6630204 - Mold Response Form

  • APPENDIX A: MOLD FIRST RESPONSE FORM

  • Date:*
     / /
  • Is mold visible?*
  • Approximate area of visible mold:*

  • Mold is on * surface. (e.g. drywall, wood)

  • Is there a history of water/moisture intrusion in this area?*
  • Were there any photos taken?*

  • Found by:

  • Forward to District Safety Manager - Action Required 24 - 48 Hours

  •  
  • Should be Empty: