Board of Health Ice Rink Inspection Sheet



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Board of Health Ice Rink Inspection Sheet

Date of Inspection: __________Inspection Conducted by:___________________________



Rink Information

Name of Rink: _____________________________________________________

Street:____________________________________________________________

City: __________________________________________State: MA

Zip Code: __________________________

Contact: __________________________________________________________

Telephone Number: ___________________ Fax Number: ________________________
Record Keeping Log

Is a Record Keeping Log kept by the rink? Y N



Is the following information kept in this log? (Circle Y for yes, N for No or enter information)

Ice Resurfacing Equipment
Brand of ice resurfacer Y N
Age of resurfacer Y N
Fuel type: Gasoline Propane

Natural Gas

Dates of tuning: Y N
Name, company and address of person

performing the tuning Y N


Name, company and address of person

performing repairs of maintenance

on the ice resurfacer Y N
Manufacturer, type and date of installation

of a catalytic converter Y N


Name, company and address of person installing

or performing maintenance of the catalytic converter Y N



Air Sampling Information
Date, location and time of every sample

of carbon monoxide or nitrogen dioxide Y N


Results of air sampling in parts per

million (ppm) for carbon monoxide and

nitrogen dioxide Y N
Name of sampling devices Y N
Method for sampling carbon monoxide colorimetric

hand-held monitor

in place chemical

sensor

computer chip
Method for sampling carbon monoxide colorimetric

computer chip


Signature of person performing the air sampling Y N
Description of correction measures taken

for air levels above correction levels Y N


Results of carbon monoxide and nitrogen

dioxide after correction measure

implemented Y N
Date of last calibration and name of person

performing the calibration Y N


Lot numbers of colorimetric tubes or computer

chip sampling devices Y N


Resurfacer Schedule

Number of resurfacing prior to inspection, that day? _________


Number of resurfacings per day:
Mon___ Tues___ Wed___ Thur___ Fri___ Sat___ Sun___


Type of Ventilation

Supply On Off Capacity (CFM)________________

Exhaust On Off Capacity (CFM)________________
Size of Rink

Square feet: _____________ Ceiling height: ___________


Indoor Air Test Results for Skating Rinks


Sample

Date

Time

Carbon Monoxide

* ppm



Nitrogen Dioxide

* ppm



Air Sample

Device



Remarks


Outside

Ambient Air





















20 Minutes

After Resurface





















40 Minutes

After Resurface





















60 Minutes

After Resurface





















Immediately After

Resurface





















20 Minutes

After Resurface





















40 Minutes

After Resurface





















60 Minutes

After Resurface





















*ppm = parts per million of air
Indoor Air Levels for Carbon Monoxide and Nitrogen Dioxide
If an air sample exceeds 30 ppm for carbon monoxide or 0.5 ppm for nitrogen dioxide, the rink must take

positive measures to decrease air concentrations of these contaminants below these standards.


If an air sample exceeds 60 ppm for carbon monoxide or 1 ppm for nitrogen dioxide, the rink must notify the

local fire department, local board of health and the Bureau of Environmental Health Assessment within 24 hours

of sampling.
If an air sample exceeds 125 ppm for carbon monoxide or 2 ppm for nitrogen dioxide, EVACUATE THE

RINK, notify the local fire department, local board of health and the Bureau of Environmental Health

Assessment.


The Bureau of Environmental Health Assessment can be contacted at (617) 624-5757 during work hours, or at

(617) 522-3700 during the night or weekend.


Form:ice4/(amended 2000)





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