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Florida Division of Emergency Management

Facility Qualification Checklist

For determining whether to pursue healthy building upgrades

Please complete the following questionnaire to determine the feasibility of HVAC-related upgrades at your facility. Use only one form per property and provide additional comments as needed.

Fields marked with an * are required.


 

Site Information

Property Information

Basic HVAC Systems Used

Note vintage, condition, how well it is performing, any planned upgrades.


Mechanical Ventilation

How are the various care areas within the facility provided with outdoor air, including its control (i.e., central control vs. individual control by the resident)?


Filtration

General Comments