**Moisture and Mold Management Program (M3P)**

Veterans Health Administration

Modified with support from the Water Intrusion and Mold Management
(WIMM) Program developed by the California Kaiser Safety Program

**Moisture Control Pre-lease Checklist**

**Control of Moisture Entry, Accumulation and Removal**

**Moisture Entry**

Rain and Groundwater

Capillary Suction

Air Movement

Vapor Diffusion

**Surroundings/Environment**

> Grading for drainage away from building (5%)
>
> Lack of roof overhangs
>
> Drainage conduits
>
> Extended downspouts/ free-draining backfill
>
> Flooding potential
>
> Site selection
>
> Water table

Underground trenching/sump pump

**Foundation**

Evidence of moisture damage

Bare soil crawl spaces

Waterproofing w/ below grade barrier

Heating climates -- Strategies for below grade basements

Rigid insulation of exterior foundation wall

Rigid insulation between foundation and room wall

Rigid insulation beneath slab

> Insulation of wall cavities

Capillary shield on footing

Cooling Climates -- Strategies for Crawl spaces and slabs

Vapor barrier on crawl space floor

Insulation of crawl space floor joists

Rigid insulation on external or internal wall

Rigid insulation of slab perimeter or wall/floor joint

**Envelope**

Exterior walls

Cladding permeability, leakage & overlap

Veneer w/ weep-holes

Weatherproofing w/ above grade barrier, drain screens & air spaces

Stuccos, papers, tyvek, caulks

Air spaces for brick veneers

Flashed bases to drain rainwater out

Cladding with 2-stage joint

Foundation drip edges

Interior vs. Exterior Air Barriers (Poly barriers, wall cavity
cellulose)

Exterior barriers: Control wind washing & trap condensation Interior
barriers: Control heat-forced moisture

Drainage tile and granular backfill

**Exterior room corners**

Poor insulation

Low air movement

Furniture blockage

Siding wind-washing

Capping siding space (Most climates)

Open siding space (High moisture climates)

**Roof**

> Materials appropriate (aging/intact)
>
> Flashing applied properly
>
> Penetrations sealed without evidence of leakage inside
>
> Non-permeable barrier for low slope roof
>
> Strategies to control temperature condensation and moisture transfer
>
> Vapor barrier above gypsum ceiling
>
> Rigid wall insulation notched around roof rafters
>
> Rigid insulation between rafter insulation and vapor barrier

**Wall-Roof intersections**

> Soffit wind baffles

**Windows/doors**

> No evidence of leakage
>
> Moisture trapping
>
> Energy rated to reduce condensation

**Rooms**

Closed doors and air movement (increase humidity)

Gradual non-occupant temperature reduction (controls humidity)

Control overcooling (summer) and over heating (winter)

> Control cold airflow against surfaces
>
> **Systems**
>
> Mechanical
>
> Motor intact, without knocking
>
> Belts, etc. wear
>
> Fan blades intact
>
> Cooling and heating coils intact
>
> Drainage pans clean
>
> Condensate lines correct
>
> Plenum without biological growth
>
> Duct liners clean
>
> Electrical
>
> Plumbing

Insulation

**Furnishings**

Ceiling tiles clean

Carpeting discoloration

**Moisture and Mold Management Program (M3P)**

Veterans Health Administration

(Facility)

Moisture and Mold Management Program

Section I: Program and Policies

Section II: Water Intrusion Specific Procedures

Section III: Mold Management Specific Procedures

Attachments

Region Specific amended procedures

# Review and Approval {#review-and-approval .Non-heading}

+-----------------------------------------------------------------------+
| The Responsible Persons for implementing Network and facility Program |
| :                                                                     |
|                                                                       |
| Director :                                                            |
|                                                                       |
| Facility Director :                                                   |
|                                                                       |
| Environmental Health and Safety:                                      |
|                                                                       |
| Infection Control Professional:                                       |
|                                                                       |
| Environmental Services:                                               |
|                                                                       |
| Facility Services Manager:                                            |
|                                                                       |
| Date:                                                                 |
+-----------------------------------------------------------------------+

**Introduction:**

Background and Program overview 11

**Section I: General policies** 11

Water Intrusion and Mold Management Program 14

Appendix I: Definitions 16

Appendix II: Guidelines for Selecting Outsource Consultants and
Contractors 19

Appendix III: Assessment Guidelines and Checklist 22

Appendix IV: References 24

**Section II: Water Intrusion Specific Procedures** 25

Water Intrusion Procedures Overview 25

Step One: Reporting 25

Step Two: Assessment 26

Step Three: Patient Risk Assessment 26

Step Four: Determine Class of Response 28

Step Five: Water Intrusion Response Procedures 28

Step Six: Close-out Investigation 29

Step Seven: Process Evaluation 29

Appendix I: Infection Control Risk Assessment Form (ICRA) 30

Appendix II: Water Intrusion Work Practice Level W-1 32

Appendix III: Water Intrusion Work Practice Level W-2 34

Appendix IV: Water Intrusion Work Practice Level W-3 35

**Section III: Mold Growth Management Specific Procedures** 44

Mold Growth Procedure Overview 44

Step One: Reporting 44

Step Two: Assessment 44

Step Three: Patient Risk Assessment 45

Step Four: Determine Class of Response 47

Step Five: Mold Response Work Practices 48

Step Six: Close-out Investigation 49

Steps Seven: Process Evaluation 50

Appendix I: Infection Control Risk Assessment Form (ICRA) 51

Appendix II: Mold Management Work Practice Level M-1 53

Appendix III: Mold Management Work Practice Level M-2 54

Appendix IV: Mold Management Work Practice Level M-3 55

Appendix V: Mold Management Work Practice Level M-4 57

Appendix VI: Mold Management Work Practice Level M-5 59

Appendix VII: WIMM Flow Chart 62

## National Program on Water Intrusion and Mold Management (WIMM)

# 1.0 Introduction

Fungi occur naturally in our environment and are an essential part of
our ecosystem. Fungi live in the soil, on plants, and on decaying
matter. Fungi represent their own kingdom, and, unlike plants, they lack
chlorophyll and must survive by digesting plant materials, using plant
and other organic materials for food. Without fungi, our environment
would be overwhelmed with large amounts of dead plant matter. Indoors,
fungi grow when moisture from sources, such as pipe leaks, roof leaks,
or condensation, encounters potential nutrients. Fungal growth inside a
building may cause a broad range of reactions, differing in part on the
susceptibility of the affected person, in part on the fungal species,
and in part on the dose. VHA patients and visitors with compromised
immune systems are at greater risk.

Fungi produce allergens, irritants, and toxins. Exposure to fungi can
cause a variety of disorders. Minor symptoms such as rhinitis, sneezing,
nasal congestion, and conjunctivitis can result from allergies or
irritation. Skin rashes and itching (dermatitis) are described. Asthma,
hypersensitivity pneumonitis, sarcoidosis, and interstitial pneumonitis
are associated with heavy prolonged exposure to fungi. Microbial
volatile organic compounds (mVOCs) are produced during fungal metabolism
and responsible for moldy or unpleasant odors. The existence or
identification of fungi indoors does not imply that building occupants
have been exposed to mycotoxins or even that such agents are present, as
molds often do not produce them. "Mold" represents a colloquial term for
fungal growth generally on surfaces and in materials.

\[VHA Facility\] is committed to providing a safe environment for our
patients, visitors and employees. Water intrusion incidents or visible
mold growth may occur in our facility. \[VHA Facility\] has established
this *Water Intrusion and Mold Management Program (WIMM)* to maintain
appropriate patient care services, to provide a safe and healthy work
environment, and to prevent damage to facility components. WIMM provides
guidelines for the assessment and response planning to water intrusion
incidents and visible mold growth. Although mold growth may represent a
health hazard under certain conditions, there are no specific regulatory
requirements that dictate how to manage or remediate identified mold
growth. WIMM was initially developed by Kaiser Permanente using U.S.
Environmental Protection Agency guidelines, the New York City
Bioaerosols Remediation Guidelines, and other current industry consensus
standards. Specific references are listed in *Section I. Appendix IV:
WIMM Program References.*

# 1.1 Discovery and Reporting

Although there currently are no governing, licensing or regulatory
requirements regarding mold management, water intrusion and accumulation
should be mitigated prior to the start of mold growth. Prompt
recognition, reporting and elimination of water intrusion will reduce
potential health risks, building systems damage and operational expense.

*\[Choose Option A or B below\]*

*\[A\]* Possible signs of water intrusion or mold growth should be
reported to the facility WIMM Program Manager. The following are
examples of events that warrant a reporting process.

-   Visible water/ moisture intrusion in locations not intended for
    moisture, such as carpets, wall surfaces, ceiling surfaces, standing
    water in building interiors, furniture, equipment drip pans, etc.;

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-   Water intrusion directly into building interiors in locations not
    intended for water to enter;

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-   Signs of building damage potentially caused by water/ moisture
    intrusion, such as warping, staining, buckling, sagging, etc.;

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-   Suspected or known visible mold growth;

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-   Odd, or unusual odors, including musty, moldy, or mildew odors;

-   Other conditions that could reasonably indicate water/ moisture
    intrusion, either hidden or visible.

*\[B\]* Employees should immediately report incidents of suspected
moisture intrusion or suspected mold growth to their immediate
supervisors. Upon confirmation, supervisors shall notify the Safety
Office and Facilities Management Office for appropriate action based on
the report. Infection Control will be notified for events occurring in
patient care areas. The Contracting Officers representative (COTR) shall
be notified for events associated with site construction.

The following are examples of events that warrant a reporting process.

-   Visible water/ moisture intrusion in locations not intended for
    moisture, such as carpets, wall surfaces, ceiling surfaces, standing
    water in building interiors, furniture, equipment drip pans, etc.;

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```
-   Water intrusion directly into building interiors in locations not
    intended for water to enter;

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```
-   Signs of building damage potentially caused by water/ moisture
    intrusion, such as warping, staining, buckling, sagging, etc.;

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```
-   Suspected or known visible mold growth;

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```
-   Odd, or unusual odors, including musty, moldy, or mildew odors;

-   Other conditions that could reasonably indicate water/ moisture
    intrusion, either hidden or visible.

##  Implementation of the Program:

This WIMM Program (WIMMP) is comprised of three sections:

**[Section I]{.underline}: Roles and Responsibilities**. Describes the
WIMM Program roles in detail and provides a backdrop for how the various
roles work in concert with each other. Additional resources are provided
in the Section I Appendices.

**[Section II]{.underline}: Water Intrusion Events.** The step-by-step
process provides guidelines for assessment of water intrusion,
determination of patient risk groups, and the corresponding response
procedures. In addition, several tools and documentation forms are
provided in the Section II Appendices to assist in assessment, response,
and record-keeping.

**[Section III]{.underline}: Mold Management.** The step-by-step process
provides guidelines for assessment of mold growth, determination of
patient risk groups, and corresponding response procedures. In addition,
several tools, documentation forms and basic mold information are
provided in the Section III Appendices to assist in assessment,
response, and record-keeping.

# 

# 

# 

# 

# 

# 

# 

# INSERT TAB HERE FOR SECTION I:

**General Policies for Water Intrusion and Mold Management Program**

# Section I: General Policies

# Roles and Responsibilities

##### 3.1 Intent

The WIMM Program provides response actions that are effective in
protecting the health of patients and employees while minimizing damage
to facility components. Additionally, WIMM is intended to ensure
responses are efficient and consist of appropriate actions that are
neither too minimal, nor too extensive, based on current industry
standards. As mold requires water to proliferate and grow, it is
important to properly manage water intrusion incidents. For that reason,
the Program includes guidelines for responding to leaks or other sources
of water to prevent potential mold growth.

WIMM team notification and response mobilization are triggered when
building system failure is verified by facilities maintenance and
inspection processes. It is the responsibility of \[Safety
Office/Facilities Management\] to ensure timely and proper notification
of the WIMM Program team.

##### 3.2 WIMM Program Management

A flow chart that outlines the process for the management of mold and
water intrusion incidents is located in Section III, Appendix VII. The
\[Safety Office/Facilities Management\] is responsible for
implementation and management of the WIMM Program, including the
following:

a.  Disseminating information and implementing appropriate training to
    WIMM Program members;

b.  Developing or modifying and implementing a facility wide reporting
    process, so that potential WIMM Program incidents will quickly and
    efficiently be reported through the appropriate staff members
    designated below:

-   Department Supervisor

-   Facility Services Manager or Building Engineer;

-   Environmental Services (housekeeping) Manager

-   Health and Safety (EH&S) Professional;

-   Infection Control (IC) Professional; and

-   VHA Network Office for assistance or notification

c.  Designating a WIMM Project Lead for communication, coordination and
    implementation of the WIMM response actions based on the location
    and extent of response plan;

d.  Implementing a system to insure that necessary equipment is readily
    available and meets current industry standards;

e.  Ensuring resources for response for after hour shifts in a 24/7
    operation are available

f.  Developing and implementing processes for:

-   Resolution of impasses within the WIMM Program Management Team;

-   Record keeping and documentation for any contracts, purchases and
    incidents; and

-   Assigning alternates or modifying roles and responsibilities for
    WIMM Program Procedures.

**3.3 Suggested WIMM Program Team Members**

The core WIMM Program Team consists of the following members:

-   [Facility Service Manager or Building Engineer]{.underline}-
    Responsible for notification of incident to WIMM Program \[Choose
    one: Lead or Team\]; manages project task to mitigate water
    infiltration and accumulation and protect facility components and
    utilities, including but not limited to HVAC, domestic water,
    sewage, electrical, alarm, fire / life safety systems;

-   [Environmental Health and Safety Professional]{.underline}-
    Responsible for notification of incident to WIMM Program \[Choose
    one: Lead or Team\], manages project task and conducts safety and
    health risk assessment; determines proper course of action to
    minimize/eliminate mold growth risk;

-   [Environmental Services (housekeeping)-]{.underline} Responsible for
    communication of incident response actions to WIMM Program Lead, and
    for housekeeping duties as they relate to implementation of the WIMM
    Program guidelines;

-   [Infection Control Professional]{.underline}- Responsible for
    communication to WIMM Program Lead, authority for development of
    patient risk assessment and related decisions of the WIMM Program
    guidelines, and communication with patient care staff .

When deemed appropriate:

-   [An Environmental Health and Safety professional]{.underline} who is
    certified in Industrial Hygiene (ABIH) with experience in Mold Risk
    Assessment and abatement.

-   [A Licensed Engineer/Contractor (PE)]{.underline} having sufficient
    experience in Water Intrusion and Ventilation; ***See Section I.
    Appendix II: Guidelines for Selecting Outsource Consultants and
    Contractors*;**

-   [Leased-space administrator/ manager (tenant
    representative)]{.underline} for the area effected by the WIMM
    incident;

-   [Specialized consultant or Physician]{.underline} as may be
    necessary for successful completion of WIMM program related work;
    ***See Section I. Appendix II: Guidelines for Selecting Outsource
    Consultants and Contractors*;**

-   [A Public Affairs or Media Relations specialist]{.underline} for any
    WIMM incidents that have the potential for being "newsworthy" based
    on size, location, patient exposures, etc*.*

-   [A representative of Labor/ Management]{.underline}- liaison with
    staff for communication;

-   [Other members designated by the WIMM Program management
    team]{.underline} as may be necessary for successful completion of
    WIMM Program related work.

**3.4 WIMM Program Team Responsibilities**

The WIMM Program Team, as a whole, should be responsible for:

A.  Familiarity with and understanding of the WIMM Program Procedures
    and support individual roles and responsibilities;

B.  Selection of a project members to facilitate implementation of the
    WIMM Program Procedures, recordkeeping, coordinate staff and
    consultant tasks, ensure regulatory compliance and communication of
    progress with team members and facility staff;

C.  Ensuring that all WIMM Program incident response personnel
    understand and are able to conduct an initial WIMM assessment and
    notification procedures for appropriate response actions. (***See
    Section I. Appendix III Assessment Guidelines and Checklist***);

D.  Ensuring that all WIMM Program incident response personnel are
    properly trained in the respective safety protocols and procedures.
    All personnel requiring personal protection equipment shall comply
    with regulatory training, fitting and medical examination;

E.  Identifying professional guidelines, publications and standards as
    approved methods. (***See Section I. Appendix IV WIMM Program
    References***); and,

F.  Determining the WIMM patient risk category, and proper
    implementation of the corresponding work practices. Review work
    periodically, and adjust the risk category as is appropriate during
    the WIMM Program related work. Use the Infection Control Risk
    Assessment Form (ICRA) for documentation purposed **(*See Section II
    Appendix I: ICRA and Section III. Appendix I Infection Control Risk
    Assessment Form).***

***Section I. Appendix I -- WIMM Program Definition of Terms***

**Acceptable level of moisture-** the level of moisture in a
material**,** or in a contained area that is normally present, and that
would not promote mold growth.

**Air** **Movers**- mechanical enhancement of water evaporation in
material drying process.

**Air Sampling**- the collection and analysis to identify airborne
contaminates and bioaerosols.

**Bioaerosol**- airborne fungi or bacteria, including associated
compounds.

**Biocide-** a chemical that can kill living organisms.

**Boroscope**- a long and thin rod-like optical device used to visually
inspect normally inaccessible areas such as spaces within walls and
inside duct.

**Bulk Sampling**- collection of a representative amount of a material
with subsequent analysis to determine the presence or quantity of mold
or bacteria.

**Dehumidification**- the process of reducing the moisture (water)
content of air.

**Engineering Controls**- methods of controlling exposures by modifying
the source or reducing the quantity released into the work area.

**Evaporation**-- the process whereby liquid is changed to a vapor or
gas.

**HEPA**- High Efficiency Particulate Arrestor. Filter that is 99.97%
efficient for the collection of 0.3 micron particles.

**Humidity**- weight of water vapor per unit weight of dry air.

**Intrusion**- entry of a material or substance into an area in which
the substance or material was not previously present.

**Microbial growth** -- proliferation of mold that is visible.

**Moisture** **Meter**- instrument used to provide direct reading of
moisture levels in building materials.

**Mold** - are a group of organisms that belong to the kingdom Fungi.
For the purposes of this document, the terms fungi and mold can be used
interchangeably. There are over 20,000 species of mold.

**Negative air pressure differential**- air pressure in an area that is
less than that of an adjacent area, resulting in air being drawn from
the high to low pressure area.

**Organic Matter**- compounds or materials that contain carbon and
support the growth of mold (paper, dust, soil, wood, cellulose, etc.).

**Patient Risk Group-** a group of patients with specific diagnosis or
immune state that predispose them to potentially increased risks due to
specific mold or water intrusion hazards.

**Readily available** -- obtainable without much difficulty so that
immediate response can be performed.

**Remediation** -- correct or repair so that a safe and healthy
environment is present.

**Respirator-** a device to prevent the inhalation of harmful
contaminants.

**Response-** evaluation and remediation activities implemented to
protect people and property when water intrusion or mold growth
incidents occur.

**Response Equipment**- machinery, instruments, supplies used to support
engineering control measures.

**Restoration-** return to original or usable and functioning condition.

**Salvageable** - can be sufficiently cleaned and re-used.

**Sealed** **bag**- an airtight and water proof bag typically sealed
with duct tape.

**Wipe Sampling-** use of adhesive, swab or other appropriate means to
collect a sample from the surface of a building material or object to
identify mold or fungus.

***Section I. Appendix II -* *Guidelines for Selecting Outsource
Consultants and Contractors***

\[NOTE: Most facility-based operations have adequate capacity and staff
to address typical water intrusion and mold management projects.
However, the decision to utilize local resources is based on site
specific factors such as staff capabilities and availability of
equipment and other resources. In specific instances where facility
management have made the determination to outsource water intrusion and
mold management services these guidelines describe the types of
providers that should be considered. The list of providers has been
categorized into areas of service and expertise. In such instances where
outsource service providers are limited or not available geographically,
this guideline has included qualifications and/or certifications that
are recommended.\]

When retaining the services of any professional or contractor, ensure
that they have adequate experience and the appropriate certifications
and licensure. Ask for and check references regarding type and size of
completed jobs.

Consultants should have both Professional Liability and Errors and
Omission coverage with limits no less than One Million Dollars
(\$1,000,000.00). Contractors should have: (a) Worker's Compensation at
levels required by applicable state law for all employees working on the
Project and employer's liability insurance with limits of not less than
Five Hundred Thousand Dollars (\$500,000.00) per occurrence; (b)
Commercial General Liability insurance with an occurrence limit of not
less than One Million Dollars (\$1,000,000), which includes the
following types of coverage: underground hazards, personal injury
liability and independent contractors; and (c) Commercial automobile
liability insurance (bodily injury and property damage) for all owned,
hired and non-owned vehicles and equipment of not less than Five Hundred
Thousand Dollars (\$500,000.00) combined single limit.

Preferred consultants and/or contractors that are retained should have
enough experience to express proficient knowledge and provide the
services of qualified staff that are licensed and/or certified with one
or more of the following credentials:

**[Consultants]{.underline}**

There is no single designation, license, or certification that qualifies
an individual to provide water restoration or mold/microbial assessment
services. The term commonly used in the industry of someone able to
serve in the capacity of providing these types of consulting services is
an Indoor Environmental Professional (IEP). Few societies have the legal
authority to withdraw a license when a member behaves in an
unprofessional or unjustified fashion. Therefore all such licenses,
designations, and certifications must all be viewed cautiously.

The IEP is an individual who is qualified by knowledge, skill,
education, training and/or experience to perform assessment of microbial
ecology of property systems, create a sampling strategy, sample indoor
environment, interpret laboratory data and establishing a scope of work
to restore areas to pre-event condition. Many IEPs possess technical
degrees or professional credentials in industrial hygiene (CIH), medical
and health sciences, biology, microbiology, mycology, public health,
environmental science, toxicology, building science, or engineering. It
is highly recommended that individuals with advanced degrees and
certifications also have additional education in industry-related
subjects including but not limited to:

-   Indoor environmental quality (IEQ);

-   water damage restoration;

-   occupational health and safety;

-   environmental monitoring and assessment;

-   construction basics;

-   construction failure;

-   building science;

-   mechanical systems operation and maintenance;

-   mechanical systems testing and remediation; and,

-   mold remediation.

**[Contractors]{.underline}**

-   ***Water Intrusion Response/Damage Restoration*** -- Rapid response
    to water intrusion and restoration of structures and contents should
    be performed by a qualified (certified) restoration specialist. This
    type of certification is offered by the IICRC and includes
    completing educational competencies for the cleaning and restoration
    of water damaged structures and articles. It is recommended that the
    contractor be a member with the Association of Specialists in
    Cleaning and Restoration (ASCR), which is a non-profit affiliation
    of restoration and cleaning professional(s) who set and promote
    industry standards for water cleanup and restoration.

-   ***Mold Growth Assessment and Remediation*** -- Several
    Organizations have begun offering certifications for supervisors
    and/or workers involved in mold remediation. These certifications
    are generally related specifically to mold or microbial remediation.
    They do not always satisfy legal requirements for worker training
    under OSHA Hazard Communication Standard 29 CFR 1910.1200 or
    Cal/OSHA CCR Title 8 Section 5194.

> The following organizations offer certifications pertaining directly
> with mold remediation. All contractors should work in conjunction with
> an Indoor Environmental Professional (i.e. CIH, QEP, etc.). The
> information provided below is a summary and does not represent a
> complete listing of requirements for the various certifications. The
> organizations should be contacted directly for a complete list of
> requirements to support their certifications.
>
> ***American Indoor Air Quality Council*** (AmIAQ):
> [www.iaqcouncil.org](http://www.iaqcouncil.org/)
>
> The American IAQ Council offers the Certified Mold Remediation
> Supervisor (CMRS) Certification. In order to qualify, the applicant
> must demonstrate experience, attend class, and pass a written
> examination.
>
> ***Indoor Air Quality Association*** (IAQA):
> [www.iaqa.org](http://www.iaqa.org/)
>
> The IAQA offers the Certified Mold Remediator (CMR) certification. CMR
> is a supervisor or manager level certification. In order to qualify,
> the applicant must demonstrate experience, attend a three-day class,
> and pass a written examination. The IAQA also offers a two-day Mold
> Remediation Worker training class that does not include certification
> testing.
>
> ***Institute of Inspection, Cleaning and Restoration Certification***
> (IICRC): [www.iicrc.org](http://www.iicrc.org/)
>
> The IICRC offers the Applied Microbial Remediation Technician (AMRT)
> as a basic certification and the Applied Microbial Remediation
> Specialist (AMRS) as an advanced certification. The AMRT certification
> requires no work experience, but does require the applicant to have
> attended class, pass an exam, and successfully complete the IICRC
> Water Restoration Technician (WRT) certification. The AMRS
> certification requires the applicant be an AMRT for a period of one
> year, demonstrate experience in mold remediation and have their Health
> and Safety Technician (HST) certification, or other approved forms of
> health and safety training.
>
> ***National Air Duct Cleaners Association*** (NADCA):
> [www.nadca.org](http://www.nadca.org/)
>
> The National Air Duct Cleaners Association (NADCA) began a program to
> certify professionals in the air duct cleaning field in November of
> 1995. Since then, more than 1000 contractors have passed the [NADCA
> exam](http://www.nadca.com/certification/apply_for_exam.asp) and have
> been [certified](http://www.nadca.com/certification/certification.asp)
> as \"Air System Cleaning Specialists\". Certification is obtained by
> passing a NADCA certification examination.  

**[Analytical Services]{.underline}**

The AIHA Environmental Microbiology Laboratory Accreditation Program
(EMLAP) is specifically for labs identifying microorganisms commonly
detected in air, fluids, and bulk samples during indoor air quality
studies. The EMLAP is designed specifically for laboratories involved in
analyzing microbiological samples to evaluate exposures in a variety of
workplaces. Participation assists the laboratory in maintaining high
quality standards. When a laboratory enters EMLAP, it is required to
participate in the AIHA Environmental Microbiology Laboratory
Proficiency Analytical Testing (EMPAT). Laboratories must achieve and
maintain a proficient rating in EMPAT. Any laboratory providing mold or
microbiological analytical services should be accredited by the American
Industrial Hygiene Association (AIHA). A listing of laboratories
participating in the AIHA Program can be found at
[www.aiha.org/LaboratoryServices/html/lists/htm](http://www.aiha.org/LaboratoryServices/html/lists/htm)
.

***Section I. Appendix III - Assessment Guidelines and Checklist***

A thorough assessment of water intrusion and potential mold growth is
important in ensuring that a safe workplace and environment of care are
maintained, and in determining appropriate response actions and remedial
strategies. A visual inspection is the most important initial step in
identifying a possible mold problem. This should include determining the
source of any moisture intrusion, identifying visible mold, determining
the extent of mold growth and the level of risk. Generally, identifying
the moisture source is the key to solving a mold problem. Any water
intrusion represents the potential for mold growth.

An assessment is typically performed:

-   In response to employee indoor air quality concerns potentially
    related to the presence of mold;

-   In response to reports of moldy, musty odors;

-   In response to reports of visible mold;

-   In response to known or suspected water intrusion events; and,

-   As part of proactive inspections to identify mold contamination.

[Site Assessment]{.underline}

When conducting a visual inspection and site assessment the following
should be included, when applicable:

-   [A visual inspection for visible mold and/or moisture
    intrusion]{.underline}. The amount or area impacted or affected by
    mold or water intrusion occurrence. Ceiling tiles, gypsum wallboard
    (sheetrock), cardboard, paper, and other cellulosic surfaces should
    be thoroughly inspected. Items with mold growth or damaged by water
    should be cleaned or disposed of in accordance with guidelines in
    the Response Section.

-   [An evaluation of potential sources of moisture
    intrusion]{.underline} (roof leaks, leaks around windows, pipe
    leaks, sewage leaks) Actions to stop water intrusion should be
    implemented as soon as feasible. Water intrusion from sewer leaks
    and backups require special cleanup procedures.

-   [A visual inspection for moisture associated with
    condensation]{.underline}.

-   [An evaluation of the potential for hidden mold]{.underline} - see
    Hidden Mold

-   [If mold is identified, determine the extent of mold]{.underline}
    present (i.e. less than 10 square feet, 10-100 square feet, more
    than 100 square feet). The extent of mold growth is a key factor in
    determining remediation engineering control and PPE requirements.

-   [If moisture intrusion is identified, determine how long materials
    have been wet]{.underline} (48 to 72 hours is a frequent cut-off
    criterion). Materials wet without attempts to dry them for longer
    than 48 or 72 hours should generally be treated as if mold growth is
    present. In colder climates this time duration may be relaxed.

-   [Determining if water damaged items are salvageable and the level of
    cleaning required.]{.underline}

-   [Predetermination of steps and resources needed for restoration of
    sensitive or irreplaceable items (e.g. outsourced restoration/drying
    services).]{.underline}

-   [Site ventilation systems should also be visually checked for water
    accumulation, wetted filters, damp room conditions and equipment
    cleanliness]{.underline}. The condensation drain pans should also be
    inspected to ensure proper drainage. Inspect coils, drain pans and
    associated duct for stagnant water and visible slime/mold. Since
    mold growth in an air stream can be a potentially significant
    problem any mold growth in an HVAC system, particularly the supply
    ductwork, must be addressed promptly.

-   [Measure of relative humidity levels to determine if it could be a
    contributing factor.]{.underline} Relative humidity levels should be
    less than 60% in an indoor environment. High relative humidity may
    be present at condensation sites where the surface temperature is
    significantly lower than the area air temperature (window sills,
    poorly insulated walls, utility chases, etc).

-   [Determine if building occupants have reported musty or moldy
    odors.]{.underline} Odors can be a key indicator of mold growth, but
    it is important to remember that perceptions can differ from person
    to person.

-   [Determine if building occupants have reported health problems.
    Coordinate with the occupational health clinic]{.underline}. See
    Medical Consultation

-   [Investigate if the site has been recently remodeled or new
    processes implemented.]{.underline} Renovation may have disturbed
    previously hidden mold, or resulted in accidental water intrusion.

-   Determination the capacity for facility operations staff
    (housekeeping/maintenance) to mitigate the site.

[Tools for Conducting Assessments]{.underline}

The use of equipment such as a boroscope to view spaces in ductwork or
behind walls, or a moisture meter to detect moisture in building
materials, may be helpful in identifying hidden sources of fungal growth
and the extent of water damage.

Moisture meters may be helpful for measuring the moisture content in a
variety of building materials following water damage. They can also be
used to monitor the process of drying damaged materials. Moisture meters
can be used on materials such as carpet, wallboard, wood, brick, and
concrete.

If a moisture meter is used, it should allow the user to determine
percent moisture content. Instrument measurements of impacted materials
should be evaluated by comparing moisture measurements from similar
materials from non-impacted areas. This type of evaluation will take in
account variations in climatic and building interior conditions. There
are two types of instruments used in determining material moisture
content; intrusive and non-intrusive. Intrusive meters require the user
to penetrate the material with a 2-pronged probe which will yield the
moisture content by percent but leaves markings that may require
patching. Moisture gradients (differential moisture) with depth can be
obtained based on probe length, which may be beneficial when inspecting
wall systems. Non-intrusive instruments can provide moisture content on
most materials but are usually limited to a penetration depth of a few
inches. However, there are more expensive (high-end) non-intrusive
meters emerging on the market that will obtain greater depths.

[Assessment -- Consider the Potential for Hidden Mold]{.underline}

In some cases, indoor mold growth may not be obvious, and therefore it
is important to consider the potential for hidden mold when conducting
inspections. It is possible that mold may be growing on hidden surfaces,
such as the back side of dry wall, wallpaper, or paneling, the top of
ceiling tiles, the underside of carpets and pads, etc.

Possible locations of hidden mold can include pipe chases and utility
tunnels (with leaking or condensing pipes), walls behind furniture
(where condensation forms), condensate drain pans inside air handling
units, porous thermal or acoustic liners inside ductwork, or roof
materials above ceiling tiles (due to roof leaks or insufficient
insulation). Some building materials, such as dry wall with vinyl
wallpaper over it or wood paneling, may act as vapor barriers, trapping
moisture underneath their surfaces and thereby providing a moist
environment where mold can grow.

You may suspect hidden mold if a building smells moldy, but you cannot
see the source, or if you know there has been water damage and building
occupants are reporting health problems. Investigating hidden mold
problems may be difficult and will require caution when the
investigation involves disturbing potential sites of mold growth---make
sure to use PPE. For example, removal of wallpaper can lead to a release
of spores from mold growing on the underside of the paper. Once hidden
mold is discovered, efforts should be made to control the release of
mold spores during the investigation phase and revise your remediation
plan to account for the total area affected by mold growth.

[Assessment -- Hazardous Materials]{.underline}

If asbestos-containing materials (ACM) or lead-based paint (LBP) have
been impacted by water intrusion or mold growth additional requirements
for removal and disposal are necessary. If ACM/LBP is known or suspected
to have been impacted, the Asbestos Program Manager should be included
as a WIMM team member. The clean-up, repair, removal, and disposal of
ACM/LBP must be performed by a qualified asbestos abatement contractor
in accordance with the VHA Policy, Federal, State, and local asbestos
abatement regulations. Employees must be properly trained and licensed
for the inspection and removal of ACM/LBP.

***Section I. Appendix IV: WIMM Program References***

**Rules and Regulations:\
**

*Respiratory Protection Program*, 29 CFR 1910.134, Occupational Safety
and Health Standards for General Industry, U.S. Department of Labor

*Personal Protective Equipment*, 29 CFR 1910.132 Occupational Safety and
Health Standards for General Industry, U.S. Department of Labor

*Hazard Communication*, 29 CFR 1910.1200, Occupational Safety and Health
Standards for General Industry, U.S. Department of Labor

*Hazard Communication*, California Code of Regulations (CCR) Title 8
Section 5194, California General Industry Safety Orders, California
Department of Industrial Relations.

**Publications:**

*A Guide for Mold Remediation in Schools and Commercial Buildings*, U.S.
Environmental Protection Agency, 2001.

*Bioaerosols: Assessment and Control*, American Conference of
Governmental Industrial Hygienists, 1999.

*Field Guide for Determination of Biological Contaminants in
Environmental Samples*, American Industrial Hygiene Association, 1996.

## *Guidelines on Assessment and Remediation of Fungi in Indoor Environments,* New York City Department of Health, 1993.

*Mold: A Guide for Clinicians*. Storey E, Dangman K, Schenck P, Yang C,
Hodgson M. University of Connecticut
**[http://www.oehc.uchc.edu/clinser/MOLD%20GUIDE.pdf](http://www.oehc.uchc.edu/clinser/MOLD GUIDE.pdf)**
(November 2004).

*Report of Microbial Growth Task Force,* American Industrial Hygiene
Association Press, May 2001.

*Standard and Reference Guide for Professional Water Damage
Restoration*, International Institute of Inspection, Cleaning and
Restoration Certification (S500) Second Edition, 1999.

*Standard for Professional Mold Remediation*, International Institute of
Cleaning and Restoration Certification (S520), First Edition 2003.

# 

# 

# INSERT TAB HERE FOR SECTION II:

**Water Intrusion Procedures**

**SECTION II: Water Intrusion**

1.0 Water Intrusion Specific Procedures Overview

The procedures in this section provide a step-by-step process for
responding to water intrusion incidents. The process is broken down into
8 essential steps:

1.  Report of water intrusion incidents to a member of the WIMM Program
    Management Team

2.  Assessment of specific reported or identified water intrusion
    incident(s)

3.  Determination of Patient Risk Group from 4 potential risk categories

4.  Determination of Class of Response and corresponding Work Practices

5.  Implementation and Completion of Response Actions

6.  Post initial response assessment

7.  Follow-up investigation

8.  Close-out documentation

**1.1 Step One -- Water Intrusion Reporting**

Whenever visible water intrusion is identified or other conditions (e.g.
warped flooring, tile or drywall) indicate that a potential water
intrusion exists, it should be reported to a member of the WIMM Program
Management Team ***(See Section I paragraph 3.3)***. Additionally, the
following water intrusion incidents should be reported:

-   Sewage release inside building;

-   Any gray water or clean water release that cannot be easily managed
    or that complete clean up and drying cannot be completed [within 1
    hour]{.underline} of when the incident initially occurred; and,

-   Any reoccurring water intrusion incident associated with damaged
    pipes, roofing material, or other exterior building barriers.

Proper reporting will enable the Program Lead to ensure appropriate
steps can be taken to assess and respond to incidents. The Program Lead
should ensure that staff who typically receive reports of identifiable
water intrusion are aware of the reporting requirements. This should
include the Safety Manager, Maintenance Manager, Engineer, Infection
Control, and COTR.

***Special Considerations for Water Intrusion Incidents:***

The WIMM Program Management Team should establish a communication
network that allows facility occupant to promptly report water intrusion
occurrences. The WIMM Program Management Team must have the ability to
determine the water intrusion work practice activity level using the
appropriate risk assessment and work practice matrix. The WIMM Program
Response Team must be provided with enough information to prepare and
have the ability to respond within [one hour of the notification
call]{.underline}. The initial response team must have the proper
training, equipment, Personal Protective Equipment (PPE) and supplies
available to address all types of water intrusion occurrences.

**NOTE: - Prompt reporting is essential to assure a rapid response and
response time is crucial. Each shift should have an immediate response
team that is capable of selecting and providing the appropriate initial
response methods.**

**1.2 Step Two: Water Intrusion Assessment**

There are three categories of potential water intrusion: Category I
"Clean" water, Category II "Gray" water, and Category III "Black" water.
Each water type requires different responses and levels of protection
for response team members. Water intrusion associated with barriers
(walls or ceilings) exceeding 48 hours must include full assessment for
visible mold growth for the enclosed spaces (e.g., hidden wall cavity)
that will be exposed upon barrier removal. Moldy odor (mVOCs) with no
visible mold should be considered indicative of mold growth, requiring a
determination for additional precaution measures from the M1-M2 category
based on the patient risk group. Precautions should be implemented to
prevent the transfer of mold odor to adjacent areas during clean up and
drying of the work site. Following worksite drying, HEPA vacuuming
should be conducted when mold odor occurs without visible mold growth.

**Category I: "Clean" Water Intrusion**

> Clean water intrusion sources result from drinking (potable) water
> supply line leaks, or sink, shower, water closet and bath overflows,
> rainwater entering the building through roof, ceiling, window, or door
> sealant leaks, HVAC system condensate, fire sprinklers or any other
> uncontaminated source of water.
>
> **Category II: "Gray" Water Intrusion**
>
> Gray water sources are derived from equipment process water,
> sink/bath/or shower drain leaks, dishwashers, and steam sterilizers.
> Any source of water that has not been contaminated by excrement (fecal
> matter) can be also be considered gray water.
>
> **Category III: "Black" Water Intrusion**
>
> Black water sources contain or have been contaminated with fecal
> matter (sewage) and are derived from toilet or sewer drainpipes.

**1.3 Step Three: Patient Risk Assessment:**

# 

# Patient Risk Group

Use the table below as a general guideline to identify the patient
population(s) potentially impacted by the water intrusion. Service units
providing patient care support may also be considered a risk group. The
intent of determining the patient risk groups is to protect immune
deficient patients that are occupying the affected area and any adjacent
area(s) where the response action is planned.

Additional factors to consider when determining the patients' risk
include: the immune status of the patient(s), the degree of invasive
procedures being conducted with the patient and/or the potential length
of exposure time in or adjacent to the affected area (for example the
comparatively greater exposure time in the hospital setting vs.
outpatient care setting).

**If more than one risk group may be affected, select the higher risk
group.**

+---------+--------------+-----------------+-------------------------+
| **Low   | **Medium     | **High Risk**   | **Highest Risk**        |
| Risk**  | Risk**       |                 |                         |
+---------+--------------+-----------------+-------------------------+
| -       | -            | -   CCU         | -   Areas providing     |
|  Office |   Cardiology |                 |     care to             |
|         |              | -   Emergency   |     immuno-compromised  |
|   Areas | -   Echo-    |     Room        |     patients            |
|         | cardiography |                 |     (inpatient)         |
| -       |              | -   Labor &     |                         |
|   Admin | -            |     Delivery    | -   Burn Unit           |
|     or  |    Endoscopy |                 |                         |
|     MD  |              | -               | -   Cardiac Cath Lab    |
|         | -   Nuclear  |    Laboratories |                         |
| offices |     Medicine |     (specimen)  | -   Central Sterile     |
|         |              |                 |     Supply              |
| -       | -   Physical | -   Newborn     |                         |
|  Confer |     Therapy  |     Nursery     | -   Intensive Care      |
| ence/Ed |              |                 |     Units (newborn,     |
| ucation | -            | -   Outpatient  |     pediatric and       |
|         |    Radiology |     Surgery     |     adult)              |
|   Rooms |     / MRI    |                 |                         |
|         |              | -   Pediatrics  | -   Medical Unit        |
|         | -   Minor    |     (In and     |     (inpatient)         |
|         |              |     Out)        |                         |
|         |   Outpatient |                 | -   Negative Pressure   |
|         |              | -   Pharmacies  |     Isolation Rooms     |
|         |    Procedure |     that do     |     (inpatient)         |
|         |     Rooms    |     com         |                         |
|         |              | pounding/mixing | -   Oncology (in and    |
|         | -   Ob-Gyn   |                 |     out patient)        |
|         |              | -   Post        |                         |
|         | -            |     Anesthesia  | -   Operating Rooms,    |
|         |   Outpatient |     Care Unit   |     including C-Section |
|         |     Pharmacy |                 |     Rooms               |
|         |              | -   Surgical    |                         |
|         | -   Primary  |     Units       | -   Infusion/dialysis   |
|         |     Care     |     (inpatient) |     clinics             |
|         |              |                 |                         |
|         | -   Medical  | -   Respiratory |                         |
|         |     and      |     Therapy     |                         |
|         |     Surgical |                 |                         |
|         |     sub      |                 |                         |
|         | -specialties |                 |                         |
+---------+--------------+-----------------+-------------------------+

The patient risk assessment and the water intrusion assessment should be
completed initially when the water intrusion incident occurs and
reviewed periodically during the remediation phase. Adjust the risk
category, as is appropriate, during the WIMM Program related work. Use
the Infection Control Risk Assessment Form (ICRA) to document the
patient risk group and corresponding work practices selected for
remediation. **(*See Section II Appendix I: ICRA)***.

**1.4 Step Four: Determine the Class of Response:**

Based upon the Water Intrusion Assessment performed (Step Two) and the
Patient Risk Assessment (Step Three), determine the class of response (W
1-3) that will be utilized to respond to the water intrusion incident.
Use the matrix below to identified the responses for water intrusion
(See *Paragraph 1.4.1)*

NOTE: VHA employees and contractors performing water intrusion responses
must receive training that includes:

-   the health hazards of contaminant being remediated (i.e. mold,
    biological hazards, medical waste);

-   additional hazards and contaminants present at the site (electrical,
    asbestos, lead, confined space, etc.)

-   proper use of personnel protective equipment; and,

-   remediation methods, and methods and means to minimize exposure.

In addition, if respiratory protection is assigned, training that
satisfies the requirement of OSHA Respiratory Protection Standards
(29CFR1910.134) must be provided.

**1.4.1 Step Five: Water Intrusion Response Procedures:**

There are 3 classes of response procedures that can be used to manage
water intrusion. The selection of the procedure is based on the type of
water intrusion (Category I, Category II and Category III) and the
patient risk group(s). The intent of the water intrusion response
activities is to recover water and promote drying of the worksite to
maintain the health and safety of facility staff and patients minimize
the mold growth and damage to building components.

To determine the appropriate WIMM Response Procedures, match the water
intrusion type (Category I, Category II, and Category III) with the
Patient Risk Group (Low, Medium, High, or Highest). Use the *Response
Procedures for Water Type Matrix* below to determine the Class of
Procedures to follow. The WIMM Response Procedures are predicated on the
length of time the water intrusion has existed and the absence of
visible mold growth or odor (\< 48 hrs. or \> 48 hrs without mold
growth). The specific procedures for each water type are found in
***Section II. Appendix II through IV.***

+-----------------+-----------------+----------------+----------------+
|                 | ***Response     |                |                |
|                 | Procedures For  |                |                |
|                 | Water Type      |                |                |
|                 | Matrix***       |                |                |
+-----------------+-----------------+----------------+----------------+
| **Patient Risk  | Category I      | Category II    | Category III   |
| Group**         |                 |                |                |
|                 | (Clean Water)   | (Gray Water)   | (Black Water)  |
+-----------------+-----------------+----------------+----------------+
| Low Risk        | W-1             | W-2            | W-3            |
+-----------------+-----------------+----------------+----------------+
| Medium Risk     | W-1             | W-2            | W-3            |
+-----------------+-----------------+----------------+----------------+
| High Risk       | W-1             | W-3            | W-3            |
+-----------------+-----------------+----------------+----------------+
| Highest Risk    | W-2             | W-3            | W-3            |
+-----------------+-----------------+----------------+----------------+

**2.0 Step Six: Close-out Investigation**

After completion of restoration activity, a follow-up investigation
should be conducted to assure effective restoration and identify any
additional WIMM activities that may need to occur. It is important to
fully document all corrective measures that were completed. To closeout
each incident, the WIMM Program Leader should ensure the following are
documented:

The close out investigation should include:

-   Review completion of risk assessment and response procedures on the
    ICRA form;

-   Visual inspection and restoration of the worksite and building
    components;

-   Interview of occupants (health symptoms) or patient care (IC);

-   Perceptions of odors and air quality; and,

-   Additional updates to staff as necessary.

**3.0 Step Seven: Process Evaluation**

A process evaluation should be conducted following project close out for
WIMMS program improvement.

-   Methods to reduce impact on patient or staff operations as a result
    of the response;

-   Recommendations for additional WIMMS response staff training; and,

-   Recommendations for WIMMS process flow and worksite coordination.

All close-out documentation should be retained for no longer than 7
years, unless legal or regulatory requirements mandate a longer
retention period.

# *Section II. Appendix I -* Infection Control Risk Assessment Form

+---+---+-----------------------------+---+---+---+----------------------+
| T |   |                             |   |   |   | Permit No:           |
| y |   |                             |   |   |   |                      |
| p |   |                             |   |   |   |                      |
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| A |   |                             |   |   |   |                      |
| : |   |                             |   |   |   |                      |
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| d |   |                             |   |   |   |                      |
| M |   |                             |   |   |   |                      |
| o |   |                             |   |   |   |                      |
| l |   |                             |   |   |   |                      |
| d |   |                             |   |   |   |                      |
| * |   |                             |   |   |   |                      |
| * |   |                             |   |   |   |                      |
+---+---+-----------------------------+---+---+---+----------------------+
| L |   |                             |   |   | P |                      |
| o |   |                             |   |   | r |                      |
| c |   |                             |   |   | o |                      |
| a |   |                             |   |   | j |                      |
| t |   |                             |   |   | e |                      |
| i |   |                             |   |   | c |                      |
| o |   |                             |   |   | t |                      |
| n |   |                             |   |   | S |                      |
| o |   |                             |   |   | t |                      |
| f |   |                             |   |   | a |                      |
| W |   |                             |   |   | r |                      |
| a |   |                             |   |   | t |                      |
| t |   |                             |   |   | D |                      |
| e |   |                             |   |   | a |                      |
| r |   |                             |   |   | t |                      |
| I |   |                             |   |   | e |                      |
| n |   |                             |   |   | : |                      |
| t |   |                             |   |   |   |                      |
| r |   |                             |   |   |   |                      |
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| n |   |                             |   |   |   |                      |
| o |   |                             |   |   |   |                      |
| r |   |                             |   |   |   |                      |
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| o |   |                             |   |   |   |                      |
| l |   |                             |   |   |   |                      |
| d |   |                             |   |   |   |                      |
| : |   |                             |   |   |   |                      |
+---+---+-----------------------------+---+---+---+----------------------+
| P |   |                             |   |   | E |                      |
| r |   |                             |   |   | s |                      |
| o |   |                             |   |   | t |                      |
| j |   |                             |   |   | i |                      |
| e |   |                             |   |   | m |                      |
| c |   |                             |   |   | a |                      |
| t |   |                             |   |   | t |                      |
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| o |   |                             |   |   | d |                      |
| o |   |                             |   |   | D |                      |
| r |   |                             |   |   | u |                      |
| d |   |                             |   |   | r |                      |
| i |   |                             |   |   | a |                      |
| n |   |                             |   |   | t |                      |
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| o |   |                             |   |   | n |                      |
| r |   |                             |   |   | : |                      |
| : |   |                             |   |   |   |                      |
+---+---+-----------------------------+---+---+---+----------------------+
| R |   |                             |   |   | P |                      |
| e |   |                             |   |   | e |                      |
| s |   |                             |   |   | r |                      |
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| n |   |                             |   |   | : |                      |
| g |   |                             |   |   |   |                      |
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| o |   |                             |   |   |   |                      |
| r |   |                             |   |   |   |                      |
| k |   |                             |   |   |   |                      |
| : |   |                             |   |   |   |                      |
+---+---+-----------------------------+---+---+---+----------------------+
| S |   |                             |   |   | T |                      |
| i |   |                             |   |   | e |                      |
| t |   |                             |   |   | l |                      |
| e |   |                             |   |   | e |                      |
| s |   |                             |   |   | p |                      |
| u |   |                             |   |   | h |                      |
| p |   |                             |   |   | o |                      |
| e |   |                             |   |   | n |                      |
| r |   |                             |   |   | e |                      |
| v |   |                             |   |   | : |                      |
| i |   |                             |   |   |   |                      |
| s |   |                             |   |   |   |                      |
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| r |   |                             |   |   |   |                      |
| : |   |                             |   |   |   |                      |
+---+---+-----------------------------+---+---+---+----------------------+
| * | * | **WATER INTRUSION: \< 48    |   | * | * | **INFECTION CONTROL  |
| * | * | hours or \> 48 without      |   | * | * | RISK GROUP**         |
| Y | N | mold**                      |   | Y | N |                      |
| E | O |                             |   | E | O |                      |
| S | * |                             |   | S | * |                      |
| * | * |                             |   | * | * |                      |
| * |   |                             |   | * |   |                      |
+---+---+-----------------------------+---+---+---+----------------------+
|   |   | CATEGORY I: Clean Water     |   |   |   | GROUP 1: Low Risk    |
+---+---+-----------------------------+---+---+---+----------------------+
|   |   | CATEGORY II: Gray Water     |   |   |   | GROUP 2: Medium Risk |
+---+---+-----------------------------+---+---+---+----------------------+
|   |   | CATERGORY III: Black Water  |   |   |   | GROUP 3: High Risk   |
+---+---+-----------------------------+---+---+---+----------------------+
|   |   |                             |   |   |   | GROUP 4: Highest     |
|   |   |                             |   |   |   | Risk                 |
+---+---+-----------------------------+---+---+---+----------------------+
| * | * | **AMOUNT OF MOLD            |   | * | * | **INFECTION CONTROL  |
| * | * | IDENTIFIED**                |   | * | * | RISK GROUP**         |
| Y | N |                             |   | Y | N |                      |
| E | O |                             |   | E | O |                      |
| S | * |                             |   | S | * |                      |
| * | * |                             |   | * | * |                      |
| * |   |                             |   | * |   |                      |
+---+---+-----------------------------+---+---+---+----------------------+
|   |   | Less than 10 square feet:   |   |   |   | GROUP 1: Low Risk    |
+---+---+-----------------------------+---+---+---+----------------------+
|   |   | 10 - 30 square feet:        |   |   |   | GROUP 2: Medium Risk |
+---+---+-----------------------------+---+---+---+----------------------+
|   |   | 30-100 square feet:         |   |   |   | GROUP 3: High Risk   |
+---+---+-----------------------------+---+---+---+----------------------+
|   |   | Greater than 100 square     |   |   |   | GROUP 4: Highest     |
|   |   | feet                        |   |   |   | Risk                 |
+---+---+-----------------------------+---+---+---+----------------------+
|   |   | HVAC System                 |   |   |   |                      |
+---+---+-----------------------------+---+---+---+----------------------+
| * |   | 1.  Control site access;    |   | 5 |   |                      |
| * |   |     Identify and remove     |   | . |   |                      |
| W |   |     source of water         |   |   |   |                      |
| - |   |     intrusion               |   |   |   |                      |
| 1 |   |                             |   | D |   |                      |
| * |   | 2.  Contain water to        |   | e |   |                      |
| * |   |     limited area.           |   | t |   |                      |
|   |   |                             |   | e |   |                      |
| * |   | 3.  Protect components,     |   | r |   |                      |
| * |   |     furnishings, etc from   |   | m |   |                      |
| D |   |     direct contact with     |   | i |   |                      |
| a |   |     water.                  |   | n |   |                      |
| t |   |                             |   | e |   |                      |
| e |   | 4.  Extract water from all  |   |   |   |                      |
| * |   |     locations impacted by   |   |   |   |                      |
| * |   |     water intrusion.        |   |   |   |                      |
|   |   |                             |   |   |   |                      |
| * |   |                             |   | a |   |                      |
| * |   |                             |   | c |   |                      |
| I |   |                             |   | t |   |                      |
| n |   |                             |   | i |   |                      |
| i |   |                             |   | o |   |                      |
| t |   |                             |   | n |   |                      |
| i |   |                             |   | s |   |                      |
| a |   |                             |   |   |   |                      |
| l |   |                             |   |   |   |                      |
| * |   |                             |   |   |   |                      |
| * |   |                             |   |   |   |                      |
|   |   |                             |   | t |   |                      |
|   |   |                             |   | o |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | r |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   | m |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   | d |   |                      |
|   |   |                             |   | i |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | t |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | n |   |                      |
|   |   |                             |   | d |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | r |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   | s |   |                      |
|   |   |                             |   | t |   |                      |
|   |   |                             |   | o |   |                      |
|   |   |                             |   | r |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | d |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | m |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | g |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   | d |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | m |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | t |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   | r |   |                      |
|   |   |                             |   | i |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | l |   |                      |
|   |   |                             |   | s |   |                      |
|   |   |                             |   | . |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | 6 |   |                      |
|   |   |                             |   | . |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | D |   |                      |
|   |   |                             |   | i |   |                      |
|   |   |                             |   | s |   |                      |
|   |   |                             |   | c |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | r |   |                      |
|   |   |                             |   | d |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | l |   |                      |
|   |   |                             |   | l |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | u |   |                      |
|   |   |                             |   | n |   |                      |
|   |   |                             |   | s |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | l |   |                      |
|   |   |                             |   | v |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | g |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | b |   |                      |
|   |   |                             |   | l |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | c |   |                      |
|   |   |                             |   | o |   |                      |
|   |   |                             |   | n |   |                      |
|   |   |                             |   | t |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   | n |   |                      |
|   |   |                             |   | t |   |                      |
|   |   |                             |   | s |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | n |   |                      |
|   |   |                             |   | d |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | f |   |                      |
|   |   |                             |   | u |   |                      |
|   |   |                             |   | r |   |                      |
|   |   |                             |   | n |   |                      |
|   |   |                             |   | i |   |                      |
|   |   |                             |   | s |   |                      |
|   |   |                             |   | h |   |                      |
|   |   |                             |   | i |   |                      |
|   |   |                             |   | n |   |                      |
|   |   |                             |   | g |   |                      |
|   |   |                             |   | s |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | p |   |                      |
|   |   |                             |   | r |   |                      |
|   |   |                             |   | o |   |                      |
|   |   |                             |   | m |   |                      |
|   |   |                             |   | p |   |                      |
|   |   |                             |   | t |   |                      |
|   |   |                             |   | l |   |                      |
|   |   |                             |   | y |   |                      |
|   |   |                             |   | . |   |                      |
+---+---+-----------------------------+---+---+---+----------------------+
| * |   | 1.  Control site access;    |   | 7 |   |                      |
| * |   |     Evacuate high-highest   |   | . |   |                      |
| W |   |     risk patients           |   |   |   |                      |
| - |   |                             |   |   |   |                      |
| 2 |   | 2.  Identify and remove     |   | R |   |                      |
| * |   |     source of water         |   | e |   |                      |
| * |   |     intrusion               |   | m |   |                      |
|   |   |                             |   | o |   |                      |
| * |   | 3.  Contain water to        |   | v |   |                      |
| * |   |     limited area.           |   | e |   |                      |
| D |   |                             |   |   |   |                      |
| a |   | 4.  Seal supply and return  |   |   |   |                      |
| t |   |     air vents.              |   |   |   |                      |
| e |   |                             |   |   |   |                      |
| * |   | 5.  Redirect and restrict   |   | s |   |                      |
| * |   |     access to affected      |   | o |   |                      |
|   |   |     areas to minimize cross |   | l |   |                      |
| # |   |     contamination from      |   | i |   |                      |
| # |   |     affected areas.         |   | d |   |                      |
| # |   |                             |   |   |   |                      |
|   |   | 6.  Protect or remove       |   |   |   |                      |
| I |   |     contents in the area    |   |   |   |                      |
| n |   |     from direct contact     |   |   |   |                      |
| i |   |     with water.             |   | m |   |                      |
| t |   |                             |   | a |   |                      |
| i |   |                             |   | t |   |                      |
| a |   |                             |   | t |   |                      |
| l |   |                             |   | e |   |                      |
|   |   |                             |   | r |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | n |   |                      |
|   |   |                             |   | d |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   | x |   |                      |
|   |   |                             |   | t |   |                      |
|   |   |                             |   | r |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | c |   |                      |
|   |   |                             |   | t |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | s |   |                      |
|   |   |                             |   | t |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | n |   |                      |
|   |   |                             |   | d |   |                      |
|   |   |                             |   | i |   |                      |
|   |   |                             |   | n |   |                      |
|   |   |                             |   | g |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | w |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | t |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   | r |   |                      |
|   |   |                             |   | . |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | 8 |   |                      |
|   |   |                             |   | . |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | D |   |                      |
|   |   |                             |   | i |   |                      |
|   |   |                             |   | s |   |                      |
|   |   |                             |   | c |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | r |   |                      |
|   |   |                             |   | d |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
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|   |   |                             |   | r |   |                      |
|   |   |                             |   |   |   |                      |
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|   |   |                             |   | b |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | g |   |                      |
|   |   |                             |   |   |   |                      |
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|   |   |                             |   | r |   |                      |
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|   |   |                             |   | n |   |                      |
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|   |   |                             |   | i |   |                      |
|   |   |                             |   | t |   |                      |
|   |   |                             |   | h |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | E |   |                      |
|   |   |                             |   | P |   |                      |
|   |   |                             |   | A |   |                      |
|   |   |                             |   | - |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | p |   |                      |
|   |   |                             |   | p |   |                      |
|   |   |                             |   | r |   |                      |
|   |   |                             |   | o |   |                      |
|   |   |                             |   | v |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   | d |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | d |   |                      |
|   |   |                             |   | i |   |                      |
|   |   |                             |   | s |   |                      |
|   |   |                             |   | i |   |                      |
|   |   |                             |   | n |   |                      |
|   |   |                             |   | f |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   | c |   |                      |
|   |   |                             |   | t |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | n |   |                      |
|   |   |                             |   | t |   |                      |
|   |   |                             |   | . |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | 1 |   |                      |
|   |   |                             |   | 0 |   |                      |
|   |   |                             |   | . |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | D |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   | t |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   | r |   |                      |
|   |   |                             |   | m |   |                      |
|   |   |                             |   | i |   |                      |
|   |   |                             |   | n |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | c |   |                      |
|   |   |                             |   | t |   |                      |
|   |   |                             |   | i |   |                      |
|   |   |                             |   | o |   |                      |
|   |   |                             |   | n |   |                      |
|   |   |                             |   | s |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | n |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   | d |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   | d |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | t |   |                      |
|   |   |                             |   | o |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | r |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   | m |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   | d |   |                      |
|   |   |                             |   | i |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | t |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | n |   |                      |
|   |   |                             |   | d |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | r |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   | s |   |                      |
|   |   |                             |   | t |   |                      |
|   |   |                             |   | o |   |                      |
|   |   |                             |   | r |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | d |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | m |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | g |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   | d |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | n |   |                      |
|   |   |                             |   | d |   |                      |
|   |   |                             |   | / |   |                      |
|   |   |                             |   | o |   |                      |
|   |   |                             |   | r |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | c |   |                      |
|   |   |                             |   | o |   |                      |
|   |   |                             |   | n |   |                      |
|   |   |                             |   | t |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | m |   |                      |
|   |   |                             |   | i |   |                      |
|   |   |                             |   | n |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | t |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   | d |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | m |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | t |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   | r |   |                      |
|   |   |                             |   | i |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | l |   |                      |
|   |   |                             |   | s |   |                      |
|   |   |                             |   | . |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | U |   |                      |
|   |   |                             |   | s |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | f |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | n |   |                      |
|   |   |                             |   | s |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | f |   |                      |
|   |   |                             |   | o |   |                      |
|   |   |                             |   | r |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | d |   |                      |
|   |   |                             |   | r |   |                      |
|   |   |                             |   | y |   |                      |
|   |   |                             |   | i |   |                      |
|   |   |                             |   | n |   |                      |
|   |   |                             |   | g |   |                      |
|   |   |                             |   | ; |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | i |   |                      |
|   |   |                             |   | f |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | n |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   | c |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   | s |   |                      |
|   |   |                             |   | s |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | r |   |                      |
|   |   |                             |   | y |   |                      |
|   |   |                             |   | . |   |                      |
+---+---+-----------------------------+---+---+---+----------------------+
| # |   | 1.  Control site access,    |   | 7 |   |                      |
| # |   |     Evacuate Medium-Highest |   | . |   |                      |
|   |   |     risk patients           |   |   |   |                      |
| W |   |                             |   |   |   |                      |
| - |   | 2.  Identify and remove     |   | R |   |                      |
| 3 |   |     source of water         |   | e |   |                      |
|   |   |     intrusion               |   | m |   |                      |
|   |   |                             |   | o |   |                      |
|   |   | 3.  Contain water to        |   | v |   |                      |
|   |   |     limited area.           |   | e |   |                      |
|   |   |                             |   |   |   |                      |
|   |   | 4.  Seal supply and return  |   |   |   |                      |
|   |   |     air vents.              |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   | 5.  Redirect and restrict   |   | s |   |                      |
|   |   |     access to affected      |   | o |   |                      |
|   |   |     areas to minimize cross |   | l |   |                      |
|   |   |     contamination from      |   | i |   |                      |
|   |   |     affected areas.         |   | d |   |                      |
|   |   |                             |   |   |   |                      |
|   |   | 6.  Protect and remove      |   |   |   |                      |
|   |   |     contents in the area    |   |   |   |                      |
|   |   |     from direct contact     |   |   |   |                      |
|   |   |     with water.             |   | m |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | t |   |                      |
|   |   |                             |   | t |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   | r |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | n |   |                      |
|   |   |                             |   | d |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   | x |   |                      |
|   |   |                             |   | t |   |                      |
|   |   |                             |   | r |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | c |   |                      |
|   |   |                             |   | t |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | w |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | t |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   | r |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | f |   |                      |
|   |   |                             |   | r |   |                      |
|   |   |                             |   | o |   |                      |
|   |   |                             |   | m |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | l |   |                      |
|   |   |                             |   | l |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | i |   |                      |
|   |   |                             |   | m |   |                      |
|   |   |                             |   | p |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | c |   |                      |
|   |   |                             |   | t |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   | d |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | l |   |                      |
|   |   |                             |   | o |   |                      |
|   |   |                             |   | c |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | t |   |                      |
|   |   |                             |   | i |   |                      |
|   |   |                             |   | o |   |                      |
|   |   |                             |   | n |   |                      |
|   |   |                             |   | s |   |                      |
|   |   |                             |   | . |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | 8 |   |                      |
|   |   |                             |   | . |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | D |   |                      |
|   |   |                             |   | i |   |                      |
|   |   |                             |   | s |   |                      |
|   |   |                             |   | c |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | r |   |                      |
|   |   |                             |   | d |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | l |   |                      |
|   |   |                             |   | l |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | b |   |                      |
|   |   |                             |   | s |   |                      |
|   |   |                             |   | o |   |                      |
|   |   |                             |   | r |   |                      |
|   |   |                             |   | b |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   | n |   |                      |
|   |   |                             |   | t |   |                      |
|   |   |                             |   | , |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | s |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | t |   |                      |
|   |   |                             |   | u |   |                      |
|   |   |                             |   | r |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | t |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   | d |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | m |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | t |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   | r |   |                      |
|   |   |                             |   | i |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | l |   |                      |
|   |   |                             |   | s |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | p |   |                      |
|   |   |                             |   | r |   |                      |
|   |   |                             |   | o |   |                      |
|   |   |                             |   | m |   |                      |
|   |   |                             |   | p |   |                      |
|   |   |                             |   | t |   |                      |
|   |   |                             |   | l |   |                      |
|   |   |                             |   | y |   |                      |
|   |   |                             |   | . |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | 9 |   |                      |
|   |   |                             |   | . |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | D |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   | c |   |                      |
|   |   |                             |   | o |   |                      |
|   |   |                             |   | n |   |                      |
|   |   |                             |   | t |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | m |   |                      |
|   |   |                             |   | i |   |                      |
|   |   |                             |   | n |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | t |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | s |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   | w |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | g |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   | - |   |                      |
|   |   |                             |   | d |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | m |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | g |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   | d |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | h |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | r |   |                      |
|   |   |                             |   | d |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | s |   |                      |
|   |   |                             |   | u |   |                      |
|   |   |                             |   | r |   |                      |
|   |   |                             |   | f |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | c |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | m |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | t |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   | r |   |                      |
|   |   |                             |   | i |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | l |   |                      |
|   |   |                             |   | s |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | w |   |                      |
|   |   |                             |   | i |   |                      |
|   |   |                             |   | t |   |                      |
|   |   |                             |   | h |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | E |   |                      |
|   |   |                             |   | P |   |                      |
|   |   |                             |   | A |   |                      |
|   |   |                             |   | - |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | p |   |                      |
|   |   |                             |   | p |   |                      |
|   |   |                             |   | r |   |                      |
|   |   |                             |   | o |   |                      |
|   |   |                             |   | v |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   | d |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | d |   |                      |
|   |   |                             |   | i |   |                      |
|   |   |                             |   | s |   |                      |
|   |   |                             |   | i |   |                      |
|   |   |                             |   | n |   |                      |
|   |   |                             |   | f |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   | c |   |                      |
|   |   |                             |   | t |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | n |   |                      |
|   |   |                             |   | t |   |                      |
|   |   |                             |   | . |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | 1 |   |                      |
|   |   |                             |   | 0 |   |                      |
|   |   |                             |   | . |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | U |   |                      |
|   |   |                             |   | s |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | f |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | n |   |                      |
|   |   |                             |   | s |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | f |   |                      |
|   |   |                             |   | o |   |                      |
|   |   |                             |   | r |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | d |   |                      |
|   |   |                             |   | r |   |                      |
|   |   |                             |   | y |   |                      |
|   |   |                             |   | i |   |                      |
|   |   |                             |   | n |   |                      |
|   |   |                             |   | g |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | n |   |                      |
|   |   |                             |   | d |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | H |   |                      |
|   |   |                             |   | E |   |                      |
|   |   |                             |   | P |   |                      |
|   |   |                             |   | A |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | v |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | c |   |                      |
|   |   |                             |   | u |   |                      |
|   |   |                             |   | u |   |                      |
|   |   |                             |   | m |   |                      |
|   |   |                             |   | . |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | D |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   | t |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   | r |   |                      |
|   |   |                             |   | m |   |                      |
|   |   |                             |   | i |   |                      |
|   |   |                             |   | n |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | c |   |                      |
|   |   |                             |   | t |   |                      |
|   |   |                             |   | i |   |                      |
|   |   |                             |   | o |   |                      |
|   |   |                             |   | n |   |                      |
|   |   |                             |   | s |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | n |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   | d |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   | d |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | t |   |                      |
|   |   |                             |   | o |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | c |   |                      |
|   |   |                             |   | o |   |                      |
|   |   |                             |   | m |   |                      |
|   |   |                             |   | p |   |                      |
|   |   |                             |   | l |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   | t |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | r |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   | m |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   | d |   |                      |
|   |   |                             |   | i |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | t |   |                      |
|   |   |                             |   | i |   |                      |
|   |   |                             |   | o |   |                      |
|   |   |                             |   | n |   |                      |
|   |   |                             |   | . |   |                      |
+---+---+-----------------------------+---+---+---+----------------------+
| * |   |                             |   |   |   |                      |
| * |   |                             |   |   |   |                      |
| D |   |                             |   |   |   |                      |
| a |   |                             |   |   |   |                      |
| t |   |                             |   |   |   |                      |
| e |   |                             |   |   |   |                      |
| * |   |                             |   |   |   |                      |
| * |   |                             |   |   |   |                      |
+---+---+-----------------------------+---+---+---+----------------------+
| * |   |                             |   |   |   |                      |
| * |   |                             |   |   |   |                      |
| I |   |                             |   |   |   |                      |
| n |   |                             |   |   |   |                      |
| i |   |                             |   |   |   |                      |
| t |   |                             |   |   |   |                      |
| i |   |                             |   |   |   |                      |
| a |   |                             |   |   |   |                      |
| l |   |                             |   |   |   |                      |
| * |   |                             |   |   |   |                      |
| * |   |                             |   |   |   |                      |
+---+---+-----------------------------+---+---+---+----------------------+
| A |   |                             |   |   |   |                      |
| d |   |                             |   |   |   |                      |
| d |   |                             |   |   |   |                      |
| i |   |                             |   |   |   |                      |
| t |   |                             |   |   |   |                      |
| i |   |                             |   |   |   |                      |
| o |   |                             |   |   |   |                      |
| n |   |                             |   |   |   |                      |
| a |   |                             |   |   |   |                      |
| l |   |                             |   |   |   |                      |
| R |   |                             |   |   |   |                      |
| e |   |                             |   |   |   |                      |
| q |   |                             |   |   |   |                      |
| u |   |                             |   |   |   |                      |
| i |   |                             |   |   |   |                      |
| r |   |                             |   |   |   |                      |
| e |   |                             |   |   |   |                      |
| m |   |                             |   |   |   |                      |
| e |   |                             |   |   |   |                      |
| n |   |                             |   |   |   |                      |
| t |   |                             |   |   |   |                      |
| s |   |                             |   |   |   |                      |
| : |   |                             |   |   |   |                      |
+---+---+-----------------------------+---+---+---+----------------------+
| * |   |                             | * |   |   |                      |
| * |   |                             | * |   |   |                      |
| A |   |                             | A |   |   |                      |
| T |   |                             | T |   |   |                      |
| T |   |                             | T |   |   |                      |
| E |   |                             | E |   |   |                      |
| N |   |                             | N |   |   |                      |
| D |   |                             | D |   |   |                      |
| E |   |                             | E |   |   |                      |
| E |   |                             | E |   |   |                      |
| S |   |                             | S |   |   |                      |
| I |   |                             | I |   |   |                      |
| G |   |                             | G |   |   |                      |
| N |   |                             | N |   |   |                      |
| A |   |                             | A |   |   |                      |
| T |   |                             | T |   |   |                      |
| U |   |                             | U |   |   |                      |
| R |   |                             | R |   |   |                      |
| E |   |                             | E |   |   |                      |
| S |   |                             | S |   |   |                      |
| * |   |                             | * |   |   |                      |
| * |   |                             | * |   |   |                      |
|   |   |                             |   |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             |   |   |   |                      |
| _ |   |                             | \ |   |   |                      |
| \ |   |                             | _ |   |   |                      |
| _ |   |                             | \ |   |   |                      |
| \ |   |                             | _ |   |   |                      |
| _ |   |                             | \ |   |   |                      |
| \ |   |                             | _ |   |   |                      |
| _ |   |                             | \ |   |   |                      |
| \ |   |                             | _ |   |   |                      |
| _ |   |                             | \ |   |   |                      |
| \ |   |                             | _ |   |   |                      |
| _ |   |                             | \ |   |   |                      |
| \ |   |                             | _ |   |   |                      |
| _ |   |                             | \ |   |   |                      |
| \ |   |                             | _ |   |   |                      |
| _ |   |                             | \ |   |   |                      |
| \ |   |                             | _ |   |   |                      |
| _ |   |                             | \ |   |   |                      |
|   |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             |   |   |   |                      |
| _ |   |                             |   |   |   |                      |
| \ |   |                             |   |   |   |                      |
| _ |   |                             |   |   |   |                      |
| \ |   |                             |   |   |   |                      |
| _ |   |                             |   |   |   |                      |
| \ |   |                             |   |   |   |                      |
| _ |   |                             |   |   |   |                      |
| \ |   |                             |   |   |   |                      |
| _ |   |                             |   |   |   |                      |
| \ |   |                             |   |   |   |                      |
| _ |   |                             |   |   |   |                      |
| \ |   |                             |   |   |   |                      |
| _ |   |                             |   |   |   |                      |
| \ |   |                             |   |   |   |                      |
| _ |   |                             |   |   |   |                      |
| \ |   |                             |   |   |   |                      |
| _ |   |                             |   |   |   |                      |
| \ |   |                             |   |   |   |                      |
| _ |   |                             |   |   |   |                      |
| \ |   |                             |   |   |   |                      |
| _ |   |                             |   |   |   |                      |
| \ |   |                             |   |   |   |                      |
| _ |   |                             |   |   |   |                      |
| \ |   |                             |   |   |   |                      |
| _ |   |                             |   |   |   |                      |
| \ |   |                             |   |   |   |                      |
| _ |   |                             |   |   |   |                      |
| \ |   |                             |   |   |   |                      |
| _ |   |                             |   |   |   |                      |
+---+---+-----------------------------+---+---+---+----------------------+
| D |   |                             | E |   |   |                      |
| a |   |                             | x |   |   |                      |
| t |   |                             | c |   |   |                      |
| e |   |                             | e |   |   |                      |
| : |   |                             | p |   |   |                      |
|   |   |                             | t |   |   |                      |
|   |   |                             | i |   |   |                      |
|   |   |                             | o |   |   |                      |
|   |   |                             | n |   |   |                      |
|   |   |                             | s |   |   |                      |
|   |   |                             | / |   |   |                      |
|   |   |                             | A |   |   |                      |
|   |   |                             | d |   |   |                      |
|   |   |                             | d |   |   |                      |
|   |   |                             | i |   |   |                      |
|   |   |                             | t |   |   |                      |
|   |   |                             | i |   |   |                      |
|   |   |                             | o |   |   |                      |
|   |   |                             | n |   |   |                      |
|   |   |                             | s |   |   |                      |
|   |   |                             | t |   |   |                      |
|   |   |                             | o |   |   |                      |
|   |   |                             | t |   |   |                      |
|   |   |                             | h |   |   |                      |
|   |   |                             | i |   |   |                      |
|   |   |                             | s |   |   |                      |
|   |   |                             | p |   |   |                      |
|   |   |                             | e |   |   |                      |
|   |   |                             | r |   |   |                      |
|   |   |                             | m |   |   |                      |
|   |   |                             | i |   |   |                      |
|   |   |                             | t |   |   |                      |
|   |   |                             | a |   |   |                      |
|   |   |                             | r |   |   |                      |
|   |   |                             | e |   |   |                      |
|   |   |                             | n |   |   |                      |
|   |   |                             | o |   |   |                      |
|   |   |                             | t |   |   |                      |
|   |   |                             | e |   |   |                      |
|   |   |                             | d |   |   |                      |
|   |   |                             | b |   |   |                      |
|   |   |                             | y |   |   |                      |
|   |   |                             | a |   |   |                      |
|   |   |                             | t |   |   |                      |
|   |   |                             | t |   |   |                      |
|   |   |                             | a |   |   |                      |
|   |   |                             | c |   |   |                      |
|   |   |                             | h |   |   |                      |
|   |   |                             | e |   |   |                      |
|   |   |                             | d |   |   |                      |
|   |   |                             | m |   |   |                      |
|   |   |                             | e |   |   |                      |
|   |   |                             | m |   |   |                      |
|   |   |                             | o |   |   |                      |
|   |   |                             | r |   |   |                      |
|   |   |                             | a |   |   |                      |
|   |   |                             | n |   |   |                      |
|   |   |                             | d |   |   |                      |
|   |   |                             | a |   |   |                      |
|   |   |                             | . |   |   |                      |
|   |   |                             | D |   |   |                      |
|   |   |                             | a |   |   |                      |
|   |   |                             | t |   |   |                      |
|   |   |                             | e |   |   |                      |
|   |   |                             | : |   |   |                      |
+---+---+-----------------------------+---+---+---+----------------------+

+-------+-----------------------------+---+------------------------------+
| M- 1  | 1.  Identify and remove any |   | 5.  Remove contaminated      |
|       |     source of water         |   |     materials from building  |
|       |     intrusion               |   |     in sealed plastic bags.  |
|       |                             |   |                              |
|       | 2.  Remediation must be     |   | 6.  Dispose of moldy         |
|       |     performed by            |   |     materials in exterior    |
|       |     appropriately trained   |   |     dumpster. Bag sharps     |
|       |     staff using respiratory |   |     objects in a manner that |
|       |     protection and PPE.     |   |     prevents puncture.       |
|       |                             |   |                              |
|       | 3.  Restrict access to      |   | 7.  Remedial worker egress   |
|       |     control work site       |   |     should be thoroughly     |
|       |     entry.                  |   |     cleaned and left dry and |
|       |                             |   |     visibly free from        |
|       | 4.  Use work practices that |   |     contamination.           |
|       |     minimize mold           |   |                              |
|       |     disturbance.            |   |                              |
+-------+-----------------------------+---+------------------------------+
| M- 2  | 1.  Identify and remove any |   | 6.  Remove contaminated      |
|       |     source of water         |   |     materials from building  |
|       |     intrusion               |   |     in sealed plastic bags.  |
|       |                             |   |                              |
|       | 2.  Remediation must be     |   | 7.  Dispose of moldy         |
|       |     performed by            |   |     materials in exterior    |
|       |     appropriately trained   |   |     dumpster. Bag sharps     |
|       |     staff using respiratory |   |     objects in a manner that |
|       |     protection and PPE.     |   |     prevents puncture.       |
|       |                             |   |                              |
|       | 3.  Restrict access to and  |   | 8.  Remedial worker egress   |
|       |     keep work area          |   |     should be HEPA vacuumed, |
|       |     unoccupied, seal unused |   |     cleaned with detergent   |
|       |     doors with plastic.     |   |     and left dry and visibly |
|       |     Place tacky mats at     |   |     free from contamination  |
|       |     exit to prevent         |   |                              |
|       |     transporting mold and   |   |                              |
|       |     debris outside the      |   |                              |
|       |     area.                   |   |                              |
|       |                             |   |                              |
|       | 4.  Use work practices that |   |                              |
|       |     minimize mold           |   |                              |
|       |     disturbance.            |   |                              |
|       |                             |   |                              |
|       | 5.  Use HEPA vacuum to      |   |                              |
|       |     capture airborne dust,  |   |                              |
|       |     if generated.           |   |                              |
+-------+-----------------------------+---+------------------------------+
| M-3   | Identify and remove any     |   | 8.  Use HEPA vacuum to       |
|       | source of water intrusion   |   |     capture airborne dust,   |
|       |                             |   |     if generated.            |
|       | Remediation must be         |   |                              |
|       | performed by appropriately  |   | 9.  Remove contaminated      |
|       | trained staff using         |   |     materials in sealed      |
|       | respiratory protection and  |   |     plastic bags and clean   |
|       | PPE.                        |   |     outside of bags with     |
|       |                             |   |     HEPA vacuum and wet      |
|       | Restrict access to and keep |   |     wiping                   |
|       | work area unoccupied, seal  |   |                              |
|       | unused doors with plastic.  |   | 10. Dispose of moldy items   |
|       | Place tacky mats at exit to |   |     promptly in exterior     |
|       | prevent transporting mold   |   |     dumpster                 |
|       | and debris outside the      |   |                              |
|       | area.                       |   | 11. Work area barriers and   |
|       |                             |   |     egress should be HEPA    |
|       | Clean, wet wipe, HEPA       |   |     vacuumed, cleaned with   |
|       | vacuum and remove all       |   |     detergent and left dry   |
|       | movable objects from work   |   |     and visibly free from    |
|       | area.                       |   |     contamination            |
|       |                             |   |                              |
|       | Clean supply and return air |   | 12. Remove barrier materials |
|       | grills with HEPA vacuum     |   |     carefully to minimize    |
|       |                             |   |     spreading of dirt and    |
|       | Seal ventilation            |   |     debris associated with   |
|       | ducts/grills with plastic   |   |     mold removal.            |
|       | and duct tape.              |   |                              |
+-------+-----------------------------+---+------------------------------+
| **D   |                             |   |                              |
| ate** |                             |   |                              |
+-------+-----------------------------+---+------------------------------+
| *     |                             |   |                              |
| *Init |                             |   |                              |
| ial** |                             |   |                              |
+-------+-----------------------------+---+------------------------------+
| M 4   | 1.  Identify and remove any |   | 8.  Remove contaminated      |
|       |     source of water         |   |     materials in sealed      |
|       |     intrusion               |   |     plastic bags and clean   |
|       |                             |   |     outside of bags with     |
|       | 2.  Remediation must be     |   |     HEPA vacuum. Wet wipe    |
|       |     performed by            |   |     bags in the              |
|       |     appropriately trained   |   |     decontamination chamber  |
|       |     staff using full-face   |   |     prior to transport area  |
|       |     respiratory protection  |   |     outside building.        |
|       |     and PPE.                |   |                              |
|       |                             |   | 9.  Contained area and       |
|       | 3.  Restrict access to and  |   |     decontamination room     |
|       |     keep work area          |   |     should be HEPA vacuumed  |
|       |     unoccupied, completely  |   |     and cleaned with damp    |
|       |     seal work area with     |   |     cloth prior to removal   |
|       |     plastic sheeting and    |   |     of isolation barriers.   |
|       |     duct tape.              |   |                              |
|       |                             |   | 10. Maintain containment and |
|       | 4.  Use exhaust fan with    |   |     negative pressure until  |
|       |     HEPA filter to create   |   |     adequate cleaning is     |
|       |     negative pressure,      |   |     validated and all        |
|       |     maintain airlocks and   |   |     visible dust is removed. |
|       |     decontamination room.   |   |                              |
|       |                             |   | 11. Remove barrier materials |
|       | 5.  Place tacky mats at     |   |     carefully to minimize    |
|       |     exit to prevent         |   |     spreading of dirt and    |
|       |     transporting mold and   |   |     debris associated with   |
|       |     debris outside the      |   |     mold removal.            |
|       |     area.                   |   |                              |
|       |                             |   |                              |
|       | 6.  Clean, wet wipe, HEPA   |   |                              |
|       |     vacuum and remove all   |   |                              |
|       |     movable objects from    |   |                              |
|       |     work area.              |   |                              |
|       |                             |   |                              |
|       | 7.  Use HEPA vacuum to      |   |                              |
|       |     capture airborne dust,  |   |                              |
|       |     if generated.           |   |                              |
+-------+-----------------------------+---+------------------------------+
| **D   |                             |   |                              |
| ate** |                             |   |                              |
+-------+-----------------------------+---+------------------------------+
| *     |                             |   |                              |
| *Init |                             |   |                              |
| ial** |                             |   |                              |
+-------+-----------------------------+---+------------------------------+
| M 5   | Remediation should be       |   | 7.  Clean work area and      |
|       | conducted by qualified      |   |     surrounding area with    |
|       | contractor or fully trained |   |     HEPA vacuum, damp cloth  |
|       | staff using full            |   |     and/or mop and detergent |
|       | respiratory protection and  |   |     solution.                |
|       | PPE.                        |   |                              |
|       |                             |   | 8.  Area should be left dry  |
|       | Securely seal (isolate)     |   |     and visibly free from    |
|       | affected HVAC section to    |   |     contamination.           |
|       | ensure no air movement in   |   |                              |
|       | the affected area.          |   | For areas \> 30 feet, in     |
|       |                             |   | addition,:                   |
|       | Cover work area with        |   |                              |
|       | plastic and seal with duct  |   | 1.  Use plastic sheeting to  |
|       | tape.                       |   |     completely isolate work  |
|       |                             |   |     area HVAC,               |
|       | Use dust suppression        |   |                              |
|       | methods during remediation. |   | 2.  Use HEPA filter exhaust  |
|       |                             |   |     fan to create negative   |
|       | Remove all mold growth      |   |     pressure.                |
|       | supporting materials that   |   |                              |
|       | cannot be cleaned. Seal in  |   | 3.  Strongly consider        |
|       | plastic bags and dispose    |   |     dismantling and disposal |
|       | promptly in exterior        |   |     of all duct work with    |
|       | dumpster.                   |   |     significant growth.      |
|       |                             |   |                              |
|       | Transport debris during     |   |                              |
|       | hours of least activity and |   |                              |
|       | along the most direct,      |   |                              |
|       | least congested route.      |   |                              |
+-------+-----------------------------+---+------------------------------+
| **D   |                             |   |                              |
| ate** |                             |   |                              |
+-------+-----------------------------+---+------------------------------+
| *     |                             |   |                              |
| *Init |                             |   |                              |
| ial** |                             |   |                              |
+-------+-----------------------------+---+------------------------------+
| Addit |                             |   |                              |
| ional |                             |   |                              |
| Req   |                             |   |                              |
| uirem |                             |   |                              |
| ents: |                             |   |                              |
+-------+-----------------------------+---+------------------------------+
|       |                             |   |                              |
+-------+-----------------------------+---+------------------------------+
| **ATT |                             | * |                              |
| ENDEE |                             | * |                              |
| SI    |                             | A |                              |
| GNATU |                             | T |                              |
| RES** |                             | T |                              |
|       |                             | E |                              |
| \_    |                             | N |                              |
| \_\_\ |                             | D |                              |
| _\_\_ |                             | E |                              |
| \_\_\ |                             | E |                              |
| _\_\_ |                             | S |                              |
| \_\_\ |                             | I |                              |
| _\_\_ |                             | G |                              |
| \_\_\ |                             | N |                              |
| _\_\_ |                             | A |                              |
| \_\_\ |                             | T |                              |
| _\_\_ |                             | U |                              |
| \_\_\ |                             | R |                              |
| _\_\_ |                             | E |                              |
| \_\_\ |                             | S |                              |
| _\_\_ |                             | * |                              |
| \_\_\ |                             | * |                              |
| _\_\_ |                             |   |                              |
| \_\_\ |                             | \ |                              |
| _\_\_ |                             | _ |                              |
| \_\_\ |                             | \ |                              |
| _\_\_ |                             | _ |                              |
| \_\_\ |                             | \ |                              |
| _\_\_ |                             | _ |                              |
| \_\_\ |                             | \ |                              |
| _\_\_ |                             | _ |                              |
|       |                             | \ |                              |
| \_    |                             | _ |                              |
| \_\_\ |                             | \ |                              |
| _\_\_ |                             | _ |                              |
| \_\_\ |                             | \ |                              |
| _\_\_ |                             | _ |                              |
| \_\_\ |                             | \ |                              |
| _\_\_ |                             | _ |                              |
| \_\_\ |                             | \ |                              |
| _\_\_ |                             | _ |                              |
| \_\_\ |                             | \ |                              |
| _\_\_ |                             | _ |                              |
| \_\_\ |                             | \ |                              |
| _\_\_ |                             | _ |                              |
| \_\_\ |                             | \ |                              |
| _\_\_ |                             | _ |                              |
| \_\_\ |                             | \ |                              |
| _\_\_ |                             | _ |                              |
|       |                             | \ |                              |
|       |                             | _ |                              |
|       |                             | \ |                              |
|       |                             | _ |                              |
|       |                             | \ |                              |
|       |                             | _ |                              |
|       |                             | \ |                              |
|       |                             | _ |                              |
|       |                             | \ |                              |
|       |                             | _ |                              |
|       |                             | \ |                              |
|       |                             | _ |                              |
|       |                             | \ |                              |
|       |                             | _ |                              |
|       |                             | \ |                              |
|       |                             | _ |                              |
|       |                             | \ |                              |
|       |                             | _ |                              |
|       |                             | \ |                              |
|       |                             | _ |                              |
|       |                             | \ |                              |
|       |                             | _ |                              |
|       |                             | \ |                              |
|       |                             | _ |                              |
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|       |                             | _ |                              |
|       |                             | \ |                              |
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|       |                             |   |                              |
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|       |                             | _ |                              |
|       |                             | \ |                              |
|       |                             | _ |                              |
|       |                             | \ |                              |
|       |                             | _ |                              |
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|       |                             | _ |                              |
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|       |                             | \ |                              |
|       |                             | _ |                              |
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|       |                             | _ |                              |
|       |                             | \ |                              |
|       |                             | _ |                              |
|       |                             | \ |                              |
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|       |                             | _ |                              |
|       |                             | \ |                              |
|       |                             | _ |                              |
+-------+-----------------------------+---+------------------------------+
| Date: |                             | E |                              |
|       |                             | x |                              |
|       |                             | c |                              |
|       |                             | e |                              |
|       |                             | p |                              |
|       |                             | t |                              |
|       |                             | i |                              |
|       |                             | o |                              |
|       |                             | n |                              |
|       |                             | s |                              |
|       |                             | / |                              |
|       |                             | A |                              |
|       |                             | d |                              |
|       |                             | d |                              |
|       |                             | i |                              |
|       |                             | t |                              |
|       |                             | i |                              |
|       |                             | o |                              |
|       |                             | n |                              |
|       |                             | s |                              |
|       |                             | t |                              |
|       |                             | o |                              |
|       |                             | t |                              |
|       |                             | h |                              |
|       |                             | i |                              |
|       |                             | s |                              |
|       |                             | p |                              |
|       |                             | e |                              |
|       |                             | r |                              |
|       |                             | m |                              |
|       |                             | i |                              |
|       |                             | t |                              |
|       |                             | a |                              |
|       |                             | r |                              |
|       |                             | e |                              |
|       |                             | n |                              |
|       |                             | o |                              |
|       |                             | t |                              |
|       |                             | e |                              |
|       |                             | d |                              |
|       |                             | b |                              |
|       |                             | y |                              |
|       |                             | a |                              |
|       |                             | t |                              |
|       |                             | t |                              |
|       |                             | a |                              |
|       |                             | c |                              |
|       |                             | h |                              |
|       |                             | e |                              |
|       |                             | d |                              |
|       |                             | m |                              |
|       |                             | e |                              |
|       |                             | m |                              |
|       |                             | o |                              |
|       |                             | r |                              |
|       |                             | a |                              |
|       |                             | n |                              |
|       |                             | d |                              |
|       |                             | a |                              |
|       |                             | . |                              |
|       |                             | D |                              |
|       |                             | a |                              |
|       |                             | t |                              |
|       |                             | e |                              |
|       |                             | : |                              |
+-------+-----------------------------+---+------------------------------+

# *Section II. Appendix II: Water Intrusion Work Practice Level W-1*

**Initial Water Removal:**

Contain the extent of water intrusion to the smallest area possible and
strive to dry the area within 48 hours of the occurrence.

1.  Identify and remove source of water intrusion.

2.  Contain water to limited area

3.  Redirect and restrict access to the affected area(s) to prevent
    slip/falls and prevent tracking to unaffected areas.

4.  Protect structural components (e.g. electrical, furnishings, other
    area contents, etc.) from direct contact by floor berms, plastic
    sheeting or relocation. Take measures to relocate items from the
    water source or remove items from the area.

5.  Extract water from all building systems or components, including
    HVAC systems, wall cavities, flooring, plumbing and electrical
    chases.

6.  Extracted water can be disposed down the sanitary drain.

7.  Asbestos-containing materials (ACM) or lead-based paint (LBP)
    impacted by water intrusion require removal, disposal, and/or
    repair. The Asbestos Program Manager must be contacted to further
    evaluate conditions and determine appropriate response actions. The
    clean-up, repair, removal, and/or disposal of ACM must be performed
    by a qualified asbestos abatement staff or contractor.

**Post Initial Response Assessment Procedures:**

1.  Determine actions to remediate and restore damaged materials

2.  Discard all unsalvageable contents and furnishings promptly.

3.  Communicate results of response actions back to the WIMM Program
    Team.

**Restoration:**

Throughout the restoration process, anticipate secondary damage and
attend to structural components that may require drying, demolition
and/or replacement. These components include, but are not limited to:

-   ceiling (tiles);

-   flooring (carpet & tile)

-   walls (gypsum board);

-   built-in furnishings and fixtures;

-   insulation; and,

-   wood.

Following demolition, debris removal, and site drying, building
components shall be surveyed for acceptable moisture content prior to
structural repairs and enclosure. Any item not achieving acceptable
moisture content within 48-hours of site drying, must be re-evaluated
for further drying and potential development of mold growth.

Restoration processes can be applied to the following:

1.  **Non-Porous Surfaces and Hard Surfaces and Floors:**

-   remove water as indicated above and mop with floor cleaner.

2.  **Overhead fixtures and equipment with trapped water:**

-   open to air, wipe down and dehumidify.

3.  **Porous Surfaces:**

Carpet / Textiles / Fibrous Coverings

1.  determine salvageable status;

2.  if possible, disengage carpet and remove pad;

3.  secure carpet to original tack strips and/or elevate without pad and
    apply drying procedures (i.e. fans/dehumidification);

4.  check floor and carpet moisture content and re-install carpet when
    dried; and,

5.  complete final carpet cleaning to limit microbial growth and
    development of odors.

> Wallboard / Hard-line Ceilings: IMPORTANT ensure all electrical and
> supply conveyance systems are de-energized, and then perform the
> following:

6.  if insulation is present remove affected area;

7.  remove and replace insulation and wallboard after applying drying
    procedures to cavity;

8.  in the absence of insulation, open areas (ports) per stud spacing to
    ventilate;

9.  if flooded, remove all sheetrock to 6 inches above the high water
    mark;

10. apply drying procedures; and,

11. patch/paint over wall ports.

> Pipe Insulation (overhead):

12. open the area to ventilate space;

13. remove pipe insulation;

14. apply drying procedures to space;

15. replace pipe insulation with new material; and,

16. replace coverings.

Drop Ceilings:

17. replace wet ceiling tiles.

> Paper / Files:

-   To be determined based on scenario i.e. amount of water, importance
    of files. ***See Section I. Appendix III***

> Furniture and Accessories

-   To be determined based on scenario i.e. amount of water, value of
    item, etc.

**Close-out Investigation**

Complete Follow-up Investigation per ***Section II paragraph 2.0*.**

**Process Evaluation**

Complete Close-out documentation per ***Sections II paragraph 3.0***

***Appendix III: Water Intrusion Work Practices Level W-2***

Areas contaminated with gray water pose a potential threat to human
health. The severity of health risk depends on the extent, content, and
degree of water contamination penetration.

Technicians performing Category II response to water intrusions must be
trained in the following areas:

-   OSHA Hazard Communication (OSHA 29CFR 1910.1200) (CCR Title 8
    Section 5194);

-   Bloodborne Pathogens prevention and use of personal protective
    equipment (PPE) in accordance with 29 CFR 1910.132 and 134 if
    applicable;

-   Use of disinfectants; and,

-   Use of response equipment.

All persons working in and around Category II (Gray) water during the
initial stages of response and prior to completion of cleaning and
restoration should be equipped with PPE including but not limited to the
following:

-   industrial-grade rubber gloves;

-   full eye/splash protection (goggles);

-   protective suit;

-   rubber boots; and,

-   hard hat if overhead hazards exist.

**Initial Water Removal:**

1.  Identify and remove source of water intrusion.

2.  Contain water to limited area.

3.  Redirect and restrict access to affected areas to minimize cross
    contamination from affected areas.

4.  Block off and seal supply and return air vents.

5.  Evacuate high or highest risk patients from area.

6.  Protect structural components (e.g. furnishings, other area
    contents, etc.) from direct contact with water. Take measures as
    quickly and as safely as possible to remove all removable items from
    the area.

7.  Remove solid matter and extract water from all locations that have
    been impacted. Vacuums must be equipped with HEPA filters.

8.  Decontaminate damaged hard surface materials with EPA-approved
    disinfectant to reduce microbial load.

9.  Excess water and organic matter must be physically removed.

10. Extract water from all locations that have been impacted by water
    intrusion including building systems or components including, but
    not necessarily limited to: HVAC and other air handling systems,
    wall cavities, flooring systems and plumbing and electrical chases.

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11. Discard all highly absorbent, saturated materials promptly without
    cross-contaminating unaffected areas.

12. Extracted wastewater can be discharged into a sanitary sewer.

13. Asbestos-containing materials (ACM) or lead-based paint (LBP)
    impacted by water intrusion require removal, disposal, and/or
    repair. The Asbestos Program Manager must be contacted to further
    evaluate conditions and determine appropriate response actions. The
    clean-up, repair, removal, and/or disposal of ACM must be performed
    by a qualified asbestos abatement staff or contractor.

**Post Initial Response Assessment Procedures:**

1.  Determine actions needed to remediate and restore damaged and/or
    contaminated materials.

2.  Before handling, decontaminate sewage-damaged materials spray or
    immerse in an EPA-approved disinfectant to reduce microorganisms.

3.  Communicate results of response actions back to the WIMM Program
    Management Team.

**Restoration:**

Anticipate secondary damage and attend to structural components that may
require drying, demolition and /or replacement. These components may
include, but are not limited to:

-   ceiling (tiles);

-   flooring (carpet & tile)

-   walls (gypsum board);

-   built-in furnishings and fixtures;

-   insulation; and,

-   wood.

All staff handling contaminated components must wear the appropriate
PPE. Following demolition, debris removal, and site drying, building
components shall be surveyed for acceptable moisture content prior to
structural repairs and enclosure. Any item not achieving acceptable
moisture content within 48-hours of site drying, must be re-evaluated
for further drying and potential development of mold growth. Use a
licensed contractor to remove, transport and properly dispose of
unsalvageable materials (i.e. carpet, cushion, drywall, and structural
wood) otherwise special arrangements that comply with all applicable
laws may be required. Hazardous materials, such as asbestos and lead,
will require special handling and disposal procedures.

Restoration processes can be applied to the following:

**1. Non-Porous Surfaces, Hard Surfaces and Floors:**

-   remove water as indicated above;

-   remove and dispose if penetration is observed (buckling, warping, or
    bubbling),;

-   clean and disinfect sub-floor with EPA-approved disinfectant; and,

-   flush clean cracks if floor is intact, (pressure wash) with
    EPA-approved disinfectant and recover with HEPA filtered extraction
    unit (use caution and adequate controls to minimize the distribution
    of bioaerosols and fluid contaminants).

**Overhead Fixtures (trapped water):**

-   open to air and wipe down with EPA-approved disinfectant and
    dehumidify.

**Porous Surfaces:** IMPORTANT ensure all electrical and supply
conveyance systems are de-energized

Carpet / Textiles / Fibrous Coverings:

1.  determine salvageable status;

2.  clear the area to expose wet surfaces (inspect and clean items;
    prevent cross contamination);

3.  disengage carpet, remove and dispose of pad;

4.  re-engage carpet without pad, and/or elevate and apply drying
    procedures (i.e. fans/dehumidification);

5.  check floor and carpet moisture content and re-install carpet when
    dried;

6.  thoroughly clean carpet to limit microbial growth and development of
    odors; and,

7.  if needed, replace with in kind flooring.

Wallboard/Hard- Ceilings:

8.  remove to nearest seam past affected area if insulation is present;

9.  remove and replace insulation and wallboard after applying drying
    procedures;

10. in the absence of ventilation, open areas (ports) per stud spacing
    to ventilate (assess for asbestos content);

11. if flooded, remove all sheetrock to 6 inches above the high water
    mark;

12. apply EPA-approved disinfectant to exposed surfaces;

13. apply drying procedures;

14. patch/paint over wall ports; and,

15. install new drywall as needed.

> Suspended Ceilings

16. remove and replace all wet ceiling tiles; and,

17. wipe supports with EPA-approved disinfectant.

Pipe Insulation

18. assess condition (integrity and ACM);

19. open to ventilate space;

20. remove contaminated pipe insulation;

21. wipe structure with EPA-approved disinfectant;

22. apply drying procedures;

23. replace pipe insulation with new material; and,

24. replace coverings.

Paper / Files

25. Dispose of all highly absorbent saturated materials.

**Follow-up Investigation**

Complete Follow-up Investigation per ***Section II paragraph 2.0*.**

**Final Response Close-out and Process Evaluation:**

Complete Close-out documentation per ***Sections II paragraph 3.0
through 3.2***

***Appendix IV: Water Intrusion Work Practices Level W-3***

Areas contaminated with Category III (Black) water pose a potential
threat to human health. The severity of health risk depends on the
extent, content, and degree of water contamination penetration.
Technicians performing Category III response to water intrusions must be
trained in the following areas:

-   OSHA Hazard Communication (OSHA 29CFR 1910.1200) (CCR Title 8
    Section 5194)

-   Bloodborne Pathogens prevention and use of personal protective
    equipment (PPE) in accordance with 29 CFR 1910.132 and 134 if
    applicable;

-   Use of disinfectants; and,

-   Use of response equipment.

All persons working in and around Category III (Black) water during the
initial stages of response and prior to completion of cleaning and
restoration should have current immunizations for Hepatitis B and must
be equipped with PPE including, but not necessarily limited to the
following:

-   industrial-grade rubber gloves;

-   full eye/splash protection (goggles);

-   protective suit;

-   rubber boots; and,

-   hard hat if overhead hazards exist.

**Initial Water Removal:**

1.  Identify and remove source of water intrusion.

2.  Contain water to limited area.

3.  Redirect and restrict access to affected areas to minimize cross
    contamination from affected areas.

4.  Block off and seal supply and return air vents.

5.  Evacuate low to highest risk patients from area.

6.  Protect structural components (e.g. furnishings, other area
    contents, etc.) from direct contact with water. Take measures as
    quickly and as safely as possible to remove all removable items from
    the area.

7.  Remove solid matter and extract water from all locations that have
    been impacted by water intrusion including building systems or
    components including, but not necessarily limited to: HVAC and other
    air handling systems, wall cavities, flooring systems, crawlspaces,
    plumbing and electrical chases. Vacuums must be equipped with HEPA
    filters.

8.  Decontaminate hard surface materials with EPA-approved disinfectant
    to reduce microbial load.

9.  Decontaminate materials before handling. Spray or immerse in an
    EPA-approved disinfectant to reduce microorganisms.

10. Discard all contaminated (saturated) materials promptly without
    cross-contaminating unaffected areas.

11. Discharge extracted wastewater into a sanitary sewer.

12. Asbestos-containing materials (ACM) or lead-based paint (LBP)
    impacted by water intrusion require removal, disposal, and/or
    repair. The Asbestos Program Manager must be contacted to further
    evaluate conditions and determine appropriate response actions. The
    clean-up, repair, removal, and/or disposal of ACM must be performed
    by a qualified asbestos abatement staff or contractor.

**Post Initial Response Assessment Procedures:**

1.  Determine actions needed to remediate and restore damaged and/or
    contaminated materials.

2.  Communicate results of response actions back to the WIMM Program
    Team.

**Restoration:**

Throughout the restoration process, anticipate secondary damage and
attend to other structural components that may require drying,
demolition and/or replacement. These components may include, but are not
limited to:

-   flooring (carpet & tile);

-   walls (gypsum board);

-   built-in furnishings and fixtures;

-   insulation; and,

-   wood.

All personnel involved with restoration must wear the appropriate PPE.
After demolition, debris removal, and assuring thorough drying,
qualified and properly licensed persons should perform authorized and
necessary structural repairs, reconstruction or cleaning.

Use a licensed contractor to remove, transport and properly dispose of
unsalvageable materials (i.e. carpet, cushion, drywall, and structural
wood) otherwise special arrangements that comply with all applicable
laws may be required. All staff handling contaminated components must
wear the appropriate PPE. Following demolition, debris removal, and site
drying, building components shall be surveyed for acceptable moisture
content prior to structural repairs and enclosure. Any item not
achieving acceptable moisture content within 48-hours of site drying,
must be re-evaluated for further drying and potential development of
mold growth.

The restoration process can be applied to the following materials:

**1. Non-Porous Surfaces and Hard Surfaces and Floors:**

-   remove water as indicated above;

-   remove and dispose if penetration is observed (buckling, warping, or
    bubbling);

-   clean and disinfect subfloor with EPA-approved disinfectant; and,

-   flush clean cracks if floor is intact, (pressure wash) with
    EPA-approved disinfectant and recover with HEPA filtered extraction
    unit (use caution and adequate controls to minimize the distribution
    of bioaerosols and fluid contaminants).

**2. Overhead Fixtures (trapped water):**

-   open to air and wipe down with EPA-approved disinfectant/
    dehumidify.

**3. Porous Surfaces:** IMPORTANT ensure all electrical and supply
conveyance systems are de-energized

-   carpet / textiles / fibrous coverings;

    1.  clear the area to expose wet surfaces (treat moved items and
        prevent cross contamination);

    2.  disengage and remove carpet and pad and dispose; and,

    3.  replace with in kind floor covering.

Wallboard / Hard Ceilings:

4.  remove and dispose all material (including insulation) to nearest
    seam past affected area;

5.  apply EPA-approved disinfectant to exposed surfaces (studs and
    plates);

6.  if flooded, remove all sheetrock to 6 inches above the high water
    mark;

7.  apply drying procedures; and,

8.  install new drywall.

Pipe Insulation

9.  assess condition (integrity and ACM);

10. open to ventilate space;

11. remove pipe insulation;

12. disinfect pipe by wiping down with EPA-approved disinfectant;

13. apply drying procedures;

14. replace pipe insulation with new material; and,

15. replace coverings.

Suspended Ceilings

16. remove and replace all wet ceiling tiles; and,

17. disinfect supports by wiping with EPA-disinfectants.

Paper / Files

18. dispose of all highly absorbent saturated materials.

**Close-out Investigation**

Complete Follow-up Investigation per ***Section II paragraph 2.0*.**

**Process Evaluation:**

Complete Close-out documentation per ***Sections II paragraph 3.0***

**INSERT TAB HERE FOR SECTION III:**

**Mold Growth Procedures**

**1.0 Mold Growth Procedures Overview**

The procedures in this section provide a step-by-step process for
responding to mold growth concerns. The process is broken down into 8
essential steps:

1.  Report of mold growth concern to a member of the WIMM Program Team;

2.  Assessment of visible mold growth;

3.  Determination of Patient Risk Group from 4 potential risk groups;

4.  Determination of Class of Response and corresponding Work Practices;

5.  Implementation and Completion of Response Action;

6.  Post initial response assessment;

7.  Close-out investigation; and,

8.  Final documentation.

**1.1 Step One -- Mold Growth Reporting**

Whenever visible mold is identified, or other chronically wet conditions
(e.g. musty odors, warped flooring) are noted that may indicate that
potential mold growth exists, it should be reported to a member of the
WIMM Program Team (See ***Section I paragraph 3.2***).

Proper reporting will enable the WIMM Program Lead to ensure appropriate
steps can be taken to assess and respond to incidents. The WIMM Program
Lead should ensure that staff who typically receive reports or identify
mold growth are aware of the reporting requirement. This should include
regional/local EH&S professionals, Facility Engineers, Infection Control
Professionals, Capital Projects/ Construction Managers, and Facility
Administrators.

**1.2 Step Two -- Mold Growth Assessment**

The WIMM Program Team Lead or designee should assess the mold growth to
determine the team members that need to be involved and the appropriate
response actions that need to be implemented. When the presence of mold
growth is reported to the WIMM Program Team, the WIMM Program Lead
should ensure that a proper assessment is performed. Additional
information to assist in conducting inspections and assessing the
presence of mold is presented in ***Section I. Appendix III: Assessment
Guidelines and Checklist.***

The WIMM Program Lead is encouraged to involve the Infection Control
professional for all incidents. Ensure that approval is obtained for all
incidents requiring a Mold Class of response Level M-3, M-4, or M-5
Response Procedures.

The assessment should determine:

-   the source of any water intrusion and when the intrusion occurred;

-   the presence and extent of mold growth;

-   the area of the facility and patient population(s) that are
    potentially impacted;

-   the presence of mold growth in the HVAC system; and,

-   the types of materials impacted by mold growth or water intrusion.

**NOTE:** It is important to determine if water intrusion incidents can
be remediated within 48 hours of when the water intrusion first
occurred. Water intrusion incidents that can be remediated within 48
hours should be mitigated in accordance with the water intrusion
procedures. Water intrusion incidents that cannot be cleaned up within
48 hours of occurrence should be assessed to determine if mold growth is
a concern. If mold growth is determined to be associated with the water
intrusion, then it should be responded to in accordance with WIMM
Program mold remediation procedures.

**Sampling**

Air, bulk, and wipe sampling for fungi are not recommended to be part of
a routine visual assessment and M-1 level mitigation for low and medium
risk patient environments. Identification of visual mold species is
required for M2-4 level mitigation through surface/wipe/swab sampling.

The assessment of staff (or patient) health symptoms and the need for
sampling should be made in concert with an occupational physician.
Decisions about appropriate remediation and response strategies can
usually be made on the basis of a visual inspection. In general,
sampling strategies to address health symptoms in rooms and units
adjacent to the M1-5 worksite should include outdoor air and
non-complaint (control) areas. Sampling without a specific purpose
greatly increases the chances of generating useless data and is
generally to be avoided.  Some issues to consider when developing a
sampling strategy to address health symptom complaints include:

-   The success of species culture is determined by the media type,
    incubation temperature and viability. Only those viable species that
    can successfully compete in the collected environmental sample will
    be identified by plate culture. In contrast, direct ID by tape or
    bulk sample will identify viable and non-viable genera, but not
    species. Direct ID samples are highly variable from surface to
    surface and are not related to airborne exposure.

-   An incubation temperature of 18 to 25C is most often used for
    culture. More complex sampling strategies would include duplicate
    plates incubated at 35 to 40 degrees.

-   Plate culture growth should be between 10 cfu/plate, the lower
    detection limit, and 1 cfu per square centimeter, the upper
    detection limit. Overloading the sample plate will decrease
    competition for slower growing species. For a 78 square centimeter
    plate, run the sampler at 30 to 60 seconds, for highly contaminated
    rooms, and about 5 minutes for control samples.

-   Only a laboratory with American Industrial Hygiene Association EMLAP
    accreditation must be used for sample analysis. ***See Section I.
    Appendix II: Guidelines for Selecting Outsource Consultants and
    Contractors.***

**1.3 Step Three: Patient Risk Assessment**

# Patient Risk Groups

Use the table below as a general guideline to evaluate the risk to the
patient population potentially impacted by mold growth. The intent of
determining the patient risk groups is to protect immune deficient
patients, visitors and employees that are occupying the affected area
and the adjacent area(s) where the response action is planned.

Identify the Patient Risk Group that will be affected. Factors to
consider when determining the patients' risk include: the immune status
of the patient(s), the degree of invasive procedures being conducted
with the patient and/or the potential length of exposure time in or
adjacent to the affected area (for example the comparatively greater
exposure time in the hospital setting vs. outpatient care setting).

**If more than one risk category will be affected, select the higher
risk group.**

+---------+--------------+-----------------+-------------------------+
| **Low   | **Medium     | **High Risk**   | **Highest Risk**        |
| Risk**  | Risk**       |                 |                         |
+---------+--------------+-----------------+-------------------------+
| -       | -            | -   CCU         | -   Areas providing     |
|  Office |   Cardiology |                 |     care to             |
|         |              | -   Emergency   |     immuno-compromised  |
|   Areas | -   Echo-    |     Room        |     patients            |
|         | cardiography |                 |     (inpatient)         |
| -       |              | -   Labor &     |                         |
|   Admin | -            |     Delivery    | -   Burn Unit           |
|     or  |    Endoscopy |                 |                         |
|     MD  |              | -               | -   Cardiac Cath Lab    |
|         | -   Nuclear  |    Laboratories |                         |
| offices |     Medicine |     (specimen)  | -   Central Sterile     |
|         |              |                 |     Supply              |
| -       | -   Physical | -   Newborn     |                         |
|  Confer |     Therapy  |     Nursery     | -   Intensive Care      |
| ence/Ed |              |                 |     Units (newborn,     |
| ucation | -            | -   Outpatient  |     pediatric and       |
|         |    Radiology |     Surgery     |     adult)              |
|   Rooms |     / MRI    |                 |                         |
|         |              | -   Pediatrics  | -   Medical Unit        |
|         | -   Minor    |     (In and     |     (inpatient)         |
|         |              |     Out)        |                         |
|         |   Outpatient |                 | -   Negative Pressure   |
|         |              | -   Pharmacies  |     Isolation Rooms     |
|         |    Procedure |     that do     |     (inpatient)         |
|         |     Rooms    |     com         |                         |
|         |              | pounding/mixing | -   Oncology (in and    |
|         | -   Ob-Gyn   |                 |     out patient)        |
|         |              | -   Post        |                         |
|         | -            |     Anesthesia  | -   Operating Rooms,    |
|         |   Outpatient |     Care Unit   |     including C-Section |
|         |     Pharmacy |                 |     Rooms               |
|         |              | -   Surgical    |                         |
|         | -   Primary  |     Units       | -   Infusion/dialysis   |
|         |     Care     |     (inpatient) |     clinics             |
|         |              |                 |                         |
|         | -   Medical  | -   Respiratory |                         |
|         |     and      |     Therapy     |                         |
|         |     Surgical |                 |                         |
|         |     sub      |                 |                         |
|         | -specialties |                 |                         |
+---------+--------------+-----------------+-------------------------+

# 

# **Determine the WIMM risk category, and proper implementation of the corresponding work practices. Review work periodically, and adjust the risk category as is appropriate during the WIMM Program related work. Use the Infection Control Risk Assessment Form (ICRA) for documentation purposed (***See Section III Appendix I: ICRA**)*****.** 

# 

# 1.4 Step Four: Determine Class of Response

Based upon the assessment performed in Step Two and the Patient Risk
Assessment performed in Step Three, the class of response can be
determined. To identify the appropriate class of responses use the Mold
Response Matrix below in Paragraph 1.4.1.

\[VHA facility\] staff and contractors performing mold responses must
receive training that includes:

-   the health hazards of contaminant being remediated (i.e. mold,
    biological hazards, medical waste);

-   additional hazards and contaminants present at the site (electrical,
    asbestos, lead, confined space, etc.);

-   appropriate use of personnel protective equipment;

-   remediation methods and practices to minimize exposure; and,

-   OSHA hazard communication, asbestos and lead based standards.

In addition, if respiratory protection is assigned, training that
satisfies the requirement of the OSHA Respiratory Protection Standards
must be provided.

## 1.4.1 Step Five: Mold Response Work Practices

## There are 5 classes of work practices that can be used to remediate mold growth. The Classes are based on the square footage of mold growth (M1-4) or the presence of mold in an HVAC system (M5). Remediation of mold has the potential for uncontrolled airborne release with transfer to adjacent areas. Initial inspections should be conducted cautiously to avoid disturbing contaminated building structures. 

## 

## A survey of room pressurization (smoke tubes) must be conducted prior to any actions. All response work practices must be conducted in a negative air pressure environment relative to the adjacent work areas. Initially, supply and return vents should be sealed to prevent HVAC contamination. Exhaust vents (100% exhaust to outdoors) may be used upon approval of the WIMM project team. Any non-filtered exhaust effluent should be reviewed for possible re-entry into the building through open windows or intakes. Room pressurization should be monitored during work procedures, and work halted for any event that may cause a disruption of pressure differentials (circuit breaker trip). 

## 

## Response work practices conducted on multiple room worksites should be sequenced to prevent cross-contamination by air flow or work procedures. Rooms should be prioritized by the distance from worksite entry, direction of air flow or the level of contamination. Once cleaned, rooms may be sealed with plastic on doorways. The specific work practices are presented in Section III. Appendix II through VI.

To determine the appropriate response procedures to implement for
identified mold growth, match the square footage amount of mold that has
been identified with the Patient Risk Group Chart (Low, Medium, High, or
Highest). Use the following Mold Response Matrix**. Note**: All molds in
the HVAC system should be remediated using Class M-5.

If asbestos-containing materials (ACM) or lead-based paint (LBP) have
been impacted by mold growth additional requirements for removal and
disposal may be necessary are necessary. If ACM/LBP is known or
suspected to have been impacted, the Asbestos Program Manager should be
included as a WIMM team member. The clean-up, repair, removal, and
disposal of ACM/LBP must be performed by a qualified asbestos abatement
contractor in accordance with the VHA Policy, Federal, State, and local
asbestos abatement regulations. Employees must be properly trained and
licensed for the inspection and removal of ACM/LBP.

  ----------- ----------- ---------- ----------- ------------- -------------
              ***Mold                                          
              Response                                         
              Matrix***                                        

  **Patient   Less than   10 to 30   30 to 100   Greater than  HVAC System
  Risk        10 square   square     square feet 100 square    
  Group**     feet        feet                   feet          

  Low Risk    M-1         M-2        M-3         M-4           M-5

  Medium Risk M-1         M-2        M-3         M-4           M-5

  High Risk   M-3         M-3        M-4         M-4           M-5

  Highest     M-3         M-4        M-4         M-4           M-5
  Risk                                                         
  ----------- ----------- ---------- ----------- ------------- -------------

**1.4.2 Cleaning Mold Affected Items**

[Non-porous]{.underline} (e.g., metals, glass, and hard plastics) and
semi-porous materials that are sound and visibly moldy may be cleaned
and reused. Mold-contaminated surfaces should be sprayed with a soap
solution. The visible mold contamination may then be removed by repeated
wet wiping. The surface should be sprayed with EPA-approved disinfectant
prior to the final wiping. Building structural items, such as wood,
concrete, and steel must be evaluated before removal.

[Porous]{.underline} materials such as ceiling tile, insulation, and
wallboards with more than a small area of contamination should be
removed and discarded. Porous materials (e.g., wallboard and fabrics)
that can be effectively cleaned may be reused, but should be discarded
if possible. Materials should be sprayed with a soap solution to reduce
the release of contamination during handling. A professional restoration
consultant should be contacted when restoring porous materials of
significant value (e.g. art work) with more than a small area of fungal
contamination. All materials to be reused should be dry and visibly free
from mold. Routine inspections should be conducted to confirm the
effectiveness of remediation work.

**2.0 Step Six: Close-out Investigation**

After completion of restoration activity, a follow-up investigation of
any mold growth should be conducted to assure effective restoration and
identify any additional WIMM activities that may need to occur. The WIMM
Program Team should assure that a final inspection, as prescribed in the
response procedures as specific work practices (M-1, M-2, M-3, M-4, M-5)
is completed and documented. The inspection should verify that all
elements of the project have been completed as intended, the final clean
up of the area has been accomplished, the area is fully restored, and
ready for use. It is important to fully document all corrective measures
that were completed. The follow-up investigation should include:

-   Review completion of risk assessment and response procedures on the
    ICRA form;

-   Visual inspection of the previously affected area(s);

-   Interview of occupants (health symptoms) or patient care (IC);

-   Perceptions of odors and indoor air quality; and,

-   Additional updates to staff as necessary.

**3.0 Steps Seven: Process Evaluation**

The WIMM Program Team should review and verify the effectiveness of the
process that was used for establishing the ICRA and Mold Growth Response
Measures. The WIMM Program Team should identify and document any key
findings that were achieved during the project that could be used to
improve the outcomes or processes in future projects. A process
evaluation should be conducted following project close out for WIMMS
program improvement.

-   Methods to reduce impact on patient or staff operations as a result
    of the response;

-   Recommendations for additional WIMMS response staff training; and

-   Recommendations for WIMMS process flow and worksite coordination.

All close-out documentation should be retained for no longer than 7
years, unless legal or regulatory requirements mandate a longer
retention period.

#  *Section III. Appendix I -* Infection Control Risk Assessment Form

+---+---+-----------------------------+---+---+---+----------------------+
| T |   |                             |   |   |   | Permit No:           |
| y |   |                             |   |   |   |                      |
| p |   |                             |   |   |   |                      |
| e |   |                             |   |   |   |                      |
| o |   |                             |   |   |   |                      |
| f |   |                             |   |   |   |                      |
| I |   |                             |   |   |   |                      |
| C |   |                             |   |   |   |                      |
| R |   |                             |   |   |   |                      |
| A |   |                             |   |   |   |                      |
| : |   |                             |   |   |   |                      |
| * |   |                             |   |   |   |                      |
| * |   |                             |   |   |   |                      |
| W |   |                             |   |   |   |                      |
| a |   |                             |   |   |   |                      |
| t |   |                             |   |   |   |                      |
| e |   |                             |   |   |   |                      |
| r |   |                             |   |   |   |                      |
| a |   |                             |   |   |   |                      |
| n |   |                             |   |   |   |                      |
| d |   |                             |   |   |   |                      |
| M |   |                             |   |   |   |                      |
| o |   |                             |   |   |   |                      |
| l |   |                             |   |   |   |                      |
| d |   |                             |   |   |   |                      |
| * |   |                             |   |   |   |                      |
| * |   |                             |   |   |   |                      |
+---+---+-----------------------------+---+---+---+----------------------+
| L |   |                             |   |   | P |                      |
| o |   |                             |   |   | r |                      |
| c |   |                             |   |   | o |                      |
| a |   |                             |   |   | j |                      |
| t |   |                             |   |   | e |                      |
| i |   |                             |   |   | c |                      |
| o |   |                             |   |   | t |                      |
| n |   |                             |   |   | S |                      |
| o |   |                             |   |   | t |                      |
| f |   |                             |   |   | a |                      |
| W |   |                             |   |   | r |                      |
| a |   |                             |   |   | t |                      |
| t |   |                             |   |   | D |                      |
| e |   |                             |   |   | a |                      |
| r |   |                             |   |   | t |                      |
| I |   |                             |   |   | e |                      |
| n |   |                             |   |   | : |                      |
| t |   |                             |   |   |   |                      |
| r |   |                             |   |   |   |                      |
| u |   |                             |   |   |   |                      |
| s |   |                             |   |   |   |                      |
| i |   |                             |   |   |   |                      |
| o |   |                             |   |   |   |                      |
| n |   |                             |   |   |   |                      |
| o |   |                             |   |   |   |                      |
| r |   |                             |   |   |   |                      |
| M |   |                             |   |   |   |                      |
| o |   |                             |   |   |   |                      |
| l |   |                             |   |   |   |                      |
| d |   |                             |   |   |   |                      |
| : |   |                             |   |   |   |                      |
+---+---+-----------------------------+---+---+---+----------------------+
| P |   |                             |   |   | E |                      |
| r |   |                             |   |   | s |                      |
| o |   |                             |   |   | t |                      |
| j |   |                             |   |   | i |                      |
| e |   |                             |   |   | m |                      |
| c |   |                             |   |   | a |                      |
| t |   |                             |   |   | t |                      |
| C |   |                             |   |   | e |                      |
| o |   |                             |   |   | d |                      |
| o |   |                             |   |   | D |                      |
| r |   |                             |   |   | u |                      |
| d |   |                             |   |   | r |                      |
| i |   |                             |   |   | a |                      |
| n |   |                             |   |   | t |                      |
| a |   |                             |   |   | i |                      |
| t |   |                             |   |   | o |                      |
| o |   |                             |   |   | n |                      |
| r |   |                             |   |   | : |                      |
| : |   |                             |   |   |   |                      |
+---+---+-----------------------------+---+---+---+----------------------+
| R |   |                             |   |   | P |                      |
| e |   |                             |   |   | e |                      |
| s |   |                             |   |   | r |                      |
| p |   |                             |   |   | m |                      |
| o |   |                             |   |   | i |                      |
| n |   |                             |   |   | t |                      |
| s |   |                             |   |   | E |                      |
| e |   |                             |   |   | x |                      |
| T |   |                             |   |   | p |                      |
| e |   |                             |   |   | i |                      |
| a |   |                             |   |   | r |                      |
| m |   |                             |   |   | a |                      |
| P |   |                             |   |   | t |                      |
| e |   |                             |   |   | i |                      |
| r |   |                             |   |   | o |                      |
| f |   |                             |   |   | n |                      |
| o |   |                             |   |   | D |                      |
| r |   |                             |   |   | a |                      |
| m |   |                             |   |   | t |                      |
| i |   |                             |   |   | e |                      |
| n |   |                             |   |   | : |                      |
| g |   |                             |   |   |   |                      |
| W |   |                             |   |   |   |                      |
| o |   |                             |   |   |   |                      |
| r |   |                             |   |   |   |                      |
| k |   |                             |   |   |   |                      |
+---+---+-----------------------------+---+---+---+----------------------+
| S |   |                             |   |   | T |                      |
| u |   |                             |   |   | e |                      |
| p |   |                             |   |   | l |                      |
| e |   |                             |   |   | e |                      |
| r |   |                             |   |   | p |                      |
| v |   |                             |   |   | h |                      |
| i |   |                             |   |   | o |                      |
| s |   |                             |   |   | n |                      |
| o |   |                             |   |   | e |                      |
| r |   |                             |   |   | : |                      |
| : |   |                             |   |   |   |                      |
+---+---+-----------------------------+---+---+---+----------------------+
| * | * | **WATER INTRUSION: \< 48    |   | * | * | **INFECTION CONTROL  |
| * | * | hours or \> 48 without      |   | * | * | RISK GROUP**         |
| Y | N | mold**                      |   | Y | N |                      |
| E | O |                             |   | E | O |                      |
| S | * |                             |   | S | * |                      |
| * | * |                             |   | * | * |                      |
| * |   |                             |   | * |   |                      |
+---+---+-----------------------------+---+---+---+----------------------+
|   |   | CATEGORY I: Clean Water     |   |   |   | GROUP 1: Low Risk    |
+---+---+-----------------------------+---+---+---+----------------------+
|   |   | CATEGORY II: Gray Water     |   |   |   | GROUP 2: Medium Risk |
+---+---+-----------------------------+---+---+---+----------------------+
|   |   | CATERGORY III: Black Water  |   |   |   | GROUP 3: High Risk   |
+---+---+-----------------------------+---+---+---+----------------------+
|   |   |                             |   |   |   | GROUP 4: Highest     |
|   |   |                             |   |   |   | Risk                 |
+---+---+-----------------------------+---+---+---+----------------------+
| * | * | **AMOUNT OF MOLD            |   | * | * | **INFECTION CONTROL  |
| * | * | IDENTIFIED**                |   | * | * | RISK GROUP**         |
| Y | N |                             |   | Y | N |                      |
| E | O |                             |   | E | O |                      |
| S | * |                             |   | S | * |                      |
| * | * |                             |   | * | * |                      |
| * |   |                             |   | * |   |                      |
+---+---+-----------------------------+---+---+---+----------------------+
|   |   | Less than 10 square feet:   |   |   |   | GROUP 1: Low Risk    |
+---+---+-----------------------------+---+---+---+----------------------+
|   |   | 10 to 30 square feet:       |   |   |   | GROUP 2: Medium Risk |
+---+---+-----------------------------+---+---+---+----------------------+
|   |   | 30-100 square feet:         |   |   |   | GROUP 3: High Risk   |
+---+---+-----------------------------+---+---+---+----------------------+
|   |   | Greater than 100 square     |   |   |   | GROUP 4: Highest     |
|   |   | feet                        |   |   |   | Risk                 |
+---+---+-----------------------------+---+---+---+----------------------+
|   |   | HVAC System                 |   |   |   |                      |
+---+---+-----------------------------+---+---+---+----------------------+
| * |   | 1.  Identify and remove     |   | 5 |   |                      |
| * |   |     source of water         |   | . |   |                      |
| W |   |     intrusion               |   |   |   |                      |
| - |   |                             |   |   |   |                      |
| 1 |   | 2.  Contain water to        |   | D |   |                      |
| * |   |     limited area.           |   | e |   |                      |
| * |   |                             |   | t |   |                      |
|   |   | 3.  Protect components,     |   | e |   |                      |
| * |   |     furnishings, etc from   |   | r |   |                      |
| * |   |     direct contact with     |   | m |   |                      |
| D |   |     water.                  |   | i |   |                      |
| a |   |                             |   | n |   |                      |
| t |   | 4.  Extract water from all  |   | e |   |                      |
| e |   |     locations impacted by   |   |   |   |                      |
| * |   |     water intrusion.        |   |   |   |                      |
| * |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
| * |   |                             |   | a |   |                      |
| * |   |                             |   | c |   |                      |
| I |   |                             |   | t |   |                      |
| n |   |                             |   | i |   |                      |
| i |   |                             |   | o |   |                      |
| t |   |                             |   | n |   |                      |
| i |   |                             |   | s |   |                      |
| a |   |                             |   |   |   |                      |
| l |   |                             |   |   |   |                      |
| * |   |                             |   |   |   |                      |
| * |   |                             |   |   |   |                      |
|   |   |                             |   | t |   |                      |
|   |   |                             |   | o |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | r |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   | m |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   | d |   |                      |
|   |   |                             |   | i |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | t |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | n |   |                      |
|   |   |                             |   | d |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | r |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   | s |   |                      |
|   |   |                             |   | t |   |                      |
|   |   |                             |   | o |   |                      |
|   |   |                             |   | r |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | d |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | m |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | g |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   | d |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | m |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | t |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   | r |   |                      |
|   |   |                             |   | i |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | l |   |                      |
|   |   |                             |   | s |   |                      |
|   |   |                             |   | . |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | 6 |   |                      |
|   |   |                             |   | . |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | D |   |                      |
|   |   |                             |   | i |   |                      |
|   |   |                             |   | s |   |                      |
|   |   |                             |   | c |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | r |   |                      |
|   |   |                             |   | d |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | l |   |                      |
|   |   |                             |   | l |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | u |   |                      |
|   |   |                             |   | n |   |                      |
|   |   |                             |   | s |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | l |   |                      |
|   |   |                             |   | v |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | g |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | b |   |                      |
|   |   |                             |   | l |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | c |   |                      |
|   |   |                             |   | o |   |                      |
|   |   |                             |   | n |   |                      |
|   |   |                             |   | t |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   | n |   |                      |
|   |   |                             |   | t |   |                      |
|   |   |                             |   | s |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | n |   |                      |
|   |   |                             |   | d |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | f |   |                      |
|   |   |                             |   | u |   |                      |
|   |   |                             |   | r |   |                      |
|   |   |                             |   | n |   |                      |
|   |   |                             |   | i |   |                      |
|   |   |                             |   | s |   |                      |
|   |   |                             |   | h |   |                      |
|   |   |                             |   | i |   |                      |
|   |   |                             |   | n |   |                      |
|   |   |                             |   | g |   |                      |
|   |   |                             |   | s |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | p |   |                      |
|   |   |                             |   | r |   |                      |
|   |   |                             |   | o |   |                      |
|   |   |                             |   | m |   |                      |
|   |   |                             |   | p |   |                      |
|   |   |                             |   | t |   |                      |
|   |   |                             |   | l |   |                      |
|   |   |                             |   | y |   |                      |
|   |   |                             |   | . |   |                      |
+---+---+-----------------------------+---+---+---+----------------------+
| * |   | 1.  Identify and remove     |   | 7 |   |                      |
| * |   |     source of water         |   | . |   |                      |
| W |   |     intrusion               |   |   |   |                      |
| - |   |                             |   |   |   |                      |
| 2 |   | 2.  Contain water to        |   | R |   |                      |
| * |   |     limited area.           |   | e |   |                      |
| * |   |                             |   | m |   |                      |
|   |   | 3.  Block off and seal      |   | o |   |                      |
| * |   |     supply and return air   |   | v |   |                      |
| * |   |     vents.                  |   | e |   |                      |
| D |   |                             |   |   |   |                      |
| a |   | 4.  Redirect and restrict   |   |   |   |                      |
| t |   |     access to affected      |   |   |   |                      |
| e |   |     areas to minimize cross |   |   |   |                      |
| * |   |     contamination from      |   | s |   |                      |
| * |   |     affected areas.         |   | o |   |                      |
|   |   |                             |   | l |   |                      |
| # |   | 5.  Evacuate high or        |   | i |   |                      |
| # |   |     highest risk patients   |   | d |   |                      |
| # |   |     from area.              |   |   |   |                      |
|   |   |                             |   |   |   |                      |
| I |   | 6.  Protect or remove       |   |   |   |                      |
| n |   |     contents in the area    |   |   |   |                      |
| i |   |     from direct contact     |   | m |   |                      |
| t |   |     with water.             |   | a |   |                      |
| i |   |                             |   | t |   |                      |
| a |   |                             |   | t |   |                      |
| l |   |                             |   | e |   |                      |
|   |   |                             |   | r |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | n |   |                      |
|   |   |                             |   | d |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   | x |   |                      |
|   |   |                             |   | t |   |                      |
|   |   |                             |   | r |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | c |   |                      |
|   |   |                             |   | t |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | w |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | t |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   | r |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | f |   |                      |
|   |   |                             |   | r |   |                      |
|   |   |                             |   | o |   |                      |
|   |   |                             |   | m |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | l |   |                      |
|   |   |                             |   | l |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | i |   |                      |
|   |   |                             |   | m |   |                      |
|   |   |                             |   | p |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | c |   |                      |
|   |   |                             |   | t |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   | d |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | l |   |                      |
|   |   |                             |   | o |   |                      |
|   |   |                             |   | c |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | t |   |                      |
|   |   |                             |   | i |   |                      |
|   |   |                             |   | o |   |                      |
|   |   |                             |   | n |   |                      |
|   |   |                             |   | s |   |                      |
|   |   |                             |   | . |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | V |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | c |   |                      |
|   |   |                             |   | u |   |                      |
|   |   |                             |   | u |   |                      |
|   |   |                             |   | m |   |                      |
|   |   |                             |   | s |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | m |   |                      |
|   |   |                             |   | u |   |                      |
|   |   |                             |   | s |   |                      |
|   |   |                             |   | t |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | b |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   | q |   |                      |
|   |   |                             |   | u |   |                      |
|   |   |                             |   | i |   |                      |
|   |   |                             |   | p |   |                      |
|   |   |                             |   | p |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   | d |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | w |   |                      |
|   |   |                             |   | i |   |                      |
|   |   |                             |   | t |   |                      |
|   |   |                             |   | h |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | H |   |                      |
|   |   |                             |   | E |   |                      |
|   |   |                             |   | P |   |                      |
|   |   |                             |   | A |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | f |   |                      |
|   |   |                             |   | i |   |                      |
|   |   |                             |   | l |   |                      |
|   |   |                             |   | t |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   | r |   |                      |
|   |   |                             |   | s |   |                      |
|   |   |                             |   | . |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | 8 |   |                      |
|   |   |                             |   | . |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | D |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   | c |   |                      |
|   |   |                             |   | o |   |                      |
|   |   |                             |   | n |   |                      |
|   |   |                             |   | t |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | m |   |                      |
|   |   |                             |   | i |   |                      |
|   |   |                             |   | n |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | t |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | d |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | m |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | g |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   | d |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | h |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | r |   |                      |
|   |   |                             |   | d |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | s |   |                      |
|   |   |                             |   | u |   |                      |
|   |   |                             |   | r |   |                      |
|   |   |                             |   | f |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | c |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | m |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | t |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   | r |   |                      |
|   |   |                             |   | i |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | l |   |                      |
|   |   |                             |   | s |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | w |   |                      |
|   |   |                             |   | i |   |                      |
|   |   |                             |   | t |   |                      |
|   |   |                             |   | h |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | p |   |                      |
|   |   |                             |   | p |   |                      |
|   |   |                             |   | r |   |                      |
|   |   |                             |   | o |   |                      |
|   |   |                             |   | v |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   | d |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | d |   |                      |
|   |   |                             |   | i |   |                      |
|   |   |                             |   | s |   |                      |
|   |   |                             |   | i |   |                      |
|   |   |                             |   | n |   |                      |
|   |   |                             |   | f |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   | c |   |                      |
|   |   |                             |   | t |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | n |   |                      |
|   |   |                             |   | t |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | t |   |                      |
|   |   |                             |   | o |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | r |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   | d |   |                      |
|   |   |                             |   | u |   |                      |
|   |   |                             |   | c |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | m |   |                      |
|   |   |                             |   | i |   |                      |
|   |   |                             |   | c |   |                      |
|   |   |                             |   | r |   |                      |
|   |   |                             |   | o |   |                      |
|   |   |                             |   | b |   |                      |
|   |   |                             |   | i |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | l |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | l |   |                      |
|   |   |                             |   | o |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | d |   |                      |
|   |   |                             |   | . |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | 9 |   |                      |
|   |   |                             |   | . |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | D |   |                      |
|   |   |                             |   | i |   |                      |
|   |   |                             |   | s |   |                      |
|   |   |                             |   | c |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | r |   |                      |
|   |   |                             |   | d |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | l |   |                      |
|   |   |                             |   | l |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | h |   |                      |
|   |   |                             |   | i |   |                      |
|   |   |                             |   | g |   |                      |
|   |   |                             |   | h |   |                      |
|   |   |                             |   | l |   |                      |
|   |   |                             |   | y |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | b |   |                      |
|   |   |                             |   | s |   |                      |
|   |   |                             |   | o |   |                      |
|   |   |                             |   | r |   |                      |
|   |   |                             |   | b |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   | n |   |                      |
|   |   |                             |   | t |   |                      |
|   |   |                             |   | , |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | s |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | t |   |                      |
|   |   |                             |   | u |   |                      |
|   |   |                             |   | r |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | t |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   | d |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | m |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | t |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   | r |   |                      |
|   |   |                             |   | i |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | l |   |                      |
|   |   |                             |   | s |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | p |   |                      |
|   |   |                             |   | r |   |                      |
|   |   |                             |   | o |   |                      |
|   |   |                             |   | m |   |                      |
|   |   |                             |   | p |   |                      |
|   |   |                             |   | t |   |                      |
|   |   |                             |   | l |   |                      |
|   |   |                             |   | y |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | w |   |                      |
|   |   |                             |   | i |   |                      |
|   |   |                             |   | t |   |                      |
|   |   |                             |   | h |   |                      |
|   |   |                             |   | o |   |                      |
|   |   |                             |   | u |   |                      |
|   |   |                             |   | t |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | c |   |                      |
|   |   |                             |   | r |   |                      |
|   |   |                             |   | o |   |                      |
|   |   |                             |   | s |   |                      |
|   |   |                             |   | s |   |                      |
|   |   |                             |   | - |   |                      |
|   |   |                             |   | c |   |                      |
|   |   |                             |   | o |   |                      |
|   |   |                             |   | n |   |                      |
|   |   |                             |   | t |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | m |   |                      |
|   |   |                             |   | i |   |                      |
|   |   |                             |   | n |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | t |   |                      |
|   |   |                             |   | i |   |                      |
|   |   |                             |   | n |   |                      |
|   |   |                             |   | g |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | u |   |                      |
|   |   |                             |   | n |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | f |   |                      |
|   |   |                             |   | f |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   | c |   |                      |
|   |   |                             |   | t |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   | d |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | r |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | s |   |                      |
|   |   |                             |   | . |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | 1 |   |                      |
|   |   |                             |   | 0 |   |                      |
|   |   |                             |   | . |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | D |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   | t |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   | r |   |                      |
|   |   |                             |   | m |   |                      |
|   |   |                             |   | i |   |                      |
|   |   |                             |   | n |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | c |   |                      |
|   |   |                             |   | t |   |                      |
|   |   |                             |   | i |   |                      |
|   |   |                             |   | o |   |                      |
|   |   |                             |   | n |   |                      |
|   |   |                             |   | s |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | n |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   | d |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   | d |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | t |   |                      |
|   |   |                             |   | o |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | r |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   | m |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   | d |   |                      |
|   |   |                             |   | i |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | t |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | n |   |                      |
|   |   |                             |   | d |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | r |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   | s |   |                      |
|   |   |                             |   | t |   |                      |
|   |   |                             |   | o |   |                      |
|   |   |                             |   | r |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | d |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | m |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | g |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   | d |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | n |   |                      |
|   |   |                             |   | d |   |                      |
|   |   |                             |   | / |   |                      |
|   |   |                             |   | o |   |                      |
|   |   |                             |   | r |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | c |   |                      |
|   |   |                             |   | o |   |                      |
|   |   |                             |   | n |   |                      |
|   |   |                             |   | t |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | m |   |                      |
|   |   |                             |   | i |   |                      |
|   |   |                             |   | n |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | t |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   | d |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | m |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | t |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   | r |   |                      |
|   |   |                             |   | i |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | l |   |                      |
|   |   |                             |   | s |   |                      |
|   |   |                             |   | . |   |                      |
+---+---+-----------------------------+---+---+---+----------------------+
| # |   | 1.  Identify and remove     |   | 7 |   |                      |
| # |   |     source of water         |   | . |   |                      |
|   |   |     intrusion               |   |   |   |                      |
| W |   |                             |   |   |   |                      |
| - |   | 2.  Contain water to        |   | R |   |                      |
| 3 |   |     limited area.           |   | e |   |                      |
|   |   |                             |   | m |   |                      |
|   |   | 3.  Block off and seal      |   | o |   |                      |
|   |   |     supply and return air   |   | v |   |                      |
|   |   |     vents.                  |   | e |   |                      |
|   |   |                             |   |   |   |                      |
|   |   | 4.  Redirect and restrict   |   |   |   |                      |
|   |   |     access to affected      |   |   |   |                      |
|   |   |     areas to minimize cross |   |   |   |                      |
|   |   |     contamination from      |   | s |   |                      |
|   |   |     affected areas          |   | o |   |                      |
|   |   |                             |   | l |   |                      |
|   |   | 5.  Evacuate high or        |   | i |   |                      |
|   |   |     highest risk patients   |   | d |   |                      |
|   |   |     from area.              |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   | 6.  Protect and remove      |   |   |   |                      |
|   |   |     contents in the area    |   |   |   |                      |
|   |   |     from direct contact     |   | m |   |                      |
|   |   |     with water.             |   | a |   |                      |
|   |   |                             |   | t |   |                      |
|   |   |                             |   | t |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   | r |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | n |   |                      |
|   |   |                             |   | d |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   | x |   |                      |
|   |   |                             |   | t |   |                      |
|   |   |                             |   | r |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | c |   |                      |
|   |   |                             |   | t |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | w |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | t |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   | r |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | f |   |                      |
|   |   |                             |   | r |   |                      |
|   |   |                             |   | o |   |                      |
|   |   |                             |   | m |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | l |   |                      |
|   |   |                             |   | l |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | l |   |                      |
|   |   |                             |   | o |   |                      |
|   |   |                             |   | c |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | t |   |                      |
|   |   |                             |   | i |   |                      |
|   |   |                             |   | o |   |                      |
|   |   |                             |   | n |   |                      |
|   |   |                             |   | s |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | t |   |                      |
|   |   |                             |   | h |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | t |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | h |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | v |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | b |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   | n |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | i |   |                      |
|   |   |                             |   | m |   |                      |
|   |   |                             |   | p |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | c |   |                      |
|   |   |                             |   | t |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   | d |   |                      |
|   |   |                             |   | . |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | V |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | c |   |                      |
|   |   |                             |   | u |   |                      |
|   |   |                             |   | u |   |                      |
|   |   |                             |   | m |   |                      |
|   |   |                             |   | s |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | m |   |                      |
|   |   |                             |   | u |   |                      |
|   |   |                             |   | s |   |                      |
|   |   |                             |   | t |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | b |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   | q |   |                      |
|   |   |                             |   | u |   |                      |
|   |   |                             |   | i |   |                      |
|   |   |                             |   | p |   |                      |
|   |   |                             |   | p |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   | d |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | w |   |                      |
|   |   |                             |   | i |   |                      |
|   |   |                             |   | t |   |                      |
|   |   |                             |   | h |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | H |   |                      |
|   |   |                             |   | E |   |                      |
|   |   |                             |   | P |   |                      |
|   |   |                             |   | A |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | f |   |                      |
|   |   |                             |   | i |   |                      |
|   |   |                             |   | l |   |                      |
|   |   |                             |   | t |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   | r |   |                      |
|   |   |                             |   | s |   |                      |
|   |   |                             |   | . |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | 8 |   |                      |
|   |   |                             |   | . |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | D |   |                      |
|   |   |                             |   | i |   |                      |
|   |   |                             |   | s |   |                      |
|   |   |                             |   | c |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | r |   |                      |
|   |   |                             |   | d |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | l |   |                      |
|   |   |                             |   | l |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | b |   |                      |
|   |   |                             |   | s |   |                      |
|   |   |                             |   | o |   |                      |
|   |   |                             |   | r |   |                      |
|   |   |                             |   | b |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   | n |   |                      |
|   |   |                             |   | t |   |                      |
|   |   |                             |   | , |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | s |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | t |   |                      |
|   |   |                             |   | u |   |                      |
|   |   |                             |   | r |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | t |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   | d |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | m |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | t |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   | r |   |                      |
|   |   |                             |   | i |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | l |   |                      |
|   |   |                             |   | s |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | p |   |                      |
|   |   |                             |   | r |   |                      |
|   |   |                             |   | o |   |                      |
|   |   |                             |   | m |   |                      |
|   |   |                             |   | p |   |                      |
|   |   |                             |   | t |   |                      |
|   |   |                             |   | l |   |                      |
|   |   |                             |   | y |   |                      |
|   |   |                             |   | . |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | 9 |   |                      |
|   |   |                             |   | . |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | D |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   | c |   |                      |
|   |   |                             |   | o |   |                      |
|   |   |                             |   | n |   |                      |
|   |   |                             |   | t |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | m |   |                      |
|   |   |                             |   | i |   |                      |
|   |   |                             |   | n |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | t |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | s |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   | w |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | g |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   | - |   |                      |
|   |   |                             |   | d |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | m |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | g |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   | d |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | h |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | r |   |                      |
|   |   |                             |   | d |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | s |   |                      |
|   |   |                             |   | u |   |                      |
|   |   |                             |   | r |   |                      |
|   |   |                             |   | f |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | c |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | m |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | t |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   | r |   |                      |
|   |   |                             |   | i |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | l |   |                      |
|   |   |                             |   | s |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | w |   |                      |
|   |   |                             |   | i |   |                      |
|   |   |                             |   | t |   |                      |
|   |   |                             |   | h |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | p |   |                      |
|   |   |                             |   | p |   |                      |
|   |   |                             |   | r |   |                      |
|   |   |                             |   | o |   |                      |
|   |   |                             |   | v |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   | d |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | d |   |                      |
|   |   |                             |   | i |   |                      |
|   |   |                             |   | s |   |                      |
|   |   |                             |   | i |   |                      |
|   |   |                             |   | n |   |                      |
|   |   |                             |   | f |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   | c |   |                      |
|   |   |                             |   | t |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | n |   |                      |
|   |   |                             |   | t |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | t |   |                      |
|   |   |                             |   | o |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | r |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   | d |   |                      |
|   |   |                             |   | u |   |                      |
|   |   |                             |   | c |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | m |   |                      |
|   |   |                             |   | i |   |                      |
|   |   |                             |   | c |   |                      |
|   |   |                             |   | r |   |                      |
|   |   |                             |   | o |   |                      |
|   |   |                             |   | b |   |                      |
|   |   |                             |   | i |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | l |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | l |   |                      |
|   |   |                             |   | o |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | d |   |                      |
|   |   |                             |   | . |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | 1 |   |                      |
|   |   |                             |   | 0 |   |                      |
|   |   |                             |   | . |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | R |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   | m |   |                      |
|   |   |                             |   | o |   |                      |
|   |   |                             |   | v |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | l |   |                      |
|   |   |                             |   | l |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | d |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | m |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | g |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   | d |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | p |   |                      |
|   |   |                             |   | o |   |                      |
|   |   |                             |   | r |   |                      |
|   |   |                             |   | o |   |                      |
|   |   |                             |   | u |   |                      |
|   |   |                             |   | s |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | m |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | t |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   | r |   |                      |
|   |   |                             |   | i |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | l |   |                      |
|   |   |                             |   | s |   |                      |
|   |   |                             |   | . |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | 1 |   |                      |
|   |   |                             |   | 1 |   |                      |
|   |   |                             |   | . |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | D |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   | t |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   | r |   |                      |
|   |   |                             |   | m |   |                      |
|   |   |                             |   | i |   |                      |
|   |   |                             |   | n |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | c |   |                      |
|   |   |                             |   | t |   |                      |
|   |   |                             |   | i |   |                      |
|   |   |                             |   | o |   |                      |
|   |   |                             |   | n |   |                      |
|   |   |                             |   | s |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | n |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   | d |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   | d |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | t |   |                      |
|   |   |                             |   | o |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | c |   |                      |
|   |   |                             |   | o |   |                      |
|   |   |                             |   | m |   |                      |
|   |   |                             |   | p |   |                      |
|   |   |                             |   | l |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   | t |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   |   |   |                      |
|   |   |                             |   | r |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   | m |   |                      |
|   |   |                             |   | e |   |                      |
|   |   |                             |   | d |   |                      |
|   |   |                             |   | i |   |                      |
|   |   |                             |   | a |   |                      |
|   |   |                             |   | t |   |                      |
|   |   |                             |   | i |   |                      |
|   |   |                             |   | o |   |                      |
|   |   |                             |   | n |   |                      |
|   |   |                             |   | . |   |                      |
+---+---+-----------------------------+---+---+---+----------------------+
| * |   |                             |   |   |   |                      |
| * |   |                             |   |   |   |                      |
| D |   |                             |   |   |   |                      |
| a |   |                             |   |   |   |                      |
| t |   |                             |   |   |   |                      |
| e |   |                             |   |   |   |                      |
| * |   |                             |   |   |   |                      |
| * |   |                             |   |   |   |                      |
+---+---+-----------------------------+---+---+---+----------------------+
| * |   |                             |   |   |   |                      |
| * |   |                             |   |   |   |                      |
| I |   |                             |   |   |   |                      |
| n |   |                             |   |   |   |                      |
| i |   |                             |   |   |   |                      |
| t |   |                             |   |   |   |                      |
| i |   |                             |   |   |   |                      |
| a |   |                             |   |   |   |                      |
| l |   |                             |   |   |   |                      |
| * |   |                             |   |   |   |                      |
| * |   |                             |   |   |   |                      |
+---+---+-----------------------------+---+---+---+----------------------+
| A |   |                             |   |   |   |                      |
| d |   |                             |   |   |   |                      |
| d |   |                             |   |   |   |                      |
| i |   |                             |   |   |   |                      |
| t |   |                             |   |   |   |                      |
| i |   |                             |   |   |   |                      |
| o |   |                             |   |   |   |                      |
| n |   |                             |   |   |   |                      |
| a |   |                             |   |   |   |                      |
| l |   |                             |   |   |   |                      |
| R |   |                             |   |   |   |                      |
| e |   |                             |   |   |   |                      |
| q |   |                             |   |   |   |                      |
| u |   |                             |   |   |   |                      |
| i |   |                             |   |   |   |                      |
| r |   |                             |   |   |   |                      |
| e |   |                             |   |   |   |                      |
| m |   |                             |   |   |   |                      |
| e |   |                             |   |   |   |                      |
| n |   |                             |   |   |   |                      |
| t |   |                             |   |   |   |                      |
| s |   |                             |   |   |   |                      |
| : |   |                             |   |   |   |                      |
+---+---+-----------------------------+---+---+---+----------------------+
| * |   |                             | * |   |   |                      |
| * |   |                             | * |   |   |                      |
| A |   |                             | A |   |   |                      |
| T |   |                             | T |   |   |                      |
| T |   |                             | T |   |   |                      |
| E |   |                             | E |   |   |                      |
| N |   |                             | N |   |   |                      |
| D |   |                             | D |   |   |                      |
| E |   |                             | E |   |   |                      |
| E |   |                             | E |   |   |                      |
| S |   |                             | S |   |   |                      |
| I |   |                             | I |   |   |                      |
| G |   |                             | G |   |   |                      |
| N |   |                             | N |   |   |                      |
| A |   |                             | A |   |   |                      |
| T |   |                             | T |   |   |                      |
| U |   |                             | U |   |   |                      |
| R |   |                             | R |   |   |                      |
| E |   |                             | E |   |   |                      |
| S |   |                             | S |   |   |                      |
| * |   |                             | * |   |   |                      |
| * |   |                             | * |   |   |                      |
|   |   |                             |   |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             |   |   |   |                      |
| _ |   |                             | \ |   |   |                      |
| \ |   |                             | _ |   |   |                      |
| _ |   |                             | \ |   |   |                      |
| \ |   |                             | _ |   |   |                      |
| _ |   |                             | \ |   |   |                      |
| \ |   |                             | _ |   |   |                      |
| _ |   |                             | \ |   |   |                      |
| \ |   |                             | _ |   |   |                      |
| _ |   |                             | \ |   |   |                      |
| \ |   |                             | _ |   |   |                      |
| _ |   |                             | \ |   |   |                      |
| \ |   |                             | _ |   |   |                      |
| _ |   |                             | \ |   |   |                      |
| \ |   |                             | _ |   |   |                      |
| _ |   |                             | \ |   |   |                      |
| \ |   |                             | _ |   |   |                      |
| _ |   |                             | \ |   |   |                      |
|   |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             | \ |   |   |                      |
| _ |   |                             | _ |   |   |                      |
| \ |   |                             |   |   |   |                      |
| _ |   |                             |   |   |   |                      |
| \ |   |                             |   |   |   |                      |
| _ |   |                             |   |   |   |                      |
| \ |   |                             |   |   |   |                      |
| _ |   |                             |   |   |   |                      |
| \ |   |                             |   |   |   |                      |
| _ |   |                             |   |   |   |                      |
| \ |   |                             |   |   |   |                      |
| _ |   |                             |   |   |   |                      |
| \ |   |                             |   |   |   |                      |
| _ |   |                             |   |   |   |                      |
| \ |   |                             |   |   |   |                      |
| _ |   |                             |   |   |   |                      |
| \ |   |                             |   |   |   |                      |
| _ |   |                             |   |   |   |                      |
| \ |   |                             |   |   |   |                      |
| _ |   |                             |   |   |   |                      |
| \ |   |                             |   |   |   |                      |
| _ |   |                             |   |   |   |                      |
| \ |   |                             |   |   |   |                      |
| _ |   |                             |   |   |   |                      |
| \ |   |                             |   |   |   |                      |
| _ |   |                             |   |   |   |                      |
| \ |   |                             |   |   |   |                      |
| _ |   |                             |   |   |   |                      |
| \ |   |                             |   |   |   |                      |
| _ |   |                             |   |   |   |                      |
| \ |   |                             |   |   |   |                      |
| _ |   |                             |   |   |   |                      |
+---+---+-----------------------------+---+---+---+----------------------+
| D |   |                             | E |   |   |                      |
| a |   |                             | x |   |   |                      |
| t |   |                             | c |   |   |                      |
| e |   |                             | e |   |   |                      |
| : |   |                             | p |   |   |                      |
|   |   |                             | t |   |   |                      |
|   |   |                             | i |   |   |                      |
|   |   |                             | o |   |   |                      |
|   |   |                             | n |   |   |                      |
|   |   |                             | s |   |   |                      |
|   |   |                             | / |   |   |                      |
|   |   |                             | A |   |   |                      |
|   |   |                             | d |   |   |                      |
|   |   |                             | d |   |   |                      |
|   |   |                             | i |   |   |                      |
|   |   |                             | t |   |   |                      |
|   |   |                             | i |   |   |                      |
|   |   |                             | o |   |   |                      |
|   |   |                             | n |   |   |                      |
|   |   |                             | s |   |   |                      |
|   |   |                             | t |   |   |                      |
|   |   |                             | o |   |   |                      |
|   |   |                             | t |   |   |                      |
|   |   |                             | h |   |   |                      |
|   |   |                             | i |   |   |                      |
|   |   |                             | s |   |   |                      |
|   |   |                             | p |   |   |                      |
|   |   |                             | e |   |   |                      |
|   |   |                             | r |   |   |                      |
|   |   |                             | m |   |   |                      |
|   |   |                             | i |   |   |                      |
|   |   |                             | t |   |   |                      |
|   |   |                             | a |   |   |                      |
|   |   |                             | r |   |   |                      |
|   |   |                             | e |   |   |                      |
|   |   |                             | n |   |   |                      |
|   |   |                             | o |   |   |                      |
|   |   |                             | t |   |   |                      |
|   |   |                             | e |   |   |                      |
|   |   |                             | d |   |   |                      |
|   |   |                             | b |   |   |                      |
|   |   |                             | y |   |   |                      |
|   |   |                             | a |   |   |                      |
|   |   |                             | t |   |   |                      |
|   |   |                             | t |   |   |                      |
|   |   |                             | a |   |   |                      |
|   |   |                             | c |   |   |                      |
|   |   |                             | h |   |   |                      |
|   |   |                             | e |   |   |                      |
|   |   |                             | d |   |   |                      |
|   |   |                             | m |   |   |                      |
|   |   |                             | e |   |   |                      |
|   |   |                             | m |   |   |                      |
|   |   |                             | o |   |   |                      |
|   |   |                             | r |   |   |                      |
|   |   |                             | a |   |   |                      |
|   |   |                             | n |   |   |                      |
|   |   |                             | d |   |   |                      |
|   |   |                             | a |   |   |                      |
|   |   |                             | . |   |   |                      |
|   |   |                             | D |   |   |                      |
|   |   |                             | a |   |   |                      |
|   |   |                             | t |   |   |                      |
|   |   |                             | e |   |   |                      |
|   |   |                             | : |   |   |                      |
+---+---+-----------------------------+---+---+---+----------------------+

+-------+-----------------------------+---+------------------------------+
| M- 1  | 1.  Identify and remove any |   | 5.  Remove contaminated      |
|       |     source of water         |   |     materials from building  |
|       |     intrusion               |   |     in sealed plastic bags.  |
|       |                             |   |                              |
|       | 2.  Remediation must be     |   | 6.  Dispose of moldy         |
|       |     performed by            |   |     materials in exterior    |
|       |     appropriately trained   |   |     dumpster. Bag sharps     |
|       |     staff using respiratory |   |     objects in a manner that |
|       |     protection and PPE.     |   |     prevents puncture.       |
|       |                             |   |                              |
|       | 3.  Restrict access to and  |   | 7.  Remedial worker egress   |
|       |     keep work area          |   |     should be thoroughly     |
|       |     unoccupied.             |   |     cleaned and left dry and |
|       |                             |   |     visibly free from        |
|       | 4.  Use work practices that |   |     contamination.           |
|       |     minimize mold           |   |                              |
|       |     disturbance.            |   |                              |
+-------+-----------------------------+---+------------------------------+
| M- 2  | 1.  Identify and remove any |   | 6.  Remove contaminated      |
|       |     source of water         |   |     materials from building  |
|       |     intrusion               |   |     in sealed plastic bags.  |
|       |                             |   |                              |
|       | 2.  Remediation must be     |   | 7.  Dispose of moldy         |
|       |     performed by            |   |     materials in exterior    |
|       |     appropriately trained   |   |     dumpster. Bag sharps     |
|       |     staff using respiratory |   |     objects in a manner that |
|       |     protection and PPE.     |   |     prevents puncture.       |
|       |                             |   |                              |
|       | 3.  Restrict access to and  |   | 8.  Remedial worker egress   |
|       |     keep work area          |   |     should be HEPA vacuumed, |
|       |     unoccupied, seal unused |   |     cleaned with detergent   |
|       |     doors with plastic.     |   |     and left dry and visibly |
|       |     Place tacky mats at     |   |     free from contamination  |
|       |     exit to prevent         |   |                              |
|       |     transporting mold and   |   |                              |
|       |     debris outside the      |   |                              |
|       |     area.                   |   |                              |
|       |                             |   |                              |
|       | 4.  Use work practices that |   |                              |
|       |     minimize mold           |   |                              |
|       |     disturbance.            |   |                              |
|       |                             |   |                              |
|       | 5.  Use HEPA vacuum to      |   |                              |
|       |     capture airborne dust,  |   |                              |
|       |     if generated.           |   |                              |
+-------+-----------------------------+---+------------------------------+
| M-3   | 1.  Identify and remove any |   | 7.  Use HEPA vacuum to       |
|       |     source of water         |   |     capture airborne dust,   |
|       |     intrusion               |   |     if generated.            |
|       |                             |   |                              |
|       | 2.  Remediation must be     |   | 8.  Remove contaminated      |
|       |     performed by            |   |     materials in sealed      |
|       |     appropriately trained   |   |     plastic bags and clean   |
|       |     staff using respiratory |   |     outside of bags with     |
|       |     protection and PPE.     |   |     HEPA vacuum and wet      |
|       |                             |   |     wiping                   |
|       | 3.  Restrict access to and  |   |                              |
|       |     keep work area          |   | 9.  Dispose of moldy items   |
|       |     unoccupied, seal unused |   |     promptly in exterior     |
|       |     doors with plastic.     |   |     dumpster                 |
|       |     Place tacky mats at     |   |                              |
|       |     exit to prevent         |   | 10. Work area barriers and   |
|       |     transporting mold and   |   |     egress should be HEPA    |
|       |     debris outside the      |   |     vacuumed, cleaned with   |
|       |     area.                   |   |     detergent and left dry   |
|       |                             |   |     and visibly free from    |
|       | 4.  Clean, wet wipe, HEPA   |   |     contamination            |
|       |     vacuum and remove all   |   |                              |
|       |     movable objects from    |   | 11. Remove barrier materials |
|       |     work area.              |   |     carefully to minimize    |
|       |                             |   |     spreading of dirt and    |
|       | 5.  Clean supply and return |   |     debris associated with   |
|       |     air grills with HEPA    |   |     mold removal.            |
|       |     vacuum                  |   |                              |
|       |                             |   |                              |
|       | 6.  Seal ventilation        |   |                              |
|       |     ducts/grills with       |   |                              |
|       |     plastic and duct tape.  |   |                              |
+-------+-----------------------------+---+------------------------------+
| **D   |                             |   |                              |
| ate** |                             |   |                              |
+-------+-----------------------------+---+------------------------------+
| *     |                             |   |                              |
| *Init |                             |   |                              |
| ial** |                             |   |                              |
+-------+-----------------------------+---+------------------------------+
| M 4   | 1.  Identify and remove any |   | 8.  Remove contaminated      |
|       |     source of water         |   |     materials in sealed      |
|       |     intrusion               |   |     plastic bags and clean   |
|       |                             |   |     outside of bags with     |
|       | 2.  Remediation must be     |   |     HEPA vacuum. Wet wipe    |
|       |     performed by            |   |     bags in the              |
|       |     appropriately trained   |   |     decontamination chamber  |
|       |     staff using full-face   |   |     prior to transport area  |
|       |     respiratory protection  |   |     outside building.        |
|       |     and PPE.                |   |                              |
|       |                             |   | 9.  Contained area and       |
|       | 3.  Restrict access to and  |   |     decontamination room     |
|       |     keep work area          |   |     should be HEPA vacuumed  |
|       |     unoccupied, completely  |   |     and cleaned with damp    |
|       |     seal work area with     |   |     cloth prior to removal   |
|       |     plastic sheeting and    |   |     of isolation barriers.   |
|       |     duct tape.              |   |                              |
|       |                             |   | 10. Maintain containment and |
|       | 4.  Use exhaust fan with    |   |     negative pressure until  |
|       |     HEPA filter to create   |   |     adequate cleaning is     |
|       |     negative pressure,      |   |     validated and all        |
|       |     maintain airlocks and   |   |     visible dust is removed. |
|       |     decontamination room.   |   |                              |
|       |                             |   | 11. Remove barrier materials |
|       | 5.  Place tacky mats at     |   |     carefully to minimize    |
|       |     exit to prevent         |   |     spreading of dirt and    |
|       |     transporting mold and   |   |     debris associated with   |
|       |     debris outside the      |   |     mold removal.            |
|       |     area.                   |   |                              |
|       |                             |   |                              |
|       | 6.  Clean, wet wipe, HEPA   |   |                              |
|       |     vacuum and remove all   |   |                              |
|       |     movable objects from    |   |                              |
|       |     work area.              |   |                              |
|       |                             |   |                              |
|       | 7.  Use HEPA vacuum to      |   |                              |
|       |     capture airborne dust,  |   |                              |
|       |     if generated.           |   |                              |
+-------+-----------------------------+---+------------------------------+
| **D   |                             |   |                              |
| ate** |                             |   |                              |
+-------+-----------------------------+---+------------------------------+
| *     |                             |   |                              |
| *Init |                             |   |                              |
| ial** |                             |   |                              |
+-------+-----------------------------+---+------------------------------+
| M 5   | 1.  Remediation should be   |   | 7.  Clean work area and      |
|       |     conducted by qualified  |   |     surrounding area with    |
|       |     contractor or fully     |   |     HEPA vacuum, damp cloth  |
|       |     trained KP staff using  |   |     and/or mop and detergent |
|       |     full respiratory        |   |     solution.                |
|       |     protection and PPE.     |   |                              |
|       |                             |   | 8.  Area should be left dry  |
|       | 2.  Securely seal (isolate) |   |     and visibly free from    |
|       |     affected HVAC section   |   |     contamination.           |
|       |     to ensure no air        |   |                              |
|       |     movement in the         |   | For areas \> 30 feet, in     |
|       |     affected area.          |   | addition,:                   |
|       |                             |   |                              |
|       | 3.  Cover work area with    |   | 9.  Use plastic sheeting to  |
|       |     plastic and seal with   |   |     completely isolate work  |
|       |     duct tape.              |   |     area HVAC,               |
|       |                             |   |                              |
|       | 4.  Use dust suppression    |   | 10. Use HEPA filter exhaust  |
|       |     methods during          |   |     fan to create negative   |
|       |     remediation.            |   |     pressure.                |
|       |                             |   |                              |
|       | 5.  Remove all mold growth  |   | 11. Strongly consider        |
|       |     supporting materials    |   |     dismantling and disposal |
|       |     that cannot be cleaned. |   |     of all duct work with    |
|       |     Seal in plastic bags    |   |     significant growth.      |
|       |     and dispose promptly in |   |                              |
|       |     exterior dumpster.      |   |                              |
|       |                             |   |                              |
|       | 6.  Transport debris during |   |                              |
|       |     hours of least activity |   |                              |
|       |     and along the most      |   |                              |
|       |     direct, least congested |   |                              |
|       |     route.                  |   |                              |
+-------+-----------------------------+---+------------------------------+
| **D   |                             |   |                              |
| ate** |                             |   |                              |
+-------+-----------------------------+---+------------------------------+
| *     |                             |   |                              |
| *Init |                             |   |                              |
| ial** |                             |   |                              |
+-------+-----------------------------+---+------------------------------+
| Addit |                             |   |                              |
| ional |                             |   |                              |
| Req   |                             |   |                              |
| uirem |                             |   |                              |
| ents: |                             |   |                              |
+-------+-----------------------------+---+------------------------------+
|       |                             |   |                              |
+-------+-----------------------------+---+------------------------------+
| **ATT |                             | * |                              |
| ENDEE |                             | * |                              |
| SI    |                             | A |                              |
| GNATU |                             | T |                              |
| RES** |                             | T |                              |
|       |                             | E |                              |
| \_    |                             | N |                              |
| \_\_\ |                             | D |                              |
| _\_\_ |                             | E |                              |
| \_\_\ |                             | E |                              |
| _\_\_ |                             | S |                              |
| \_\_\ |                             | I |                              |
| _\_\_ |                             | G |                              |
| \_\_\ |                             | N |                              |
| _\_\_ |                             | A |                              |
| \_\_\ |                             | T |                              |
| _\_\_ |                             | U |                              |
| \_\_\ |                             | R |                              |
| _\_\_ |                             | E |                              |
| \_\_\ |                             | S |                              |
| _\_\_ |                             | * |                              |
| \_\_\ |                             | * |                              |
| _\_\_ |                             |   |                              |
| \_\_\ |                             | \ |                              |
| _\_\_ |                             | _ |                              |
| \_\_\ |                             | \ |                              |
| _\_\_ |                             | _ |                              |
| \_\_\ |                             | \ |                              |
| _\_\_ |                             | _ |                              |
| \_\_\ |                             | \ |                              |
| _\_\_ |                             | _ |                              |
|       |                             | \ |                              |
| \_    |                             | _ |                              |
| \_\_\ |                             | \ |                              |
| _\_\_ |                             | _ |                              |
| \_\_\ |                             | \ |                              |
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| _\_\_ |                             | _ |                              |
| \_\_\ |                             | \ |                              |
| _\_\_ |                             | _ |                              |
|       |                             | \ |                              |
|       |                             | _ |                              |
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|       |                             |   |                              |
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|       |                             | \ |                              |
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|       |                             | \ |                              |
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|       |                             | \ |                              |
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|       |                             | \ |                              |
|       |                             | _ |                              |
+-------+-----------------------------+---+------------------------------+
| Date: |                             | E |                              |
|       |                             | x |                              |
|       |                             | c |                              |
|       |                             | e |                              |
|       |                             | p |                              |
|       |                             | t |                              |
|       |                             | i |                              |
|       |                             | o |                              |
|       |                             | n |                              |
|       |                             | s |                              |
|       |                             | / |                              |
|       |                             | A |                              |
|       |                             | d |                              |
|       |                             | d |                              |
|       |                             | i |                              |
|       |                             | t |                              |
|       |                             | i |                              |
|       |                             | o |                              |
|       |                             | n |                              |
|       |                             | s |                              |
|       |                             | t |                              |
|       |                             | o |                              |
|       |                             | t |                              |
|       |                             | h |                              |
|       |                             | i |                              |
|       |                             | s |                              |
|       |                             | p |                              |
|       |                             | e |                              |
|       |                             | r |                              |
|       |                             | m |                              |
|       |                             | i |                              |
|       |                             | t |                              |
|       |                             | a |                              |
|       |                             | r |                              |
|       |                             | e |                              |
|       |                             | n |                              |
|       |                             | o |                              |
|       |                             | t |                              |
|       |                             | e |                              |
|       |                             | d |                              |
|       |                             | b |                              |
|       |                             | y |                              |
|       |                             | a |                              |
|       |                             | t |                              |
|       |                             | t |                              |
|       |                             | a |                              |
|       |                             | c |                              |
|       |                             | h |                              |
|       |                             | e |                              |
|       |                             | d |                              |
|       |                             | m |                              |
|       |                             | e |                              |
|       |                             | m |                              |
|       |                             | o |                              |
|       |                             | r |                              |
|       |                             | a |                              |
|       |                             | n |                              |
|       |                             | d |                              |
|       |                             | a |                              |
|       |                             | . |                              |
|       |                             | D |                              |
|       |                             | a |                              |
|       |                             | t |                              |
|       |                             | e |                              |
|       |                             | : |                              |
+-------+-----------------------------+---+------------------------------+

***Section III. Appendix II:* *Mold Management* *Work Practice Level
M-1***

\[VHA facility\] staff performing remediation should receive training on
proper clean up methods, personal protection, and potential health
hazards. This training can be performed as part of a program to comply
with the requirements of the OSHA Hazard Communication Standard (29 CFR
1910.1200).

Respiratory protection (N95 disposable respirator), in accordance with
the OSHA respiratory protection standard (29 CFR 1910.134) is
recommended. Gloves and eye protection should be worn. Assignment of
respiratory protection requires a written respiratory protection
program, medical evaluations, and annual training.

a.  Identify and remove any source of water intrusion.

b.  Restrict access (i.e. close doors) to immediate work area. The
    immediate work area should be unoccupied

c.  Full containment of the work area is not necessary. Work practices
    should be used that minimize the disturbance of mold so that it does
    not migrate outside the immediate work area.

d.  Work practices to minimize dust generation should be used. Dust
    suppression methods, such as using wet wiping methods can be
    effective if small amounts of dust could potentially be generated.
    However, it is important to minimize water use so that materials are
    not excessive moist. Also, using a HEPA vacuum when necessary to
    capture airborne dust at the generation source can be effective.

e.  Contaminated materials that cannot be cleaned should be removed from
    the building in a sealed plastic bag.

f.  Moldy materials should be sealed in a plastic bag using duct tape
    and disposed of in regular trash in exterior dumpster. Sharp objects
    should be bagged in a manner to prevent puncture, such as using
    double bags. Try whenever possible to transport debris during the
    hours of least activity in the building and along the most direct,
    but least congested route.

g.  The work area and areas used by remedial workers for egress should
    be cleaned with a damp cloth and/or mop and a detergent solution.

h.  Visually inspect work area to ensure that it has been left dry and
    visibly free from contamination and debris. Ensure source of water
    intrusion has been repaired or eliminated.

i.  Complete Follow-up Investigation and Closeout documentation per
    Sections 6.0 through 7.2 of main document.

***Section III. Appendix III:* *Mold Management* *Work Practice Level
M-2*:**

Remediation can be conducted by regular building maintenance staff. Such
persons should receive training on proper clean up methods, personal
protection, and potential health hazards. This training can be performed
as part of a program to comply with the requirements of the OSHA Hazard
Communication Standard (29 CFR 1910.1200) and Cal OSHA CCR Title 8
Section 5194.

Respiratory protection (e.g., N95 disposable respirator), in accordance
with the OSHA respiratory protection standard (29 CFR 1910.134) is
recommended. Gloves and eye protection should be worn. Assignment of
respiratory protection requires a written respiratory protection
program, annual fit testing, medical evaluations, and annual training.

a.  Identify and remove source of water intrusion.

b.  Restrict access (i.e. close doors) to immediate work area. Seal
    unused doors with plastic and/or duct tape. Keep immediate work area
    unoccupied. Place tacky mats at the exit to prevent transporting
    mold and debris outside the immediate work area.

c.  Cover the work area with a plastic sheet(s) and seal with duct tape
    before remediation, to contain dust/debris. Seal return air ducts
    with plastic and duct tape.

d.  Use work practices to minimize dust generation. Dust suppression
    methods, such as using wet wiping methods can be effective if small
    amounts of dust could potentially be generated. However, it is
    important to minimize water use so that materials are not excessive
    moist.

e.  Use a HEPA vacuum when necessary to capture airborne dust at the
    generation source can be effective.

f.  Contaminated materials that cannot be cleaned should be removed from
    the building in sealed plastic bags. Moldy materials should be
    sealed in a plastic bag using duct tape and disposed of in regular
    trash in exterior dumpster. Try whenever possible to transport
    debris during the hours of least activity in the building and along
    the most direct, but least congested route.

g.  The work area and areas used by remedial workers for egress should
    be HEPA vacuumed (a vacuum equipped with a High-Efficiency
    Particulate Air filter) and hard flooring cleaned with a damp cloth
    and/or mop with a detergent solution.

h.  Visually inspect work area to ensure that it has been left dry and
    visibly free from contamination and debris. Ensure source of water
    intrusion has been repaired or eliminated.

i.  Complete Follow-up Investigation and Closeout documentation per
    Sections 6.0 through 7.2 of main document

***Section III. Appendix IV:* *Mold Management* *Work Practice Level
M-3*:**

A qualified contractor or experienced qualified Kaiser Permanente staff
should perform the work. Such persons should receive training on proper
clean up methods, personal protection, and potential health hazards.
This training can be performed as part of a program to comply with the
requirements of the OSHA Hazard Communication Standard (29 CFR
1910.1200) and Cal OSHA CCR Title 8 Section 5194.

Respiratory protection (e.g., N95 disposable respirator), in accordance
with the OSHA respiratory protection standard (29 CFR 1910.134) is
recommended. Gloves and eye protection should be worn. Assignment of
respiratory protection requires a written respiratory protection
program, annual fit testing, medical evaluations, and annual training.

a.  Consult a health and safety professional with experience performing
    microbial investigations prior to remediation activities to provide
    oversight for the project.

b.  If abatement procedures are expected to generate a lot of dust
    (e.g., abrasive cleaning of contaminated surfaces, demolition of
    plaster walls) or the visible concentration of the fungi is heavy
    (blanket coverage as opposed to patchy), then remediation procedures
    for Level IV must be followed.

c.  Identify and remove source of water intrusion.

d.  Clean, wet wipe, HEPA vacuum and remove all objects from the work
    area if visible mold is in the room. Remove all removable objects
    prior to beginning remediation of mold.

e.  The work area and areas directly adjacent should be covered with a
    plastic sheet(s) and taped before remediation, to contain
    dust/debris.

f.  Clean supply and return air grills with HEPA vacuum or other methods
    to remove visible dust.

g.  Seal ventilation ducts/grills in the work area and areas directly
    adjacent with plastic sheeting.

h.  The work area and areas directly adjacent should be unoccupied.
    Further vacating of people from spaces near the work area is
    recommended for high and highest risk areas.

i.  Dust suppression methods, such as using wet wiping methods can be
    effective if small amounts of dust could potentially be generated.
    However, it is important to minimize water use so that materials are
    not excessive moist. Also, using a HEPA vacuum when necessary to
    capture airborne dust at the generation source can be effective.

j.  Contaminated materials that cannot be cleaned should be removed from
    the building in sealed plastic bags.

k.  Moldy items should be sealed in a plastic bag and disposed of in
    regular trash in exterior dumpster. Debris should be promptly
    bagged. The outside of bags should be cleaned using a HEPA vacuum
    and wet wiping before transport outside the work area. Try whenever
    possible to transport debris during the hours of least activity in
    the building and along the most direct, but least congested route.

l.  Bags should not be allowed to accumulate, and carried outside the
    building for disposal at least daily.

m.  The work area, including the temporary barriers, egress surfaces,
    and surrounding areas should be HEPA vacuumed and cleaned with a
    damp cloth and/or mop and a detergent solution. All areas should be
    left dry and visibly free from contamination and debris.

n.  Following the removal of barriers, visually inspect work area to
    ensure that it has been left dry and visibly free from contamination
    and debris. Ensure source of water intrusion has been repaired or
    eliminated.

o.  Complete Follow-up Investigation and Closeout documentation per
    Section 6.0 through 7.2 of main document.

***Section III. Appendix V:* *Mold Management* *Work Practice Level
M-4*:**

A health and safety professional with experience performing microbial
investigations should be consulted prior to remediation activities to
provide oversight for the project. The following procedures are
recommended:

a.  Identify and remove any source of water intrusion.

b.  For amounts greater than 100 square feet, personnel trained in the
    handling of hazardous materials equipped with:

    i.  Minimum N95 respirators for amounts less than 100 square feet
        with minimal dust generation.

    ii. Full-face respirators, P-100 for amounts greater than 100 square
        feet or when dust will be generated.

    iii. Disposable protective clothing covering both head and shoes

    iv. Gloves

c.  Containment of the affected area:

    i.  Complete isolation of work area from occupied spaces using
        plastic sheeting sealed with duct tape (including ventilation
        ducts/grills, fixtures, and any other openings)

    ii. The use of an exhaust fan with a HEPA filter to generate
        negative differential inside the contained work area in relation
        to surrounding area.

    iii. Airlocks and decontamination room

d.  Vacate people from spaces immediately adjacent to the work area for
    highest risk categories.

e.  Use dust suppression methods, such as using wet wiping methods can
    be effective if small amounts of dust could potentially be
    generated. However, it is important to minimize water use so that
    materials are not excessive moist. Also, using a HEPA vacuum when
    necessary to capture airborne dust at the generation source can be
    effective.

f.  Remove contaminated materials that cannot be cleaned from the
    building in sealed plastic bags.

g.  Clean the outside of the bags with a damp cloth and a detergent
    solution or HEPA vacuumed in the decontamination chamber prior to
    their transport to uncontaminated areas of the building.

h.  Seal moldy materials in a plastic bag with duct tape and dispose of
    in regular trash in an exterior dumpster. Try whenever possible to
    transport debris during the hours of least activity in the building
    and along the most direct, but least congested route.

i.  The contained area and decontamination room should be HEPA vacuumed
    and cleaned with a damp cloth and/or mop and be visibly clean prior
    to the removal of isolation barriers.

j.  The containment and negative pressure should be maintained until a
    visual inspection is conducted that determines an adequate level of
    cleanliness, with no visible dust has been achieved. The inspection
    should be performed by \-\--using "white glove" methods to wipe
    surfaces to determine if visible dust is present on surfaces.

k.  However, if it is determined that air sampling is to be performed,
    samples should be collected both prior to the commencement of work
    and following an acceptable visual inspection. The criteria for
    acceptable airborne concentrations of fungi is a post visual
    inspection sample that measures airborne concentrations of fungi
    below concentrations measured prior to the commencement of work.

l.  Following satisfactory inspection, the containment can be dismantled

m.  Following the removal of containment barriers, visually inspect work
    area to ensure that it has been left dry and visibly free from
    contamination and debris. Ensure source of moisture has been
    repaired or eliminated.

n.  Air monitoring should only be conducted prior to occupancy if
    baseline air sampling was conducted and results are available.

o.  Complete Follow-up Investigation and Closeout documentation per
    Sections 6.0 through 7.2 of main document

***Section III. Appendix VI:* *Mold Management* *Work Practice Level
M-5*:**

**[A Small Isolated Area of Contamination (\<10 square feet) in the HVAC
System]{.underline}**

Remediation should be conducted by a qualified contractor or qualified
KP staff that has received training on proper clean up methods, personal
protection, and potential health hazards. This training can be performed
as part of a program to comply with the requirements of the OSHA Hazard
Communication Standard (29 CFR 1910.1200 and Cal OSHA CCR Title 8
Section 5194\...

a.  Respiratory protection (e.g., N95 disposable respirator), in
    accordance with the OSHA respiratory protection standard (29 CFR
    1910.134), is recommended. Gloves and eye protection should be worn.

b.  The affected section of the HVAC system should be isolated and
    sealed to prevent airflow to areas outside the affected work area.
    Shut down HVAC system as necessary to prevent airflow if affected
    area cannot be isolated.

c.  The work area should be covered with a plastic sheet(s) and sealed
    with tape before remediation, to contain dust/debris.

d.  Dust suppression methods, such as misting (not soaking) surfaces
    prior to remediation, are recommended.

e.  Growth supporting materials that are contaminated, such as the paper
    on the insulation of interior lined ducts and filters, should be
    removed. Other contaminated materials that cannot be cleaned should
    be removed in sealed plastic bags. Moldy materials should be sealed
    in a plastic bag with duct tape and disposed of in regular trash in
    exterior dumpster. Try whenever possible to transport debris during
    the hours of least activity in the building and along the most
    direct, but least congested route.

f.  The work area and areas immediately surrounding the work area should
    be HEPA vacuumed and cleaned with a damp cloth and/or mop and a
    detergent solution.

g.  All areas should be left dry and visibly free from contamination and
    debris.

h.  A variety of biocides are recommended by HVAC manufacturers for use
    with HVAC components, such as, cooling coils and condensation pans.
    HVAC manufacturers should be consulted for the products they
    recommend for use in their systems.

i.  Complete Follow-up Investigation and Closeout documentation per
    Sections 6.0 through 7.2 of main document.

**Level M-5 -- *Mold Management Work Practices: ***

[**Areas of Contamination (\>10 square feet) in the HVAC
System**]{.underline}

A health and safety professional with experience performing microbial
investigations should be consulted prior to remediation activities to
provide oversight for remediation projects involving more than a small
isolated area in an HVAC system. Work procedures should follow NAIMA
recommendations. The following procedures are recommended:
<http://www.aiha.org/aihce04/handouts/po131morse.pdf>

In general, respiratory protection using P-100 devices is necessary:

a.  A qualified contractor using personnel trained in the handling of
    hazardous materials equipped with: Respiratory protection (e.g., N95
    disposable respirator), in accordance with the OSHA respiratory
    protection standard (29 CFR 1910.134), is recommended. Use gloves
    and eye protection and Full-face respirators with HEPA cartridges
    and disposable protective clothing covering both head and shoes
    should be worn if contamination is greater than 30 square feet.

b.  The affected section of the HVAC system should be isolated and
    sealed to prevent airflow to areas outside the affected work area.
    Shut down HVAC system as necessary to prevent airflow if affected
    area cannot be isolated.

c.  Contain affected area.

d.  Complete isolation of work area from the other areas of the HVAC
    system using plastic sheeting sealed with duct tape.

e.  The use of an exhaust fan with a HEPA filter to generate negative
    differential inside the contained work area in relation to
    surrounding area.

f.  Airlocks and decontamination room if contamination is greater than
    30 square feet.

g.  It is strongly recommended that HVAC systems and duct work with
    significant growth be dismantled and disposed of and not cleaned

h.  Contaminated materials that cannot are not cleaned should be removed
    in sealed plastic bags. When a decontamination chamber is present,
    the outside of the bags should be cleaned with a damp cloth and a
    detergent solution or HEPA vacuumed prior to their transport to
    uncontaminated areas of the building.

i.  Moldy materials should be sealed in a plastic bag with duct tape and
    disposed of in regular trash in exterior Dumpster. Try whenever
    possible to transport debris during the hours of least activity in
    the building and along the most direct, but least congested route.

j.  The contained area and decontamination room should be HEPA vacuumed
    and cleaned with a damp cloth and/or mop and a detergent solution
    prior to the removal of isolation barriers.

k.  The containment should be maintained until a visual inspection is
    conducted that determines an adequate level of cleanliness with no
    visible mold or moisture is present in the containment area. A
    boroscope should be used to visually inspect areas of the system
    that cannot be accessed.

l.  Complete Follow-up Investigation and Closeout documentation per
    Section 6.0 and 7.0 of main document.

###