Figure 2 - Air Cleaning Device Inspection Checklist June 1, 19981. Air cleaning device designation or number ______________2. Date of inspection (mm/dd/yy) ______________3. Time of inspection (a.m./p.m.) ______________4. Air cleaning device operating properly (y/n) ______________5. Tears, holes or abrasions in fabric filter (y/n) ______________6. Dust on clean side of fabric filters (y/n) ______________7. Other signs of malfunctions or potential malfunctions (y/n) ______________8. Describe other malfunctions or signs of potential malfunctions ______________ __________________________________________________________
9. Describe corrective action(s) taken ___________________________________ __________________________________________________________
10. Date and time corrective action taken ______________
11. Inspected by: _______________ ______________ ______________ ________
Print/type name Title Signature Date
_______________ ______________ ______________ ________
Print/type name Title Signature Date
Haw. Code R. tit. 11, subtit. 1, ch. 501, fig. 2