Rick Stein
R&L Envirocare
PO Box 135
Fair Grove, MO 65648
417.942.2451
Active NORMI Member

Summary of IAQ Assessment

These questions are a compilation of the answers you gave in the PSP-IAQ Assessment Booklet and represent that main pieces of information needed by your PSP (Professional Screening Partner) to offer suggestions, recommendations, and possible solutions. You will NOT be required to put all of the information from your booklet into this summary but the information you CAN supply will be very helpful and expedite the solutions stage of this program. Thank you.

Name
Address
City
State/Province
Zip/Postal Code
Phone
eMail

Do you have a living room? Yes No

Do you have a family room or large den? Yes No

How many bedrooms do you have?

How many bathrooms do you have?

Do you have a separate laundry room closed off by a door? Yes No

How many central air conditioning systems (or furnaces) do you have with a duct system?

On page 15, question number 12, did you answer Y or N? Yes No

GENERAL LIVING AREAS (Pages 7-8)
	Please enter your answer to question 10	Yes No
	Please enter your answer to question 11	Yes No

BEDROOMS (Pages 9-11)
	Please enter your answer to question 10	Yes No
	Please enter your answer to question 11	Yes No
	Please enter your answer to question 12	Yes No
	Please enter your answer to question 13	Yes No

BATHROOMS (Page 12)
	Please enter your answer to question 1	Yes No
	Please enter your answer to question 2	Yes No
	Please enter your answer to question 7	Yes No
	Please enter your answer to question 11	Yes No


KITCHEN (Page 13)
	Please enter your answer to question 7	Yes No

LAUNDRY AREA (Page 13)
	Please enter your answer to question 4	Yes No
	Please enter your answer to question 6	Yes No

BASEMENT (Page 14)
	Please enter your answer to question 1	Yes No

ATTIC (Page 14)
	Please enter your answer to question 1	Yes No
	Please enter your answer to question 2	Yes No
	Please enter your answer to question 4	Yes No
	Please enter your answer to question 5	Yes No
	Please enter your answer to question 6	Yes No

AIR CONDITIONING SYSTEMS (Page 15)
	Did you answer yes to any of questions 1 - 11?	Yes No
	Please enter your answer to question 12	Yes No
	Please enter your answer to question 13	Yes No

Enter Security Code Below:

The Environmental TASC Force Program

Summary of IAQ Assessment