Indoor Environmental Quality Commissioning

Chapter 1
Project: _____________________________________________ Address: ________________________________
Owner: _____________________________________________ Email/Phone: _____________________________
Owner’s Project Manager: ______________________________ Email/Phone: _____________________________
Cx Provider: _________________________________________ Email/Phone: _____________________________
Date Initiated: ______________________ Date Revised: ______________________
System Integrated System

Chapter 2
Commissioning
Commissioning Commissioning
Item Equipment/System Complete—
Required— Required—
Date
Y/N Y/N
1. Outdoor air systems and controls
Humidity, dry bulb, air drafts

Chapter 3
Building pressurization
2. Glare, direct solar
3. Noise and acoustics
4. Refrigerant safety and exhaust systems

Chapter 4
5. Air filtration
6. Construction phase IAQ programs and
application
7. Postconstruction building air flushing
8. Contaminant testing

Chapter 5
Appendix B
Appendix B

The approval section that follows can be used if applicable to the planning process. Approval can be granted by the
Owner/representative, Design Team, or CxP depending on the Owner’s requirements.

I have reviewed the required items and plans and verified that they meet the project requirements:
Owner or Owner’s Representative Name: ___________________________________________________________
Appendix B

Company Name: ______________________________________________________________________________

Signature: _____________________________________________ Date: _________________________________