New Jersey Department of Health

Consumer, Environmental and Occupational Health Service

Environmental and Occupational Health Assessment Program

PO Box 369, Trenton, NJ 08625-0369

Child Care Center - Indoor Environmental Health Assessment

Form H: ASSESSMENT SUMMARY, CONCLUSIONS, RECOMMENDATIONS AND CORRECTIVE ACTIONS

Facility Name

Street Address

City

County

Directions: Provide the following information. Use an addition sheet, if necessary.

I. Assessment Summary
Summarize the Assessment Conducted of this Facility/Site

II. Conclusions
Indicate your Conclusions regarding the Assessment Conducted of this Facility/Site

III. Recommendations
Indicate any Recommendations for this Facility/Site

IV. Corrective Actions

(Use additional sheets, if necessary)
Type of

Corrective Action	Date

Completed	Clearance Methodology

(Include copies of sample results)	Location of

Corrective Action	Corrective Action

Performed by

(list name and address

of contractor)

Name of Person Completing this Form (print legibly or type)

Title

Signature	Date

Child Care Center - Indoor Environmental Health Assessment

Form h: assessment summary, conclusions, recommendations and corrective actions

(Continued)

CEHS-8

AUG 12	Page 2 of 2 Pages.

AUG 12	Page 1 of 2 Pages.

CEHS-8, Form H: Assessment Summary, Conclusions, Recommendations and Corrective Actions

CEHS-8, Form H, Conclusions, Assessment Summary, Recommendations, Corrective Actions, child care center, indoor environmental health assessment

ewhite

2012-03-20

NJDOH