Ventilation Systems Policy
V1.0
Table of Contents
1. Introduction ... 3
2. Purpose of this Policy ... 3
3. Scope ... 3
4. Definitions / Glossary ... 3
5. Ownership and Responsibilities ... 4
5.1. The Chief Executive ... 4
5.2. The Head of Estates Operations ... 4
5.3. The Head of Capital Planning and Projects ... 4
5.4. Private Finance Initiative Services Providers/Lease Plus Arrangement ... 4
5.5. The Informed Client ... 4
5.6. Authorised Engineer (Ventilation) (AE(V)) ... 4
5.7. Authorised Person (Ventilation) (AP(V)) ... 4
5.8. Competent Person (Ventilation) (CP(V)) ... 4
5.9. Infection Prevention Control Team ... 5
5.10. Trust Members of Staff ... 5
6. Standards and Practice ... 5
6.1. Design and Installation ... 5
6.2. Standards ... 5
6.3. Maintenance ... 5
6.4. Operational Procedures ... 6
6.5. Information... 6
6.7. Maintenance Tasks ... 6
7. Dissemination and Implementation ... 10
8. Monitoring compliance and effectiveness ... 11
9. Updating and Review ... 11
10. Equality and Diversity ... 12
10.2. Equality Impact Assessment ... 12
Appendix 1. Governance Information ... 13
Appendix 2. Initial Equality Impact Assessment Form ... 15
Appendix A ... 17
Appendix B ... 18
Appendix C ... 19
Appendix D ... 20
1. Introduction
1.1. Ventilation is used extensively in healthcare premises to closely control the environment and air movement of the space that it serves. This is for both the comfort of occupants in buildings and to contain, control and reduce hazards to patients, staff and visitors from airborne contaminants including, dust and harmful micro-organisms.
1.2. This Policy sets out the detailed requirements for the maintenance and safe operation of all air conditioning and ventilation plant. These will be maintained so that they do not present a risk to persons either in the vicinity of the plant, in areas served by the plant, or a statutory compliance risk to the Royal Cornwall Hospitals NHS Trust (referred to as the „Trust‟).
1.3. This version supersedes any previous versions of this document.
2. Purpose of this Policy
2.1. This Policy requires that all ventilation and air conditioning equipment is installed, inspected, serviced and maintained in accordance with all Statutory
Instruments, NHS Guidelines and Health Technical Memorandums (HTM) to ensure that such equipment does not pose a health or operational risk to either, staff,
patients or visitors.
3. Scope
3.1. This Policy applies to all staff, service users and contractors associated with the Trust. Those persons with defined responsibilities should read this policy, and where applicable, read and understand the ventilation procedures manual.
3.2. This Policy covers all maintenance activities on ventilation and air conditioning plant within the Trust, and any sites which the Trust is responsible for the
maintenance of ventilation equipment. This will include, but not limited to, local room extraction plants up to full air handling and conditioning systems.
3.3. This policy document and associated ventilation procedures manual cannot anticipate all eventualities, therefore professional judgement should be used to identify the appropriate course of action needed.
3.4. The on-going risk management process will enable those involved, namely, the Responsible Person Ventilation, Authorised Person Ventilation, Competent Persons and Infection Prevention Control Team to identify the level of vulnerability and risks posed to individuals; including service users, staff members and visitors, thereby ensure appropriate action will be taken.
4. Definitions / Glossary
Private Finance Initiative (PFI) – scheme or building funded privately and leased to the Trust.
Health & Safety Executive (HSE) Health Technical Memorandum (HTM) Health Building Notice (HBN)
5. Ownership and Responsibilities
5.1. The Chief Executive
Has overall responsibility for ensuring that suitable and sufficient procedures are in place to manage and maintain the Trust‟s ventilation and air conditioning equipment.
5.2. The Head of Estates Operations
Is responsiblefor ensuring this Policy is implemented and a Senior Engineer, as Authorised Engineer (Ventilation) (AE (V)), is appointed. That all Estates related work is carried out by competent and trained staff, including checks on contractors. All appointments are to be made in writing.
5.3. The Head of Capital Planning and Projects
is responsible for ensuring that the requirements of this policy are observed and adhered to during projects and other contract works.
5.4. Private Finance Initiative Services Providers/Lease Plus
Arrangement
Will appoint in writing their own Authorised and Deputy Persons; who will ensure that adequate arrangements are in place to achieve compliance with this policy and associated procedures. Details of such persons shall be notified in writing to the Trust‟s Director of Estates & Facilities.
5.5. The Informed Client
Is responsible for ensuring that the PFI/ Lease plus Arrangement partner is compliant with this policy including the maintenance of appropriate records.
5.6. Authorised Engineer (Ventilation) (AE(V))
Is responsible for providing advice on ventilation systems and to audit via critical maintenance audits, review and witness documentation on system validation.
5.7. Authorised Person (Ventilation) (AP(V))
The Ventilation Engineer for the Trust is the appointed AP(V) responsible for the implementation and operation of safety policies and procedures relating to the engineering aspects of air conditioning and ventilation systems.
5.8. Competent Person (Ventilation) (CP(V))
TheSenior Estates and Facilities Manager is responsible for maintaining site lists of CP(V), who have received appropriate training, in order to carry out maintenance, validation and periodic testing of Air conditioning and ventilation systems.
5.9. Infection Prevention Control Team
The Infection Prevention Control Team will nominate a point of contact to advise on the monitoring of microbiological performance of the air conditioning and ventilation systems.
5.10. Trust Members of Staff
All Trust staff members are responsible for reporting defects and faults with any ventilation systems, as they occur, via the Estates Department Helpdesk.
6. Standards and Practice
6.1. Design and Installation
6.1.1. All new ventilation and air conditioning equipment will be designed, installed and commissioned by suitably qualified Engineers and Tradespersons. They will be compliant with the requirements of Health Technical Memorandum (HTM) 03 and other legislation; such as, the Health and Safety at Work Act 1974, the Control of Substances Hazardous to Health Regulations 2002, the HSE Control of Legionella Approved Code Of Practice L8, Regulatory Fire Reform Order and specific requirements under the Medicines Act 1968. Copies of all HTM‟s can be found online at the Government Library Webpage.
6.1.2. Such a system must be appropriate for the area for which it was designed and is only installed where absolutely necessary and by agreement with the Infection Prevention Control Team.
6.1.3. Information for all new equipment, concerning its installation, designed mode of operation together with full details of maintenance procedures, shall be provided as part of the commissioning process.
6.1.4. In areas undergoing refurbishment, advice will be sought from the Infection Prevention Control Team to determine the requirements of the existing ventilation and air conditioning systems. Where systems will not meet current HTM 03 standards, equipment will be upgraded or replaced.
6.2. Standards
6.2.1. Operational Standards applied during the design and installation of ventilation and air condition systems will not to be reduced during the operation and life of the equipment. This will be evidenced through the use of planned maintenance records held within the Estates Department. Assessment of the suitability of older ventilation systems shall be made with the assistance of the Authorising Engineer (Ventilation) and the Infection Prevention Control Team.
6.3. Maintenance
6.3.1. All service and maintenance procedures shall conform to the
principles set out in “Specialised Ventilation for Healthcare premises” HTM 03-01, and the “Approved Code of Practice on the Prevention of Control of
Legionella” published by the Health & Safety Commission and “The control of Legionella, hygiene, „safe‟ hot water, cold water and drinking water systems” (HTM) 04-01 and any subsequent legislation or guidelines.
6.4. Operational Procedures
6.4.1. The following operational procedures shall be defined:
Differentiation between critical and non-critical plant.
The safe plant start, run, set-back, restart and stop procedures, including minimum run up times to achieve desired operating conditions
Frost protection sequence
Arrangements for protecting and “mothballing” the plant if unused for extended periods, and to prevent it becoming a possible source of infection.
Schedules of routine maintenance activities.
Maintenance and routine inspections records shall be maintained. Details of the above and any specific risk assessments will be kept in
the operational procedures manual within the Estates Department.
6.5. Information
6.5.1. Maintenance and routine inspections records shall be maintained for ventilation plant, and kept within the Estates Department electronic database. 6.5.2. For the safety of contractors and maintenance staff the following information shall be provided adjacent to the plant to which it refers:
a) General information regarding the intended operation of the plant together with a schematic diagram of the equipment and its distribution system. b) Information concerning the purpose of the plant and details of those
departments and/or personnel served by the plant and who should be informed prior to switching off or carrying out maintenance activities. c) Information required for the safety of the personnel carrying out the service
and maintenance activities.
6.6. These procedures set out a frequency of tests, appropriate recording sheets and guidance. All maintenance will conform to the principles set out in HTM03-01 and HTM04-01.
6.7. Maintenance Tasks
6.7.1. Ventilation System Plant Inspections (Quarterly, 6 Monthly and Annual)
6.7.1.1. All ventilation systems, as a minimum, will be subject to:
An annual visual inspection to ensure that the system is still required
The fire containment (Damper) has not been breached The general condition of the system is fit for purpose The system is operating as designed
6.7.1.2. For each inspection a simple check sheet will be used. (Non-critical ventilation systems (Appendix D) and (Non-critical systems (Appendix E)).
6.7.1.3. The record sheets include space for recording chlorination of chiller batteries and humidifiers. (Detail of this procedure can be found within the Legionella prevention procedures). The periodicity of
inspections is set out in Appendix B.
6.7.2. Annual Verification for Critical Ventilation Systems
6.7.2.1. All critical ventilation systems will be subject to an annual verification to ensure:
6.7.2.2. The ventilation system should achieve not less than 75% of the design air-change rate given in Appendix H, or its original design
parameters. Old design parameters based on plant age can be obtained from HTM 2025, Microbiological Commissioning and Monitoring of Operating Theatre Suites (Lidwell. 1972), IHVE Guide (1965 edition). 6.7.2.3. The pressure regime should achieve not less than 75% of the design value given in Appendix 2 of Part A, or its original design
parameters, and the pressure gradient relationships with regards to surrounding areas must be maintained. Old design parameters based on plant age can be obtained from HTM 2025, Microbiological Commissioning and Monitoring of Operating Theatre Suites (Lidwell. 1972),IHVE Guide (1965 edition).
6.7.2.4. The sound levels quoted in HTM 03 Table 2are maximum permissible levels and should not be exceeded. Measurements should be made using at least a Type 2 sound meter fitted with a muff. Its accuracy should be checked using a calibration sound source before use.
6.7.2.5. Further guidance from HTM03-01 Part B paragraphs 4.19 to 4.28 are followed as appropriate for:
Vertical ultra-clean operating theatres Horizontal ultra-clean operating theatres Category 3 and 4 laboratories
Pharmacy aseptic suites
Sterile Service packing and inspection rooms LEV‟s
6.7.3. Filter Changing
6.7.3.1. The routine changing of filters should be carried out either when the manometer across the filters reaches the designed change limit or on a time basis, provided the designed manometer maximum pressure differential is not exceeded. Suitable records of filter changes will be kept.
6.7.4. Quarterly Chlorination of Chilled water Circuits
6.7.4.1. Chilled water refrigeration units must be inspected, cleaned and chlorinated every 3 months. Details of this process are contained within the Legionella procedures; this work may be contracted out, any works that are contracted out will be under a detailed specification under
the Trusts contracting arrangement, as a minimum, the contractor must provide the following information:
Make Model Serial no. Location Area served Filter checked Filter cleaned Filter replaced
Hypochlorite cleaning of cooling coil Hypochlorite cleaning of drain pan
Hypochlorite cleaning of condensate drain Date/time/engineers signature
6.7.5. Portable Air Conditioning Units
6.7.5.1. Portable air conditioning units are available from the Estates Stores or hired-in when required during excessive building temperatures. They typically incorporate internal recirculation air filters and a drainage system to remove condensate from the cooling coil. The Infection Prevention Control Team must be consulted before these types of units are deployed.
6.7.5.2. All portable units will be inspected and cleaned every week that they remain in use. Records of this service and inspection will be kept. The units must be inspected and thoroughly cleaned before being placed into use. Units that are to be used in areas containing
immune-compromised patients will, unless new, need to have a bacterial
fumigation before being deployed. Units that have been used in isolation rooms or areas containing symptomatic patients will be fumigated before being used in other locations or returned to store or the hirer.
6.7.5.3. Air conditioning units employing an internal water reservoir and wick to promote evaporative cooling will not be used within the Trust; any of these units found in circulation will be immediately removed and
destroyed.
6.7.6. Description of Ventilation Systems and Classification
6.7.6.1. Ventilation systems within the Trust are divided into two categories; critical and non-critical. The criterion below defines those ventilation systems which are considered critical:
Operating theatres of any type, including rooms used for interventional investigations (for example catheter
laboratories)
Patient isolation facility of any type
Critical care, intensive treatment or high-dependency unit Neonatal unit
Category 3 or 4 laboratory or room Pharmacy aseptic suite
Inspection and packing room in a sterile services department, sterile endoscope re-processing rooms
MRI, CAT and other types of emerging imaging technologies that require particularly stable environmental conditions to remain within calibration
Any system classified as an LEV system under the COSHH Regulations (some of these systems may be subject to local management contracts within the department)
Any other system that clearly meets the definition 6.7.6.2. The loss of service from such a system would seriously degrade the ability of the premises to deliver optimal healthcare. 6.7.6.3. The Head of Estates is responsible for ensuring that an
inventory of critical and non-critical ventilation systems is kept up to date. This inventory will be discussed and signed off by the Infection Prevention Control Team. The importance of this definition is to determine the
maintenance regime. Sample sheet Appendix A.
6.7.7. Inspection, Condition Assessment and Operational Parameters
6.7.7.1. The Trust has a range of ventilation plants of varying age and to meet all the criteria of HTM03 will take significant time. To ensure that replacement funding resources are correctly prioritised, an initial
assessment of condition and compliance will be made. The systems will be graded into the categories indicated within HTM03; this grading system gives guidance on the best course of action for each grade. The funding requirement for each system will then be added to the Estates Backlog Maintenance Risk Weighted Capital Bid Register as detailed in the
planned and reactive maintenance policy. This process will be repeated on a five yearly basis or when changes are to be made. The sheet for initial assessment is attached at Appendix C.
6.7.8. Mothballing Plant
6.7.8.1. It may be necessary to stop the use of plant but maintain it in an operational condition for an extended or undetermined period of time. For this scenario refer to the procedures manual for details.
6.7.8.2. To re-instate the plant, a commissioning procedure will need to be written for the specific plant; guidance on this procedure should be sought from HTM03-01, the Authorised Person (Ventilation) and the Infection Prevention Control Team.
6.7.9. Mothballing Split Air Conditioning
6.7.9.1. It may be necessary to mothball split air conditioning plant, in this configuration the written scheme in the procedures manual will be adhered to.
6.7.9.2. To re-instate the split air conditioning plant, a commissioning procedure will need to be written for the specific air conditioning unit; guidance on this procedure will be sought from HTM03-01, the AP (V) and the Infection Prevention Control Team.
6.7.10. Frost Protection
6.7.10.1. Trust ventilation systems will have frost protection in the event of very low outside air temperatures or plant faults. The protection works by detecting the air temperature after the frost/fog coil; should the air temperature be equal to or below 30C, the plant will stop and the frost/fog coil will open fully. The plant will then not start again until manually reset; this reset will only happen once it is operationally safe to re-start the plant and no risk of coil failure exists.
6.7.11. Fire Dampers
6.7.11.1. Fire dampers are fitted in the ventilation system where ducts pass through fire walls and barriers. There are two general types of dampers:
Fusible link spring loaded dampers fitted to older buildings, which require heat from a fire to activate and will not stop smoke penetration prior to the fusible link activating the damper.
Motor driven spring loaded fire dampers activated by the fire alarm system fitted to new buildings and are designed to stop smoke on fire alarm activation. These dampers will be
subject to periodic servicing and testing at a frequency specified in Appendix B and appropriate records kept.
6.7.12. Ventilation Supply and Extract Grill Cleaning
6.7.12.1. The ventilation supply and extract grills are to be cleaned regularly to ensure that dust does not build up. The periodicity of this will be the same as High level dusting as detailed in the National Cleaning Standards for the NHS. This is a routine part of the Domestic Services function; details of these standards are contained in Standard Operating Procedure (SOP) for Hotel Services Department. The Estates Department will ensure that each supply and extract grill, within patient critical care areas, are disassembled and deep cleaned annually.
7. Dissemination and Implementation
7.1. The policy will be disseminated to all Divisional Directors and Directorate Managers and via the Documents Library.
7.2. Copies will also be made available to Estates Department, Contractors, Estates Intranet Site, Project Co [PFI Services Providers] (via Contracts office).
7.3. Authorised Person and Competent Person will be trained in line with this policy. Training will take place at specialist training facilities.
8. Monitoring compliance and effectiveness
Element to bemonitored
Compliance with this document will be monitored via the Estates Department, through annual audits and inspections
Lead Nominated Lead AP Ventilation with guidance from AE Ventilation Tool Appendix A to E detail the monitoring and control documentation
required for compliance with this policy.
Advice and annual Audits from the AE Ventilation will confirm compliance.
Frequency Compliance with this policy is required for all new equipment or projects concerning Ventilation systems.
Independent Annual Audits will confirm compliance. Reporting
arrangements
All issues and reports relating to this policy will be sent to the Infection Prevention and Control committee.
Reports submitted to this committee will detail the actions required to ensure compliance with HTM guidance where possible and will detail actions required to remedy any defects or faults. Meetings are to have minutes.
Acting on
recommendations and Lead(s)
Estates Department will undertake subsequent recommendations and action planning for any or all deficiencies and
recommendations within reasonable timeframes.
The Estates lead for this will be the nominated AP Ventilation Required actions will be identified and completed in a specified timeframe
Change in practice and lessons to be shared
Required changes to practice will be identified and actioned by the nominated AP Ventilation, within the appropriate time frame, this will be coordinated under the guidance of the nominated AE Ventilation.
Lessons will be shared with all the relevant stakeholders
9. Updating and Review
9.1. This policy will need to be reviewed every 3 years, or subject to any industry and Government guidance and best practice updates.
9.2. Revisions can be made ahead of the review date when the procedural document requires updating. Where the revisions are significant and the overall policy is changed, the author should ensure the revised document is taken through the standard consultation, approval and dissemination processes. 9.3. Where the revisions are minor, e.g. amended job titles or changes to the procedures in the Appendices, approval can be sought from the Executive
Director responsible for signatory approval, and can be re-published accordingly without having gone through the full consultation and ratification process.
9.4. Any revision activity is to be recorded in the Version Control Table as part of the document control process
10. Equality and Diversity
10.1. This document complies with the Royal Cornwall Hospitals NHS Trust service Equality and Diversity statement".
10.2. Equality Impact Assessment
Appendix 1. Governance Information
Document Title Ventilation Systems Policy
Date Issued/Approved: 12th November 2013
Date Valid From: 12th November 2013
Date Valid To: 1st November 2016
Directorate / Department responsible (author/owner):
Steven Carter, Energy and Environment Officer, Estates Department
Contact details: 01872 253872
Brief summary of contents
Policy for the maintenance, control and
assurance of all ventilation plant and equipment within the Trust.
Suggested Keywords: Ventilation, Maintenance, Infection Control
Target Audience RCHT PCH CFT KCCG
Executive Director responsible
for Policy: Director of Estates Date revised:
This document replaces (exact
title of previous version): New Document Approval route (names of
committees)/consultation: Health & Safety Committee Divisional Manager confirming
approval processes Director of Estates Name and Post Title of additional
signatories Not Required
Signature of Executive Director
giving approval {Original Copy Signed} Publication Location (refer to
Policy on Policies – Approvals and Ratification):
Internet & Intranet
Intranet Only
Document Library Folder/Sub
Folder Estates/General
Links to key external standards HTM guidance located on the Estates Server,
also available on the Internet
Related Documents: Procedures documentation located on the
Training Need Identified?
Yes. Authorised Person training required and Competent Person training required.
Training takes place at specialist training facilities.
Version Control Table Date Versio
n No Summary of Changes
Changes Made by
(Name and Job Title) 16 Apr 13 V1.0 Initial Issue
Steven Carter, Energy and
Environment Officer
All or part of this document can be released under the Freedom of Information Act 2000
This document is to be retained for 10 years from the date of expiry. This document is only valid on the day of printing
Controlled Document
This document has been created following the Royal Cornwall Hospitals NHS Trust Policy on Document Production. It should not be altered in any way without the
Appendix 2. Initial Equality Impact Assessment Form
Are there concerns that the policy could have differential impact on:
Equality Strands: Yes No Rationale for Assessment / Existing Evidence
Age X
Name of Name of the strategy / policy /proposal / service function to be assessed (hereafter referred to as policy) (Provide brief description):
Directorate and service area: Is this a new or existing Policy? Name of individual completing
assessment:
Telephone: 1. Policy Aim*
Who is the strategy / policy / proposal / service function aimed at?
To set out the detailed requirements for the maintenance and safe operation of all air conditioning and ventilation plant within the Trust
2. Policy Objectives* Ensure compliance with Statutory instruments, industry best practice guidance. To ensure that such equipment does not pose a health and operational risk to either staff, patients or members of the public. 3. Policy – intended
Outcomes*
Guidance for the best practice maintenance of ventilation plant and equipment
Compliance with Statutory instruments.
Compliance with industry best practice guidance 4. *How will you
measure the outcome?
Annual plant and equipment inspections
Regular audits from the independent AE Ventilation
Detailed remedial action plans together with evidence based remedial actions, approved by the AE Ventilation and signed off as completed by the AE Ventilation.
5. Who is intended to benefit from the policy?
All Trust staff, patients and members of the public Estates and Facilities Department
6a) Is consultation required with the workforce, equality groups, local interest groups etc. around this policy?
b) If yes, have these *groups been
consulted?
C). Please list any groups who have been consulted about this procedure.
No consultation required
7. The Impact
Sex (male, female, trans-gender / trans-gender reassignment) X Race / Ethnic communities /groups X Disability - learning disability, physical disability, sensory impairment and mental health problems X Religion / other beliefs X
Marriage and civil partnership
X
Pregnancy and maternity X
Sexual Orientation, Bisexual, Gay, heterosexual, Lesbian
X
You will need to continue to a full Equality Impact Assessment if the following have been highlighted:
You have ticked “Yes” in any column above and
No consultation or evidence of there being consultation- this excludes any policies which have been identified as not requiring consultation. or
Major service redesign or development
8. Please indicate if a full equality analysis is recommended. Yes No 9. If you are not recommending a Full Impact assessment please explain why.
Signature of policy developer / lead manager / director Date of completion and submission
Names and signatures of members carrying out the Screening Assessment
1. 2.
Keep one copy and send a copy to the Human Rights, Equality and Inclusion Lead,
c/o Royal Cornwall Hospitals NHS Trust, Human Resources Department, Knowledge Spa, Truro, Cornwall, TR1 3HD
A summary of the results will be published on the Trust‟s web site. Signed _______________
Appendix A
Royal Cornwall Hospitals Ventilation System Inventory Sample Area Served Supply Plant Exhaust Plant Critical or Non-critical Cooling Humidification Connected Year of Manufacture
Appendix B
Frequency of Maintenance Type of System Cr itical with co o lin g o r h u m idifica tio n Cr itical wi th o u t co o lin g o r h u m idifica tio n Non -cr itical wi th co o lin g o r h u m idifica tio n Non -cr itical wi th o u t co o lin g o r h u m idifica tio n S p lit A C P o rtab le A C u n it Fir e Da m p e r fu sible link 5 ye a r che ck Fir e Da m p e r M o to r driven A n n u a l ch e ck Annual inspection Annual validation Quarterly inspection Quarterly chlorination Six-monthly chlorination Six-monthly clean Filter change periodicity 6 month or sooner if required 6 month or sooner if required 6 month or sooner if required 6 month or sooner if required 6 month or sooner if required 6 month or sooner if required 5-year compliance inspection Weekly inspection and clean Fire damper inspection and function test Appendix C
Royal Cornwall Hospitals overall condition assessment of ventilation plant against HTM03 criteria.
Hospital Plant Room
Air –handling unit Age of unit Year of
manufacture Area served by
unit
Date of survey Name
General condition: End useful life Poor Average Good
Compliance with minimum standards
Poor Average Good
Maintenance quality Poor Average Good
Estimated cost of replacement/repair/upgrade:____________ Capital bid number:______________
Risk assessment:
Likelihood:_____ Consequence:_____ Risk:_____
_____________ ___________ _________ ______________ ___________ ________
Engineer Name Sign Date Infection Control Sign Date Name
Appendix D
No Survey question Yes No Comments
1 Plant running?
2 Is the unit and its associated plant secure from unauthorised access? 3 Is the unit safely accessible for
inspection and maintenance? 4 Is the air intake positioned to avoid
short circuiting with extract or foul air from other sources such as gas
scavenging outlets? 5 Are all inspection lights operating? 6 Are motorised dampers fitted to the
intake and discharge? 7 Are fan motor(s) outside of the air
stream?
8 Is the fan drive train visible without removing covers?
9 Is the cooling coil located on the discharge side of the fan? 10 Is an energy-recovery system fitted
(state type)?
11 Are condensate drainage systems fitted to all energy recovery
systems, cooling coils and humidifiers in accordance with Chapter 3 of Health Technical Memorandum 03-01, Part B? 12 Are drainage traps clean and filled
with water? (see Table 3 in Health Technical Memorandum 03-01,
Part B)
13 Is the drain trap air break at least 15 mm?
14 If a humidifier is fitted, state the
type – - -
15 Is the humidifier capable of operation?
16 Is there space to safely change the filters?
17 Are there test holes in the principal ducts?
18 Are the test holes capped?
19 What is the general condition of the
exterior of the AHU? - -
20 Are the principal ducts lagged? 21 What is the general condition of the
associated control valves and pipework?
- -
22 Is the pipework adequately
lagged?
23 Is the system clearly labelled? 24 Record main filter differential
pressure - -
25 Record pre-filter differential
pressure - -
26 Does the plant have frost
No Survey question Yes No Comments ventilation procedure. Section 10
Switch plant off. Fit padlock to isolator 27 Did the motorised dampers close
on plant shut-down? 28 Is the intake section including
insect screen and fog coil clean? 29 Are the pre-filters correctly fitted
with no air bypass?
30 Where applicable are all drive belts correctly tensioned and aligned? 31 Is the cooling matrix clean? 32 Are all drip-trays fully accessible or
capable of being removed for cleaning and have a fall to drain? 33 Are the drainage trays stainless? 34 Are the drainage trays clean? 35 Are there any signs of water
ponding in the AHU? 36 Is the heater matrix clean for each
heater battery?
37 Have the main filters been correctly fitted with no air bypass? 38 Is AHU and it‟s associated main
ductwork clean internally? 39 Did all BMS alarms activate on
BMS front end and plantroom control panel?
Energise Plant 40 Did unit restart satisfactorily
Test Automatic fan changeover
41 Did auto changeover operate?
Details of any schedule holiday breaks that can be added to BMS control. E.G. Christmas shutdown.
Appendix E
Building Management Control Parameters
Sunday Monday Tuesday Wednesday Thursday Friday Saturday Run Scheduled 12 am 1 am 2 am 3 am 4 am 5 am 6 am 7 am 8 am 9 am 10 am 11 am 12 pm 1 pm 2 pm 3 pm 4 pm 5 pm 6 pm 7 pm 8 pm 9 pm 10 pm 11 pm 12 am
