Laboratory Assessment Form © Siemens AG 2017 siemens.
Project: Date: Client Engineer: Siemens Engineer: Facility: Area: Use: Customer contact name: Siemens contact name: © Siemens AG, Page 2 of 8
1. How many of these critical areas are there in your facility? None 1.1 Chemical labs 1.2 Biological labs 1.3 Animal labs 1.4 Infectious Isolation rooms 1.5 Sterilization 1.6 Operating Suites 1.7 Cleanrooms 1.8 Protective Isolation 1.9 Pharmacies Approximate # Comment 2. How many special ventilation devices are there in your facility? None Approximate # Monitor/Controls? 2.1 Fume hoods Yes No 2.2 Biological safety cabinets Yes No 2.3 Laminar flow benches Yes No 2.
3. How often are these critical areas used? N/A 3.1 Chemical labs 3.2 Biological labs 3.3 Infectious Isolation rooms 3.4 Sterilization 3.5 Operating Suites 3.6 Cleanrooms 3.7 Protective Isolation 3.8 Pharmacies 3.9 Fume hoods Seldom Often Continuously 3.10 Biological safety cabinets 3.11 Laminar flow benches Comment 4. How would you rate the ventilation performance associated with these areas? (from 1 to 5, 1 being poor and 5 being excellent) N/A 4.1 Chemical labs 4.
. Who performs the following tasks at your facility? Inside staff 5.1 Maintains compliance documentation 5.2 Evaluates room pressurization 5.3 Fume hood certification 5.4 Biological safety cabinet certification 5.5 Laminar flow benches certification 5.6 Clean room certification 5.7 Ethylene Oxide monitoring 5.8 Other chemical exposure monitoring Contractor How often? Comment 6.
8. Who’s building control system is in your facility? 9. What costs are associated with poor performance of these areas? 10. What comfort/IAQ complaints does the client receive and how often? 11. Are there persistent hot or cold spots in the facility? 12. What are their biggest concerns regarding their facility? 13. Are they maintaining compliance reports and how is data collected? 14. For how many hours weekly are the lab rooms occupied? 15.
16. What are the costs of the electricity in euro/kWh? 17. What are the costs of the gas/oil in euro/kWh? 18. How many square meters (m2) are the laboratories? 19. What is the ceiling height in the laboratories in meters (m)? 20. How many laboratory rooms are there? 21. What is the chiller plant efficiency (kW/ton)? 22. What is the facility age (in case of lab renovation please provide the year of renovation)? 23. What is the facility total electricity spend (kWh)? 24.
25. Please select Sum Sum Fume hood type Aux Air CV Exhaust system type Central Individual Controls Type Pneum DDC Lab occupancy monitored Yes No Sum CV 2 position Sum VAV Comment 26. Can you please provide the following information. Yes 26.1 Floor plans drawings of the mechanical equipment 26.2 Controls sequence of operation (room and Fume Hood) 26.3 Fume Hood Certification Report No Follow 27.
