March 2011 

DEPARTMENT OF HEALTH AND HUMAN SERVICES 

Centers for Disease Control and Prevention 

National Institute for Occupational 

Safety and Health 

Evaluation of dampnessassociated respiratory symptoms 

with relocation of staff during 

remediation of an elementary 

school 

Workplace

Safety and Health

This Health Hazard Evaluation (HHE) report and any recommendations made herein are for the specific 

facility evaluated and may not be universally applicable. Any recommendations made are not to be 

considered as final statements of NIOSH policy or of any agency or individual involved. Additional HHE 

reports are available at http://www.cdc.gov/niosh/hhe/ 

Rachel Bailey, DO, MPH
 

Ju-Hyeong Park, ScD, MPH, CIH
 

Rena Saito, PhD
 

Kathleen Kreiss, MD 


Jean Cox-Ganser, PhD
 

Health Hazard Evaluation Report 

HETA 2009-0172-3124 

North Carolina 
The employer shall post a copy of this report 

for a period of 30 calendar days at or near 

the workplace(s) of affected employees. The 

employer shall take steps to insure that the 

posted determinations are not altered, defaced, 

or covered by other material during such 

period. [37 FR 23640, November 7, 1972, as 

amended at 45 FR 2653, January 14, 1980]. 
Contents
 

Abbreviations......................................................................iv
 RepoRt 

Highlights of the NIOSH Health Hazard Evaluation.............v
 

Summary .......................................................................... viii
 

Introduction..........................................................................1
 

Background .........................................................................1
 

Assessment.........................................................................2
 

Results.................................................................................8
 

Discussion .........................................................................47
 

Recommendations.............................................................58
 

References ........................................................................60
 

Tables ................................................................................63
 

Figures...............................................................................83
 

Appendix A County Department of Public Health Faculty/Staff 


Questionnaire ....................................................................98
 

Appendix B County Department of Public Health Parent Questionnaire
 

.........................................................................................103
 

Appendix C NIOSH March 2010 questionnaire...................................108
 

Appendix d County Department of Public Health Statement Dated 25 


June 2009........................................................................120
 

Appendix e NIOSH Email dated 22 July: HETA 2009-0172 – Requested 

Summary of Findings Discussed during the Breakfast 

Meeting on 16 July 2009 .................................................123
 

Health Hazard Evaluation Report 2009-0172-3124 Page i
 
Contents (Continued) 

Appendix F	 County Department of Public Health Report on Faculty/Staff 


Questionnaire Results at the Elementary School ...........125
 

A County Department of Public Health Report on Parent ppendix G Questionnaire Results at the Elementary School ...........130
 

A The Turner Building Science and Design preliminary report ppendix H 

dated 21 July 2009 .........................................................135
 

Appendix i NIOSH email to parents dated 19 October 2009: HETA 


2009-0172 .......................................................................139
 

Appendix J EMC Engineers, Inc. HVAC Retro-commissioning Report 


dated December 2009 ....................................................141
 

A The Turner Building Science and Design final report dated 8 ppendix K January 2010 ..................................................................160
 

Appendix L The Turner Building Science and Design Final Report 


Pictures ...........................................................................180
 

Appendix M	 NIOSH Interim Report, HETA 2009-0172 .......................209
 

Appendix n EMC Engineers, Inc. Seasonal HVAC Retro-commissioning 


Report dated May 2010 ..................................................263
 

Appendix o	 Elementary School IAQ Project Progress Update ...........285
 

Appendix p Sporicidin Disinfectant Solution Label .............................298
 

Page ii	 Health Hazard Evaluation Report 2009-0172-3124 
Contents (Continued) 

Appendix Q NIOSH Draft Mold & Dampness Assessment Sheet........299
 

ACKnowLedGMents Acknowledgements and Availability of Report.................311
 

Health Hazard Evaluation Report 2009-0172-3124 Page iii 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ABBReviAtions
 2/3 wing First and second grade wing 

4/5 wing Fourth and fifth grade wing 

ASHRAE American Society of Heating, Refrigeration and Air-Conditioning Engineers 

BAS Building automation system 

BASE Building Assessment Survey and Evaluation 

BRFSS Behavioral Risk Factor Surveillance System 

CDC Centers for Disease Control and Prevention 

CO2 Carbon dioxide 

cfu/g Colony forming units per gram 

EPA Environmental Protection Agency 

oF Degrees Fahrenheit 

GM Geometric mean 

HEPA High-efficiency particulate air 

HP Heat pump 

HVAC Heating, ventilation, and air conditioning 

k/1 wing Kindergarten and first grade wing 

mg/m3 Milligrams per cubic meter 

m2 Square meter 

m3 Cubic meter 

NHANES III Third National Health and Nutrition Examination Survey 

NIOSH National Institute for Occupational Safety and Health 

ppm Parts per million 

RH Relative Humidity 

VOC Volatile organic compounds 

WHO World Health Organization 

Page iv Health Hazard Evaluation Report 2009-0172-3124 
HiGHLiGHts oF tHe
 

niosH HeALtH 

HAzARd evALuAtion 

In July 2009, a school 

district requested 

a health hazard 

evaluation to investigate 

concerns about indoor 

environmental quality at 

an elementary school in 

North Carolina. 

What NIOSH Did: 

●	 NIOSH investigators visually assessed the school in 

conjunction with a building science contractor hired by the 

school district. 

●	 We evaluated moisture content of some floors and exterior 

walls. 

●	 We monitored indoor air quality parameters (carbon dioxide, 

relative humidity, and temperature). 

●	 We collected floor dust samples in some rooms to analyze for 

microorganisms. 

●	 We met with staff from the county health department to 

review their questionnaire data. 

●	 We analyzed de-identified questionnaire data provided by the 

county health department in 2009. 

●	 We interviewed school staff members by phone. 

●	 We reviewed and summarized historical environmental 

reports.
 

●	 We administered a health questionnaire to school staff when 

the school reopened after remediation in 2010. 

What NIOSH Found: 

●	 The school had a history of dampness, high humidity, 

interior mold growth, ventilation problems, biocide use on 

carpet and in the ventilation systems, and building-related 

symptoms among staff and students. 

●	 We smelled musty, moldy odors in the basement, crawl 

space, and occupied space of the media center wing.
 

●	 Surface drainage problems allowed drainage of rainwater 

toward the concrete walkways with puddling of water 

adjacent to the classroom wings. 

●	 A storm drain outside the media center was blocked. 

●	 The foam roof on the old section of the school was damaged. 

●	 There was excessive moisture in an exterior concrete block 

wall of the gym. 

●	 Flashing at the juncture between old and new buildings was 

inadequate. 

Health Hazard Evaluation Report 2009-0172-3124 Page v
 

 

HiGHLiGHts oF tHe 

niosH HeALtH 

HAzARd evALution 

(Continued) 

●	 Airflow between rooms was problematic. 

●	 Open soffits in classroom wings allowed unconditioned 

outdoor air into the building.
 

●	 Levels of fungi in floor dust were lower than previous 

sampling before floor cleaning and biocide use. 

●	 Two staff members reported building-related symptoms 

suggestive of hypersensitivity pneumonitis.
 

●	 A health department questionnaire survey found that staff 

(and students via their parents) reported building-related 

health symptoms, including difficulty breathing/asthma 

attacks, eye symptoms, headaches, and fatigue when in the 

school building during the 2008/2009 school year. 

●	 Building-related symptoms reported by elementary school staff 

decreased after relocation of the staff to other schools. 

What The School District Administration Has 

Done since the NIOSH Site Visit in 2009: 

●	 Removed carpet and replaced with hard floors (after testing 

slab for moisture content). 

●	 Installed a vapor barrier and depressurized the basement and 

crawl space under the media center. 

●	 Repaired the roof and inadequate flashing and sealed 

classroom wing soffits.
 

●	 Recommissioned the heating, ventilation, and airconditioning system.
 

●	 Relocated staff and students to alternate sites during 

remediation and repair at the school.
 

●	 Reopened the school in February 2010 after remediation of 

the school. 

●	 Implemented the Environmental Protection Agency’s Indoor 

Air Quality Tools for Schools Program. 

What The School District Administration Can 

Do: 

●	 Modify surface drainage around the school building to 

prevent puddling and drainage of water towards the building. 

Page vi	 Health Hazard Evaluation Report 2009-0172-3124 
 

 

HiGHLiGHts oF tHe 

niosH HeALtH 

HAzARd evALution 

(Continued) 

●	 Follow the manufacturer’s recommended maintenance 

schedules for maintaining the heating, ventilation, and air 

conditioning system. 

●	 Routinely monitor the school in a standardized way for 

possible re-occurrence of dampness.
 

●	 Walk through the entire school and check for water 

incursion during and after heavy rains.
 

●	 Correct the cause of any identified dampness problems and 

clean or remove water-damaged materials. 

●	 Use proper containment methods to prevent worker 

exposures and contamination of unaffected sections of the 

building during any remediation. 

●	 Record the date and location of water-damaged materials and 

remediation steps taken. 

●	 Avoid routine use of biocides. 

●	 Facilitate confidential reporting of dampness problems and 

building-related health effects by employees. 

●	 Monitor for possible reoccurrence of building-related 

symptoms, if needed, with occupant health questionnaires. 

●	 Encourage building occupants (employees and students) to 

see a healthcare provider if they develop or have developed 

persistent or worsening respiratory or other health symptoms 

while in the school building. 

What the Elementary School Faculty and Staff 

Can Do: 

●	 Participate in health questionnaires. 

●	 Inform the school administration of any water leaks, 

dampness, musty or moldy odors, or ventilation problems in 

the school building. 

●	 See a healthcare provider if you develop or have developed 

recurring or worsening respiratory symptoms or other health 

symptoms while working in the school building. 

●	 Let your supervisor know if your healthcare provider 

recommends relocation to another work area to prevent 

exposure to mold or dampness-related contaminants that 

may be causing or exacerbating your symptoms. 

Health Hazard Evaluation Report 2009-0172-3124	 Page vii 
suMMARy
 

NIOSH considers 

dampness in occupied 

buildings a public health 

problem that requires 

remediation. NIOSH 

investigators found a 

history of dampness, 

mold growth, high 

indoor relative humidity, 

ventilation problems, 

biocide use, and 

respiratory symptoms 

with a building-related 

pattern related to the 

elementary school. 

The school closed 

for remediation after 

the 2008/2009 school 

year and reopened on 

February 22, 2010. The 

prevalence of buildingrelated symptoms 

among staff decreased 

after relocation, while 

the school building was 

closed for remediation. 

In June 2009, school district management requested a health hazard 

evaluation to investigate concerns about indoor environmental 

quality at an elementary school. Since August 2005, after 

renovations and the addition of three classroom wings, there have 

been many issues regarding indoor environmental quality, including 

building-related symptoms and a history of dampness, mold growth, 

high humidity, and ventilation problems. Since 2005, the school 

district has had many consultants evaluate the school; we briefly 

summarize their findings in this report. 

In July 2009, a NIOSH team visited at the elementary school. We 

worked in conjunction with the Turner Building Science and Design 

Group, hired by the school district. We found (1) a musty, moldy 

odor in the basement, crawl space, and occupied space in the media 

center; (2) surface drainage issues around the school; (3) a blocked 

storm drain with standing water; (4) a damaged roof; (5) inadequate 

flashing; (6) moisture in the gym’s exterior concrete block wall; (7) 

pressure airflow issues between conditioned and unconditioned 

spaces; and (8) outdoor humid air entering through the classroom 

wing soffits. Except for the musty odor in the basement and crawl 

space under the media center, these findings were consistent with 

previous findings by consultants. 

During the site visit, we met with the medical director and other 

staff of the county health department and reviewed results of a 

questionnaire they had offered to the staff and parents of the school 

during May 2009. The health department shared de-identified 

data with us; our analysis indicated that, during the 2008/2009 

school year while in the school building (1) 31% of staff and 13% 

of students had difficulty breathing/asthma attacks; (2) 52% of staff 

and 28% of students had one or more upper respiratory symptoms; 

(3) 75% of staff and 28% of students had eye symptoms; (4) 92% of 

staff and 49% of students had headaches; (5) 44% of staff and 6% of 

students had fatigue; and (6) 25% of staff and 20% of students had 

nosebleeds. Some school staff members who were interviewed over 

the telephone by a NIOSH medical officer reported building-related 

symptoms that were suggestive of hypersensitivity pneumonitis, an 

uncommon and potentially chronic condition known to be related 

to damp buildings. 

In August 2009, the school remained closed for remediation after 

summer break. The school district worked with the Turner Group 

and other consultants to address issues identified during the July 

2009 site visit. The school reopened on February 22, 2010. During 

Page viii Health Hazard Evaluation Report 2009-0172-3124 
 

suMMARy (Continued) 

March 2–4, 2010, NIOSH investigators administered a health 

questionnaire to the elementary school staff. Compared with results 

of the previous health department survey, the NIOSH survey found 

that fewer staff reported headaches, sneezing, throat symptoms, 

eye symptoms, cough attacks, fatigue, nosebleeds, and difficulties 

remembering things or concentrating, consistent with a resolution 

of many employees’ symptoms while out of the school building. 

The prevalence of nasal symptoms and skin symptoms were higher 

in the NIOSH questionnaire than the health department survey, 

but fewer than 25% of those with these symptoms in the NIOSH 

survey reported they were work-related. Of staff that participated 

in the health department survey and worked at the school during 

the 2008/2009 school year, 74% reported they had symptoms 

that went away after leaving the school building, consistent with a 

work-related pattern. The 3%–7% prevalences of lower respiratory 

symptoms (i.e., shortness of breath, chest tightness, wheezing, and 

cough attacks) noted in the NIOSH questionnaire were much lower 

than prevalences of the two lower respiratory symptoms (breathing 

difficulty/asthma attacks (31%) and cough (15%)) in the health 

department survey. 

At the time of the March 2010 NIOSH questionnaire, the overall 

prevalences of ever and current physician-diagnosed asthma among 

participating school staff in the NIOSH survey were not significantly 

different than what would be expected in North Carolina 

when compared to the BRFSS survey of the North Carolina 

adult population. Most staff reporting asthma had experienced 

asthma prior to beginning employment at the elementary school. 

Compared to the U.S. adult population in the NHANES III, a 

nationally representative survey, the elementary school employees 

had significantly lower than expected rates of lifetime and current 

asthma, chronic bronchitis, shortness of breath on exertion, 

and nasal allergies, including hay fever. When we compared the 

elementary school employees who participated in the NIOSH 

survey to U.S. office workers in the BASE study, we found no excess 

of work-related upper and lower respiratory symptoms, headache, 

unusual tiredness and fatigue, or dry itchy skin among the school 

employees. 

The NIOSH health survey showed apparent resolution of many 

health symptoms likely associated with indoor environmental 

quality issues in the school building before remediation. If there 

are no future concerns, there may be no reason to resurvey the 

employees who have reoccupied the school. However, if concerns 

Health Hazard Evaluation Report 2009-0172-3124 Page ix 
suMMARy (Continued) 

do arise in the future, another questionnaire can be administered 

to employees and compared to the NIOSH assessment to determine 

if increases in building-related symptoms have occurred. No 

specific environmental measurements are known to predict health 

outcomes for individuals, so assessing health is the only option for 

determining the adequacy of building remediation in improving 

indoor environmental quality. 

Keywords: NAICS 611110 (Elementary and Secondary Schools), 

indoor environmental quality, asthma, hypersensitivity pneumonitis, 

respiratory symptoms, engineering controls, relative humidity, carbon 

dioxide, ventilation. 

Page x Health Hazard Evaluation Report 2009-0172-3124 
intRoduCtion 

The National Institute for Occupational Safety and Health (NIOSH) 

received a Health Hazard Evaluation request from the management 

of a North Carolina school district on June 16, 2009, to investigate 

concerns about indoor environmental quality at an elementary 

school. The request listed concerns about mold, high levels of 

carbon dioxide (CO2

), and problems with the heating, ventilation, 

and air-conditioning (HVAC) system. Health concerns included 

headaches, fatigue, insomnia, dizziness, bronchitis, pneumonia, 

sinus problems, sore throat, rashes, nausea, vision problems, and 

others. 

BACKGRound
 

The school was built in the 1930s, with additions in the 1970s. 

The original building is currently used for the media center, 

library, offices, health center, teachers’ lounge, and testing room. 

In 2003, construction began on three new classroom wings and a 

cafeteria. The addition was attached to the gym, which was built in 

the 1970s and remodeled during the construction process. In May 

2005, before the 2004/2005 school year ended, the kindergarten/ 

first grade (k/1) wing and administrative wing were opened and 

occupied. The second/third grade (2/3) and fourth/fifth grade 

(4/5) wings (Figure 1) opened in August 2005, a few days before the 

start of school. Classroom wings are on the west side of the school, 

the gym is on the east side, and the old original building is on the 

north side. The playgrounds and ball fields are the highest points 

on the site. Except for the media center, which has a clerestory 

above it and a basement and crawl space beneath it, the school is 

single-story construction on a concrete slab. 

During the 2008/2009 school year, the school had 88 faculty 

and staff and 738 students. Since the additions to the school in 

2005, there have many issues regarding indoor environmental 

quality. These are summarized in the Results section of this report 

under “Chronological History of Environmental Findings and 

Remediation at the Elementary School.” 

Health Hazard Evaluation Report 2009-0172-3124 Page 1 
 

AssessMent 

July 2009 Site Visit 

A NIOSH team of two industrial hygienists, an epidemiologist, and 

a medical officer completed a site visit at the elementary school from 

July 14–16, 2009. Consultants from the Turner Building Science 

and Design Group, hired by the school district, also participated in 

the site visit, and the NIOSH team conferred with them during and 

after the site visit. 

On the first morning, we conducted an opening meeting with 

school staff, parents, and news media to discuss the Health Hazard 

Evaluation program and the purpose of our visit. We then met with 

the principal, teachers, and parents for approximately one hour to 

discuss their concerns. This was followed by a NIOSH initial walkthrough of the school accompanied by school staff, parents, and 

news media. During the rest of the site visit, members of the local 

Parent Teacher Association often accompanied us as we evaluated 

the school. 

In addition to visual assessment techniques, we used moisture 

meters (TramexTM Concrete Encounter CME4 and Tramex Moisture 

Encounter, Tramex Limited, Co., Dublin, Ireland) and an infrared 

camera (IR-InsightTM, Fluke Corporation, Everett, Washington, 

United States) to check for moisture in walls. Additionally, we used 

smoke tubes to visualize airflow and observe pressure differentials 

between rooms and the corridors inside the school building. 

Turner Group staff and NIOSH staff used digital pressure gauges 

(The Energy Conservatory, Minneapolis, Minnesota, United States) 

to measure pressure differentials at exterior doors; the results were 

documented on diagrams of the school and given to Turner Group 

staff for further analysis. 

We selected 21 rooms (Table 1) to collect environmental samples 

(6 fully carpeted rooms, 11 carpeted rooms with 10%–25% tiled 

floor, and 4 rooms with entirely tiled or wooden floors). These 

rooms were selected either because occupants had reported health 

or environmental issues, or previous environmental consultants’ 

reports documented elevated mold concentrations in air or floor 

dust. We collected floor dust samples into polyethylene filter socks 

using a L’il HummerTM backpack vacuum sampler (Pro-Team Inc, 

Boise, Idaho, United States) (flow rate = 100 cubic feet per minute). 

To collect enough dust for microbial analyses, we vacuumed either a 

2 square meter (m2

) area of the floor around the teacher’s workstation 

or a 1 m2 area of floor around the teacher’s work station plus a 

0.8 m2 area around the edges of the room (a total of 1.8 m2

) for a 

Page 2 Health Hazard Evaluation Report 2009-0172-3124 
AssessMent (Continued) 

total of five minutes. Room 108 was excluded because we could not 

collect enough dust for analysis. In the media center, which was 

larger than classrooms and offices, we collected two separate dust 

samples; one from a 2 m2 area of a rug in the room and another 

from the edge of the room. We also measured wet bulb and dry 

bulb temperatures on the floor surface to compute water activity 

(the amount of free or available water for microorganisms) and air 

temperature and relative humidity (RH) at the end of dust sampling 

in each room. 

We sealed the vacuumed dust samples in plastic bags and 

transported them to the NIOSH laboratory. At the NIOSH 

laboratory, we emptied the dust collected in each sample into 50 

milliliter pyrogen-free conical tubes and homogenized by rotation 

on a 360-degree rotary arm shaker at 65 revolutions per minute 

for 2 hours. We removed hair, fluff, and other large objects from 

the sample before homogenization. We weighted, partitioned, and 

sent the dust samples to an environmental microbiology laboratory 

accredited by the American Industrial Hygiene Association (EMLab 

P&K, San Bruno, California, United States). We requested analysis 

of the dust samples for culturable fungi with full speciation, Gramnegative bacteria, and Actinomycetes because these microbes have 

been associated with dampness in buildings. We also requested 

analysis for Gram-positive bacteria because humans are often 

a source of this type of bacteria. Dust samples were cultured for 

Actinomycetes at three different temperatures — room temperature, 

35 degrees Celsius, and 55 degrees Celsius. The laboratory reported 

culturable fungi, bacteria, and Actinomycetes as colony forming 

units per gram (cfu/g) of dust. We categorized fungal species into 

hydrophilic, mesophilic, and “other fungi” groups. Hydrophilic 

fungi (or water-loving fungi) are defined as fungal species requiring 

high water content for survival and growth in building materials 

(water activity >0.9). Mesophilic fungi are fungal species that 

require water activity between 0.8 and 0.9. In damp conditions, 

hydrophilic fungi will overgrow mesophilic fungi. Fungal species not 

categorized as either hydrophilic or mesophilic were included in the 

“other fungi” group. We used three sources [WHO 2009; Hung et 

al. 2005; Flannigan and Miller 2001] to determine the water activity 

requirement of each fungal species and to categorize them into one 

of three groups; hydrophilic, mesophilic, “other” fungi. Among the 

three sources [WHO 2009; Hung et al. 2005; Flannigan and Miller 

2001], we choose the classification with the highest water activity. 

We computed fractions of the hydrophilic and mesophilic fungi for 

each dust sample by dividing the concentration of each group of 

Health Hazard Evaluation Report 2009-0172-3124 Page 3 
AssessMent (Continued) 

fungi by the total concentration. 

We visited the county health department; the medical director shared 

de-identified data from a self-administered paper questionnaire that 

they had offered to the faculty/staff (Appendix A) and parents of 

students (Appendix B) at the elementary school in May and June 

2009. We interviewed with three staff members by phone regarding 

health concerns they believed were related to the school building. 

On the last day of the site visit, we had a breakfast meeting with 

representatives of the school district about our findings and 

recommendations. This was followed by a brief closing meeting 

at the elementary school with school staff, parents, local health 

department staff, and the news media. Prior to, during, and after 

the site visit, we obtained documentation from the school district 

and the health department regarding indoor environmental quality 

issues at the school. We used this documentation to summarize the 

historical environmental problems and actions that had occurred at 

the school during the past five years. 

Health Department Questionnaire Data 

In May 2009, the county health department surveyed elementary 

school employees and parents/guardians of students at the elementary 

school with self-administered paper questionnaires (Appendices A 

and B) that focused on the 2008/2009 and 2007/2008 school years. 

Throughout this report, we refer to faculty and staff as “staff” or 

“staff members” and parents or guardians as “parents.” The health 

department chose the 2008/2009 and 2007/2008 time frame to 

determine if there were changes in building-related symptoms after 

the installation of a dehumidification system in the classroom 

section of the school during the summer of 2008. 

The staff and parent questionnaires included questions on primary 

office or classroom, symptoms, health conditions, medication, 

smoking status, and home exposures. Participants were first asked if 

they experienced any of the following symptoms while in the school 

building during the 2008/2009 school year: (1) headaches; (2) dry 

eyes; (3) unusual sneezing episodes; (4) difficulty breathing/asthma 

attacks; (5) nosebleeds; or (6) any other symptoms (participant 

asked to write in other symptoms). Participants who answered 

“no” or did not write-in a symptom they experienced during the 

2008/2009 school year were asked to stop the questionnaire at that 

point. For these participants, no information was collected on 

symptoms during the 2007/2008 school year, health conditions, 

Page 4 Health Hazard Evaluation Report 2009-0172-3124 
AssessMent (Continued) 

medication, smoking status, or home exposures. Participants who 

did report experiencing symptoms in 2008/2009 were asked about 

whether they experienced any of the same list of symptoms during 

the 2007/2008 school year. They were also asked if they had the 

following conditions: (1) chronic respiratory disease; (2) undergoing 

chemotherapy or radiation therapy; (3) immune system stressed by 

disease or other cause; (4) allergic rhinitis; or (5) asthma. Those 

participants were further asked to report rooms or areas in the 

building where their symptoms were worst and if their symptoms/ 

problems went away after leaving the building. Participants also 

had the opportunity to write in additional information at the end 

of the questionnaire. The questionnaire did not seek information 

about physician diagnosis or date of onset of health conditions. The 

questionnaires did not include standardized symptom or asthma 

questions, which would have allowed us to compare staff rates to 

U.S. or state population rates. 

We received de-identified questionnaire data from the health 

department in Microsoft Excel® (Microsoft, Redmond, Washington, 

United States) format and imported it into SAS® (version 9.2, SAS 

Institute Inc., Cary, North Carolina, United States) for analysis. 

The Excel database included variables created for the specific health 

conditions and symptoms asked in the questionnaire, as well as 

variables for write-in symptoms. The write-in variables included 

rash, nausea, sinus problems, insomnia, dizziness, fatigue, sore 

throat, and vision problems. We created additional variables for 

other symptoms written in by participants for each school. These 

included cough, allergies, metallic taste, memory loss, eye symptoms 

(burning, itching, red, dry, or tearing), skin problems (eczema, rash, 

dry skin, itchy skin, or tingling skin), nasal symptoms (stuffy, itchy, 

burning, runny, or dry), throat symptoms (dry, scratchy, or sore), 

and voice symptoms (hoarse voice or laryngitis). Additionally, 

we grouped symptoms into upper respiratory symptoms (sinus 

problems, nasal symptoms, sneezing, throat symptoms, and/or voice 

symptoms), lower respiratory symptoms (breathing problem/asthma 

attack and/or cough), and mucous membrane irritation symptoms 

(eye, nasal, throat, and/or voice symptoms). 

We grouped school building areas into six categories (gym/cafeteria 

wing, administrative wing, media center wing, k/1 wing, 2/3 wing, 

and 4/5 wing). Staff was assigned to a work wing based on their 

primary classrooms or offices. We assigned students to a classroom 

wing based on their primary classrooms/homerooms. If a student 

did not have a primary classroom/homeroom listed in the database, 

we assigned the student to a classroom wing based on his or her age 

Health Hazard Evaluation Report 2009-0172-3124 Page 5 
 

AssessMent (Continued) 

(if it was available). Students 5 or 6 years old were assigned to the 

k/1 wing; students 8 years old to the 2/3 wing; and students 10, 11, 

or 12 years old to the 4/5 wing. We did not assign students aged 7 

or 9 years old because their wing assignment would differ based on 

whether they started kindergarten at 5 or 6 years-old. Therefore in 

2008/2009, we did not assign wings for three 7-year-olds and four 

9-year olds. 

March 2010 Site Visit 

During March 2–4, 2010, we returned and administered an 

interview-based health questionnaire (Appendix C) with questions 

about respiratory symptoms and other symptoms, chest illnesses, 

medications, work environment, work history at the elementary 

school, and smoking habits. Some questions were adapted from two 

national surveys (1) the Building Assessment Survey and Evaluation 

(BASE) study [Womble et al. 1996], a 1994–1998 Environmental 

Protection Agency (EPA) survey of office employees at office 

buildings with no known or perceived problems in large U.S. cities; 

and (2) the Third National Health and Nutrition Examination 

Survey (NHANES III) [CDC 1996], a 1988–1994 survey of the U.S. 

civilian, noninstitutionalized population. We asked about symptoms 

during the four-week period (January 24 through February 21, 2010) 

prior to the reopening of the elementary school on February 22, 

2010. Some participants had re-entered the school approximately 

two to six weeks before February 22, 2010 to get their work areas 

ready. For these participants, we had them answer the four-week 

symptom questions relating to the four weeks prior to re-entering 

the school building. For example, if they started coming to the 

elementary school on February 15, we had them answer the four 

week symptoms questions for the period of January 17 through 

February 14, 2010. 

We asked if symptoms stayed the same, worsened, or improved 

when away from the school building. If symptoms improved away 

from the building, we considered them work-related. We grouped 

symptoms into upper respiratory symptoms (stuffy, itchy, or runny 

nose; sneezing; sore or dry throat; or sinusitis or sinus problems), 

lower respiratory symptoms (chest wheezing; chest tightness; 

shortness of breath attacks; coughing attacks; awakened by breathing 

difficulty; shortness of breath on exertion; or cough with phlegm), 

mucous membrane symptoms (stuffy, itchy, or runny nose; watery, 

itchy eyes; or sore or dry throat), and constitutional symptoms (fever 

and chills; flu-like achiness or achy joints; tiredness, fatigue, or 

drowsiness; difficulty remembering or concentrating; or dizziness or 

Page 6 Health Hazard Evaluation Report 2009-0172-3124 
 

 

 

AssessMent (Continued) 

lightheadedness; headache). All school employees were invited to 

participate. 

Statistical Analysis 

We used SAS software for data analyses. When analyzing the health 

department survey, we calculated prevalence of reported symptoms 

experienced by staff and by parents (for their children who attend 

the elementary school) during the 2008/2009 and/or 2007/2008 

school years. We used McNemar’s test to determine if there 

were statistically significant differences in symptom prevalences 

during the 2008/2009 and 2007/2008 school years among staff 

and students who worked or attended during the 2008/2009 and 

2007/2008 school years and who had answered “yes” or wrote in a 

response to one of the six symptom questions on the first page of the 

health department questionnaire (Appendices A and B). We used 

the likelihood ratio chi-square test to test for significant differences 

when comparing 2008/2009 symptom prevalences among classroom 

wings. When analyzing data from the NIOSH survey, we used 

Pearson’s exact test to test for significant differences in symptom 

prevalences between different work areas at the elementary school. 

McNemar’s test was used to compare symptom prevalences among 

employees who had worked at the elementary school during the 

2008/2009 school year and returned to the school for the opening 

in February 2010. A probability level of p < 0.05 was considered 

statistically significant. A probability level of 0.05 ≤ p < 0.10 was 

considered marginally significant. We calculated prevalence ratios of 

diagnoses and respiratory symptoms in comparison with U.S. adult 

population expected prevalences from NHANES III data and BASE 

data, and with 2009 expected values for North Carolina from the 

Behavioral Risk Factor Surveillance System (BRFSS) [NCCDPHP 

2009]. 

Health Hazard Evaluation Report 2009-0172-3124 Page 7 
 

ResuLts
 Chronology of Environmental Findings and

Remediation at the Elementary School 

August 2005 

Prior to school opening in August 2005, library books were shrinkwrapped on rolling homemade presswood carts and moved from 

the library in the media center wing of the original building to the 

pre-kindergarten classroom (room 613) in the new k/1 wing (Figure 

1), where they were stored for two months. In August 2005, when 

the 2/3 and 4/5 wings were completed, the books were moved to 

a temporary media center (classroom 500) in the 4/5 wing; at this 

time, the books and carts in the pre-kindergarten classroom were 

covered in a gray-green mold and an overwhelming moldy smell was 

noted in the room. A contractor cleaned the books before they 

were moved to classroom 500 and stored on wooden bookcases. 

In August 2005, visible mold was also found on carpet in classrooms 

427 and 625 (Figure 2), upholstered chairs in the records room (room 

109) (Figure 3), and on picture frames in the storage room (room 

111) (Figure 4). Later, after the school year began, mold reappeared 

on some of the books in the temporary media center in classroom 

500. Many books were thrown out while others were again cleaned. 

By the end of August 2005, visible mold had been identified in the 

k/1 wing (classroom 613, 625), 2/3 wing (classroom 427), 4/5 wing 

(classroom 500), and the administrative wing (rooms 109 and 111). 

During this time frame, the school was having problems with high 

RH and the new HVAC system was being commissioned to assure 

that it would perform as intended. Additionally, parents had 

begun notifying the school that their children were complaining 

of headaches and respiratory symptoms. On August 25, 2005, the 

county health department received two complaints about mold 

on library books. The health department inspector who visited 

the school reported that the school was humid, and that this issue 

needed to be addressed to control mold growth. The inspector 

returned on August 31, 2005 and noted that the humidity issues 

had improved; however, staff reported headaches and irritation of 

the eyes, throat, and ears. 

September 2005 

During September 2005, school maintenance staff continued to 

adjust the HVAC system; mold and RH were still a concern. A 

consultant found that air filters in the heat pump (HP) units were 

Page 8 Health Hazard Evaluation Report 2009-0172-3124 
ResuLts (Continued) 

very dusty and poorly fitting; they were replaced. The unit (HP-42) 

that served classroom 500 had some visible dry buildup on the 

coil front; a sample of the material grew mold (Penicillium). RH in 

sampled rooms exceeded 60% (range: 61–72%). Because mold was 

found in carpet samples, new carpet was put in classroom 625 and 

vinyl composition tile in the health center (room 101). 

In September 2005, the North Carolina Division of Occupational 

Safety and Health received a complaint regarding (1) elevated carbon 

dioxide (CO2

) levels (2000 parts per million (ppm) and 5000 ppm) 

in classrooms 502 and 508 in the 4/5 wing; (2) exposure to mold 

in the school (including the media center, which was closed due 

to mold on books, the health center, classroom 520, and around 

the gym); and (3) respiratory symptoms among employees. Parents 

continued to report that their children were experiencing respiratory 

symptoms, headaches, and fatigue. 

The school hired an industrial hygiene consultant to test and 

monitor indoor air quality. He reported that a malfunctioning HP 

and damper were the cause of the elevated CO2 levels in classrooms 

502 and 508. The HP was replaced, and the damper was fixed. 

The consultant also noted that an outside wall in classroom 400 

was damaged by water from an exterior leak during construction, 

and this was to be removed by a mold remediation firm. 

October 2005 

In October 2005, the North Carolina Division of Occupational 

Safety and Health closed their case at the school on the grounds 

that the alleged hazardous conditions had been corrected or no 

longer existed. However, during October 2005, the county health 

department notified the school district that the health department 

continued to receive complaints from parents regarding indoor 

environmental quality issues such as mold and RH at the elementary 

school. There were also concerns about the water supply quality 

and radon levels at the school, which were later found to be within 

normal ranges. 

November 2005 

In November 2005, CO2 levels continued to be elevated in some 

classrooms, including classroom 503 (1534 ppm fully occupied), 

classroom 505 (1484 ppm fully occupied), classroom 623 (1250 

ppm fully occupied), and classroom 625 (1370 ppm fully occupied). 

Health Hazard Evaluation Report 2009-0172-3124 Page 9 
 

ResuLts (Continued) 

Return air dampers were installed in some classrooms to increase 

outdoor air supply to these rooms. However, during this same 

month, the water boiler and several HPs had “tripped out” for 

unknown reasons. The HP fans may have been off during CO2 

testing, and this may have resulted in the elevated CO2 levels. In 

a further attempt to improve ventilation, the CO2 setpoints for the 

two HPs serving the four classrooms with elevated CO2 levels (HP-28 

for classrooms 623 and 625 and HP-41 for classrooms 503 and 505) 

were reduced to 900 ppm. However, the school continued to have 

problems with elevated CO2

 levels as well as high RH. 

February 2006 

In February 2006, mold was identified from surface samples taken 

from the top of a dusty mobile cart and from a small canvas bag 

that sat on a dusty bookcase in the Testing Room (room 115). 

The canvas bag was discarded. The industrial hygiene consultant 

recommended that the surfaces in this room be professionally 

cleaned, which was done. 

May-August 2006 

In May 2006, many teachers reported “stuffy” rooms and left their 

windows open for end-of-grade testing to help prevent symptoms in 

their students during the testing. In early June 2006, the architect 

notified the construction company that the CO2 controllers did not 

meet the specifications in the contract documents. Additionally, he 

notified them of a broken storm drainage line and problems with 

sewage lines (also identified in a February 2006 inspection). 

In mid-June 2006, a Trane TracerTM MP581 programmable controller 

with temperature, CO2

, and humidity sensors was installed at the 

school. A two-day test run was done with the new unit controlling 

classroom 618 (HP-26) in the k/1 wing. This was compared to 

classroom 627 (HP-25) across the hall, which did not have the new 

sequence installed. During the first day of testing, it was rainy 

with an outside temperature of 65 degrees Fahrenheit (°F) and an 

RH of 90%; during the second day, it was sunny with an outside 

temperature and RH ranging from 73°F–80°F and 32%–49%, 

respectively. The Trane TracerTM programmable unit sequence 

of operation called for the unit to be placed in dehumidification 

mode when the zone humidity reached 65% RH and off when the 

zone humidity reached 55% RH. However, during the two days, 

the compressor did not turn off due to the zone humidity levels 

ranging between approximately 64% and 70% and never reaching 

Page 10 Health Hazard Evaluation Report 2009-0172-3124 
ResuLts (Continued) 

the 55% level. The temperature stayed between approximately 71°F 

and 73°F. The Trane consultants determined that since there was 

no type of reheat available, the only way to keep the room from 

over-cooling during the dehumidification mode was to switch the 

unit from cooling to heating. Once this occurred, the air entering 

the space was no longer dehumidified, and the humidity rapidly 

rose. However, once the discharge air temperature was low enough 

to dehumidify the air, the room again became over cooled, and 

the unit had to be changed back to the heating mode. The Trane 

consultants had concerns about the wear and tear on the equipment. 

The reversing valve changed from cooling to heating or from 

heating to cooling over 25 times during three hours of operation. 

During normal operation, the reversing valve should only change 

once or twice in a given day because it is usually heating or cooling, 

not switching back and forth between the two. The consultants 

thought that most of the humidity problems were associated with 

the introduction of outdoor air. They recommended that the 

outdoor air be pre-treated with dedicated units to allow the existing 

HPs to control the zone temperature. 

With continued oversight by Trane personnel, the test control 

system was adjusted to better handle humidity with minimal 

reversing of the unit from cooling to heating and heating to cooling. 

In July 2006, the temperature and RH in classroom 520, a room 

with complaints, was monitored for five days. During the day, the 

temperature ranged from approximately 70°F–77°F, and RH ranged 

from 50%–60%; however, during other times, the conditions in the 

room exceeded 80°F and 65% RH. 

On July 22, 2006, several roof leaks occurred after a heavy rain. 

Water penetrated rooms in the k/1 wing (603, 606, 608, 610, 616, 

619, corridor between 603 and 608), 2/3 wing (401, 407, 418, 421, 

427), 4/5 wing (500, 505), administrative wing (104, 106, 108), 

and gym/cafeteria wing (201). In August 2006, visible mold was 

discovered on carpet in classrooms 406, 424, 427, and 623. The 

indoor RH was reported to be high during this time. The carpets in 

these rooms were cleaned and treated with an antimicrobial agent 

(or biocide). This same month, a leak occurred in a water-line joint, 

which was subsequently fixed. 

February 2007 

In February 2007, the North Carolina Department of Environmental 

and Natural Resources reported several ceiling leaks during a school 

Health Hazard Evaluation Report 2009-0172-3124 Page 11 
 

 

 

 

 

ResuLts (Continued) 

inspection. 

October 2007 

In October 2007, fungal spore concentrations were measured in 

the air outdoor and inside the school. By spore trap sampling, 

the outdoor total spore count was 14,302 spores per cubic meter 

(spores/m3

); the top four outside fungal genera identified were 

Cladosporium, Ascospores, Basidiospores, and Aspergillus/Penicillium. 

Eleven indoor locations (416, 503, 505, 514, 517, 519, 521, 618, 625, 

627, and the main office) were tested. The five rooms with the 

highest total spore counts were classroom 521 (7,680 spores/m3

), 

the main office (5,055 spores/m3

), classroom 517 (3,370 spores/m3), 

classroom 505 (2,586 spores/m3

), and classroom 503 (2,429 spores/ 

m3

). Although the four predominant fungal genera found outside 

were also found in many of the classrooms, a number of other fungal 

genera were more predominant in indoor locations. Compared 

with outdoor air, Alternaria counts were higher in the main office 

and in classrooms 503, 505, 514, 517, and 521; Curvularia counts 

were higher in the main office and classrooms 503, 514, 517, and 

521; Drechslera/Bipolaris counts were higher in the main office and 

classrooms 505, 517, and 521; Pithomyces counts were higher in the 

main office and classroom 521, and Epicoccum counts were higher 

in classroom 521. Myxomycete/Smut-like was not found outside 

but was found in the main office and classrooms 503, 505, 514, 517, 

521, 625, and 627. Nigrospora was not found outside but was found 

in the main office and classrooms 517 and 521. 

(NOTE: NIOSH indoor air scientists do not currently recommend 

routine air sampling for mold in indoor environmental quality 

evaluations because there are no established health-based standards 

for acceptable levels of mold and limited short-term air sampling 

may be misleading.) 

Later in October 2007, consultants tested for airborne CO2 levels 

and analyzed air, surface, and carpet samples for fungal materials. 

CO2 levels were above the level recommended by the American 

Society of Heating, Refrigeration and Air-Conditioning Engineers 

(ASHRAE) in 10 (416, 503, 514, 517, 519, 520, 521, 618, 625, 

627) of 13 rooms tested. Three (classrooms 416, 618, 625) of the 

10 rooms with elevated CO2 had levels that exceeded 1,500 ppm. 

Spore trap sampling inside and outside the school revealed outdoor 

total counts of 2,083 spores/m3 (outside the front of the school) 

and 2,983 spores/m3 (outside classroom 405) and indoor total spore 

Page 12 Health Hazard Evaluation Report 2009-0172-3124 
 

 

ResuLts (Continued) 

counts ranging from 66 to 359 spores/m3 (classrooms 405, 416, 

503, 514, 517, 519, 521, 608, 625, and office lobby). The five rooms 

with the highest total spore counts were classroom 503 (359 spores/ 

m3

), classroom 517 (346 spores/m3), classroom 521 (293 spores/m3), 

classroom 625 (213 spores/m3

), and classroom 608 (212 spores/m3). 

The top four fungal genera identified both outside and indoors were 

Basidiospores, Cladosporium, Penicillium/Aspergillus, and Ascospores. 

Surface samples were collected from insulation in the supply 

air plenums of nine air handling units. Six of the nine samples 

grew Cladosporium. Samples from three of these air handlers (air 

handlers 37, 41, and 49) had trace to minimal fungal growth; one 

(air handler 26) had low fungal growth, one (air handler 12) had 

moderate fungal growth, and one (air handler 14) had high fungal 

growth. The consultants recommended that the insulation inside 

these six air handlers be cleaned or replaced. In December 2007, a 

cleaning company cleaned air handlers 12, 14, 26, and 49. 

Carpet dust samples from classrooms 423, 517, 519, 521, and the 

office lobby showed viable fungal spore concentrations ranging from 

132,600 cfu/g in classroom 517 to 1,176,000 cfu/g in classroom 

423. The consultants recommended (1) cleaning carpets with a 

commercial-grade high efficiency particulate air (HEPA) vacuum 

cleaner; (2) use of mats to capture particulate at the outdoor 

entryway to each affected room or area; and (3) possibly routing 

students returning from the outside through the main entrance to 

the school. The school district subsequently reported (1) delivery of 

three new HEPA-filtered back-pack vacuum cleaners and two new 

HEPA-filtered upright vacuum cleaners; (2) securing doorway mats; 

and (3) addressing student reentry into the school through the main 

entrance. 

January 2008 

In January 2008, an inspector from the North Carolina Department 

of Environmental and Natural Resources reported a bad leak in the 

central receiving room ceiling during a school inspection. 

September 2008 

In September 2008, consultants measured temperature, humidity, 

and CO2 and sampled carpet dust for fungal spores and indoor air 

for total volatile organic compound (VOC). Indoor temperatures 

(range: 71.3°F–72.4°F) and RH (range: 48.9%–53.0%) were 

within the ASHRAE recommended levels. CO2 measurements 

Health Hazard Evaluation Report 2009-0172-3124 Page 13 
 

ResuLts (Continued) 

(range: 657-1,189 ppm) were elevated in classroom 514 (1,189 

ppm) and classroom 519 (1,086 ppm). The consultants reported 

that the air handling unit serving classroom 519 might not have 

been functioning properly at the time of testing. Additionally, 

the consultant noted the window in classroom 521 (651 ppm) may 

have been open during testing in that room. These rooms were 

retested, and the CO2 levels in classroom 519 (954 ppm) and 

classroom 521 (898 ppm) were below the ASHRAE recommended 

limit. Classroom 514 had an elevated CO2 measurement (1,158 

ppm). The school district reported making adjustments to the air 

handler for room 514 to decrease the CO2 level. In classroom 407, 

carpet sampling for fungal spores revealed 1,300,000 cfu/g; the 

top three fungal genera identified were Alternaria, Aspergillus, and 

Cladosporium. Fungal spore trap samples of air were analyzed from 

two locations outside of the school building (total counts of 10,736 

spores/m3 and 6,896 spores/m3

) and 11 indoor locations — an office 

and classrooms 405, 407, 414, 501, 514, 519, 520, 521, 618, and 627 

(total count range: < 78–392 spores/m3

). The three rooms with 

the highest total spore counts were classroom 514 (392 spores/m3

), 

classroom 618 (313 spores/m3

), and classroom 521 (with window 

open) (313 spores/m3

). All three total VOCs were below 0.5 mg/ 

m3

. The specific locations of VOC sampling were not mentioned 

in the report. 

October 2008 

In October 2008, carpet in the main lobby, the secretary/treasurer’s 

office, and classrooms 407, 501, 503 was cleaned and treated with 

Sporicidin®. HVAC units 12 (front office), 48 (classroom 501), 

and 50 (classroom 407) were cleaned by contact vacuuming with 

a HEPA vacuum. Fan blowers and coils were HEPA-vacuumed, 

and the HVACs were sanitized with Sporicidin®. The rooms were 

wiped down and HEPA-vacuumed following the cleaning process. 

December 2008 

In December 2008, an off-white substance was observed coming 

from the ductwork in the main office area and in classroom 618 

after some air handling units had been cleaned. There was concern 

that the white substance was from the cleaning agent used or 

possibly the mineral content in the water. An industrial hygiene 

consultant observed an off-white powdery substance in three air 

handler units inspected and informed a school official. The school 

official contacted the cleaning contractor and was told that no 

white substances were used in the cleaning of the coils. The coil 

Page 14 Health Hazard Evaluation Report 2009-0172-3124 
ResuLts (Continued) 

cleaner contained butyl cellosolve (ethylene glycol monobutyl ether 

or 2-butoxyethanol), a type of glycol ether, which is water soluble 

and often used as a solvent. An industrial hygiene consultant 

sampled the air for total particulates, butyl cellosolve, and fungal 

materials and sampled surfaces for fungal materials in the office 

area and room 618. In the three areas (office lobby and rooms 113 

and 618) where the white substance was observed coming out of the 

ductwork, total particulate concentrations (range: 0.20–0.53 mg/ 

m3

) did not differ substantially from total particulate concentration 

in the break room (0.34 mg/m3

), which had not had coil cleaning. 

All three air sampling results (office lobby and rooms 113 and 

618) for butyl cellosolve were below the detection limit (< 0.72 

ppm) for the analytical method; thus, they were below the NIOSH 

recommended exposure limit (5 ppm) and the Occupational Safety 

and Health Administration permissible exposure limit (50 ppm) at 

the time of testing. Two outdoor fungal spore trap samples revealed 

total counts of 1,746 spores/m3 and 653 spores/m3 compared to 

total spore counts of 53 structures/m3 in room 618, 93 spores/m3 

in the office lobby, and 653 spores/m3 in room 113. The laboratory 

detected an Aspergillus conidiophore in the air sample taken in room 

113. The consultants conducted surface sampling on horizontal 

surfaces in three locations (office conference room table, lobby login book, and plastic lid in classroom 618) where the white substance 

was observed. Very few miscellaneous spores were present; no mold 

grew from these samples. 

April 2009 

In early April 2009, an industrial hygiene consultant from the 

Occupational and Environmental Epidemiology Branch of the 

North Carolina Department of Health and Human Services and a 

building systems engineer for the public schools of North Carolina 

visited the school to evaluate the indoor environment. During the 

site visit, the industrial hygiene consultant reported a moldy odor in 

the northwest corner of the assistant principal’s office (room 108) 

where carpet had been pulled up. He noted that the northwest 

wall was common to the new and old buildings. He also noted 

a history of recurrent water damage to the ceiling tiles above the 

ramp connecting the new and old buildings. Additionally, there 

was evidence of termites swarming in that area. In classroom 520 in 

the 4/5 wing, he reported a musty, earthy odor or an odor similar 

to citrus-based cleaning products when a carpet square was lifted. 

He also reported a microbial odor outside the bathrooms in the 4/5 

hall and a history of roof leaks in the music room (room 407) and 

Health Hazard Evaluation Report 2009-0172-3124 Page 15 
ResuLts (Continued) 

the Spanish room (room 501), which shared a common wall located 

where a north-south roof intersected an east-west roof. In classroom 

427, he reported a history of recurring problems with mold growth 

in the carpet. He recommended the school district: 

1.	 remove the carpet (using proper procedures) and replace 

with vinyl composition tile (after measurement of concrete 

floor moisture content) in rooms 108, 520, and the music 

room; 

2.	 identify and correct the sources of water movement through 

the exterior wall in room 108; 

3.	 repair flashing on the parapet where the old and new 

building were joined; 

4.	 investigate the source of roof leaks above the music and 

Spanish room; 

5.	 encourage students to use the main doors to enter and exit 

the building to reduce the amount of soils, dust, debris and 

allergens brought into the building; 

6.	 install barrier mats at each entrance long enough that a 

person would take at least five full steps on the mat; 

7.	 vacuum carpet daily; 

8.	 identify and correct odor sources at the bathroom in the 

4/5 hall; 

9.	 investigate sources of moisture under the concrete slab; 

10. integrate pest management techniques to control the termite 

infestation where the new and old buildings meet; 

11. analyze absentee data or other data to look for patterns 

where problems may exist. 

During the same site visit, the building systems engineer for 

the public schools of North Carolina reported ceiling tile stains 

throughout the school, especially in the area where the old and new 

buildings were joined. He noted a tendency for maintenance staff 

to replace stained ceiling tiles without first repairing the leaks. He 

recommended fixing leaks before replacing the ceiling tiles. He 

noted that foam roof sections in the older section of the school 

were showing signs of deterioration and would need to be replaced, 

especially if the number of leaks increased. He noted that flashing 

in some areas over the media center did not cover enough of the 

wall to prevent rain penetration, and that some exterior bricks 

on the wall had deteriorated, which may have contributed to the 

Page 16	 Health Hazard Evaluation Report 2009-0172-3124 
 

ResuLts (Continued) 

leaks into the assistant principal’s office. He recommended that the 

metal cap flashing on the north side be extended down to cover 

gaps between the existing flashing and the brick wall. The engineer 

also reported that surface water drainage toward the building kept 

the slab wet. To help keep surface water away from the building 

slab, he recommended installing a French drain between the school 

and the higher ground of the playground area to drain groundwater 

toward the streets. He recommended construction of swales around 

the building on the playground side and improvement of drainage 

around the courtyard surface areas to better drain water away from 

the buildings. He noted that some of the existing drop inlets 

might need to be lowered. He reported RH variations indicating 

moisture-related issues in the classrooms closest to the playground. 

He recommended keeping the RH between 30% and 60% with 

installation of room dehumidifiers in classrooms where the HVAC 

system could not maintain an RH of 60% or below. (The school 

district reported that they tested the RH in the school, and on 

average, the RH readings were at or below 60%.) Lastly, the engineer 

reported a significant amount of visible mold under the carpet in 

the assistant principal’s office. He noted that several classrooms 

had odors which were masked by carpet cleaning compounds. He 

recommended removal of carpet and replacement with floor tile 

in carpeted rooms where odors and/or excessive moisture were 

detected. 

Later in April 2009, another industrial hygiene consultant from 

Workplace Group monitored temperature, humidity, and CO2 in 

classrooms 516 and 520. He also sampled adhesive from beneath 

the carpet in classroom 501 and the underside of carpet in classroom 

520 and the assistant principal’s office for fungal materials. The 

adhesive beneath the carpet in classroom 501 was negative for 

fungal growth or spores. In the assistant principal’s office and 

classroom 520, Aspergillus and Penicillium were detected on the 

carpet backing. Mold growth, scored from 1 to 4 with 4 denoting 

the highest concentration, was scored 3 in classroom 520 and 4 in 

the assistant principal’s office. In classroom 516, the temperature 

ranged from 66.7oF –75.1oF (average 70.8oF, median 70.2oF), the 

RH ranged from 22.7%–30.9% (average: 25.9%, median: 26.1%), 

and CO2 from 350–750 ppm (average: 500 ppm, median: 460 ppm). 

In room 520, the temperature ranged from 67.4oF–75.3oF (average: 

73.0oF, median: 73.5oF), the RH from 20.6%–51.0% (average: 

33.3%, median 33.0%), and CO2 from 330–1710 ppm (average: 700 

ppm, median: 540 ppm), exceeding the recommended limit of 1100 

ppm at one point during testing. 

Health Hazard Evaluation Report 2009-0172-3124 Page 17 
ResuLts (Continued) 

In mid-April 2009, floor consultants performed moisture testing of 

interior floor slabs in the assistant principal’s office and classrooms 

427, 516, 518, 520, and 618. In addition, a consultant engineer 

reviewed floor and wall conditions. In his report, he noted that 

interior floor slabs were being tested for moisture by a flooring 

company, and the surface preparation was suspect, as evidenced by 

adhesive residue and curing compounds under the testing chamber. 

He mentioned that the school was reported to have had high levels 

of humidity for an extended period of time when the new addition 

was opened in 2005, and adjustments had been made to the HVAC 

system. Monitors for temperature and humidity were removed, and 

relative humidity was no longer monitored on the interior of the 

school. Surface water draining from the elevated ball fields was 

ponding adjacent to concrete walkways instead of being directed 

across the gravel roadway and away from the school. He also noted 

significant roof leaks on the flat roof over the utility/storage room at 

the southeast corner of the school just west of the gym. He reported 

over 18 ceiling tiles were damaged. In the main hallway where the 

old and the new buildings interface, he reported damaged ceiling 

tiles from water intrusion which appeared to be from a roof leak. 

In mid-April, the carpet in the assistant principal’s office was 

replaced with vinyl composition tile. 

May 2009 

During the second week in May 2009, a senior environmental 

health specialist from the county health department visited the site 

and noted a water-stained ceiling tile in room 619. She noted in her 

report that a previous site visit by state and local agencies on April 

3, 2009 outlined a variety of issues and recommendations. 

Also during the second week of May 2009, an industrial hygiene 

consultant from Workplace Hygiene sampled carpet, surface, and 

air for fungal materials (in rooms 115, 206, 420, 421, 422, 423, 

425, 427, 500, 503, 514, 515, 516, 610, 616, 618, 627) and air for 

VOC. The indoor fungal air sampling results ranged from no 

spores detected in classroom 627 to 940 spores/m3 in classroom 

420. The six rooms with the highest total spores were classroom 

420 (940 spores/m3

), classroom 206 (705 spores/m3), classroom 

427 (549 spores/m3

), classroom 514 (549 spores/m3), classroom 115 

(470 spores/m3

), and classroom 425 (470 spores/m3). The outdoor 

samples (outside the 2/3 and k/1 wings) ranged from 18,103 to 

28,134 spores/m3

; the top three outside fungi species identified were 

Page 18 Health Hazard Evaluation Report 2009-0172-3124 
 

 

ResuLts (Continued) 

Ascospores, Basidiospores, and Cladosporium. The outdoor counts 

were higher than the indoor counts except for Myxomycete/Smutlike, which was higher in room 420 than outside. Surfaces beneath 

the carpeting were sampled in the same 17 rooms, in a paper tray in 

room 115, and on a water-damaged wall in room 500. Because the 

carpet was glued to the floor, only one location was selected from 

each room. With the exception of the k/1 wing (where carpet did 

not extend to exterior doors) and room 206 (which had no exterior 

door), the samples were collected near the exterior doors of each 

classroom because the consultants thought this area would more 

likely have excessive moisture. Spores were not detected on the 

carpet backing in rooms 425, 503, 515, and 616. With the exception 

of room 421, spore concentrations were characterized as “trace to 

light.” The carpet backing in room 421 had a surface concentration 

of mold spores identified as Aspergillus/Penicillium characterized as 

“loaded” and concentrations of Basidiospores and Cladosporium 

characterized as “trace” to “light.” 

Carpet sampling results for mold ranged from 30,000 cfu/g in room 

115 to > 2,000,000 cfu/g in classroom 516. Six of the 16 results 

exceeded 1,000,000 cfu/g (room 206, > 1,333,333; classroom 514, > 

1,600,000; classroom 515, > 1,600,000; classroom 516, > 2,000,000; 

classroom 618, > 1,000,000; classroom 627, 1,460,000). Total VOC 

results ranged from 0.18 milligrams per cubic meter (mg/m3

) for 

a sample collected outdoors to 1.6 mg/m3 in classroom 425. The 

consultants noted that the Green Building Council established a 

recommended limit for VOCs of 0.5 mg/m3 for new buildings, and 

that Washington State established a limit of 0.5 mg/m3 in buildings. 

Six (rooms 420, 423, 425, 500, 501, 514) of the 20 areas sampled 

exceeded the 0.5 mg/m3 limit. The consultant reported cleaning 

activities were going on during the sampling, and this may have 

affected the results. The cleaning products used were not listed. The 

industrial hygiene consultant recommended the school district (1) 

test for aldehydes to determine whether their presence contributed 

to reports of bloody noses; (2) test (by smoke or pressure) the drain 

lines to check for leaks; (3) inspect and (if necessary) clean the air 

handlers, and replace any contaminated insulation found; and (4) 

forward the consultant’s report to the county health department. 

Later in May 2009, an engineer consultant assessed the school and 

found “slight humidity in the administration office”, but thought 

the air quality in the school seemed acceptable. He evaluated 

the mechanical systems in the 2/3 and 4/5 wings and thought 

the system was well designed. However, in an outdoor air unit, 

Health Hazard Evaluation Report 2009-0172-3124 Page 19 
ResuLts (Continued) 

he found standing water in the condensate drain pan and noted 

the filters for these units needed to be replaced. The engineer 

relieved the pressure on the unit and drained the pan completely. 

He noted that the units were designed to be free of standing water 

and recommended that drainage of these units be evaluated to 

determine the problem. Another contractor checked the drain pans 

and found that the drain piping did not appear to allow complete 

drainage in the drain pan. However, he did not note carryover of 

moisture to the fan compartment or ductwork and did not see any 

dirt or other problems that would cause a mold issue in the unit or 

drain pan. The two consultants agreed that an adjustment in the 

trays should solve the problem. A school staff member was reported 

to have immediately started the adjustment. 

The engineer consultant also found that CO2 sensors in the 

ventilation system had been electrically jumped and thereby 

disabled, and that the outdoor air units had been set at 100% 

fresh air to get as much air into the building as possible. However, 

outdoor air did not appear to be getting into the building. CO2 

concentrations inside the building were around 500 ppm when the 

building was unoccupied for three days. Additionally, the building 

was noted to be in a neutral pressure condition when it should have 

been in a positive pressure condition. The consultant noted that 

the HVAC system serving the school was designed properly but 

was not operating correctly. He recommended the system be recommissioned and the outdoor air system be checked to see if it was 

sized correctly. A third consultant noted that the CO2 sensors were 

part of a previous attempt to control fresh air intake and were not 

intended to be part of the current ventilation control. However, 

when the system was most recently balanced, the dampers were 

bypassed in the open position to allow the scheduled fresh air to 

be delivered from the new air handling unit to the classroom units 

to ensure the right amount of air reached each unit. The prior 

summer, when the new system was installed, fans and dampers 

were set up and a balance contractor verified flow to each unit and 

all were apparently 95% or better for scheduled air supply. The 

school planned to have the ventilation air calculations reviewed 

to determine if any further re-commissioning was necessary. The 

engineer consultant found a lot of construction dust in the return 

ductwork and recommended the duct system be cleaned. He noted 

the filters were being maintained and the ductwork on the other 

side of the filter was clean. 

During May 2009, the carpet in classrooms 407, 501, 508, 518, 

Page 20 Health Hazard Evaluation Report 2009-0172-3124 
ResuLts (Continued) 

and 625 was replaced with vinyl composition tile. During the last 

weekend in May 2009, a carpet cleaning company cleaned all the 

remaining carpet in the school with an antimicrobial agent. 

During the last week in May 2009, the county health department 

distributed questionnaires for staff and parents at the elementary 

school. 

June 2009 

In mid-June 2009, the medical director and others from the county 

health department toured the school. In a media briefing on the 

following day (June 16, 2009), he reported that when they toured 

the school a month earlier they could find no mold or dampness; 

however, during the June tour, they did observe moisture in a wall 

and a small patch of mildew behind a banner in the gymnasium. 

The county health department reported in a document dated 

June 25, 2009 that approximately 800 questionnaire surveys were 

distributed and about half were returned within the one-week 

deadline (Appendix D). The document stated that the summary of 

the responses showed that the “driving” symptoms were headache 

and fatigue that occurred within the school and resolved when fresh 

air was obtained by opening windows and doors to the classrooms, 

by going outside, or by going home. The document noted that 

other symptoms, particularly nosebleeds, were also reported, though 

without a clear pattern of occurrence to suggest they were buildingrelated. 

July 2009 

In mid-July 2009, NIOSH investigators and Turner Group 

consultants visited the elementary school on three consecutive 

days. 

During this visit, we noted a strong musty, moldy odor in the 

basement (Figure 5) and crawl space under the media center. Lime 

was observed on the crawl space dirt floor. We also noted a musty 

smell in the corridor around the media center, particularly near the 

school museum. Surface water from playgrounds drained towards 

the classroom wings; it appeared water could puddle near concrete 

walkways adjacent to classroom wings, especially near the 2/3 and 

4/5 wings (Figures 6, 7, and 8). A storm drain outside the media 

center was blocked, and there was standing water in it (Figure 9). 

There were multiple locations on the foam roof surface where the 

roof membrane had been compromised; there were signs of softness 

and bubbling of the membrane (Figures 10 and 11). There did not 

Health Hazard Evaluation Report 2009-0172-3124 Page 21 
ResuLts (Continued) 

appear to be adequate flashing at the junction of the parapet wall 

(above room 206) and the gym (Figure 12). Room 206 had stained 

carpet, wavy baseboards, and walls which appeared to have been 

newly painted. Inside the school, we noted excessive moisture (with 

an infrared camera) in the gym’s exterior concrete block wall where 

a leak had been repaired. We also noted that multiple classrooms 

were under negative pressure instead of positive pressure relative to 

the corridor. Multiple restrooms were also under positive pressure 

instead of negative pressure. During the day, the plenum above 

the classroom ceilings was generally under positive pressure in 

relation to the exterior of the building. However at night, when the 

dehumidifier (which served the classroom wings) was turned off, this 

sometimes resulted in the plenum being under negative pressure in 

relation to the outside of the building. This allowed outside humid 

air to enter the plenum through the soffits in the classroom wings. 

From the mezzanine area, where the dehumidifier was located, we 

observed dust on classroom ceilings and ducts (Figures 13 and 14). 

Some of the coils for the HVAC air handlers had residue that may 

have been mold contamination (Figure 15). 

Water activity on floor materials from the 23 areas (21 rooms) 

sampled ranged from 0.52 to 0.81 (median = 0.69) on the 

date of investigation. Average water activity on the floor in the 

administration wing (0.76) and media center wing (0.73) were above 

the median, while average water activity in the k/1 wing was lowest 

(0.57) (Table 2). RH in the building ranged from 34% to 69%. 

Average RH was higher in the administrative wing (59%) than the 

other wings of the building and lowest in k/1 wing (37%), and 2/3 

wing (39%). Air temperature did not show a wide range within the 

building (range = 70.5oF–74.1oF). 

From the 22 floor dust samples, we recovered 20 fungal species, 

yeasts, and unidentifiable non-sporulating fungi (Figure 16). 

Identified hydrophilic (water-loving) fungi from the dust samples 

included Alternaria alternata, Epicoccum nigrum, Trichoderma konigii, 

Aspergillus fumigatus, Mucor plumbeus, Rhizopus stolonifer, and yeasts. 

Identified mesophilic fungi included Cladosporium cladosporioides, 

Aureobasidium pullulans, Fusarium oxysporum, Aspergillus ochraceus, 

Aspergillus niger, Aspergillus versicolor, Paecilomyces varioti, Penicillium 

aurantiogriseum. Among the species recovered, Cladosporium 

cladosporioides occurred most frequently (recovered from all 22 

samples). Eighty-six percent of the samples contained Epicoccum 

nigrum and 64% contained Alternaria alternate, both hydrophilic 

fungi. Bipolaris australiensis, which was not classified as either 

Page 22 Health Hazard Evaluation Report 2009-0172-3124 
 

 

ResuLts (Continued) 

hydrophilic or mesophilic, was recovered from 64% of samples. 

The overall geometric mean (GM) concentration of total culturable 

fungi measured in the dust samples was 6,000 cfu/g dust (Table 

3). Overall sample GM concentration of culturable hydrophilic 

fungi was 1,200 cfu/g. Analysis of the fractions of hydrophilic and 

mesophilic fungi showed that, 83% of the total culturable fungi 

were either mesophilic (61%) or hydrophilic (22%). Among fungi 

found in more than 40% of samples, Cladosporium cladosporioides 

(GM = 2,852 cfu/g), Epicoccum nigrum (GM = 1,130 cfu/g), and 

Aureobasidium pullulans (GM = 733 cfu/g) were recovered at higher 

concentrations than others. The overall GM concentration of 

Gram-positive bacteria measured in the building was 396,000 cfu/g 

where as the concentration of Gram-negative bacteria was 8,500 

cfu/g. None of the 22 samples grew Actinomycetes (fungus-like 

bacteria). 

Levels of total fungi, Gram-positive, and Gram-negative bacteria 

by building wing are summarized in Table 4. The gym/cafeteria 

wing (N = 1; 24,000 cfu/g) and the 2/3 wing (N = 4; 23,500 

cfu/g) had the highest level of total culturable fungi in floor dust, 

approximately eight-times higher than those of the media center (N 

= 3; 2,900 cfu/g) and the 4/5 wing (N = 6; 2,900 cfu/g). Similarly, 

concentrations of hydrophilic fungi in dust were several times 

higher in the gym/cafeteria and 2/3 wing than in other areas. The 

proportions of total fungi represented by hydrophilic fungi were 

similar among wings and ranged between 20% (administration 

wing) and 29% (k/1 wing). Except for the k/1 wing, the pattern of 

Gram-negative bacteria concentrations by building wing was similar 

to those observed for culturable fungi. The level of Gram-negative 

bacteria was more than an order of magnitude higher in the 2/3 

wing (52,000 cfu/g) than in the media center (2,500 cfu/g) and the 

4/5 wing (3,900 cfu/g). The levels of Gram-positive bacteria were 

highest in the k/1 wing (855,600 cfu/g), followed by the 2/3 wing 

(660,100 cfu/g), and the media center (631,600 cfu/g). 

We identified 10 rooms where measurements were made by both 

NIOSH investigators and previous consultants: two rooms in the 

administration area, one in the gym area, two in the 2/3 wing, three 

in the 4/5 wing, and two in the k/1wing. Eight of the 10 rooms 

had measurements in May 2009 and July 2009 (Table 5). Room 100 

(lobby in the administration area) had measurements in October 

2007 and July 2009 (Table 6). Room 407 had measurements in 

September and October 2008 and July 2009 (Table 6). Based on 

Health Hazard Evaluation Report 2009-0172-3124 Page 23 
ResuLts (Continued) 

the comparisons, we found that the fungal levels measured during 

the 2009 NIOSH investigation were 4 to 1,000-fold lower than those 

measured previously by consultants in all rooms except for room 115 

in the administration wing, which showed similar levels at the two 

sampling times. Measurements from three rooms in the 4/5 wing 

showed dramatically decreased (90 to 1000-fold lower) fungal levels 

in the NIOSH investigation compared to those measured about two 

months before (May 2009). 

On the last day of the July 2009 site visit, we communicated 

preliminary findings with the concurrence of the Turner Group 

at a breakfast meeting with officials from the school district. The 

following week, we e-mailed school district officials a brief summary 

of the findings discussed during the meeting (Appendix E). 

Additionally in July 2009, we notified school district officials via 

teleconference that some elementary school employees interviewed 

over the telephone reported building-related symptoms suggestive 

of hypersensitivity pneumonitis. We also communicated that there 

appeared to be a high prevalence of respiratory symptoms at the 

school based on the summary of the county health department 

questionnaire survey results. (Appendices F and G). 

The Turner Group summarized their preliminary findings in a 

document dated July 21, 2009 (Appendix H). Their findings and 

recommendations included: 

1.	 Finding: dirt-floor crawl space under the media center is a 

possible source of mold. Recommendation: install flexible 

vapor barrier and depressurize air space under the vapor 

barrier in the crawl space under the media center. 

2.	 Finding: inadequate flashing at junction between the 

parapet wall and gym wall above room 206 causing 

water intrusion leading to mold growth in the carpet. 

Recommendation: install through-wall-flashing at edge of 

parapet. 

3.	 Finding: discolored drywall on inside of exterior wall 

in classroom 400, at the site of an earlier leak that 

led to occupant reports of mold under the cove base. 

Recommendation: repair roof junction joints to provide 

adequate flashing. 

4.	 Finding: dehumidification system operation suspect, 

evidenced by high humidity (70%+) in the 4/5 wing. 

Recommendation: provide retro-commissioning of HVAC 

system to verify proper system capacity and sequence of 

Page 24	 Health Hazard Evaluation Report 2009-0172-3124 
ResuLts (Continued) 

operation. 

5.	 Finding: possible HP refrigerant leaks indicated by 64oF 

discharge at HP serving classroom 520 and humidity levels 

monitored at 70%–80% in room. Alternatively, quantity 

of outdoor air being handled exceeded coil capacity. 

Recommendation: provide retro-commissioning of HVAC 

system to verify proper system capacity and sequence of 

operation; 

6.	 Finding: classroom wings not sealed at soffit, allowing excess 

air leakage in and out (depending on mechanical system 

operation). Recommendation: seal soffit to prevent air 

infiltration and ensure means for exhaust/relief. 

7.	 Finding: HP design conducive to growing mold due to 

proximity of filter and cooling coil. Recommendation: 

provide new filter boxes upstream to create separation 

between filter and coil. 

8.	 Finding: concerns about odors from drains, particularly 

HP drains, when the traps are allowed to dry out. 

Recommendation: review maintenance tasks and schedules; 

on-going maintenance to assure that drain traps do not dry 

out. 

9.	 Finding: bathrooms not consistently at negative pressure 

relative to hall. Recommendation: balance air flows as part 

of retro-commissioning process, possibly increase supply air 

to hall; 

10. Finding: mechanical room in office area under significant 

negative pressure. Recommendation: seal duct joints on 

all return air and possibly supply air and verify air flows on 

retro-commissioning. 

11. Finding: unknown issues regarding storm runoff at the 

end of the 2/3 and 4/5 wings with possibility of water 

getting under slab if it pools against the exterior walls. 

Recommendation: verify adequate site drainage, clean site 

drainage system as necessary, and provide means to limit 

runoff of sand and other surface material. 

12. Finding: original design of classroom wings modulated 

between 3.5 cubic feet per minute per person and 7.5 cubic 

feet per minute per person from 1000 ppm CO2

 to 1800 

ppm; when dehumidification systems installed, CO2 control 

eliminated and all areas receive 7.5 cubic feet per minute per 

person. Recommendation: balance outdoor air supply and 

Health Hazard Evaluation Report 2009-0172-3124	 Page 25 
ResuLts (Continued) 

mark dampers as part of retro-commissioning project. 

13. Finding: numerous open bubbles on the foam roof with 

compromise of the aluminum paint. Recommendation: 

obtain estimate to repair/replace the foam roof. 

14. Finding: possible leak from sewer vent and/or roof flashing 

of vent through roof in classroom 500. Recommendation: 

replace or repair flashing. 

15. Finding: building not observed during the occupied mode 

and some operational conditions were not observed. 

Recommendation: provide monitoring of conditions during 

occupancy to evaluate operation under occupancy (after 

retro-commissioning of systems). 

August 2009 

In August 2009, the elementary school remained closed for 

remediation after the summer break. Students attended three 

alternate sites. Kindergartners and first-graders attended another 

elementary school; second and third graders attended a nearby 

military academy; and fourth and fifth graders attended a middle 

school. 

October 2009 

In October 2009, NIOSH sent an e-mail to parents who requested a 

summary of our findings from the site visit (Appendix I). 

November 2009 

In November 2009, EMC Engineers, Inc. was contracted by the 

school district to retro-commission the HVAC systems at the school 

(Appendix J). Regarding the water-source HPs, EMC personnel 

encountered the following issues: 

1.	 The building automation system (BAS) was not scheduled 

to vary any building equipment function based on building 

occupancy; there was 24/7/365 operation. EMC personnel 

decided to leave it as found until the new schedule was 

implemented. The new recommended schedule was (a) 

office and media center areas, occupied 5 am – 10 pm; (b) 

classroom wings and gym/cafeteria, occupied 6 am – 10 pm; 

and (c) data closets, occupied continuously. 

2.	 Setpoint control was found to be from the BAS for all HPs. 

3.	 A significant number of HP discharge air temperature 

Page 26	 Health Hazard Evaluation Report 2009-0172-3124 
ResuLts (Continued) 

sensors were found to be out of range. EMC personnel 

reported that this point was not critical to unit operation 

but should read accurately to correctly convey HP operation. 

4.	 Various graphics errors were found on the Trane 

workstation in the boiler room. 

5.	 Low air flows were observed in several HPs. 

6.	 All space temperature setpoints for HPs were independently 

controlled in the BAS and did not follow any unified area 

control. EMC and Turner Group personnel discussed 

this, and a determination was made that global setpoints 

should be applied to the HPs, with local temperature sensor 

control. 

7.	 HP-11 (which serves offices in the physical education area 

and a small corridor) was found to be incapable of supplying 

the designed amount of air to the offices it served. To 

bring values to within 10% of design values, SCI personnel 

installed larger supply diffusers and Phoenix T&B personnel 

proportioned the supply. 

8.	 Sheaves for the fans of HP-48 and HP-55 (which serve areas 

in the 2/3 wing) were found to be adjusted incorrectly, and 

setscrews were damaged. Sheaves were replaced; Phoenix 

T&B personnel adjusted them to the correct settings, which 

were then verified by EMC personnel. 

9.	 HP-43 (serving areas in the 4/5 wing) was not accessible on 

the 4/5 wing graphic. This was corrected by SCI personnel. 

10. All HPs were set up as members of a variable air volume 

system in the Tracer SummitTM BAS, which was incorrect. 

This was corrected. EMC personnel verified the corrections. 

11. A foreign object, measuring approximately 2’ x 2’ was found 

inside one of the supply ducts in the 4/5 wing. EMC 

reported that the object, which appeared to be a camping 

shower, was removed by Phoenix T&B personnel. 

12. EMC personnel found that the majority of HPs had air 

flows within +/-10% of design values. However, a small 

number of units exhibited air flow slightly beyond this 

threshold. The outdoor air units were providing air to the 

associated wings of the building, at volumes consistent with 

those specified by the designer. Based on the final Test and 

Balance Report, the units were operating generally within 

the +/-10% of design. EMC personnel recommended: 

Health Hazard Evaluation Report 2009-0172-3124	 Page 27 
ResuLts (Continued)

1.	 Setpoints of 70oF during the heating season and 74oF 

during the cooling season. 

2.	 That all outside doors and operable windows remain 

closed at all times to aid in maintaining acceptable indoor 

conditions. 

3.	 Regular air filter inspections of all units, including 

the makeup air units, at least every three months per 

manufacturer’s recommendations, with filters changed 

when warranted by visual inspection. 

4.	 Consistent space temperature setpoints within logical zones 

of the building (i.e., classroom wings; office and media 

center areas; gym/cafeteria areas; and data closets) to help 

reduce the potential for wide temperature fluctuations 

among each zone’s spaces. 

5.	 Use of global setpoint values, referenced in each HP 

controller, in the Trane BAS. 

6.	 Unoccupied setpoint temperature offsets of 5oF from 

occupied setpoints (i.e., unoccupied cooling setpoints 5oF 

higher than occupied cooling setpoints; unoccupied heating 

setpoints 5oF lower than occupied heating setpoints). 

EMC personnel evaluated the tempered water system and found 

the following issues, which were corrected: 

1.	 No programming was in place to rotate the building loop 

pumps upon failure of a pump. SCI personnel corrected 

this programming. 

2.	 The outside air temperature sensor was not calibrated, and 

the outside air humidity sensor was incorrectly terminated. 

SCI personnel corrected both of these issues. 

3.	 All pumps in the main mechanical room were operating 

in manual mode instead of being automatically controlled 

from the BAS. 

After functional testing on the tempered water system, EMC 

personnel were confident that the system would be able to maintain 

the loop water temperature, so that the water source HPs throughout 

the building would be able to maintain space temperature effectively. 

T&B consultants verified the loop water balance. 

EMC personnel evaluated the makeup air units and found the 

following issues, which were corrected: 

1.	 The makeup air units were found to trip when outside air 

Page 28	 Health Hazard Evaluation Report 2009-0172-3124 
ResuLts (Continued) 

temperatures fell below a low temperature limit of 29oF. 

Trends were set up in the BAS to capture system parameters 

at the time of trip. 

2.	 The location of the outdoor air sensor was incorrect, 

resulting in readings not reflective of actual outdoor air 

conditions. The sensor was relocated to a proper location 

on the north wall of the main mechanical room and verified 

by EMC personnel. 

EMC personnel evaluated the fans and systems and found the 

following issues, which were corrected: 

1.	 Several exhaust fans (ER-1, EF-3, EF-4, EF-5, EF-6, and 

EF-10) did not respond (start/stop) when the associated HPs 

were occupied / unoccupied. 

2.	 The ceiling grill in the janitor’s closet outside the multipurpose room was not connected to an exhaust duct, which 

resulted in no exhaust from the space, and likely contributed 

to the objectionable odors noted in that vicinity. 

3.	 Exhaust fan EF-9 was located above the fire-rated ceiling 

in the 4/5 wing and was not accessible. Access was cut in 

beneath the fan. 

4.	 A substantial number of dampers located above fire-rated 

ceilings were not accessible due to the absence of access 

doors or panels. This was corrected by cutting in access. 

EMC personnel planned to be onsite the first week of May 2010 to 

confirm proper cooling-season operation of the makeup air units, 

HPs, and associated systems. 

The school district administration continued to consult with the 

Turner Group to address issues found during the initial site visit 

in July 2009 and during further testing. Additional findings by 

the Turner Group (Appendices K and L) included visible mold 

on some small portions of gypsum board removed at floor level 

and water-damaged walls in the clerestory area above the media 

center that were suspected to have supported mold growth in the 

past. The walls were removed or cleaned. Dried leaves and other 

dried organic material found trapped in the structure of the media 

center were removed. Some of the clerestory windows were resealed 

and existing roof scuppers (i.e., roof drains) were lowered. An old 

unused ventilation system in the clerestory space was removed, 

and the ventilation openings sealed because they were defeating 

Health Hazard Evaluation Report 2009-0172-3124	 Page 29 
 

 

ResuLts (Continued) 

the building’s thermal envelope. Blower-door tests and infrared 

imaging indicated that the soffits in the classroom wings were a 

source of many air leaks. Other heat and air leak areas identified 

on the thermal imaging included doors, windows, and the base of 

the building wall. Turner Group consultants reviewed photos that 

showed some plumbing waste line vents in the classroom wings 

that should have been connected to the waste line roof vents were 

instead open to the space above the ceilings. This was corrected. 

Additionally, some of the waste line roof vents were located less 

than 10 feet from roof-mounted air inlets. They were apparently 

relocated to meet the minimum 10 feet distance between roof vents 

and air inlets specified by construction drawings. Slab testing results 

reported in the Turner Group’s final report noted that the concrete 

flooring in some rooms (106, 110, 400, 425, 502, 514, 608, 610, 

614, 616, 617, 618, and 627) had more moisture penetration (over 

5.0 pounds per 1000 square feet per 24 hours) than other rooms. 

They also noted that some classrooms (505, 516, 608, and 614) had 

rusted sill plates, possibly due to water damage. In addition to the 

recommendations in their preliminary report, the Turner Group 

also recommended: 

1.	 new floor maintenance systems and schedules because the 

school no longer had textile floor covers but either hard 

vinyl or terracotta floor surfaces. 

2.	 limiting noise by fitting feet of desks, chairs, and other 

objects with felt pads or with rolling castor wheels designed 

for hard floors. 

3.	 avoiding use of textile floor coverings of any size except 

track-off mats. 

4.	 using track-off mats at all main entries and avoiding use of 

classroom fire-exits for routine entry and exit. 

5.	 setting occupied temperature setpoint of 70oF heating and 

74oF cooling in accordance with recommendations made by 

the commissioning agent. 

6.	 operating the school in occupied and unoccupied cycles. 

7.	 continuing additional monitoring of space conditions 

throughout the remaining heating season and the upcoming 

cooling season to verify proper operation of the HVAC 

system and controls. 

8.	 additional evaluation and possible corrective work to further 

limit heat loss and air leaks from doors, windows, and base 

of the walls. 

Page 30	 Health Hazard Evaluation Report 2009-0172-3124 
 

ResuLts (Continued) February 2010 

In February 2010, NIOSH investigators released an interim report 

(Appendix M), which summarized the environmental problems 

at the school, our walkthrough observations and environmental 

sample results, our analysis of the health department questionnaire 

data, and our recommendations, which had been previously shared 

with school district officials. 

March 2010 

During the NIOSH walkthrough inspection in March 2010, after 

the school had reopened, we found the school to be clean and 

organized. We did not observe any dampness or stained ceiling 

tiles. The carpet in the school building had been replaced with hard 

floors (Figures 17 and 18). In the corridors, doormats were noted at 

the exterior doors (Figures 19–22). In the library/media center, an 

exterior door was being installed (Figure 23). 

May 2010 

In May 2010, EMC Engineers, Inc. performed seasonal testing of 

the HVAC systems (Appendix N). Overall, EMC personnel found 

the building systems to be operating well within the guidelines and 

recommendations established in the Turner Group report and the 

EMC retro-commissioning report. Regarding the water-source HPs, 

EMC personnel observed the following: 

1.	 The BAS was found to control all HPs on the following 

schedules: (a) Office and Media Center areas, occupied 

5 a.m. – 10 p.m.; (b) classroom wings and gym/cafeteria, 

occupied 6 a.m. – 10 p.m.; (c) data closets, occupied 

continuously. 

2.	 Space temperature measurements immediately following 

transition from unoccupied to occupied operation revealed 

that the HPs overshot the occupied setpoints by up to 

2.5oF. Classroom HPs took anywhere from 30 minutes to 1 

hour to resolve the overshoot condition. When overshoot 

was occurring, there were instances of teachers arriving to 

prepare for class while room temperatures were either too 

warm or too cold. This resulted in trouble calls to school 

district maintenance department. EMC personnel were 

informed by operations staff of the school district that 

generally there was no occupancy of the school after 9 p.m. 

As a result, EMC personnel recommended that the BAS 

occupancy schedule be adjusted. 

Health Hazard Evaluation Report 2009-0172-3124	 Page 31 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ResuLts (Continued) 

3.	 Setpoint control was found to be from the BAS for all HPs, 

with setpoints as follows: (a) office and media center — 

occupied cooling at 74oF and unoccupied cooling at 79oF, 

(b) classroom wings and gym/cafeteria — occupied cooling 

at 72oF and unoccupied cooling at 77oF. 

4.	 A review of trouble calls generated since reoccupying the 

school revealed that a significant number of calls originated 

from staff working in the office and media center. Testing 

showed that the HPs controlling these spaces were able 

to satisfactorily maintain a lower setpoint consistent with 

the classroom wings. EMC personnel recommended 

lowering the cooling setpoints, while remaining within the 

guidelines of the Turner Group report. 

5.	 Space temperature sensor calibrations for the HPs were 

found to generally be within +/- 0.5oF, with the following 

exceptions: 

HP Room Tracer Summit Temp. Measured Temp. Cal. Error 

40 514 71.2 69.7 -1.5 

47 422 72.2 71.0 -1.1 

1 Central Receiving 74.4 76 +1.6 

6 Gym hallway 72.8 75.1 +2.3 

7 Kitchen 74.9 73.1 -1.8 

37 517 72.8 73.6 +0.8 

39 515 71.9 72.7 +0.8 

53 406 72.1 70.4 -1.7 

55 401 71.4 69.9 -1.5 

58 Office hallway 74 75.9 +1.9 

6.	 EMC consultants observed the position of outside doors 

and windows and found the exterior door and windows 

open in one classroom on the 4/5 wing. They also 

observed rocks or other objects (i.e., microphone stand 

base and bricks) outside of exterior doors to classrooms and 

corridors, apparently used to prop the doors open at times. 

They noted the exterior door and door frame in classroom 

521 was damaged, allowing conditioned air to escape to the 

outside. Additionally, they noted it was difficult to pull the 

door shut to latch it, allowing potential unauthorized access 

to the school if the door was left unlatched. 

Page 32	 Health Hazard Evaluation Report 2009-0172-3124 
ResuLts (Continued) 

7.	 The outdoor air humidity sensor connected to the BAS 

was found to be reading incorrectly. It gave an implausible 

reading of 122.9% while a calibrated test instrument gave a 

reading of 74%. 

8.	 On the BAS graphic screen, classroom 501 did not have a 

link to HP-48, which serves that area. 

9.	 A heat-generating cathode ray tube computer monitor was 

found to have been placed directly beneath the thermostat 

of HP-55 in classroom 401. The heat generated by this 

monitor was influencing the thermostat and keeping the 

room much colder than the BAS setpoint. 

10. The cooling setpoint of HP-34 (serving areas in the k/1 

wing) was found to be 74oF, slightly higher than the 

intended setpoint of 72oF. 

11. The space temperature sensor installed in classroom 501 was 

found to be wired to an unknown point. EMC personnel 

were unable to determine the termination point for this 

sensor due to inability to access above the hard ceiling in the 

hallway. 

12. HP-48 serves classroom 421 and classroom 501, where the 

single thermostat controlling this HP is located, but control 

of space temperatures of both these classrooms was found to 

be acceptable and consistent. 

13. Air filters for HPs showed expected amounts of build-up 

consistent with the approximately 90 days of use they had 

experienced. 

14. No issues with the BAS were found and communication to 

all HPs was present. 

15. HP-24 was continually producing cold air. Although 

temporarily altering the setpoints caused the HP controller 

to switch to heating mode, discharge air temperature 

remained at levels consistent with cooling operation. The 

reversing valve was tested and found to operate properly, 

but the HP controller was operating inappropriately — 

constantly energizing the reversing valve. 

16. Review of the Tracer Summit alarm log revealed three 

instances when the Building Control Unit communications 

ceased during the week of May 3, 2010. The alarm log 

contained no indication of how long communications were 

down or why communications ceased. There was no impact 

Health Hazard Evaluation Report 2009-0172-3124	 Page 33 
ResuLts (Continued) 

on HP operation or indoor conditions; however, EMC 

personnel recommended that the alarm log be periodically 

reviewed to determine if communication losses increase in 

frequency. 

17. The low refrigerant pressure switch of HP-9 circuit #1 was 

found to be in the off position. Subsequent investigation 

by school district personnel revealed that this circuit’s 

refrigerant had escaped. 

18. The controller for HP-26 had been replaced with the 

same type of controller used for all other similar HPs in 

the school. The operation of this HP was now consistent 

with the others, consistent with a recommendation in the 

original EMC report. 

19. The supply fan motor for HP-12 stopped working while 

EMC personnel were conducting seasonal testing. 

Maintenance personnel from the school district made 

repairs to correct this. 

20.The rigid copper piping associated with the water-source 

HP building loop, located in the mezzanines above the 

classroom wings, lacked sufficient structural support in 

numerous locations. Unnecessary strain was being placed 

on soldered pipe joints, which could lead to failure of the 

joints and a potential for catastrophic flooding inside the 

school. 

EMC personnel made the following recommendations: 

1.	 Revise the BAS occupancy schedule to help settle space 

temperatures before employees arrive in the mornings. 

The revised schedules were as follows: (a) office and 

media center areas, occupied 4 a.m–9 p.m.; (b) classroom 

wings and gym/cafeteria, occupied 5 a.m.– 9 p.m.; and (c) 

data closets, occupied continuously. These changes were 

implemented on May 7, 2010. 

2.	 Revise the temperature setpoints to provide acceptable 

space temperatures and alleviate trouble calls to school 

district maintenance department; the revised temperature 

setpoints were as follows: (a) office and media center, 72oF 

for occupied cooling and 77oF for unoccupied cooling; (b) 

classroom wings and gym/cafeteria, no changes; and (c) 

data closets, no changes. These changes were implemented 

by May 7, 2010. EMC personnel recommended that all 

unoccupied off-sets remain at +/- 5.0oF. 

Page 34	 Health Hazard Evaluation Report 2009-0172-3124 
ResuLts (Continued) 

3.	 Continue regular air filter inspections on all units, 

including the makeup air units, at least every 3 months per 

manufacturer’s recommendations, changing filters when 

warranted by visual inspection. 

4.	 Use trained personnel with the proper calibrated equipment 

to assess air flow to help prevent unnecessary trouble calls 

stemming from inaccurate observations or assumptions. 

5.	 Calibrate the thermostats in the kitchen, central receiving, 

the gym hallway, office hallway, and rooms 401, 406, 422, 

514, 515, 517, and 522 to within factory tolerances (+/- 0.5o 

F). If calibration is not possible, replace the thermostat and 

verify the new thermostat calibration with a calibrated test 

instrument. 

6.	 Keep windows and outside doors closed to aid in 

maintaining acceptable indoor conditions. Additionally, 

custodial staff should regularly clear the areas around all 

exterior doors of rocks or objects that may deliberately or 

inadvertently impede full closing of those doors. 

7.	 Replace or repair the outside doorframe and correct the 

door alignment for room 521. 

8.	 Calibrate the outdoor air humidity transmitter for the BAS 

and verify the scaling of the device input in the BAS. 

9.	 Add a link to HP-48 in the 4/5 wing graphic of the BAS to 

facilitate easy access to the HP controller from the 2/3 wing 

graphic. 

10. Investigate the HP-24 controller to determine why the 

reversing valve was always energized, and repair or replace 

the controller. 

11. Set the setpoints for HP-34 to the same profile as for the 

other classroom HPs. 

12. Continue to follow unit manufacturer’s recommendations 

on frequency for changing air filters, but observe filters 

for increased build-up and increase filter-change frequency 

as necessary, especially during periods of high traffic (i.e., 

move-in and move-out at beginning and end of school year). 

13. Review the Tracer Summit alarm log weekly and look for 

building control unit communication failures. If these 

failures start to appear more frequently than weekly, 

consider building control unit replacement. 

14. Investigate the cause of the refrigerant leak out of HP-9 

Health Hazard Evaluation Report 2009-0172-3124	 Page 35 
ResuLts (Continued) 

circuit #1 and repair as necessary. Once repairs have been 

made, HP-9 performance should be reviewed daily for 1 

week to determine effectiveness of repairs. 

15. Install pipe supports with dielectric insulation properties, 

where missing, on all HP loop piping in the building. 

Straight, plumb, and properly sized saddle-bracket supports 

should be installed every six feet to evenly distribute the 

weight of the piping. 

No issues were discovered with respect to the tempered water system 

(i.e., the operation of the cooling tower, heat exchanger, or pumps in 

cooling-season operation), makeup air units, or the building exhaust 

fans. Fans controlled by HPs and thermostatically-controlled fans 

were operational. 

Appendix O summarizes the remediation activities completed at the 

elementary school since the NIOSH site visit in July 2009. 

Health Findings 

Telephone interviews with three staff members 

Staff Member A 

During the early part of the 2008/2009 school year, this staff 

member, with no prior history of respiratory illness, developed 

headaches, scratchy throat, laryngitis, sinus infection, and deep 

cough. He/She noted that the carpet in the classroom sometimes 

felt damp, and the room smelled like “a wet dog,” or musty, 

especially when it rained, or when the power was off and there was 

no ventilation. He/She was diagnosed with bronchitis and then 

pneumonia. While he/she had pneumonia, he/she had profound 

fatigue and night sweats but no fever or chills. He/She did not 

respond to antibiotics and was eventually given corticosteroid 

shots. His/Her symptoms improved when he/she was restricted 

from work for a short period of time, but then returned when he/ 

she went back to work. He/She improved until the carpet was 

pulled up, at which time he/she experienced the same progression 

of symptoms, diagnoses, antibiotics with no effect, and finally 

corticosteroid (prednisone) treatment, which made him/her feel 

better. When the ventilation ducts were cleaned, he/she developed 

wheezing and was treated with an inhaler (corticosteroid with longacting bronchodilator) and oral corticosteroids. Additionally, he/ 

Page 36 Health Hazard Evaluation Report 2009-0172-3124 
ResuLts (Continued) 

she reported that fish in one of the classrooms died, and the class 

was relocated for a few days because of the strong disinfectant smell. 

In the summer of 2009, while out of the school, he/she had no 

wheezing, cough, fatigue, headaches, or medication requirement. 

Staff Member B 

Since the opening of the new school building in 2005, this staff 

member developed recurrent sinus infections. He/She had postnasal drip, difficulty breathing, chest tightness, a metallic taste 

in his/her mouth, lungs that “hurt,” and “clogged” ears. During 

the 2008/2009 school year, he/she experienced three episodes 

of “dizziness” and “lightheadedness” with a sense that he/she 

might “pass out” in the school. Other symptoms included a deep 

cough during exercise and some dyspnea on exertion, as if he/she 

“couldn’t take a deep breath” when he/she walked. He/She noted 

his/her cough more outside of the building than inside, and it was 

sometimes dry and other times productive. Other than cough, he/ 

she reported no symptoms outside of the school building. His/Her 

symptoms worsened progressively over the course of the work week. 

During weekends and holiday breaks, the symptoms improved, but 

he/she would get sick upon returning to the building. During May 

and June 2009, his/her symptoms got much worse after the carpet 

was torn up at the school. 

Being in the media room made him/her nauseous and feel like he/ 

she was getting the flu and had excessive fatigue. Sometimes he/she 

had night sweats and felt feverish and occasionally chilly. During 

the last two months of school during the 2008/2009 school year, 

he/she noted difficulty concentrating, remembering, and recalling. 

He/She also experienced frequent wheezing and sneezing attacks, 

itchy/burning eyes, and headaches. By the end of each week, he/ 

she felt he/she was getting sick, but then felt better on Saturdays. 

He/She normally is an active person but gave up exercise during the 

second half of the 2008/2009 school year due to excessive fatigue. 

His/Her fatigue resolved within two weeks following the end of the 

2008/2009 school year. 

He/She reported no allergies on testing, except to cats, which was 

apparently minimal, and he/she does not have a cat. Though some 

symptoms during the last couple months of the 2008/2009 school 

year were treated with alternating antibiotics and corticosteroids, 

medications did not helped his/her symptoms. However, within 

a couple of weeks of school ending, he/she felt well again, with no 

Health Hazard Evaluation Report 2009-0172-3124 Page 37 
ResuLts (Continued) 

need for medications. 

He/She provided personal observations: the 4/5 wing had leaks 

from bathroom pipes; when it rained, the ceiling tiles got stained 

and were changed; the gym had mold on the walls; the carpet in 

the physical education teacher’s room separated from a damp wall; 

the administration offices smelled musty, like an old basement; a 

dehumidifier was placed in the administration area, but it did not 

seem to serve all the offices; and there were two termite swarms in 

the corridor near the library. 

Staff Member C 

This staff member, with no prior history of respiratory illness, 

developed respiratory and sinus infections, itchy/watery eyes, 

rashes, decreased appetite, fatigue, and difficulty concentrating and 

focusing during the 2008/2009 school year. He/she did not note 

any cough, wheezing, fever, or chills, but sometimes “gasped for air.” 

Since the end of the 2008/2009 school year, his/her symptoms have 

improved, and he/she feels less fatigued and more alert. 

He/She provided personal observations: there were many ceiling 

leaks at the school; water was sometimes evident in ceiling light 

fixtures in a classroom wing; stained ceiling tiles were frequently 

replaced; and there was mold growth and condensation on the gym 

walls. 

Health Department Questionnaire results 

Participation and Demographics 

Fifty-two of 88 (59%) staff members participated in the county 

health department questionnaire in May 2009. All 52 participants 

worked at the elementary school during the 2008/2009 school 

year; 45 of the 52 participants also worked at the school during the 

2007/2008 school year. Two of the staff participants who worked at 

the school during both school years stopped the questionnaire after 

the first page, as directed by the questionnaire instructions; they 

had answered “no” to experiencing any of the following symptoms 

while in the school building during the 2008/2009 school year (1) 

headaches; (2) dry eyes; (3) unusual sneezing episodes; (4) difficulty 

breathing/asthma attacks; (5) nosebleeds; or (6) other symptoms. 

Therefore, these two participants who worked at the school during 

both school years did not provide information on symptoms in the 

school building during the 2007/2008 school year, or on health 

Page 38 Health Hazard Evaluation Report 2009-0172-3124 
ResuLts (Continued) 

conditions, medication, smoking status, or home exposures. 

Seven hundred and thirty-eight (738) students attended the 

elementary school in 2008/2009 and 734 in 2007/2008. Parents 

of 388 students completed the questionnaire. We excluded data 

from one questionnaire because the student did not attend the 

school during the 2008/2009 or 2007/2008 school year. Of the 

remaining 387 student questionnaires, 385 attended during the 

2008/2009 school year, representing about 52% of the 738 students 

who attended that year; 308 attended during the 2007/2008 school 

year; and 306 attended during both school years. 

Of the 387 students, 122 reported not having the symptoms on 

the first page of the questionnaire while in the school building 

during the 2008/2009 school year. Despite instructions to stop the 

questionnaire at that point, questionnaires were completed for 11 of 

these 122. Therefore, 276 (71%) of the 387 participants completed 

the entire questionnaire, representing less than 40% of the student 

body. 

Of the 48 staff who reported their 2008/2009 primary classroom 

or office, 40 (83%) worked primarily in classroom wings and eight 

(17%) in other wings (Table 7). Of the 385 participating students 

who attended the school during the 2008/2009 school year, we were 

able to determine the primary classroom/homeroom wing for 376 

students; 111 of these 376 (30%) were located in the k/1 wing, 136 

(36%) in the 2/3 wing, and 129 (34%) in the 4/5 wing (Table 7). 

Five of 50 (10%) staff members reported smoking cigarettes, pipes, 

or cigars or having a smoker in their household. Nineteen of 276 

(7%) parents reported a smoker in the household. 

Six of 50 (12%) participating staff members reported one or more 

of the following in their homes: a history of water leaks; water 

stains on the wall and ceiling; or mold or mildew problems. Of 

the participating student households, 23 of 276 (8%) reported one 

or more water leaks; water stains on the wall or ceiling; or mold or 

mildew. 

Six Staff with Daily Breathing Problems/Asthma 

Attacks 

As an indication of the presence of chronic lower respiratory 

problems possibly associated with the school building, we 

Health Hazard Evaluation Report 2009-0172-3124 Page 39 
 

ResuLts (Continued) 

summarized responses from the questionnaires of six staff members 

who reported having “difficulty breathing/asthma attacks” daily 

while at work in the school building during the 2008/2009 school 

year. None of them reported smoking or having smokers in their 

households. Two of the six staff members reported having asthma 

and one reported allergic rhinitis. We do not have information 

on dates of diagnosis of these conditions, but one person reported 

an onset of 2007/2008 or earlier and the other reported an onset 

in 2008/2009. Only the two staff members with asthma reported 

being on prescription breathing medication. 

These six staff members worked in the 2/3, 4/5, or administrative 

wings. They reported symptoms associated with their own primary 

work areas and also with the staff lounge and media center. Four of 

the six staff members reported that their symptoms resolved hours 

to several days after leaving the school. 

All six employees reported a variety of symptoms related to being 

in the school building. As a group, their symptoms included chesttightness, shortness of breath, coughing, difficulty breathing on 

awakening, fatigue, sore throat, headache, eye problems, nasal and 

sinus problems, skin problems, nosebleeds, nausea, vomiting, and 

a metallic taste in the mouth. Five of these six staff members had 

visited a doctor multiple times (from two to more than 30 times) 

during the 2008/2009 school year for the health problems reported 

on the questionnaire. 

Health Conditions 

Of participating staff, 34% reported seasonal allergies; 8% asthma; 

and 8% allergic rhinitis. For students, 48% had seasonal allergies; 

16% asthma; and 12% allergic rhinitis (Table 8). 

Building-related Symptoms During the 2008/2009 

School Year 

Seventy-four percent (74%) (37 of 50) of staff and 53% (145 of 274) 

of students had at least one symptom/problem that resolved after 

leaving the building during the 2008/2009 school year. 

Lower respiratory symptoms 

Thirty-eight percent (38%) of staff and 19% of students experienced 

at least one lower respiratory symptom while in the school; difficulty 

breathing/asthma attacks was the most commonly experienced 

lower respiratory symptom occurring while in the school for both 

staff (31%) and students (13%) (Tables 9 and 10). Of the 16 staff 

Page 40 Health Hazard Evaluation Report 2009-0172-3124 
ResuLts (Continued) 

who reported difficulty breathing/asthma attacks while in the 

school, 38% (6 of 16) reported them daily, 56% (9 of 16) sometimes, 

and 6% (1 of 16) rarely. Of the 42 (of 49) students with available 

frequency data; 5% (2 of 42) were reported to have had difficulty 

breathing/asthma attacks daily, 79% (33 of 42) sometimes, and 

17% (7 of 42) rarely. Fifteen percent of staff and 7% of students 

had a cough while in the school. 

Upper respiratory symptoms 

Fifty-two percent (52%) of staff and 28% of students experienced at 

least one upper respiratory symptom while in the school; unusual 

sneezing was the most commonly experienced upper respiratory 

symptom for both staff (31%) and students (23%) (Tables 9 and 10). 

Other reported upper respiratory symptoms while in the school 

included: sinus problems (25% of staff and 5% of students); voice 

or throat symptoms (27% of staff and 5% of students); and nasal 

symptoms (10% of staff and 5% of students) (Tables 9 and 10). 

Mucous membrane irritation 

Eighty-seven percent (87%) of staff and 32% of students experienced 

at least one mucous membrane symptom while in the school; eye 

symptoms were the most commonly experienced mucous membrane 

symptoms for both staff (75%) and students (28%) (Tables 9 and 

10). 

Headache 

Headache was the most common symptom experienced while in 

the school for both staff (92%) and students (49%) (Tables 9 and 

10). Of the 47 (out of 48) staff for whom headache frequency data 

were available, 55% (26 of 47) reported experiencing headaches 

daily while in the school, 43% (20 of 47) sometimes, and 2% (1 

of 47) rarely. Of the 182 (out of 187) students for whom headache 

frequency data were available, 25% (45 of 182) were reported to have 

experienced headaches daily at school, 57% (104 of 182) sometimes, 

and 18% (33 of 182) rarely. 

Fatigue 

Fatigue while in the school was reported for 44% of staff and 6% of 

students. 

Nosebleed 

Nosebleeds while in the school were also commonly reported for 

both staff (25%) and students (20%). Of the 10 (out of 13) staff 

for whom nosebleed frequency data were available, 10% (1 of 10) 

Health Hazard Evaluation Report 2009-0172-3124 Page 41 
ResuLts (Continued) 

reported them daily, 70% (7 of 10) sometimes, and 20% (2 of 10) 

rarely. Of the 72 (out of 77) students for whom nosebleed frequency 

data were available, 11% (8 of 72) were reported to have had them 

daily, 60% (43 of 72) sometimes, and 29% (21 of 72) rarely. 

Symptoms by Classroom Wing 

The health department questionnaire asked the participants to 

provide room numbers or descriptions of areas in the school 

where they experienced more symptoms or discomfort. Of the 

52 participating staff members who worked at the school during 

the 2008/2009 school year, 27 indicated one or more rooms or 

areas where they experienced more symptoms or discomfort in the 

school. Of these 27 staff members, 12 reported the media room, 

12 reported areas in the administrative wing, 10 reported areas in 

the 4/5 wing, eight reported areas in the 2/3 wing, four reported 

areas in the k/1 wing, and three reported areas in the gym/cafeteria 

wing. 

Of the 385 students who attended the school during the 2008/2009 

school year, parents of 86 of these students indicated one or more 

rooms or areas where their child experienced more symptoms or 

discomfort in the school. Fifty-four of the 86 parents reported areas 

in the 4/5 wing, 43 reported areas in the 2/3 wing, 18 reported 

areas in the k/1 wing, and two reported the gym. The music room 

(in the 2/3 wing) was most commonly mentioned, with 16 writeins. 

Table 9 shows the prevalences of reported symptoms among 

participating staff by primary work wing during the 2008/2009 

school year. Upper respiratory symptoms were significantly more 

prevalent (p < 0.05) among staff who worked in the 2/3 or 4/5 

wings compared to staff who worked in the k/1 wing (Figure 24). 

Lower respiratory symptoms were marginally more prevalent (p < 

0.10) among staff who worked in the 2/3 or 4/5 wings compared to 

staff who worked in the k/1 wing. 

Table 10 shows the prevalence of reported symptoms by homeroom 

wing of students during the 2008/2009 school year. Headaches 

and nosebleeds were significantly more prevalent (p < 0.05) among 

students whose primary/homeroom classrooms were in the 2/3 

or 4/5 wing compared to students whose primary/homeroom 

classrooms were in the k/1 wing (Figure 25). Dry eyes, unusual 

sneezing, breathing difficulties/asthma attacks, and upper 

Page 42 Health Hazard Evaluation Report 2009-0172-3124 
 

ResuLts (Continued) 

respiratory symptoms were marginally more prevalent (p < 0.10) 

among students whose primary/homeroom classrooms were in the 

2/3 or 4/5 wing compared to students whose primary/homeroom 

classroom were in the k/1 wing. 

Symptoms During the 2008/2009 and 2007/2008 

School Years 

Staff (Figure 26) and students (Figure 27) who reported symptoms 

in the 2008/2009 school year and who worked or attended the 

elementary school during 2007/2008 and 2008/2009 school years 

had headache, dry eyes, unusual sneezing, breathing difficulties/ 

asthma attacks, nosebleeds, and upper and lower respiratory 

symptoms were more likely to report experiencing these symptoms 

during the 2008/2009 school year than during the 2007/2008 

school year; the results were statistically significant (p < 0.05). 

NIOSH Questionnaire Results 

Demographics 

At the elementary school, 70 of 89 (79%) current staff members 

participated in the March 2010 questionnaire. Demographics and 

the primary work areas of the participants are summarized in Tables 

11 and 12. Table 13 shows the schools that the participants worked 

at while the elementary school was closed for remediation. Of the 

70 participants, 66 had worked at the elementary school during 

the 2008/2009 school year. The majority of staff members were 

nonsmokers (94%). 

Physician-diagnosed health conditions 

Self-reported physician-diagnosed health conditions are summarized 

in Table 14. Physician-diagnosed sinusitis or sinus infections were 

reported by 64% (45/70). Of these, 29 reported they were first 

diagnosed with sinusitis or sinus problems before they starting 

work at the elementary school, five reported they were diagnosed 

after starting work at the elementary school but before the school 

reopened in 2005, and seven reported they were first diagnosed 

after it reopened in 2005. Four did not report a date of diagnosis. 

Thirteen participants reported sinusitis or sinus problems during 

the four weeks before returning to the elementary school following 

its remediation; 11 of these reported their sinusitis or sinus problems 

were diagnosed by a physician. 

Health Hazard Evaluation Report 2009-0172-3124 Page 43 
ResuLts (Continued) 

Physician-diagnosed hay fever or nasal allergies were reported by 

34% (24 of 70); however, 41% (29 of 70) reported having nasal 

allergies, including hay fever. Of the 24 with a reported physician 

diagnosis of hay fever or nasal allergies, 17 reported they were first 

diagnosed before they started working at the elementary school, 

five reported they were first diagnosed after starting work at the 

elementary school but before it reopened in 2005, and one reported 

being initially diagnosed after it reopened in 2005. One participant 

did not report a date of diagnosis. 

Prevalence of ever having been diagnosed with asthma was 10% (7 

of 70), and prevalence of current physician-diagnosed asthma was 

7% (5 of 70). Six of the seven participants with a history of asthma 

reported their asthma was diagnosed prior to employment at the 

elementary school. One participant reported diagnosis of asthma 

after the school reopened in 2005. 

Health Symptoms During the Four Weeks Before 

Returning to the School in 2010 

Tables 15 and 16 show prevalences of symptoms during the previous 

four weeks prior to starting back at the elementary following its 

remediation. In these tables, work-related symptoms were those 

reported to be better while away from the school (i.e., military 

academy, other elementary school, or middle school) that they 

worked at while the elementary school was closed for remediation. 

Stuffy, itchy, or runny nose (24%) was the most commonly reported 

symptom, followed by dry or itchy skin (21%), headache (19%), 

sneezing (16%), sore or dry throat (14%), cough with phlegm (14%), 

and watery, itchy eyes (13%). Thirty-one percent (37%) of staff 

reported using medications for nasal-sinus or eye problems during 

this four-week period. 

Table 17 shows the prevalence of various health conditions reported 

one or more times per week by school staff during the four-week 

period prior to reporting to the elementary school in February 

2010. When we excluded staff members who had not worked at the 

elementary school during the 2008/2009 school year, we observed 

similar prevalences. 

Compared with participants in the BASE study, which asked U.S. 

office workers about symptoms that occurred one or more days per 

week in the last four weeks and that got better away from work, the 

elementary school employees did not have statistically significant 

excesses of sneeze, sore/dry throat, unusual tiredness, chest 

Page 44 Health Hazard Evaluation Report 2009-0172-3124 
 

ResuLts (Continued) 

wheezing, shortness of breath, cough, headache, or dry itchy skin 

(Table 18). 

When we compared questionnaire responses of the elementary 

school staff with those of NHANES III examinees, school employees 

had a statistically significant excess of nasal allergies compared to 

the U.S. adult population (Table 19). There were no statistically 

significant differences between the school staff and the U.S. adult 

population with respect to prevalences of shortness of breath on 

exertion, asthma, or chronic bronchitis. 

The overall prevalences of lifetime and current physician-diagnosed 

asthma among participating school staff were not significantly 

different from expected compared to BRFSS survey data from the 

North Carolina adult population (Table 20). 

Health Symptoms During the 2008/2009 School 

Year at the Elementary School 

Table 21 shows prevalences of symptoms by type of wing (classroom 

vs. non-classroom). Compared to non-classroom wings, classroom 

wings were associated with statistically higher prevalences of unusual 

tiredness or fatigue; watery, itchy eyes; and upper respiratory 

symptoms. Table 22 shows the prevalence of symptoms by primary 

work area. There were no statistically significant differences in the 

distribution of symptoms among the k/1, 2/3, and 4/5 wings. 

Health Symptoms Following Remediation at the 

Elementary School 

Of the 70 school staff, 16 (23%) reported having health symptoms 

that they considered possibly related to working in the elementary 

school building since its reopening in February 2010. Of the 16, 

six reported eye symptoms (four–dry eyes, one–allergy symptoms, 

and one-drippy eyes); five reported fatigue, tiredness, or feeling 

worn-out; five reported dry, scratchy, or sore throat symptoms; four 

reported headaches; four reported dry, flaky, or eczematous skin; 

three reported cough; two reported hoarseness; two reported nasal 

symptoms; one reported dehydration; one reported sneezing attacks; 

one reported clogged ears, and one reported sinus problems. 

Health Hazard Evaluation Report 2009-0172-3124 Page 45 
 

 

ResuLts (Continued) Comparison of health symptom prevalences during 

the 2008/2009 school year and during the fourweek period prior to returning to the elementary 

school in February 2010 

Table 23 shows prevalences of symptoms and the percentage of 

staff who reported their symptoms were work-related during the 

2008/2009 school year and during the four week period prior to 

returning to the elementary school following remediation. The 

prevalences of headaches; unusual tiredness or fatigue; upper 

and lower respiratory symptoms; watery, itchy eyes; difficulty 

remembering things or concentrating; and fever, chills, or flu-like 

symptoms were significantly greater during the 2008/2009 school 

year than during the four weeks prior to returning to the school. 

Less than 10 staff members reported nosebleeds during either time 

period. Work-relatedness for these 2008/2009 symptoms ranged 

from 73%–90%. Because of the differences in time periods, we did 

not present statistical testing for data in Table 23. 

Comparison of NIOSH and Health Department 

Questionnaire Responses Concerning Symptoms 

During the 2008/2009 School Year at the 

Elementary School 

Headache, eye symptoms, and fatigue or tiredness were three of 

the most commonly reported symptoms during the 2008/2009 

school year in both surveys. Many more participants in the NIOSH 

survey reported difficulty with memory or concentration during 

the 2008/2009 school year (44%) than in the health department 

survey (13%). Substantially more staff reported nosebleeds in the 

health department survey (25%) than in the NIOSH survey (11%). 

Similar percentages of upper and lower respiratory symptoms were 

reported in both surveys. 

Page 46 Health Hazard Evaluation Report 2009-0172-3124 
 

 

 

disCussion
 Following a request from the school district to investigate respiratory 

illness and dampness at the elementary school, NIOSH assisted the 

school district and county health department in the evaluation of 

the school, motivated the hiring of building consultants, provided 

recommendations, and supported the decision to close the school 

for remediation at the end of the 2008/2009 school year. During 

the remediation process, school management acted on many of the 

NIOSH and building consultant recommendations, including (1) 

repairing the roof and inadequate flashing; (2) removing the carpet 

in the school and replacing it with hard floors (after testing slab for 

moisture content); (3) installing a vapor barrier and depressurizing 

the basement and crawl space under the media center; (4) sealing 

classroom wing soffits; (5) recommissioning the HVAC system; 

and (6) implementing the EPA’s Indoor Air Quality Tools for Schools 

Program. The school reopened on February 22, 2010. In Appendix 

O, there is a list with pictures compiled by the school district of 

remediation activities completed at the school. 

The decision to close the elementary school during the remediation 

to address the underlying issues of water intrusion, humidity, and 

ventilation was a prudent one. The remediation we recommended 

is easier to do when a building is not occupied; health effects 

associated with dampness commonly are made worse when 

remediation occurs in occupied buildings. To help prevent worker 

exposures and contamination of unaffected sections of the building 

during remediation, proper containment is always warranted during 

remediation, whether the building being remediated is occupied or 

unoccupied. 

As documented in this report (see Results section and Appendices 

J and N), there have been problems with the HVAC system at 

the elementary school after renovations and the addition of the 

classroom wings. In addition, there have been widespread dampness 

and mold growth at the school since 2005. Visible mold was found 

recurrently on books, carpet, upholstered furniture, picture frames, 

and walls. The significance of the visible mold is that it reflects 

chronic dampness and potential health hazards for staff and 

students. Musty odors indicate that mold is actively growing. Mold 

cannot grow without moisture and a source of organic nutrients; 

high relative humidity is sufficient to support mold growth on 

organic substrates in indoor environments, including paper, 

adhesives, wood, and textiles. 

There were several sources of dampness in the school. Consultants 

Health Hazard Evaluation Report 2009-0172-3124 Page 47 
disCussion (Continued) 

reported RH measurements above 70%, exceeding recommended 

ranges of 30%–60% for most indoor environments. Problems 

with the building’s HVAC system and with air flow in parts of the 

building allowed the outdoor, unconditioned air to enter the school 

through areas such as the crawl space under the media center, 

clerestory above the media center, and soffits in the classroom 

wings. There was potential for the formation of condensation. 

Additionally, the air flow and ventilation problems at the school 

may have allowed the transport of mold spores from reservoirs such 

as the crawl space and basement under the media center, where a 

strong musty odor were detected. 

Inadequate flashing was also a source of dampness at the school. 

During the July 2009 site visit, NIOSH investigators and Turner 

Group consultants found inadequate flashing at the junction 

between the parapet wall above room 206 and the gym. In room 

206, the carpet was stained and the baseboards were warped, likely 

from water damage. A few months earlier, a consulting engineer 

visited the school and reported that inadequate flashing over areas 

of the media center had caused deterioration of exterior bricks, 

which likely allowed penetration of rain water and contributed 

to leaks in the assistant principal’s office. During the same site 

visit, the consultant also reported finding a substantial amount of 

visible mold under the carpet in that office. In 2005, an exterior 

wall in classroom 400 was damaged by water from an exterior leak 

during construction. In July 2009, the Turner Group reported that 

the drywall in this room was discolored, and that there had been 

occupant reports of mold found under the cove base. Although the 

wall flashing had been repaired, the Turner Group recommended 

repair of the associated roof junction joints to provide adequate 

flashing. 

Consultants over the years have also reported ceiling and roof 

leaks. Following a heavy rain in July 2006, roof leaks occurred in 

all three classroom wings, the administrative wing, and one of the 

offices near the gym. In February 2007, an official of the North 

Carolina Department of Environmental and Natural Resources 

reported several ceiling leaks. The following year during a similar 

inspection, a bad leak was reported in the ceiling over the central 

receiving room. In April 2009, an engineer consultant reported 

significant roof leaks over the utility/storage room near the gym. 

Also during April 2009, more than one consultant noted stained 

ceiling tiles throughout the school, especially where the old and 

new buildings were structurally joined. There was also a history 

Page 48 Health Hazard Evaluation Report 2009-0172-3124 
 

disCussion (Continued) 

of roof leaks where the north-south roof intersects with the eastwest roof above the music and Spanish rooms, which shared a 

common wall. Consultants and building occupants have reported 

that water-stained ceiling tiles were often replaced before the leaks 

were repaired. Although we observed no stained ceiling tiles during 

our July 2009 visit, we did find defects in the flat roof over the old 

section of the school, suggesting the likelihood of water leaks. 

Consultants have reported that landscaping around the school 

tends to result in the drainage of water toward the school building, 

allowing pooling of water adjacent to the school. Slab test results 

reported in the Turner Group’s final report demonstrated that 

the concrete flooring in some rooms had more moisture (over 

5.0 pounds per 1000 square feet per 24 hours) than other rooms. 

Turner Group consultants also noted that some classrooms had 

rusted sill plates possibly due to water damage. 

Since the school was remodeled in 2005, various methods have been 

tried to correct the ventilation problems, excessive humidity, and 

water leakage through the building envelope. However, additional 

indoor environmental quality issues may have resulted from use of 

cleaning agents, such as biocides, in the HVAC system and on the 

carpet. The school had tried to keep the carpets clean with HEPAfiltered vacuuming; the carpeting had also had repeated moisture 

infusion from steam cleaning and chemical treatments with biocides 

intended to control mold growth. Carpet can act like a sponge 

to absorb and often hold these fluids and odors (as was noted by 

some consultants). Carpeted areas are frequently associated with 

increased building-related symptoms. Carpets may release volatile 

organic compounds, especially when new or after treatments with 

chemicals, including biocides intended to control mold growth. 

Even with routine cleaning, carpets can accumulate dust and harbor 

dust mites that can cause allergic symptoms. In damp conditions, 

accumulated dusts may contain fungi and bacteria, as was the case 

at the elementary school. 

Air, swab, and vacuum sampling documented the presence of 

microorganisms within the school. Microorganisms can be found 

in samples collected from any indoor environment, and usually the 

indoor fungi reflect what has come in with outdoor air. Repeated 

air sampling for fungi often reveals that levels of fungi in the air are 

highly variable at different times during the same day or at different 

locations in the same room. At present, no environmental standards 

exist with which to predict health risk based on air sampling. For 

Health Hazard Evaluation Report 2009-0172-3124 Page 49 
disCussion (Continued) 

that reason, NIOSH scientists do not recommend the common 

consultant practice of conducting room air sampling, nor have we 

found room air sampling helpful for detecting reservoirs of hidden 

mold within walls or under carpets. Although counts of fungi in 

the air, whether as spores or colony forming units, are difficult to 

interpret, air sampling is sometimes helpful. For example, when 

the qualitative or quantitative distribution of airborne fungal types 

indoors differs from outdoors, an indoor source of fungal growth 

may exist. The consultant sampling documented some indoor 

fungal species that were higher in indoor samples than outdoor 

samples or did not occur in outdoor samples. This suggests that 

there were indoor sources of mold growth, as was evident by 

visual inspection and by smelling moldy odors at the school. The 

predominance of hydrophilic fungi documented in the elementary 

school suggests indoor sources related to chronic dampness. 

In July 2009, we collected floor dust samples at the elementary school 

and found that mesophilic and hydrophilic fungi together accounted 

for more than 80% of the total fungal concentration. According to 

the American Industrial Hygiene Association guidelines [Hung et 

al. 2005], samples dominated by the presence of hydrophilic fungi 

indicate chronic dampness, while the predominance of a species 

mix of mesophilic fungi indicates alternating wet and dry cycles. 

Our sampling results showed that the 2/3 wing had the highest 

average fungal concentrations (of both hydrophilic and total fungi) in 

floor dust, while the 4/5 wing and the media center had the lowest. 

These findings suggest chronic dampness in the 2/3 wing. We also 

found a high concentration of gram-negative bacteria in rooms of 

the 2/3 wing, which is also consistent with chronic dampness in 

that wing because, as with hydrophilic fungi, gram-negative bacteria 

require relatively high moisture for proliferation [Burge et al. 1994]. 

The rooms in the k/1 wing had the lowest average water activity 

on floor materials compared to the other wings. This finding may 

imply that the carpets or tiles in the k/1 wing were relatively drier 

than those in other wings. 

The concentrations of culturable fungi in the floor dust samples 

we collected during July 2009 were consistently and substantially 

lower than those in samples collected earlier by environmental 

consultants. During the last weekend in May 2009, the school 

had cleaned all the carpets in the school with an antimicrobial 

(biocide) agent. Additionally in May 2009, the carpet in room 407 

had been replaced with vinyl composite tile. Cleaning with biocide 

Page 50 Health Hazard Evaluation Report 2009-0172-3124 
disCussion (Continued) 

and replacement of carpet with tiles may account for the apparent 

decrease in levels of fungi in floor carpet dust; however, microbial 

growth could recur if dampness problems are not sufficiently 

resolved at present or adequately controlled in the future. 

Upon review of environmental reports of activities at the 

elementary school, we determined that the biocide Sporicidin® 

(The Sporicidin Company, Rockville, Maryland) had been applied 

in the HVAC system and on carpets. Biocides, including fungicides 

and disinfectants, are chemical agents that destroy or harm living 

organisms [EPA 1997; Cole and Foarde 1999; Prezant et al. 

2008]. Any biocide must be registered for use by the EPA under 

the Federal Insecticide, Fungicide, and Rodenticide Act, and EPA 

biocide registration is granted only for specific biocide uses. Thus, 

only biocides specifically approved for use in an HVAC system can 

be applied in a HVAC system [EPA 1997]. Sporicidin Disinfectant 

Solution and Sporicidin Brand Disinfectant Spray are approved 

by the EPA for cleaning air ducts (EPA Registration # 8383-3 and 

8383-4, respectively). The product label (Appendix P) indicates that 

Sporicidin® must be only applied to hard, non-porous surfaces of air 

ducts. This product is not approved for use in internally insulated 

air duct systems. According to the EPA, biocides registered for use 

in HVAC systems have low toxicity levels and the lowest level of 

efficacy [Lantz 2009]; however, the EPA notes that risk assessment 

for use of most biocides in HVAC systems has not been completed 

[EPA 2002]. The product label (Appendix P) indicates that 

Sporicidin® is approved for use on carpets; however, formal risk 

assessment for Sporicidin® use on carpets has not been done [EPA 

2009]. There is potential for exposure to biocide residues in treated 

carpet especially since the product label claims that this product has 

residual anti-fungal properties lasting for over six months. 

Use of biocides in HVAC systems is controversial. Although 

biocide use may help reduce mold and bacterial growth, all biocides 

have some level of toxicity and unnecessary exposures should be 

avoided. The growth of mold and bacteria in indoor environments 

is due to excess moisture; thus, application of biocide as a protective 

action is unnecessary if moisture is properly controlled. Applying 

biocides directly into HVAC ducts may result in dissemination of 

these chemicals throughout occupied office areas and classrooms, 

resulting in possible occupant exposures and health effects. 

Exposure to airborne mold can cause respiratory health effects even 

when the mold is not viable (alive), so mold exposures can continue 

even after biocide treatment, further detracting from biocide use in 

Health Hazard Evaluation Report 2009-0172-3124 Page 51 
 

 

 

disCussion (Continued) 

HVAC ducts [Cole and Foarde 1999; NYCDHMH 2008; Prezant et 

al. 2008]. 

The New York City Guidelines [NYCDHMH 2008] and the 

American Conference of Governmental Industrial Hygienists [Cole 

and Foarde 1999] do not recommend biocide use in HVAC systems 

as a routine cleaning practice due to the questionable effectiveness 

of some of these chemicals to prevent microbiological growth and 

also due to uncertainties regarding health outcomes from associated 

exposures of building occupants to biocides. Biocides should not 

be applied in an occupied building or in an operating HVAC 

system [Sesline et al. 1994]. Given current uncertainty about the 

safety of biocide use in HVAC system ducts, any biocide use in 

HVAC systems or ductwork, even EPA-approved biocides such as 

Sporicidin®, should be minimized, carefully monitored in terms 

of occupant health and air quality, and guided by professional 

judgment [Prezant et al. 2008]. 

An environmental sampling report we reviewed stated that the coil 

cleaner used in December 2008 at the elementary school contained 

butyl cellosolve (2-butoxyethanol). The Agency for Toxic Substances 

and Disease Registry stated that exposure to 2-butoxyethanol may 

result in irritation of the nose and eyes, headache, a metallic taste, and 

vomiting [ATSDR 1999]. High exposure levels may cause breathing 

problems [ATSDR 1999]. Air sampling for 2-butoxyethanol after 

the coil cleaning showed levels were below both the Occupational 

Safety and Health Administration permissible exposure limit and 

the NIOSH recommended exposure limit; however, we have no 

information on air levels of 2-butoxyethanol during the cleaning, 

when levels are likely to have been higher. 

Excessive indoor dampness is a recognized public health problem. 

In 2004, the Institute of Medicine of the National Academies 

published an extensive review of past scientific studies on the 

health effects of damp buildings [IOM 2004]. In 2009, the World 

Health Organization (WHO) published guidelines for dampness 

and mold based on an updated review [WHO 2009]. The WHO 

report states that “excess moisture on almost all indoor materials 

leads to growth of microbes, such as mould, fungi, and bacteria, 

which subsequently emit spores, cells, fragments and volatile 

organic compounds into indoor air. Moreover, dampness initiates 

chemical or biological degradation of materials, which also pollutes 

indoor air.” With respect to health effects, the WHO report points 

out that (1) clinical evidence is sufficient to conclude that exposure to 

Page 52 Health Hazard Evaluation Report 2009-0172-3124 
 

disCussion (Continued) 

mold and other dampness-related microbial agents in the indoor 

environment increases the risk of hypersensitivity pneumonitis, 

chronic rhinosinusitis, and allergic fungal sinusitis; (2) epidemiological 

evidence is sufficient to conclude that occupants of damp or moldy 

buildings are at increased risk of respiratory symptoms (specifically 

upper respiratory tract symptoms, cough, wheeze, and shortness of 

breath), respiratory infections, asthma development, current asthma, 

and asthma exacerbation; and (3) epidemiological evidence suggests that 

occupants of damp or moldy buildings are also at increased risk of 

bronchitis and allergic rhinitis. Importantly, the WHO guidelines 

note that although atopy and allergy increases susceptibility to 

dampness-related health effects, such health effects are also found 

in non-atopic building occupants. 

The WHO guidelines relevant to occupational environments are as 

follows [WHO 2009]: 

●	 Persistent dampness and microbial growth on interior surfaces and 

in building structures should be avoided or minimized, as they may 

lead to adverse health effects. 

●	 Indicators of dampness and microbial growth include the presence 

of condensation on surfaces or in structures, visible mold, perceived 

moldy odor and a history of water damage, leakage or penetration. 

Thorough inspection and, if necessary, appropriate measurements 

can be used to confirm indoor moisture and microbial growth. 

●	 As the relations between dampness, microbial exposure and health 

effects cannot be quantified precisely, no quantitative healthbased guideline values or thresholds can be recommended for 

acceptable levels of contamination with microorganisms. Instead, 

it is recommended that dampness and mold-related problems be 

prevented. When they occur, they should be remediated because they 

increase the risk of hazardous exposure to microbes and chemicals. 

●	 Well-designed, well-constructed, well-maintained building envelopes 

are critical to the prevention and control of excess moisture and 

microbial growth, as they prevent thermal bridges and the entry 

of liquid or vapor-phase water. Management of moisture requires 

proper control of temperatures and ventilation to avoid excess 

humidity, condensation on surfaces and excess moisture in materials. 

Ventilation should be distributed effectively throughout spaces, and 

stagnant air zones should be avoided. 

●	 Building owners are responsible for providing a healthy workplace 

or living environment free of excess moisture and mold, by ensuring 

proper building construction and maintenance. The occupants are 

Health Hazard Evaluation Report 2009-0172-3124	 Page 53 
disCussion (Continued) 

responsible for managing the use of water, heating, ventilation and 

appliances in a manner that does not lead to dampness and mold 

growth. 

From our limited telephone interviews and from the health 

department questionnaire responses, we found evidence of buildingrelated lower respiratory problems among building occupants, and 

we suspect at least two employees had hypersensitivity pneumonitis 

caused by microbial exposures in the school. Hypersensitivity 

pneumonitis is a serious lung disease in which an individual’s 

immune system reacts to repeated exposure to organic dusts 

(materials from living things such as plants, animals, bacteria, or 

fungi) or other sensitizing agents [Patel et al. 2001]. Symptoms can 

include cough, shortness of breath, muscle aches, fever, chills, and 

fatigue. In work-related hypersensitivity pneumonitis cases, the first 

sign that the illness is due to exposures at work may be that the 

worker’s symptoms and medical test abnormalities (e.g., pulmonary 

function tests) improve during periods of time away from work 

and worsen on return to work. Continued exposure can lead to 

lung scarring and permanent shortness of breath. The two staff 

members with symptoms suggestive of hypersensitivity pneumonitis 

both reported that their symptoms (e.g., fatigue, fever, chills, cough, 

and shortness of breath) resolved with time away from the school 

and recurred upon return to the school building. Physicians often 

fail to consider a diagnosis of hypersensitivity pneumonitis. As a 

result, hypersensitivity pneumonitis is under-recognized, and even 

a single case related to a building should be considered a sentinel 

event requiring investigation and remediation [Weltermann et 

al. 1998]. Hypersensitivity pneumonitis has been documented 

in workers in buildings with contaminated air-conditioners, 

ductwork, and HVAC filters [Bernstein et al. 1983; Scully et al. 

1979; Fink et al. 1976; Banaszak et al. 1970; Arnow et al. 1978]. 

Hypersensitivity pneumonitis has also occurred employees in waterdamaged buildings with roof leaks, plumbing leaks, poorly draining 

condensation pans, or high indoor relative humidity [Seuri et al. 

2000; Thörn et al. 1996 Weltermann et al. 1998; Hoffman et al. 

1993]. 

The health department survey done in May 2009 showed that 

elementary school staff had high rates of lower respiratory 

symptoms, mucous membrane irritation, and headaches during the 

2008/2009 school year. Even if we adjusted for the response rate 

of 59%, these symptom rates would still be high. Staff and students 

who attended the school during the 2007/2008 and 2008/2009 

school years had more upper and lower respiratory symptoms, as 

Page 54 Health Hazard Evaluation Report 2009-0172-3124 
 

disCussion (Continued) 

well as headaches, dry eyes, and nosebleeds during the 2008/2009 

school year than during the 2007/2008 school year, suggesting the 

problems at the school were getting worse. Based on the NIOSH 

and health department surveys, headaches, eye symptoms, and 

fatigue or tiredness were commonly experienced by school staff 

during the 2008/2009 school year. In the NIOSH survey, staff also 

commonly reported difficulty remembering things or concentrating 

during the 2008/2009 school year. 

There were some limitations in our evaluation of the health 

department survey data. The health department questionnaire 

contained some open-ended questions in which the participants 

were asked to answer in their own words. These types of answers are 

often difficult to categorize for statistical analysis. Additionally, the 

questionnaire did not ask specifically about cough, wheeze, chest 

tightness, itchy or runny nose, or other symptoms; some participants 

wrote in these and other symptoms on the questionnaire. While 

the questionnaire did ask about improvement of symptoms after 

leaving the school building, we could not determine which specific 

symptoms improved away from the school building. Additionally, 

the response rate (that is, the number of questionnaires that were 

returned to the health department) was low, and the results may 

not be representative of the whole school population. Parents 

filled out the questionnaires for their children. Such surrogate or 

proxy reporting is often used for surveys of children, but may be less 

accurate than direct reporting. Thus, with respect to our analyses 

of health data relating to the elementary school, survey data for 

the staff may be more reliable than that for the students. Lastly, 

the health department questionnaire did not ask about physiciandiagnosed asthma and did not contain other standardized symptom 

questions needed to compare with results from national or state 

surveys to determine if the school staff had elevated symptom rates. 

Nevertheless, the questionnaire represented an attempt to 

systemically collect data to determine policy and prioritize 

interventions. Priority had to be given to the entire school because 

of the prevalence of reported symptoms and the environmental 

findings throughout the school. Additionally, the school buildingrelatedness of the symptoms reported by staff and parents were 

consistent with building-related exposures causing symptoms. Also, 

case reports obtained by non-standardized telephone interviews 

indicated that some illness that may have been caused by exposures 

in the school building was severe enough to have required medical 

consultation and treatment. Most worrisome were symptoms 

suggestive of building-related hypersensitivity pneumonitis. This, 

Health Hazard Evaluation Report 2009-0172-3124 Page 55 
disCussion (Continued) 

along with the high rates of asthma/breathing difficulties reported 

by building occupants during the 2008/2009 school year, warranted 

action, taken by the school, to relocate the staff and students during 

remediation. 

After remediation for indoor dampness and mold problems, 

building managers, building occupants, and their employers often 

wish to know if the building is “safe.” Building consultants often 

recommend and perform “clearance” air sampling after remediation 

in an attempt to demonstrate that the building is safe for occupants. 

However, there is no scientific basis for the use of air sampling for 

this purpose. Once remediation is completed (sources of excessive 

dampness corrected; moldy and water-damaged materials removed; 

musty odors no longer evident), the best evidence that the building 

is safe may be that employees no longer experience building-related 

symptoms. 

The NIOSH questionnaire administered to school staff a week after 

they reoccupied the elementary school building addressed health 

symptoms experienced during the four weeks prior to the reopening 

of the school in February 2010 and during the 2008/2009 school 

year at the elementary school. Upper and lower respiratory 

symptoms (with the exception of nasal symptoms), as well as 

mucous membrane symptoms and constitutional/nonspecific 

type symptoms, were reported much less commonly in the four 

weeks prior to returning to the elementary school than during the 

2008/2009 school year, suggesting that building-related symptoms 

resolved in most staff while they were temporarily out of the damp 

school building. We did not observe lower prevalences of skin or 

nasal symptoms. This may have been because of the winter season 

and dry air. In any case, fewer than 25% of staff members with 

stuffy, itchy, or runny noses or dry or itchy skin reported it was 

work-related. 

The overall prevalences of lifetime and current physician-diagnosed 

asthma among the elementary school staff who participated in the 

NIOSH survey were not significantly different than what would 

be expected in North Carolina based on the BRFSS survey of the 

North Carolina adult population. Most staff with asthma reported 

that onset of their asthma occurred before they began working 

at the school. Compared to the U.S. adult population surveyed 

in NHANES III, elementary school employees had significantly 

lower than expected rates of lifetime and current asthma, chronic 

bronchitis, shortness of breath on exertion, and nasal allergies, 

Page 56 Health Hazard Evaluation Report 2009-0172-3124 
disCussion (Continued) 

including hay fever. Compared to U.S. office workers who 

participated in BASE, elementary school employees did not have 

excess rates of work-related upper and lower respiratory symptoms, 

headache, unusual tiredness and fatigue, or dry itchy skin. 

Findings from the NIOSH health survey after remediation can 

serve as a baseline to help assess whether the apparently improved 

health is maintained among the employees who have reoccupied 

the elementary school. Of the school staff who participated in the 

NIOSH survey, 16 (23%) reported having health symptoms that 

they considered possibly related to working in the school building 

after its reopening in February 2010. Fatigue, headaches, and eye 

and throat symptoms (often described as dry, scratchy, or itchy) 

were the most commonly reported symptoms among these 16 staff 

members. Some of these recent eye and throat symptoms may 

have been due to dry air; during winter months, indoor relative 

humidity tends to be low because the heating system is on more 

of the time. Additionally, improved ventilation resulting from the 

retro-commissioning of the HVAC system may have enhanced a dry 

sensation among some building occupants. 

Controlling water activity is the most effective approach for 

preventing fungal growth in indoor settings. This is accomplished 

by fixing water leaks, controlling relative humidity, and keeping 

surface temperatures high enough to prevent condensation; dry 

buildings do not become moldy. When water activity is high, mold 

can be limited by reducing the availability of nutrients that support 

fungal growth. One good way to help limit fungal growth in indoor 

settings is to replace carpeted flooring with hard flooring, as the 

school has done. Hard floors provide little inherent nutrients and 

can be cleaned to prevent dust accumulation. 

Our specific recommendations for the elementary school are 

presented in the following section. 

Health Hazard Evaluation Report 2009-0172-3124 Page 57 
ReCoMMendAtions
 1. 

2. 

3. 

4. 

5. 

6. 

7. 

8. 

9. 

Assess surface drainage around the school building and 

make modifications to prevent puddling and drainage of 

water towards the building. 

Maintain the HVAC system by following the manufacturer’s 

recommended maintenance schedules, including replacing 

air filters at least every three months, checking drip pans, 

ensuring thermostats are in working order, and checking/ 

cleaning ventilation system dampers to ensure proper 

functioning. 

Make all the repairs recommended in the EMC Engineers, 

Inc. report dated May 2010 (Appendix N), which are 

summarized in the Results section of this report. 

Do not use biocides in ductwork or on floors as a routine 

practice. 

Continue to routinely assess the school for water intrusion 

and damage and high relative humidity and correct these 

upon discovery. During and after heavy rains, walk through 

the entire school and check for water incursion. When 

sources of moisture are identified, repairs should be made 

to prevent further water entry into the building. Mold and 

moisture-damaged materials should be promptly removed or 

cleaned with appropriate containment to minimize exposure 

of building occupants. 

Keep a record of when and where water-damaged materials 

are discovered and what has been done to fix the underlying 

problem leading to the water damage. Areas with moldy or 

earthy odors or visible mold should likewise be identified, 

remediated, and documented. 

Use a dampness/mold check-sheet (Appendix Q) during 

routine inspections of the school to record current problem 

areas and prioritize responsive action. 

If and when any remediation is required, use proper 

containment methods to minimize exposures for 

remediation workers, building occupants, and unaffected 

sections of the building. 

Encourage employees to report dampness and buildingrelated health problems and designate a contact person 

for this purpose. Allow confidential reports with an 

appropriately located locked drop box or an appropriately 

designed web-based electronic reporting system. 

Page 58 Health Hazard Evaluation Report 2009-0172-3124 
ReCoMMendAtions 

(Continued) 10. If needed, use occupant health questionnaires to collect 

information on building-related symptoms and compare 

symptom prevalences with the NIOSH questionnaire done 

in March 2010 to determine if symptom prevalences have 

changed and appear to be work-related. 

11. Continue to implement the EPA’s Indoor Air Quality Tools 

for Schools Program. 

12. Any member of the staff or student body who experiences 

worsening, persistent, or recurrent respiratory or other 

health symptoms that may be associated with being in the 

school building should see a healthcare provider. 

Health Hazard Evaluation Report 2009-0172-3124	 Page 59 
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10:138–145. 

Thörn A, Lewné M, Belin L [1996]. Allergic alveolitis in a school environment. Scan J Work Environ 

Health 22:311-314. 

Weltermann BM, Hodgson M, Storey E, DeGraff AC, Bracker A, Groseclose S, Cole SR, Cartter M, 

Phillips D [1998]. Hypersensitivity pneumonitis: a sentinel event investigation in a wet building. Am J Ind 

Med 34:499–505. 

Health Hazard Evaluation Report 2009-0172-3124 Page 61 
ReFeRenCes (Continued) 

Womble SE, Ronca EL, Girman JR, Brightman HS [1996]. Developing baseline information on buildings 

and indoor air quality. In: IAQ 96 Paths to Better Building Environments/Health Symptoms in Building 

Occupants. Atlanta, GA: ASHRAE (American Society of Heating, Refrigeration and Air-Conditioning 

Engineers), pp. 109–117. 

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WHO Regional Office for Europe. 

Page 62 Health Hazard Evaluation Report 2009-0172-3124 
tABLes

 Table 1. Microbial agents in floor dust samples collected by NIOSH, July 2009 

Room* 

Fungi Bacteria 

Species cfu/g† cfu/g† 

100a Alternaria alternata 2,000 Gram positive 610,000 

Cladosporium cladosporioides 4,900 Gram negative, non-fermentative 7,300 

Epicoccum nigrum 2,000 Broad spectrum 380,000 

Fusarium oxysporum 980 

Total fungi 9,800 

113a Aureobasidium pullulans 640 Gram positive 280,000 

Biopolaris australiensis 91 Gram negative, non-fermentative 5,600 

Cladosporium cladosporioides 1,500 Broad spectrum 450,000 

Mucor plumbeus 91 

Nonsporulating fungi 180 

Penicillium lividium 180 

Trichoderma koningii 91 

Total fungi 2,800 

115a Aspergillus versicolor 960 Gram positive 67,000 

Aureobasidium pullulans 960 Gram negative, non-fermentative 6,100 

Biopolaris australiensis 1,900 Broad spectrum 95,000 

Cladosporium cladosporioides 13,000 

Epicoccum nigrum 2,900 

Nonsporulating fungi 1,900 

Penicillium lividium 960 

Total fungi 23,000 

116a Cladosporium cladosporioides 1,600 Gram positive 450,000 

Epicoccum nigrum 540 Gram negative, non-fermentative 4,600 

Nonsporulating fungi 270 Broad spectrum 63,000 

Penicillium aurantiogriseum 89 

Total fungi 2,500 

206a Alternaria alternata 1,000 Gram positive 170,000 

Aspergillus glaucus 2,000 Gram negative, non-fermentative 7,500 

Aspergillus niger 1,000 Broad spectrum 210,000 

Aspergillus versicolor 1,000 

Biopolaris australiensis 1,000 

Cladosporium cladosporioides 14,000 

Epicoccum nigrum 2,000 

Fusarium oxysporum 1,000 

Rhizopus stolonifer 1,000 

Total fungi 24,000 

407b Alternaria alternata 

Aspergillus glaucus 

Aspergillus niger 

1,900 

2,800 

940 

Gram positive 

Gram negative, non-fermentative 

Broad spectrum 

94,000 

6,300 

1,200,000 

Health Hazard Evaluation Report 2009-0172-3124 Page 63
tABLes (Continued) 

Aspergillus ochraceus 940 

Cladosporium cladosporioides 7,500 

Epicoccum nigrum 1,900 

Nonsporulating fungi 1,9001 

Total fungi 8,000 

418c Biopolaris australiensis 1,900 Gram positive 1,700,000 

Cladosporium cladosporioides 19,000 Gram negative, non-fermentative 3,800,000 

Epicoccum nigrum 1,900 Broad spectrum 1,800,000 

Mucor plumbeus 950 

Total fungi 24,000 

421c Alternaria alternata 920 Gram positive 540,000 

Aureobasidium pullulans 4,600 Gram negative, non-fermentative 10,000 

Biopolaris australiensis 1,800 Broad spectrum 220,000 

Cladosporium cladosporioides 4,600 

Epicoccum nigrum 5,500 

Nonsporulating fungi 2,800 

Total fungi 20,000 

424c Alternaria alternata 1,000 Gram positive 2,200,000 

Aureobasidium pullulans 2,000 Gram negative, non-fermentative 19,000 

Biopolaris australiensis 1,000 Broad spectrum 8,900,000 

Cladosporium cladosporioides 21,000 

Curvularia lunata 1,000 

Epicoccum nigrum 4,000 

Fusarium oxysporum 1,000 

Nonsporulating fungi 2,000 

Yeasts other 2,000 

Total fungi 35,000 

502a Alternaria alternata 93 Gram positive 380,000 

Aureobasidium pullulans 370 Gram negative, non-fermentative 1,900 

Biopolaris australiensis 190 Broad spectrum 2,700,000 

Cladosporium cladosporioides 1,900 

Epicoccum nigrum 470 

Nonsporulating fungi 280 

Yeasts other 280 

Total fungi 3,600 

503c Alternaria alternata 88 Gram positive 650,000 

Aureobasidium pullulans 350 Broad spectrum 560,000 

Biopolaris australiensis 88 

Cladosporium cladosporioides 1,600 

Epicoccum nigrum 530 

Total fungi 2,700 

505c Alternaria alternata 

Aspergillus fumigates 

Biopolaris australiensis 

880 

880 

880 

Gram positive 

Gram negative, non-fermentative 

Broad spectrum 

120,000 

3,800 

210,000 

Page 64 Health Hazard Evaluation Report 2009-0172-3124 
tABLes (Continued) 

Cladosporium cladosporioides 3,500 

Epicoccum nigrum 2,600 

Nigrospora sphaerica 880 

Total fungi 9,600 

515c Alternaria alternata 88 Gram positive 360,000 

Aspergillus niger 270 Gram negative, non-fermentative 3,800 

Biopolaris australiensis 180 Broad spectrum 380,000 

Cladosporium cladosporioides 710 

Epicoccum nigrum 180 

Fusarium oxysporum 88 

Nigrospora sphaerica 88 

Total fungi 1,600 

516c Alternaria alternata 200 Gram positive 1,000,000 

Aspergillus niger 300 Gram negative, non-fermentative 8,700 

Cladosporium cladosporioides 1,600 Broad spectrum 360,000 

Nonsporulating fungi 400 

Total fungi 2,500 

520b Aspergillus versicolor 390 Gram positive 5,900 

Cladosporium cladosporioides 490 Gram negative, non-fermentative 2,600 

Curvularia lunata 98 Broad spectrum 19,000 

Epicoccum nigrum 290 

Nigrospora sphaerica 98 

Nonsporulating fungi 200 

Total fungi 1,600 

610c Alternaria alternata 960 Gram positive 290,000 

Aureobasidium pullulans 960 Gram negative, non-fermentative 2,000 

Biopolaris australiensis 960 Broad spectrum 4,000,000 

Cladosporium cladosporioides 5,800 

Epicoccum nigrum 2,900 

Nonsporulating fungi 1,900 

Trichoderma koningii 960 

Total fungi 14,000 

612c Biopolaris australiensis 980 Gram positive 12,000,000 

Cladosporium cladosporioides 4,900 Gram negative, non-fermentative 5,200 

Epicoccum nigrum 2,000 Broad spectrum 810,000 

Mucor plumbeus 980 

Total fungi 8,800 

618c Alternaria alternata 93 Gram positive 550,000 

Aspergillus fumigates 93 Gram negative, non-fermentative 170,000 

Aureobasidium pullulans 190 Broad spectrum 46,000,000 

Biopolaris australiensis 93 

Cladosporium cladosporioides 1,300 

Epicoccum nigrum 470 

Nonsporulating fungi 93 

Health Hazard Evaluation Report 2009-0172-3124 Page 65
tABLes (Continued) 

Trichoderma koningii 

Total fungi 

93 

2,400 

623c Aureobasidium pullulans 460 Gram positive 280,000 

Biopolaris australiensis 92 Gram negative, non-fermentative 32,000 

Cladosporium cladosporioides 1,500 Broad spectrum 220,000 

Epicoccum nigrum 460 

Total fungi 2,500 

MR-1Ad Alternaria alternata 86 Gram positive 6,000 

Aspergillus niger 86 Gram negative, non-fermentative 86 

Aspergillus ochraceus 170 Broad spectrum 26,000 

Aspergillus versicolor 340 

Cladosporium cladosporioides 170 

Fusarium oxysporum 170 

Paecilomyces variotii 86 

Penicillium crustosum 260 

Total fungi 1,400 

MR-1Bd Aspergillus niger 93 Gram positive 21,000,000 

Cladosporium cladosporioides 370 Gram negative, non-fermentative 1,600 

Epicoccum nigru 93 Broad spectrum 350,000 

Trichoderma koningii 93 

Total fungi 650 

MR-2e Alternaria alternata 1,700 Gram positive 2,000,000 

Aspergillus versicolor 860 Gram negative, non-fermentative 110,000 

Cladosporium cladosporioides 17,000 Broad spectrum 4,100,000 

Epicoccum nigrum 5,200 

Fusarium oxysporum 860 

Nonsporulating fungi 860 

Trichoderma koningii 860 

Total fungi 28,000 

*Room 108 was excluded because we were unable to collect enough dust for microbial analyses. 

†cfu/g: colony forming units per gram (Total fungi values have been rounded by the reporting laboratory.) 

Note: MR-1A, MR-1B = library – samples collected from wood floor edge; MR-2 = library – samples collected from rugs; a 

carpet; b tile; c carpet with partial tile floor; d wood floor; e rug 

Page 66 Health Hazard Evaluation Report 2009-0172-3124 
tABLes (Continued) 

Table 2. Arithmetic mean and standard deviation of water activity on the floor surface, and relative 

humidity and temperature in air by school building wing, July 2009 

Building wing Number of 

samples Water activity Relative humidity (%) Temperature (°F) 

Gym/cafeteria 1 0.60 ( - )* 53.0 ( - ) 73.0 ( - ) 

Administration 5 0.76 (0.09) 59.0 (9.4) 71.6 (0.7) 

Media center 3 0.73 (0.03) 55.0 (1.7) 72.1 (0.2)

 k/1 4 0.57 (0.07) 36.8 (2.2) 72.4 (1.4)

 2/3 4 0.66 (0.10) 38.8 (5.7) 72.1 (0.4)

 4/5 6 0.69 (0.06) 53.8 (3.6) 72.8 (0.7) 

*Values in parentheses represent standard deviations 

Table 3. Overall building floor dust concentrations (cfu/g*) of culturable fungi and bacteria, July 2009 

N=22 dust 

samples 

Total fungi Hydrophilic 

fungi 

Mesophilic or 

hydrophilic 

fungi 

Gram negative 

bacteria 

Gram positive 

bacteria 

Minimum 650 86 650 86 5,900 

Maximum 35,000 7,800 31,000 5,600,000 21,000,000 

Geometric 

mean 6,000 1,200 5,200 8,500 396,000 

Geometric 

standard 

deviation 

3.3 4.2 3.3 8.1 7.0 

*Colony forming units per gram 

Table 4. Floor dust concentrations (cfu/g*) of culturable fungi and bacteria by wing, July 2009 

Building wing N 

Total 

fungi 

Hydrophilic 

fungi 

Gram negative 

bacteria 

Gram positive 

bacteria 

Gym/cafeteria 1 24,000 ( - ) † 4,000 ( - ) 7,700 ( - ) 170,000 ( - ) 

Administration 4 6,300 (2.9) 1,000 (4.3) 5,900 (1.2) 267,900 (2.7) 

Media center 3 2,900 (7.3) 500 (11.1) 2,500 (37.7) 631,600 (66.7) 

k/1 4 5,200 (2.4) 1,500 (3.0) 15,800 (7.1) 855,600 (6.0) 

2/3 4 23,500 (1.3) 4,700 (1.5) 52,000 (23.4) 660,100 (4.2) 

4/5 6 2,900 (2.0) 600 (3.1) 3,900 (1.7) 199,500 (6.5) 

* Colony forming units per gram 

†Values in parentheses represent geometric standard deviations 

Health Hazard Evaluation Report 2009-0172-3124 Page 67 
tABLes (Continued) 

Table 5. Results of floor dust fungal sampling collected by environmental consultant, May 2009, and 

NIOSH, July 2009 

Room number 

and wing

Consultant – 05/08/2009 

(cfu/g*) 

NIOSH – July 2009

(cfu/g*) 

115 

in administration wing 

Yeast (30,000) Aspergillus versicolor (960) 

Aspergillus pullulans (960) 

Biopolaris australiensis (1,900) 

Cladosporium cladosporioides (13,000) 

Epicoccum nigrum (2,900) 

Nonsporulating fungi (1,900) 

Penicillium lividium (960) 

Total (30,000) Total (23,000) 

206 

in gym/cafeteria wing 

Alternaria 

Aspergillus 

Epicoccum 

Eurotium 

Nonsporulating fungi 

Penicillium 

Yeast 

Total (> 1.3 million) 

Alternaria alternata (1,000) 

Aspergillus glaucus (2,000) 

Aspergillus niger (1,000) 

Aspergillus versicolor (1,000) 

Biopolaris australiensis (1,000) 

Cladosporium cladosporioides (14,000) 

Epicoccum nigrum (2,000) 

Fusarium oxysporum (1,000) 

Rhizopus stolonifer (1,000) 

Total (24,000) 

421 Alternaria (5,000) Alternaria alternata (920) 

in 2/3 wing Aspergillus (65,000) 

Bipolaris (5,000) 

Cladosporium (75,000) 

Curvularia (5,000) 

Epicoccum (60,000) 

Exserohilium (5,000) 

Nonsporulating fungi (70,000) 

Yeast (40,000) 

Total (330,000) 

Aspergillus pullulans (4,600) 

Biopolaris australiensis (1,800) 

Cladosporium cladosporioides (4,600) 

Epicoccum nigrum (5,500) 

Nonsporulating fungi (2,800) 

Total (20,000) 

503 Acremonium (8,000) Alternaria alternata (88) 

in 4/5 wing Alternaria (40,000) 

Bipolaris (4,000) 

Cladosporium (36,000) 

Epicoccum (48,000) 

Nonsporulating fungi (60,000) 

Phoma (12,000) 

Trichoderma (12,000) 

Yeast (24,000) 

Total (244,000) 

Aspergillus pullulans (350) 

Biopolaris australiensis (88) 

Cladosporium cladosporioides (1,600) 

Epicoccum nigrum (530) 

Total (2,700) 

515 

in 4/5 wing 

Alternaria 

Aspergillus 

Aureobasidium 

Alternaria alternata (88) 

Aspergillus niger (270) 

Biopolaris australiensis (180) 

Page 68 Health Hazard Evaluation Report 2009-0172-3124 
tABLes (Continued) 

Bipolaris 

Chrysosporium 

Cladosporium 

Curvularia 

Epicoccum 

Nonsporulating 

Penicillium 

Stemphylium 

Trichoderma 

Yeast 

Total (> 1.6 million) 

Cladosporium cladosporioides (710) 

Epicoccum nigrum (180) 

Fusarium oxysporum (88) 

Nigrospora sphaerica (88) 

Total (1,600) 

516 Alternaria Alternaria alternata (200) 

in 4/5 wing Aspergillus 

Bipolaris 

Chrysosporium 

Cladosporium 

Epicoccum 

Eurotium 

Fusarium 

Geotrichum 

Mucor 

Nonsporulating fungi 

Penicillium 

Yeast 

Total (> 2 million) 

Aspergillus niger (300) 

Cladosporium cladosporioides (1,600) 

Nonsporulating fungi (400) 

Total (2,500) 

610 Alternaria (13,333) Alternaria alternata (960) 

in k/1 wing Bipolaris (6,667) 

Cladosporium (6,667) 

Epicoccum (13,333) 

Nonsporulating (13,333) 

Yeast (13,333) 

Total (86,667) 

Aspergillus pullulans (960) 

Biopolaris australiensis (960) 

Cladosporium cladosporioides (5,800) 

Epicoccum nigrum (2,900) 

Nonsporulating fungi (1,900) 

Trichoderma koningii (960) 

Total (14,000) 

618 Alternaria Alternaria alternata (93) 

in k/1 wing Aspergillus 

Cladosporium 

Epicoccum 

Geotrichun 

Mucor 

Nonsporulating 

Penicillium 

Trichoderma 

Yeast 

Total (> 1.0 million) 

Aspergillus fumigatus (93) 

Aspergillus pullulans (190) 

Biopolaris australiensis (93) 

Cladosporium cladosporioides (1,300) 

Epicoccum nigrum (470) 

Nonsporulating fungi (93) 

Trichoderma koningii (93) 

Total (2,400) 

*cfu/g: colony forming units per gram (values preceded by ‘>’ symbol were too numerous to count – no individual fungal 

species counts were made) 

Health Hazard Evaluation Report 2009-0172-3124 Page 69
tABLes (Continued) 

Table 6. Results of floor dust fungal sampling collected by environmental consultants, October 2007, September 

2008, and October 2008, and by NIOSH, July 2009 

Room 

number 

Consultant – Oct 2007 

(cfu/g*) 

Consultant – Sept 

2008 (cfu/g*) 

Consultant – Oct 2008 

(cfu/g*) 

NIOSH – July 2009 

(cfu/g*) 

100

(office lobby) 

Acremonium (380,000) 

Cladosporium (290,000) 

Curvularia lunata (48,000) 

Epicoccum nigrum (95,000) 

Fusarium solani (95,000) 

Total (908,000) 

Alternaria alternata (2,000) 

Cladosporium cladosporioides (4,900) 

Epicoccum nigrum (2,000) 

Fusarium oxysporum (980) 

Total (9,800) 

407

in 4/5 wing 

Alternaria (200,000) 

Aspergillus (320,000) 

Cladosporium (40,000) 

Bipolaris (40,000) 

Epicoccum (20,000) 

Penicillium (20,000) 

Phoma (600,000) 

Wallemia (60,000) 

Total (1,300,000) 

Alternaria (1,081) 

Aspergillus (17,838) 

Aureobasidium (1,081) 

Cladosporium (4,865) 

Bipolaris (1,622) 

Epicoccum (6,486) 

Wallemia (541) 

Yeast (1,081) 

Nonsporulating fungi (541) 

Total (35,135) 

Alternaria alternata (1,900) 

Aspergillus glaucus (2,800) 

Aspergillus niger (940) 

Aspergillus ochraceus (940) 

Cladosporium cladosporioides (7,500) 

Epicoccum nigrum (1,900) 

Nonsporulating fungi (1,9001) 

Total fungi (8,000) 

*cfu/g: colony forming units per gram 

Page 70 Health Hazard Evaluation Report 2009-0172-3124 
tABLes (Continued) 

Table 7. Primary work area or homeroom wing during 2008/2009 school year; health department survey, 

May 2009 

Wing 

Staff 

n=48* 

Students 

n=376† 

k/1 18 (38%) 111 (30%) 

2/3 13 (27%) 136 (36%) 

4/5 9 (19%) 129 (34%) 

Non-classroom‡ 8 (17%) – 

*Four of the 52 staff participants did not indicate their primary work location. 

†We could not classify the primary classroom wing for 9 of the 385 students whose parents responded to the questionnaire. 

‡gym/cafeteria wing, administration wing, or media center wing 

Table 8. Prevalence of health conditions; health department survey, May 2009 

Staff 

n=50* 

Students 

n=276† 

Seasonal allergies 17 (34%) 132 (48%) 

Asthma 4 (8%) 44 (16%) 

Allergic rhinitis 4 (8%) 33 (12%) 

Chronic respiratory disease 0 4 (1%) 

Suppressed immune system 1 (2%) 2 (0.7%) 

Cystic fibrosis 1 (2%) 0 

Radiation or chemotherapy 0 0 

*Data missing for 2 of the 52 staff participants. 

†Data missing for 111 of the 387 students whose parents participated in the questionnaire. 

Health Hazard Evaluation Report 2009-0172-3124 Page 71 
tABLes (Continued) 

Table 9. Prevalence of staff symptoms reported to occur while in the school building during the 

2008/2009 school year, by primary work wing*; health department survey, May 2009 

Overall 

n=52 

k/1 wing 

n=18 

4/5 wing 

n=9 

2/3 wing 

n=13 

Nonclassroom 

wings‡ 

n=8 

Headache† 48 (92%) 18 (100%) 8 (89%) 12 (92%) 7 (100%) 

Eye symptoms 39 (75%) 15 (83%) 8 (89%) 9 (69%) 4 (57%) 

Fatigue 23 (44%) 9 (50%) 6 (67%) 5 (38%) 1 (14%) 

Throat symptoms 12 (23%) 5 (28%) 0 6 (46%) 0 

Breathing difficulty/ 

asthma† 16 (31%) 4 (22%) 4 (44%) 5 (38%) 3 (43%) 

Unusual sneezing† 16 (31%) 4 (22%) 6 (67%) 3 (23%) 3 (38%) 

Nosebleed† 13 (25%) 4 (22%) 2 (22%) 3 (23%) 2 (29%) 

Sinus problems 13 (25%) 2 (11%) 2 (22%) 6 (46%) 3 (43%) 

Nausea 7 (13%) 2 (11%) 1 (11%) 3 (23%) 1 (14%) 

Cough 8 (15%) 2 (11%) 2 (22%) 3 (23%) 1 (14%) 

Skin problems 10 (19%) 1 (6%) 3 (33%) 4 (31%) 1 (14%) 

Dizziness 11 (21%) 6 (33%) 1 (11%) 3 (23%) 1 (14%) 

Memory loss 7 (13%) 1 (6%) 1 (11%) 3 (23%) 1 (14%) 

Nasal symptoms 5 (10%) 0 0 3 (23%) 1 (1%) 

Metallic taste 4 (8%) 0 1 (11%) 2 (15%) 1 (14%) 

Voice symptoms 5 (10%) 1 (6%) 2 (22%) 2 (15%) 0 

Insomnia 3 (6%) 0 1 (11%) 2 (15%) 0 

Vision problems 4 (8%) 1 (6%) 2 (22%) 0 0 

Allergies 1 (2%) 0 0 0 1 (14%) 

Throat or voice 

symptoms 14 (27%) 5 (28%) 2 (22%) 6 (46%) 0 

Lower respiratory 

symptoms 20 (38%) 5 (28%) 5 (56%) 7 (54%) 3 (43%) 

Upper respiratory 

symptoms 27 (52%) 7 (39%) 7 (78%) 9 (69%) 3 (43%) 

Mucous membrane 

irritation 45 (87%) 16 (89%) 9 (100%) 13 (100%) 4 (57%) 

*Four of the 52 staff participants did not indicate their primary work location. 

†Symptoms specifically asked about in the questionnaire 

‡Gym/cafeteria wing, administration wing, or media center wing 

Page 72 Health Hazard Evaluation Report 2009-0172-3124 
 

 

tABLes (Continued) 

Table 10. Prevalence of student symptoms reported to occur while in the school building during the 

2008/2009 school year, overall and by homeroom wing*; health department survey, May 2009 

Overall 

n=385 

k/1 wing 

n=111 

2/3 wing 

n=136 

4/5 wing 

n=129 

Headache† 187 (49%) 40 (36%) 72 (53%) 72 (56%) 

Eye symptoms 106 (28%) 22 (20%) 41 (30%) 41 (32%) 

Fatigue 23 (6%) 8 (7%) 5 (4%) 10 (8%) 

Throat symptoms 19 (5%) 4 (4%) 6 (4%) 7 (5%) 

Breathing difficulty/ 

asthma† 49 (13%) 9 (8%) 18 (13%) 20 (16%) 

Usual sneezing† 88 (23%) 19 (17%) 31 (23%) 36 (28%) 

Nosebleed† 77 (20%) 15 (14%) 35 (26%) 25 (19%) 

Sinus problems 18 (5%) 6 (5%) 7 (5%) 5 (4%) 

Nausea 16 (4%) 2 (2%) 7 (5%) 7 (5%) 

Cough 28 (7%) 9 (8%) 12 (9%) 5 (4%) 

Skin problems 34 (9%) 10 (9%) 11 (8%) 12 (9%) 

Dizziness 8 (2%) 1 (1%) 6 (4%) 1 (0.8%) 

Memory loss 1 (0.3%) 0 0 1 (0.8%) 

Nasal symptoms 20 (5%) 5 (5%) 10 (7%) 4 (3%) 

Metallic taste 0 0 0 0 

Voice symptoms 0 0 0 0 

Insomnia 3 (0.8%) 0 2 (1%) 1 (0.8%) 

Vision problems 6 (2%) 1 (1%) 2 (1%) 3 (2%) 

Allergies 9 (2%) 2 (2%) 6 (4%) 1 (0.8%) 

Throat or voice symptoms 19 (5%) 4 (4%) 6 (4%) 7 (5%) 

Lower respiratory 

symptoms 72 (19%) 17 (15%) 26 (19%) 25 (19%) 

Upper respiratory 

symptoms 106 (28%) 24 (22%) 39 (29%) 40 (31%) 

Mucous membrane 

irritation 123 (32%) 27 (24%) 45 (33%) 48 (37%) 

* We could not classify the primary classroom wing for 9 of the 385 participants. 

†Symptoms specifically asked about in the questionnaire 

Health Hazard Evaluation Report 2009-0172-3124 Page 73 
tABLes (Continued) 

Table 11. Characteristics of staff; NIOSH survey, March 2010 

Variable Staff 

n=70 

Mean age, years (range) 45 (21-66) 

Mean years employed at school (range) 7 (0.04-30) 

Female, n (%) 59 (84%) 

Smoking status 

Current smoker, n (%) 

Former smoker, n (%) 

Never smoker, n (%) 

4 (6%) 

7 (10%) 

59 (84%) 

Job category 

Teachers/student teachers/teacher assistants 

Office/administration staff 

Custodians 

Other 

47 (67%) 

7 (10%) 

7 (10%) 

9 (13%) 

Table 12. Primary work area of staff during the 2009/2010 school year; NIOSH survey, March 2010 

Wing Staff 

n=70 

k/1 17 (24%) 

2/3 17 (24%) 

4/5 13 (19%) 

Administrative 7 (10%) 

Everywhere 7 (10%) 

Gym/cafeteria 3 (4%) 

Other* 6 (9%) 

*More than one primary area but not ‘everywhere’ 

Table 13. Work location of staff while the elementary school closed for remediation; NIOSH survey, 

March 2010 

Staff 

n=70 

Military academy 25 (36%) 

Other elementary school 17 (24%) 

Middle school 18 (26%) 

Other 10 (14%) 

Page 74 Health Hazard Evaluation Report 2009-0172-3124 
2010 

tABLes (Continued) 

Table 14. Participant reported health conditions ever-diagnosed by a physician; NIOSH survey, March 

Staff 

n=70 

Sinusitis or sinus infections 45 (64%) 

Hay fever or nasal allergies 24 (34%) 

Acute bronchitis 16 (23%) 

Eczema, dermatitis, or skin allergy 15 (21%) 

Pneumonia 9 (13%) 

Ever asthma 7 (10%) 

Current asthma 5 (7%) 

Heart disease 4 (6%) 

Chronic bronchitis 3 (4%) 

Health Hazard Evaluation Report 2009-0172-3124 Page 75 
tABLes (Continued) 

Table 15. Prevalence of symptoms and their work-relatedness (portion of those with symptoms), health 

conditions, and medication usage during the four-week period prior to reporting to the elementary school 

for the February 2010 reopening; NIOSH survey, March 2010 

Staff 

n=70 

Workrelated 

Stuffy, itchy, or runny nose 17 (24%) 4 (24%) 

Dry or itchy skin 15 (21%) 3 (20%) 

Headache 13 (19%) 2 (15%) 

Sneezing 11 (16%) 0 

Sore or dry throat 10 (14%) 2 (20%) 

Cough with phlegm 10 (14%) 0 

Watery, itchy eyes 9 (13%) 4 (44%) 

Cough attacks 5 (7%) 1 (20%) 

Shortness of breath on level ground or up slight hill 3 (4%) 1 (33%) 

Chest tightness 3 (4%) 0 

Tiredness or fatigue 3 (4%) 0 

Nosebleed 3 (4%) 0 

Shortness of breath attacks 2 (3%) 0 

Fever and chills 2 (3%) 0 

Chest wheezing 2 (3%) 0 

Difficulty remembering things or concentrating 2 (3%) 0 

Dizziness or lightheadedness 1 (1%) 0 

Awakened by breathing difficulty 1 (1%) 0 

Flu-like achiness or achy joints 0 0 

Cold 13 (19%) – 

Sinusitis or sinus problems 13 (19%) – 

Bronchitis 4 (6%) – 

Upper respiratory symptoms* 27 (39%) – 

Mucous membrane irritation† 23 (33%) – 

Lower respiratory symptoms‡ 15 (21%) – 

Constitutional / nonspecific symptoms§ 14 (20%) – 

Used any medications for breathing problems 5 (7%) – 

Used any inhaled beta-agonists 4 (6%) – 

Used any medications for nasal-sinus or eye problems 22 (31%) – 

*One or more of the following symptoms: stuffy, itchy, or runny nose; sneezing; sore or dry throat; sinusitis or sinus 

problems 

† One or more of the following symptoms: stuffy, itchy, or runny nose; watery, itchy eyes; or sore or dry throat 

‡One or more of the following symptoms: chest wheezing; chest tightness; shortness of breath attacks; coughing attacks; 

awakened by breathing difficulty; shortness of breath on exertion (hurrying on level ground or walking up hill); cough with 

phlegm 

§One or more of the following symptoms: headache; tiredness or fatigue; fever and chills; difficulty remembering things or 

concentrating; dizziness or lightheadedness; or flu-like achiness or achy joints 

Page 76 Health Hazard Evaluation Report 2009-0172-3124 
tABLes (Continued) 

Table 16. Prevalence of symptoms and their work-relatedness (portion of those with symptoms), health 

conditions, and medication usage during the four-week period prior to reporting to the elementary school for its 

February 2010 reopening, as reported by current staff, by temporary school location; NIOSH survey, March 2010 

Military 

academy 

n=25 

Workrelated 

Military 

academy 

Other 

elementary 

school 

n=17 

Workrelated 

Other 

elementary 

school 

Middle 

school 

n=18 

Workrelated 

Middle 

school 

Other 

locations 

n=10 

Workrelated 

Other 

locations 

Stuffy, itchy, or runny nose 9 (36%) 3 (33%) 2 (12%) 0 5 (28%) 0 1 (10%) 1 (100%) 

Dry or itchy skin 5 (20%) 1 (20%) 3 (18%) 0 5 (28%) 1 (20%) 2 (20%) 1 (50%) 

Headache 6 (24%) 1 (17%) 3 (18%) 1 (33%) 2 (11%) 0 2 (20%) 0 

Sneezing 4 (16%) 0 3 (18%) 0 4 (22%) 0 0 0 

Sore or dry throat 6 (24%) 1 (17%) 2 (12%) 0 2 (11%) 1 (50%) 0 0 

Cough with phlegm 2 (8%) 0 3 (18%) 0 3 (17%) 0 2 (20%) 0 

Watery, itchy eyes 3 (12%) 3 (100%) 3 (18%) 0 2 (11%) 0 1 (10%) 1 (100%) 

Cough attacks 2 (8%) 1 (50%) 1 (6%) 0 1 (6%) 0 1 (10%) 0 

Shortness of breath on level 

ground or up slight hill 1 (4%) 1 (100%) 0 0 1 (6%) 0 1 (10%) 0 

Chest tightness 0 0 1 (6%) 0 1 (6%) 0 1 (10%) 0 

Tiredness or fatigue 0 0 1 (6%) 0 1 (6%) 0 1 (10%) 0 

Shortness of breath attacks 0 0 1 (6%) 0 0 0 1 (10%) 0 

Fever and chills 0 0 1 (6%) 0 1 (6%) 0 0 0 

Chest wheezing 1 (4%) 0 1 (6%) 0 0 0 0 0 

Nosebleed 2 (8%) 0 1 (6%) 0 0 0 0 0 

Difficulty remembering things 

or concentrating 0 0 1 (6%) 0 0 0 1 (10%) 0 

Dizziness or lightheadedness 0 0 0 0 0 0 1 (10%) 0 

Awakened by breathing 

difficulty 0 0 0 0 0 0 1 (10%) 0 

Flu-like achiness or achy joints 0 0 0 0 0 0 0 0 

Cold 5 (20%) – 4 (24%) – 3 (17%) – 1 (10%) – 

Sinusitis or sinus problems 4 (16%) – 4 (24%) – 3 (17%) – 2 (20%) – 

Bronchitis 1 (4%) – 2 (12%) – 1 (6%) – 0 – 

Upper respiratory symptoms* 12 (48%) – 5 (29%) – 7(39%) – 3 (30%) – 

Mucous membrane irritation† 10 (40%) – 4 (24%) – 7 (39%) – 2 (20%) – 

Lower respiratory symptoms‡ 4 (16%) – 4 (24%) – 4 (22%) – 3 (30%) – 

Constitutional / nonspecific 

symptoms§ 6 (24%) – 4 (24%) – 2 (11%) – 2 (20%) – 

Used any medications for 

breathing problems 1 (4%) – 1 (6%) – 2 (11%) – 1 (10%) – 

Used any inhaled beta-agonists 1 (4%) – 1 (6%) – 1 (6%) – 1 (10%) – 

Used any medications for 

nasal-sinus or eye problems 7 (28%) – 8 (47%) – 5 (28%) – 2 (20%) – 

*One or more of the following symptoms: stuffy, itchy, or runny nose, sneezing, sore or dry throat, sinusitis or sinus problems 

† One or more of the following symptoms: stuffy, itchy, or runny nose; watery, itchy eyes, or sore or dry throat 

‡One or more of the following symptoms: chest wheezing, chest tightness, shortness of breath attacks, coughing attacks, awakened 

by breathing difficulty, shortness of breath on exertion (hurrying on level ground or walking up hill), cough with phlegm 

§ One or more of the following symptoms: headache; tiredness or fatigue; fever and chills; difficulty remembering things or 

concentrating; dizziness or lightheadedness; or flu-like achiness or achy joints 

Health Hazard Evaluation Report 2009-0172-3124 Page 77 
tABLes (Continued) 

Table 17. Prevalence of staff health symptoms occurring one or more times per week during the four-week 

period before returning to the elementary school for its reopening; NIOSH survey, March 2010 

Current elementary 

school staff 

n=70 

Current elementary 

school staff who also 

worked at the school 

during the 2008/2009 

school year 

n=66 

Dry or itchy skin 15 (21%) 14 (21%) 

Stuffy, itchy, or runny nose 14 (20%) 13 (20%) 

Sneezing 10 (14%) 10 (15%) 

Headache 10 (14%) 10 (15%) 

Watery, itchy eyes 9 (13%) 8 (12%) 

Cough with phlegm 8 (11%) 8 (12%) 

Sore or dry throat 8 (11%) 8 (12%) 

Cough attacks 5 (7%) 5 (8%) 

Shortness of breath on exertion (hurrying on 

level ground or walking up hill) 3 (4%) 3 (5%) 

Chest wheezing 2 (3%) 2 (3%) 

Chest tightness 2 (3%) 2 (3%) 

Tiredness or fatigue 2 (3%) 2 (3%) 

Difficulty remembering things or concentrating 2 (3%) 2 (3%) 

Nosebleed 2 (3%) 2 (3%) 

Shortness of breath attacks 1 (1%) 1 (2%) 

Awakened by breathing difficulty 0 0 

Fever and chills 0 0 

Flu-like achiness or achy joints 0 0 

Dizziness or lightheadedness 0 0 

Upper respiratory symptoms* 19 (27%) 18 (28%) 

Mucous membrane irritation† 18 (26%) 17 (26%) 

Lower respiratory symptoms‡ 13 (19%) 13 (20%) 

Constitutional / nonspecific symptoms§ 10 (14%) 10 (15%) 

*One or more of the following symptoms: stuffy, itchy, or runny nose, sneezing, sore or dry throat, sinusitis or sinus 

problems 

†One or more of the following symptoms: stuffy, itchy, or runny nose; watery, itchy eyes, or sore or dry throat.
 

‡One or more of the following symptoms: chest wheezing, chest tightness, shortness of breath attacks, coughing attacks, 

awakened by breathing difficulty, shortness of breath on exertion (hurrying on level ground or walking up hill), cough with 

phlegm.
 

§One or more of the following symptoms: headache; tiredness or fatigue; fever and chills; difficulty remembering things or 

concentrating; dizziness or lightheadedness; or flu-like achiness or achy joints. 

Page 78 Health Hazard Evaluation Report 2009-0172-3124 
2010 

tABLes (Continued) 

Table 18. Symptom prevalence ratios* based on comparison with BASE survey; NIOSH survey, March 

Elementary school staff 

Prevalence ratio 

(95% CI)†‡ 

Sneeze 0 (0-0.5) 

Sore/dry throat 0.2 (0.04-1.2) 

Unusual tiredness, fatigue 0 (0-0.4) 

Wheezing or whistling in the chest 0 (0-3.0) 

Chest tightness 0 (0-2.5) 

Shortness of breath 0 (0-3.0) 

Cough 0.3 (0.05-1.6) 

Headache 0.2 (0.05-0.7) 

Dry itchy skin 0.9 (0.3-2.5) 

*Unadjusted prevalence ratios

 †95% CI: 95% confidence interval 

‡95% CIs that exclude 1.0 are statistically significantly different from comparison with U.S. office workers 

Table 19. Comparison of respiratory symptoms and diagnoses reported by school employees (during 

the four-week period prior to reporting to the elementary school for the reopening) with the U.S. adult 

population (NHANES III)*; NIOSH survey, March 2010 

Overall Male Female 

Prevalence ratio 

(95% CI)†‡ 

Prevalence ratio 

(95% CI) †‡ 

Prevalence ratio 

(95% CI) †‡ 

Shortness of breath on exertion 

(hurrying on level ground or walk up a 

slight hill) 

0.2 (0.08-0.7) 0.8 (0.1-4.6) 0.2 (0.04-0.6) 

Nasal allergies, including hay fever§ 2.3 (1.5-3.3) 3.1 (1.2-7.9) 2.1 (1.4-3.3) 

Chronic bronchitis (physiciandiagnosed) 0.7 (0.2-2.1) 0 (0-13.7) 0.8 (0.3-2.2) 

Ever asthma (physician-diagnosed) 1.3 (0.6-2.7) 2.5 (0.7-9.0) 1.1 (0.5-2.6) 

Current asthma (physician-diagnosed) 1.5 (0.6-3.5) 2.1 (0.4-11.8) 1.4 (0.5-3.6) 

*Indirect standardization for age, gender, smoking status, and race 

†95% CI: 95% confidence interval

 ‡95% CIs that exclude 1.0 are statistically significantly different from comparison with U.S. adult population 

§

NIOSH question included physician-diagnosed hay fever or nasal allergies; NHANES III question asked about physiciandiagnosed hay fever (“Has a doctor ever told you that you had hay fever?”) 

Health Hazard Evaluation Report 2009-0172-3124 Page 79 
 

tABLes (Continued) 

Table 20. Comparison of physician-diagnosed asthma among elementary school staff to the North 

Carolina state population prevalence (2009 BRFSS); NIOSH survey, March 2010 

Staff 

Prevalence ratio 

(95% CI)*†

 Ever asthma 

Male 1.7 0.5-6.1

 Female 0.6 0.2-1.3

 Overall 0.7 0.3-1.5

 Current asthma

 Male 1.6 0.3-9.1

 Female 0.7 0.3-1.8

 Overall 0.8 0.3-1.8 

*95% CI: 95% confidence interval 

†95% CIs that exclude 1.0 are statistically significantly different from comparison with the North Carolina state population 

Table 21. Prevalence of symptoms reported by elementary school staff during the 2008/2009 school year, 

by primary work area*

; NIOSH survey, March 2010 

Classroom wings† 

(n=45) 

Non-classroom wings‡ 

(n=13) P value§ 

Headaches 34 (76%) 7 (54%) 0.17 

Unusual tiredness or fatigue 33 (73%) 4 (31%) 0.008 

Upper respiratory symptoms 30 (67%) 4 (31%) 0.03 

Difficulty remembering 

things or concentrating 25 (56%) 4 (31%) 0.21 

Watery, itchy eyes 25 (56%) 2 (15%) 0.01 

Lower respiratory symptoms 24 (53%) 6 (46%) 0.76 

Fever, chills, or flu-like 

symptoms 10 (22%) 4 (31%) 0.71 

Nosebleeds 3 (7%) 3 (23%) 0.12 

*8 of the 66 participants who worked at the elementary school during the 2008/2009 school year had more than one 

primary work area and could not be classified as working primarily in classroom or non-classroom wings. 

†Classroom wings include the k/1, 2/3, and 4/5 wings. 

‡Non-classroom wings include the administration, media center, gym, and cafeteria areas. 

§Pearson Chi-square exact test; p<0.05 - statistically significant; 0.05<p<0.10 - marginally significant 

Page 80 Health Hazard Evaluation Report 2009-0172-3124 
tABLes (Continued) 

Table 22. Prevalence of symptoms reported by elementary school staff during the 2008/2009 school year, 

by primary work area; NIOSH survey, March 2010 

k/1 wing 

(n=17) 

2/3wing 

(n=16) 

4/5 wing 

(n=11) P value* 

Admin 

wing 

(n=7) 

Gym/ 

cafeteria 

wing 

(n=3) 

Other 

(n=7) 

Everywhere 

(n=5) 

Lower 

respiratory 

symptoms 

7 (41%) 11 (69%) 5 (45%) 0.26 4 (57%) 1 (33%) 2 (29%) 0 

Watery, itchy 

eyes 9 (53%) 9 (56%) 6 (55%) 1.0 1 (14%) 1 (33%) 2 (29%) 1 (20%) 

Upper 

respiratory 

symptoms 

9 (53%) 12 (75%) 8 (73%) 0.37 2 (29%) 2 (67%) 3 (43%) 1 (20%) 

Unusual 

tiredness or 

fatigue 

13 (76%) 12 (75%) 7 (64%) 0.83 4 (57%) 0 2 (29%) 0 

Fever, chills, 

or flu-like 

symptoms 

3 (18%) 5 (31%) 2 (18%) 0.66 3 (43%) 1 (33%) 0 0 

Difficulty 

remembering 

things or 

concentrating 

9 (53%) 8 (50%) 7 (64%) 0.80 4 (57%) 0 1 (14%) 0 

Headaches 14 (82%) 11 (69%) 8 (73%) 0.68 5 (71%) 2 (67%) 4 (57%) 1 (20%) 

Nosebleeds 2 (12%) 0 1 (9%) 0.46 3 (43%) 0 1 (14%) 0 

*Pearson Chi-square exact test; p < 0.05 - statistically significant; 0.05 ≤ p< 0.10 - marginally significant; comparison was 

among classroom wings 

Health Hazard Evaluation Report 2009-0172-3124 Page 81 
2010 

tABLes (Continued) 

Table 23. Prevalence of health symptoms and their work-relatedness (portion of those with symptom) 

reported by elementary school staff during the 2008/2009 school year and during the four-week period 

prior to returning to the elementary school for its reopening in February 2010; NIOSH survey, March 

2008/2009 school 

year 

n=66* 

Work-related 

2008/2009 school 

year 

n (%) 

4-week period 

prior to returning 

to the school 

n=66* 

Work-related 

4-week period 

prior to returning 

to the school 

n (%) 

Headaches 45 (68%) 36 (80%) 12 (18%) 2 (17%) 

Unusual tiredness or 

fatigue 38 (58%) 34 (89%) 3 (5%) 0 

Upper respiratory 

symptoms 37 (56%) 27 (73%) 26 (39%) – 

Lower respiratory 

symptoms 30 (45%) 25 (83%) 15 (23%) – 

Watery, itchy eyes 29 (44%) 26 (90%) 8 (12%) 3 (38%) 

Difficulty remembering 

things or concentrating 29 (44%) 24 (83%) 2 (3%) 0 

Fever, chills, or flu-like 

symptoms 14 (21%) 12 (86%) 2 (3%)† 0 

Nosebleeds 7 (11%) 6 (86%) 3 (5%) 0 

*Excludes participating staff who did not work at the elementary school during the 2008/2009 school year 

†

Includes participants who reported episodes of fever and chills and/or episodes of flu-like achiness or achy joints during the 

4 weeks before returning to the elementary school. 

Page 82 Health Hazard Evaluation Report 2009-0172-3124 
FiGuRes 

Figure 1. Diagram of the elementary school. 

Health Hazard Evaluation Report 2009-0172-3124 Page 83
 
FiGuRes (Continued) 

Figure 2. Visible mold on carpet in a classroom (room 625), August 2005 (courtesy of building occupant). 

Figure 3. Visible mold on upholstered chairs in the records room (room 109), August 2005 (courtesy of 

building occupant). 

Page 84 Health Hazard Evaluation Report 2009-0172-3124 
FiGuRes (Continued) 

Figure 4. Visible mold on picture frames in the storage room (room 111), August 2005 (courtesy of 

building occupant). 

Figure 5. Basement below the media center wing, July 2009. 

Health Hazard Evaluation Report 2009-0172-3124 Page 85 
FiGuRes (Continued) 

Figure 6. School grounds sloping downward towards classroom wings, July 2009. 

Figure 7. School grounds sloping downward towards classroom wings, July 2009. 

Page 86 Health Hazard Evaluation Report 2009-0172-3124 
FiGuRes (Continued) 

Figure 8. School grounds sloping downward towards classroom wings, July 2009. 

Figure 9. Blocked storm drain outside of the media center, July 2009. 

Health Hazard Evaluation Report 2009-0172-3124 Page 87
 
FiGuRes (Continued) 

Figure 10. Foam roof adjacent to gym, July 2009. 

Figure 11. Foam roof over media center wing, July 2009. 

Page 88 Health Hazard Evaluation Report 2009-0172-3124 
FiGuRes (Continued) 

Figure 12. Flashing judged to be inadequate and that appeared to be mounted superficially at the junction 

between the parapet wall (above room 206) and the gym, July 2009. 

Figure 13. Plenum above classroom ceiling, showing ductwork and dust, July 2009. 

Health Hazard Evaluation Report 2009-0172-3124 Page 89 
FiGuRes (Continued) 

Figure 14. Plenum above classroom ceiling, showing ductwork and dust, July 2009. 

Figure 15. Coils in HVAC air handlers, showing dust and possible mold contamination, July 2009. 

Page 90 Health Hazard Evaluation Report 2009-0172-3124 
FiGuRes (Continued) 

Figure 16. Percent frequency of occurrence individual fungal species in floor dust samples, July 2009. 

Health Hazard Evaluation Report 2009-0172-3124 Page 91
 
FiGuRes (Continued) 

Figure 17. Classroom, March 2010. 

Figure 18. Classroom, March 2010. 

Page 92 Health Hazard Evaluation Report 2009-0172-3124 
FiGuRes (Continued) 

Figure 19. Corridor in classroom wing, March 2010. 

Figure 20. Main corridor, March 2010. 

Health Hazard Evaluation Report 2009-0172-3124 Page 93
 
FiGuRes (Continued) 

Figure 21. Corridor in media center wing, March 2010. 

Figure 22. Corridor in media center wing, March 2010. 

Page 94 Health Hazard Evaluation Report 2009-0172-3124 
FiGuRes (Continued) 

Figure 23. Media center, showing temporary containment barrier for installation of exterior door, March 

2010. 

Figure 24. Comparison of symptom prevalences in 2008/2009 school year by classroom wing in 40 staff 

members1

. 

Health Hazard Evaluation Report 2009-0172-3124 Page 95 
FiGuRes (Continued) 

Figure 25. Comparison of symptom prevalences in 2008/2009 school year by classroom wing in 376 

students1

. 

Figure 26. Comparison of symptoms prevalences in 2007/2008 and 2008/2009 school years in 43 staff 

members1

 who had symptoms during the 2008/2009 school year and worked at this school both years. 

Page 96 Health Hazard Evaluation Report 2009-0172-3124 
FiGuRes (Continued) 

Figure 27. Comparison of symptom prevalences in 2007/2008 and 2008/2009 school years in 221 

students1

 who had symptoms during the 2008/2009 school year and attended this school both years.
 

Health Hazard Evaluation Report 2009-0172-3124 Page 97
 
 

 

 

 

 

 

 

 

 

 

 

 

Appendix A: GuiLFoRd County depARtMent oF puBLiC HeALtH
 

FACuLty/stAFF QuestionnAiRe
 

Faculty/Staff 

HEALTH 

QUESTIONNAIRE 

Oak Ridge Elementary School 

May 2009 

This is a survey of the Guilford County Department of Public Health. The purpose of the survey is to assess 

the health of faculty and staff of the Oak Ridge Elementary School. Participation is voluntary. The information 

you provide is confidential. Your name and address is requested in the event that we need to follow-up with you 

for additional information. 

Name (Last/First/Middle Initial) ____________ ______ 

Home Address 

City State Zip ______ 

Home Phone Age ________ 

When did you work at Oak Ridge Elementary School? (Check all that apply) 

2008-2009 School Year (August 2008-May 2009) _______ 

2007-2008 School Year (August 2007-May 2008) _______ 

Where at Oak Ridge Elementary School is your office or classroom located currently and in previous 

years? 

2008-2009 School Year: Primary Classroom #___________ or Office # __________ 

2007-2008 School Year: Primary Classroom #____________or Office # __________ 

During the 2008-9 school year (from August 2008-May 2009) did you experience any of the following 

symptoms while at work in the school building? (Circle all that apply) 

If YES, how frequently? 

(daily, sometimes, rarely) 

1. Headaches YES NO ___________________ 

2. Dry eyes YES NO ___________________ 

3. Unusual sneezing episodes YES NO ___________________ 

4. Difficulty breathing, asthma attacks YES NO ___________________ 

5. Nosebleeds YES NO ___________________ 

6. Other symptoms, discomfort ____________________________________________ 

ORES Staff 1 

Page 98 Health Hazard Evaluation Report 2009-0172-3124
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Appendix A: GuiLFoRd County depARtMent oF puBLiC HeALtH

 FACuLty/stAFF QuestionnAiRe (Continued) 

If you answered NO to questions 1-5 and reported no other symptoms or discomfort in question 6, you may 

STOP the survey at this point and return your survey to Oak Ridge Elementary School according to the 

cover sheet instructions. 

If you answered YES to any of the symptom questions above or listed other symptoms, did you seek 

medical care for any of these concerns?	 YES NO 

If you did seek medical care in 2008-9, where did you seek care? (If so, please check and in the parentheses 

write in how many times) 

Doctor’s Office _____ (____) Emergency Room ______ (_____) Hospital Admission ______ (_____) 

During the 2007-8 school year (August 2007-May 2008) did you experience any of the following symptoms 

while at work in the school building ? (Circle all that apply) 

If YES, how frequently? 

(daily, sometimes, rarely) 

1. Headaches	 YES NO _____________________ 

2. Dry eyes	 YES NO _____________________ 

3. Unusual sneezing episodes YES NO _____________________ 

4. Difficulty breathing, asthma attacks YES NO _____________________ 

5. Nosebleeds	 YES NO _____________________ 

6. Other symptoms, discomfort ______________________________________________ 

If you answered YES to any of the symptom questions above or listed other symptoms, did you seek 

medical care for any of these concerns?	 YES NO 

If you did seek medical care in 2007-8, where did you seek care? (If so, please check and then in the 

parentheses write in how many times): 

Doctor’s Office _____ (_____) Emergency Room _____ (_____) Hospital Admission ______ (_____) 

Is there a particular room or area in the building where you experience more symptoms or discomfort? 

YES NO 

If YES, what is room number or description of room?_______________________________________ 

Do you have any of the following health conditions? (This information will be kept confidential.) 

1. Chronic respiratory disease	 YES NO 

2. Undergoing chemotherapy or radiation therapy YES NO 

3. Immune system suppressed by disease or other causes YES NO 

ORES Staff 2 

Health Hazard Evaluation Report 2009-0172-3124	 Page 99 
 

 

 

 

 

____________________________________________ 

____________________________________________ 

____________________________________________ 

____________________________________________ 

____________________________________________ 

____________________________________________ 

______________________________________ 

 

 

Appendix A: County depARtMent oF puBLiC HeALtH

 FACuLty/stAFF QuestionnAiRe (Continued) 

4. Allergic rhinitis YES NO 

5. Asthma YES NO 

6. Seasonal Allergies YES NO 

7. Cystic Fibrosis YES NO 

What prescription medications are you taking? 

What over the counter medications are you taking? 

What herbal therapies are you taking? 

When did the symptoms/problems start? 

2007-2008 school year or earlier________ 2008-2009 school year ________ 

Of the symptoms/problems you have been experiencing, which are the worst? 

When are the symptoms/problems generally worse? 

Beginning of the week ______End of the week _______Particular days______________ 

Morning ______ Afternoon _______ Particular times of day _________________ 

Spring _____ Summer _____ Fall ______ Winter ______ 

When do symptoms/problems go away? 

After leaving the building YES NO 

If YES, how long does it take to go away? ______________________________ 

ORES Staff 3 

Page 100 Health Hazard Evaluation Report 2009-0172-3124 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Appendix A: County depARtMent oF puBLiC HeALtH

 FACuLty/stAFF QuestionnAiRe (Continued) 

Do you smoke cigarettes, a pipe or cigars? YES NO 

Are there any other smokers in your household? YES NO 

If YES, how many total smokers in household? __________

 Please provide us with some information about your current home:

 house duplex mobile home__ other 

a. Age of building:	 years 

b.	 Type of heating: forced hot air 

water/steam 

electric 

gas 

oil 

c How many people live in your household? 

d.	 Are there any pets in your household? YES NO 

If YES, please specify. 

e.		 Do you use a humidifier at home? YES NO 

f.	 Do you have wall to wall carpeting in your home? YES NO 

g. Have there been any water leaks in your home? YES NO 

If YES, describe. 

h.	 Have you noticed visible water stains on the walls? YES NO 

i.	 Visible stains on ceiling or ceiling tiles? YES NO 

j.	 Have you noticed mold or mildew? YES NO 

If YES, was the mold problem corrected? YES NO 

When? ______________________________________ 

Is there any additional information you feel we should know? 

This concludes the survey. Please see the cover letter for instructions on returning the survey. 

Thank you for your participation! 

ORES Staff 4 

Health Hazard Evaluation Report 2009-0172-3124	 Page 101 
 

 

Appendix A: County depARtMent oF puBLiC HeALtH

 FACuLty/stAFF QuestionnAiRe (Continued) 

Extra page for any additional information you wish to provide. 

ORES Staff 5 

Page 102 Health Hazard Evaluation Report 2009-0172-3124 
 

 

 

 

 

 

 

 

 

 

 

Appendix B: County depARtMent oF puBLiC HeALtH pARent 

QuestionnAiRe 

Parent/Guardian 

HEALTH 

QUESTIONNAIRE
 

Oak Ridge Elementary School
 

May 2009
 

This is a survey of the Guilford County Department of Public Health. The purpose of the survey is to assess 

the health of students attending the Oak Ridge Elementary School. This survey should be completed by one 

of the student’s parents or guardian. If you have more than one child at Oak Ridge Elementary School, a 

separate survey should be completed for each child. Participation is voluntary. The information you provide is 

confidential. Your name and address is requested in the event that we need to follow-up with you for additional 

information. 

Name of Child (Last/First/Middle Initial) ____________ ______ 

Home Address 

City State Zip ______
 

Home Phone Age ________
 

Name of Parent or Guardian who completed survey ____________________________________
 

Which years did your child attend Oak Ridge Elementary School? (Check all that apply) 

2008-2009 School Year (August 2008-May 2009) _______ 

2007-2008 School Year (August 2007-May 2008) _______ 

2006-2007 School Year (August 2006-May 2007) _______ 

2005-2006 School Year (August 2005-May 2006) _______ 

2004-2005 School Year (August 2004-May 2005) _______ 

Where at Oak Ridge Elementary School is your child’s main classroom or homeroom located for the last 

two years? 

2008-2009 School Year: Primary Classroom or Homeroom #___________ 

2007-2008 School Year: Primary Classroom or Homeroom #____________
 

During the 2008-9 school year (from August 2008-May 2009) did your child experience any of the following 

symptoms while in the school building? (Circle all that apply) 

If YES, how frequently? 

(daily, sometimes, rarely) 

1. Headaches YES NO _____________________ 

2. Dry eyes YES NO _____________________ 

3. Unusual sneezing episodes YES NO _____________________ 

ORES Parent/Guardian 1 

Health Hazard Evaluation Report 2009-0172-3124 Page 103 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Appendix B: County depARtMent oF puBLiC HeALtH 

pARent QuestionnAiRe (Continued) 

4. Difficulty breathing, asthma attacks YES NO _____________________ 

5. Nosebleeds YES NO _____________________ 

6. Other symptoms, discomfort ______________________________________________ 

If you answered NO to questions 1-5 and your child reported no other symptoms or discomfort in question 

6, you may STOP the survey at this point and return your survey to Oak Ridge Elementary School 

according to the cover sheet instructions. 

If you answered YES to any of the symptom questions above or listed other symptoms, did you seek 

medical care for your child for any of these concerns? YES NO 

If you did seek medical care for your child in 2008-9, where did you seek care? (If so, please check and in 

the parentheses write in how many times) 

Doctor’s Office _____( ) Emergency Room _____ ( ) Hospital Admission _____ ( ) 

During the 2007-8 school year (August 2007-May 2008) did your child experience any of the following 

symptoms while in the school building ? (Circle all that apply) 

If YES, how frequently? 

(daily, sometimes, rarely) 

1. Headaches YES NO _____________________ 

2. Dry eyes YES NO _____________________ 

3. Unusual sneezing episodes YES NO _____________________ 

4. Difficulty breathing, asthma attacks YES NO _____________________ 

5. Nosebleeds YES NO _____________________ 

6. Other symptoms, discomfort ______________________________________________ 

If you answered YES to any of the symptom questions above or listed other symptoms, did you seek 

medical care for your child for any of these concerns? YES NO 

If you did seek medical care for your child in 2007-8, where did you seek care? (If so, please check and in 

the parentheses write in how many times) 

Doctor’s Office _____ ( ) Emergency Room _____ ( ) Hospital Admission _____ ( ) 

Is there a particular room or area in the building where your child experienced more symptoms or 

discomfort (Room number or description)? YES NO 

If YES, what is the room number or description of area?____________________________________ 

Does your child have any of the following health conditions? (This information will be kept confidential.) 

ORES Parent/Guardian 2 

Page 104 Health Hazard Evaluation Report 2009-0172-3124 
 

 

 

 

 

 

 

 

____________________________________________ 

____________________________________________ 

____________________________________________ 

____________________________________________ 

____________________________________________ 

____________________________________________ 

______________________________________ 

 

Appendix B: County depARtMent oF puBLiC HeALtH 

pARent QuestionnAiRe (Continued) 

1. Chronic respiratory disease YES NO 

2. Undergoing chemotherapy or radiation therapy YES NO 

3. Immune system suppressed by disease or other causes YES NO 

4. Allergic rhinitis YES NO 

5. Asthma YES NO 

6. Seasonal Allergies YES NO 

7. Cystic Fibrosis YES NO 

What prescription medications does your child take? 

What over the counter medications does your child take? 

What herbal therapies does your child take? 

When did the symptoms/problems start? 

2007-2008 school year or earlier________ 2008-2009 school year ________ 

Of the symptoms/problems your child has been experiencing, which are the worst? 

When are the symptoms/problems generally worse? 

Beginning of the week ______End of the week _______Particular days______________ 

Morning ______ Afternoon _______ Particular times of day _________________ 

Spring _____ Summer _____ Fall ______ Winter ______ 

ORES Parent/Guardian 3 

Health Hazard Evaluation Report 2009-0172-3124 Page 105 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Appendix B: County depARtMent oF puBLiC HeALtH 

pARent QuestionnAiRe (Continued) 

When do symptoms/problems go away? 

After leaving the building YES	 NO 

If YES, how long does it take to go away? ______________________________

 _____________________________________________________________________________________ 

Are there any smokers in your household? YES NO 

If YES, how many total smokers in household? __________

 Please provide us with some information about the home where your child lives:

 house duplex mobile home__ other 

a. Age of building:	 years 

b.	 Type of heating: forced hot air
 

water/steam
 

electric
 

gas
 

oil
 

c How many people live in your household? 

d.	 Are there any pets in your household? YES NO 

If YES, please specify. 

e.		 Do you use a humidifier at home? YES NO 

f.	 Do you have wall to wall carpeting in your home? YES NO 

g. Have there been any water leaks in your home/ 

apartment? YES NO 

If YES, describe. 

h.	 Have you noticed visible water stains on the walls? YES NO 

i.	 Visible stains on ceiling or ceiling tiles? YES NO 

j.	 Have you noticed mold or mildew? YES NO 

If YES, was the mold problem corrected? YES NO 

When? ______________________________________ 

Is there any additional information you feel we should know? 

ORES Parent/Guardian 4 

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Appendix B: County depARtMent oF puBLiC HeALtH 

pARent QuestionnAiRe (Continued) 

This concludes the survey. Please see the cover letter for instructions on returning the survey. 

Thank you for your participation! 

Extra space for any additional information you wish to provide. 

ORES Parent/Guardian 

Health Hazard Evaluation Report 2009-0172-3124 Page 107 

 5 
 

 

 

 

 

 

 

Appendix C: niosH MARCH 2010 QuestionnAiRe 

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
 

CENTERS FOR DISEASE CONTROL AND PREVENTION
 

NATIONAL INSTITUTE FOR OCCUPATIONAL SAFETY AND HEALTH
 

Oak Ridge Elementary School 

Oak Ridge, NC 

HETA 2009-0172 

The National Institute for Occupational Safety and Health (NIOSH) is a part of the United States Public 

Health Service and an institute within the Centers for Disease Control and Prevention (CDC) that is 

concerned with workplace health and safety. In 2009, we received a Health Hazard Evaluation request from 

officials of Guilford County Schools to evaluate health concerns that may be related to your workplace 

environment. The purpose of this survey is to assess the current health of employees. 

This is a questionnaire about your health history and work history. All medical and other personal 

information that you provide NIOSH is considered confidential in accordance with the Privacy Act of 1974 

(Public Law 93-579). The information you provide NIOSH will be summarized so that no individual is 

identified. All information is stored at NIOSH until destroyed. Management will not see your response. 

If you have any questions about this survey or your participation, please contact the NIOSH project officer 

Dr. Rachel Bailey. She will be at Oak Ridge Elementary School from March 2-4, 2010. Additionally, you 

may contact her at 1(800) 232-2114 or (304) 285-5757. 

“BY COMPLETING THIS QUESTIONNAIRE, YOU INDICATE YOUR CONSENT TO 

PARTICIPATE IN THIS STUDY.” 

Thank you for your participation. 

Page 108 Health Hazard Evaluation Report 2009-0172-3124 
Appendix C: niosH MARCH 2010 QuestionnAiRe (Continued) 

NIOSH-Administered Current Employee Health Questionnaire 

Identification and Demographic Information 

1. Survey Date: __ __/__ __/2010 

2. Name: _________________ ______ _______________________ First MI Last 

3. Home Telephone Number: ( __ __ __) __ __ __ - __ __ __ __ 

4. Date of Birth: __ __ / __ __ / __ __ __ __ Month Day Year 

5. Gender: 1.____ Male 2.____ Female 

6. Ethnicity (Please choose one): 

 1.____ Hispanic or Latino 

 0.____ Not Hispanic or Latino 

 

7. Race (Please choose all that apply): 

 1.____ American Indian or Alaska Native 

 2.____ Asian 

 3.____ Black or African American 

 4.____ Native Hawaiian or Other Pacific Islander 

 5.____ White 

Health Hazard Evaluation Report 2009-0172-3124	 Page 109 

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Appendix C: niosH MARCH 2010 QuestionnAiRe (Continued) 

I am going to ask you some questions about your health in the four-week timeframe prior to Oak Ridge 

Elementary School re-opening on February 22, 2010; therefore from January 24, 2010 to February 21, 

2010. Some questions will ask about your symptoms away from “the building”. “The building” refers 

to the school building you worked in during January 24, 2010 to February 21, 2010. The answers to 

many of these questions will be “Yes” or “No.” If you are in doubt about whether to answer “Yes” or 

“No,” then please answer “No.” 

8.1 During the 4 weeks before returning to Oak Ridge Elementary School, did you have wheezing or 

whistling in your chest at any time? 

1. Yes ___ 0. No ___ 

IF YES: 

8.2 Did you have wheezing or whistling in your chest one or more times per week during those 4 weeks? 

1.Yes ___ 0.No ___ 

8.3 When you were away from the building was this wheezing or whistling in your chest: 

1.Same ___ 2.Worse ___ 3.Better ___ 

8.4 In what month and year did you first have wheezing or whistling in your chest? 

__ __ / __ __ __ __ 

Month Year 

9.1 During the 4 weeks before returning to Oak Ridge Elementary School, did you have chest tightness? 

1.Yes ___ 0. No ___ 

IF YES: 

9.2 Did you have chest tightness one or more times per week during those 4 weeks? 

1.Yes ___ 0. No ___ 

9.3 When you were away from the building was the chest tightness: 

1. Same ___ 2. Worse ___ 3. Better ___ 

9.4 In what month and year did you first have chest tightness? __ __ / __ __ __ __ 

Month Year 

10.1 During the 4 weeks before returning to Oak Ridge Elementary School, did you have attacks of 

shortness of breath? 1. Yes ___ 0. No ___ 

IF YES: 

10.2 Did you have attacks of shortness of breath one or more times per week during those 4 weeks? 

1. Yes ___ 0. No ___ 

10.3	 When you were away from the building were the attacks of shortness of breath: 

1.Same ___ 2.Worse ___ 3.Better ___ 

10.4 In what month and year did you first have attacks of shortness of breath? __ __ / __ __ __ __ 

Month Year 

3
 

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Appendix C: niosH MARCH 2010 QuestionnAiRe (Continued) 

11.1 During the 4 weeks before returning to Oak Ridge Elementary School, did you have coughing 

attacks? 1. Yes ___ 0. No ___ 

IF YES: 

11.2 Did you have coughing attacks one or more times per week during those 4 weeks? 

1. Yes ___ 0. No ___ 

11.3 When you were away from the building were the coughing attacks: 

1.Same ___ 2.Worse ___ 3.Better ___ 

11.4 In what month and year did you first have coughing attacks? __ __ / __ __ __ __ 

Month Year 

12.1 During the 4 weeks before returning to Oak Ridge Elementary School, were you awakened by an 

attack of breathing difficulty? 

1. Yes ___ 0. No ___ 

IF YES: 

12.2 Were you awakened by an attack of breathing difficulty one or more times per week during those 

4 weeks? 1. Yes ___ 0. No ___ 

12.3 When you were away from the building was the awakening by attacks of 

breathing difficulty: 1.Same ___ 2.Worse ___ 3.Better ___ 

12.4 In what month and year were you first awakened by an attack of breathing difficulty? 

__ __ / __ __ __ __ 

Month Year 

13.1 During the 4 weeks before returning to Oak Ridge Elementary School, did you have shortness of 

breath when hurrying on level ground or walking up a slight hill? 1. Yes ___ 0. No ___ 

IF YES: 

13.2 Did you have shortness of breath when hurrying on level ground or walking up a slight hill one or 

 more times per week during those 4 weeks? 1. Yes ___ 0. No ___ 

13.3 When you were away from the building was this shortness of breath: 

1.Same ___ 2.Worse ___ 3.Better ___ 

13.4 In what month and year did you first have this shortness of breath? __ __ / __ __ __ __ 

Month Year 

14.1 During the 4 weeks before returning to Oak Ridge Elementary School, did you have a cough with 

phlegm? 1.Yes ___ 0.No ___ 

IF YES: 

14.2 Did you have cough with phlegm one or more times per week during those 4 weeks? 

1.Yes ___ 0.No ___ 

14. 3 When you were away from the building was the cough with phlegm: 

1.Same ___ 2.Worse ___ 3.Better ___ 

14.4 In what month and year did you first have cough with phlegm? 

Health Hazard Evaluation Report 2009-0172-3124 

__ __ / __ __ __ __ 

Month Year 

4 

Page 111 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Appendix C: niosH MARCH 2010 QuestionnAiRe (Continued) 

15.1 During the 4 weeks before returning to Oak Ridge Elementary School, did you have episodes of
 

fever and chills? 1.Yes ___ 0.No ___ 

IF YES: 

15.2 Did you have episodes of fever and chills one or more times per week during those 4 weeks? 

1.Yes ___ 0.No ___ 

15.3 When you were away from the building were these episodes of fever and chills: 

1.Same ___ 2.Worse ___ 3.Better ___ 

15.4 In what month and year did you first have episodes of fever and chills? __ __ / __ __ __ __ 

Month Year 

16.1 During the 4 weeks before returning to Oak Ridge Elementary School, did you have episodes of flulike achiness or achy joints? 

1.Yes ___ 0.No ___ 

IF YES: 

16.2 Did you have episodes of flu-like achiness or achy joints one or more times per week during those 4 

weeks? 1.Yes ___ 0.No ___ 

16. 3 When you were away from the building was the flu-like achiness or achy joints: 

1.Same ___ 2.Worse ___ 3.Better ___ 

16.4 In what month and year did you first have episodes of flu-like achiness or achy joints? 

__ __ / __ __ __ __ 

Month Year 

17.1 During the 4 weeks before returning to Oak Ridge Elementary School, did you have unusual 

tiredness or fatigue? 

1. Yes ___ 0. No ___ 

IF YES: 

17.2 Did you have unusual tiredness or fatigue one or more times per week during those 4 

weeks? 1. Yes ___ 0. No ___ 

17.3 When you were away from the building was the unusual tiredness or 

fatigue: 

1.Same ___ 2.Worse ___ 3.Better ___ 

17.4 In what month and year did you first have unusual tiredness or fatigue? 

__ __ / __ __ __ __ 

Month Year 

5
 

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Appendix C: niosH MARCH 2010 QuestionnAiRe (Continued) 

18.1 During the 4 weeks before returning to Oak Ridge Elementary School, did you have difficulty 

remembering things or concentrating? 

1.Yes ___ 0.No ___ 

IF YES: 

18.2 Did you have difficulty remembering things or concentrating one or more times per week during 

those 4 weeks? 1.Yes ___ 0.No ___ 

18.3 When you were away from the building was the difficulty remembering things or 

concentrating: 

1.Same ___ 2.Worse ___ 3.Better ___ 

18.4 In what month and year did you first have difficulty remembering things or concentrating? 

__ __ / __ __ __ __ 

Month Year 

19.1 During the 4 weeks before returning to Oak Ridge Elementary School, did you have dizziness or 

lightheadedness? 1.Yes ___ 0.No ___ 

IF YES: 

19.2 Did you have dizziness or lightheadedness one or more times per week during those 4 weeks? 

1.Yes ___ 0.No ___ 

19.3 When you were away from the building was the dizziness or lightheadedness: 

1.Same ___ 2.Worse ___ 3.Better ___ 

19.4 In what month and year did you first have dizziness or lightheadedness? __ __ / __ __ __ __ 

Month Year 

20.1 During the 4 weeks before returning to Oak Ridge Elementary School, did you have headaches? 

1.Yes ___ 0.No ___ 

IF YES: 

20.2 Did you have headaches one or more times per week during those 4 weeks? 

1.Yes ___ 0.No ___ 

20.2 When you were away from the building were the headaches: 

1.Same ___ 2.Worse ___ 3.Better ___ 

21.1 During the 4 weeks before returning to Oak Ridge Elementary School, did you have any episodes of 

stuffy, itchy or runny nose? 

1.Yes ___ 0.No ___ 

IF YES: 

21.2 Did you have a stuffy, itchy or runny nose one or more times per week during those 4 weeks? 

1.Yes ___ 0.No ___ 

21.3	 When you were away from the building was the stuffy, itchy or runny nose: 

1.Same ___ 2.Worse ___ 3.Better ___ 

22.1 During the 4 weeks before returning to Oak Ridge Elementary School did you have sneezing? 

1.Yes ___ 0.No ___ 

IF YES: 

Health Hazard Evaluation Report 2009-0172-3124 Page 113 

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Appendix C: niosH MARCH 2010 QuestionnAiRe (Continued) 

22.2 Did you have sneezing one or more times per week during those 4 weeks? 

1.Yes ___ 0.No ___ 

22.3	 When you were away from the building was the sneezing: 

1.Same ___ 2.Worse ___ 3.Better ___ 

23.1 During the 4 weeks before returning to Oak Ridge Elementary School, did you have dry or itchy 

skin? 1.Yes ___ 0.No ___ 

IF YES: 

23.2 Did you have dry or itchy skin one or more times per week during those 4 weeks? 

1.Yes ___ 0.No ___ 

23.3	 When you were away from the building was the dry or itchy skin: 

1.Same ___ 2.Worse ___ 3.Better ___ 

23.4 In what month and year did you first have dry or itchy skin? __ __ / __ __ __ __ 

Month Year 

24.1 During the 4 weeks before returning to Oak Ridge Elementary School, did you have episodes of 

watery, itchy eyes? 

1.Yes ___ 0.No ___ 

IF YES: 

24.2 Did you have watery or itchy eyes one or more times per week during those 4 weeks? 

1.Yes ___ 0.No ___ 

24.3 When you are away from the building were the watery or itchy eyes: 

1.Same ___ 2.Worse ___ 3.Better ___ 

24.4 In what month and year did you first have watery or itchy eyes? __ __ / __ __ __ __ 

Month Year 

25.1 During the 4 weeks before returning to Oak Ridge Elementary School, did you have a sore or dry 

throat? 1.Yes ___ 0.No ___ 

IF YES: 

25.2 Did you have a sore or dry throat one or more times per week during those 4 weeks? 

1.Yes ___ 0.No ___ 

25.3 When you were away from the building was the sore or dry throat: 

1.Same ___ 2.Worse ___ 3.Better ___ 

25.4 In what month and year did you first have a sore or dry throat? __ __ / __ __ __ __ 

Month Year 

26.1 During the 4 weeks before returning to Oak Ridge Elementary School, did you have a nosebleed? 

1.Yes ___ 0.No ___ 

IF YES: 

26.2 Did you have nosebleeds one or more times per week during those 4 weeks? 

1.Yes ___ 0.No ___ 

7
 

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Appendix C: niosH MARCH 2010 QuestionnAiRe (Continued) 

26.3 When you were away from the building were the nosebleeds: 

1.Same ___ 2.Worse ___ 3.Better ___ 

27. During the 4 weeks before returning to Oak Ridge Elementary School did you have a cold? 

1.Yes ___ 0.No ___ 

28. During the 4 weeks before returning to Oak Ridge Elementary School did you have sinusitis or sinus 

problems? 1.Yes ___ 0.No ___ 

29.1 During the 4 weeks before returning to Oak Ridge Elementary School did you have bronchitis? 

1.Yes ___ 0.No ___ 

IF YES: 

29.2 Was it confirmed by a doctor? 1.Yes ___ 0.No ___ 

30.1 Do you have any nasal allergies, including hay fever?	 1. Yes ___ 0.No ___ 

IF YES: 

30.2 How old were you when you first had hay fever or nasal allergies? ______________ 

31. Have you ever had eczema or any kind of skin allergy? 1. Yes ___ 0.No ___ 

32.1 Has a physician ever told you that you have asthma?	 1. Yes ___ 0. No ___ 

IF YES: 

32.2 In what month and year were your first diagnosed with asthma? __ __ / __ __ __ __ 

Month Year 

32.3 Do you still have asthma? 1.Yes ___ 0.No ___ 

32.4	 During the last six months prior to returning to Oak Ridge Elementary School, how many times did 

you get treatment for an acute asthma attack at a doctor’s office, urgent care facility, or emergency 

department? _______Times 

33. During the 4 weeks before returning to Oak Ridge Elementary School, how many days did you miss 

work because of respiratory health problems? 

_______ Days 

34. During the 4 weeks before returning to Oak Ridge Elementary School, how many days did you miss 

work because of health problems other than respiratory? 

_______ Days 

Medications for Breathing Problems 

I am now going to ask you some questions about medication use in the four-week timeframe prior to 

Oak Ridge Elementary School re-opening on February 22, 2010; therefore from January 24, 2010 to 

February 21, 2010. 

35.1 During the 4 weeks before returning to Oak Ridge Elementary School did you use any prescription 

or over-the-counter medications for breathing problems? 1.Yes ___ 0.No ___ 

 IF YES: 

Health Hazard Evaluation Report 2009-0172-3124 Page 115 

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Appendix C: niosH MARCH 2010 QuestionnAiRe (Continued) 

35.2 In those 4 weeks, did you use any inhaled beta-agonists (quick-relief medicine, such as 

Albuterol or Proventil) for breathing problems? 1.Yes ___ 0.No ___ 

If yes to 35.2: 

35.3 Did you use your beta-agonist inhaler (quick-relief medicine, such as Albuterol or Proventil) on a 

daily basis during those 4 weeks? 1.Yes ___ 0.No ___ 

35.4 Did you use any over-the-counter inhalers or pills (e.g. Primatene) for 

breathing problems during those 4 weeks? 1.Yes ___ 0.No ___ 

36.1 During the 4 weeks before returning to Oak Ridge Elementary School did you use any prescription 

or over-the-counter medications for nasal-sinus or eye problems? 1.Yes ___ 0.No ___ 

IF YES: 

36.2 Select the prescription or over-the-counter medications you used for nasal-sinus or eye problems 

during those 4 weeks? 

͙Antihistamine pills (Claritin, Zyrtec, Allegra etc) 

͙Decongestant pills (Sudafed, etc) 

͙Decongestant nasal spray (Afrin, Otrivin, etc) 

͙Prescription nasal spray (Flonase, Nasalcrome, Atrovent nasal spray,etc) 

͙Eye drops (Visine, Clear eyes, Livostin, etc) 

͙Other (please specify _________________________________________ 

37. Have you ever been told by a physician that you had any of the following conditions? 

IF YES: 

Conditions Told by a physician you had it? Month and Year of 

first diagnosis? 

37.1 Hay fever or nasal allergies 1.Yes ___ 0.No ___ 

37.2 Sinusitis or sinus infections 1.Yes ___ 0.No ___ 

37.3 Eczema, dermatitis, or skin allergy 1.Yes ___ 0.No ___ 

37.4 Acute bronchitis 1.Yes ___ 0.No ___ 

37.5 Chronic bronchitis 1.Yes ___ 0.No ___ 

37.6 Emphysema 1.Yes ___ 0.No ___ 

37.7 Pneumonia 1.Yes ___ 0.No ___ 

37.8 Hypersensitivity pneumonitis 1.Yes ___ 0.No ___ 

37.9 Sarcoidosis 1.Yes ___ 0.No ___ 

37.10 Heart disease 1.Yes ___ 0.No ___ 

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Appendix C: niosH MARCH 2010 QuestionnAiRe (Continued) 

38.	 Did you work at Oak Ridge Elementary School during the 2008/2009 school year? 

1.Yes ___ 0.No ___
 

IF YES: 

39.1. Did you have any lower respiratory symptoms such as cough, shortness of breath, chest tightness, or 

wheezing while at work in the Oak Ridge Elementary School building during the 2008/2009 school year? 

1. Yes ___ 0.No ___ year 

IF YES 

39.2 When you were away from the Oak Ridge Elementary School building while it was closed for 

remediation were your lower respiratory symptoms: 1.Same ___ 2.Worse ___ 3.Better ___ 

40.1. Did you have episodes of watery, itchy eyes while at work in the Oak Ridge Elementary School 

building during the 2008/2009 school year? 

1.Yes ___ 0.No ___ 

IF YES 

40.2 When you were away from the Oak Ridge Elementary School building while it was closed for 

remediation were your watery, itchy eyes: 1.Same ___ 2.Worse ___ 3.Better ___ 

41.1. Did you have upper respiratory symptoms such as stuffy, itchy or runny nose; sore or dry throat; or 

sneezing while at work in the Oak Ridge Elementary School building during the 2008/2009 school year? 

1.Yes ___ 0.No ___ 

IF YES 

41.2 When you were away from the Oak Ridge Elementary School building while it was closed for 

remediation were your upper respiratory symptoms: 1.Same ___ 2.Worse ___ 3.Better ___ 

42.1. Did you have unusual tiredness or fatigue while at work in the Oak Ridge Elementary School 

building during the 2008/2009 school year? 1.Yes ___ 0.No ___ 

IF YES 

42.2 When you were away from the Oak Ridge Elementary School building while it was closed for 

remediation was your unusual tiredness or fatigue: 1.Same ___ 2.Worse ___ 3.Better ___ 

43.1. Did you have fever, chills, or flu-like symptoms while at work in the Oak Ridge Elementary School 

building during the 2008/2009 school year? 

1.Yes ___ 0.No ___ 

IF YES 

43.2 When you were away from the Oak Ridge Elementary School building while it was closed for 

remediation were your fever, chills, or flu-like symptoms: 1.Same ___ 2.Worse ___ 3.Better ___ 

Health Hazard Evaluation Report 2009-0172-3124 Page 117 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

Appendix C: niosH MARCH 2010 QuestionnAiRe (Continued) 

44.1. Did you have difficulty remembering things or concentrating while at work in the Oak Ridge 

Elementary School building during the 2008/2009 school year? 1.Yes ___ 0.No ___ 

IF YES 

44.2 When you were away from the Oak Ridge Elementary School building while it was closed for 

remediation was the difficulty remembering things or concentrating: 

1.Same ___ 2.Worse ___ 3.Better ___ 

45.1. Did you have headaches while at work in the Oak Ridge Elementary School building during the 

2008/2009 school year? 1.Yes ___ 0.No ___ 

IF YES 

45.2 When you were away from Oak Ridge Elementary School while it was closed for remediation 

were your headaches: 1.Same ___ 2.Worse ___ 3.Better ___ 

46.1. Did you have nosebleeds while at work in the Oak Ridge Elementary School building during the 

2008/2009 school year? 1.Yes ___ 0.No ___ 

IF YES 

46.3 When you were away from the Oak Ridge Elementary School building while it was closed for 

remediation were your nosebleeds: 1.Same ___ 2.Worse ___ 3.Better ___ 

47. Where was your primary work area during the 2008/2009 school year at Oak Ridge Elementary 

School? 

___k/1 wing ___2/3 wing _____4/5 wing ____administrative wing ___media center wing 

______gym area ______cafeteria ______other (please describe:____________________) 

48.1 Since the Oak Ridge Elementary School re-opening in February 2010, have you had any health 

symptoms that you consider possibly related to working in this building? 1. Yes ___ 0. No ___ 

IF YES 

48.2 Please describe:_________________________________________________________________ 

Work Information 

49. Where did you work when Oak Ridge Elementary School was closed

 for repair and remediation from August 2009 to February 2010? 

_____Oak Ridge Military Academy 

_____Colfax Elementary School 

_____Pearce Elementary School 

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________________________________________________________________________________________ 

________________________________________________________________________________________ 

Appendix C: niosH MARCH 2010 QuestionnAiRe (Continued) 

_____Northwest Middle School Campus 

_____Other (Please specify:______________) 

50. What is your current job title: 1._____Teacher 

2._____Teacher’s Aide 

3._____Clerical/Secretarial 

4._____Administration 

5._____Maintenance 

6._____Custodian 

7._____Librarian 

8. _____Counselor 

9._____Nurse 

10. ____Cafeteria worker 

11._____Other (please specify____________) 

51. When did you first start working at Oak Ridge Elementary School? ___ ___ /___ ___ ___ ___ 

Month Year 

52. Where is your current primary work area at Oak Ridge Elementary School? 

___k/1 wing ___2/3 wing _____4/5 wing ____administrative wing ___media center wing
 

______gym area ______cafeteria ______other (please describe :____________________) 

Tobacco Use Information 

I am now going to ask you a few questions about tobacco use. 

53.1 Have you ever smoked cigarettes? 1. ___ Yes 0. ___ No 

(NO if less than 20 packs of cigarettes 

in a lifetime or less than 1 cigarette a day for 1 year.) 

IF YES: 

53.2 How old were you when you first started smoking regularly? ______ Years old 

53.3 Over the entire time that you have smoked, what is the average number of cigarettes that you smoked 

per day? ______ Cigarettes/day 

53.4 Do you still smoke cigarettes? 1. ___ Yes 0. ___ No 

IF NO: 

53.5 How old were you when you stopped smoking cigarettes regularly? ______ Years old 

54. Do you have any comments or concerns that might contribute to our investigation? 

Thank you for participating in this survey! 

12 

Health Hazard Evaluation Report 2009-0172-3124 Page 119 
 

Appendix d: County deptARtMent oF puBLiC HeALtH stAteMent dAted 25 

June 2009 

25 June 2009 

In April 2009, the Guilford County Department of Public Health received a request to evaluate 

reports that the staff and students of Oak Ridge Elementary School (ORES) had been exposed to and had 

become ill from mold growth within the building. Since the request, Public Health staff has: 

1. Inspected the building 

2. Interviewed teachers and staff 

3. Attended the open forum at the ORES 

4. Reviewed environmental reports 

5. Met with School officials and administration 

6. Reviewed the medical literature pertaining to mold and human health 

7. Acquired information from representatives of the Centers for Disease Control and Prevention 

8. Acquired information from two EPA funded physicians expert on mold and human health 

9. Acquired information from the North Carolina Department of Public Health 

10. Constructed, administered, collated and interpreted a health survey of staff and parents/guardians of 

students at ORES 

The following statements represent our current understanding of the origin of the ORES concerns 

and recommendations based on the available science and medical knowledge. As with any diagnosis, our 

opinions are subject to change as inspections proceed at the school over the summer. 

Oak Ridge Elementary School is an amalgam of a renovated building and adjacent new 

construction. As many such large patchwork facilities experience, there were leaks in the roofline that 

allowed water to enter at various points. The indoor dampness elicited mold growth that ultimately 

became visible to parents and staff. Cultures were taken of the area in 2007 and yielded Aspergillus 

and Penicillium. The testing procedure is not standardized and there are no accepted guidelines to allow 

interpretation of results.) 

The Guilford County School Administration has hired and listened to numerous experts on indoor 

air quality. They have patched rooflines, diverted drainage channels, replaced drywall, and put down tile in 

place of carpet. The areas of the building which have dampness and mold have either been remediated or 

are in the process of remediation. 

The appropriate response to finding visible mold in any building is to find and to repair the leak, 

which allowed the moisture to enter, and to clean or to replace the surfaces where the mildew has grown. 

Further additional efforts are not medically indicated at this time. The detection of antibodies to molds in 

any person is expected and a sign of an intact and normal immune system. 

Page 120 Health Hazard Evaluation Report 2009-0172-3124 
Appendix d: County deptARtMent oF puBLiC HeALtH stAteMent dAted 25 

June 2009 (Continued) 

The purpose of our recent survey was to catalog the symptoms of students and staff. We asked 

in the survey whether during the last two years individuals had had dry eyes, rashes, allergic symptoms, 

headaches and the like. Approximately 800 surveys were distributed. Half of the surveys returned within 

the week’s deadline: a respectable response. A summary of the responses showed that the driving symptoms 

were headache and fatigue that occurred within the school and that resolved when fresh air was obtained by 

opening windows and doors to the classrooms, by going outside or by going home (see Appendices 1 and 2). 

Nosebleeds were also common. Other symptoms were tabulated, but their frequency was not as elevated; 

nor was there a specific pattern evident. 

The building appears to be under-ventilated. A century ago, all buildings were constructed to have 

large windows, high ceilings, front porches, fireplaces or steam radiators. It has been only within the last 

decades that we’ve closed the windows and truly moved indoors. Conditioned air, must be humidified or 

dehumidified, filtered or circulated, heated or cooled in combinations. As a consequence, some building 

dwellers have found that the absence of a constant source of large volumes of fresh air elicits headache, 

fatigue, difficulty concentrating and other, equally immeasurable but real symptoms. These symptoms are 

related to build up of CO2 or other human and building castoffs. The symptoms abate with larger amounts 

of circulated air. The symptoms detailed in the ORES survey match this pattern. Our own inspection of the 

building encountered many rooms in the school that needed more air flow for comfort. 

Another reported and frequent problem reported by staff and parents and found in the survey is 

nosebleeding (epistaxis). Nosebleeds are common in school-aged children. The two leading causes of 

nosebleeds are dry air and trauma (nose-picking). We know that the introduction of a dehumidifier last 

summer in response to the finding of mold resulted in dryer air this year compared to last. However, we 

found no significant difference between last year’s experience and this year’s with respect to nosebleeding. 

Regardless, rather than a sign of exposure to molds, nosebleeds are likely due to dry air. Dry air has been 

raised as a concern by the state’s environmental review. 

Beyond the survey, in direct interviews and in emails, teachers have reported an unusual clustering of 

students needing glasses. Twenty-five percent of children will develop refractive errors during these school 

years. The sudden increase in discovered refractive errors is due to the appropriate vigilance of the teachers 

for reading difficulties and then hyper-vigilance for others once the index cases were found. The continued 

surveillance of school-aged children for visual problems is encouraged, but there is no scientific or medical 

basis on which to blame a school’s environmental for students needing eyeglasses. Our recommendations 

continue to be: 

1. Focus on the HVAC system and recalibrate air exchanges according to the guidelines in the engineer’s reports; 

2. Reassess the settings on the carry our dehumidification system to assure the best settings for each 

season of the year. 

3. Take advantage of summertime school closings to continue to research possible causes of the symptoms. Invite official governmental and research agencies on iste for testing such as National Institute of Occupational Safety and Health (NIOSH), US Dept of Health and Human Services (USDHHS), and the Centers 

for Disease Control (CDC). 

Health Hazard Evaluation Report 2009-0172-3124 Page 121 
Appendix d: County deptARtMent oF puBLiC HeALtH stAteMent dAted 25 

June 2009 (Continued) 

References: 

Bush, R. K., Portnoy, J. M., Saxon, A. (2006). The medical effects of mold exposure. Journal of Allergy 

& Clinical Immunology 117(2), 326-333. 

CDC. (2006) Mold Prevention Strategies and Possible Health Effects in the Aftermath of Hurricanes and 

Major Floods. MMWR 55(RR08), 1-27. 

Chang, C. and Gershwin, M. E. (2005) Mold hysteria: Origin of the hoax. Clinical and Developmental 

Immunology 12(2), 151-158. 

Coats, D.K. and Paysse, E.A. Refractive errors in children. Available at www.uptodate. 

com. 

Geller R. (2006) Mold. Safe and Healthy School Environments. New York: Oxford University Press. 

Gomzi M, Bobic J, Radosevic-Vidacek B, et al. (2007) Sick building syndrome: psychological, somatic, 

and environmental determinants. Arch Environ Occup Health. 62(3), 147-55. 

Hansen AM, Meyer HW, and Gyntelberg F. (2008) Building-related symptoms and stress indicators. Indoor 

Air 18(6):440-6. 

Institute of Medicine. (2004) Damp Indoor Spaces and Health. Washington: National Academies Press. 

Messner, AH. Evaluation of epistaxis in children. Available at www.uptodate.com. 

NIOSH HEALTH HAZARD EVALUATION REPORT. HETA #2005-0112-2980 Taft Elementary 

School, Santa Ana, California. September 2005. Available at http://www.cdc.gov/niosh/hhe/reports. 

Norbäck D, Nordström K. (2008) Sick building syndrome in relation to air exchange rate, CO(2), room 

temperature and relative air humidity in university computer classrooms: an experimental study. Int Arch 

Occup Environ Health. 82(1), 21-30. 

Rabito, F. A., Iqbal, S., Kiernan, M.P. et al. (2008) Children’s respiratory health and mold levels in 

New Orleans after Katrina: A preliminary look. Journal of Allergy & Clinical Immunology. 121(3), 

622-625. 

Redd, S.C. 2002. State of the Science on Molds and Human Health. Statement for the Record Before the 

Subcommittees on Oversight and Investigations and Housing and Community Opportunity Committee on 

Financial Services. United States House of Representatives. Available at http://www.cdc.gov/mold/pdfs/ 

moldsci.pdf. 

Page 122 Health Hazard Evaluation Report 2009-0172-3124 
 

 

 

Appendix e: niosH eMAiL dAted 22 JuLy: HetA 2009-0172 – ReQuested 

suMMARy oF FindinGs disCussed duRinG tHe BReAKFAst MeetinG 

on 16 JuLy 2009 

From: Bailey, Rachel L. (CDC/NIOSH/DRDS) 

Sent: Wednesday, July 22, 2009 12:32 PM 

To: ‘Becoats, Eric J’ 

Cc: Bailey, Rachel L. (CDC/NIOSH/DRDS); Cox-Ganser, Jean (CDC/NIOSH/DRDS); Park, Ju-Hyeong (CDC/NIOSH/ 

DRDS) 

Subject: HETA 2009-0172 - Requested summary of findings discussed during the breakfast meeting on July 16, 

2009. 

Dr. Becoats, 

As requested, below is a summary of our interim findings discussed during the breakfast meeting on July 

16, 2009. 

We noted a strong musty, moldy odor from the basement and crawl space under the media center. Lime 

was observed on the crawl space floor. We also occasionally noted a musty smell in the corridor around 

the media center in particular near the school museum. We discussed that this problem should be 

mitigated such that no air from the basement and crawl space reaches the occupied space. 

We noted surface drainage issues around the school mainly between the 2/3 and 4/5 wings. Additionally, 

a storm drain outside the media center was blocked with standing water in it. Such issues may lead to 

water infiltrating the concrete slab. We discussed that these problems be addressed. 

The foam roof on the old section of the school had multiple damaged areas, and there did not appear 

to be adequate flashing at the junction between Room 206 and the Gym. Inside the school, we noted 

moisture (with the infrared camera) in the gym’s exterior concrete block wall where the bleachers are 

located. This was an area where a leak had been repaired. We addressed the need for the roof and 

flashing to be repaired. 

We noted pressure airflow issues between rooms and spaces. For example, the classrooms should 

generally have a positive pressure in regard to the corridor, and the bathrooms should have a negative 

pressure in regard to the outer room. This was not always the case. During the day, the attic was under 

positive pressure in regard to the exterior of the building. However at night when the dehumidifier 

(which serves the classroom wings) was turned off, this resulted in the attic being under negative 

pressure in regard to the outside of the building. This allowed outside humid air to enter the attic from 

the soffits. From the mezzanine area where the dehumidifier is located, we observed dust on classroom 

ceilings and ducts. We discussed that the Turner Group would be addressing solutions for these issues. 

From our initial inspection, it is possible that some of the coils for the HVAC air handlers may have 

mold contamination. As further discussed by the Turner Group, these issues will have to be addressed. 

We agreed that the classroom carpets should continued to be removed following appropriate protocols. 

We also discussed the need to evaluate the moisture levels of the concrete slab. 

Health Hazard Evaluation Report 2009-0172-3124 Page 123 
 

 

Appendix e: niosH eMAiL dAted 22 JuLy: HetA 2009-0172 – ReQuested 

suMMARy oF FindinGs disCussed duRinG tHe BReAKFAst MeetinG 

on16 JuLy 2009 (Continued) 

We appreciate the cooperation from Guilford County Schools and the faculty, staff, and parents of Oak 

Ridge Elementary School. We will continue to analyze the data from your school and will be providing 

you with an interim report in the future. If you have any questions or concerns, please feel free to 

contact us. 

Sincerely, 

Jean Cox-Ganser, Ph.D. 

Epidemiologist 

Ju-Hyeong Park, Sc.D., C.I.H. 

Industrial Hygienist 

Rachel L. Bailey, D.O., M.P.H. 

Medical Officer 

Respiratory Disease Hazard Evaluation and 

Technical Assistance Program 

Field Studies Branch 

Division of Respiratory Disease Studies 

Page 124 Health Hazard Evaluation Report 2009-0172-3124 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Appendix F: County depARtMent oF puBLiC HeALtH RepoRt on tHe FACuLty/ 

stAFF QuestionnAiRe ResuLts At tHe eLeMentARy sCHooL 

Guilford County Department of Public Health 

June 12, 2009 

Oak Ridge Elementary School 

Faculty/Staff Questionnaire Results 

Survey conducted between May 29 and June 5, 2009 

Completed Surveys: 50 of 88 faculty and staff 

Average age of teachers and staff: 44 Age range: 25-61 

Worked at school during the 08-09 school year: 96% 

Worked at school during the 07-08 school year: 92% 

Symptoms, 08-09 

Headache: 92%
 

Of those reporting headaches, 54.3% reported daily, 43.5% sometimes, and 2.2% rarely
 

Dry Eyes: 74%
 

Of those reporting dry eyes, 70.3% reported daily, 27% sometimes
 

Unusual Sneezing Episodes: 30%
 

Of those reporting sneezing, 26.7% daily, 53.3% sometimes, and 13.3% rarely
 

Difficulty Breathing/asthma attacks: 28%
 

Of those reporting breathing problems, 42.9% daily, 50% sometimes, and 7.1% rarely
 

Nosebleeds: 26%
 

Of those reporting nosebleeds, 7.7% daily, 53.8% sometimes, 15.4% rarely
 

Rashes: 10% 

Nausea: 14% 

Sinus problems: 20% 

Insomnia: 6% 

Dizziness: 22% 

Fatigue: 42% 

Sore throat: 18% 

Vision problems: 8% 

Other symptoms written in: 

Acid reflux: 6% 

Vomiting: 2% 

Allergy symptoms: 4% 

Eczema: 6% 

Bronchitis: 2% 

Pneumonia: 2% 

1 

Metallic taste in mouth: 8% 

Cough: 14% 

Health Hazard Evaluation Report 2009-0172-3124 Page 125 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Appendix F: County depARtMent oF puBLiC HeALtH RepoRt on tHe FACuLty/ 

stAFF QuestionnAiRe ResuLts At tHe eLeMentARy sCHooL (Continued) 

Trouble concentrating: 6%
 

Trouble remembering: 14%
 

Losing voice/hoarse: 8%
 

Watery eyes: 4%
 

Dry skin: 2%
 

Dry throat: 6%
 

Red eyes/burning 14%
 

Ear pressure/ache 8%
 

Miscarriage 2%
 

Muscle cramp 2%
 

Body aches/pain 4%
 

Lacerations on eyes 2%
 

Reduced sensation of taste, smell 2%
 

# of Symptoms reported: For the 2008-2009 school year, 6% of faculty/staff reported 

0 symptoms, 10% reported 1 symptom, 6% reported 2 symptoms, 18% reported 3 symptoms, 

22% reported 4 symptoms, 16% reported 5 symptoms, 12% reported 6 symptoms, 2% 

reported 9 symptoms, and 2% reported 10 symptoms. 

Did persons seek care for symptoms in 08-09? 

54% of all teachers/staff respondents sought care for their symptoms at a doctor’s office, ER or 

hospital. The most common source of care was the doctor’s office, with 24 persons reporting 

doctor visits. Reports of doctor visits range from one visit to more than 30 visits. Three 

individuals went to the emergency room for care, with one reporting 4 ER visits. Two persons 

were hospitalized for their symptoms. 

Symptoms, 07-08 

Headache: 72%
 

Of those reporting headaches, 36.1% reported daily, 58.3% sometimes, and 6.6% rarely
 

Dry Eyes: 56%
 

Of those reporting dry eyes, 42.9% reported daily, 53.6% sometimes
 

Unusual Sneezing Episodes: 16%
 

Of those reporting sneezing, 100% sometimes
 

Difficulty Breathing/asthma attacks: 14%
 

Of those reporting breathing problems, 28.6% daily, 71.4% sometimes
 

Nosebleeds: 10%
 

Of those reporting nosebleeds, 100% sometimes
 

Rashes: 

Nausea: 

Sinus problems: 

0% 

4% 

18% 

Insomnia: 

Dizziness: 

2% 

4% 

2 

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Appendix F: County depARtMent oF puBLiC HeALtH RepoRt on tHe FACuLty/ 

stAFF QuestionnAiRe ResuLts At tHe eLeMentARy sCHooL (Continued) 

Fatigue: 20% 

Sore throat: 8% 

Vision problems: 6% 

Other symptoms written in: 

Acid reflux: 2%
 

Bronchitis: 2%
 

Cough: 2%
 

Trouble concentrating: 4%
 

Trouble remembering: 6%
 

Losing voice/hoarse: 2%
 

Red eyes/burning 10%
 

Body aches/pain 4%
 

Reduced sensation of taste, smell 2%
 

# of Symptoms reported: For the 2007-2008 school year, 12% of faculty/staff reported 

0 symptoms, 18% reported 1 symptom, 20% reported 2 symptoms, 10% reported 3 

symptoms, 14% reported 4 symptoms, 4% reported 5 symptoms, 2% reported 6 

symptoms, and 6% reported 7 symptoms. 

Did persons seek care for symptoms in 07-08? 

34% of all faculty/staff respondents sought care for their symptoms at a doctor’s office, 

ER or hospital. The most common source of care was the doctor’s office with 14 persons 

reporting doctor visits. Reports of visits range from one visit to 20 visits. Three individuals went 

to the emergency room for care, with one person going to the ER on 5 occasions. Two persons 

reported being hospitalized. 

Is there a particular area of the building where persons experience more symptoms? 

Rooms listed include 406, 407, 421, 209, 405, 501, 423, 425, 405, 500 (2), 514, 518, 520, 606, 

613, and 617. Other areas include the media center (9 reports), lounge, main office (4 reports), 

Spanish room, 4/5 hallway (2 reports), testing room, and gym (2 reports) 

Pre-existing health conditions: 

Chronic respiratory disease: 2% 

Undergoing chemotherapy or radiation therapy: 0% 

Immune system suppressed by disease or other cause: 0% 

Allergic rhinitis: 8% 

Asthma: 8% 

Seasonal allergies: 32% 

Cystic fibrosis: 2% 

3 

Health Hazard Evaluation Report 2009-0172-3124 Page 127 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Appendix F: County depARtMent oF puBLiC HeALtH RepoRt on tHe FACuLty/ 

stAFF QuestionnAiRe ResuLts At tHe eLeMentARy sCHooL (Continued) 

When did symptoms start? 

2007-2008 or earlier 58% 

2008-2009 30% 

Missing 12% 

Of the symptoms being experienced, which are the worst? 

Headaches 32%
 

Dry or itchy eyes 18%
 

Fatigue 18%
 

Breathing 10%
 

Coughing 6%
 

Other symptoms listed: sinus problems, allergy symptoms, weight loss, dizziness, eczema 

on legs and arms, tightness in chest, metallic taste
 

When are symptoms generally worse? 

Beginning of the week: 22%
 

End of week: 38%
 

Particular days: All week, 28%, Monday, 2%, Friday, 2%
 

Morning: 30%
 

Afternoon: 58%
 

Particular times of day: After 4:00, 2%; All day, 8%; night time, 2%; random, 2%
 

Spring: 56%
 

Summer: 18%
 

Fall: 44%
 

Winter: 54%
 

Do symptoms go away after leaving the building: Yes = 72%, No = 18% 

How long does it take for the symptoms to go away: no clear pattern; responses range 

from a few minutes to a few days. 

Home Characteristics 

Does respondent smoke? Yes = 4%, No = 92% 

Are there others in household who smoke? Yes = 6%, No = 90% 

House type: House = 90%, Other = 6% 

Age of home: Mean 15 years old, range 2-40 

4 

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Appendix F: County depARtMent oF puBLiC HeALtH RepoRt on tHe FACuLty/ 

stAFF QuestionnAiRe ResuLts At tHe eLeMentARy sCHooL (Continued) 

Type of heat: Electric = 36%, Forced hot air = 10%, Gas = 46%, Oil = 2%, 

Steam = 2% 

Number of persons in household: 1 = 10%; 2 = 28%; 3 = 20%; 4 = 34%; 5 = 4% 

Pets in household: Yes = 58%, No = 38% 

Type of pet: dogs, cats and gerbils 

Humidifier: Yes = 24%; No = 72% 

Wall to wall carpet: Yes = 48%, No = 48% Water leaks? Yes = 6% 

5
 

Health Hazard Evaluation Report 2009-0172-3124 Page 129 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

Appendix G: County depARtMent oF puBLiC HeALtH RepoRt on pARent 

QuestionnAiRe ResuLts At tHe eLeMentARy sCHooL 

Guilford County Department of Public Health 

June 12, 2009 

Oak Ridge Elementary School 

Parent Questionnaire Results 

Survey conducted between May 29 and June 5, 2009 

Completed Surveys: 377 

Average age of children: 8.5 Age range: 5-12 

Child attended school during the 08-09 school year: 99.2% 

Child attended school during the 07-08 school year: 79.0% 

Child attended school during the 06-07 school year: 53.6% 

Child attended school during the 05-06 school year: 32.4% 

Child attended school during the 04-05 school year: 14.6% 

Symptoms, 08-09 

Headache: 47.7%
 

Of those reporting headaches, 22.8%% reported daily, 56.7% sometimes, and 17.8% rarely
 

Dry Eyes: 24.4%%
 

Of those reporting dry eyes, 27.2% reported daily, 54.3% sometimes, and 14.1% rarely
 

Unusual Sneezing Episodes: 22.8%
 

Of those reporting sneezing, 27.9% daily, 51.2% sometimes, and 11.7% rarely
 

Difficulty Breathing/asthma attacks: 12.8%
 

Of those reporting breathing problems, 4.3% daily, 69.4% sometimes, and 14.9% rarely
 

Nosebleeds: 19.6%
 

Of those reporting nosebleeds, 10.8% daily, 55.4% sometimes, 28.4% rarely
 

Rashes: 6.6% 

Nausea: 4% 

Sinus problems: 3.7% 

Insomnia: 0.8% 

Dizziness: 1.9% 

Fatigue: 4.8% 

Sore throat: 4.8% 

Vision problems: 1.6% 

Other symptoms written in: 

Vomiting and diarrhea: 2% 

Allergy symptoms: 1% 

Eczema: 2% 

1 

Bronchitis: 0.5% 

Pneumonia: 0.5% 

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Appendix G: County depARtMent oF puBLiC HeALtH RepoRt on pARent

 QuestionnAiRe ResuLts At tHe eLeMentARy sCHooL (Continued) 

Cough: 6% 

Trouble concentrating: 0.2% 

Trouble remembering: 0.2% 

Eyes red, burn, watery: 2% 

Dry itchy skin: 2% 

Dry throat: 0.2% 

Ear pressure/ache 2% 

Body aches/pain 3% 

Stuffy, runny nose 4% 

Irritable 0.5% 

Circles under eyes 0.8 

Number of Symptoms: For the 08-09 school year, 36.1% of parents reported 0 symptoms, 

20.2% reported 1 symptom, 18.0% reported 2 symptoms, 13.3% reported 3 symptoms, 6.9% 

reported 4 symptoms, 3.7% reported 5 symptoms, 1.6% reported 5 symptoms, and 1 parent 

reported 13 symptoms. 

Did persons seek care for symptoms in 08-09? 

23% of parents sought care for their child’s symptoms at a doctor’s office, with number of visits 

ranging from 1-15. Four parents sought care for their child at the emergency room and one 

parent had their child hospitalized 

Symptoms, 07-08 

Headache: 23.6%
 

Of those reporting headaches, 13.5% reported daily, 68.5% sometimes, and 11.2% rarely
 

Dry Eyes: 9.8%
 

Of those reporting dry eyes, 18.9% reported daily, 48.6% sometimes, 16.2% rarely
 

Unusual Sneezing Episodes: 12.2%
 

Of those reporting sneezing, 19.6% reported daily, 58.6% sometimes, and 8.7% rarely
 

Difficulty Breathing/asthma attacks: 7.7%
 

Of those reporting breathing problems, 10.3% daily, 65.5% sometimes, and 13.8% rarely
 

Nosebleeds: 8.0%
 

Of those reporting nosebleeds, 16.7% reported daily, 70% sometimes and 20% rarely
 

Rashes: 2.7% 

Nausea: 1.3% 

Sinus problems: 2.4% 

Insomnia: 0% 

Dizziness: 0.3% 

Fatigue: 1.9% 

Sore throat: 2.1% 

2 

Health Hazard Evaluation Report 2009-0172-3124 Page 131 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Appendix G: County depARtMent oF puBLiC HeALtH RepoRt on pARent

 QuestionnAiRe ResuLts At tHe eLeMentARy sCHooL (Continued) 

Vision problems: 0.3% 

Other symptoms written in: 

Vomiting and diarrhea: 2% 

Allergy symptoms: 1% 

Eczema: 2% 

Bronchitis: 0.5% 

Pneumonia: 0.5% 

Cough: 6% 

Trouble concentrating: 0.2% 

Trouble remembering: 0.2% 

Eyes red, burn, watery: 2% 

Dry itchy skin: 2% 

Dry throat: 0.2% 

Ear pressure/ache 2% 

Body aches/pain 3% 

Stuffy, runny nose 4% 

Irritable 0.5% 

Circles under eyes 0.8 

Number of Symptoms: For the 07-08 school year, 64.7% of parents reported 0 symptoms, 

14.9% reported 1 symptom, 9.3% reported 2 symptoms, 7.4% reported 3 symptoms, 2.4% 

reported 4 symptoms, 1.1% reported 5 symptoms, and 0.3% reported 6 symptoms. 

Did persons seek care for symptoms in 07-08?
 

23% of parents sought care for a child’s symptoms at a doctor’s office, with number of visits 

ranging from 1 to 10+. Four parents took their child to the emergency room for care and one 

parent reported having their child hospitalized due to his or her symptoms. 

Is there a particular area of the building where persons experience more 

symptoms? 

Nearly every room in the school was reported at least once. Rooms reported by more than one 

parent included 416, 418, 420, 424, 425, 500, 514, 515, 517, 518, 520, 521,610, 618, 619, and 

the music room. 

Pre-existing health conditions: 

Chronic respiratory disease: 

Undergoing chemotherapy or radiation therapy: 

Immune system suppressed by disease or other cause: 

Allergic rhinitis: 

Asthma: 

Seasonal allergies: 

Cystic fibrosis: 

1.1% 

0% 

0.5% 

8.2% 

11.7% 

33.4% 

0% 

3 

Page 132 Health Hazard Evaluation Report 2009-0172-3124 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Appendix G: County depARtMent oF puBLiC HeALtH RepoRt on pARent

 QuestionnAiRe ResuLts At tHe eLeMentARy sCHooL (Continued) 

When did symptoms start? 

2007-2008 or earlier 35% 

2008-2009 27% 

Missing 38% 

Of the symptoms being experienced, which are the worst? 

The most common reported “worst” symptom was headaches, followed by nosebleeds, coughs 

and congestion, asthma and breathing problems, eye problems and rashes. 

When are symptoms generally worse? 

Beginning of the week: 6.4% 

End of week: 15.6% 

Particular days: All week, 7.5%, specific days each less than 1% 

Morning: 10.3% 

Afternoon: 25.7% 

Particular times of day: No specific time of day reported by more than 1% 

Spring: 38% 

Summer: 9.8% 

Fall: 25.7% 

Winter: 28.9% 

Do symptoms go away after leaving the building: Yes = 37.1%, No = 22% 

How long does it take for the symptoms to go away: no clear pattern; responses range 

from improvement immediately after leaving the building to a few days. 

Home Characteristics 

Are there smokers in household? Yes = 4.8% 

Total smokers in household Eleven parents reported one smoker, two reported two 

smokers and one reported four smokers in the household. 

House type: House = 66.8%, Mobile home = 0.3%, Other = 0.5% 

Age of home: Mean 10 years old, range 1-80 

Type of heat: Electric = 19.6%, Forced hot air = 13.8%, Gas = 30.2%, Oil = 0.3%, 

Steam = 0.5% 

4 

Health Hazard Evaluation Report 2009-0172-3124	 Page 133 
 

 

 

 

 

 

Appendix G: County depARtMent oF puBLiC HeALtH RepoRt on pARent

 QuestionnAiRe ResuLts At tHe eLeMentARy sCHooL (Continued) 

Number of persons in household: Mean number = 4.3, Mode = 4; range from 2-9 

Pets in household: 43.5% reported pets in the household 

Type of pet: dogs and cats primarily, as well as hamsters, fish, mice, geckos, rabbits, turtles 

and gerbils
 

Humidifier: Yes = 20.4%
 

Wall to wall carpet: Yes = 35.3% Water leaks? Yes = 4.2%
 

Water stains: Yes = 0% Ceiling stains? Yes = 2.1%
 

Mold: Yes = 1.6%
 

5
 

Page 134 Health Hazard Evaluation Report 2009-0172-3124 
 

 

 

 

 

 

 

Appendix H: tHe tuRneR BuiLdinG sCienCe And desiGn pReLiMinARy 

RepoRt dAted 21 JuLy 2009 

Apprendix D: The H.S. Turner Group preliminary report 

TURNER 

GROUP TURNER BUILDING SCIENCE & DESIGN, LLC 

26 PINEWOOD LANE, HARRISON, MAINE 04040-4334 TEL: 207-583-4571 FAX: 207-583-4572 

www.hlturner.com www.turnerbuildingscience.com 

Oak Ridge Elementary School 

Very Preliminary Draft Indoor Air Quality Issues 

x Issue: Dirt floor crawl space under the original building is a likely source of 

mold. 

Observation: Occupant reports of mold odors, observation of conditions and 

odors in crawl space and basement. 

Preliminary Recommendation: Provide flexible vapor barrier (fire 

retardant?) and depressurization of air space under vapor barrier. 

x Issue: Inadequate flashing at junction between parapet wall and Gym wall above 

Room 206 causing water intrusion leading to mold growth in carpet. 

Observation: Flashing clearly appears to be mounted on surface rather than 

continuing through brick Gym wall to drainage plane, occupant reports of wetted 

materials in Room 206, observation of Room 206 walls, floor (newly painted cove 

base wavy, carpet stains. 

Preliminary Recommendation: Install through wall flashing at edge of 

parapet to connect through brick to drainage layer behind. 

x Issue: Repaired flashing at wall in Room 400 was once a leak source. 

Observation: Discolored drywall on exterior wall, occupant reports, mold found 

under cove base 

Preliminary Recommendation: Repair roof junction joints to provide 

adequate flashing 

x Issue: Dehumidification system operation suspect, evidenced by high humidity 

(70% +) in 4/5 wing, 

Observation: Measurement of relative humidity in hall, mechanical space and 

Room 520 (long-term) 

Preliminary Recommendation: Provide retro commissioning of HVAC 

system with respect to verify proper system capacity and sequence of 

operation, are all HP units involved with dehumidification system working 

BUILDING SCIENTISTS x IAQ CONSULTANTS 

Draft Issues 07-21-09.doc ¤Copyright 2009 

Health Hazard Evaluation Report 2009-0172-3124 Page 135 
 

 

 

 

 

 

 

 

 

Appendix H: tHe tuRneR BuiLdinG sCienCe And desiGn pReLiMinARy 

RepoRt dAted 21 JuLy 2009 (Continued) 

x Issue: Possible heat pump refrigerant leaks, 

Observation: Indicated by 64qF discharge at HP serving Room 520 and humidity 

levels monitored at 70%-80% in room, or quantity of outside air being handled 

exceeds that of coil capacity 

Preliminary Recommendation: Provide retro commissioning of HVAC 

system with respect to verifying proper system capacity and sequence of 

operation. 

x	 Issue: Classroom wings not sealed at soffit, allowing excess air leakage in and out 

(depending on mechanical system operation). 

Observation: Pressure measurements indicate indoor/outdoor delta P only 2-4 Pa 

(low) while providing approx. 10,000 cfm excess OA. Also noted that rooms 

with highest number of complaints tended to be near extended overhang or have 

two exposures of soffit. Verified air directon at soffit openings with chemical 

smoke. Dust on top of ductwork in attic space. 

Preliminary Recommendation: Sealing of soffit to prevent air 

infiltration. Note: If soffit sealed, provide means for exhaust/relief. 

Determine design logic for current system. Dirt/pesticide being drawn in 

through soffit? 

x	 Issue: Heat pump design conducive to growing mold due to proximity of filter
 

and cooling coil. 

Observation: Observation and photos of configuration. New filters installed- no 

signs of current mold growth on filters. 

Preliminary Recommendation: Provide new filter boxes upstream to 

create separation between coil and filter 

x	 Issue: Concerns about odors from dry traps, particularly at heat pump drains, 

since air is distributed to occupants. 

Observation: Traps at heat pumps had water when we observed, but addition of 

dehumidification systems will tend to dry out downstream traps. 

Preliminary Recommendation: Review maintenance tasks and 

schedules, On-going maintenance issue. 

Oak Ridge Elementary School
 

File: Draft Issues 07-21-09.doc Page 2 ¤Copyright 2009 

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Appendix H: tHe tuRneR BuiLdinG sCienCe And desiGn pReLiMinARy 

RepoRt dAted 21 JuLy 2009 (Continued) 

x Issue: Bathrooms not at negative pressure consistently with respect to hall. 

Observation: Measurements, drawings, and smoke test 

Preliminary Recommendation: Balance air flows as part of retro 

commissioning process, move some supply air to hall? 

x Issue: Mechanical room in Office area under significant negative pressure. 

Observation: Change in duct noise when opening door, May indicate excess 

leakage on the return side of ducts, insufficient outside air, etc. 

Preliminary Recommendation: Provide duct joint sealant on all RA 

(&SA?). Verify air flows on retro commissioning 

x Issue: Unknown issues regarding storm runoff at end of 2/3 and 4/5 wings. 

Observation: Drawing review seems to indicate the possibility of water getting 

under slab if it pools against exterior wall. Observations indicate possible 

plugged storm drains – downspouts could overcharge drainage. 

Preliminary Recommendation: Verify adequate site drainage and clean 

site drainage system as necessary. Provide means to limit runoff sand and 

other surface material 

x Issue: Original design of classroom wings modulated between 3.5 cfm/person and 

7.5 cfm/person from 1000 ppm CO2 to 1800 ppm. When dehumidification 

systems installed, carbon dioxide control eliminated and all areas receive 7.5 

cfm/person?? 

Observation: Original drawings and renovation drawings. Need confirmation of 

damper position (not clearly marked on damper shaft). No balancing report 

available. 

Preliminary Recommendation: Provide balancing of OA system and 

marking of dampers as part of retro commissioning project 

x Issue: Foam roof appears to be a concern. Numerous locations where the 

aluminum paint has been comprised. 

Observation: Many opened bubbles of foam. 

Preliminary Recommendation: Obtain roofing contractors estimate to 

repair/replace foam roof 

Oak Ridge Elementary School
 

File: Draft Issues 07-21-09.doc Page 3 ¤Copyright 2009 

Health Hazard Evaluation Report 2009-0172-3124 Page 137 
 

 

Appendix H: tHe tuRneR BuiLdinG sCienCe And desiGn pReLiMinARy 

RepoRt dAted 21 JuLy 2009 (Continued) 

x Issue: Occupant photos of room 500 indication possible leak from sewer vent 

and/or roof flashing of VTR 

Observation: Photos and observation of stained ceiling tile tees. 

Preliminary Recommendation: Replace or repair flashing. 

x Issue: Building not observed during occupied mode, some operational conditions 

not observed. 

Preliminary Recommendation: Provide monitoring of conditions during 

occupancy to evaluate operation under occupancy (after retro 

commissioning of systems) 

Oak Ridge Elementary School
 

File: Draft Issues 07-21-09.doc Page 4 ¤Copyright 2009 

Page 138 Health Hazard Evaluation Report 2009-0172-3124 
Appendix i: niosH eMAiL to pARents dAted 19 oCtoBeR 2009: 

HetA 2009-0172 

From: Bailey, Rachel L. (CDC/NIOSH/DRDS) 

Sent: Monday, October 19, 2009 12:58 PM 

To: ‘Becoats, Eric J’ 

Cc: Bobadilla, Leobardo; ‘Carr, Nora’ 

Subject: HETA 2009-0172 - Oak Ridge Elementary School 

Dr. Becoats, 

We have had some parents inquire about when the school will reopen and who will make the decision to 

open the school. Below is text from the email that was sent out to parents requesting this information. 

NIOSHemail.pdf 

Dear Parent, 

Guilford County Schools will determine when the school reopens, and NIOSH has no role to play in 

this decision. As you know in July 2009, we performed a three day site visit at Oak Ridge Elementary 

School at the request of Guilford County Schools. On the last day during a breakfast meeting, 

we met with representatives from Guilford County Schools and discussed our observations and 

recommendations. We discussed the following findings: 

1. Musty, moldy odor from the basement and crawl space under the media center 

2. Surface drainage/landscaping issues around the school 

3. Blocked storm drain with standing water 

4. Damaged roof 

5. Inadequate flashing 

6. Moisture in the gym’s exterior concrete block wall 

7. Pressure airflow issues between conditioned and unconditioned spaces 

8. Outside humid air entering through the classroom wing soffits 

After the site visit, we sent an email to the school administration that briefly summarized our 

conversation (please see attachment) and have been in contact with them since our visit. NIOSH has 

evaluated numerous buildings and has found that indoor environmental quality problems can generally 

be corrected using remediation practices that are fairly standardized. For Oak Ridge Elementary School 

these are the following: 1) remove carpet and replace with hard floors (after testing slab for moisture 

content), 2) install a vapor barrier and depressurize the crawl space under the media center, 3) repair the 

roof, 4) repair the flashing, 5) seal classroom wing soffits, and 6) recommission the HVAC system. 

Health Hazard Evaluation Report 2009-0172-3124 Page 139 
Appendix i: niosH eMAiL to pARents dAted 19 oCtoBeR 2009: 

 HetA 2009-0172 (Continued) 

Although the final report is not out, these specific issues and our recommendations were discussed with 

the school administration. We have found that remediation similar to what we recommended is easier to 

do when a building is not occupied and that health effects associated with dampness commonly continue 

and are made worse when remediation occurs in occupied buildings. Accordingly, we think the decision 

to close Oak Ridge Elementary School during the remediation to address the underlying issues of water 

intrusion, humidity, and ventilation was a prudent one. In our report, we are summarizing the many 

consultant reports and timeline of remediation of which we hope will be useful. However, we do not 

anticipate that the decisions regarding reopening the school are dependent on receipt of the final report. 

Sincerely, 

Jean Cox-Ganser, Ph.D. Epidemiologist 

Ju-Hyeong Park, Sc.D., C.I.H. Industrial Hygienist 

Rachel L. Bailey, D.O., M.P.H. Medical Officer 

Centers for Disease Control and Prevention 

National Institute for Occupational Safety and Health 

Division of Respiratory Disease Studies 

Field Studies Branch 

1095 Willowdale Road 

M/S H2800 

Morgantown, West Virginia 26505 

Page 140 Health Hazard Evaluation Report 2009-0172-3124 
 

 

Appendix J: eMC enGineeRs, inC. HvAC RetRo-CoMMissioninG

 RepoRt dAted deCeMBeR 2009 

FINAL REPORT 

Retro-Commissioning of HVAC Systems 

Oak Ridge Elementary 

Oak Ridge, NC 

Prepared for:
 

Guilford County Schools
 

EMC Project No. 1C409021.000 

December 2009 

Prepared by: 

E M C Engineers, Inc. 

706 Hillsborough Street, Suite 102 

Raleigh, NC 27603 

EMC Engineers, Inc. 1-1 December 2009 

Health Hazard Evaluation Report 2009-0172-3124 Page 141 
 Appendix J: eMC enGineeRs, inC. HvAC RetRo-CoMMissioninG

 RepoRt dAted deCeMBeR 2009(Continued)
 

INTENTIONAL BLANk PAGE 

EMC Engineers, Inc. 1-2 December 2009 

Page 142 Health Hazard Evaluation Report 2009-0172-3124 
 

 

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Table of Contents

1 Testing Summary ........................................................................................................ 6 
 

1.1 Water Source Heat Pumps .................................................................................... 6 
 

1.1.1 Heat Pump Graphics ..................................................................................... 6 
 

1.1.2 System Description ....................................................................................... 7 
 

1.1.3 System Testing .............................................................................................. 8 
 

1.1.4 Summary of Findings .................................................................................... 9 
 

1.1.5 System Parameters ...................................................................................... 11 
 

1.1.6 Conclusions & Recommendations .............................................................. 11 
 

1.2 Tempered Water System .................................................................................... 13 
 

1.2.1 Tempered Water System Graphics ............................................................. 13 
 

1.2.2 System Description ..................................................................................... 13 
 

1.2.3 System Testing ............................................................................................ 13 
 

1.2.4 Summary of Findings .................................................................................. 14 
 

1.2.5 System Parameters ...................................................................................... 15 
 

1.2.6 Conclusions & Recommendations .............................................................. 15 
 

1.3 Makeup Air Units ............................................................................................... 16 
 

1.3.1 Makeup Air Unit Graphics.......................................................................... 16 
 

1.3.2 System Description ..................................................................................... 17 
 

1.3.3 System Testing ............................................................................................ 18 
 

1.3.4 Summary of Findings .................................................................................. 18 
 

1.3.5 System Parameters ...................................................................................... 18 
 

1.3.6 Conclusions & Recommendations .............................................................. 19 
 

1.4 Exhaust Fans and Systems ................................................................................. 19 
 

1.4.1 System Description ..................................................................................... 19 
 

1.4.2 Summary of Findings .................................................................................. 19 
 

1.4.3 Conclusions & Recommendations .............................................................. 19 
 

List of Tables

Table 1: Supply Air Balance Test Sample.....................................................11 

Table 2: Loop water test and balance data.....................................................14 

Table 3: Boiler and Cooling Tower As-Found Set-points.....................................15 

Table 4: AHU-G Supply Air Balance............................................................18 

Table 5: AHU-G As-Found Set-points...........................................................19 

List of Figures

Figure 1: Heat Pump HP-22 graphic................................................................6 

Figure 2: Heat Pump HP-58 graphic ...............................................................7 

Figure 3: Tempered Water System Graphic ....................................................13 

Figure 4: AHU-E (screen 1)..........................................................................16 

Figure 5: AHU-E (screen 2)..........................................................................17 

EMC Engineers, Inc. 1-3 December 2009 

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 RepoRt dAted deCeMBeR 2009(Continued) 

List of Appendices

Appendix A – Scope of Work 

Appendix B – Issues Log 

Appendix C – TAB Verification 

Appendix D – Activity Reports 

Appendix E – Functional Tests 

Appendix F – Test & Balance Report 

Appendix G – Heat Pump Start-Up Log Sheets 

EMC Engineers, Inc. 1-4 December 2009 

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 RepoRt dAted deCeMBeR 2009(Continued) 

Executive Summary 

EMC was selected to perform retro-commissioning functional testing at Oak Ridge 

Elementary School, a part of the Guilford County Schools System (GCS). In addition 

to EMC, GCS retained the services of The Phoenix Agency to perform test and 

balance work on the process water and air distribution systems, and Systems 

Contractors, Inc. (SCI) to perform various mechanical and building automation 

system (BAS) repairs. Functional testing performed by EMC included point-to-point 

verification of field devices associated with each piece of mechanical equipment and 

verification of BAS graphic linkages, setpoints, and reporting.
 

The American Society of Heating and Refrigeration, and Air Conditioning Engineers 

(ASHRAE) defines building commissioning as “the process of ensuring that systems 

are designed, installed, functionally tested and capable of being operated and 

maintained to perform in conformity with design intent.” The owner of a facility 

can further define goals for commissioning according to their desired outcomes for 

the selected facility. This project was a retro-commissioning project and as such, did
 

not involve all aspects of commissioning found in new construction projects.
 

EMC was contracted for retro-commissioning of the building in November 2009. 

EMC performed a comprehensive review of the available plans, and was scoped to 

commission the following systems: 

x Building automation systems, including linkages to remote monitoring and control sites 

x Testing of building automation operator workstation graphics 

x Heat Pumps, water pumps, piping, and associated equipment 

x Make Up Air Unit 

x Hot Water, pumps, piping, condensate, cooling towers, heat exchangers and associated 

equipment 

x Local Boiler(s), combustion air systems, and boiler controls
 

x Exhaust fans, kitchen ventilation systems 

Functional acceptance testing of the systems generated over 150 items in the issues 

log. Those issues were addressed as work progressed. The complete issues log can 

be found in Appendix B. 

EMC Engineers, Inc. 1-5 December 2009 

Health Hazard Evaluation Report 2009-0172-3124 Page 145 
 

 

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 RepoRt dAted deCeMBeR 2009(Continued) 

1 Testing Summary 

1.1 Water Source Heat Pumps 

1.1.1 Heat Pump Graphics 

Below are screen captures which represent the typical heat pump graphics found on the 

Trane Tracer Summit front-end of the building automation system.
 

Figure 1 - Heat Pump HP-22 graphic 

EMC Engineers, Inc. 1-6 December 2009 

Page 146 Health Hazard Evaluation Report 2009-0172-3124 
 

 

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Figure 2 - Heat Pump HP-58 graphic 

1.1.2 System Description 

There are 58 water source heat pumps in the building, serving various spaces 

independently. The loop water condensing coils in the heat pump units are served 

by one hot water boiler for heating, and a cooling tower for cooling. There is also an 

associated plate-type heat exchanger used to transfer heat to or from the building 

loop. The building is divided into wings identified on plans as follows: 

x	 A/B - Multi-Purpose and Dining/Kitchen areas 

o	 Heat pump 1 serves the Central Receiving area 

o	 Heat pumps 2 through 5 serve the Multi-Purpose Room and 

associated stage areas 

o	 Heat pump 6 serves corridor and toilet spaces 

o	 Heat pumps 7 through 9 serve Kitchen and Dining areas 

o	 Heat pump 10 serves a Data Room 

o	 Heat Pump 11 serves the two P.E. offices and a small corridor 

x C/D - Offices and Media Center 

o	 Heat pump 58 serves the main corridor between the Offices and the 

Multi-Purpose Room 

EMC Engineers, Inc. 1-7 December 2009 

Health Hazard Evaluation Report 2009-0172-3124	 Page 147 
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 RepoRt dAted deCeMBeR 2009(Continued)
 

o	 Heat pumps 12 through 18 serve office spaces and are connected to a 

common outside air intake hood 

o	 Heat pump 19 serves a Data Room 

o	 Heat pump 21 serves the Media Center Workroom and Speech Room. 

This unit has a re-heat coil, which is intended to utilize loop water for 

control of supply air temperature during dehumidification of the 

associated spaces 

o	 Heat pumps 20 and 24 serve the corridors outside the Media Center. 

Each of these units has a re-heat coil, which is intended to utilize loop 

water for control of supply air temperature during dehumidification 

of the associated spaces 

o	 Heat pumps 22 and 23 serve the Media Center. Each of these units has 

a re-heat coil, which is intended to utilize loop water for control of 

supply air temperature during dehumidification of the associated 

spaces 

x	 E-Wing (400-series Classrooms) 

o	 Heat pumps 44 through 56 primarily serve classroom spaces, with a 

small portion of capacity utilized for support spaces within the wing. 

Each of these heat pumps is also connected to AHU-E for the purposes 

of introduction of outside air. These heat pumps are located on a 

mezzanine above this classroom wing 

x	 F-Wing (500-series Classrooms) 

o	 Heat pumps 35 through 43 primarily serve classroom spaces, with a 

small portion of capacity utilized for support spaces within the wing. 

Each of these heat pumps is also connected to AHU-F for the purposes 

of introduction of outside air. These heat pumps are located on a 

mezzanine above this classroom wing 

x	 G-Wing (600-series Classrooms) 

o	 Heat pumps 25 through 34 primarily serve classroom spaces, with a 

small portion of capacity utilized for support spaces within the wing. 

Each of these heat pumps is also connected to AHU-G for the 

purposes of introduction of outside air. These heat pumps are located 

on a mezzanine above this classroom wing 

Compressor staging and power characteristics of the heat pumps vary. The heat 

pump units all control space temperature by utilizing building loop water 

condensing coils. 

1.1.3 System Testing 

EMC was scoped to verify the TAB effort for diffusers and outlets of heat pumps, 

dedicated outdoor air system, exhaust and hydronic systems by witnessing 

measurements made by the TAB contractor. For a given heat pump unit, each 

EMC Engineers, Inc. 1-8 December 2009 

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EMC Engineers, Inc. 1-9 December 2009 

 

 

 

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 RepoRt dAted deCeMBeR 2009(Continued) 

diffuser was measured by the TAB contractor and recorded by EMC. EMC also 

verified outside air balance where applicable on heat pump units.
 

EMC was scoped to perform testing as follows: 

x 100% testing of Heat Pump operation
 

x
 100% testing on Makeup Air Units 

x 100% testing of heat exchange hydronic system, including pumps, heat exchangers, 

cooling tower and associated equipment 

x 100% testing of Supervisory Controls, Graphics, Schedules 

x 100% testing of Exhaust Fans 

Point-to-point testing included checking calibration of the space temperature sensor 

and discharge air temperature sensor for each heat pump. Verification of the 

calibration of humidity sensors, where applicable, was also performed. 

The functional test verification involved imposing varying degrees of heating and 

cooling demand on a unit, and recording whether or not the unit reacted properly 

with its associated compressor and/or control valves. 

1.1.4 Summary of Findings 

The following issues were commonly encountered by EMC, and subsequently 

addressed by various personnel: 

x	 The BAS was not scheduled to unoccupy any building equipment at any 

time. This 24/7/365 operation was discussed amongst the testing team and 

the decision was made to leave as found until the new schedule is 

implemented. The new recommended schedule is as follows: 

o	 Office and Media Center areas 

 Occupied 5 a.m. – 10 p.m. 

 Unoccupied 10 p.m. – 5 a.m. 

o	 Classroom wings and Gymnasium / Cafeteria 

 Occupied 6 a.m. – 10 p.m. 

 Unoccupied 10 p.m. – 6 a.m. 

o	 Data closets 

 Occupied continuously 

x Setpoint control was found to be from the BAS for all heat pumps.
 

x A significant number of heat pump discharge air temperature sensors were 

found to be out of range. This point is not critical to unit operation, but 

should read accurately in order to accurately convey heat pump operation 

x Various graphics errors on the Trane workstation in the boiler room 

x Low air flows in several heat pumps 

x All heat pump space temperature setpoints are independently controlled in 

the BAS, and do not follow any unified area control. EMC and Turner 

Building Sciences discussed this and a determination was made that global 

setpoints should be applied to the heat pumps, with local temperature sensor 

control 

Health Hazard Evaluation Report 2009-0172-3124	 Page 149 
 

 

 

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The following issues were isolated instances found by EMC and corrected: 

x	 Heat pump 11 was found to be capable of supplying less than the designed 

amount of air to the offices it served. SCI installed larger supply diffusers and 

Phoenix T&B proportioned supply to bring values to within 10% of design 

values 

x	 Sheaves for the fans of Heat pumps 48 and 55 were found to be adjusted 

incorrectly and setscrews damaged. Sheaves were replaced and Phoenix T&B 

adjusted to correct settings, which were then verified by EMC
 

x	 Heat pump 43 was not accessible from the F-Wing graphic. SCI personnel 

corrected this issue
 

x	 All Heat pumps were set up as members of a VAV Air System in Tracer
 

Summit. This was incorrect, and was later corrected. EMC verified the
 

corrections 

x	 A foreign object, measuring approximately 2’ x 2’ was found to have been 

placed inside one supply duct in the F-Wing (500-series rooms). This object 

appears to be a camping shower. The object was removed by Phoenix T&B 

personnel (see attached photograph) 

EMC Engineers, Inc. 1-10 December 2009 

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1.1.5 System Parameters 

Table 1 shows a sampling of the test and balance verification performed on the Heat
 

Pump Units: 

Table 1: Supply Air Balance Test Sample 

Supply Air Balance 

Heat Pump Design TAB Actual 

% 

Design 

HP-58 2400 2127 2162 90% 

HP-43 400 437 437 109% 

HP-17 1400 0 1425 102% 

HP-22 2000 0 1853 93% 

HP-23 2000 0 1886 94% 

HP-32 2200 0 2082 95% 

HP-24 1800 0 1792 100% 

HP-21 1250 0 1325 106% 

HP-29 2700 0 2534 94% 

HP-31 2700 0 2492 92% 

HP-51 2400 0 2716 113% 

HP-49 2400 0 2651 110% 

HP-50 1800 0 1890 105% 

HP-48 2500 2817 2823 113% 

HP-46 2400 2666 2360 98% 

HP-33 1800 0 1886 105% 

HP-35 1400 1473 1485 106% 

HP-39 2000 0 2051 103% 

HP-28 2000 0 1932 97% 

HP-26 1450 0 1422 98% 

1.1.6 Conclusions & Recommendations 

The majority of heat pumps have air flows within +/- 10% of design values. 

However, a small number of units exhibited air flow slightly beyond this threshold. 

Appendix F details each unit’s air flow values. The outside air units are providing 

air to the associated wings of the building, at volumes consistent with those 

specified by the designer. Based on the final Test and Balance Report, the units are 

operating generally within +/- 10% of design. 

Recommended setpoints are as follows: Heating Season (70 deg F); Cooling Season 

(74 deg F). In order to aid in maintaining acceptable indoor conditions, all outside 

doors as well as all operable windows should remain closed at all times. 

EMC Engineers, Inc. 1-11 December 2009 

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EMC recommends that regular air filter inspections be performed on all units, 

including the makeup air units, at least every 3 months per manufacturer’s 

recommendations, with filter changes conducted when visual inspection indicates 

necessity. 

Space temperature setpoints should be consistent within logical zones of the 

building, in order to help reduce the potential for wide temperature fluctuations
 

between that zone’s spaces. EMC recommends using global setpoint values in the 

Trane BAS, which are referenced in each heat pump controller. Logical zones with 

common setpoints should be as follows: 

x Classroom wings – common setpoint 

x Office and Media Center areas – common setpoint 

x Gymnasium and Cafeteria areas – common setpoint
 

x Data closets – common setpoint 

Recommended Trane BAS schedules for occupied and unoccupied operation of the 

system are as follows: 

x Office and Media Center areas
 

o Occupied 5 a.m. – 10 p.m. 

o Unoccupied 10 p.m. – 5 a.m.
 

x Classroom wings and Gymnasium / Cafeteria 

o Occupied 6 a.m. – 10 p.m. 

o Unoccupied 10 p.m. – 6 a.m.
 

x Data closets 

o Occupied continuously 

Recommended setpoint temperature offset of 5 degrees from occupied setpoints (i.e. 

unoccupied cooling setpoints 5 deg F higher than occupied cooling setpoints; 

unoccupied heating setpoints 5 deg F lower than occupied heating setpoints).
 

EMC Engineers, Inc. 1-12 December 2009 

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1.2 Tempered Water System 

1.2.1 Tempered Water System Graphics 

Below is a screen capture of the tempered water system graphic found on the Trane
 

Tracer Summit front-end of the building automation system.
 

Figure 3 – Tempered Water System Graphic 

1.2.2 System Description 

The condensing coils on the water source heat pump units are served by loop water, 

which is heated and cooled by a heat exchanger. This heat exchanger is piped to one 

(1) hot water boiler, and also one cooling tower. The loop water is circulated by two 

constant-speed pumps (P-1 and P-2). Water is pumped through the cooling tower 

by one (1) pump (P-3), and water is pumped through the hot water boiler by one (1) 

pump (P-4). The tempered water system maintains the loop water temperature 

between 60 and 82°F, all year round, so that the water source heat pumps can control 

space temperature effectively. 

1.2.3 System Testing 

EMC worked with the T&B Contractor to verify the water balance on the loop water. 

Table 2 below lists the findings of that work. 

EMC Engineers, Inc. 1-13 December 2009 

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Table 2: Loop water test and balance data 

# Description 

Disch. 

press 

(Feet) 

Suct. 

Press 

(Feet) 

Disch. 

SHUT 

OFF 

Head 

(FEET) 

Suct. 

SHUT 

OFF 

Head 

(FEET) 

Design 

Ft Head 

Total 

Design 

GPM 

As Found 

Measured 

GPM 

% of 

Design 

Meas. 

Tot. ft. 

head 

P-1 Loop Pump 80 11.74 86 15 145 875 800 91.4% 157 

P-2 Loop Pump 75.97 11.8 85 17.7 145 875 850 97.1% 148 

P-3 

Tower 

Pump 28.5 0.58 40.4 3.2 60 1050 920 87.6% 64.5 

P-4 Boiler Pump 25.5 2.2 35.5 3.8 55 160 175 109% 53.8 

EMC verified the control inputs and control outputs used in the operation of the 

Boiler, Cooling Tower, and Heat Exchanger. All control input data points 

corresponding to temperatures and humidity were verified for calibration within 

±1°F and ±3%RH respectively, with a NIST-traceable temperature and humidity 

measurement device provided by EMC. All digital commands, such as pump 

start/stop commands were visually verified for proper equipment reaction. All 

analog commands such as valve positions were visually verified for proper 

equipment reaction by sending commands of 0%, 50%, and 100% of scale from the 

Building Automation System (BAS). Valves were verified to fully open and close 

upon command. All applicable heat pump digital points, such as compressor 

start/stop were verified by commanding units to run or stop. All applicable heat 

pump and outside air unit control input data points such as temperature sensors 

were verified for calibration within ±1°F and ±3%RH respectively, with a NISTtraceable temperature and humidity measurement device provided by EMC. 

Upon satisfactory operation and accuracy of control input and output data points, 

EMC worked to verify that the sequence of operations was fully and correctly 

implemented, and that the transient changes in operation of the units were made 

apparent on the Graphics for the BAS. 

Any deficiencies that were found during controls verification were documented 

online by EMC in the WebCx database and were readily available to project team 

members, so that issues could be corrected, and EMC could verify the corrections. 

1.2.4 Summary of Findings 

The following were isolated instances found by EMC, and corrected: 

x No programming in place to rotate the building loop pumps upon failure of a 

pump. SCI personnel corrected this programming 

x The outside air temperature sensor was not calibrated. Also, the outside air 

humidity sensor was incorrectly terminated. Both of these were corrected by 

SCI personnel 

EMC Engineers, Inc. 1-14 December 2009 

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x All pumps in the main mechanical room were found to be operating in the 

“Hand” position – not being controlled automatically from the BAS 

1.2.5 System Parameters 

Table 3 shows the set-points found for the Boilers and Cooling Tower. 

Table 3: Boiler and Cooling Tower As-Found Set-points 

Set-point Name As-Found Value 

Condenser Water Loop Supply Temperature 75°F 

Boiler Loop Supply Temperature 145°F 

Boiler OA Disable 60°F 

Boiler Loop Temp Low-Limit Startup 50°F 

1.2.6 Conclusions & Recommendations 

After functional testing on the Tempered Water System, EMC is confident that the 

system will be able to maintain the loop water temperature, such that the water 

source heat pumps throughout the building will be able to maintain space 

temperature effectively. 

EMC Engineers, Inc. 1-15 December 2009 

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1.3 Makeup Air Units 

1.3.1 Makeup Air Unit Graphics 

Below are screen captures of the typical outside/makeup air unit graphics found on the 

Trane Tracer Summit front-end of the building automation system.
 

Figure 4 - AHU-E (screen 1) 

EMC Engineers, Inc. 1-16 December 2009 

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Figure 5 - AHU-E (screen 2) 

1.3.2 System Description 

x AHU-E provides conditioned outside air to the heat pumps associated with 

this wing of the building. The unit is connected to eight (8) water-to-water 

heat pump modules whose sole purpose is to condition the outside air prior 

to introduction into the building heat pumps 

x AHU-F provides conditioned outside air to the heat pumps associated with 

this wing of the building. The unit is connected to seven (7) water-to-water 

heat pump modules whose sole purpose is to provide cooling and re-heat 

capability for the conditioning of outside air prior to introduction into the 

building heat pumps 

x AHU-G provides conditioned outside air to the heat pumps associated with 

this wing of the building. The unit is connected to six (6) water-to-water heat 

pump modules whose sole purpose is to provide cooling and re-heat 

capability for the conditioning of outside air prior to introduction into the 

building heat pumps 

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1.3.3 System Testing 

EMC verified the air balance on AHU-G as a sample, by witnessing the Test and 

Balance contractor measure airflow on the unit under design conditions.
 

EMC verified the control inputs and control outputs used in the operation of the Air 

Handler. All control input data points corresponding to temperatures and humidity 

were verified for calibration within ±1°F and ±3%RH respectively, with a NISTtraceable temperature and humidity measurement device provided by EMC. All 

digital commands, such as supply fan start/stop, were visually verified for proper 

equipment reaction. All analog commands such as air damper position, and hot and 

chilled water valve positions were visually verified for proper equipment reaction 

by sending commands of 0%, 50%, and 100% of scale from the Building Automation 

System (BAS). Dampers were verified to fully open and close upon command.
 

Upon satisfactory operation and accuracy of control input and output data points, 

EMC verified that the sequence of operations was fully and correctly implemented, 

and that the transient changes in operation of the air handler were made apparent
 

on the Graphics for the BAS. 

Any deficiencies that were found during controls verification were documented and 

distributed by EMC, so that the Controls Contractor or Mechanical Contractor could 

correct the issues, and EMC could verify the corrections. Appendix B contains the 

list of issues discovered and resolved. 

1.3.4 Summary of Findings 

The following issues were found by EMC: 

x	 The makeup air units were found to trip on freezestat (low temperature limit) 

when outside air temperatures fell below 29 degrees. Trends were set up in 

the BAS to capture system parameters at the time of trip.
 

x	 Outdoor air sensor location was discovered to be incorrect, resulting in 

readings not reflective of actual outdoor air conditions. The sensor was 

relocated to a proper location on the north wall of the main mechanical room 

and verified by EMC.
 

1.3.5 System Parameters 

Table 4 shows the air balance on AHU-G, as witnessed by EMC. 

Table 4: AHU-G Supply Air Balance 

Design (CFM) Measured 

(CFM) 

Average 

FPM Percent of Design 

3490 3402 922.7 97% 

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Table 5 shows the set-points found for AHU-G. 

Table 5: AHU-G As-Found Set-points 

Set-point Name As-Found Value 

Winter Discharge Temp 70°F 

Summer Discharge Temp 70°F 

Dehumidification Start 60% 

1.3.6 Conclusions & Recommendations 

EMC will schedule to be onsite the first week of May, 2010 to confirm proper cooling 

season operation of the makeup air units, heat pumps, and associated systems. 

1.4 Exhaust Fans and Systems 

1.4.1 System Description 

There are seventeen (17) Exhaust Fans installed, which serve various mechanical 

equipment spaces, kitchen spaces, janitor’s closets, art classroom kiln spaces, and 

bathrooms. Exhaust fans serving bathrooms and janitor’s closets are controlled by 

the BAS through the starting and stopping of the associated water source heat 

pump’s fan. Exhaust fan 17 is controlled by a local wall thermostat in the main 

electrical room, behind the boiler room. Exhaust fan 16 is controlled by the BAS, and 

serves the boiler room. This fan runs continuously. 

System Testing 

EMC was scoped to verify sequence of operations on 100% of the exhaust fans, by 

performing a functional test. The functional test involved imposing start/stop 

commands on the exhaust fans from the BAS, and recording whether or not the 

exhaust fans reacted properly. 

1.4.2 Summary of Findings 

The following issues were isolated instances found by EMC, and corrected: 

x Exhaust fans 1, 3, 4, 5, 6, and 10 would not respond (start/stop) when the 

associated heat pumps were occupied/unoccupied) 

x	 The exhaust duct to the janitor’s Closet outside the Multi-Purpose Room was 

not connected to the ceiling grill. This resulted in no exhaust from the space, 

and likely contributed to objectionable odors in the vicinity 

x	 Exhaust Fan EF-9 was not accessible due to being located above the rated 

ceiling in the F-Wing. Necessary access was cut in beneath the fan 

A substantial number of dampers located above rated ceilings were not 

accessible due to the absence of access doors or panels. Access was 

subsequently cut in 

1.4.3 Conclusions & Recommendations 

The exhaust fans are operating correctly. No recommendations at this time. 

EMC Engineers, Inc. 1-19 December 2009 

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dAted 8 JAnuARy 2010 

OVERVIEW OF WORk COMPLETED TO IMPROVE
 

INDOOR AIR QUALITY AND HVAC OPERATION 

OAk RIDGE ELEMENTARY SCHOOL
 

OAk RIDGE, NORTH CAROLINA
 

JANUARY 2010
 

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dAted 8 JAnuARy 2010 (Continued) 

TURNER 

GROUP T H E H. L. T U R N E R G R O U P I n c .
 

27 LOCKE ROAD, CONCORD, NH 03301-5417 TELEPHONE: 603-228-1122 FAX: 603-228-1126 

January 8, 2010 

Mr. Leo Bobadilla Via Email: bobadil@gcsnc.com 

Chief Operations Officer 

Guilford County Schools 

617 West Market Street 

Greensboro, NC 27401 

SUBJECT: Report on Work Completed at Oakridge Elementary School 

Oakridge, North Carolina 

TBS Project #S0873-01 

Dear Mr. Bobadilla: 

In accordance with our approved Scope of Services, we are pleased to offer the following report of our 

observations and analysis of the indoor air quality, building envelope, and HVAC systems at the Oakridge 

School in Oakridge, North Carolina. The work performed was in accordance with our approved Scope of 

Services dated July 10, 2009, and as amended on July 29, 2009. Our final site visit was completed on 

December 17, 2009. 

An analysis of the adequacy of indoor air quality provided to the occupants of the school is the focus of this 

work effort. During our analysis, we have taken into consideration US EPA, State of North Carolina, and 

other professional guidance concerning indoor air quality within school facilities. Our site observations, 

building environmental measurements, and air sampling are the basis of all our recommendations. 

The enclosed report is of a technical nature. Therefore, to evaluate the recommendations made herein 

properly, it is recommended that the reader have technical knowledge of the facility. 

The H.L. Turner Group Inc. (TTG) has enjoyed the opportunity to serve as professional consultants to 

Guilford County Schools. Please contact me if you have any questions or need further clarification of any 

items within this report. You can reach me at our Vermont office at (802) 592-3097, Mr. William Turner in 

our Harrison, Maine office at (207) 583-4571, ext. 11, or Mr. Steven Caulfield at ext. 14. 

Sincerely, 

THE H.L. TURNER GROUP INC. 

Frederick T. McKnight, P.E. 

Chief Indoor Air Quality Engineer 

William A. Turner P.E. 

Senior Vice President 

Steven M. Caulfield, P.E. 

Senior Vice President 

FTM/sai Enclosures 

cc: /James Smith, GCS/Gerald Greeson, GCS/Alex Elkan 

ARCHITECTS x ENGINEERS x BUILDING SCIENTISTS x CONSTRUCTION MANAGERS 

Turner_final_report.doc ¤Copyright 2010 

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dAted 8 JAnuARy 2010 (Continued) 

TABLE OF CONTENTS 

1.0	 EXECUTIVE SUMMARY....................................................................................... 1 

1.1 Summary of Recommendations .................................................................... 3 

2.0	 BUILDING DESCRIPTION .................................................................................... 5 

3.0	 OBSERVATIONS AND TESTING......................................................................... 5 

3.1	 Additional Services ....................................................................................... 6 

3.2	 Protocols for Improvement ........................................................................... 6 

4.0	 RESULTS AND DISCUSSION OF RESULTS ....................................................... 7 

4.1	 Work Completed to Limit Potential for Mold Growth ................................. 8 

4.1.1 Removal of Water Damaged Building Material ............................... 8 

4.1.2 Installation of Replacement Flooring................................................ 9 

4.1.3 Modifications to Existing Heat Pumps ............................................. 9 

4.2	 Work Completed to Limit Water Intrusion ................................................... 10 

4.2.1 Site Work to Limit Possible Liquid Water Entry .............................. 10 

4.2.2 Roof and Flashing Work to Limit Liquid Water Entry ..................... 10 

4.3	 Work Completed to Limit Water Vapor and Unplanned Air Flows ............ 11 

4.3.1 Crawl Space Moisture and Microbial Control .................................. 11 

4.3.2 Soffit Sealing: Controlling Unplanned Air Flow and Humidity ....... 12 

4.3.3 Waste Piping Vent Line Repairs ....................................................... 13 

4.4	 Work Completed to Meet Design Air Flows ................................................ 13 

4.4.1	 Retro-Commissioning, Terminal Air Balancing Controlling
 

Unplanned Air Flows, and Maintaining Humidity Levels ................ 13 

4.5 Final Cleaning .............................................................................................. 14 

5.0	 RECOMMENDATIONS .......................................................................................... 15 

5.1	 Preliminary Recommendations ..................................................................... 15 

5.2 Additional Recommendations....................................................................... 15 

Recommendation #1: New Floor Maintenance Systems and Schedules ................. 15 

Recommendation #2: Limiting Noise ...................................................................... 15 

Recommendation #3: Do Not Use Textile Floor Coverings .................................... 15 

Recommendation #4: Use Track-Off Mats and Limit Exiting to Control Dirt 

Levels .................................................................................... 15 

Recommendation #5: Occupied Temperature Set Points ........................................ 16 

Recommendation #6: Occupied Cycles ................................................................... 16 

Recommendation #7: Additional Monitoring of Space Temperatures, Humidity, 

and Ventilation Rates ............................................................ 16 

Recommendation #8: Additional Engineering Services to Increase Energy 

Efficiency .............................................................................. 16 

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APPENDICES 

Appendix A: Protocols for Improvement
 

Appendix B: Material Removal Spore Trap Clearance Tests 

Appendix C: Final Cleaning Spore Trap Clearance Tests
 

Appendix D: Temperature and Humidity 

Appendix E: Blower Door Test Results 

Appendix F: Concrete Moisture Tests 

Appendix G: Photos 

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1.0 EXECUTIVE SUMMARY 

At the request of Ms. Heather Larkin and Mr. Leo Bobadilla, The H.L. Turner Group Inc. 

(TTG) conducted an initial building evaluation in conjunction with NIOSH, and 

subsequently produced a series of protocol documents providing detailed recommendations 

for improvement. Our work also included a series of site visits to observe work completed 

by contractors and school personnel that was based on the written protocols. This report 

concludes all currently approved observations, measurements, and sampling as outlined in 

our approved Scope of Services dated July 10, 2009, and an addendum dated July 29, 

2009. (Note: Additional site work has yet to be completed as noted below, and additional 

work may be required to complete the new recommendations made herein.) 

These recommendations focus on changes in operation and maintenance procedures for the 

building. The recommendations are made because of the modifications made to the 

existing building envelope and HVAC systems. The building modifications were 

completed based on a series of recommendations that were made after our initial site visit, 

which was completed in conjunction with a site visit from a NIOSH team of health experts. 

The initial recommendations were outlined on July 21, 2009 in our report “Oak Ridge 

Elementary School Very Preliminary Draft Indoor Air Quality Issues”. 

The building was not occupied during our evaluations; therefore, direct observation of the 

spaces, when occupied, was not possible. However, reports completed by other 

consultants prior to our work that included some measurements of indoor conditions 

during occupancy were made available for our use. Our analysis and recommendations 

made in previous reports, and made herein, are based primarily on our observations, test 

results, available reports from other consultants, and our understanding of guidelines and 

standards published by ASHRAE, ACGIH, NIOSH, USEPA, and the State of North 

Carolina concerning the indoor environment of educational facilities. 

We anticipate that the work completed to decrease unplanned airflows, increase the 

building ventilation rates, improve control of space humidity, remove and replace building 

materials, improve site drainage, as well as complete air and water balancing and 

commissioning the mechanical system, will improve the air quality within the facility. 

However, if occupants begin to acquire symptoms typical of poor air quality, then further 

building evaluations and assessments may be required. 

The Guilford County Schools system reportedly is working to implement the USEPA 

Tools for Schools program for all schools in the county. When completely implemented 

the Tools for Schools program will provide a framework for professional staff, parents, 

maintenance staff, and the school administrators to identify and assign resources to make 

improvements to address indoor air quality concerns. 

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In essence, our evaluations, observations, and resulting test reports indicate the following: 

x That there are no amplified microbial sources contributing spores to the indoor air 

of the tested spaces of the Oak Ridge School. 

x Initial air balancing measurements indicated some HVAC units were not meeting 

the design airflow parameters. 

x

x

Modifications to the existing HVAC systems combined with balancing and retrocommissioning of the systems have verified that the building HVAC systems are 

now operating within the parameters of the initial design. 

Cleaning of dust accumulations on the coils and the fan casings of the heat pumps 

has been completed. 

x Envelope repairs to the soffit, crawl space, and to the clerestory have been 

completed to minimize the impact of unplanned air flows. 

x Building repairs to walls and roofs have eliminated known sources of moisture 

intrusion. 

x Modifications to the existing plumbing vent piping have helped to reduce emission 

of odors into the occupied space. 

x Removal and replacement of textile floor coverings with vinyl tiles and removal of 

glue-on ceiling tiles have decreased the risk of future amplified microbial sources 

being found within the building. 

x Modifications to the existing HVAC system with respect to the location of filters 

and cooling coils have been completed to minimize the opportunity for the coils to 

wet the filter surfaces and promote mold growth. 

x The building has been thoroughly cleaned as part of the remediation project. A 

series of spore trap samples has indicated that the indoor environment has fewer 

spores than the outdoor air, suggesting that the indoor spaces do not have sources 

of amplified microbial growth. 

In addition, some site work has not yet been completed, due to seasonal climate and 

weather conditions. The work may not be completed until spring of 2010. The site work 

is intended to minimize the amount of surface run-off that pools next to the building during 

torrential storm events. 

Additional recommendations made herein include: 

x Installing track-off mats to control the amounts of dirt and other material tracked 

into the building. 

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x	 Restricting the use of classroom fire-exit doors to only those doors that have trackoff matting systems in place. 

x	 Not reintroducing textile floor covings (throw rugs) back into the spaces with 

ground contact flooring.
 

x	 The hard nature of the new flooring will increase the reverberation of noise and
 

will do little to absorb noise energy. Measures including placing felt pads on 

movable furniture are recommended.
 

x	 Floor maintenance and cleaning schedules will need to be adjusted for the new 

floor types installed.
 

x	 Temperature set points and offsets recommended by the commissioning agent are 

recommended, and occupied/unoccupied scheduling of HVAC equipment is also 

recommended.
 

x	 Additional monitoring of space temperatures, humidity, and ventilation rates to 

verify system operation and capacity. 

x	 Additional engineering studies to provide options to improve building air and heat 

leaks found in thermal images.
 

1.1 Summary of Recommendations 

See July 21, 2009 report Oak Ridge Elementary School Very Preliminary Draft Indoor Air 

Quality Issues for details on the preliminary recommendations. The preliminary 

recommendations are summarized below. Additional recommendations are also
 

summarized below. See Section 5 for more details on the additional recommendations 

made herein.
 

Preliminary Recommendations: 

1. Crawl Space: Provide flexible vapor barrier (fire retardant?) and depressurization of 

air space under vapor barrier. 

2. Install through-wall flashing at edge of parapet to connect through brick to drainage 

layer behind. 

3. Repair roof junction joints to provide adequate flashing. 

4. Provide retro-commissioning of HVAC system with respect to verifying proper
 

system capacity and sequence of operation. 

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5.	 Provide retro-commissioning of HVAC system with respect to verifying proper
 

system capacity and sequence of operation. 

6. Sealing of soffit to prevent air infiltration. (Note: If soffit is sealed, provide means 

for exhaust/relief.) 

7. Provide new filter boxes upstream to create separation between coil and filter. 

8. Review maintenance tasks, schedules, and on-going maintenance issues. 

9.	 Balance air flows as part of retro-commissioning process; move some supply air to
 

hall.
 

10. Verify air flows on retro-commissioning. Provide duct joint sealant on all RA &
 

SA if necessary.
 

11. Verify adequate site drainage and clean site drainage system as necessary. Provide 

means to limit run-off sand and other surface material.
 

12. Provide balancing of OA system and marking of dampers as part of retrocommissioning project. 

13. Obtain roofing contractors estimate to repair/replace foam roof. 

14. Replace or repair flashing. 

15. Provide monitoring of conditions during occupancy to evaluate operation under 

occupancy (after retro-commissioning of systems). 

Additional Recommendations: 

Recommendation #1: New Floor Maintenance Systems and Schedules 

Recommendation #2: Limiting Noise
 

Recommendation #3: Do Not Use Textile Floor Coverings 

Recommendation #4: Use Track-Off Mats and Limit Exiting to Control Dirt Levels
 

Recommendation #5: Occupied Temperature Set Points
 

Recommendation #6: Occupied Cycles
 

Recommendation #7: Monitoring of Occupied Spaces for Temperature, Humidity and
 

Ventilation Rates
 

Recommendation #8: Additional Engineering Services to Increase Energy Efficiency 

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dAted 8 JAnuARy 2010 (Continued) 

2.0 BUILDING DESCRIPTION 

The facility reportedly underwent a major renovation six years ago. During that 

renovation, the majority of the interior finishes were replaced, some materials such as the 

media center floor were refurbished, and new mechanical and electrical systems were 

installed. The school facility included a main building and remote buildings (i.e. remote 

from the main building, but within the current site). The renovations included building 

additions that connected all of the buildings on-site into a single continuous facility (under 

one roof). The subject areas of our evaluation were all normally occupied spaces within 

the Oak Ridge Elementary, and other spaces that may be affecting the occupied spaces, 

such as crawl spaces and utility rooms. 

The walls (in general) based on observation, are composed of a brick facade. The new 

classroom wings (400 wing, 500 wing, and 600 wing) and the administration wing have a 

cavity frame wall behind the facade. The structure is light gauge steel framing with an 

exterior grade gypsum sheathing covered with 1" thick rigid insulation board. The cavity 

space is filled with 6" fiberglass batt insulation with a Kraft-type paper backing. The 

interior side of the cavity is covered with paper faced interior grade gypsum board. The 

wall in the gym/cafeteria wing is a CMU block wall behind the exterior brick facade. The 

original building is a solid brick wall in lieu of a brick facade. The interior finish of the 

media center is a plasterboard or gypsum board on strapping attached to the brick. 

Doors and windows are steel framed; doors are steel panel and glass, with a varying 

proportion of glass. Windows are thermo-pane-type with double-glazing. The frame types 

are either fixed-type, or combination fixed and operable sliding casement-type. All floors 

except those in the media center wing are slab-on-grade poured concrete. The media 

center wing has wood floors supported by wood framing above a crawl space. 

Roofs are a combination of flat (low pitch) and pitched roofs. Reportedly, the pitched roof 

is comprised of a metal exterior roof panel mounted on a 3" thick foam gypsum board 

panel that is mounted on a 1-1⁄2" metal roof deck. The flat roofs are either a ballasted builtup bituminous roof, rolled roofing, or a foam-in-place roof. Components that lie under 

these roofs were not observed, except for the media center where the roof deck and 

structure are wood. The finished ceiling is predominately a suspended lay-in ceiling. 

Some exceptions include the gym, which has no finished ceiling and utility rooms. 

3.0 OBSERVATIONS AND TESTING 

A series of tests and observations were completed in our initial site visit. The test results 

and the observations that were of concern to us were briefly reported in our July 21, 2009 

report Oak Ridge Elementary School Very Preliminary Draft Indoor Air Quality Issue. 

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3.1 Additional Services 

As a result of our initial recommendations, an addendum to expand our Scope of Services 

was requested by the school administration. The addendum, dated July 29, 2009, included 

performing additional analysis and providing written protocols detailing the 

recommendations made in the preliminary report. 

Additional testing completed after our initial site visit included: 

x Measuring concrete moisture emission rates. Concrete emissions tests were 

conducted by others. Test results were made available to us. We completed 

additional real-time moisture content measurements of selected concrete floors. 

x

x

Observing wall conditions for visible mold behind selected walls finishes with 

vinyl wallpaper. 

Completing observations of the clerestory space above the media center ceiling for 

both visible mold and conditions that may result in unplanned air flows. 

x The exterior sides of the building walls were scanned with a thermal imaging 

camera (Flir ModelB360) to locate air leaks. The scans were completed before the 

recommended soffit sealing was begun, and then again, after the soffit sealing was 

completed. The tests completed after the soffit sealing included a series of scans 

taken during occupied cycle, and a scan completed during unoccupied cycle. 

x Blower door testing was completed in conjunction with the thermal scans to 

quantify the air leakage. The blower door tests were completed with the HVAC 

system in unoccupied cycle in order to measure the total pressure induced leakage 

rate. 

3.2 Protocols for Improvement 

A number of protocols were assembled based on the preliminary recommendations. The 

protocols are detailed recommendations for improvement of specific conditions observed. 

It is our understanding that the protocols were used to develop plans and specifications that 

the school department used to solicit bids to make the recommended improvements. 

Below is a summary list of protocols released under this project. The protocols are 

available for review in Appendix A. 

x Air and water balance (with respect to retro-commissioning) (10/08/09) 

x Automatic controls (with respect to retro-commissioning) (10/08/09) 

x Coil cleaning (including heat pump casing) (10/08/09) 

x Crawl space venting (including vapor barrier) (10/08/09) 

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x	 Filter boxes (and return duct modifications) (10/08/09) 

x	 Filter returns (10/08/09) 

x	 Final cleaning (11/24/09) 

x	 Oak Ridge carpet removal (including removal and cleaning of all contents) 

(8/13/09) 

x	 Oak Ridge glue-on ceiling tile removal (10/18/09) 

x	 Oak Ridge VCT (8/13/09) 

x	 Retro-commissioning (10/08/09) 

x	 Roof flashing (and miscellaneous roofing repairs) (10/08/09) 

x	 Soffit (10/20/09) 

x	 Site work comments on submitted plan (11/20/09) 

4.0 RESULTS AND DISCUSSION OF RESULTS 

The focus of all the work completed included: 

x	 Removal of flooring textiles and other building materials that had a high potential 

to promote microbial growth. 

x	 Minimizing unplanned air flows. 

x	 Increasing control over the indoor humidity. 

x	 Measuring and adjusting outdoor air flow to meet the intent of the initial design 

(7.5 CFM/Occupant as set by building codes of the State of North Carolina). 

The textile floor coverings were replaced with solid vinyl tiles. Other removed materials 

were replaced with new suitable materials where the proper function of the building 

required replacement. (Note: Some materials such as the glue-on ceiling tiles were 

removed without replacement, because the tiles did not affect the function or appearance of 

the building.) 

The recommendations for improvement fall into four major groupings: 

x	 Work needed to reduce the potential for mold growth. 

x	 Work needed to reduce potential moisture intrusions. 

x	 Work needed to control water vapor in air (humidity), including correction of 

unplanned air flows. 

x	 Work needed to correct the building operation to verify that it meets the initial 

design intent with respect to air flows, system capacity, and operation. 

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After all interior work was completed, the building was given a final thorough cleaning 

where all surfaces were vacuumed or damp wiped, floors were vacuumed, wet cleaned 

with an extractor, and reportedly waxed. 

The following sections summarize work completed to improve indoor air quality and are 

presented by the categories outlined above. 

4.1 Work Completed to Limit Potential for Mold Growth 

4.1.1 Removal of Water Damaged Building Material 

A series of bulk samples of carpet dust collected from the installed carpets (samples 

collected by others) revealed repeated incidents of amplified microbial reservoirs within 

the carpet. Mitigation of amplified reservoirs found in textile floor coverings is not 

recommended by ACGIH. Removal of the textile is the recommended procedure. (Note: 

this was not on our preliminary list of recommendations because the school department 

had informed us of their plans to remove the carpet. However, we did provide them with a 

protocol for removal of carpet, at their request.) 

The first task undertaken to improve air quality at this facility was to remove the carpeting 

and other water-damaged materials found in the facility (small quantities of ceiling tiles 

and gypsum board). As a precaution, the carpeting and other materials were removed 

under conditions of isolation and containment. The removal process included removal and 

cleaning of all non-fixed contents (such as desks, chairs, and materials) from the building. 

The non-fixed contents were visually inspected for signs of mold growth; none was 

reportedly found. All contents not showing visible signs of mold growth were then 

cleaned using ACGIH recommended practices and shipped to a conditioned storage site or 

to other locations for use at that location. See Oak Ridge Carpet Removal Protocol and 

Oak Ridge Glue on Ceiling Tile Removal for details of cleaning and containment systems. 

(Note: Reportedly, none of the non-fixed contents were found to have visual signs of mold. 

In addition, the removal of glue-on tiles was not part of the preliminary list of 

recommendations because they were discovered after the list of recommendations was 

presented.) 

The conditioned storage site was another building (former school) owned by the school 

system. The storage site and the contents, while in storage, were observed and found to be 

in a dry location with normal occupied temperatures and humidity. Reportedly, the storage 

site was observed daily by maintenance personnel who entered the building to look for 

water leaks or abnormal temperatures. 

Removal of water damaged building materials and finishes were completed in each of the 

classroom wings, the administrative wing, and the media center under conditions of 

isolation and containment. Each wing was separately isolated and contained before 

removal of water damaged building materials. Isolation and containment means that the 

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space is physically isolated from the rest of the building with the installation of a physical 

barrier. HVAC systems were also isolated from the space by covering registers and grilles. 

Containment of the space was accomplished by inducing an air pressure in the isolated area 

that was lower than the air pressure in the surrounding building areas. 

Materials removed, in addition to the textile floor coverings, included some small portions 

of gypsum board at floor level. These pieces of gypsum showed signs of visible mold. 

Glue-on ceiling tiles located above the dropped ceiling tiles in the media center wing, and 

wood bead board ceilings also located above the dropped ceiling in the media center wing, 

were also removed or cleaned. Areas of water damaged walls in the clerestory area above 

the dropped ceiling tile in the media center were suspected of having supported mold 

growth in the past. Although the walls were not currently found to be supporting growth, 

they were also removed or cleaned, as well as removing water damaged building materials, 

dried leaves, and other dried organic material found trapped in the building construction in 

the media center wing. In addition, selected portions of the walls in the classroom wings 

covered with vinyl wallpaper were observed for visible mold growth by peeling back the 

wallpaper. No visible mold growth was observed under the vinyl wallpaper. 

Once the identified suspected water damaged materials (carpet, wallboard sections, organic 

materials, and ceiling materials) were removed from each wing, the wing was thoroughly 

cleaned as outlined in the protocol. A series of airborne spore trap samples were 

collected and sent to the lab for analysis. See Appendix B for lab results of spore trap 

sampling. The installed isolation and containment systems were removed after the spore 

trap sample results indicated that the spore count inside the containment area was less than 

the outdoor spore count. 

4.1.2 Installation of Replacement Flooring 

After removal of the containment and isolation systems, moisture emission tests were 

conducted on the bare concrete subfloor. See Appendix F for test results and real-time 

moisture meter readings. In conjunction with the vapor emission tests, visual observations 

were completed, and real-time moisture content readings were collected with a Protimeter 

(Serial #6600-089). The emissions test results and the moisture measurements were used 

to determine the type of flooring and adhesive that would replace the textile floor 

coverings. See Oak Ridge VCT Protocol for details. 

4.1.3 Modifications to Existing Heat Pumps 

The location of the air filters in front (upstream) of the cooling/heating coils at each heat 

pump in the HVAC system provide an elevated risk of mold growth, especially during any 

period of cooling. The downstream filter surfaces were observed to be within a few inches 

of upstream coil surfaces. The make and model of the heat pump with a similar air filter 

arrangement had been observed (in a different facility) to have a high risk of developing 

microbial reservoirs, due to the very close proximity of organic material in the filter, and 

the moisture from condensation at the cooling coil. While visible mold growth was not 

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observed on the filter surfaces at the time of our site work, the arrangement of filters and 

coils have been known to provide an elevated risk for microbial growth. (Note: The 

observed filters in the heat pumps were fairly new, having been changed days before our 

site visit as part of the ongoing filter maintenance program.) 

Based on the known risks and our recommendations, the air filters were moved further 

upstream from the cooling/heating coils. The filters were moved to the return air registers 

in heat pump systems serving the classroom wings, and in other selected locations where 

the arrangement of return air and outdoor air ducts restricted the relocation of the filters, 

and the outdoor air was filtered separately. The remaining heat pump systems had 

arrangements that provided sufficient room to locate the filter further upstream while not 

allowing unfiltered outdoor air to bypass the filter. See Filter Boxes Protocol and Filter 

Returns Protocol for details. 

Additionally, the cooling/heating coils and the heat pump fan casing were cleaned to 

remove a build-up of filter material that had collected on the coil surface. See Coil 

Cleaning Protocol for details. (Note: We did not recommend duct cleaning because duct 

cleaning would have little beneficial impact due to an absence of significant deposition of 

dust or nutrient material in the duct system. Our observation of some portions of the return 

ducts in the classroom wings did not show signs of heavy accumulation of material or 

signs of moisture damage (staining).) 

4.2 Work Completed to Limit Water Intrusion 

4.2.1 Site Work to Limit Possible Liquid Water Entry 

Based on observation and reports from occupants, the site around the building has finished 

grades that would allow water to pond against the building walls during times of torrential 

rainfall. Water at the base of the exterior walls may have been responsible at times for 

conditions that promoted microbial growth within the carpets in some classrooms. Site 

grade modification plans have been developed and reportedly will be implemented at the 

earliest opportunity after the winter rainy season ends. The implementation of the 

modifications in the spring is not likely to have an adverse impact on the building in the 

short-term because the carpets have been removed and replaced with a floor covering that 

is more resistant to moisture. 

4.2.2 Roof and Flashing Work to Limit Liquid Water Entry 

Our observations of the roofs and the visible flashing at the base of high walls where these 

walls intersected the roofs, observations of reported past leak areas, and occupants reports, 

suggested that the flashing may not be functioning properly. We recommended additional 

evaluation including destructive disassembly of some of these areas to make additional 

evaluations and then repairs as necessary. The disassembly revealed through-the-wall 

flashing that was extended up the wall approximately 1⁄4". The observed extension up the 

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wall would fail to keep water from getting behind the flashing when winds were greater 

than an estimated 17 MPH. 

In addition, some of the corner and cap flashing assemblies that were observed appeared 

not to be constructed well enough to keep water from getting behind the flashing. Once 

water gets behind the flashing and into the wall structure, damage to the wall may occur, 

and water may be found inside of the building. 

Work was completed on the flashing to increase the extension and limit the potential for 

wind driven rain to defeat the flashing. See Roof Flashing Protocol for details. Additional 

work was completed to repair flashing that was identified as needing replacement. 

Additional evaluation of the flashing and edge details of the roof at the clerestory was also 

completed and some of the clerestory windows were resealed. The existing roof scuppers 

were also lowered. 

The clerestory space above the media center was also found to have abandoned ventilation 

systems that were not removed in the last renovation. The abandoned system did not serve 

any purpose with respect to the current use of the space. The ventilation system was 

defeating the building thermal envelope. The systems were removed and the openings 

sealed. 

4.3 Work Completed to Limit Water Vapor and Unplanned Air Flows 

4.3.1 Crawl Space Moisture and Microbial Control 

The media center wing of the building does not have a slab-on-grade floor that is typical of 

the remaining building areas, but has a crawl space under a wood framed and wood deck 

floor. The crawl space was an earthen floor space enclosed by perimeter foundation walls. 

The crawl space also included a walk-in space that was the old boiler/electrical room for 

the original building. The heating plant and electrical distribution panels are no longer 

located in this space. 

Depending upon the operation of the HVAC system, moist air from the crawl space would 

flow into the media center wing from the crawl space (i.e. unplanned air flow). In addition 

to moist air, the potential for the transport of mold spores (from reservoirs observed in the 

crawl space) into the media center wing was high during times that the HVAC system 

operation would allow infiltration into the media center wing. 

To limit moisture entry into the crawl space and to prevent excessive moisture build-up, 

the crawl space was isolated from the earthen floor with a poly vapor barrier. The vapor 

barrier is sealed to the foundation wall. The wall is insulated with polyisocyanurate and all 

the existing vent openings through the foundation wall were sealed. Other openings 

between the crawl space and the media center above were sealed with spray foam sealant. 

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The crawl space was provided with a sub-membrane sump pump to remove liquid ground 

water that rises to the surface beneath the poly vapor barrier. A sub-membrane vapor 

removal system was also installed to control water vapor levels under the membrane. A 

system of dehumidifiers was placed in the crawl space and the old boiler room to limit 

moisture (as vapor in air) to 50% relative humidity. See Crawl Space Venting Protocol for 

details. (Note: The poly vapor barrier was attached to the foundation wall using an 

alternate method that eliminated the wood strip, which was feared to introduce an 

additional source of food for termites. The alternate system used was the standard 

attachment method used by the installing contractor.) 

4.3.2 Soffit Sealing: Controlling Unplanned Air Flow and Humidity 

The soffit area of the three classroom wings was observed and found to incorporate a 

number of large and small openings through the building thermal enclosure, allowing 

leakage of unconditioned air into and out of the building, depending on the operation of the 

HVAC system. The leakage sites would allow humid air into the building, especially 

during unoccupied times. The introduction of humid air into the building is not desirable. 

Humid air counteracts the dehumidification systems and adds moisture to the space that 

can result in condensation upon cooler surfaces (such as the floors). See Soffit Protocol for 

details of modifications. 

Soffit sealing included adding gypsum sheathing to the large openings at the end of each 

classroom corridor, adding fire-stop to all cracks and openings, applying spray-on foam to 

seal all openings in the wall behind the soffit, installing relief vents from the classrooms up 

into the plenum above the classroom ceilings, and installing relief vents to the outside, 

fitted with weighted back draft dampers to allow air to leave the plenum freely, but restrict 

the flow from the outside into the plenum. 

Blower door tests and infrared imaging indicated that the soffit was a source of numerous 

large and small air leak areas. 

Initial blower door testing was completed prior to sealing the soffit. A second set of tests 

were completed after the soffit sealing was complete. See Appendix E for blower door test 

results and Appendix G for infrared images. The blower door results are graphed 

separately for each wing tested. The graphs show the total leakage from the wing prior to 

the soffit sealing work, and the leakage from the wing after completion of the soffit sealing 

work. The difference between the two tests indicates the amount of air leakage that existed 

at the soffit prior to sealing the soffit. 

Other heat and air leak areas identified on the thermal imaging included doors, windows, 

and the base of the building wall. 

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4.3.3	 Waste Piping Vent Line Repairs 

Several photos of the plumbing vent piping provided by other consultants working with us 

on this project were reviewed. The photos indicated some plumbing waste line vents in the 

classroom wings were open to the space above the ceilings. The latest as-built drawings 

indicated that these lines should have been connected to the waste line vents. These
 

opened vents have reportedly been connected to the waste vent systems. In addition, some 

of the waste line vents through the roof were reportedly less than 10 feet from roof 

mounted air inlets. These through the roof vent lines were reportedly relocated to meet the
 

minimum 10 foot distance between roof vents and air inlets as specified by the
 

construction drawings.
 

4.4 Work Completed to Meet Design Air Flows 

4.4.1	 Retro-Commissioning, Terminal Air Balancing Controlling Unplanned 

Air Flows, and Maintaining Humidity Limits 

Initial space temperature and humidity measurements combined with our observations and 

occupant provided information, pertaining to thermal comfort and air quality, lead to our 

recommendation for retro-commissioning and air balancing. Commissioning is a
 

systematic process of ensuring that all building systems perform interactively according to
 

the design intent and the Owner’s operational needs. As retro-commissioning (post 

occupancy commissioning), the commissioning process encompasses system
 

documentation, equipment operation, control system calibration and operation, testing and 

balancing, and system performance testing.
 

Testing and balancing included balancing the air flows (supply air, return air, exhaust air, 

and outdoor air) of all heat pumps and the associated outdoor air systems. Providing the 

proper amounts of air to each space with the correct proportion of outside air is critical for 

maintaining air quality, including recommended humidity levels. 

Retro-commissioning services verified that the design amounts of air, including outdoor 

air, are currently being provided. In addition, it verified that the HVAC system is 

conditioning the air to the extent that the design intended. The services were provided in 

accordance with our protocol, Retro-Commissioning Protocol and Air and Water Balance
 

and Automatic Controls. For protocol details, see Appendix A. The commissioning report 

will be released separately by the commissioning agent, EMC Engineering, Inc., Raleigh, 

NC.
 

Indoor temperature and humidity data collected at the site prior to the beginning of 

improvement work, and at a point where the work was approximately 95% complete, can 

be viewed in Appendix D. The data shows high humidity in Room 520 during July when
 

the system was operating in an unoccupied cycle (outdoor air units were off). In addition, 

data was collected after the soffit sealing was complete, but prior to the reinstallation of the
 

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soffit panels. At that time, the work to modify the HAVC system was approximately 95% 

complete, and temperature monitoring indicated that the space temperatures were very 

constant (within a degree variation). The same data also depicts the different operating 

conditions under which the corner classroom (Room 520) operates. The temperature 

swings in Room 520 were greater than non-corner classrooms. Similar temperature 

readings were collected in July with respect to temperature variation; however, the space 

temperature remained within 1-1⁄2 degrees. 

Preliminary balancing indicated that the outdoor air supply to the media center was low 

and could not be adjusted to meet the design intent. Additional equipment was added to 

the media center HVAC systems to provide the quantities of OA required to meet the 

original design amounts. Reportedly, balancing of all the other systems in the building to 

meet the original design was successfully completed. Replacement parts (thermostats and 

other devices) were required in order to provide the intended control sequence. The retrocommissioning efforts are reported in the final commissioning report submitted by the 

commissioning agent. The report also includes the final air and water balancing report. 

4.5 Final Cleaning 

At the completion of all interior work to improve air quality, the building was thoroughly 

cleaned. Cleaning occurred prior to the reintroduction of any of the contents that were in 

storage or in use at other sites. A series of spore trap tests were completed that compared 

inside levels to outside levels. The series included 300-second sample intervals and 600­

second sample intervals. The sample interval is selected based on observation and other 

information which is used to determine the potential of overloading (or under loading) the 

samplers. Results from both interval lengths indicate that the spaces have lower spore 

counts than the outdoors. 

After the final cleaning of the building materials at the off-site storage, and in use in other 

locations were, or will be, reintroduced into the Oak Ridge School. Materials in storage 

were observed for signs of visible mold growth and odors by trained industrial hygienists 

from S&ME prior to reintroduction into the Oak Ridge School facility. 

Conclusion 

We believe the buildings HVAC system is performing in accordance with the intent of the 

design as reported in the commissioning agents report. Additionally testing suggests that 

unplanned airflows that affected humidity levels in the building, as well as the air quality 

have been reduced. Moisture damaged materials and materials that were found to be at an 

elevated risk of damage from moisture have been removed and replaced with material less 

susceptible to moisture damage. Based on the improved building performance as outlined 

above, our experience, our observations of conditions at the facility, the available spore 

trap test results, the commissioning report, and air leakage test results, we believe the 

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building can be reoccupied. Occupants should be aware of, and conform to, the intent of 

our additional recommendations made herein concerning the operation of the facility. 

5.0 RECOMMENDATIONS 

5.1 Preliminary Recommendations 

Our initial observations and tests were the basis for our preliminary recommendations, and 

were reported in our July 21, 2009 preliminary report, Oak Ridge Elementary School Very 

Preliminary Draft Indoor Air Quality Issue. The additional recommendations made below 

are presented in recognition that the building has undergone a series of fundamental 

changes and will require some additional changes in maintenance and operation. 

Our recommendations made below include some best practices with respect to 

maintenance and verification monitoring. These recommendations do not necessarily need 

to be completed prior to re-occupancy. Many are dependent on specific modes of 

operations that may not reflect actual operating conditions. 

5.2 Additional Recommendations 

Recommendation #1: New Floor Maintenance Systems and Schedules 

The school no longer has textile floor coverings. All finished floors are either hard vinyl 

surfaces or TerraCotta. The hard surface floors will not hide dirt and organic materials as 

the previous textile floor coverings did. Reportedly, the school system’s Custodial Support 

Procedures document outlines the system’s procedures and schedules for maintaining hard 

surface floors. These procedures should be followed with respect to maintenance of the 

new floors. 

Recommendation #2: Limiting Noise 

Hard surface flooring will not absorb noise energy as readily as textile flooring. Desks, 

chairs, and other objects that are regularly moved across the floor should be fitted with felt 

pads on the bottom of their feet, or fitted with rolling castor wheels designed for hard 

surface floors. 

Recommendation #3: Do Not Use Textile Floor Coverings 

We do not recommend using textile floor coverings of any size (except track-off mats) in 

any area of the building where the floor type is concrete slab-on-grade. 

Recommendation #4: Use Track-Off Mats and Limit Exiting to Control Dirt Levels 

We recommend that the floors at all main entries be covered with track-off mats. A 

recommended track-off mat system should be designed to remove moisture from the 

bottom of footwear, to remove course material, and to remove fine material from the 

bottom of shoes. The mats should extend beyond the entry door a sufficient distance to 

allow adequate moisture and debris removal. Additionally, we do not recommend that the 

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classroom fire-exits be used as normal entry doors. All entry into the building should be 

through main entries fitted with the proper track-off mats. Some doors in some 

classrooms, such as the kindergarten area, may need to be fitted with track-off mats to 

allow access to the gated play area. 

Recommendation #5: Occupied Temperature Set Points 

The HVAC systems have been commissioned, which included calibration of all sensors 

and is capable of maintaining set point conditions. We recommend set points of 70o

F 

heating and 74o

F cooling in accordance with recommendations made by the 

commissioning agent. However, the sensors that control the systems are zoned such that 

two rooms are served by a single heat pump with a thermostat placed in one of the two 

spaces. The sensors may need to be adjusted to different values than recommended in 

order to maintain the desired temperatures (between 70 and 74 degrees) in the spaces. 

Additionally, some sensors may not properly sense the space temperature due to its 

location; therefore, these too may need an adjustment at the thermostat dial that is beyond 

the recommended range. 

Recommendation #6: Occupied Cycles 

We recommend, in the interest of energy savings, that the school be operated with an 

occupied cycle and an unoccupied cycle. The occupied cycle should include continuous 

fan operation of the heat pumps and outdoor air systems, and occupied temperatures as 

recommended above in Recommendation #5. The unoccupied cycle should include a 5 

degree offset from the occupied temperature set points, and the heat pump fans should run 

only on demand for heating or cooling. The outdoor air systems should be off and the 

associated OA dampers closed. 

Recommendation #7: Additional Monitoring of Space Temperatures, Humidity, and 

Ventilation Rates 

We recommend additional monitoring of space conditions throughout the remaining 

heating season of this year, and the upcoming cooling season, to verify that the HVAC 

systems and controls are operating properly, and that the systems have the capacity to 

maintain space conditions at the recommended set point conditions. 

Recommendation #8: Additional Engineering Services to Increase Energy Efficiency 

The thermal images taken of the buildings perimeter walls indicated that the door, 

windows, and the base of the walls were additional sources of heat leaks. Collectively 

these leaks may account for another large portion of the total air leakage measured by the 

blower door tests. We recommend additional evaluation and possible corrective work to 

further limit the heat loss and air leaks. Limiting the air leaks may have an additional 

favorable impact on the unplanned air flows that occur during the unoccupied cycles. 

Limiting air leaks at doors may be as simple as adding commercial grade weather-stripping 

to the perimeter of doors. 

. 

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Appendix L: tHe tuRneR BuiLdinG sCienCe And desiGn FinAL RepoRt piCtuRes 

Appendix F: The H.S. Turner Group preliminary final report pictures 

Shell Pressure Monitoring

Temperature &, Humidity Monitoring

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Blower Door Testing

Typical Vinyl Wallpaper Observation

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Typical Wall Observation

Typical Classroom Containment & Isolation

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Typical Poor Filter Installation

Dirty Coil

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Typical Marked OA Balancing Damper

Clean Coil

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Media Center Clearstory

Media Center Clearstory

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Media Center Clearstory

Open Plumbing Vent Lines

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Vent Through Roof And OA Inlet

Crawl Space Vapor Barrier

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Crawl Space Vapor Barrier

Crawl Space Vapor Barrier

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Crawl Space Vapor Barrier

Crawl Space Vapor Barrier

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Crawl Space Vapor Barrier

As Found Roof Flashing

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As Found Roof Flashing

As Found Roof Flashing

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Visual signs of Site runoff

Visual signs of Site runoff

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Visual signs of Site runoff

As Found Soffit Air Leaks

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As Found Soffit Air Leaks

As Found Soffit Air Leaks

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As Found Soffit Air Leaks

As Found Soffit Air Leaks

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Appendix L: tHe tuRneR BuiLdinG sCienCe And desiGn FinAL RepoRt piCtuRes 

(Continued) 

As Found Soffit Air Leaks

Soffit Sealing

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Soffit Sealing

Soffit Sealing

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Soffit Sealing

Soffit Sealing

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Soffit Sealing

IR November 10, 2009 Soffit Leaks


 

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IR November 10, 2009 Soffit Leaks

IR November 10, 2009 Soffit Leaks

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IR November 10, 2009 Soffit Leaks

IR November 10, 2009 Soffit Leaks


 

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IR November 10, 2009 Soffit Leaks

IR December 16, 2009 Soffit Sealing

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(Continued) 

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(Continued) 

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(Continued) 

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Appendix M: niosH inteRiM RepoRt, HetA 2009-0172 

DEPARTMENT OF HEALTH & HUMAN SERVICES Public Health Service

 _______________________________________________________________________________________________

 Phone: (304) 285-5751 Centers for Disease Control

 Fax: (304) 285-5820 and Prevention (CDC)

 National Institute for Occupational

 Safety and Health (NIOSH)

 1095 Willowdale RoaD

 Morgantown, WV26505-2888

 February 24, 2010 

HETA 2009-0172 

Interim Letter 

Eric Becoats, Ed.D. 

Chief Administrative Officer 

Guilford County Schools
 

712 North Eugene Street
 

Greensboro, NC 27401 

Dear Dr. Becoats: 

The purpose of this letter is to convey a report on the findings of the National Institute for Occupational Safety 

and Health (NIOSH) Health Hazard Evaluation at Oak Ridge Elementary School at 2050 Oak Ridge Road, in Oak 

Ridge, North Carolina. A copy of the interim report is enclosed. We recommend that you post the interim report 

in a prominent place accessible to the employees for a period of 30 calendar days. 

As you are aware, during the week of March 1, 2010, we are planning to administer a health survey questionnaire 

at Oak Ridge Elementary School to employees who wish to participate. Much of the questionnaire will address 

health symptoms experienced the four weeks prior to the re-opening of the school. We see this cross-sectional 

survey as part of surveillance to document the extent of resolution of a public health problem likely associated 

with dampness in the building before remediation. We will analyze the data from that questionnaire and provide 

you with the findings as soon as we can. 

 If you have any questions or concerns, please feel free to contact us at (800) 232-2114. 

Sincerely, 

Rachel L. Bailey, DO, MPH 

Medical Officer 

Ju-Hyeong Park, ScD, CIH 

Industrial Hygienist 

Rena Saito, PhD 

Industrial Hygienist 

Health Hazard Evaluation Report 2009-0172-3124 Page 209 
 

 

 

 

 

Appendix M: niosH inteRiM RepoRt, HetA 2009-0172 (Continued) 

Jean Cox-Ganser, Ph.D. 

Research Team Supervisor 

Respiratory Disease Hazard Evaluation and 

Technical Assistance Program 

Field Studies Branch 

Division of Respiratory Disease Studies 

cc: 

Mr. Maurice “Mo” Green, Superintendent 

Ms. Nora Carr, Chief of Staff 

Ms. Ann Kraft, Oak Ridge Elementary School Principal 

Ms. Jackie Burney, Oak Ridge Elementary School Assistant Principal 

Dr. Ward Robinson, Guilford County Department of Public Health 

Ms. Ashley Royal, Parent Teacher Association 

Page 210 Health Hazard Evaluation Report 2009-0172-3124 
Appendix M: niosH inteRiM RepoRt, HetA 2009-0172 (Continued) 

HETA 2009-0172 

Interim Report 

February 24, 2010 

INTRODUCTION 

The National Institute for Occupational Safety and Health (NIOSH) received a Health Hazard Evaluation (HHE) 

request from Guilford County Schools’ management on June 16, 2009 to investigate concerns about indoor 

environmental quality (IEQ) at Oak Ridge Elementary School located at 2050 Oak Ridge Road, in Oak Ridge, 

North Carolina (NC). The request listed concerns about mold, high levels of carbon dioxide (CO2

), and problems 

with the heating, ventilation, and air-conditioning (HVAC). Health concerns included headaches, fatigue, 

insomnia, dizziness, bronchitis, pneumonia, sinus problems, sore throat, rashes, nauseas, vision problems, and 

others. 

BACkGROUND 

Oak Ridge Elementary School was built in the 1930s with additions in the 1970s. The original building is 

currently used for the media center, library and offices including the health center, teachers’ lounge, and testing 

room. In 2003, construction began on three new classroom wings. The addition was attached to the gym that was 

built in the 1970s and remodeled during the construction process. In May 2005, before the 2004/2005 school year 

ended, the kindergarten/first grade (k/1) wing and administrative wing were opened and occupied. The second/ 

third grade (2/3) and fourth/fifth grade (4/5) wings (Figure 1) opened in August 2005, a few days before the start 

of school. Classroom wings are to the west side of the school, the gym is to the east side, and the old original 

building is to the north side (Figure 1). The playgrounds and ball fields are the highest points on the site. 

During the 2008/2009 school year, the school had 88 faculty and staff and 738 students. Since the reopening of 

the school in 2005, there have many issues regarding IEQ which are summarized in the result section under “Brief 

history of environmental findings and remediation at Oak Ridge Elementary School.” 

ASSESSMENT 

A NIOSH team of two industrial hygienists, an epidemiologist, and a medical officer completed a site visit at 

Oak Ridge Elementary School from July 14-16, 2009. Consultants of the H.S. Turner Group (also known as the 

“Turner Group”), a building science and design company, hired by Guilford County Schools also participated in 

the site visit, and the NIOSH team conferred with them during and since the site visit. 

On the first morning, we conducted an opening meeting with school staff, parents, and news media to discuss 

the HHE program and the purpose of our visit. We then met with the principal, teachers, and parents for 

approximately one hour to discuss their concerns. This was followed by a NIOSH initial walkthrough of the 

school accompanied by school staff, parents, and news media. During the rest of the site visit, members of the 

Parent Teacher Association often accompanied us as we evaluated the school. 

In addition to a visual assessment of the school, we used moisture meters and an infrared camera to check for 

moisture in walls and other surfaces. Additionally, we used smoke tubes to visualize airflow and observe pressure 

differentials between rooms and the corridors inside the school building. The Turner Group used digital pressure 

gauges (The Energy Conservatory, Minneapolis, MN, USA), and NIOSH staff worked with the Turner Group staff 

to measure pressure differentials at exterior doors; the results were documented on diagrams of the school and 

given to the Turner Group for further analysis. 

We selected 21 rooms (Table 1) to collect environmental samples (6 fully carpeted rooms, 11 carpeted rooms 

with 10 percent (%) to 25% tiled floor, 4 rooms with tiled or wooden floor). These rooms were selected either 

because occupants had reported health or environmental issues, or the previous environmental consultants’ reports 

documented elevated mold concentrations either in air or floor dust. We collected floor dust samples 

into polyethylene filter socks using a L’il HummerTM backpack vacuum sampler (flow rate=100 cubic feet per 

minute). To collect enough dust for microbial analyses, we vacuumed either a 2 meter squared (m2

) area on the 

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Appendix M: niosH inteRiM RepoRt, HetA 2009-0172 (Continued) 

floor around the teacher’s work station or around the edges of the room (0.8 m2) and 1 m2 area of floor around the 

teacher’s work station (a total of 1.8 m2

) for a total of five minutes. Even using these methods, we were not able 

to collect enough dust from room 108 for microbial analyses, and thus, the room was excluded in data analyses. 

In the media center, which was larger than classrooms and offices, we collected two separate dust samples; one 

from a 2 m2

 area on a rug in the room and another from the edge of the room. We also measured wet bulb and dry 

bulb temperatures on the floor surface to compute water activity (Aw: the amount of free or available water for 

microorganisms) and air temperature and relative humidity (RH) at the end of the dust sampling in each room. 

The vacuumed dust samples were sealed in plastic bags and transported to the NIOSH laboratory where the 

collected dust in the filter socks was empted into 50 milliter (ml) pyrogen-free conical tubes and homogenized by 

rotation on a 360-degree rotary arm shaker at 65 revolutions per minute for 2 hours. We removed hair, fluff, and 

other larger objects from the sample before homogenization. The dust samples were then weighed, partitioned, 

and sent to the American Industrial Hygiene Association (AIHA)-accredited Environmental Microbiology 

Laboratory P&K (EMLab P&K, San Bruno, California). We analyzed dust samples for culturable fungi with 

full speciation, gram negative bacteria, and Actinomycetes because these microbes have been associated with 

dampness in buildings. We also analyzed for gram positive bacteria as humans are often a source of this type of 

bacteria. Dust samples were cultured for Actinomycetes at three different temperatures - room temperature, 35 

degrees Celsius (°C), and 55°C. The laboratory reported culturable fungi, bacteria, and Actinomycetes as colony 

forming units (cfu) per gram (g) of dust. We categorized fungal species into hydrophilic, mesophilic, and “other 

fungi” groups. Hydrophilic fungi (or water-loving fungi) are defined as fungal species which require high water 

content in building materials (Aw>0.9) for survival and growth. Mesophilic fungi are fungal species that require 

water activity to be between 0.8 and 0.9. In damp conditions, hydrophilic fungi will overgrow mesophilic fungi. 

Fungal species which were not categorized as either hydrophilic or mesophilic were included in the “other fungi” 

group. We used three sources [WHO 2009; Hung et al. 2005; Flannigan and Miller 2001] to determine the water 

activity of the fungi in order to categorize them into one of the three groups. If a fungal species was classified 

differently (hydrophilic vs. mesophilic vs. “other”) among the three sources, we choose the classification with the 

highest water activity. We computed a fraction of the hydrophilic and mesophilic fungi for each collected dust 

sample by dividing the concentration of each group of fungi by the total concentration. 

We visited the Guilford County Department of Public Health. The medical director shared de-identified data from 

a self-administered paper questionnaire that the health department offered to the faculty/staff (Appendix A) and 

parents of students (Appendix B) at Oak Ridge Elementary School in May and June 2009. 

NIOSH staff conducted telephone interviews with three staff members regarding health concerns believed related 

to the school. 

On the last day of the site visit, we had a breakfast meeting with Guilford County School representatives 

regarding our findings and recommendations. This was followed by a brief closing meeting at the Oak Ridge 

Elementary School. 

Prior to, during, and after the site visit, we obtained documentation from the school regarding indoor 

environmental quality issues at the school. We used this documentation to summarize the historical 

environmental problems and actions that had occurred at the school over the past five years. 

Health department questionnaire data 

In May 2009, the Guilford County Department of Public Health surveyed faculty/staff and parents/guardians of 

students at Oak Ridge Elementary School with self-administered paper questionnaires (Appendices A and B) that 

focused on the 2008/2009 and 2007/2008 school years. Throughout the report, we will refer to faculty and staff as 

“staff” or “staff members” and “parents” or “guardians” as “parents”. The health department chose the 2008/2009 

and 2007/2008 time frame to determine if there were any retrospective changes in building-related symptoms 

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Appendix M: niosH inteRiM RepoRt, HetA 2009-0172 (Continued) 

after the installation of a dehumification system in the classroom section of the school during the summer of 2008 

between the two school years. 

The staff and parent questionnaires included questions on primary office or classroom, symptoms, health 

conditions, medication, smoking status, and home exposures. For each specific school year (2008/2009 then 

2007/2008), the participants were asked if they experienced any of the following symptoms while in the school 

building: 1) headaches, 2) dry eyes, 3) unusual sneezing episodes, 4) difficulty breathing/asthma attacks, 5) 

nosebleeds, or 6) any other symptoms (participant asked to write-in other symptoms). However, participants who 

answered “no” or did not write-in a symptom on the first page of the questionnaire (that asked about symptoms 

during the 2008/2009 school year) were asked to stop the questionnaire at that point. For these participants, 

no information was collected on symptoms during the 2007/2008 school year, health conditions, medication, 

smoking status, and home exposures. For participants who did have symptoms in 2008/2009, they were also 

asked if they had the following conditions: 1) chronic respiratory disease, 2) undergoing chemotherapy or 

radiation therapy, 3) immune system stressed by disease or other cause, 4) allergic rhinitis, or 5) asthma. The 

participants were asked to report rooms or areas in the building where their symptoms were worst and if their 

symptoms/problems went away after leaving the building. Additionally, they had the opportunity to write 

in additional information at the end of the questionnaire. Information about physician diagnosis of health 

conditions and date of onset of the health conditions in the questionnaire was not sought in the questionnaire. 

The questionnaires did not include standardized symptom or asthma questions which would have allowed us to 

compare rates to the US or state population rates. 

We received the de-identified questionnaire data from the health department in excel format and converted it 

into SAS databases. The excel database had variables created for the specific health conditions and symptoms 

asked in the questionnaire. The database also had additional variables created for write-in symptoms that 

corresponded to the 2008/2009 or the 2007/2008 school year. The write-in variables included rash, nausea, sinus 

problems, insomnia, dizziness, fatigue, sore throat, and vision problems. We created additional variables for 

other symptoms written in by participants for each school year. These included cough, allergies, metallic taste, 

memory loss, eye symptoms (burning, itching, red, dry, or tearing), skin problems (eczema, rash, dry skin, itchy 

skin, or tingling skin), nasal symptoms (stuffy, itchy, burning, runny, or dry nose), throat symptoms (dry, scratchy, 

or sore), and voice symptoms (hoarse voice or laryngitis). Additionally, we grouped symptoms into upper 

respiratory symptoms (sinus problems, nasal symptoms, sneezing, throat symptoms, and/or voice symptoms), 

lower respiratory symptoms (breathing problem/asthma attack and/or cough), and mucous membrane irritation 

symptoms (eye symptoms, nasal symptoms, throat symptoms, and/or voice symptoms). 

We grouped classroom and offices into six location categories (gym/cafeteria wing, administrative wing, media 

room wing, k/1 wing, 2/3 wing, and 4/5 wing). We assigned staff to a primary work wing based on the locations 

of their classrooms or offices. We assigned students to a classroom wing based on the locations of their primary 

classrooms/homerooms. If a student did not have a primary classroom/homeroom listed in the database, we 

assigned the student to a classroom wing based on his or her age (if it was available). Students 5 or 6 years old 

were assigned to the k/1 wing; students 8 years old to the 2/3 wing; and students 10, 11, or 12 years old to the 4/5 

wing. We did not assign students aged 7 or 9 years old because their wing assignment would differ based on if 

they started kindergarten at 5 or 6 years old. Therefore in 2008/2009, we did not assign three 7-year olds and four 

9-year olds. 

We used SAS version 9.2 (SAS Institute, Cary, NC) for data analyses. We calculated prevalence of symptoms 

reported by staff and parents for their children who attended Oak Ridge Elementary School during the 2008/2009 

and/or 2007/2008 school year. We used the McNemar’s test to determine if there was a statistical difference 

in symptom prevalence during the 2008/2009 and 2007/2008 school years in staff and students who worked or 

attended during the 2008/2009 and 2007/2008 school years and who had answered “yes” or wrote in a response to 

one of the six symptom questions on the first page of the health department questionnaire (Appendices A and 

Health Hazard Evaluation Report 2009-0172-3124 Page 213 
Appendix M: niosH inteRiM RepoRt, HetA 2009-0172 (Continued) 

B). We used the likelihood ratio chi-square test to test for significance when we compared symptom prevalences 

during the 2008/2009 school year by classroom wing for staff and students. A probability level of p < 0.05 

was considered statistically significant. A probability level of p ≥ 0.05 and p < 0.10 was considered marginally 

significant. 

RESULTS 

Brief history of environmental findings and remediation at Oak Ridge Elementary School 

Prior to school opening in August 2005, library books were shrink-wrapped on homemade rolling press wood 

carts and moved from the library/media center in the old building to the pre-kindergarten classroom (room 613) in 

the k/1 wing (Figure 1) and stored for two months. In August 2005, when the 2/3 and 4/5 wings were completed, 

the books were moved to the temporary media center (classroom 500) in the 4/5 wing; at this time, the books 

and carts in the pre-k classroom were covered in a grayish green mold, and the room had an overwhelming 

moldy smell. A contractor cleaned the books before they were moved to classroom 500 and stored on wooden 

bookcases. 

In August 2005, visible mold was also found on carpet in classrooms 427 and 625 (Figure 2), upholstered 

chairs in the records room (room 109) (Figure 3), and on picture frames in the storage room (room 111) (Figure 

4). Later, after the school year began, mold started to grow back on some of the books in the temporary media 

center in classroom 500. Many books were thrown out while others were again cleaned. By the end of August 

2005, visible mold had been identified in the k/1 wing (classroom 613, 625), 2/3 wing (classroom 427), 4/5 wing 

(classroom 500), and the administrative wing (rooms 109 and 111). 

During this time frame, the HVAC system was being commissioned, and the school was having problems with 

high RH. Additionally, parents had begun notifying the school that their children were complaining of headaches 

and respiratory symptoms. On August 25, 2005, the Guilford County Department of Public Health received two 

complaints about mold on library books. The health department inspector who visited the school reported that the 

school was humid, and that this issue needed to be addressed; otherwise, the mold would likely come back. The 

inspector returned on August 31, 2005 and noted that the humidity issues had improved; however, staff reported 

headaches and irritation of the eyes, throat, and ears. 

During September 2005, the school continued to adjust the HVAC system; mold and RH were still a concern. 

A consultant found that air filters in the heat pump (HP) units were very dusty and poorly fitting; they were 

replaced. The unit (HP 42) that served classroom 500 had some visible dry buildup on the coil front; a sample of 

the material grew mold (Pencillium). RH in the majority of rooms tested exceeded 60% (ranged from 61-72%). 

Elevated mold counts in carpet samples resulted in the replacement of carpet in classroom 625 with new carpet 

and in the health center (room 101) with vinyl composition tile (VCT). 

In September 2005, the North Carolina Division of Occupational Safety and Health received a complaint 

regarding 1) elevated carbon dioxide (CO2

) levels (2000 parts per million (ppm) and 5000 ppm) in classrooms 

502 and 508 in the 4/5 wing, 2) exposure to mold in the school (including the media center which was closed 

due to mold on books, the health center, classroom 520, and around the gym), and 3) respiratory symptoms in 

employees. Additionally during this time, parents continued to report their children were having respiratory 

symptoms, headaches, and fatigue. 

In response to the complaint to the state agency, the school hired an industrial hygiene consultant to test and 

monitor issues related to indoor air quality. He reported that a malfunctioning heat pump and damper were the 

cause of the elevated CO2

 levels in classrooms 502 and 508. The heat pump was replaced, and the damper was 

fixed. The consultant also noted in the report that an outside wall in classroom 400 was water damaged due to an 

exterior leak during construction, and this was to be removed by a mold remediation firm. 

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Appendix M: niosH inteRiM RepoRt, HetA 2009-0172 (Continued) 

In October 2005, the North Carolina Division of Occupational Safety and Health closed their case at the school 

on the grounds that the alleged hazardous conditions had been corrected or no longer existed. However during 

October 2005, the Guilford County Department of Public Health notified the school district that the health 

department continued to receive complaints from parents regarding indoor air quality issues such as mold and RH 

at Oak Ridge Elementary School. There were also concerns about the water supply and radon levels at the school 

which upon testing were found to be within normal range. 

In November 2005, the school continued to have elevated CO2 levels in some classrooms. They included 

classroom 503, 1534 ppm (fully occupied); classroom 505, 1484 ppm (fully occupied); classroom 623, 1250 

ppm (fully occupied), and classroom 625, 1370 ppm (fully occupied). Return air dampers were installed in some 

classrooms so more outdoor air could be delivered via the intake. However, during this same month, the water 

boiler and several heat pumps had “tripped out” for unknown reasons. Apparently, the heat pump fans may have 

been “off” during CO2 testing, and this may have resulted in the elevated CO2 levels. The CO2 set point for the 

four classrooms with elevated CO2 levels (HP 28 for classrooms 623 and 625 and HP 41 for classrooms 503 and 

505) were set to 900 ppm. However, the school continued to have problems with elevated CO2

 levels and high 

RH. 

Mold continued to be found in the school. In the Testing Room (room 115) on February 2006, mold was 

identified from surface samples taken from the top of a dusty mobile cart and from a small canvas bag that sat on 

a dusty bookcase. The canvas bag was discarded. The industrial hygiene consultant recommended that the room 

and surfaces be professionally cleaned, which was done. 

In May 2006, many teachers reported “stuffy” rooms, and left their windows open for end-of-grade testing to 

avoid symptoms in their students during the testing. In early June 2006, the construction company was notified 

(by the architect) that the CO2 controllers did not meet the specifications in the contract documents. Additionally, 

he notified them of a broken storm drainage line and problems with sewage lines (also identified in a February 

2006 inspection). 

In mid June 2006, a Trane MP581 programmable controller with temperature, CO2

, and humidity sensors was 

installed at the school. A two day test run was done with the new unit controlling classroom 618 (HP-26) in the 

k/1 wing. This was compared to classroom 627 (HP-25) across the hall which did not have the new sequence 

installed. During the first day of testing, it was rainy with a temperature of 65 degrees Fahrenheit (°F) with a 

RH of 90%; during the second day, it was sunny with the outside temperature and RH ranging from 73-80 °F 

and 32-49%, respectively. The Trane programmable unit sequence of operation called for the unit to be placed 

in dehumidification mode when the zone humidity reached 65% RH and “off” when the zone humidity reached 

55% RH. However, during the two days, the compressor did not turn off due to the zone humidity levels ranging 

between approximately 64% and 70% and never reaching the 55% level. The temperature stayed between 

approximately 71°F and 73°F. The Trane consultants determined that since there was no type of reheat available, 

the only way to keep the room from over-cooling during the dehumidification mode was to switch the unit from 

cooling to heating. Once this occurred, the air entering the space was no longer dehumidified, and the humidity 

rapidly rose. However, once the discharge air temperature was low enough to dehumidify the air, the room 

again became over cooled, and the unit had to be changed back to the heating mode. The Trane consultants had 

concerns about the “wear and tear” on the equipment. During the test, the compressor never shut off because 

the room RH never reached 55%. Also, the reversing valve changed from cooling to heating or from heating to 

cooling over 25 times during three hours of operation. During normal operation, the reversing valve should only 

change once or twice in a given day because it is usually heating or cooling, not switching back and forth between 

the two. The consultants thought that most of the humidity problems were associated with the introduction of 

outside air. They recommended that the outside air be “pre-treated” with dedicated units to allow the existing heat 

pumps to control the zone temperature. 

The school continued to meet with Trane personnel, and they adjusted the “test” control system so it better 

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Appendix M: niosH inteRiM RepoRt, HetA 2009-0172 (Continued) 

handled humidity with minimal reversing of the unit from cooling to heating. In July 2006, the temperature and 

RH in classroom 520, a room with complaints, was monitored for five days. During the day, the temperature 

ranged from approximately 70-77°F, and RH ranged from 50-60%; however, during other times the temperature 

reached above 80°F and 65% RH. 

On July 22, 2006, several roof leaks occurred in the school after a heavy rain. Water penetrated rooms in the k/1 

wing (603, 606, 608, 610, 616, 619, corridor between 603 and 608), 2/3 wing (401, 407, 418, 421, 427), 4/5 wing 

(500 and 505), the administrative wing (104, 106, 108), and gym/cafeteria wing (201). In August 2006, visible 

mold was discovered on carpet in classrooms 406, 424, 427, and 623. The indoor RH was reported to be high 

during this time. The carpets in these rooms were cleaned and treated with an antimicrobial agent (or biocide). 

This same month, a leak occurred in a water line joint, which was subsequently fixed. 

In February 2007, the North Carolina Department of Environmental and Natural Resources reported several 

ceiling leaks during a school inspection. 

In October 2007, spore trap analysis was performed outside and inside the school. The outside total spore 

count was 14,302 spores/m3

; the top four outside fungal genera identified were Cladosporium, Ascospores, 

Basidiospores, and Aspergillus/Penicillium. Eleven indoor locations (416, 503, 505, 514, 517, 519, 521, 618, 

625, 627, and the main office) were tested, and the total spore count ranged from 353 to 5,055 spores/m3. The five 

rooms with the highest total spore counts were classroom 521 (7,680 spores/m3

), the main office (5,055 spores/ 

m3

), classroom 517 (3,370 spores/m3), classroom 505 (2,586 spores/m3), and classroom 503 (2,429 spores/m3). 

The top four outside fungal genera were also found in many of the classrooms but at lower levels. Alternaria 

counts were higher in the main office and in classrooms 503, 505, 514, 517, and 521 than levels found outside. 

Curvularia counts were higher in the main office and classrooms 503, 514, 517, and 521 than outdoor levels. 

Drechslera/Bipolaris counts were higher in the main office and classrooms 505, 517, and 521 than outdoor 

levels. Pithomyces was higher in the main office and classroom 521 than outdoors levels. Nigrospora was not 

found outside but was found in the main office and classrooms 517 and 521. Epicoccum counts were higher in 

classroom 521 than found outside. Myxomycete/Smut-like was not found outside but was found in the main office 

and classrooms 503, 505, 514, 517, 521, 625, and 627. 

(NOTE: NIOSH indoor air scientists do not currently recommend routine air sampling for mold in indoor air 

quality evaluations because there are no established health-based standards for acceptable levels of biological 

agents and limited short-term air sampling may be misleading.) 

Later in October 2007, consultants tested for CO2 and performed air, surface, and carpet samples for fungal 

materials. CO2

 levels were above the level recommended by the American Society of Heating, Refrigeration, and 

Air-Conditioning Engineers (ASHRAE) in 10 (416, 503, 514, 517, 519, 520, 521, 618, 625, 627) of 13 rooms 

tested. Three (classrooms 416, 618, 625) of the 10 rooms with elevated CO2 had levels that exceeded the 1,500 

parts per million (ppm) established by North Carolina schools. Spore trap analysis performed inside and outside 

the school revealed an outdoor total spore count of 2,083 spores/m3 (outside the front of the school) and 2,983 

spores/m3 (outside classroom 405). The top four fungal genera identified in the sample collected outside the front 

of the school were Basidiospores, Cladosporium, Penicillum/Aspergillus, and Ascospores. Ten indoor locations 

(classrooms 405, 416, 503, 514, 517, 519, 521, 608, 625, and office lobby) were tested, and the total spore count 

ranged from 66 to 359 spores/m3

. The five rooms with the highest total spore counts were classroom 503 (359 

spores/m3

), classroom 517 (346 spores/m3), classroom 521 (293 spores/m3), classroom 625 (213 spores/m3), and 

classroom 608 (212 spores/m3

). The top four indoor fungal genera identified were Basidiospores, Cladosporium, 

Penicillum/Aspergillus, and Ascospores. 

Surface samples were collected from the insulation in the supply air plenums of nine air handling units. Six of the 

nine samples had fungal growth of Cladosporium. Three of these air handlers (air handlers 37, 41, and 49) 

had trace to minimal fungal growth; two had low (air handler 26) to moderate (air handler 12) fungal growth, and 

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Appendix M: niosH inteRiM RepoRt, HetA 2009-0172 (Continued) 

one (air handler 14) had a high surface concentration of fungal growth. The consultants recommended that the 

insulation inside these six air handlers be cleaned or replaced. In December 2007, a cleaning company cleaned air 

handlers 12, 14, 26, and 49. 

Carpet dust samples from classrooms 423, 517, 519, 521, and the office lobby showed the concentration of 

viable fungal spores ranged from 132,600 cfu/gram in room 517 to 1,176,000 cfu/gram in classroom 423. The 

consultants recommended that 1) carpets be cleaned with a commercial grade HEPA vacuum cleaner, 2) use of 

mats to capture particulate at the outdoor entry way to rooms or areas affected, and 3) possibly route students 

returning from the outside through the main entrance to the facility. Guilford County Schools reported they 1) 

delivered three new Pro-Team HEPA filtered back-pack vacuum cleaners and two new Windsor HEPA-filtered 

upright vacuum cleaners, 2) secured doorway mats, and 3) addressed student reentry into the school through the 

main entrance. 

In January 2008, an inspector from the North Carolina Department of Environmental and Natural Resources 

reported a “bad leak” in the Central Receiving Room ceiling during a school inspection. 

In September 2008, consultants performed temperature, humidity, and CO2

 measurements and carpet sampling 

for fungal spores and total volatile organic compound (VOC) sampling. Indoor temperature (range measured: 

71.3-72.4°F) and humidity readings (range measured: 48.9-53.0%) were within the ASHRAE recommended 

levels. CO2

 measurements (range measured: 657-1189 ppm) were elevated in classroom 514 (1189 ppm) and 

classroom 519 (1086 ppm). The consultants reported that the air handling unit serving classroom 519 might 

not have been functioning properly at the time of testing. Additionally, the consultant noted the window in 

classroom 521 (651 ppm) may have been open during testing in that room. These rooms were retested, and the 

CO levels in classroom 519 (954 ppm) and classroom 521 (898 ppm) were below the ASHRAE recommended 2 

limit. Classroom 514 had an elevated CO2

 measurement of 1,158 ppm. Guilford County Schools reported 

making adjustments to the air handler for room 514 to drop the CO2

 levels. In classroom 407, carpet sampling 

for fungal spores revealed 1,300,000 cfu/g; the top three fungal genera identified were Alternaria, Aspergillus, 

and Cladosporium. Air sampling for fungal spores (spore trap analysis) performed in two locations outside of the 

school building revealed a total spore count of 10,736 spores/m3 and 6,896 spores/m3

. Eleven indoor locations 

(office and classrooms 405, 407, 414, 501, 514, 519, 520, 521, 618, and 627) were tested, and the total spore 

count ranged from <78 to 392 spores/m3

. The three rooms with the highest total spore counts were classroom 514 

(392 spores/m3

), classroom 618 (313 spores/m3), and classroom 521 with window open (313 spores/m3). Three air 

samples for total VOCs were taken and all were below 0.5 mg/m3

. The specific locations of the VOC sampling 

were not mentioned in the report. 

In October 2008, carpet in the main lobby, the secretary/treasurer’s office, and classrooms 407, 501, 503 were 

cleaned and treated with Sporicidin. HVAC units 12 (front office), 48 (classroom 501), and 50 (classroom 407) 

were cleaned including contact vacuuming with a HEPA vacuum. Debri was captured with a negative pressure 

HEPA vacuum. Additionally, fan blowers and coils were HEPA vacuumed, and the HVACs were sanitized with 

Sporicidin. The rooms were wiped down and HEPA vacuumed following the cleaning process. 

In December 2008, an off-white substance was observed coming from the ductwork in the main office area and 

one of the classrooms (room 618) after cleaning had been conducted in some air handling units at the school. 

There was concern that the white substance was from the coil cleaning agent or possibly the mineral content in 

the water. An industrial hygiene consultant observed an off-white powdery substance in the three air handler 

units inspected and informed a school official who contacted the cleaning contractor and was told that no white 

substances were used in the cleaning of the coils. The coil cleaner contained butyl cellosolve (also called ethylene 

glycol monobutyl ether or 2-butoxyethanol), a type of glycol ether, which is water soluble and often used as 

a solvent. The industrial hygiene consultant performed total particulate monitoring, air sampling for butyl 

cellosolve, and air and surface sampling for fungal materials in the office area and room 618. In the three areas 

(office lobby and rooms 113 and 618) where the white substance was observed coming out of the duct work, the 

Health Hazard Evaluation Report 2009-0172-3124 Page 217 
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total particulate concentrations ranged from 0.20 - 0.53 mg/m3 and did not differ significantly from the break 

room (room 123) measurement of 0.34 mg/m3

. The break room had not had coil cleaning and was tested in order 

to compare results with the affected areas. All three air sampling results (office lobby and rooms 113 and 618) 

for butyl cellosolve were below the detection limit (< 0.72 ppm) for the analytical method; thus, they were below 

the NIOSH recommended exposure limit (REL) (5 ppm) and the Occupational Safety and Health Administration 

(OSHA) permissible exposure limit (PEL) (50 ppm) at the time of testing. Two outdoor fungal air samples (spore 

trap analysis) revealed a total spore count of 1,746 structures/m3 and 653 structures/m3 compared to total spore 

counts of 53 structures/m3

 in room 618, and 93 structures/m3 in the office lobby, and 653 structures/m3 in room 

113. The laboratory detected an Aspergillus conidiophore in the air sample taken in room 113. The consultants 

conducted surface sampling on horizontal surfaces in three locations (office conference room table, lobby log-in 

book, and plastic lid in classroom 618) where the white substance was observed. Very few miscellaneous spores 

were present; no mold growth occurred in the samples taken. 

In early April 2009, an industrial hygiene consultant from the Occupational and Environmental Epidemiology 

Branch of the North Carolina Department of Health and Human Services and a building systems engineer for the 

public schools of North Carolina performed site visits to evaluate the indoor environment at the school. During 

the site visit, the industrial hygiene consultant reported a moldy odor in the northwest corner of the assistant 

principal’s office (room 108) where carpet had been pulled up. He noted that the northwest wall was a common 

wall to the new and the old buildings. He also noted a history of recurrent water damage to the ceiling tiles above 

the ramp which connects the new and old buildings. Additionally, there had been evidence of termites swarming 

that area. In classroom 520 in the 4/5 wing, he reported a musty, earthy odor or an odor similar to citrus-based 

cleaning products when a carpet square was lifted. He also reported a microbial odor outside the bathrooms in 

the 4/5 hall and a history of roof leaks in the music room (room 407) and the Spanish room (room 501) which 

share a common wall located under an area where a north-south roof intersects an east-west roof. In classroom 

427, he reported a history of recurring problems with mold growth in the carpet. He recommended the school 

district 1) remove the carpet (using proper procedures) and replace with VCT (after measurement of concrete floor 

moisture content) in rooms 108, 520, and the music room; 2) identify and correct the sources of water movement 

through the exterior wall in room 108; 3) repair flashing on the parapet where the old and new building were 

joined; 4) investigate the source of roof leaks above the music and Spanish room; 5) encourage students to use 

the main doors to enter and exit the building to reduce the amount of soils, dust, debris and allergens brought into 

the building; 6) install barrier mats at entrances that are long enough that a person would take at least five full 

steps on the mat; 7) vacuum carpet daily; 8) identify and correct odor sources at the bathroom in the 4/5 hall; 9) 

investigate sources of moisture under the concrete slab; 10) integrate pest management techniques to control the 

termite infestation where the new and old buildings meet; and 11) analyze absentee data or other data to look for 

patterns where problems may exist. 

During the same site visit, the building systems engineer for the public schools of North Carolina reported 

ceiling tile stains throughout the school especially, in the area where the old and new buildings were structurally 

joined. He noted in his report there was a tendency to replace stained ceiling tiles before repairing the leaks. He 

recommended fixing leaks before replacing the ceiling tiles. He noted that foam roof sections in the older section 

of the school were showing signs of deterioration and would need to be replaced especially if there were an 

increase in the number of leaks. He noted that flashing connections in some areas over the media center did not 

cover enough of the wall to prevent rain penetration, and some of the exterior bricks on the wall had deteriorated 

which may have contributed to the leaks in the assistant principal’s office. He recommended that the metal cap 

flashing on the north side be extended down to cover the gaps between the existing flashing and the brick wall. 

The engineer also reported that surface water drainage toward the building kept the slab wet. He recommended 

reducing moisture migration toward the building slab by installing a French drain between the school and the high 

ground of the playground area to drain groundwater toward the streets in order to keep it away from the building. 

He recommended construction of swales around the building on the playground side and improvement of drainage 

around the courtyard surface areas to better drain water away from the buildings. He noted that some 

of the existing drop inlets might need to be lowered. He reported variations in RH in different areas and that 

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Appendix M: niosH inteRiM RepoRt, HetA 2009-0172 (Continued) 

the classrooms closest to the playground generally appeared to have moisture-related issues. He recommended 

keeping the RH ideally between 30 and 60% with installation of room dehumidifiers in classrooms where the 

HVAC system could not maintain an RH of 60% or below. The school district reported that they tested the RH in 

the school, and that on average, the RH readings were at or below 60%. Lastly, he reported a significant amount 

of visible mold under the carpet in the assistant principal’s office. He noted that several classrooms had odors 

which where masked by carpet cleaning compounds. He recommended removal of carpet and replacement with 

floor tile in carpeted rooms were odors and/or moisture where detected. 

Later in April 2009, another industrial hygiene consultant from Workplace Group performed bulk sampling of 

adhesive beneath the carpet in classroom 501; surface testing of the underside of carpet for fungal materials in 

classroom 520 and the assistant principal’s office; and monitored temperature, humidity, and CO2 in classrooms 

516 and 520. Bulk sampling of the adhesive beneath the carpet in classroom 501 was negative for fungal growth 

or spores. In the assistant principal’s office and classroom 520, Aspergillus and Pencillium were detected on the 

carpet backing. Mold growth was rated from 1 to 4 with 4 denoting the highest concentration. The mold score 

was 3 in classroom 520 and 4 in the assistant principal’s office. In classroom 516, the temperature ranged from 

66.7-75.1 oF (average 70.8oF, median 70.2 oF); the RH ranged from 22.7-30.9% (average: 25.9%, median: 26.1%); 

and CO2 from 350-750 ppm (average: 500 ppm, median: 460 ppm). In room 520, the temperature ranged from 

67.4 oF – 75.3 (average: 73.0 oF, median: 73.5 oF); the RH from 20.6-51.0% (average: 33.3%, median 33.0%); and 

CO2 from 330-1710 ppm (average: 700 ppm, median: 540 ppm), exceeding the recommended limit of 1,100 ppm 

at one point during testing. 

In mid April 2009, floor consultants performed moisture testing of interior floor slabs in the assistant principal’s 

office and classrooms 427, 516, 518, 520, and 618. During this same time frame, a consultant engineer performed 

a site visit to review floor and wall conditions. In his report, he noted that interior floor slabs were being tested for 

moisture by a flooring company, and the surface preparation was suspect, as evidenced by adhesive residue and 

curing compounds under the testing chamber. He mentioned that the school was reported to have had high levels 

of humidity for an extended period of time when the new addition was opened in 2005, and adjustments had been 

made to the HVAC system. Monitors for temperature and humidity were removed, and relative humidity was no 

longer monitored on the interior of the school. Surface water draining from the elevated ballfields was allowed 

to pond in areas adjacent to the concrete walkways instead of being directed across the gravel roadway. He also 

noted significant roof leaks on the flat roof over the utility/storage room at the southeast corner of the school just 

west of the Gym structure. He reported over 18 ceiling tiles were damaged. In the main hallway where the old 

and the new buildings interface, he reported damaged ceiling tiles from water intrusion which appeared to be from 

a roof leak. 

In mid April, the carpet in the assistant principal’ office was replaced with VCT. 

During the second week in May 2009, a senior environmental health specialist from Guilford County Department 

of Public Health toured the site and noted a water stained ceiling tile in room 619. She noted in her report that a 

previous site visit by state and local agencies on April 3, 2009 outlined a variety of issues and recommendations. 

Also during the second week of May 2009, an industrial hygiene consultant from Workplace Hygiene conducted 

carpet, surface, and air sampling for fungal materials (in rooms 115, 206, 420, 421, 422, 423, 425, 427, 500, 503, 

514, 515, 516, 610, 616, 618, 627), and VOC air sampling. The indoor fungal air samples ranged from no spores 

detected in classroom 627 to 940 spores per cubic meter in classroom 420. The six rooms with the highest total 

spores were classroom 420 (940 spores/m3

), classroom 206 (705 spores/m3), classroom 427 (549 spores/m3), 

classroom 514 (549 spores/m3

), classroom115 (470 spores/m3), and classroom 425 (470 spores/m3). The outdoor 

samples (outside of 2/3 and k/1 wings) ranged from 18,103 to 28,134 spores/m3

; the top three outside fungi 

species identified were Ascospores, Basidiospores, and Cladosporium. The outdoor fungi were higher than the 

indoor fungi except for Myxomycete/Smut-like which was higher in room 420. Surface sampling was 

conducted beneath the carpeting in the same 17 rooms, in a paper tray in room 115, and on a wall that experienced 

Health Hazard Evaluation Report 2009-0172-3124 Page 219 
Appendix M: niosH inteRiM RepoRt, HetA 2009-0172 (Continued) 

water damage in room 500. Because the carpet was glued to the floor, only one location was selected from each 

room. With the exception of the k/1 wing and room 206, the samples were collected near the exterior doors of 

each classroom because the consultants thought this area would likely have the moisture issues. The carpet in the 

rooms in the k/1 wing did not extend to exterior doors and room 206 did not have an exterior door. Spores were 

not detected on the carpet backing in rooms 425, 503, 515, and 616. In the other areas sampled with the exception 

of room 421, the spore concentrations were characterized as “trace to light.” The carpet backing in room 421 

had a surface concentration of mold spores identified as Aspergillus/Penicillium characterized as “loaded” and 

concentrations of basidiospores and Cladosporium characterized as “trace” to “light”. 

Carpet sampling results ranged from 30,000 cfu/gram in room 115 to > 2,000,000 cfu/gram in classroom 516. Six 

of the 16 results exceeded 1,000,000 cfu/gram (room 206, >1,333,333; classroom 514, >1,600,000; classroom 

515, >1,600,000; classroom 516, >2,000,000; classroom 618, >1,000,000; classroom 627, 1,460,000 ). Total 

VOC air sampling ranged from 0.18 mg/m3

 for a sample collected outdoors to 1.6 mg/m3 in classroom 425. The 

consultants noted in their report that the Green Building Council established a recommended concentration limit 

for VOCs of 0.5 mg/m3 for new buildings, and Washington State established 0.5 mg/m3

 in buildings. Six (420, 

423, 425, 500, 501, 514) of the 20 areas sampled exceeded the 0.5 mg/m3 limit. The consultant reported cleaning 

activities were going on during the sampling, and this may have affected the results. The cleaning products 

used were not listed. The industrial hygiene consultant recommended the school district 1) test for aldehydes 

to determine whether their presence contributed to reports of bloody noses, 2) test (by smoke or pressure) the 

drain lines to check for leaks 3) inspect and clean the air handlers (if necessary), and replace any contaminated 

insulations (if found), and 4) forward the consultant’s report to the county health department. 

Later in May 2009, an engineer consultant assessed the school and found “slight humidity in the administration 

office”, however, thought the air quality in the school seemed acceptable. He evaluated the mechanical systems 

in the 2/3 and 4/5 wings and thought the system was well designed. However, in an outdoor air unit, he found 

standing water in the condensate drain pan and noted the filters for these units needed to be replaced. The 

engineer relieved the pressure on the unit and drained the pan completely. He noted that the units were designed 

to be free of standing water and recommended that drainage of these units be looked at to determine the problem. 

Another contractor checked the drain pans and found that the drain piping did not appear to allow complete 

drainage in the drain pan. However, he did not note carryover of moisture to the fan compartment or ductwork 

and did not see any dirt or other issue that would cause a mold issue in the unit or drain pan. The two consultants 

agreed that an adjustment in the trays should solve the problem. A school staff member was reported to start the 

work immediately. 

The engineer consultant also found that the CO2 ventilation system had been disabled, sensors had been “jumped 

out”, and the outdoor air units had been set at 100% which appeared to be done to get as much air into the 

building as possible. However, outdoor air did not appear to be getting into the building. CO2

 readings inside 

the building (that was unoccupied for three days) were around 500 ppm. Additionally, the building was noted to 

be in a neutral pressure condition but with the CO2 system disabled it apparently should have been in a positive 

pressure condition. The consultant noted that the HVAC system serving the school was a nice design but was not 

operating correctly. He recommended the system be re-commissioned and the outdoor air system be checked to 

see if it was sized correctly. A third consultant noted that that the CO2

 sensors were part of a previous attempt to 

control fresh air intake and were not part of the current ventilation control. However, when the system was most 

recently balanced, the dampers were bypassed in the open position to allow the scheduled fresh air to be delivered 

from the new air handling unit to the classroom units to ensure the right amount of air reached each unit. The 

prior summer, when the new system was installed, fans and dampers were set up and a balance contractor verified 

flow to each unit and all were apparently 95% or better for air scheduled to go to the units. The school planned to 

have the ventilation air calculations double checked to determine if any further re-commissioning was necessary. 

The engineer consultant found a lot of construction dust in the return ductwork and recommended the duct system 

be cleaned. He noted the ductwork on the other side of the filter was clean, and the filters were being maintained. 

Page 220 Health Hazard Evaluation Report 2009-0172-3124 
Appendix M: niosH inteRiM RepoRt, HetA 2009-0172 (Continued) 

During May 2009, the carpet in classrooms 407, 501, 508, 518, and 625 was replaced with VCT. During the 

last weekend in May 2009, a carpet cleaning company cleaned all the remaining carpet in the school with an 

antimicrobial agent. 

During the last week in May 2009, the Guilford County Department of Public Health distributed questionnaires 

for staff and parents at Oak Ridge Elementary School. In mid June 2009, the medical director of the health 

department and his colleagues toured the school. In a media briefing on the following day (June 16, 2009), he 

reported that when they toured the school a month earlier they could find no mold or dampness; however, the day 

before, they did observe moisture in a wall and a small patch of mildew behind a banner in the gymnasium 

The Guilford County Department of Public Health reported in a document dated June 25, 2009 that approximately 

800 questionnaire surveys were distributed and about half were returned within the week’s deadline (in Appendix 

C). The document stated that the summary of the responses showed that the “driving” symptoms were headache 

and fatigue that occurred within the school and resolved when fresh air was obtained by opening windows and 

doors to the classrooms, by going outside, or by going home. The document noted that nosebleeds were also 

common, and other symptoms were tabulated, but their frequencies were not as elevated; nor was there a specific 

pattern evident. 

In mid July 2009, NIOSH and the Turner Group performed a three day site visit at Oak Ridge Elementary School. 

On the last day during a breakfast meeting, NIOSH staff and the Turner Group met with representatives from 

Guilford County Schools. The Turner Group summarized their preliminary findings in a document dated July 

21, 2009 (Appendix D). Their findings and recommendations included: 1) finding: dirt floor crawl space under 

the media center as possible source of mold / recommendation: install flexible vapor barrier and depressurize air 

space under the vapor barrier in the crawl space under the media center; 2) finding: inadequate flashing at junction 

between the parapet wall and gym wall above room 206 causing water intrusion leading to mold growth in the 

carpet / recommendation: install through-wall-flashing at edge of parapet to connect through brick to drainage 

layer behind; 3) finding: discolored drywall on exterior wall and repaired flashing at wall in classroom 400 (once 

a leak source with occupant reports of mold found under the cove base) / recommendation: repair roof junction 

joints to provide adequate flashing; 4) finding: dehumidification system operation suspect, evidence by high 

humidity (70%+) in the 4/5 wing / recommendation: provide retro commissioning of HVAC system with respect 

to verify proper system capacity and sequence of operation; 5) finding: possible heat pump refrigerant leaks 

indicated by 64oF discharge at HP serving classroom 520 and humidity levels monitored at 70-80% in room, or 

quantity of outside air being handled exceeded coil capacity / recommendation: provide retro commissioning of 

HVAC system with respect to verifying proper system capacity and sequence of operation; 6) finding: classroom 

wings not sealed at soffit, allowing excess air leakage in and out (depending on mechanical system operation) / 

recommendation: sealing of soffit to prevent air infiltration and ensure means for exhaust/relief; 7) finding: heat 

pump design conducive to growing mold due to proximity of filter and coiling coil / recommendation: provide 

new filter boxes upstream to create separation between coil and filter; 8) finding: concerns about odors from dry 

traps, particularly at heat pump drains, since air distributed to occupants / recommendation: review maintenance 

tasks and schedules, on-going maintenance issue; 9) finding: bathrooms not at negative pressure consistently 

with respect to hall / recommendation: balance air flows as part of retro commissioning process, possibly 

move some supply air to hall; 10) finding: mechanical room in office area under significant negative pressure / 

recommendation: provide duct joint sealant on all return air and possibly supply air and verify air flows on retro 

commissioning; 11) finding: unknown issues regarding storm runoff at the end of the 2/3 and 4/5 wings with 

possibility of water getting under slab if it pools against the exterior walls / recommendation: verify adequate 

site drainage, clean site drainage system as necessary, and provide means to limit runoff sand and other surface 

material; 12) finding: original design of classroom wings modulated between 3.5 cubic feet per minute per 

person and 7.5 cubic feet per minute per person from 1000 ppm CO2 to 1800 ppm; when dehumidification 

systems installed, carbon dioxide control eliminated and all areas receive 7.5cubic feet per minute per person / 

recommendation: provide balancing of outdoor air system and marking of dampers as part of retro 

Health Hazard Evaluation Report 2009-0172-3124 Page 221 
Appendix M: niosH inteRiM RepoRt, HetA 2009-0172 (Continued) 

commissioning project; 13) finding: numerous open bubbles on the foam roof with compromise of the aluminum 

paint / recommendation: obtain roofing contractors to estimate the repair/replace of the foam roof; 14) finding: 

possible leak from sewer vent and/or roof flashing of vent thru roof in classroom 500 / recommendation: replace 

or repair flashing; 15) finding: building not observed during the occupied mode and some operational conditions 

were not observed / recommendation: provide monitoring of conditions during occupancy to evaluate operation 

under occupancy (after retro commissioning of systems). 

The Guilford County Schools continued to consult with the Turner Group to address issues found during the 

initial site visit in July 2009 and other issues found during further testing. 

In August 2009, Oak Ridge Elementary School remained closed after the summer break for remediation. Students 

attended three alternate sites. Kindergartners and first-graders attended Colfax Elementary school; second and 

third graders attended Oak Ridge Military Academy; and fourth and fifth graders attended Northwest Middle 

School. 

Some additional findings identified by the Turner Group (Appendices E and F) included visible mold on some 

small portions of gypsum board removed at floor level, water damaged walls in the clerestory area above the 

media center that were suspected to have supported mold growth in the past. The walls were removed or cleaned. 

Dried leaves and other dried organic material found trapped in the building construction in the media center 

were removed. Some of the clerestory windows were resealed and existing roof scuppers were lowered. An old 

ventilation system in the clerestory space that was no longer in use was removed and the openings sealed because 

it was defeating the building thermal envelope. Blower door tests and infrared imaging indicated that the soffits 

in the classroom wings were a source of many air leaks. Other heat and air leak areas identified on the thermal 

imaging included doors, windows, and the base of the building wall. The Turner Group consultants’ reviewed 

photos that showed some plumbing waste line vents in the classroom wings were open to the space above the 

ceilings and should have been connected to the waste line vents. This was corrected. Additionally, some of the 

waste line vents through the roof were less than 10 feet from the roof mounted air inlets. They were apparently 

relocated to meet the minimum 10 feet distance between roof vents and air inlets specified by construction 

drawings. Slab testing results reported in the Turner Group’s final report noted that the concrete flooring in some 

rooms (106, 110, 400, 425, 502, 514, 608, 610, 614, 616, 617, 618, and 627) had more moisture (over 5.0 pounds 

per 1000 square feet per 24 hours) than other rooms. They also noted that some classrooms (505, 516, 608, and 

614) had rusted sill plates possibly due to water damage. In addition to the recommendations in their preliminary 

report, the Turner Group also recommended 1) new floor maintenance systems and schedules since the school no 

longer had textile floor covers but either hard vinyl surfaces or TerraCotta; 2) limit noise by fitting desks, chairs, 

and other objects with felt pads on their feet, or fitted with rolling castor wheels designed for hard floors; 3) avoid 

the use of textile floor coverings of any size except track-off mats; 4) use track-off mats at all main entries and do 

not use classroom fire-exits as normal entry door; 5) set occupied temperature set point of 70oF heating and 74oF 

cooling in accordance with the recommendations made by the commissioning agent; 6) operate the school in an 

occupied cycle and an unoccupied cycle; 7) continue additional monitoring of space conditions throughout the 

remaining heating season of this year, and the upcoming cooling season, to verify the HVAC system and controls 

are operating properly; 8) additional evaluation and possible corrective work to further limit heat loss and air 

leaks from doors, windows, and base of the walls. 

Appendix G summarizes the remediation activities completed at Oak Ridge Elementary School since the NIOSH 

site visit in July 2009. 

NIOSH walkthrough July 2009 

We noted a strong musty, moldy odor in the basement (Figure 5) and crawl space under the media center. Lime 

was observed on the crawl space dirt floor. We also noted a musty smell in the corridor around the media center, 

in particular near the school museum. Surface drainage from playgrounds drained towards the classroom wings; 

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Appendix M: niosH inteRiM RepoRt, HetA 2009-0172 (Continued) 

it appeared water could puddle near concrete walkways adjacent to classroom wings especially near the 2/3 and 

4/5 wings (Figures 6, 7, and 8). A storm drain outside the media center was blocked with standing water in it 

(Figure 9). The foam roof had multiple locations where the surface had been compromised; there 

were signs of softness and bubbling of the roof membrane (Figures 10 and 11). There did not appear to 

be adequate flashing at the junction between the parapet wall (above room 206) and the gym (Figure 12). Room 

206 had stained carpet, wavy appearing baseboards, and walls which appeared newly painted. Inside the school, 

we noted moisture (with the infrared camera) in the gym’s exterior concrete block wall in an area where a leak 

had been repaired. We also noted pressure airflow issues between rooms and spaces. Multiple classrooms were 

under negative pressure instead of positive pressure in regard to the corridor. Multiple restrooms had positive 

pressure instead of negative pressure. During the day, the plenum above the classroom ceilings was generally 

under positive pressure in regard to the exterior of the building. However at night when the dehumidifier (which 

served the classroom wings) was turned off, this sometimes resulted in the plenum being under negative pressure 

in regard to the outside of the building. This allowed outside humid air to enter the plenum through the soffits 

in the classroom wings. From the mezzanine area where the dehumidifier was located, we observed dust on 

classroom ceilings and ducts (Figures 13 and 14). Some of the coils for the HVAC air handlers had residue that 

may have been mold contamination (Figure 15). 

On the last day of the site visit, we communicated these findings with the concurrence of the Turner Group at a 

breakfast meeting with officials from Guilford County Schools. The following week, we emailed school district 

officials a brief summary of the findings discussed during the breakfast meeting (Appendix H). Additionally in 

July 2009, we had a teleconference with school district officials in which we notified them that some Oak Ridge 

Elementary School employees interviewed over the telephone reported building-related symptoms suggestive of 

hypersensitivity pneumonitis. We also noted that there appeared to be a high prevalence of respiratory symptoms 

at the school based on the summary of the questionnaire survey results that Guilford County Department of Public 

Health provided to us (Appendices I and J); we had not yet done our own statistical analysis of the de-identified 

questionnaire data. In October 2009, we sent an email to parents who requested a summary of our findings from 

the site visit (Appendix K). 

Environmental results 

Water activity in floor materials, relative humidity, and temperature 

Water activity on floor materials from the 23 areas (21 rooms) sampled ranged from 0.52 to 0.81 with a median 

of 0.69 on the date of investigation. Average water activity on the floor in the administration wing (0.76), media 

center wing (0.73), and 4/5 wing (0.69) were above the school median (0.688) while average water activity in 

the k/1 wing was lowest (0.57) (Table 2). RH in the building ranged from 34 to 69%. Average RH was higher in 

the administrative wing (59%) than the other wings of the building and lowest in k/1 wing (37%), and 2/3 wing 

(39%). Air temperature did not show a wide range within the building (range=70.5 – 74.1oF). 

Microbial concentration in floor dust samples 

From the 22 samples analyzed, we recovered 20 fungal species, yeasts, and unidentifiable non-sporulating fungi 

(Figure 16). Identified hydrophilic (water-loving) fungi from the dust samples included Alternaria alternata, 

Epicoccum nigrum, Trichoderma konigii, Aspergillus fumigatus, Mucor plumbeus, Rhizopus stolonifer, and 

yeasts [WHO 2009; Hung et al. 2005; Flannigan and Miller 2001]. Identified mesophilic fungi included 

Cladosporium cladosporioides, Aureobasidium pullulans, Fusarium oxysporum, Aspergillus ochraceus, 

Aspergillus niger, Aspergillus versicolor, Paecilomyces varioti, Penicillium aurantiogriseum [WHO 2009; Hung 

et al. 2005; Flannigan and Miller 2001]. Among the species recovered, Cladosporium cladosporioides occurred 

most frequently in dust samples (recovered from all 22 samples=100% occurrence). Epicoccum nigrum and 

Alternaria alternata (water-loving fungi) were recovered from 86% and 64% of samples, respectively. Bipolaris 

australiensis [WHO 2009; Hung et al. 2005; Flannigan and Miller 2001] which was not identified as either 

hydrophilic or mesophilic was recovered from 64% of samples. 

Health Hazard Evaluation Report 2009-0172-3124 Page 223 
Appendix M: niosH inteRiM RepoRt, HetA 2009-0172 (Continued) 

The building overall geometric mean (GM) of total culturable fungi was 6,000 colony-forming units per gram 

(g) dust (Table 3). Overall building GM concentration of hydrophilic fungi was 1,200 cfu/g. Analysis of 

the fractions of hydrophilic and mesophilic fungi showed that on average, 83% of the total culturable fungi 

were either mesophilic (61%) or hydrophilic (22%). Among fungi identified from more than 40% of samples, 

Cladosporium cladosporioides (GM = 2,852 cfu/g), Epicoccum nigrum (GM=1,130 cfu/g), and Aureobasidium 

pullulans (GM=733 cfu/g) were recovered with higher concentration than others. The overall building GM of 

gram-positive bacteria (396,000 cfu/g) was higher than that of gram-negative bacteria (8,500 cfu/g). None of the 

22 samples had Actinomycetes (fungus-like bacteria). 

Levels of total fungi, gram-positive, and gram-negative bacteria by building wing are summarized in Table 4. 

The gym-cafeteria wing (N=1, 24,000 cfu/g) and 2/3 wing (N=4, 23,500 cfu/g) had the highest level of total 

culturable fungi in floor dust, approximately eight-times higher than those of the media center (N=3, 2,900 cfu/g) 

and 4/5 wing (N=6, 2,900 cfu/g). We observed a similar pattern for the levels of hydrophilic fungi in dust. The 

percentages of hydrophilic fungi in total fungal concentration were similar among wings and ranged between 

20% (administration wing) and 29% (k/1 wing). Except for the k/1 wing, we observed a similar pattern in gramnegative bacteria concentration by building wing as those observed with culturable fungi. The level of gramnegative bacteria was more than an order of magnitude higher in the 2/3 wing (52,000 cfu/g) than in the media 

center (2,500 cfu/g) and 4/5 wing (3,900 cfu/g). However, the levels of gram-positive bacteria were highest in k/1 

wing (855,600 cfu/g), followed by 2/3 wing (660,100 cfu/g), and the media center (631,600 cfu/g). 

Comparison of NIOSH measurements with historical measurements of fungi in floor dust 

We identified 10 rooms which had both NIOSH and previous consultants’ measurements: two rooms in the 

administration area, one in the gym area, two in the 2/3 wing, three in the 4/5 wing, and two in the k/1wing. Eight 

of the 10 rooms had measurements in May 2009 and July 2009 (Table 5). Room 100 (lobby in the administration 

area) had measurements in October 2007 and July 2009 (Table 6). Room 407 had measurements in September 

and October 2008 and July 2009. Based on the comparisons, we found that the fungal levels measured during the 

2009 NIOSH investigation were 4 to 1,000-fold lower than those measured previously by consultants in all rooms 

except for room 115 in the administration wing which showed similar levels. Measurements from three rooms in 

the 4/5 wing showed dramatically decreased (90 to 1000-fold lower) fungal levels in the NIOSH investigation 

compared to those measured about two months before (May 2009). 

Health results 

Telephone interviews with three staff members 

Staff member A 

During the early part of the 2008/2009 school year, this staff member, with no prior history of respiratory illness, 

developed headaches, scratchy throat, laryngitis, sinus infection, and deep cough. He/She noted that the carpet 

sometimes felt damp, and the room smelled like “a wet dog”, or musty especially when it rained, and when the 

power was off, and there was no ventilation. He/She was diagnosed with bronchitis and then pneumonia. While 

he/she had pneumonia, he/she had profound fatigue, night sweats but no fever or chills. He/She did not respond 

to antibiotics and was eventually given steroid shots. He/She was restricted from work for a short period of time, 

improved, and then got sick again when he/she went back to work. He/She improved until the carpet was pulled 

up, at which time he/she had the same progression of symptoms, diagnoses, antibiotics with no effect, and finally 

prednisone, which made him/her feel better. The ventilation ducts were cleaned; however, during this time, he/she 

developed wheezing and was treated with an inhaler (corticosteroid with long acting bronchodilator β2

 agonist) 

and oral steroids. Additionally he/she reported that fish in one of the classrooms died, and the class was relocated 

for a few days because of the strong disinfectant smell. In the summer of 2009, while out of the school, he/she 

had no wheezing, cough, fatigue, headaches, or medication requirement. 

Staff member B 

Since the opening of the new school building in 2005, this staff member developed recurrent sinus infections. He/ 

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Appendix M: niosH inteRiM RepoRt, HetA 2009-0172 (Continued) 

She had post-nasal drip, difficulty breathing, chest tightness, a metallic taste in his/her mouth, lungs that “hurt”, 

and clogged ears. Additionally, he/she described three episodes of “dizziness, lightheadedness and feeling” that 

he/she might “pass out” in the school building during the 2008/2009 school year. Other symptoms included a 

deep cough during exercise and some dyspnea on exertion as if he/she “couldn’t take a deep breath” when he/ 

she walked. He/She noted his/her cough more outside of the building than inside, and it was sometimes dry and 

other times productive. Other than cough, he/she reported no symptoms outside of the school building. His/Her 

symptoms got progressively worse over the course of the work week. During holiday breaks and weekends, the 

symptoms improved, but he/she would get sick upon return to the building. During May and June 2009, his/her 

symptoms got much worse after the carpet was torn up at the school. 

The media room made him/her nauseous, and he/she felt like he/she was getting the flu and had excessive fatigue. 

Sometimes he/she had night sweats and felt feverish and occasionally felt chilly. During the last two months of 

school during the 2008/2009 school year, he/she noted difficulty concentrating, remembering, and recalling. He/ 

She also had lots of wheezing and also reported sneezing attacks, itchy burning eyes, and headaches. By the 

end of the week, he/she thought he/she was getting sick, but he/she felt better on Saturdays. He/She normally 

is an active person but during the second half of the 2008/2009 school year, he/she gave up exercise because of 

excessive fatigue, but his/her fatigue went away within two weeks of the end of the 2008/2009 school year. 

He/She reported no allergies on testing, except to cats, which was apparently minimal, and he/she does not have 

a cat. Medications have not helped his/her symptoms, and he/she has had particular difficulties the last couple 

months of the 2008/2009 school year with alternating antibiotics and steroids. However, within a couple of weeks 

of school being out this past summer, he/she has been healthy again, with no need for medications. 

He/She noted that the 4/5 wing has had leaks from the bathroom pipes. When it rained, the ceiling tiles got 

stained and were changed. The gym has had mold on the walls, and the physical education teacher’s room 

had carpet separating from a damp wall. The administration offices smelt musty, like an old basement. A 

dehumidifier was placed in the administration area; however, it did not seem to serve all the offices. In the 

corridor near the library, there were two termite swarms. 

Staff member C 

During the 2008/2009 school year, this staff member with no prior history of respiratory illness developed 

respiratory and sinus infections, itchy/watery eye, rashes, decreased appetite, fatigue, and difficulty concentration 

and focusing. He/she did not note any cough, wheezing, fever, or chills but sometimes “gasped for air”. Since the 

end of the 2008/2009 school year, his/her symptoms have improved, and he/she feels less fatigued and more alert. 

He/She noted many ceiling leaks at the school and water in fluorescent light covers in a classroom wing. He/She 

noted that stained ceiling tiles were constantly being replaced at the school, and the gym had issues with mold 

growth and condensation on the walls. 

De-identified questionnaire data (from Guilford County Department of Public Health) 

Participation and Demographics 

Fifty-two of 88 (59%) staff members participated in the questionnaire. All 52 participants worked at Oak 

Ridge Elementary School during the 2008/2009 school year; forty-five of the 52 participants also worked at the 

school during the 2007/2008 school year. Two of the staff participants who worked at the school during both 

school years stopped the questionnaire after the first page as directed by the questionnaire instructions; they had 

answered “no” to experiencing any of the following symptoms while in the school building during the 2008/2009 

school year: 1) headaches, 2) dry eyes, 3) unusual sneezing episodes, 4) difficulty breathing/asthma attacks, 5) 

nosebleeds, or 6) other symptoms. Therefore, 2 (4%) of 45 staff participants who worked at the school during 

both school years did not provide information on symptoms in the school building during the 2007/2008 school 

year, health conditions, medication, smoking status, or home exposures. 

Health Hazard Evaluation Report 2009-0172-3124 Page 225 
Appendix M: niosH inteRiM RepoRt, HetA 2009-0172 (Continued) 

Seven hundred and thirty-eight (738) students attended Oak Ridge Elementary School in 2008/2009 and 734 

in 2007/2008. Parents of 388 students completed the questionnaire. We excluded data from one questionnaire 

because the student did not attend the school during the 2008/2009 or 2007/2008 school year. Of the 387 students 

whose parents’ who filled out the survey, 385 attended during the 2008/2009 school year; 308 attended during the 

2007/2008 school year; and 306 attended during both schools years. 

Of the 387 students, 122 did not have the symptoms (identified on the first page of the questionnaire) while in 

the school building during the 2008/2009 school year and were instructed to stop the questionnaire at that point; 

however, 11 continued on with the questionnaire. Parents for 77 (25%) of 308 students who attended Oak Ridge 

Elementary School during the 2007/2008 school year stopped the questionnaire after the first page and did provide 

information on symptoms in the school building during the 2007/2008 school year, health conditions, medication, 

environmental tobacco exposure at home, and other home exposures. Parents for 34 (9%) of 385 students who 

only attended Oak Ridge Elementary School during the 2008/2009 school year stopped the questionnaire after the 

first page and did provide any information on health conditions, medications, environmental tobacco exposure at 

home, and other home exposures. Therefore, 276 (71%) of the 387 completed the entire questionnaire 

Of the 48 staff who reported their 2008/2009 primary classroom or office, 40 (83%) worked primarily in 

classroom wings and eight (17%) in other wings (Table 7). Of the 385 students who attended the school during 

the 2008/2009 school year, we were able to determine the primary classroom/homeroom wing for 376 students; 

111 (30%) were located in the k/1 wing, 136 (36%) in the 2/3 wing, and 129 (34%) in the 4/5 wing (Table 7). 

Five of 50 (10%) staff members reported smoking cigarettes, pipes, or cigars or having a smoker in their 

household. Nineteen of 276 (7%) parents reported a smoker in the household. 

Six of 50 (12%) staff members reported one or more of: a history of water leaks in their homes; water stains on 

the wall and ceiling; or mold or mildew problems. Of the participating student households, 23 of 276 (8%) had 

one or more of water leaks; water stains on the wall or ceiling, or mold or mildew. 

Six staff who reported daily breathing problems/asthma attacks during the 2008/2009 school year on the health 

department questionnaire 

As an indication of the presence of chronic lower respiratory problems possibly associated with the school 

building we have summarized the reports from the questionnaire of six staff members who reported having 

“difficulty breathing/ asthma attacks” daily while at work in the school building during the 2008/2009 school year. 

None of them smoked or had other smokers in their households. Two of the six staff members reported having 

asthma and one reported allergic rhinitis. We do not have systematic information on dates of diagnosis of these 

conditions, but one person reported an onset of 2007/2008 or earlier and the other reported an onset in 2008/2009. 

Only the two staff members with asthma reported being on prescription breathing medication. 

These six staff members worked in the 2/3, 4/5 and administrative wings, and apart from their own work areas, 

also reported symptoms associated with being in the staff lounge and media center. Four of the six staff members 

reported that their symptoms went away after leaving the building with time frames for improvement ranging 

from hours to several days. 

All of these employees reported a constellation of symptoms related to being in the building as well as breathing 

difficulties. As a group, their symptoms included chest-tightness, shortness of breath, coughing, difficulty 

breathing on awakening, fatigue, sore throat, headache, eye problems, nasal and sinus problems, skin problems, 

nosebleeds, nausea, vomiting, and a metallic taste in the mouth. 

As an indication of severity of health problems, the health department questionnaire had asked about seeking 

medical attention. Five of these six staff members had visited a doctor multiple times (from two to more than 30 

times) during the 2008/2009 school year for the health problems reported on the questionnaire. 

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Appendix M: niosH inteRiM RepoRt, HetA 2009-0172 (Continued) 

Health conditions 

For staff, 34% reported seasonal allergies; 8% asthma; and 8% allergic rhinitis. For students, 48% had seasonal 

allergies; 16% asthma; and 12% allergic rhinitis (Table 8). 

Building-related symptoms during the 2008/2009 school year 

Lower respiratory symptoms 

Thirty-eight percent (38%) of staff and 19% of students experienced at least one lower respiratory symptom while 

at school; 31% of staff and 13% of students had difficulty breathing/asthma attacks (Table 9). Of the 16 staff 

who reported difficulty breathing/asthma attacks, 38% (6/16) reported them daily, 56% (9/16) sometimes, and 6% 

(1/16) rarely. Of the 42 (out of 49) students with available frequency data, 5% (2/42) had difficulty breathing/ 

asthma attacks daily, 79% (33/42) sometimes, and 17% (7/42) rarely. Fifteen percent of staff and 7% of students 

had a cough at school.
 

Upper respiratory symptoms
 

Fifty-two percent (52%) of staff and 28% of students had at least one upper respiratory symptom while at school. 

Unusual sneezing was the most common symptom reported with 31% of staff and 23% of students experiencing 

it. 

Twenty-five percent of staff and 5% of students had sinus problems; 27% of staff and 5% of students had voice or 

throat symptoms, and 10% of staff and 5% of students had nasal symptoms. 

Mucous membrane irritation
 

Eighty-seven percent (87%) of staff and 32% of students had at least one mucous membrane symptom; 75% of 

staff and 28% of students had eye symptoms at school. 

Headache
 

Headache was the most common symptom in participating staff (92%) and students (49%) (Table 9). Of the 47 

(out of 48) staff for which we had headache frequency data, 55% (26/47) reported headaches daily at school, 43% 

(20/47) sometimes, and 2% (1/47) rarely. Of the 182 (out of 187) students with available headache frequency 

data, 25% (45/182) had headaches daily at school, 57% (104/182) sometimes, and 18% (33/182) rarely. 

Fatigue
 

Forty-four percent (44%) of staff and 6% of students had fatigue while at school. 

Nosebleed
 

Twenty-five percent (25%) of staff and 20% of students had nosebleeds. For the 10 out of 13 staff who reported 

nosebleed frequency, 10% (1/10) reported them daily, 70% (7/10) sometimes, and 20% (2/10) rarely. For 

students, we had frequency data for 72 out of 77 students with nosebleeds; 11% (8/72) had them daily, 60% 

(43/72) sometimes, and 29% (21/72) rarely. 

Work-related symptoms 

Seventy-four percent (74%) (37/50) of staff and 53% (145/274) of students at Oak Ridge Elementary School 

during the 2008/2009 school year had symptoms/problems that went away after leaving the building. 

Symptoms by classroom wing 

The health department questionnaire asked the participants to provide a room number or description of areas in 

the school where they experienced more symptoms or discomfort. Of the 52 staff members who worked at the 

school during the 2008/2009 school year, 27 staff members wrote in one more rooms or areas that caused them to 

experience more symptoms or discomfort. Of these 27 staff members, 12 reported the media room, 12 reported 

areas in the administrative wing, 10 reported areas in the 4/5 wing, eight reported areas in the 2/3 wing, four 

reported areas in the k/1 wing, and three reported areas in the gym-cafeteria wing. 

Health Hazard Evaluation Report 2009-0172-3124 Page 227 
Appendix M: niosH inteRiM RepoRt, HetA 2009-0172 (Continued) 

Of the 385 students who attended the school during the 2008/2009 school year, parents for 86 of these students 

wrote in one or more rooms or areas where their child experienced more symptoms or discomfort in the school. 

Fifty-four of the 86 parents reported areas in the 4/5 wing, 43 reported areas in the 2/3 wing, 18 reported areas in 

the k/1 wing, and two reported the gym. The music room was mentioned the most with 16 write-ins. 

Table 10 shows the prevalence of reported symptoms by primary work wing of staff during the 2008/2009 school 

year. Upper respiratory symptoms were significantly (p<0.05) (Figure 17) more prevalent among staff who 

worked in the 2/3 or 4/5 wings compared to staff who worked in the k/1 wing. Lower respiratory symptoms were 

more prevalent (marginally significant, p<0.10) among staff who worked in the 2/3 or 4/5 wings compared to staff 

who worked in the k/1 wing. 

Table 11 shows the prevalence of reported symptoms by primary homeroom wing of students during the 

2008/2009 school year. Headaches and nosebleeds were significantly more prevalent among students whose 

primary/homeroom classroom were in the 2/3 or 4/5 wing compared to students whose primary/homeroom 

classroom were in the k/1 wing. Dry eyes, unusual sneezing, breathing difficulties/asthma attacks, and upper 

respiratory symptoms were more prevalent (marginally significant, p<0.10) among students whose primary/ 

homeroom classroom were in the 2/3 or 4/5 wing compared to students whose primary/homeroom classroom were 

in the k/1 wing (Figure 18). 

Symptoms reported during the 2008/2009 and 2007/2008 school years 

Staff (Figure 19) and students (Figure 20) who reported symptoms in the 2008/2009 school year and who worked 

or attended Oak Ridge Elementary School during 2007/2008 and 2008/2009 school year had headache, dry eyes, 

unusual sneezing, breathing difficulties/asthma attacks, nosebleeds, and upper and lower respiratory symptoms 

more frequently during the 2008/2009 school year than during the 2007/2008 school year; the results were 

statistically significant (p<0.05). 

DISCUSSION 

Oak Ridge Elementary School has had a long history of widespread dampness with mold growth since re-opening 

in August 2005 after renovations and the addition of three classroom wings. Visible mold was found recurrently 

on books, carpet, upholstered furniture, picture frames, and walls. The significance of visible mold is that it 

reflects chronic dampness and exposure hazards for staff and students. The significance of musty odors is that 

mold is actively growing. Mold cannot grow without moisture and a source of food, which is usually carbon in 

paper, wood, building materials, adhesives, and dirt. The dampness in Oak Ridge Elementary School had several 

sources. High relative humidity (RH) reflects dampness and can support mold growth. Consultants reported 

measurements above 70%, in contrast to recommended ranges of 30-60% for indoor light work. Ongoing 

problems with the building’s heating, ventilation, and air-conditioning (HVAC) system and air flow issues 

allowed the incursion of outside, unconditioned air into the school through areas such as the crawl space under 

the media center, clerestory above the media center, and soffits in the classroom wings. There was potential for 

the formation of condensation. Additionally, the air flow and ventilation issues at the school may have allowed 

the transport of mold spores from reservoirs such as the crawl space and basement under the media center where a 

strong musty odor was detected. 

Inadequate flashing was also a source of dampness at the school. During the July 2009 site visit, NIOSH and the 

Turner Group found inadequate flashing at the junction between the parapet wall above room 206 and the gym. 

The carpet in room 206 was stained and had wavy baseboards likely from water damage. A few months earlier, 

an engineer performing a site visit at the school reported inadequate flashing connections over areas of the media 

center resulting in deterioration of exterior bricks which likely allowed penetration of rain water and contributed 

to leaks in the assistant principal’s office. During the same site visit, the consultant also reported finding a 

significant amount of visible mold under the carpet in this office. In 2005, an exterior wall in classroom 400 

was water damaged due to an exterior leak during construction. In July 2009, the Turner Group reported that the 

drywall in this room was discolored, and that there had been occupant reports of mold found under the cove base. 

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Appendix M: niosH inteRiM RepoRt, HetA 2009-0172 (Continued) 

Although the wall flashing had been repaired, the Turner Group recommended repair of the roof junction joints to 

provide adequate flashing. 

Various consultants over the years have reported ceiling and roof leaks. Following a heavy rain in July 2006, 

roof leaks occurred in all the classroom wings as well as in the administrative wing and one of the offices near the 

gym. In February 2007, an official of the North Carolina Department of Environmental and Natural Resources 

reported several ceiling leaks. The following year during a similar inspection, a bad leak was reported in the 

ceiling over the central receiving room. In April 2009, an engineer consultant reported significant roof leaks over 

the utility/storage room near the gym. Also during April 2009, more than one consultant noted stained ceiling 

tiles throughout the school especially where the old and new buildings were structurally joined. There is also a 

history of roof leaks where the north-south roof intersects with the east-west roof above the music and Spanish 

rooms; these two rooms share a common wall. Previous consultants and building occupants reported a history 

of replacing ceiling tiles before repairing the leaks. During the NIOSH site visit, we observed no stained ceiling 

tiles; however, we did find defects in the flat roof over the old section of the school, suggesting the likelihood of 

water leaks. 

Various consultants reported landscaping issues around the school that resulted in the drainage of water toward 

the school building allowing pooling of water adjacent to the school. Slab testing results reported in the Turner 

Group’s final report noted that the concrete flooring in some rooms had more moisture (over 5.0 pounds per 1000 

square feet per 24 hours) than other rooms. The Turner consultants also noted that some classrooms had rusted 

sill plates possibly due to water damage. 

The school tried various ways to remediate mold, ventilation issues, humidity, and leakage through the building 

envelope from roof and flashing problems. However, additional indoor environmental quality issues may have 

resulted from use of cleaning agents such as biocides in the HVAC system and on the carpet. The school had 

tried to keep the carpets clean and vacuumed them with HEPA filters; however, the carpeting had been subjected 

to repeated moisture infusion from steam cleaning and chemical treatments with biocides intended to control 

mold growth. Carpet can act like a sponge to absorb and often hold these fluids and odors (as was noted by 

some consultants). Carpeted areas are frequently associated with increased building-related symptoms. They 

may release volatile organic compounds (VOCs), contain dust mites that can cause allergic symptoms, and are 

reservoirs for accumulated dusts. Dusts may contain fungi and bacteria as was the case at Oak Ridge Elementary 

School reflecting dampness effects on microbial proliferation. 

Air, swab and vacuum sampling documented the presence of various microorganisms within the school over 

the years. Any indoor environment will have various microorganisms in such samples, and usually the indoor 

fungi reflect what has come in with outdoor air. Repeated air sampling for fungi often results in highly variable 

levels over the same day or at different locations in the same room. At present, no environmental standards exist 

with which to predict health risk. For that reason, NIOSH scientists do not recommend the common consultant 

practice of conducting air sampling, nor have we found air sampling helpful when there are reservoirs of hidden 

mold within walls or under carpets. Although counts of fungi in the air, whether spores or colony forming units, 

are difficult to interpret, sometimes sampling is helpful. If the qualitative or quantitative distribution of fungal 

types indoor differs from outdoors, an indoor source of fungal growth may exist. The consultant 

sampling documented some indoor fungal species that were higher in indoors samples than outdoor samples or 

did not occur in outdoor samples. This suggests that there were indoor sources of mold growth, as was evident 

visually by inspection and by smelling moldy odors. Water-loving fungi reflect indoor sources related to chronic 

dampness. 

NIOSH collected floor dust samples and found that mesophilic and hydrophilic (water-loving) fungi together 

accounted for more than 80% of the total fungal concentration. According to the American Industrial Hygiene 

Association guidelines [Hung et al. 2005], samples dominated by the presence of water-loving fungi reflects 

chronic dampness, while the predominance of a species mix of mesophilic fungi indicates alternating wet and dry 

Health Hazard Evaluation Report 2009-0172-3124 Page 229 
Appendix M: niosH inteRiM RepoRt, HetA 2009-0172 (Continued) 

cycles. 

Our results showed that the 2/3 wing had the highest average fungal (both total and hydrophilic fungi) 

concentrations in floor dust while the 4/5 wing and the media center had the lowest. We also found a high 

concentration of gram-negative bacteria in rooms of the 2/3 wing. These findings suggest that the 2/3 wing may 

have had underlying ongoing dampness issues because high levels of gram-negative bacteria and hydrophilic 

fungi which require high moisture contents in floor materials for proliferation. The rooms in the k/1 wing had 

the lowest average water activity on floor materials compared to the other wings at the school. This finding may 

imply that the carpets or tiles in this k/1 wing were relatively drier than those in other wings. 

The concentrations of fungi in floor dust from the rooms of the school building collected during the NIOSH 

survey were consistently and substantially lower than environmental consultants reported before the NIOSH 

investigation. During the last weekend in May 2009, the school had cleaned all the carpets in the school with an 

antimicrobial (biocide) agent. Additionally in May 2009, the carpet in room 407 had been replaced with vinyl 

composite tile. The cleaning activity and replacement of carpet with tiles appeared to decrease the levels of 

culturable fungi in the floor carpet dust. However, if there are any unresolved dampness problems, the cleaning 

activity or replacement itself will not prevent recurrence of microbial growth in the future. 

Upon review of environmental reports of activities at the school, we determined that the biocide Sporicidin (The 

Sporicidin Company, Rockville, MD) had been applied in the HVAC system and on carpets. Biocides, including 

fungicides and disinfectants, are chemical agents that destroy or harm living organisms [EPA 1997; Macher 1999; 

Prezant, Weekes, and Miller 2008]. Any biocide must be registered for use by the Environmental Protection 

Agency (EPA) under the Federal Insecticide, Fungicide, and Rodenticide Act. This EPA biocide registration is 

granted only for specific biocide uses; thus, only biocides specifically approved for use in a HVAC system can be 

applied in a HVAC system [EPA 1997]. Sporicidin Disinfectant Solution and Sporicidin Brand Disinfectant Spray 

are approved by the EPA for air duct cleaning (EPA Registration # 8383-3 and 8383-4, respectively). The product 

label (Appendix L) indicates that Sporicidin must be only applied to hard, non-porous surfaces of air ducts. This 

product is not approved for use in internally-insulated air duct systems. According to the EPA, biocides registered 

for use in HVAC systems have low toxicity levels and the lowest level of efficacy [Lantz, 2009]; however, the 

EPA notes that risk assessment for use in HVAC systems has not been completed for Sporicidin. The product 

label (Appendix L) indicates that this product is approved for use on carpets; however, formal risk assessment for 

Sporicidin use on carpets has not been done. There is potential for exposure to biocide residues in treated carpet 

especially since the product label claims that this product has residual anti-fungal properties lasting for over six 

months. 

An historical environmental sampling report stated that the coil cleaner used in December 2008 contained butyl 

cellosolve (2-butoxyethanol). The Agency for Toxic Substances and Disease Registry stated that exposure to 

butyl cellosolve may result in irritation of the nose and eyes, headache, a metallic taste, and vomiting. High 

exposure levels may cause breathing problems [ATSDR 1999]. Air sampling results for butyl cellosolve that 

occurred after the coil cleaning had been completed were below the NIOSH REL and OSHA PEL; however, we 

have no information on air levels of butyl cellosolve during the cleaning. 

Use of biocides in HVAC systems is controversial. Although biocide use may help reduce mold and bacterial 

growth, all biocides have some level of toxicity and unnecessary exposures should be avoided. Biocide exposure 

may have contributed to some symptoms and the fish kill in a classroom fish tank. The growth of mold and 

bacteria is due to excess moisture in indoor environments; thus, application of biocide as a protective action 

is unnecessary if moisture is properly controlled. Applying biocides directly into HVAC ducts may result in 

dissemination of these chemicals throughout the building and into occupied office areas resulting in possible 

occupant exposures and health effects. Since some mold exposures can result in respiratory health effects even 

when they are not viable (alive), mold exposures can continue even with biocide treatment further detracting from 

biocide use in HVAC ducts [Macher 1999; NYCDHMH 2008; Prezant, Weekes, and Miller, 2008]. 

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Appendix M: niosH inteRiM RepoRt, HetA 2009-0172 (Continued) 

The New York City Guidelines and the American Conference of Governmental Industrial Hygienists do not 

recommend biocide use in HVAC systems as a routine cleaning practice due to both the questionable effectiveness 

of some of these chemicals to prevent microbiological growth and also due to uncertainties regarding health 

outcomes from occupant biocide exposures [Macher 1999; NYCDHMH 2008]. Biocides should not be applied 

in occupied buildings or in an operating HVAC system [Sesline 1994]. Given the uncertainty created by a lack of 

research on the safety of biocide use in HVAC system ducts, any biocide use in HVAC systems or ductwork, even 

EPA approved biocides such as Sporicidin, should be minimized, carefully monitored in terms of occupant health 

and air quality, and guided by professional judgment [Prezant, Weekes, and Miller 2008]. 

Excessive indoor dampness is a public health problem. In 2004, the Institute of Medicine of the National 

Academies (IOM) conducted an extensive review of past scientific studies on the health effects of damp buildings. 

Based on its review of the research that has been conducted, the IOM found sufficient evidence that indoor 

dampness or mold is associated with asthma symptoms (in sensitized asthmatic persons), cough, wheeze, and 

nasal and throat symptoms. In addition, the IOM found sufficient evidence that exposure to mold or bacteria 

in damp indoor environments is associated with hypersensitivity pneumonitis. It found limited or suggestive 

evidence that exposure to indoor dampness is associated with the development of shortness of breath and asthma. 

Since the IOM review, NIOSH research has documented several damp office buildings with increased risk of 

new-onset asthma. 

In 2009, the World Health Organization (WHO) published guidelines for dampness and mold. The WHO 

Executive Summary states that excess moisture on almost all indoor materials leads to growth of microbes, such 

as mold and bacteria, which subsequently emit spores, cells, fragments and VOCs into indoor air. Additionally, 

dampness initiates chemical or biological degradation of materials, which also pollutes indoor air. In the chapter 

on health effects, the authors of the WHO guidelines concluded that there is sufficient epidemiological evidence 

of an association between indoor dampness-related factors and asthma development, asthma exacerbation, 

current asthma, respiratory infections, upper respiratory tract symptoms, cough, wheeze, and shortness of breath. 

There is now limited or suggestive evidence for bronchitis and allergic rhinitis being related to dampness-related 

exposures. There is clinical evidence that exposure to mold and other dampness-related microbial agents increase 

the risk for hypersensitivity pneumonitis, chronic rhinosinusitis, and allergic fungal sinusitis. Importantly, the 

WHO guidelines note that although atopy and allergy increases susceptibility to dampness-related health effects, 

such health effects are also found in non-atopic building occupants. 

The WHO guidelines relevant to occupational environments are as follows: 

•	 Persistent dampness and microbial growth on interior surfaces and in building structures should be 

avoided or minimized, as they may lead to adverse health effects. 

•	 Indicators of dampness and microbial growth include the presence of condensation on surfaces or in 

structures, visible mold, perceived moldy odor and a history of water damage, leakage or penetration. 

Thorough inspection and, if necessary, appropriate measurements can be used to confirm indoor moisture 

and microbial growth. 

•	 As the relations between dampness, microbial exposure and health effects cannot be quantified precisely, 

no quantitative health-based guideline values or thresholds can be recommended for acceptable levels 

of contamination with microorganisms. Instead, it is recommended that dampness and mold-related 

problems be prevented. When they occur, they should be remediated because they increase the risk of 

hazardous exposure to microbes and chemicals. 

•	 Well-designed, well-constructed, well-maintained building envelopes are critical to the prevention and 

control of excess moisture and microbial growth, as they prevent thermal bridges and the entry of liquid 

or vapor-phase water. Management of moisture requires proper control of temperatures and ventilation to 

Health Hazard Evaluation Report 2009-0172-3124	 Page 231 
 

Appendix M: niosH inteRiM RepoRt, HetA 2009-0172 (Continued)

 avoid excess humidity, condensation on surfaces and excess moisture in materials. Ventilation should be 

distributed effectively throughout spaces, and stagnant air zones should be avoided. 

•	 Building owners are responsible for providing a healthy workplace or living environment free of excess 

moisture and mold, by ensuring proper building construction and maintenance. The occupants are 

responsible for managing the use of water, heating, ventilation and appliances in a manner that does not 

lead to dampness and mold growth. 

As documented in this report and in other consultant reports, Oak Ridge Elementary School has had ongoing 

problems with their HVAC system since re-opening in August 2005. However, during the remediation process, 

the school district worked with ventilation experts, and the HVAC system was recently retro-commissioned. The 

report can be found on the Guilford County School’s website (http://www.gcsnc.com/oakridge/turner.html). 

At Oak Ridge Elementary School there was evidence of building-related symptoms. Staff during the 2008/2009 

school year had high rates of lower respiratory symptoms, mucous membrane irritation, and headaches. Even if 

we adjust for the response rate of 59%, these symptoms rates are still high. Staff and students who attended the 

school during the 2007/2008 and 2008/2009 school years had more upper and lower respiratory symptoms as 

well as headaches, dry eyes, and nosebleeds during the 2008/2009 school year than the 2007/2008 school year, 

suggesting the problems at the school were getting worse. 

From our limited telephone interviews and from the health department questionnaire responses, we saw evidence 

of building-related lower respiratory problems in building occupants, and we suspect at least two employees had 

occupational hypersensitivity pneumonitis. Hypersensitivity pneumonitis is a serious lung disease in which an 

individual’s immune system responds to repeated exposure to organic dusts (materials from living things such as 

plants, animals, bacteria, or fungi) or other sensitizing agents [Patel et al. 2001]. Symptoms can include cough, 

shortness of breath, muscle aches, fever, chills, and fatigue. In work-related hypersensitivity pneumonitis cases, 

the first sign that the illness is due to exposures at work may be that the worker’s symptoms and medical tests 

(e.g., pulmonary function tests) improve during periods of time away from work and then worsen on return to 

work. Continued exposure can lead to lung scarring and permanent shortness of breath. The two staff members 

with symptoms suggestive of hypersensitivity pneumonitis both reported that their symptoms (e.g., fatigue, fever, 

chills, cough, and shortness of breath ) resolved with time away from the school and reoccurred upon return 

to the school building. Physicians rarely consider a diagnosis of hypersensitivity pneumonitis, particularly in 

nonindustrial workers. 

Hypersensitivity pneumonitis is under-recognized, and a single case related to a building should be considered a 

sentinel event requiring investigation and remediation [Weltermann et al. 1998]. Hypersensitivity pneumonitis 

has been documented in workers in buildings with contaminated air-conditioners, ductwork, and HVAC 

filters [Bernstein et al. 1983; Scully et al. 1979; Fink et al. 1976; Banaszak et al. 1970; Arnow et al. 1978]. 

Hypersensitivity pneumonitis has also occurred in workers who worked in water-damaged buildings with roof 

leaks, plumbing leaks, poorly draining condensation pans, or high indoor relative humidity [Seuri et al. 2000; 

Thörn et al. 1996 Weltermann et al. 1998; Hoffman et al. 1993]. 

Once sources of moisture have been identified, mold and moisture-damaged materials should be promptly cleaned 

or removed with appropriate containment to minimize exposure to building occupants; and that necessary repairs 

be made to prevent further water entry into the building. 

Accordingly, we think the decision to close Oak Ridge Elementary School during the remediation to address 

the underlying issues of water intrusion, humidity, and ventilation was a prudent one. We have found that 

remediation similar to what we recommended at Oak Ridge Elementary School is easier to do when a building 

is not occupied and that health effects associated with dampness commonly are made worse when remediation 

occurs in occupied buildings. 

Page 232	 Health Hazard Evaluation Report 2009-0172-3124 
Appendix M: niosH inteRiM RepoRt, HetA 2009-0172 (Continued) 

After remediation, employees and management often wish to know if the building is then “safe”. Building 

consultants often recommend and perform “clearance” air sampling after work has been completed in an attempt 

to demonstrate that the building is safe for occupants. However, there is no scientific basis for the use of air 

sampling for this purpose. Once remediation is completed (moldy and damaged materials removed; musty 

odors no longer evident), the best evidence that the building is safe may be that employees no longer experience 

building-related symptoms. In large populations of workers, using employee health questionnaires may be 

helpful to collect information on building-related symptoms, particularly among persons new to the building 

after remediation (i.e., those without “sensitizing” historical exposures during a period of water damage). 

Unfortunately, even if most employees experience improvement in their symptoms, and new employees remain 

free of building-related symptoms, some employees with allergic conditions may not notice an improvement. 

Because their immune systems may continue to react to very small amounts of substances to which they are 

allergic, such individuals may have to avoid the building even after an otherwise successful remediation. An 

individualized management plan (such as assigning an affected employee to a different work location, perhaps at 

a remote site) is sometimes required, depending upon medical findings and recommendations of the individual’s 

physician. 

Our evaluation was built on the many efforts of the school administration, public health department, and 

consultants since 2005. Nevertheless, some limitations existed in the evaluation of this school. The health 

department questionnaire contained some open-ended questions in which the participants were asked to answer 

in their own words. These types of answers are often time consuming and difficult to categorize for statistical 

analysis. Additionally, the questionnaire asked for the presence of five specific symptoms but did not ask about 

cough, wheeze, chest tightness, itchy or runny nose, or other symptoms. Some participants wrote in these and 

other symptoms on the questionnaire. The questionnaire did ask about improvement of symptoms after leaving 

the school building; however, we could not determine which specific symptoms improved away from the school 

building. Additionally, the response rate (that is, the number of questionnaires that were returned to the health 

department) was low, and the results may not be representative of the whole school population. Parents filled 

out the questionnaires for their children instead of relying on self-report of the students. This type of surrogate 

or proxy reporting is often used for elementary-aged children, but may be less accurate than staff information. 

Lastly, the questionnaire did not ask about physician-diagnosed asthma and did not contain other standardized 

symptom questions. Accordingly, we were unable to compare results to national or state data to see if the school 

staff had elevated symptom rates. Within the school, staff in all areas appeared to have high rates of buildingrelated symptoms. 

Nevertheless, the questionnaire was a systemic attempt to collect data on which to base policy and prioritize 

interventions. Priority had to be given to the entire school because of the prevalence of reported symptoms and 

the environmental findings. Additionally, the school building-relatedness of the symptoms reported by the staff 

and parents supported building-related exposures. Also, the case reports supported illness severe enough to have 

required medical consultation and treatment. Most worrisome were symptoms suggestive of hypersensitivity 

pneumonitis. This along with the high rates of asthma/breathing difficulties reported by staff and students during 

the 2008/2009 school year warranted public health action, as taken by the school, to relocate the staff and students 

during remediation. 

Oak Ridge Elementary School reopened on February 22, 2010. NIOSH has been coordinating with officials 

from Guilford County Schools to administer a computerized health survey questionnaire to the employees at the 

school who wish to participate during March 2-4, 2010. Much of the questionnaire will address health symptoms 

experienced the four weeks prior to the re-opening of the school. We see this cross-sectional survey as part of 

surveillance to document the extent of resolution of a public health problem likely associated with dampness 

in the building before remediation. No environmental measurements are known to predict health outcomes, so 

assessing health is the only option. This assessment of health symptoms can serve as a baseline to help assess 

whether health is maintained after employees reoccupy the school. If there are no concerns, there may not be a 

reason to resurvey the employees. However, if concerns arise, such a survey would be invaluable. 

Health Hazard Evaluation Report 2009-0172-3124 Page 233 
Appendix M: niosH inteRiM RepoRt, HetA 2009-0172 (Continued) 

RECOMMENDATIONS 

Although we realize many of the recommendations have been acted on (Appendix G) since NIOSH’s site visit. 

For completeness, we have listed all our recommendations. 

1. Improve surface drainage (landscaping) around the school to prevent drainage of water (e.g, rainwater and 

melting snow) toward the concrete walkways with puddling of water adjacent to the school. 

2. Ensure proper functioning of storm drains. Ensure that the storm drains and pipes remain clear of leaves, grass 

cuttings, and other material. 

3. Remove carpet and replace with hard floors (after testing slab for moisture content). 

4. Install a vapor barrier and depressurize the basement and crawl space under the media center. 

5. Repair the roof. 

6. Repair inadequate flashing identified by NIOSH and the Turner Group. 

7. Seal classroom wing soffits. 

8. Recommission the HVAC system. 

9. Maintain the HVAC system by following the manufacturer’s recommended maintenance schedules including 

replacement of air filters, checking to make sure thermostats are in working order, and checking/cleaning 

ventilation system dampers in rooms to ensure proper functioning. 

10. Continue to assess the school for water intrusion and damage and high relative humidity and correct these 

upon discovery. Prevent worker exposures and contamination of unaffected sections of the building during 

remediation. 

11. Do not use biocides as standard procedures. 

12. Implement a systematic way for faculty and staff to report problems in their work areas. Facilitate the 

confidential reporting of dampness problems and building-related health effects by employees by designating a 

contact person such as the school nurse. A locked drop box could also be used to report problems. 

13. Use occupant health questionnaires to collect information on the building-related symptoms at re-opening and 

after occupancy, if needed 

14. Use a dampness/mold check-sheet during routine inspections of the school. An example can be found in 

Appendix M. 

15. Consider implementing the EPA’s Indoor Air Quality Tools for Schools Program. 

Information can be found on the EPA website at http://www.epa.gov/iaq/schools/ 

Page 234 Health Hazard Evaluation Report 2009-0172-3124 
Appendix M: niosH inteRiM RepoRt, HetA 2009-0172 (Continued) 

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(hve5@cdc.gov), December 8. 

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remediation of fungi in indoor environments [online]. [date assessed: 2010 Jan 7]. Available from URL: www.nyc. 

gov/html/doh/downloads/pdf/epi/epi-mold-guidelines.pdf. 

Patel A, Ryu J, Reed C [2001]. Hypersensitivity pneumonitis: current concepts and future questions. J Allergy 

Clin Immunol 108:661–670. 

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Prezant B, Weekes DM, Miller JD, ed. [2008]. Recognition, evaluation, and control of indoor mold. Fairfax, VA: 

American Industrial Hygiene Association, p. 207.
 

Scully RF, Galdabini JJ, McNeely BU [1979]. Case records of the Massachusetts General Hospital: Case 47-1979; 

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SeslineD, Ames RG, Howd RA [1994]. Irritative and systemic symptoms following exposure to Microban 

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Thörn A, Lewné M, Belin L [1996]. Allergic alveolitis in a school environment. Scan J Work Environ Health 

22:311-4.
 

Weltermann BM, Hodgson M, Storey E, DeGraff AC, Bracker A, Groseclose S, Cole SR, Cartter M, Phillips D 

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Appendix M: niosH inteRiM RepoRt, HetA 2009-0172 (Continued) 

Table 1. Microbial agents* in floor samples† collected by NIOSH during July 2009 site visit 

Room Fungi Bacteria 

Species cfu/g cfu/g 

100a Alternaria alternata 2,000 Gram positive 610,000 

Cladosporium cladosporioides 4,900 Gram negative, non-fermentative 7,300 

Epicoccum nigrum 2,000 Broad spectrum 380,000 

Fusarium oxysporum 980 

Total fungi 9,800 

113a Aureobasidium pullulans 640 Gram positive 280,000 

Biopolaris australiensis 91 Gram negative, non-fermentative 5,600 

Cladosporium cladosporioides 1,500 Broad spectrum 450,000 

Mucor plumbeus 91 

Nonsporulating fungi 180 

Penicillium lividium 180 

Trichoderma koningii 91 

Total fungi 2,800 

115a Aspergillus versicolor 960 Gram positive 67,000 

Aureobasidium pullulans 960 Gram negative, non-fermentative 6,100 

Biopolaris australiensis 1,900 Broad spectrum 95,000 

Cladosporium cladosporioides 13,000 

Epicoccum nigrum 2,900 

Nonsporulating fungi 1,900 

Penicillium lividium 960 

Total fungi 23,000 

116a Cladosporium cladosporioides 1,600 Gram positive 450,000 

Epicoccum nigrum 540 Gram negative, non-fermentative 4,600 

Nonsporulating fungi 270 Broad spectrum 63,000 

Penicillium aurantiogriseum 89 

Total fungi 2,500 

206a Alternaria alternata 1,000 Gram positive 170,000 

Aspergillus glaucus 2,000 Gram negative, non-fermentative 7,500 

Aspergillus niger 1,000 Broad spectrum 210,000 

Aspergillus versicolor 1,000 

Biopolaris australiensis 1,000 

Cladosporium cladosporioides 14,000 

Epicoccum nigrum 2,000 

Fusarium oxysporum 1,000 

Rhizopus stolonifer 1,000 

Total fungi 24,000 

407b Alternaria alternata 1,900 Gram positive 94,000 

Aspergillus glaucus 2,800 Gram negative, non-fermentative 6,300 

Aspergillus niger 940 Broad spectrum 1,200,000 

Aspergillus ochraceus 940 

Cladosporium cladosporioides 7,500 

Health Hazard Evaluation Report 2009-0172-3124 Page 237
Appendix M: niosH inteRiM RepoRt, HetA 2009-0172 (Continued) 

Epicoccum nigrum 

Nonsporulating fungi 

Total fungi 

1,900 

1,900 

8,000 

418c Biopolaris australiensis 1,900 Gram positive 1,700,000 

Cladosporium cladosporioides 19,000 Gram negative, non-fermentative 3,800,000 

Epicoccum nigrum 1,900 Broad spectrum 1,800,000 

Mucor plumbeus 950 

Total fungi 24,000 

421c Alternaria alternata 920 Gram positive 540,000 

Aureobasidium pullulans 4,600 Gram negative, non-fermentative 10,000 

Biopolaris australiensis 1,800 Broad spectrum 220,000 

Cladosporium cladosporioides 4,600 

Epicoccum nigrum 5,500 

Nonsporulating fungi 2,800 

Total fungi 20,000 

424c Alternaria alternata 1,000 Gram positive 2,200,000 

Aureobasidium pullulans 2,000 Gram negative, non-fermentative 19,000 

Biopolaris australiensis 1,000 Broad spectrum 8,900,000 

Cladosporium cladosporioides 21,000 

Curvularia lunata 1,000 

Epicoccum nigrum 4,000 

Fusarium oxysporum 1,000 

Nonsporulating fungi 2,000 

Yeasts other 2,000 

Total fungi 35,000 

502a Alternaria alternata 93 Gram positive 380,000 

Aureobasidium pullulans 370 Gram negative, non-fermentative 1,900 

Biopolaris australiensis 190 Broad spectrum 2,700,000 

Cladosporium cladosporioides 1,900 

Epicoccum nigrum 470 

Nonsporulating fungi 280 

Yeasts other 280 

Total fungi 3,600 

503c Alternaria alternata 88 Gram positive 650,000 

Aureobasidium pullulans 350 Broad spectrum 560,000 

Biopolaris australiensis 88 

Cladosporium cladosporioides 1,600 

Epicoccum nigrum 530 

Total fungi 2,700 

505c Alternaria alternata 880 Gram positive 120,000 

Aspergillus fumigatus 880 Gram negative, non-fermentative 3,800 

Biopolaris australiensis 880 Broad spectrum 210,000 

Cladosporium cladosporioides 3,500 

Epicoccum nigrum 2,600 

Nigrospora sphaerica 880 

Total fungi 9,600 

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Appendix M: niosH inteRiM RepoRt, HetA 2009-0172 (Continued) 

515c Alternaria alternata 88 Gram positive 360,000 

Aspergillus niger 270 Gram negative, non-fermentative 3,800 

Biopolaris australiensis 180 Broad spectrum 380,000 

Cladosporium cladosporioides 710 

Epicoccum nigrum 180 

Fusarium oxysporum 88 

Nigrospora sphaerica 88 

Total fungi 1,600 

516c Alternaria alternata 200 Gram positive 1,000,000 

Aspergillus niger 300 Gram negative, non-fermentative 8,700 

Cladosporium cladosporioides 1,600 Broad spectrum 360,000 

Nonsporulating fungi 400 

Total fungi 2,500 

520b Aspergillus versicolor 390 Gram positive 5,900 

Cladosporium cladosporioides 490 Gram negative, non-fermentative 2,600 

Curvularia lunata 98 Broad spectrum 19,000 

Epicoccum nigrum 290 

Nigrospora sphaerica 98 

Nonsporulating fungi 200 

Total fungi 1,600 

610c Alternaria alternata 960 Gram positive 290,000 

Aureobasidium pullulans 960 Gram negative, non-fermentative 2,000 

Biopolaris australiensis 960 Broad spectrum 4,000,000 

Cladosporium cladosporioides 5,800 

Epicoccum nigrum 2,900 

Nonsporulating fungi 1,900 

Trichoderma koningii 960 

Total fungi 14,000 

612c Biopolaris australiensis 980 Gram positive 12,000,000 

Cladosporium cladosporioides 4,900 Gram negative, non-fermentative 5,200 

Epicoccum nigrum 2,000 Broad spectrum 810,000 

Mucor plumbeus 980 

Total fungi 8,800 

618c Alternaria alternata 93 Gram positive 550,000 

Aspergillus fumigatus 93 Gram negative, non-fermentative 170,000 

Aureobasidium pullulans 190 Broad spectrum 46,000,000 

Biopolaris australiensis 93 

Cladosporium cladosporioides 1,300 

Epicoccum nigrum 470 

Nonsporulating fungi 93 

Trichoderma koningii 93 

Total fungi 2,400 

623c Aureobasidium pullulans 460 Gram positive 280,000 

Biopolaris australiensis 92 Gram negative, non-fermentative 32,000 

Cladosporium cladosporioides 1,500 Broad spectrum 220,000 

Epicoccum nigrum 460 

Health Hazard Evaluation Report 2009-0172-3124 Page 239
Appendix M: niosH inteRiM RepoRt, HetA 2009-0172 (Continued) 

Total fungi 2,500 

MR-1Ad Alternaria alternata 86 Gram positive 6,000 

Aspergillus niger 86 Gram negative, non-fermentative 86 

Aspergillus ochraceus 170 Broad spectrum 26,000 

Aspergillus versicolor 340 

Cladosporium cladosporioides 170 

Fusarium oxysporum 170 

Paecilomyces variotii 86 

Penicillium crustosum 260 

Total fungi 1,400 

MR-1Bd Aspergillus niger 93 Gram positive 21,000,000 

Cladosporium cladosporioides 370 Gram negative, non-fermentative 1,600 

Epicoccum nigrum 93 Broad spectrum 350,000 

Trichoderma koningii 93 

Total fungi 650 

MR-2e Alternaria alternata 1,700 Gram positive 2,000,000 

Aspergillus versicolor 860 Gram negative, non-fermentative 110,000 

Cladosporium cladosporioides 17,000 Broad spectrum 4,100,000 

Epicoccum nigrum 5,200 

Fusarium oxysporum 860 

Nonsporulating fungi 860 

Trichoderma koningii 860 

Total fungi 28,000 

*

Total fungi values have been rounded by the reporting laboratory; †room 108 was excluded because we were unable to 

collect enough dust for microbial analyses. Note: MR-1A, MR-1B = library – samples collected from edge; MR-2= library– 

samples collected from rugs; a carpet; b tile; c carpet with partial tile floor; d wood floor; e rug 

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Appendix M: niosH inteRiM RepoRt, HetA 2009-0172 (Continued) 

Table 2. Arithmetic mean and standard deviation of water activity on the floor surface, and relative 

humidity and temperature in air by wing at Oak Ridge Elementary School 

Building wings Number of 

samples Water activity Relative humidity (%) Temperature (°F) 

Gym-cafeteria 1 0.60 ( - ) 53.0 ( - ) 73.0 ( - ) 

Admin 5 0.76 (0.09) 59.0 (9.4) 71.6 (0.7) 

Media center 3 0.73 (0.03) 55.0 (1.7) 72.1 (0.2)

 k/1 4 0.57 (0.07) 36.8 (2.2) 72.4 (1.4) 

2/3 4 0.66 (0.10) 38.8 (5.7) 72.1 (0.4) 

4/5 6 0.69 (0.06) 53.8 (3.6) 72.8 (0.7) 

Table 3. Overall building (N=22) concentration (cfu/g) of culturable fungi and bacteria 

Total fungi Hydrophilic 

fungi 

Mesophilic or 

hydrophilic 

fungi 

Gram negative 

bacteria 

Gram positive 

bacteria 

Minimum 650 86 650 86 5,900 

Maximum 35,000 7,800 31,000 5,600,000 21,000,000 

Geometric 

mean 6,000 1,200 5,200 8,500 396,000 

Geometric 

STD* 3.3 4.2 3.3 8.1 7.0 

*

STD: standard deviation 

Table 4. Geometric mean (Geometric Standard Deviation†) of culturable fungi and bacteria (cfu/g*) by 

wing 

Wings N 

Total 

fungi 

Hydrophilic 

fungi 

Gram negative 

bacteria 

Gram positive 

bacteria 

Gymcafeteria 1 24,000 ( - ) 4,000 ( - ) 7,700 ( - ) 170,000 ( - ) 

Admin 4 6,300 (2.9) 1,000 (4.3) 5,900 (1.2) 267,900 (2.7) 

Media center 3 2,900 (7.3) 500 (11.1) 2,500 (37.7) 631,600 (66.7) 

k/1 4 5,200 (2.4) 1,500 (3.0) 15,800 (7.1) 855,600 (6.0) 

2/3 4 23,500 (1.3) 4,700 (1.5) 52,000 (23.4) 660,100 (4.2) 

4/5 6 2,900 (2.0) 600 (3.1) 3,900 (1.7) 199,500 (6.5) *

Geometric standard deviation; †colony forming unit per gram 

Health Hazard Evaluation Report 2009-0172-3124 Page 241 
Appendix M: niosH inteRiM RepoRt, HetA 2009-0172 (Continued) 

Table 5. Comparison of results from historical environmental consultants’ reports from May 2009 with 

NIOSH results for fungal concentration in floor dust 

Room number 05/08/2009 

(Consultant results) cfu/g 

July 2009 

(NIOSH Results) cfu/g 

115 Yeast (30,000) Aspergillus versicolor (960) 

in admin wing Aspergillus pullulans (960) 

Biopolaris australiensis (1,900) 

Cladosporium cladosporioides (13,000) 

Epicoccum nigrum (2,900) 

Nonsporulating fungi (1,900) 

Penicillium lividium (960) 

Total (30,000) Total (23,000) 

206 Alternaria Alternaria alternata (1,000) 

in gym-cafeteria wing Aspergillus Aspergillus glaucus (2,000) 

Epicoccum Aspergillus niger (1,000) 

Eurotium Aspergillus versicolor (1,000) 

Nonsporulating fungi Biopolaris australiensis (1,000 

Penicillium Cladosporium cladosporioides (14,000) 

Yeast Epicoccum nigrum (2,000) 

Fusarium oxysporum (1,000) 

Rhizopus stolonifer (1,000) 

Total (>1.3 million)* Total (24,000) 

421 Alternaria (5,000) Alternaria alternata (920) 

in 2/3 wing Aspergillus (65,000) Aspergillus pullulans (4,600) 

Bipolaris (5,000) Biopolaris australiensis (1,800) 

Cladosporium (75,000) Cladosporium cladosporioides (4,600) 

Curvularia (5,000) Epicoccum nigrum (5,500) 

Epicoccum (60,000) Nonsporulating fungi (2,800) 

Exserohilium (5,000) 

Nonsporulating fungi (70,000) 

Yeast (40,000) 

Total (330,000) Total (20,000) 

503 Acremonium (8,000) Alternaria alternata (88) 

in 4/5 wing Alternaria (40,000) Aspergillus pullulans (350) 

Bipolaris (4,000) Biopolaris australiensis (88) 

Cladosporium (36,000) Cladosporium cladosporioides (1,600) 

Epicoccum (48,000) Epicoccum nigrum (530) 

Nonsporulating fungi (60,000) 

Phoma (12,000) 

Trichoderma (12,000) 

Yeast (24,000) 

Total (244,000) Total (2,700) 

515 Alternaria Alternaria alternata (88) 

in 4/5 wing Aspergillus Aspergillus niger (270) 

Aureobasidium Biopolaris australiensis (180) 

Bipolaris Cladosporium cladosporioides (710) 

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Appendix M: niosH inteRiM RepoRt, HetA 2009-0172 (Continued) 

Chrysosporium 

Cladosporium 

Curvularia 

Epicoccum 

Nonsporulating 

Penicillium 

Stemphylium 

Trichoderma 

Yeast 

Total (>1.6 million) 

Epicoccum nigrum (180) 

Fusarium oxysporum (88) 

Nigrospora sphaerica (88) 

Total (1,600) 

516 Alternaria Alternaria alternata (200) 

in 4/5 wing Aspergillus 

Bipolaris 

Chrysosporium 

Cladosporium 

Epicoccum 

Eurotium 

Fusarium 

Geotrichum 

Mucor 

Nonsporulating fungi 

Penicillium 

Yeast 

Total (>2 million)* 

Aspergillus niger (300) 

Cladosporium cladosporioides (1,600) 

Nonsporulating fungi (400) 

Total (2,500) 

610 Alternaria (13,333) Alternaria alternata (960) 

in k/1 wing Bipolaris (6,667) 

Cladosporium (6,667) 

Epicoccum (13,333) 

Nonsporulating (13,333) 

Yeast (13,333) 

Total (86,667) 

Aspergillus pullulans (960) 

Biopolaris australiensis (960) 

Cladosporium cladosporioides (5,800) 

Epicoccum nigrum (2,900) 

Nonsporulating fungi (1,900) 

Trichoderma koningii (960) 

Total (14,000) 

618 Alternaria Alternaria alternata (93) 

in k/1 wing Aspergillus 

Cladosporium 

Epicoccum 

Geotrichun 

Mucor 

Nonsporulating 

Penicillium 

Trichoderma 

Yeast 

Total (>1.0 million)* 

Aspergillus fumigatus (93) 

Aspergillus pullulans (190) 

Biopolaris australiensis (93) 

Cladosporium cladosporioides (1,300) 

Epicoccum nigrum (470) 

Nonsporulating fungi (93) 

Trichoderma koningii (93) 

Total (2,400)

 *Too numerous to count – no individual spore type counts made 

Health Hazard Evaluation Report 2009-0172-3124 Page 243
Appendix M: niosH inteRiM RepoRt, HetA 2009-0172 (Continued) 

Table 6. Comparison of results from historical environmental consultants’ reports from October 2007 and 

September and October 2008 with NIOSH results for fungal concentration in floor dust 

Room 

number 

10/29/2007 

(Consultant) 

09/24/2008 

(Consultant) cfu/g 

10/27/2008 

(Consultant) cfu/g 

July 2009 

(NIOSH Results) cfu/g 

100

(office lobby) 

Acremonium (380,000) 

Cladosporium (290,000) 

Curvularia lunata (48,000) 

Epicoccum nigrum (95,000) 

Fusarium solani (95,000) 

Total (908,000) 

Alternaria alternata (2,000) 

Cladosporium cladosporioides (4,900) 

Epicoccum nigrum (2,000) 

Fusarium oxysporum (980) 

Total (9,800) 

407

in 4/5 wing 

Alternaria (200,000) 

Aspergillus (320,000) 

Cladosporium (40,000) 

Bipolaris (40,000) 

Epicoccum (20,000) 

Penicillium (20,000) 

Phoma (600,000) 

Wallemia (60,000) 

Total (1,300,000) 

Alternaria (1,081) 

Aspergillus (17,838) 

Aureobasidium (1,081) 

Cladosporium (4,865) 

Bipolaris (1,622) 

Epicoccum (6,486) 

Wallemia (541) 

Yeast (1,081) 

Nonsporulating fungi 

(541) 

Total (35,135) 

Alternaria alternata (1,900) 

Aspergillus glaucus (2,800) 

Aspergillus niger (940) 

Aspergillus ochraceus (940) 

Cladosporium cladosporioides (7,500) 

Epicoccum nigrum (1,900) 

Nonsporulating fungi (1,9001) 

Total fungi (8,000) 

Page 244 Health Hazard Evaluation Report 2009-0172-3124 
Appendix M: niosH inteRiM RepoRt, HetA 2009-0172 (Continued) 

Table 7. Primary work area or homeroom wing of staff and students participating in the health 

department questionnaire 

Staff Student 

Wings 

2008-2009 

school year 

n=48* 

2008-2009 

school year 

n=376† 

k/1 18 (38%) 111 (30%) 

2/3 13 (27%) 136 (36%) 

4/5 9 (19%) 129 (34%)

Non-classroom 

wings‡ 8 (17%) -

*

four of the 52 participants did not provide their primary work location; 

†

we could not classify the primary classroom wing for nine of the 385 participants; 

‡

gym/cafeteria, administration, or media center wings. 

Table 8. Prevalence of health conditions reported by staff and students 

Staff 

n=50* 

Students 

n=276† 

Seasonal 

allergies 17 (34%) 132 (48%) 

Asthma 4 (8%) 44 (16%) 

Allergic 

rhinitis 4 (8%) 33 (12%) 

Chronic 

respiratory 

disease 

0 4 (1%) 

Suppressed 

immune 

system 

1 (2%) 2 (0.7%) 

Cystic fibrosis 1 (2%) 0 

Radiation or 

chemotherapy 0 0 

*

data was missing for two of the of the 52 staff participants; 

†

data was missing for 111 of the 387 students whose parents 

 participated in the questionnaire 

Health Hazard Evaluation Report 2009-0172-3124 Page 245 
Appendix M: niosH inteRiM RepoRt, HetA 2009-0172 (Continued) 

Table 9. Prevalence of symptoms* reported to occur while in the school building by school staff and 

students during the 2008/2009 school year 

Staff 

n=52 

Students 

n=385 

Headache† 48 (92%) 187 (49%) 

Eye symptoms 39 (75%) 106 (28%) 

Fatigue 23 (44%) 23 (6%) 

Unusual sneezing† 16 (31%) 88 (23%) 

Breathing difficulty/ 

asthma† 16 (31%) 49 (13%) 

Sinus problems 13 (25%) 18 (5%) 

Nosebleed† 13 (25%) 77 (20%) 

Throat symptoms 12 (23%) 19 (5%) 

Dizziness 11 (21%) 8 (2%) 

Skin problems 10 (19%) 34 (9%) 

Cough 8 (15%) 28 (7%) 

Nausea 7 (13%) 16 (4%) 

Memory loss 7 (13%) 1 (0.3%) 

Nasal symptoms 5 (10%) 20 (5%) 

Voice symptoms 5 (10%) 0 

Vision problems 4 (8%) 6 (2%) 

Metallic taste 4 (8%) 0 

Insomnia 3 (6%) 3 (0.8%) 

Allergies 1 (2%) 9 (2%) 

Throat or voice 

symptoms 14 (27%) 19 (5%) 

Lower respiratory 

symptoms 20 (38%) 72 (19%) 

Upper respiratory 

symptoms 27 (52%) 106 (28%) 

Mucous membrane 

irritation 45 (87%) 123 (32%) *

includes write-in responses; †symptoms specifically asked about in the questionnaire. 

Page 246 Health Hazard Evaluation Report 2009-0172-3124 
Appendix M: niosH inteRiM RepoRt, HetA 2009-0172 (Continued) 

Table 10. Prevalence of symptoms by primary work wing of 48* staff members during the 2008/2009 

school year 

k/1 wing 

n=18 

4/5 wing 

n=9 

2/3 wing 

n=13 

Nonclassroom 

wings‡ 

n=8 

Headache† 18 (100%) 8 (89%) 12 (92%) 7 (88%) 

Eye symptoms 15 (83%) 8 (89%) 9 (69%) 4 (50%) 

Fatigue 9 (50%) 6 (67%) 5 (38%) 1 (13%) 

Throat symptoms 5 (28%) 0 6 (46%) 0 

Breathing difficulty/ 

asthma† 4 (22%) 4 (44%) 5 (38%) 3 (38%) 

Unusual sneezing† 4 (22%) 6 (67%) 3 (23%) 3 (38%) 

Nosebleed† 4 (22%) 2 (22%) 3 (23%) 2 (25%) 

Sinus problems 2 (11%) 2 (22%) 6 (46%) 3 (38%) 

Nausea 2 (11%) 1 (11%) 3 (23%) 1 (13%) 

Cough 2 (11%) 2 (22%) 3 (23%) 1 (13%) 

Skin problems 1 (6%) 3 (33%) 4 (31%) 1 (13%) 

Dizziness 6 (33%) 1 (11%) 3 (23%) 1 (13%) 

Memory loss 1 (6%) 1 (11%) 3 (23%) 1 (13%) 

Nasal symptoms 0 0 3 (23%) 1 (13%) 

Metallic taste 0 1 (11%) 2 (15%) 1 (13%) 

Voice symptoms 1 (6%) 2 (22%) 2 (15%) 0 

Insomnia 0 1 (11%) 2 (15%) 0 

Vision problems 1 (6%) 2 (22%) 0 0 

Allergies 0 0 0 1 (13%) 

Lower respiratory 

symptoms 5 (28%) 5 (56%) 7 (54%) 3 (38%) 

Upper respiratory 

symptoms 7 (39%) 7 (78%) 9 (69%) 3 (38%) 

Mucous membrane 

irritation 16 (89%) 9 (100%) 13 (100%) 4 (50%) 

*

four of the 52 participants did not provide their primary work location; †symptoms specifically 

asked about in the questionnaire; ‡gym/cafeteria, administration, or media center wings. 

Health Hazard Evaluation Report 2009-0172-3124 Page 247 
 

Appendix M: niosH inteRiM RepoRt, HetA 2009-0172 (Continued) 

Table 11. Prevalence of symptoms by primary homeroom wing of 376*

 students during the 2008/2009 school year 

k/1 wing 

n=111 

2/3 wing 

n=136 

4/5 wing 

n=129 

Headache† 40 (36%) 72 (53%) 72 (56%) 

Eye symptoms 22 (20%) 41 (30%) 41 (32%) 

Fatigue 8 (7%) 5 (4%) 10 (8%) 

Throat symptoms 4 (4%) 6 (4%) 7 (5%) 

Breathing difficulty/ 

asthma† 9 (8%) 18 (13%) 20 (16%) 

Usual sneezing† 19 (17%) 31 (23%) 36 (28%) 

Nosebleed† 15 (14%) 35 (26%) 25 (19%) 

Sinus problems 6 (5%) 7 (5%) 5 (4%) 

Nausea 2 (2%) 7 (5%) 7 (5%) 

Cough 9 (8%) 12 (9%) 5 (4%) 

Skin problems 10 (9%) 11 (8%) 12 (9%) 

Dizziness 1 (1%) 6 (4%) 1 (0.8%) 

Memory loss 0 0 1 (0.8%) 

Nasal symptoms 5 (5%) 10 (7%) 4 (3%) 

Metallic taste 0 0 0 

Voice symptoms 0 0 0 

Insomnia 0 2 (1%) 1 (0.8%) 

Vision problems 1 (1%) 2 (1%) 3 (2%) 

Allergies 2 (2%) 6 (4%) 1 (0.8%) 

Throat or voice 

symptoms 4 (4%) 6 (4%) 7 (5%) 

Lower respiratory 

symptoms 17 (15%) 26 (19%) 25 (19%) 

Upper respiratory 

symptoms 24 (22%) 39 (29%) 40 (31%) 

Mucous membrane 

irritation 27 (24%) 45 (33%) 48 (37%) 

*

 we could not classify the primary classroom wing for nine of the 385 participants; 

†

symptoms specifically asked about in the questionnaire. 

Page 248 Health Hazard Evaluation Report 2009-0172-3124 
Appendix M: niosH inteRiM RepoRt, HetA 2009-0172 (Continued) 

Figure1. Diagram of Oak Ridge Elementary School 

Health Hazard Evaluation Report 2009-0172-3124 Page 249
 
Appendix M: niosH inteRiM RepoRt, HetA 2009-0172 (Continued) 

Figure 2. Visible mold on carpet in classroom 625, August 10, 2005 (courtesy of building occupant) 

Figure 3. Visible mold on upholstered chairs in the records room (room 109), August 10, 2005 (courtesy 

of building occupant) 

Page 250 Health Hazard Evaluation Report 2009-0172-3124 
Appendix M: niosH inteRiM RepoRt, HetA 2009-0172 (Continued) 

Figure 4. Visible mold on picture frames in the storage room (room 111), August 10, 2005 (courtesy of 

building occupant) 

Figure 5. Basement below the media center wing, July 14, 2009 

Health Hazard Evaluation Report 2009-0172-3124 Page 251 
Appendix M: niosH inteRiM RepoRt, HetA 2009-0172 (Continued) 

Figure 6. Downward sloping ground towards classroom wings, July 14, 2009 

Figure 7. Downward sloping ground towards classroom wings, July 14, 2009 

Page 252 Health Hazard Evaluation Report 2009-0172-3124 
Appendix M: niosH inteRiM RepoRt, HetA 2009-0172 (Continued) 

Figure 8. Downward sloping ground towards classroom wings, July 14, 2009 

Figure 9. Blocked storm drain outside of the media center, July 14, 2009 

Health Hazard Evaluation Report 2009-0172-3124 Page 253
 
Appendix M: niosH inteRiM RepoRt, HetA 2009-0172 (Continued) 

Figure 10. Foam roof adjacent to gym, July 14, 2009 

Figure 11. Foam roof over media center wing, July 14, 2009 

Page 254 Health Hazard Evaluation Report 2009-0172-3124 
Appendix M: niosH inteRiM RepoRt, HetA 2009-0172 (Continued) 

Figure 12. Inadequate flashing that appeared to be mounted superficially at the junction between the 

parapet wall (above room 206) and the gym, July 14, 2009 

Figure 13. Dust on classroom ceilings and ducts in plenum, July 16, 2009 

Health Hazard Evaluation Report 2009-0172-3124 Page 255 
Appendix M: niosH inteRiM RepoRt, HetA 2009-0172 (Continued) 

Figure 14. Dust on classroom ceilings and ducts in plenum, July 16, 2009 

Figure 15. Coils for HVAC handlers showing dust and possible mold contamination , July 16, 2009 

Page 256 Health Hazard Evaluation Report 2009-0172-3124 
Appendix M: niosH inteRiM RepoRt, HetA 2009-0172 (Continued) 

Figure 16. Percent frequency of occurrence in samples for individual fungal species 

Health Hazard Evaluation Report 2009-0172-3124 Page 257
 
Appendix M: niosH inteRiM RepoRt, HetA 2009-0172 (Continued) 

Figure 17. Comparison of symptom prevelances in 2008/2009 school year by classroom wing in 40 staff 

members1 

Page 258 Health Hazard Evaluation Report 2009-0172-3124 
Appendix M: niosH inteRiM RepoRt, HetA 2009-0172 (Continued) 

Figure 18. Comparison of symptom prevalences in 2008/2009 school year by classroom wing in 376 

students1
 

Health Hazard Evaluation Report 2009-0172-3124 Page 259
 
Appendix M: niosH inteRiM RepoRt, HetA 2009-0172 (Continued) 

Figure 19. Comparison of symptom prevalences in 2007/2008 and 2008/2009 school years in 43 staff 

members1

 who had symptoms during the 2008/2009 school year and worked at this school both years 

Page 260 Health Hazard Evaluation Report 2009-0172-3124 
Appendix M: niosH inteRiM RepoRt, HetA 2009-0172 (Continued) 

Figure 20. Comparison of symptom prevalences in 2007/2008 and 2008/2009 school years in 221 

students1

 who had symptoms during the 2008/2009 school year and attended this school both years
 

Health Hazard Evaluation Report 2009-0172-3124 Page 261
 
Appendix M: niosH inteRiM RepoRt, HetA 2009-0172 (Continued) 

Appendices 

Appendix A: Guilford County Department of Public Health faculty/staff questionnaire 

Appendix B: Guilford County Department of Public Health parent questionnaire 

Appendix C: Guilford County Department of Public Health statement dated 25 June 2009 

Appendix D: The H.S. Turner Group preliminary report dated 21 July 2009 

Appendix E: The H.S. Turner Group final report dated 8 January 2010 

Appendix F: The H.S. Turner Group final report pictures 

Appendix G: Oak Ridge Elementary School-IAQ project progress update 

Appendix H: NIOSH email dated 22 July: HETA 2009-0172 – Requested summary of findings 

 discussed during the breakfast meeting on July 16, 2009. 

Appendix I: Guilford County Department of Public Health report on the faculty/staff 

 questionnaire results at Oak Ridge Elementary School 

Appendix J: Guilford County Department of Public Health report on parent questionnaire results 

 at Oak Ridge Elementary School 

Appendix K: NIOSH email to dated 19 October 2009: HETA 2009-0172 – Oak Ridge 

 Elementary School 

Appendix L: Sporicidin disinfectant solution label 

Appendix M: NIOSH draft mold & dampness assessment sheet 

Page 262 Health Hazard Evaluation Report 2009-0172-3124 
 

 

Appendix n: eMC enGineeRs, inC. seAsonAL HvAC RetRo- CoMMissioninG RepoRt dAted MAy 2010 

Seasonal Inspection Report 

Retro-Commissioning of HVAC Systems 

Oak Ridge Elementary 

Oak Ridge, NC 

Prepared for:
 

Guilford County Schools
 

EMC Project No. 1C409021.000 

May 2010 

Prepared by: 

E M C Engineers, Inc. 

706 Hillsborough Street, Suite 102 

Raleigh, NC 27603 

Page 1 of 22 

Health Hazard Evaluation Report 2009-0172-3124 Page 263 
 Appendix n: eMC enGineeRs, inC. seAsonAL HvAC RetRo- CoMMissioninG RepoRt dAted MAy 2010 (Continued) 

INTENTIONAL BLANk PAGE 

Page 2 of 22
 

Page 264 Health Hazard Evaluation Report 2009-0172-3124 
 

 

 

 

Conclusions & Recommendations .............................................................. 22

List of Tables

Table Figures

Figure 1 - Rocks found at double doors at east-end of 400 hallway ................................... 7

Figure 2 - Rock found at double doors at north-end of 600 hallway .................................. 8

Figure 3 - Bricks found at double doors at middle of east-side of 600 hallway ................. 8

Figure 4 - Rock found at door on Linville Road side of main hallway .............................. 9

Figure 5 - Microphone stand base found outside classroom 407 outside door ................... 9

Figure 6 - Rock found beside outside door of room 505 .................................................. 10

Figure 7 – Frame of outside door to classroom 521damaged ........................................... 10

Appendix n: eMC enGineeRs, inC. seAsonAL HvAC RetRo- CoMMissioninG RepoRt dAted MAy 2010 (Continued) 

Table of Contents
 

Seasonal Verification Summary ......................................................................................... 5 
 

1.1 Water Source Heat Pumps .................................................................................... 5 
 

1.1.1 System Verification ...................................................................................... 5 
 

1.1.2 Summary of Findings .................................................................................... 5 
 

1.1.3 Conclusions & Recommendations .............................................................. 18 
 

1.2 Tempered Water System .................................................................................... 20 
 

1.2.1 System Verification .................................................................................... 20 
 

1.2.2 Summary of Findings .................................................................................. 20 
 

1.2.3 Conclusions & Recommendations .............................................................. 20 
 

1.3 Makeup Air Units ............................................................................................... 21 
 

1.3.1 System Verification .................................................................................... 21 
 

1.3.2 Summary of Findings .................................................................................. 21 
 

1.3.3 Conclusions & Recommendations .............................................................. 21 
 

1.4 Exhaust Fans and Systems ................................................................................. 22

1.4.1 System Verification .................................................................................... 22

1.4.2 Summary of Findings .................................................................................. 22

1.4.3

Table 1 - Outdoor conditions for testing period .................................................................. 4 
 

Table 2 - Space Sensor Calibration Issues .......................................................................... 6 
 

Table 3 - Units with multiple trouble calls after Feb 22, 2010 ......................................... 17 
 

of

Figure 8 – Outside door of classroom 521 dragging on threshold .................................... 11 
 

Figure 9 – Classroom 521 door showing 1⁄2” gap when door not physically pulled shut . 11 
 

Figure 10 - Outdoor Air Humidity reading 122.9% RH ................................................... 12 
 

Figure 11 - CRT directly beneath thermostat in classroom 401 ....................................... 13 
 

Figure 12 - HP-24 heat output @ 100%, but discharge air temp. @ 44.2 deg F. ............. 14 
 

Figure 13 - HP-9 low pressure safety cutout .................................................................... 15 
 

Figure 14 - Typical Outdoor Air Unit graphic screen (occupied operation) .................... 21 
 

Page 3 of 22 

Health Hazard Evaluation Report 2009-0172-3124 Page 265 
 

 

 

 

 

 

 

 

Appendix n: eMC enGineeRs, inC. seAsonAL HvAC RetRo- CoMMissioninG RepoRt dAted MAy 2010 (Continued) 

Executive Summary 

EMC was selected to perform retro-commissioning functional testing at Oak Ridge 

Elementary School, a part of the Guilford County Schools System (GCS). Initial 

functional testing in the unoccupied school concluded in December, 2009 and the 

school was re-occupied by students and staff beginning February 22, 2010. 

As part of its contract, EMC performed seasonal testing during the cooling season in 

order to assess the operation of systems at that time. Evaluation of building systems 

with the school fully furnished and occupied, while in the cooling mode was 

performed in order to identify any shortcomings of the systems or performance 

issues related to equipment or system operation in real-time. This report is a result of 

that seasonal testing, which was performed the week of May 3, 2010. 

EMC performed cooling season tests on the following systems: 

x Building automation system 

x Verification of building automation system operator workstation graphics 

x Heat Pumps, water pumps, piping, and associated equipment 

x Make Up Air Units and associated glycol heat pumps 

x Hot Water, pumps, piping, condensate, cooling towers, heat exchangers and 

associated equipment 

x Exhaust Fans 

Overall, EMC found the building systems to be operating well within the guidelines 

and recommendations established in the Turner Building Sciences report and the 

EMC Retro Commissioning Report. With the exception of a minor setpoint 

adjustment for the Office and Media Center areas, no adjustment of control 

parameters was found to be necessary during the course of seasonal testing. Weather 

conditions during seasonal testing were generally as follows: 

Outdoor temperature and humidity conditions for the testing period were as 

follows: 

5/3 5/4 5/5 5/6 5/7 

High 

Temperature 76 83 85 88 87 

Low 

Temperature 71 65 59 63 61 

Humidity 

High (%RH) 84% 87% 90% 84% 60% 

Humidity 

Low (%RH) 64% 31% 31% 34% 32% 

Table 1 - Outdoor conditions for testing period 

Page 4 of 22 

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Appendix n: eMC enGineeRs, inC. seAsonAL HvAC RetRo- CoMMissioninG RepoRt dAted MAy 2010 (Continued) 

Seasonal Verification Summary 

1.1 Water Source Heat Pumps 

1.1.1 System Verification 

EMC verified operation of the water source heat pumps in cooling mode to 

determine proper operation of the units and the units’ ability to satisfy design 

the occupied setpoint by up to 2 1⁄2 degrees either side of the cooling setpoint. 

Classroom heat pumps took anywhere from 30 minutes to 1 hour to resolve the 

overshoot condition and begin maintaining space temperatures within the 

controller’s deadband range. During the time when overshoot was occurring, there 

were instances of teachers arriving to prepare for class while room temperatures 

were either too warm or too cold. This resulted in unnecessary trouble calls to GCS 

Maintenance. Also, discussions with GCS operations staff indicated that there 

conditions for the spaces they serve. 

EMC performed testing as follows: 

x Heat Pump operation in occupied cooling mode, including testing for 

overshoot after occupied transition 

x Occupancy scheduling currently in place in the BAS 

x Setpoint offset and fan control in unoccupied cooling mode 

x Adherence to global space temperature setpoint ranges and occupancy 

schedules set forth in the January 2010 Turner Building Sciences report 

x Verification of space temperature sensor calibrations 

EMC also verified whether each heat pump’s space temperature sensor was being 

blocked by classroom furnishings or being influenced by sources of heat or cold, 

which would impact the unit’s ability to properly control space temperature. 

1.1.2 Summary of Findings 

x The BAS was found to control all heat pumps on the following schedules: 

o Office and Media Center areas 

 Occupied 5 a.m. – 10 p.m. 

 Unoccupied 10 p.m. – 5 a.m. 

o Classroom wings and Gymnasium / Cafeteria 

 Occupied 6 a.m. – 10 p.m. 

 Unoccupied 10 p.m. – 6 a.m. 

o Data closets 

 Occupied continuously 

Observation of space temperatures immediately following transition from 

unoccupied to occupied operation revealed that the heat pumps would overshoot 

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Appendix n: eMC enGineeRs, inC. seAsonAL HvAC RetRo- CoMMissioninG RepoRt dAted MAy 2010 (Continued) 

should typically not be a need to occupy the school after 9 p.m. As a result, the BAS 

occupancy schedule should be adjusted. Recommendations are shown in section 

1.1.3. 

x Setpoint control was found to be from the BAS for all heat pumps, with 

setpoints as follows: 

o Office and Media Center 

 Occupied Cooling at 74 deg F 

 Unoccupied Cooling at 79 deg F 

o Classroom wings and Gymnasium / Cafeteria 

 Occupied Cooling at 72 deg F 

 Unoccupied Cooling at 77 deg F 

A review of trouble calls generated since re-occupying the school revealed that a 

aforementioned Turner report is recommended. Recommendations are shown in 

significant number of hot calls originated from personnel working in the office and 

media center. Testing of the heat pumps’ ability to control these spaces to a setpoint 

consistent with the classroom wings was conducted and found to be satisfactory. 

Lowering cooling setpoints, while remaining within the guidelines of the 

section 1.1.3. 

x

HP 	 Measured Temp. Cal. Error

40 	 71.2 69.7 Ͳ1.5 deg F

47 	 72.2 71.0 Ͳ1.1 deg F

74.4 76 +1.6 deg F

72.8 75.1 +2.3 deg F

74.9 73.1 Ͳ1.8 deg F

72.8 73.6 +0.8 deg F

71.9 72.7 +0.8 deg F

72.1 70.4 Ͳ1.7 deg F

71.4 69.9 Ͳ1.5 deg F

74 75.9 +1.9 deg F

Where calibration error in the list above is expressed in a negative (-) number, the 

space is generally colder than setpoint by that amount. Where this value is a positive 

(+) number, the space is generally warmer than setpoint by that amount. 

Observation of the position of outside doors and windows was made while 

conducting seasonal testing in order to verify compliance with EMC’s earlier 

recommendations. The following was observed: 

Heat pump space temperature sensor calibrations were found to generally be 

within 1 deg F (+/- .5 deg F) with the following exceptions: 

Room Tracer Temp.

514

422

1 Central Receiving

6 Gym Hallway

7 Kitchen

37 Rm 517

39 Rm 515

53 Rm 406

55 Rm 401

58 Office Hallway

Table 2 - Space Sensor Calibration Issues 

Page 6 of 22 

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 Appendix n: eMC enGineeRs, inC. seAsonAL HvAC RetRo- CoMMissioninG RepoRt dAted MAy 2010 (Continued) 

x On 5/6/2010 at approximately 10:30 a.m., classroom 517 was observed while 

occupied and found to have the outside door propped open and the operable 

windows open. Outside conditions at the time were approximately 80 

degrees and 74% relative humidity. The teacher in this classroom, Mrs. Jones 

informed EMC that she had been instructed by the principal, Ann Kraft to 

open the door and windows. 

x All hallway doors leading to the outside were closed, however a number of 

these doors had a rock or some other heavy object located by the door 

opening. Discussion with various Oak Ridge school personnel indicated that 

these were used to prop the doors open at times. The following photographs 

were taken of doors where these objects were found: 

Figure 1 - Rocks found at double doors at east-end of 400 hallway 

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Health Hazard Evaluation Report 2009-0172-3124 Page 269 
 

 

Appendix n: eMC enGineeRs, inC. seAsonAL HvAC RetRo- CoMMissioninG RepoRt dAted MAy 2010 (Continued) 

Figure 2 - Rock found at double doors at north-end of 600 hallway 

Figure 3 - Bricks found at double doors at middle of east-side of 600 hallway 

Page 8 of 22 

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Appendix n: eMC enGineeRs, inC. seAsonAL HvAC RetRo- CoMMissioninG RepoRt dAted MAy 2010 (Continued) 

Figure 4 - Rock found at door on Linville Road side of main hallway 

x	 Other classroom outside doors were found to have either a rock or another 

heavy object located beside them, which have also been used to prop these 

doors open. These are shown in figures 5 and 6. 

Figure 5 - Microphone stand base found outside classroom 407 outside door 

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Health Hazard Evaluation Report 2009-0172-3124	 Page 271 
 

 

Appendix n: eMC enGineeRs, inC. seAsonAL HvAC RetRo- CoMMissioninG RepoRt dAted MAy 2010 (Continued) 

Figure 6 - Rock found beside outside door of room 505 

x	 Figure 7 shows the outside door to classroom 521, and the door frame which 

has been badly damaged. The resulting misalignment of the door now 

the door is not latched. 

requires deliberate action to pull the door shut to the point of latching. Figure 

8 shows the door sweep and the spot the door is dragging on as a result of the 

door misalignment. There is a large open area when the door is not pulled 

shut shown in figure 9, which not only allows conditioned air to escape the 

room, but also has the potential to allow unauthorized access to the school if 

Figure 7 – Frame of outside door to classroom 521damaged 

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Appendix n: eMC enGineeRs, inC. seAsonAL HvAC RetRo- CoMMissioninG RepoRt dAted MAy 2010 (Continued) 

Figure 8 – Outside door of classroom 521 dragging on threshold 

Figure 9 – Classroom 521 door showing 1⁄2” gap when door not physically pulled shut 

Page 11 of 22 

Health Hazard Evaluation Report 2009-0172-3124 Page 273 
 

 

Appendix n: eMC enGineeRs, inC. seAsonAL HvAC RetRo- CoMMissioninG RepoRt dAted MAy 2010 (Continued) 

x The outdoor Air Humidity sensor connected to the BAS was found to be 

reading incorrectly. Using a calibrated test instrument, outdoor humidity at 

this sensor was found to be 74%, while the BAS reading showed 122.9% 

Figure 10 - Outdoor Air Humidity reading 122.9% RH 

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Appendix n: eMC enGineeRs, inC. seAsonAL HvAC RetRo- CoMMissioninG RepoRt dAted MAy 2010 (Continued) 

x Classroom 501, located on the BAS graphic screen does not have a link to HP48. 

x A computer monitor (CRT) was found to have been placed directly beneath 

the thermostat of HP-55, in classroom 401 (Figure 11). The heat generated by 

the CRT was directly influencing the thermostat and keeping the room much 

colder than the BAS setpoint. 

Figure 11 - CRT directly beneath thermostat in classroom 401 

x	 HP-34 cooling setpoint was found to be at 74 deg F. 

x	 The space temperature sensor installed in classroom 501 was found to be 

wired to an unknown point. EMC was unable to determine the termination 

point for this sensor due to no access above hard ceiling in the hallway. 

Classroom 501is served by HP-48, which also serves classroom 421 where the 

thermostat is located, and control of space temperatures of both classrooms is 

acceptable and consistent. 

x	 Air filters for heat pumps showed expected amounts of build-up consistent 

with the approximately 90 days of use they have experienced. 

x No issues with BAS communication to all heat pumps were present. 

x Principal Ann Kraft demonstrated the unscientific method of using a facial 

tissue taped to the end of a yard stick to assess air flow in office spaces. This 

method is unreliable and cannot account for supply or return diffuser 

placement, air movement caused by sources outside the installed air 

conditioning system, or drafts which may be induced or naturally occurring. 

Since these air currents cannot be seen, this “tissue test” is unreliable. 

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Appendix n: eMC enGineeRs, inC. seAsonAL HvAC RetRo- CoMMissioninG RepoRt dAted MAy 2010 (Continued) 

x HP-24 was found to constantly energize its reversing valve, thereby causing 

the unit to continually produce cold air. Temporarily altering the setpoints 

caused the heat pump controller to change to heating mode, however 

discharge air temperature remained at levels consistent with cooling 

operation. The reversing valve was tested and found to be operating 

properly, however the heat pump controller is constantly energizing the 

reversing valve. 

Figure 12 - HP-24 heat output @ 100%, but discharge air temp. @ 44.2 deg F. 

x Review of Tracer Summit alarm log revealed three instances during the week 

of May 3, 2010 where the Building Control Unit (BCU) communications 

ceased. No indication in alarm log of how long communications were down 

and no obvious reason why communications ceased. There was no impact to 

heat pumps operation or school environment conditions, however the Tracer 

Summit alarm log should be periodically reviewed to determine if future 

communication losses become more prevalent. 

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Appendix n: eMC enGineeRs, inC. seAsonAL HvAC RetRo- CoMMissioninG RepoRt dAted MAy 2010 (Continued) 

x
 HP-9 circuit #1 was found to be off on the low refrigerant pressure switch. 

Subsequent investigation by GCS personnel revealed that this circuit’s 

refrigerant charge had escaped. 

Figure 13 - HP-9 low pressure safety cutout 

x	 The controller for HP-26 has been replaced with the same type of controller 

used for all other similar heat pumps in the school. This was a 

recommendation from EMC’s original report. The operation of this heat 

pump is now consistent with the others. 

x	 HP-12’s supply fan motor stopped working while EMC was conducting
 

seasonal testing. GCS Maintenance personnel responded to affect repairs.
 

x	 The rigid copper piping associated with the water source heat pumps’ 

building loop, located in the mezzanines above the classroom wings lacks 

sufficient support in numerous locations. Unnecessary strain is being placed 

on soldered pipe joints, which will lead to premature failure of the joints and 

a potential for catastrophic flooding. 

Page 15 of 22 

Health Hazard Evaluation Report 2009-0172-3124	 Page 277 
 

 

ͷȀ͸ȀʹͲͳͲͻǣͶͲǣͲͲ

ͷȀ͸ȀʹͲͳͲͻǣ͵ͷǣͲͲ

ͻǣ͵ͲǣͲͲ

Appendix n: eMC enGineeRs, inC. seAsonAL HvAC RetRo- CoMMissioninG RepoRt dAted MAy 2010 (Continued) 

x Space temperatures of a group of 9 heat pumps with multiple hot or cold calls 

since re-occupying the school on Feb 22, 2010 was trended. The following 

snapshot in Table 3 was captured on 5/6/2010: 

ǦͳͶ Ǧʹʹ Ǧʹ͵ Ǧ͵ʹ Ǧ͵͹ ǦͶͲ ǦͶ͹ ǦͷͲ Ǧͷͷ ǦʹͶ

ǣ

ͷȀ͸ȀʹͲͳͲͳͳǣʹͲǣͲͲ

͹ʹǤͲ ͹ͳǤ͸ ͹ͳǤ͸ ͹ʹǤͷ ͹ͳǤ͵ ͹ʹǤͲ ͹ʹǤͲ ͹ʹǤ͸ ͹ͳǤ ͅ ͸ͻǤͳ

ͷȀ͸ȀʹͲͳͲͳͳǣͳͷǣͲͲ

͹ʹǤͲ ͹ͳǤ͵ ͹ͳǤ͵ ͹ʹǤͷ ͹ͳǤ͵ ͹ʹǤʹ ͹ʹǤͲ ͹ʹǤͷ ͹ͳǤ ͅ ͸ͻǤͳ

ͷȀ͸ȀʹͲͳͲͳͳǣͳͲǣͲͲ

͹ʹǤͲ ͹ͲǤͻ ͹ͲǤͻ ͹ʹǤͷ ͹ͳǤͶ ͹ʹǤͷ ͹ʹǤͳ

͹ͳǤ ͅ ͸ͻǤʹ

͹ͳǤ ͅ ͸ͻǤ͵

͹ʹǤͳ ͹ͳǤ͸ ͸ͻǤ͵

͹ʹǤ͵

͹ʹǤͷ

͹ʹǤͷ ͹ͳǤ͹ ͸ͻǤͳ

ͷȀ͸ȀʹͲͳͲͳͳǣͲͷǣͲͲ

͹ʹǤͳ ͹ͲǤ ͅ ͹ͲǤ ͅ ͹ʹǤͶ ͹ͳǤͷ ͹ʹǤ ͅ ͹ʹǤͳ ͹ʹǤ͵

ͷȀ͸ȀʹͲͳͲͳͳǣͲͲǣͲͲ

͹ʹǤͲ ͹ͳǤͳ ͹ͳǤͳ ͹ʹǤͶ ͹ͳǤ͸ ͹ʹǤ͸ ͹ʹǤͲ ͹ʹǤ͵

ͷȀ͸ȀʹͲͳͲͳͲǣͷͷǣͲͲ

͹ʹǤͲ ͹ͳǤͳ ͹ͳǤͳ ͹ʹǤ͵ ͹ʹǤͳ ͹ʹǤͷ ͹ʹǤʹ

ͷȀ͸ȀʹͲͳͲͳͲǣͷͲǣͲͲ

͹ʹǤͲ ͹ͳǤͶ ͹ͳǤͶ ͹ʹǤʹ ͹ʹǤʹ ͹ʹǤͷ ͹ʹǤʹ ͹ͳǤ͸ ͸ͻǤ͵

ͷȀ͸ȀʹͲͳͲͳͲǣͶͷǣͲͲ

͹ʹǤͲ ͹ͳǤ͹ ͹ͳǤ ͅ ͹ʹǤͷ ͹ʹǤ͵ ͹ʹǤͶ ͹ʹǤͳ ͹ͳǤͶ ͸ͻǤʹ

ͷȀ͸ȀʹͲͳͲͳͲǣͶͲǣͲͲ

͹ʹǤ͵



͹ʹǤͳ ͹ʹǤͲ ͹ʹǤͲ ͹ʹǤͷ ͹ʹǤͳ ͹ʹǤͶ ͹ʹǤ͵



͹ʹǤͳ ͹ʹǤʹ ͹ʹǤʹ ͹ʹǤͷ ͹ʹǤͳ ͹ʹǤͶ



͹ʹǤͳ ͹ʹǤ͸ ͹ʹǤ͸ ͹ʹǤͷ ͹ʹǤ͵ ͹ʹǤͶ



͹ʹǤͲ ͹ʹǤ͹ ͹ʹǤ ͅ ͹ʹǤͷ ͹ʹǤͶ ͹ʹǤͶ



͹ʹǤͲ ͹ʹǤ ͅ ͹ʹǤ ͅ ͹ʹǤͷ ͹ʹǤͶ ͹ʹǤͶ



͹ʹǤͲ ͹ʹǤ ͅ ͹ʹǤ ͅ ͹ʹǤͶ ͹ʹǤͶ ͹ʹǤͶ



͹ͳǤͻ ͹ʹǤͻ ͹ʹǤͻ ͹ʹǤ͵ ͹ʹǤ͸ ͹ʹǤͶ



͹ͳǤͻ ͹ʹǤ͹ ͹ʹǤ͹ ͹ʹǤͶ ͹ʹǤ͸ ͹ʹǤͶ



͹ͳǤͻ ͹ʹǤͷ ͹ʹǤͷ ͹ʹǤͶ ͹ʹǤ ͅ ͹ʹǤͶ



͹ͳǤͻ ͹ʹǤͳ ͹ʹǤͳ ͹ʹǤʹ ͹ʹǤ ͅ ͹ʹǤͶ



͹ʹǤͲ ͹ͳǤ ͅ ͹ͳǤ ͅ ͹ʹǤͷ ͹ʹǤͻ ͹ʹǤͶ



͹ʹǤͲ ͹ͳǤͷ ͹ͳǤͷ ͹ʹǤͶ ͹͵ǤͲ ͹ʹǤͷ

͹ʹǤͳ ͹ͳǤ ͅ ͹ͳǤ ͅ ͹ʹǤͷ ͹ʹǤͳ ͹ʹǤͶ ͹ʹǤͷ ͹ͳǤ͸ ͸ͻǤʹ

ͷȀ͸ȀʹͲͳͲͳͲǣ͵ͷǣͲͲ

͹ʹǤ͵ ͹ͳǤ͸ ͸ͻǤʹ

ͷȀ͸ȀʹͲͳͲͳͲǣ͵ͲǣͲͲ

͹ʹǤͶ ͹ʹǤ͵ ͹ͳǤ͹ ͸ͻǤʹ

ͷȀ͸ȀʹͲͳͲͳͲǣʹͷǣͲͲ

͹ʹǤͶ ͹ʹǤ͵ ͹ͳǤ͹ ͸ͻǤʹ

ͷȀ͸ȀʹͲͳͲͳͲǣʹͲǣͲͲ

͹ʹǤ͵ ͹ʹǤʹ ͹ͳǤ͸ ͸ͻǤͶ

ͷȀ͸ȀʹͲͳͲͳͲǣͳͷǣͲͲ

͹ʹǤͶ ͹ʹǤͳ ͹ͳǤ͹ ͸ͻǤ͵

ͷȀ͸ȀʹͲͳͲͳͲǣͳͲǣͲͲ

͹ʹǤͶ ͹ʹǤͳ ͹ͳǤ͸ ͸ͻǤ͵

ͷȀ͸ȀʹͲͳͲͳͲǣͲͷǣͲͲ

͹ʹǤ ͅ ͹ͳǤ ͅ ͹ͳǤ͹ ͸ͻǤʹ

ͷȀ͸ȀʹͲͳͲͳͲǣͲͲǣͲͲ

͹ʹǤ͹ ͹ͳǤ ͅ ͹ͳǤ͸ ͸ͻǤʹ

ͷȀ͸ȀʹͲͳͲͻǣͷͷǣͲͲ

͹ʹǤ͸ ͹ͳǤ ͅ ͹ͳǤ͸ ͸ͻǤ͵

ͷȀ͸ȀʹͲͳͲͻǣͷͲǣͲͲ

͹ʹǤͷ ͹ͳǤ ͅ ͹ͳǤ͹ ͸ͻǤ͵

ͷȀ͸ȀʹͲͳͲͻǣͶͷǣͲͲ

͹ʹǤͷ ͹ͳǤ ͅ ͹ͳǤͻ ͸ͻǤͷ

͹ʹǤͷ ͹ͳǤͻ ͹ͳǤ͹ ͸ͻǤͶ



͹ʹǤͳ ͹ͳǤʹ ͹ͲǤͻ ͹ʹǤ͸ ͹͵Ǥʹ ͹ʹǤͶ ͹ʹǤ͸ ͹ͳǤ ͅ ͹ͳǤ ͅ ͸ͻǤͷ

ͷȀ͸ȀʹͲͳͲ 

͹ʹǤͳ ͹ͲǤͻ ͹ͳǤͳ ͹ʹǤͷ ͹͵Ǥͳ ͹ʹǤ͵ ͹ʹǤ͸ ͹ͳǤͻ ͹ͳǤ͹ ͸ͻǤͷ

ͷȀ͸ȀʹͲͳͲͻǣʹͷǣͲͲ

͹ʹǤͳ ͹ͳǤͳ ͹ͳǤͳ ͹ʹǤͷ ͹͵Ǥͳ ͹ʹǤ͵ ͹ʹǤ͸ ͹ʹǤͲ ͹ͳǤ͸ ͸ͻǤͶ

ͷȀ͸ȀʹͲͳͲͻǣʹͲǣͲͲ

͹ʹǤͳ ͹ͳǤͳ ͹ͳǤͶ ͹ʹǤ͸ ͹͵ǤͲ ͹ʹǤ͵ ͹ʹǤ͸ ͹ʹǤͳ ͹ͳǤ͸ ͸ͻǤͶ

ͷȀ͸ȀʹͲͳͲͻǣͳͷǣͲͲ

͹ʹǤͳ ͹ͳǤͶ ͹ͳǤͶ ͹ʹǤͷ ͹ʹǤͻ ͹ʹǤͶ ͹ʹǤ͸ ͹ʹǤͳ ͹ͳǤ͸ ͸ͻǤ͵

ͷȀ͸ȀʹͲͳͲͻǣͳͲǣͲͲ

͹ʹǤͲ ͹ͳǤ͹ ͹ͳǤ͹ ͹ʹǤͶ ͹ʹǤ ͅ ͹ʹǤ͵ ͹ʹǤͷ ͹ʹǤ͵ ͹ͳǤͻ ͸ͻǤͶ

ͷȀ͸ȀʹͲͳͲͻǣͲͷǣͲͲ

͹ʹǤͲ ͹ͳǤͻ ͹ͳǤͻ ͹ʹǤͷ ͹ʹǤ ͅ ͹ʹǤͶ ͹ʹǤͷ ͹ʹǤͶ ͹ͳǤͻ ͸ͻǤʹ

ͷȀ͸ȀʹͲͳͲͻǣͲͲǣͲͲ

͹ͳǤͻ ͹ʹǤͲ ͹ʹǤͲ ͹ʹǤͷ ͹ʹǤ ͅ ͹ʹǤͶ ͹ʹǤ͸ ͹ʹǤͷ ͹ͳǤ ͅ ͸ͻǤ͵

ͷȀ͸ȀʹͲͳͲ ͅǣͷͷǣͲͲ

Page 16 of 22 

Page 278 Health Hazard Evaluation Report 2009-0172-3124 
 Appendix n: eMC enGineeRs, inC. seAsonAL HvAC RetRo- CoMMissioninG RepoRt dAted MAy 2010 (Continued) 

͹ͳǤͻ ͹ʹǤ͵ ͹ʹǤ͵ ͹ʹǤͷ ͹ʹǤ ͅ ͹ʹǤͷ ͹ʹǤ͸ ͹ʹǤͶ ͹ͳǤͻ ͸ͻǤʹ

ͷȀ͸ȀʹͲͳͲ ͅǣͶͷǣͲͲ

͹ʹǤͲ ͹ʹǤ ͅ ͹ʹǤ ͅ ͹ʹǤͶ ͹ʹǤ ͅ ͹ʹǤ͸ ͹ʹǤ͸ ͹ʹǤ͵ ͹ͳǤͻ ͸ͻǤ͵

ͷȀ͸ȀʹͲͳͲ ͅǣͶͲǣͲͲ

͹ʹǤͳ ͹͵ǤͲ ͹͵ǤͲ ͹ʹǤ͵ ͹ʹǤ ͅ ͹ʹǤ͹ ͹ʹǤ͸ ͹ʹǤ͵ ͹ͳǤ ͅ ͸ͻǤʹ

ͷȀ͸ȀʹͲͳͲ ͅǣ͵ͷǣͲͲ

͹ʹǤʹ ͹͵ǤͲ ͹͵ǤͲ ͹ʹǤʹ ͹ʹǤ ͅ ͹ʹǤ ͅ ͹ʹǤ͸ ͹ʹǤʹ ͹ͳǤͻ ͸ͻǤʹ

ͷȀ͸ȀʹͲͳͲ ͅǣ͵ͲǣͲͲ

͹ʹǤͳ ͹ʹǤ͹ ͹ʹǤ͹ ͹ʹǤͳ ͹ʹǤ ͅ ͹ʹǤ͹ ͹ʹǤ͸ ͹ʹǤͳ ͹ͳǤ ͅ ͸ͻǤʹ

ͷȀ͸ȀʹͲͳͲ ͅǣʹͷǣͲͲ

͹ʹǤͳ ͹ʹǤ͹ ͹ʹǤͷ ͹ʹǤͲ ͹ʹǤ ͅ ͹ʹǤ ͅ ͹ʹǤ͹ ͹ʹǤͲ ͹ʹǤͲ ͸ͻǤ͵

ͷȀ͸ȀʹͲͳͲ ͅǣʹͲǣͲͲ

͹ʹǤͲ ͹ʹǤͷ ͹ʹǤͳ ͹ͳǤͻ ͹ʹǤ ͅ ͹ʹǤ ͅ ͹ʹǤ͸ ͹ʹǤͳ ͹ͳǤ ͅ ͸ͻǤ͵

ͷȀ͸ȀʹͲͳͲ ͅǣͳͷǣͲͲ

͹ͳǤͻ ͹ʹǤͳ ͹ͳǤ͹ ͹ͳǤͻ ͹ʹǤ ͅ ͹ʹǤ ͅ ͹ʹǤ͹ ͹ʹǤͳ

͹ͳǤͻ ͸ͻǤ͵

͹ʹǤͲ ͸ͻǤͶ

͹ʹǤͲ ͸ͻǤͷ

͹ʹǤͲ ͸ͻǤͶ

ͷȀ͸ȀʹͲͳͲ ͅǣͳͲǣͲͲ

͹ͳǤ ͅ ͹ͳǤͶ ͹ͳǤ͵ ͹ͳǤͻ ͹ʹǤ ͅ ͹ʹǤ͸ ͹ʹǤ͸ ͹ʹǤͳ

ͷȀ͸ȀʹͲͳͲ ͅǣͲͷǣͲͲ

͹ͳǤͻ ͹ͳǤͶ ͹ͳǤ͵ ͹ͳǤ ͅ ͹ʹǤ͹ ͹ʹǤ͸ ͹ʹǤ͸ ͹ʹǤͳ

ͷȀ͸ȀʹͲͳͲ ͅǣͲͲǣͲͲ

͹ͳǤͻ ͹ͳǤ͵ ͹ͳǤ͵ ͹ͳǤ ͅ ͹ʹǤͷ ͹ʹǤͶ ͹ʹǤͶ

ͷȀ͸ȀʹͲͳͲ͹ǣͷͷǣͲͲ

͹ʹǤͲ ͹ͳǤ͸ ͹ͳǤ͸ ͹ͳǤ͹ ͸ͻǤ͸

ͷȀ͸ȀʹͲͳͲ͹ǣͷͲǣͲͲ

͹ʹǤͲ ͹ͳǤ ͅ ͹ͳǤ ͅ ͹ͳǤ͹

͹ʹǤ͵

͹ʹǤͶ ͹ʹǤͶ ͹ʹǤͷ ͹ʹǤͷ ͹ʹǤͲ

͹ʹǤ͵ ͹ʹǤʹ ͹ʹǤ͵ ͹ʹǤͷ

͹ʹǤͳ ͹ʹǤͳ ͹ʹǤͶ ͹ʹǤͶ

͹ͳǤͻ ͹ʹǤͲ ͹ʹǤʹ ͹ʹǤͷ

͹ʹǤͲ ͹ʹǤͲ ͹ʹǤ͵ ͹ʹǤͶ

͹ʹǤͲ ͹ʹǤͲ ͹ʹǤʹ ͹ʹǤ͵

͹ͳǤͻ ͸ͻǤͷ

ͷȀ͸ȀʹͲͳͲ͹ǣͶͷǣͲͲ

͹ʹǤͳ ͹ʹǤͲ ͹ʹǤͲ ͹ͳǤ͹ ͹ͳǤͻ ͸ͻǤͷ

ͷȀ͸ȀʹͲͳͲ͹ǣͶͲǣͲͲ

͹ʹǤͳ ͹ʹǤͶ ͹ʹǤͶ ͹ͳǤ͹ ͹ͳǤ ͅ ͸ͻǤͷ

ͷȀ͸ȀʹͲͳͲ͹ǣ͵ͷǣͲͲ

͹ʹǤͳ ͹ʹǤ ͅ ͹ʹǤ͹ ͹ͳǤ͹ ͹ͳǤ ͅ ͸ͻǤͷ

ͷȀ͸ȀʹͲͳͲ͹ǣ͵ͲǣͲͲ

͹ʹǤͳ ͹ʹǤ͹ ͹ʹǤͷ ͹ͳǤ͹ ͹ͳǤ ͅ ͸ͻǤ͸

ͷȀ͸ȀʹͲͳͲ͹ǣʹͷǣͲͲ

͹ʹǤʹ ͹ʹǤͷ ͹ʹǤ͵ ͹ͳǤ͹ ͹ʹǤͲ ͹ʹǤͳ ͹ʹǤ͵ ͹ʹǤͶ ͹ʹǤͲ ͸ͻǤ͸

ͷȀ͸ȀʹͲͳͲ͹ǣʹͲǣͲͲ

͹ʹǤͳ ͹ʹǤ͵ ͹ͳǤͻ ͹ͳǤ͸ ͹ʹǤͳ ͹ʹǤͲ ͹ʹǤʹ ͹ʹǤ͵ ͹ʹǤͲ ͸ͻǤͷ

Table 3 - Units with multiple trouble calls after Feb 22, 2010 

Page 17 of 22 

Health Hazard Evaluation Report 2009-0172-3124 Page 279 
 

 

 

 

 

 No changes 

(all unoccupied offsets should remain at +/- 5 degrees) 

Note: As of 5/7/2010 the above setpoint changes have been implemented. 

x EMC recommends that regular air filter inspections continue to be performed 

on all units, including the makeup air units, at least every 3 months per 

manufacturer’s recommendations, with filter changes conducted when visual 

inspection indicates necessity. 

x Air flow assessments should be made by trained personnel with the proper 

Appendix n: eMC enGineeRs, inC. seAsonAL HvAC RetRo- CoMMissioninG RepoRt dAted MAy 2010 (Continued) 

1.1.3 Conclusions & Recommendations 

x To aid in having space temperatures settled within the controller’s deadband 

by the time teachers and staff arrive in the mornings, the revised 

recommended schedule is as follows: 

o Office and Media Center areas 

 Occupied 4 a.m. – 9 p.m. 

 Unoccupied 9 p.m. – 4 a.m. 

o Classroom wings and Gymnasium / Cafeteria 

 Occupied 5 a.m. – 9 p.m. 

 Unoccupied 9 p.m. – 5 a.m. 

o Data closets 

 Occupied continuously 

Note: As of 5/7/2010 the above schedule changes have been implemented. 

x To provide acceptable space temperatures and alleviate unnecessary trouble 

calls to GCS Maintenance, the revised recommended temperature setpoints 

are as follows: 

o Office and Media Center 

 Occupied Cooling – 72 deg F 

 Unoccupied Cooling – 77 deg F 

o Classroom wings and Gymnasium / Cafeteria 

 No changes 

o Data closets 

calibrated equipment in order to prevent erroneous trouble calls stemming 

from inaccurate observations or assumptions. 

x Thermostats shown in the list in section Table 2 above should be calibrated to 

within factory tolerances (+/- .5 deg F). If calibration is not possible, the 

thermostat should be replaced and the new thermostat calibration verified 

with a calibrated test instrument. 

Page 18 of 22 

Page 280 Health Hazard Evaluation Report 2009-0172-3124 
 

 

 

 

 

 

 

frequently than weekly, BCU replacement should be considered. 

x Investigate HP-9 to determine the cause of refrigerant leak out of circuit #1 

and repair as necessary. Once repairs are made, HP-9 performance should be 

reviewed daily for 1 week to determine effectiveness of repairs. 

x

Appendix n: eMC enGineeRs, inC. seAsonAL HvAC RetRo- CoMMissioninG RepoRt dAted MAy 2010 (Continued) 

x In order to aid in maintaining acceptable indoor conditions, all outside doors 

as well as all operable windows should continue to remain closed at all times. 

Additionally, custodial staff should regularly clear the areas around all 

exterior doors of rocks or objects that may deliberately or inadvertently 

impede the full closing of those doors. 

x The outside door frame for room 521 should be replaced or repaired. If repair 

is made, the door alignment should be corrected as well. 

x

x

x

x

x

air filter changes. Observe filters for increased build-up during periods of 

high traffic (i.e. move-in and move-out at beginning and end of school year) 

and adjust filter change periodicity as determined to be necessary. 

x Review Trane Tracer Summit alarm log weekly, paying particular attention 

for BCU communication failures. If these failures start appearing more 

Install pipe supports every 6 feet, where missing on all building heat pump 

loop piping. These supports should be properly anchored to building 

structural components vice sheetrock anchors. Supports should be straight 

and plumb and their length should be such that the full weight of the copper 

piping is supported by the hangers. Threaded rod with saddle brackets sized 

to hold up to 2” copper pipe, with dielectric insulator material should be 

used. 

The outdoor air humidity transmitter for the BAS should be calibrated 

properly. The scaling of the device input in the BAS should also be verified as 

correct for the device. 

A link to HP-48 should be added to the F-wing graphic in the BAS to facilitate 

easy access to the heat pump controller from the E-wing graphic. 

HP-24 controller should be investigated to determine why the reversing valve 

is always energized, and repair or replace controller as determined necessary. 

HP-34 setpoints should be set the same as other classroom heat pumps. 

Continue following unit manufacturer’s recommendations on frequency of 

Page 19 of 22 

Health Hazard Evaluation Report 2009-0172-3124 Page 281 
 

 

Appendix n: eMC enGineeRs, inC. seAsonAL HvAC RetRo- CoMMissioninG RepoRt dAted MAy 2010 (Continued) 

1.2 Tempered Water System 

1.2.1 System Verification 

EMC verified the operation of the Cooling Tower, Heat Exchanger, Building Loop 

Pumps, and Tower Pumps for proper cooling season operation. All digital 

commands, such as pump start/stop commands were visually verified for proper 

equipment reaction. 

EMC worked to verify that the sequence of operations was fully and correctly 

implemented, and that the transient changes in operation of the units were still 

made apparent on the Graphics for the BAS. 

1.2.2 Summary of Findings 

No issues were discovered with respect to the operation of the cooling tower, heat 

exchanger or pumps in cooling season operation. 

time. 

1.2.3 Conclusions & Recommendations 

This tempered water system is operating as designed. No recommendations at this 

Page 20 of 22 

Page 282 Health Hazard Evaluation Report 2009-0172-3124 
 

 

 

 

Appendix n: eMC enGineeRs, inC. seAsonAL HvAC RetRo- CoMMissioninG RepoRt dAted MAy 2010 (Continued) 

1.3 Makeup Air Units 

1.3.1 System Verification 

EMC verified that during occupied periods supply air temperature was generally at 

or near 70 deg F, and supply air humidity was generally between 45 and 50% RH. 

During unoccupied periods, an offset of 5 degrees was observed when units were 

activated upon a call for operation of one or more associated heat pumps in that 

building wing. Supply humidity levels during unoccupied periods were observed as 

remaining unchanged. Reheat water temperatures generally ranged from 95 – 100 

deg F and glycol supply temperatures were observed to be between 40 – 45 deg F. 

The outdoor air units followed the occupancy schedule of the classroom wings and 

stopped off when the wing went into unoccupied, unless there was at least one heat 

pump calling for cooling, in which case the outdoor unit would start or continue to 

run. 

1.3.2 Summary of Findings 

No issues were discovered with respect to the operation of the outdoor air units. 

Figure 14 - Typical Outdoor Air Unit graphic screen (occupied operation) 

1.3.3 Conclusions & Recommendations 

The units are operating as designed. No recommendations at this time. 

Page 21 of 22 

Health Hazard Evaluation Report 2009-0172-3124 Page 283 
 

 

 

Appendix n: eMC enGineeRs, inC. seAsonAL HvAC RetRo- CoMMissioninG RepoRt dAted MAy 2010 (Continued) 

1.4 Exhaust Fans and Systems 

1.4.1 System Verification 

EMC verified operation of the building exhaust fans. Fans controlled by heat pumps 

were operational, as were thermostatically-controlled fans. No issues related to 

exhaust fans were discovered during seasonal inspection. 

1.4.2 Summary of Findings 

No issues were discovered with respect to the operation of the exhaust fans. 

1.4.3 Conclusions & Recommendations 

The exhaust fans are operating correctly. No recommendations at this time. 

Page 22 of 22 

Page 284 Health Hazard Evaluation Report 2009-0172-3124 
Appendix o: eLeMentARy sCHooL iAQ pRoJeCt pRoGRess updAte 

As of 01/12/10 Oak Ridge Elementary SchoolͲIAQ Project
 

Progress Update
 

# ACTIVITY

% Complete SUBSTANTIAL

P D C COMPLETION DATE STATUS

1

Remove and clean building contents, move to new

sites and storage. 100 100 100 8/14/2009 Complete

2 Sheetrock repaired from initial NIOSH and Turner visit 100 100 100 8/17/2009 Complete

3 Removal of Carpeting 100 100 100 9/4/2009 Complete

4 Installation of VCT/moisture testing 100 100 100 9/11/2009 Complete

5

Installation of new filter boxes upstream from water

source heat pump & clean coils 100 100 100 12/6/2009 Complete

6

Removal of old ceiling tiles above suspended ceiling

media center hall and sealing around windows 100 100 100 11/9/2009 Complete

7

Sheetrock replacement/repair resulting from

exploratory and base cove work 100 100 100 10/19/2009 Complete

8

Vapor barrier and depressurization of crawl space

under the media center. 100 100 100 10/23/2009 Complete

9 Roof flashing and roof repairs 100 100 100 12/30/2009 Complete

10 Sealing of classroom wings/soffits/exhaust 100 100 100 12/13/2009 Complete

11 Site drainage review/modifications 100 100 0 TBD

Pending due to weather

conditions/ wet groundsͲ

Turner Consulting has

verbally informed us that it is

not necessary to complete

this work in order to occupy

the building.

12 RetroͲcommissioning of HVAC system 100 100 100 12/23/2009 Complete

13 Building Cleaning 100 100 100 12/18/2009

CompleteͲNote: Cleaning

efforts will be ongoing as the

moveͲin occurs.

14 Moisture in gym exterior walls 100 100 100 10/30/2009 Complete

15 Turner ConsultingͲSite Review/Data Review NA NA NA 1/5/2010

CompleteͲTurner onͲsite

12/15 thru 12/18

16 Turner Consulting Report NA NA NA 1/12/2010 Complete

Phase:

PͲPlanning

DͲDesign/Protocol Development

CͲConstruction

Notes:

1.In addition, to the Indoor Air Quality Work (IAQ) related work currently underway staff is also

coordinating with the County building department/fire marshal's office and any other necessary

Authorities Having Jurisdiction (AHJ's) to resolve any code related issues discovered as a result of ongoing

building evaluations. Based on recent discussions with the County building department and the fire

marshal's office we do not believe that any of the work currently being proposed (Ex. add an exterior door

and reconfigure some interior doors in the media center) would impact reͲoccupancy of ORE in a Jan.ͲFeb.

timeframe.

2.This is intended to provide a snapshot of the work that has been identified to date in working with

Turner Consulting.Additional work resulting from ongoing evaluations, pending NIOSH report and any

unforseen conditions may be added and/or modify line items noted above, as applicable

DRAFT 1

Health Hazard Evaluation Report 2009-0172-3124 Page 285
 

A

#3

ppendix o: eLeMentARy sCHooL iAQ pRoJeCt pRoGRess updAte 

(Continued) 

REMOVAL OF CARPETING

REMOVAL OF CARPETING

Page 286 Health Hazard Evaluation Report 2009-0172-3124 
 

Append

#4

ix o: eLeMentARy sCHooL iAQ pRoJeCt pRoGRess updAte . (Continued) 

MOISTURE TESTING

INSTALLATION OF VCT

Health Hazard Evaluation Report 2009-0172-3124 Page 287 
 

Appendix o: eLeMentARy sCHooL iAQ pRoJeCt pRoGRess updAte 

(Continued) 

#5

REMOVAL OF AIR FILTERS AT HEAT

PUMP

INSTALLATION OF NEW FILTER

BOXES IN CLASSROOM

Page 288 Health Hazard Evaluation Report 2009-0172-3124 
 

Appendix o: eLeMentARy sCHooL iAQ pRoJeCt pRoGRess updAte 

(Continued) 

#5

DIRTY COILS

CLEANED COILS

Health Hazard Evaluation Report 2009-0172-3124 Page 289 
 

Appendix o: eLeMentARy sCHooL iAQ pRoJeCt pRoGRess updAte 

(Continued) 

#6

REMOVAL OF OLD CEILING TILES

ABOVE SUSPENDED CEILING MEDIA

CENTER HALL

CEILING TILES REMOVED

Page 290 Health Hazard Evaluation Report 2009-0172-3124 
 

Appendix o: eLeMentARy sCHooL iAQ pRoJeCt pRoGRess updAte 

(Continued) 

#6

REMOVAL OF CEILING TILES

CLEANED AND SEALED WINDOWS

ABOVE MEDIA CENTER

Health Hazard Evaluation Report 2009-0172-3124 Page 291 
 

Appendix o: eLeMentARy sCHooL iAQ pRoJeCt pRoGRess updAte 

(Continued) 

#7

FINDINGS FROM EXPLORATORY AND

BASE COVE WORK

SHEETROCK REPLACEMENT AND

REPAIR

REPAIRED WALL

Page 292 Health Hazard Evaluation Report 2009-0172-3124 
 

Appendix o: eLeMentARy sCHooL iAQ pRoJeCt pRoGRess updAte 

(Continued) 

#8

MOLDED FLOOR SYSTEM

CLEANED FLOOR SYSTEM AND

INSTALLED VAPOR BARRIER

DEHUMIDIFIER INSTALLED

Health Hazard Evaluation Report 2009-0172-3124 Page 293 
 

Appendix o: eLeMentARy sCHooL iAQ pRoJeCt pRoGRess updAte 

(Continued) 

#9

PROBLEMATIC ROOF FLASHING

ROOF FLASHING REPAIRS IN

PROGRESS

COMPLETED ROOF FLASHING

REPAIR

Page 294 Health Hazard Evaluation Report 2009-0172-3124 
 

Appendix o: eLeMentARy sCHooL iAQ pRoJeCt pRoGRess updAte 

(Continued) 

#9

OLD ROOF STRUCTURE

NEW ROOF STRUCTURE

Health Hazard Evaluation Report 2009-0172-3124 Page 295 
 

Append

#10

ix o: eLeMentARy sCHooL iAQ pRoJeCt pRoGRess updAte 

(Continued)

PROBLEMATIC SOFFIT CONDITIONS

SOFFIT REPAIR AND FIRE CAULKED

SEAMS

COMPLETED SOFFIT REPAIR WITH

FOAM INSULATION

Page 296 Health Hazard Evaluation Report 2009-0172-3124 
 

A

#14

ppendix o: eLeMentARy sCHooL iAQ pRoJeCt pRoGRess updAte 

(Continued) 

MOISTURE INTRUSION ON GYM 
 

WALL 
 

DAMAGED DRAIN CAUSING MOISTURE

INTRUSION

DRAIN REPAIRED GYM WALL

REPAINTED

Health Hazard Evaluation Report 2009-0172-3124 Page 297 
Appendix L: Sporicidin disinfectant solution label

Appendix p: spoRiCidin disinFeCtAnt soLution LABeL
 

Page 298 Health Hazard Evaluation Report 2009-0172-3124 
v3.0

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Appendix Q: niosH dRAFt MoLd & dAMpness AssessMent sHeet
 

Health Hazard Evaluation Report 2009-0172-3124 Page 299
 

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Appendix Q: niosH dRAFt MoLd & dAMpness AssessMent sHeet 

(Continued) 

National Institute for Occupational Safety and Health (NIOSH) 

Centers for Disease Control and Prevention (CDC) 

Department of Health and Human Services 

NIOSH Contact: Michelle Martin 304-285-5734 or moldsheet#1@cdc.gov 

PILOT Study 

Dampness and Mold Assessment Tool Instructions Packet 

NIOSH has developed an observational assessment tool for dampness and mold in buildings. 

GOAL: To provide valuable information for motivating remediation, prioritizing intervention, 

and evaluating remediation effectiveness. 

Through past research, NIOSH has shown in studies of a community college and a health care facility
 

involving 15 buildings that the dampness and mold scores, obtained by using a similar assessment tool,
 

were associated with respiratory health outcomes in the building occupants (Park et al. 2004, Indoor Air;
 

14:425-433; Cox-Ganser et al. 2009, Indoor Air 19(4):280-290).
 

The tool consists of: 

1. A form which is used to assess signs of dampness, water damage, mold growth, 

and musty odors in rooms and areas throughout a building. 

2. A Microsoft Access database application to enter data collected from hard copy 

assessment forms for electronic record keeping and reports. 

Through a National Occupational Research Agenda project and a Public Health Project, NIOSH has 

partnered with the Maine Indoor Air Quality Council (MIAQC), the University of Connecticut Health Center, 

and school districts in both Maine and Connecticut to pilot the use of the observational assessment tool. 

NIOSH has developed a training presentation and a hard copy package, and we have successfully trained 

school district facility managers in the use of the tool. In working together with school business managers, 

facility managers, and custodians, the form has been used in small and large school districts of different 

building types. With their feedback, we have made changes to make the tool more useful. 

The Dampness and Mold Assessment Tool is free to the public. We encourage using the tool to 

assist with proactive environmental efforts in buildings and request feedback on the tool’s utility. 

Please send all feedback to: mold#1@cdc.gov. 

Page 300 Health Hazard Evaluation Report 2009-0172-3124 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 - - 

 

 

 

Appendix Q: niosH dRAFt MoLd & dAMpness AssessMent sHeet 

(Continued) 

Purpose of the Dampness and Mold Assessment Tool 

NIOSH PILOT Study NIOSH Contact: Michelle Martin 304 285 5734 or moldsheet#1@cdc.gov 

The purpose of this tool is to: 

Identify and record areas of dampness or mold throughout your building. 

Trigger early repair and remediation to avoid potential health effects and more costly repair and 

remediation. 

Create awareness of potential problem areas. 

Track (monitor) past and present problem areas by repeating the use of this tool at the frequency 

which your individual facility determines. 

Assessment, identification, repair and remediation cycle: 

STEP 1. Use the Dampness and Mold Assessment Form in all rooms 

and areas of your building. 

Facilities staff or trained professionals should use separate forms to assess each 

room and area of your building. 

Repeat Step 1 using the tool at 

regular intervals to potentially 

identify areas of dampness and 

mold before severe conditions 

Did you find develop.

areas of potential 

dampness or mold 

using this tool? NO 

YES 

STEP 2. Find the sources of moisture identified in Step 1. 

Facilities staff or trained professionals should conduct further inspection of the 

areas of dampness and mold to identify sources of water incursion, and repair 

and remediation needs. 

STEP 3. Perform repairs and remediation. 

Facilities staff or trained professionals should repair sources of moisture then 

remediate damaged areas following guidelines such as Mold Remediation in 

Schools and Commercial Buildings (Environmental Protection Agency) 

http://www.epa.gov/iedmold1/pdfs/moldremediation.pdf or New York City 

Guidelines on Assessment and Remediation of Fungi in Indoor Environments 

(New York City Department of Health and Mental Hygiene) 

http://www.nyc.gov/html/doh/downloads/pdf/epi/epi-mold-guidelines.pdf 

Should assessments end after remediation? No! Go back to Step 1. 

2
 

Health Hazard Evaluation Report 2009-0172-3124 Page 301
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 - -

Appendix Q: niosH dRAFt MoLd & dAMpness AssessMent sHeet 

(Continued) 

General Instructions (assessing rooms with the form) 

NIOSH PILOT Study NIOSH Contact: Michelle Martin 304 285 5734 or moldsheet#1@cdc.gov 

Individuals who are experiencing respiratory health symptoms, and have concerns that exposures to 

dampness and mold are related to their symptoms, are cautioned about using the form in potential problem 

areas. 

1)	 When completing the assessment form, first fill-in the date, observer, building, wing, 

floor, room number, and room type that you are inspecting in the top area of the 

sheet. Use one sheet per room. 

2)	 Fill in any observation of MOLD ODOR. Be sure to smell for mold odor when you first walk 

into each room. When listing a source, refer to the first (yellow shaded) column on the left of 

the page. Determine whether a smell is mild, moderate, or heavy (strong). 

3)	 Typical room components within a room are listed in the first (yellow shaded) column and 

should be systematically assessed in the order given. If a room has other components 

you will assess than those listed, write the name of the component on the line provided next 

to the “Other” row. 

4)	 An “X” should be placed in the next column next to any room component that is not 

applicable (NA) or does not exist in the room you are assessing. 

5)	 In the next three columns, for each room component, score the combined size of the 

following types of observed areas: damage or stains, visible mold, and wetness or 

dampness. Base scores solely on size (see next page). 

3
 

Page 302	 Health Hazard Evaluation Report 2009-0172-3124 
 

 

 

 

 

 - -

 

Appendix Q: niosH dRAFt MoLd & dAMpness AssessMent sHeet 

(Continued) 

General Instructions (assessing rooms with the form) 

NIOSH PILOT Study NIOSH Contact: Michelle Martin 304 285 5734 or moldsheet#1@cdc.gov 

6)	 Provide additional information in the “Notes” column. 

7)	 Do not complete the gray areas for “column totals”, “column averages” , or “row totals”. 

Save this for later. 

Determining Size-based Scores 

Scoring is based on four sizes: 

0 = NONE 

1 = the combined size of damage/stain, visible mold, or wet/damp areas that are approximately 

the size of the actual “Dampness and Mold Assessment Form” or smaller. 

Form size = 8 1⁄2 inches X 11 inches 

2 = the combined size of damage/stain, visible mold, or wet/damp areas that are between the 

size of the “Dampness and Mold Assessment Form” and the size of a standard interior 

door. 

Door size = 32 inches X 80 inches 

3 = the combined size of the damage/stain, visible mold, or wet/damp areas that are larger than the 

size of an interior door. 4 

Health Hazard Evaluation Report 2009-0172-3124	 Page 303 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 - -

Appendix Q: niosH dRAFt MoLd & dAMpness AssessMent sHeet 

(Continued) 

Special Notes 

NIOSH PILOT Study NIOSH Contact: Michelle Martin 304 285 5734 or moldsheet#1@cdc.gov 

 Is it a stain or is it mold? Most of the time this is difficult to determine. If you are not 

certain what you see is mold: 

1) mark as “None” in the “Visible Mold” column 

2) score the size of the stain in the “Damage or Stains” column 

3) write a note in the “Notes” column 

If you observe severe areas of damage or visible mold: 

1) score according to size for both “Damage or Stains” and “Visible Mold” 

2) write a note in the “Notes” column on how severe you observe the area to be 

Photographs can be useful for documenting conditions. You may consider taking a 

photograph of an area that appears to be severe and referring to the photograph in the 

“Notes” column. 

 Is it currently wet or damp? It may be beneficial to touch an area to determine whether it 

is moist. The purpose of this question is to identify how current a leak may be. 

We recommend that you wash your hands after touching damp areas. Areas of 

obvious moisture or mold DO NOT need to be touched. 

 If you observe areas of moisture on fixtures, such as condensation on pipes under 

toilets and sinks, include your observations by filling in the appropriate bubble for the size of 

the affected area in the “Wet or Damp” column and make a note in the “NOTES” section. 

 If you notice a stain on an item that appears unrelated to sources of water incursion 

within the room, include this in the “NOTES” section as “incidental”. 

 After being in a building for a lengthy period of time, it may become difficult to determine 

if there is a mold odor present in a room. To prevent this problem, we recommend that 

you take periodic breaks outside of the building. If you smell something other than mold 

odor, include this in the “NOTES” column. Always try to detect the smell of mold 

immediately as you enter each room. 

 Remember the scoring is based on size, not on density or darkness of the stain or mold. 

5
 

Page 304	 Health Hazard Evaluation Report 2009-0172-3124 
s

 

 

 

 

 

 

 - -

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Appendix Q: niosH dRAFt MoLd & dAMpness AssessMent sHeet 

(Continued) 

Example 1 

NIOSH PILOT Study NIOSH Contact: Michelle Martin 304 285 5734 or moldsheet#1@cdc.gov 

Example 1: Assessing the CEILING 

Picture of stained ceiling tiles. These two stains were the only stains observed on the entire 

ceiling in this room. If there were other areas of damage/stain, visible mold, or damp/wet 

conditions, you would also combine the size of those areas for one score for the entire ceiling. 

1) DAMAGE or STAIN 

The damage to this ceiling area 

appears to be somewhat 

extensive. A score for this 

would be a 2 because both 

stains together are bigger than 

the size of the assessment 

form but smaller than a 

standard interior door. 

2) VISIBLE MOLD 

It is hard to determine if 

there is mold in this 

example, so you might 

score this as a 0 but note 

(in the “Notes” column) 

that there may be mold 

growth. 

3) WET or DAMP 

Both areas feel damp by touch 

and both together appear to be 

larger than the size of the 

assessment form but smaller 

than the size of a standard 

interior door. This example 

would have a score of 2. 

DAMAGE or 

STAIN 

0 1 2 3 

   

MOLD 

AREA 

0 1 2 3 

   

WET or 

DAMP 

0 1 2 3 

   

6
 

Health Hazard Evaluation Report 2009-0172-3124 Page 305 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 - -

 

 

 

 

 

 

 

 

Appendix Q: niosH dRAFt MoLd & dAMpness AssessMent sHeet 

(Continued) 

Example 2 

NIOSH PILOT Study NIOSH Contact: Michelle Martin 304 285 5734 or moldsheet#1@cdc.gov 

Example 2: Assessing the WALLS 

Picture of wall and floor. This area of wall damage and mold is the only problem area observed 

on all the walls in this room. If there were other areas of damage/stain, visible mold, or 

wet/damp conditions, you would also combine the size of those areas for one score for all the 

walls in the room. 

It should be noted in the 

“Notes” box that the damage 

and mold in this example 

appear to be severe. 

1) DAMAGE or STAIN 

There appears to be a large 

area of visible mold and 

damage to the wall in this 

example. The score would be 

2 because the area is bigger 

than the size of the 

assessment form and smaller 

than a standard interior door. 

2) VISIBLE MOLD 3) WET or DAMP 

The area of visible mold Current moisture in this 

appears to be significant. The

score would be 2 because the 

example was not found,

therefore the score is 0. 

area is bigger than the size of

the assessment form and 

smaller than a standard interior 

door. 

DAMAGE or 

STAIN 

0 1 2 3 

   

MOLD 

AREA 

0 1 2 3 

   

WET or 

DAMP 

0 1 2 3 

   

7
 

Page 306 Health Hazard Evaluation Report 2009-0172-3124 
 

 

 

 

 

 

 

 - -

Appendix Q: niosH dRAFt MoLd & dAMpness AssessMent sHeet 

(Continued) 

How to Calculate Total or Average Scores per Room 

NIOSH PILOT Study NIOSH Contact: Michelle Martin 304 285 5734 or moldsheet#1@cdc.gov 

There are two ways you can choose to score your results using hardcopies. Method I is 

calculating total scores per room and Method II is calculating average scores per room. When 

the Microsoft Access software for this tool becomes available, it will automatically provide results 

and summary reports based on both methods when data is entered. 

Scoring Method I – Total Room Score 

After completing the assessment form: 

a) add circled numbers in each column and enter in “Column Totals” 

b) add circled numbers in each row and enter in “Row Totals” 

c) Add the 3 column totals for the Total Room Score (example: 8 + 4 + 6 = 18) 

b 

c 

Total 

Room 

Score 

a 

8
 

Health Hazard Evaluation Report 2009-0172-3124 Page 307 
 

 

 

 

 

 

 

 

 - -

 

Appendix Q: niosH dRAFt MoLd & dAMpness AssessMent sHeet 

(Continued) 

How to Calculate Total or Average Scores per Room 

NIOSH PILOT Study NIOSH Contact: Michelle Martin 304 285 5734 or moldsheet#1@cdc.gov 

Scoring Method II – Average Room Score 

After completing the assessment form:
 

a) Complete Scoring Method I for total room score.
 

b) In each column, divide the column total by the number of scores in the bubbles above and
 

enter that number in the column average (example: 8 ÷ 5 = 1.6) 

c) add all column averages (1.6 + 0.8 + 1.2 = 3.6) and divide by 3 to get an Average Room 

Score (example: 3.6 ÷ 3 = 1.2 Average Room Score) 

b c 

Average 

Room 

Score 

Overall totals are used for record keeping and for comparison. Use 

these totals to determine whether the areas observed were overall better or 

worse than the previous assessment taken. 

9
 

Page 308 Health Hazard Evaluation Report 2009-0172-3124 
 

Appendix Q: niosH dRAFt MoLd & dAMpness AssessMent sHeet 

(Continued) 10 

Health Hazard Evaluation Report 2009-0172-3124 Page 309
 
 

 

 

Appendix Q: niosH dRAFt MoLd & dAMpness AssessMent sHeet 

(Continued) 

CDC/NIOSH PILOT 

NIOSH Contact: 

Michelle Martin 304-285-5734 or 

moldsheet#1@cdc.gov 

11
 

Page 310 Health Hazard Evaluation Report 2009-0172-3124 
ACKnowLedGeMents And 

AvAiLABiLity oF RepoRt 

The Respiratory Disease Hazard Evaluation and Technical 

Assistance Program (RDHETAP) of NIOSH conducts field 

investigations of possible health hazards in the workplace. These 

investigations are conducted under the authority of Section 20(a) 

(6) of the Occupational Safety and Health (OSH) Act of 1970, 29 

U.S.C. 669(a)(6), or Section 501(a)(11) of the Federal Mine Safety 

and Health Act of 1977, 30 U.S.C. 951(a)(11), which authorizes 

the Secretary of Health and Human Services, following a written 

request from any employers or authorized representative of 

employees, to determine whether any substance normally found 

in the place of employment has potentially toxic effects in such 

concentrations as used or found. 

RDHETAP also provides, upon request, technical and consultative 

assistance to federal, state, and local agencies; labor; industry; and 

other groups or individuals to control occupational health hazards 

and to prevent related trauma and disease. 

The findings and conclusions in this report are those of the 

authors and do not necessarily represent the views of NIOSH. 

Mention of any company or product does not constitute 

endorsement by NIOSH. In addition, citations to websites 

external to NIOSH do not constitute NIOSH endorsement of 

the sponsoring organizations or their programs or products. 

Furthermore, NIOSH is not responsible for the content of these 

websites. All Web addresses referenced in this document were 

accessible as of the publication date. 

This report was prepared by Rachel Bailey, Ju-Hyeong Park, Rena 

Saito, Kathleen Kreiss, and Jean Cox-Ganser of the Division of 

Respiratory Disease Studies. Field assistance was provided by 

Michael Beaty, David Spainhour, Eva Suarthana, and Sandra 

White. Database management was provided by Nicole Edwards 

and Brian Tift. Analytical support was provided by Nicole 

Edwards, Kathy Fedan, and Brian Tift. Desktop publishing was 

performed by Tia McClelland. 

Copies of this report have been sent to representatives at the school 

district, elementary school, local parent teacher association, county 

health department, and OSHA Regional Office. This report is 

Health Hazard Evaluation Report 2009-0172-3124 Page 311 
 

 

ACKnowLedGeMents And 

AvAiLABiLity oF RepoRt 

(Continued)	 not copyrighted and may be freely reproduced. The report may be 

viewed and printed from the following internet address: http:// 

www.cdc.gov/niosh/hhe. Copies may be purchased from the 

National Technical Information Service at 5825 Port Royal Road, 

Springfield, Virginia 22161. Information regarding the NTIS stock 

number may be obtained from the NIOSH Publications Office at 

the Cincinnati address. 

Page 312	 Health Hazard Evaluation Report 2009-0172-3124 
Below is a recommended citation for this report: 

NIOSH [2011]. Health Hazard Evaluation Report: Evaluation of dampnessassociated respiratory symptoms with relocation of staff during remediation of an 

elementary school, North Carolina. Cincinnati, OH: U.S. Department of Health 

and Human Services, Public Health Service, Centers for Disease Control and 

Prevention, National Institutute for Occupational Safety and Health, NIOSH HETA 

No. 2009-0172-3124. 

To receive NIOSH documents or information about 

occupational safety and health topics 

1-800-35-NIOSH

Fax: 1-513-533-8573 

E-mail: pubstaft@cdc.gov 

or visit the NIOSH web site at: 

http://www.cdc.gov/niosh/hhe 

Delivering on the Nation’s promise: 

Safety and health at work for all people 

through research and prevention.

 National Institute for Occupational 

Safety and Health 

contact NIOSH at: 

(1-800-356-4674)