected it is in Substantial Compliance.
Inspector Signature: ______Date: ______

RADON SHORT-TERM TEST INFORMATION:

At Retrieval: Closed House Conditions? Yes __ No __ / No Tampering? Yes __ No __ / Rn Fan Operating? Yes __ No __
Door hanger? Yes ___ No ___ / HVAC System On? Yes __ No __
Weather Conditions: Gamma: ______Elev.: ______
Start Date: / Start Time: / AM / PM / Stop Date: / Stop Time: / AM / PM
Electret 1: / Initial Volt: / Final Volt: / Result (pCi/L):
Electret 2: / Initial Volt: / Final Volt: / Result (pCi/L)::
Reader ID: / Calib Date: / Average (pCi/L):
Test Location (level): ______
INVALID RADON TEST
Invalid Test communicated to superintendent and Failure Form provided to RAH Personnel
Inspector Signature: ______Date: ______
VALID RADON TEST
Inspector Signature: ______Date: ______

Colorado Vintage Companies, Inc.; 719-632-1215; ; Fax – 719-632-9607