Responding to Indoor Mold Concerns: A Resource for Environmental Public Health Professionals
Inspection Observations
ROOM
VISIBLE MOLD
VISIBLE MOISTURE OR WATER STAINS
ODOR DETECTED HUMIDITY LEVEL IMPACTED AREAS (E.G., CEILING, WALLS, FLOORING)
YES □ NO □
YES □ NO □
YES □ NO □
Living room
%
ft²
YES □ NO □
YES □ NO □
YES □ NO □
Kitchen
%
ft²
YES □ NO □
YES □ NO □
YES □ NO □
Bathroom(s)
%
ft²
YES □ NO □
YES □ NO □
YES □ NO □
Bedroom(s)
%
ft²
YES □ NO □
YES □ NO □
YES □ NO □
Basement/attic
%
ft²
YES □ NO □
YES □ NO □
YES □ NO □
Other areas (specify)
%
ft²
NOTES
Note . Appendix B form incorporates items from: Storey, E., Dangman, K.H., Schenck, P., DeBernardo, R.L., Yang, C.S., Bracker, A., & Hodgson, M.J. (2024). Guidance for clinicians on the recognition and management of health effects related to mold exposure and moisture indoors . University of Connecticut Health Center. https://health.uconn.edu/occupational- environmental/wp-content/uploads/sites/25/2015/12/mold_guide.pdf
National Institute for Occupational Safety and Health. (2018). Dampness and mold assessment tool: General buildings, forms, & instructions. Centers for Disease Control and Prevention . https://www.cdc.gov/niosh/docs/2019-115/ pdfs/2019-115.pdf
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