County of Ottawa Health Department Environmental Health Services

AIR BALANCE REPORT FORM

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AIR BALANCE REPORT FORM

Name of Establishment _______________________________________________________ Address _______________________________City __________________________________ Hood Equipment Manufacturer________________________________________________ Installation Contractor _______________________________________________________ Architect ____________________________________________________________________ Air Testing Company _________________________________________________________ Equipment Used For Testing__________________________________________________

Certification of Air Testing

I certify the exhaust and make-up air system(s) have been balanced in accordance with the specifications and/or conditions on the approved plans. Test report prepared by: _____________________________________________ ______________________ Signature Date

Make-Up Air and/or HVAC System(s)

Required

Actual Unit No. Make Model Fan HP

Fan RPM Fan CFM Fan RPM Fan CFM

*For HVAC units CFM of outside air must be shown.

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Make-Up Air and/or HVAC System(s) – Continued

OPENING Unit

No. Area Served No. Size Gross

Area Ft2 Net Area Ft2

Measured Velocities Avg. FPM CFM

Building Pressure Positive Negative Pressure in Inches W.G. ______________________ Barometric Pressure ___________________ Outside Air Temperature _____________________ Smoke Tested Yes No

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Exhaust System(s)

Hood No.

Open Sides of Canopy

Filter Manufacturer

Filter Model

Filter Trade Size

Filter Face Size

1 2 3 4

1 2 3 4

1 2 3 4

1 2 3 4

1 2 3 4

Required

Actual Fan No. Make Model Fan HP

Fan RPM Fan CFM Fan RPM Fan CFM

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Exhaust System(s) – Continued

HOOD O.D. Fan No.

Equipment Served Length Width

Filter # Left to Right

Filter Face

Area Ft2 Measured Velocities at Filter* Avg.

FPM CFM

*A minimum of 5 filter velocity readings per filter must be recorded.