This presentation includes a step by step process in how to conduct a Healthy Homes inspection and recommend corrective actions. It will instruct participants in how to recognize “red flags” that cause unhealthy housing conditions including lead dust and paint, asthma triggers, moisture intrusion, radon, asbestos, insect and rodent infestation, and poor indoor air quality.

1. GOOD Afternoon & Welcome!
Wednesday, December 12, 2012 (1:00 p.m. to 4:45 p.m.)
Healthy Housing Inspection and Remediation Techniques
 This session will include a step by step process in how to
conduct a Healthy Homes inspection and recommend
corrective actions.
 It will instruct participants in how to recognize “red flags”
that cause unhealthy housing conditions including lead dust
and paint, asthma triggers, moisture intrusion, radon,
asbestos, insect and rodent infestation, and poor indoor air
quality.

2. Healthy Homes
1. History/Evolution
2. Concept/Theory/Definition
3. Primary components (Step by Step)
A. Questionnaire
B. Visual Assessment
1) (Red flags)
a) Lead dust and paint
b) Asthma triggers
c) Moisture intrusion
d) Radon
e) Asbestos,
f) Insect and rodent infestation
g) Poor indoor air quality.
4. Remediation options/tech.
5. Summarize HH Process

3. History/Evolution
• 1938, American Public Health Association (APHA)
formulated Basic Principles of Healthful Housing to
promote the “physical, mental and social health” in & of
housing.
• Established 30 Principles
– Physiological Needs (8)
– Psychological Needs (7)
– Protection against Contagion(8)
– Protection against Accidents (7)
• identified Specific Requirements
• Methods of Attainment

4. History/Evolution
1. U.K. used the Principals as a foundational
document in the development of a HH rating
system. (Newark RFP)
2. CDC modeled its original basic housing
inspection manual after the principals
3. U.S. has endorsed these principals in the
“Healthy Housing Reference Manual” (HH
Manual).

5. ACTUAL BIDS SUBMITTED Year 1 Year 2
Company A $845.00 $875.00
LEW Corp $2,975.00 $2,874.00
Company B $650.00 $650.00
Company C $7,550.00 $7,550.00
Company D $395.00 $385.00

6. History/Evolution

7. 7 Principals of Modern
Healthy Homes
1. Dry: Damp houses provide a nurturing environment for mites, roaches, rodents, and molds,
all of which are associated with asthma.
2. Clean: Clean homes help reduce pest infestations and exposure to contaminants.
3. Pest-Free: Recent studies show a causal relationship between exposure to mice and
cockroaches and asthma episodes in children; yet inappropriate treatment for pest
infestations can exacerbate health problems, since pesticide residues in homes pose risks for
neurological damage and cancer.
4. Safe: The majority of injuries among children occur in the home. Falls are the most frequent
cause of residential injuries to children, followed by injuries from objects in the home, burns,
and poisonings.
5. Contaminant-Free: Chemical exposures include lead, radon, pesticides, volatile organic
compounds, and environmental tobacco smoke. Exposures to asbestos particles, radon gas,
carbon monoxide, and second-hand tobacco smoke are far higher indoors than outside.
6. Ventilated: Studies show that increasing the fresh air supply in a home improves respiratory
health.
7. Maintained: Poorly-maintained homes are at risk for moisture and pest problems.
Deteriorated lead-based paint in older housing is the primary cause of lead poisoning, which
affects some 240,000 U.S. children.

8. History/Evolution
• These documents & the basic “Key Principals’
of modern Healthy Housing associate with;
1. Dryness 2. Cleanliness
3. Proper Ventilation 4. Pest Free
5. Contaminants avoidance 6. Well Maintained
7. Safe !!!

9. Current Initiative for HH
• U.S. initiatives related to healthy homes were created to
develop a holistic approach to healthy housing based on the
following broad objectives:
ho·lis·tic
/hoʊˈlɪs tɪk/ Show Spelled [hoh-lis-tik] Show IPA
adjective 1. incorporating the concept of holism in theory or practice: holistic psychology.
ho·lism
/ˈhoʊ lɪz əm/ Show Spelled [hoh-liz-uh m] Show IPA
noun, Philosophy . 1. the theory that whole entities, as fundamental components of reality, have an existence other than as the
mere sum of their parts. Compare organicism ( def 1 ) .
2. Also, holiatry. Medicine/Medical . care of the entire patient in all aspects.

10. Develop national healthy homes capacity through cross disciplinary grants,
contracts, and other activities at the federal, state, tribal, and community levels
that research and demonstrate low-cost, effective home hazard assessment and
intervention methods.
Develop effective education and outreach materials, with a particular focus
on high-risk populations, to increase public awareness of residential hazards
and highlight effective actions households can take to reduce the risk for illness
and injury.
Broaden the scope of single-issue public health and safety programs—such as
childhood lead poisoning prevention, residential asthma intervention, injury
prevention— to adopt a holistic approach addressing multiple housing
deficiencies that affect health and safety.
Build competency among environmental public health practitioners, public
health nurses, housing specialists, housing owners, housing managers, and
others who work in the community so they can incorporate healthy housing
activities into their professional activities.
Holistic Approaches - Broad Objective

11. Primary Components
of a HH Evaluation
1. Resident Questionnaire
2. Visual Assessment
Sub Components of both
LEAD PAINT & DUST ASTHMA TRIGGERS
MOISTURE INTRUSION RADON
ASBESTOS INSECT & RODENTS
IN-DOOR AIR QUALITY + PLUS + PLUS + PLUS

12. Resident questionnaire
Questions about
? Housing
Characteristics
? In-door
pollutants
? Home safety
? Health
Assessment data
(voluntary)
Healthy Homes Model Résident
Questionnaire
Information from questionnaire
responses can provide important
clues that point to housing
deficiencies.
The Healthy Homes Model
Resident Questionnaire is a tool
that can be adapted by local
jurisdictions to meet their specific
needs.

13. Healthy Homes Model Résident Questionnaire
WAS QUESTIONNAIRE ADMINISTERED?
? Q:Yes or No Q:Why not:
? Q:Vacant Date:
? Name of Questionnaire Administrator:
? Building and/or Unit Address: _____
City, State, Zip:
? No. of persons living in unit:
? No. of children:
? Age of children living in unit:
? Unit status Q:Occupied or Vacant

15. Healthy Homes Model Résident Questionnaire
• Voluntary Health Assessment Data
– 1st ? – have U or others Incurred these cond.
When in the house w/in <12months
– 2nd ? Any symptoms worsen when in unit, better
when leaving?
 Allergies
 Eye Irritation
 Doc. diag. Asthma or Symptoms: cough, wheezing, shortness breath, chest
tightness, Phlegm w/o cold
 Headaches
 Hay fever
 Chronic Bronchitis
 Respiratory Disease
 Sinus Problems
 Ear Infections
 Skin infection/rash
•Injuries
•Poisonings
•Others issues

16. Visual Assessment
IMPORTANT NOTE: The visual assessment should be used to
collect information that can be determined without asking
questions of a resident. (YOUR OWN SITE RECONASSANCE)
 Site: Fencing, Gates, Grounds/pavements, Play areas, Other()
 Building Exterior: Doors, fire escapes, foundations, lighting, roofs, walls,
windows
 Building Systems: Electrical Sys. , Fire Protection, HVAC
 Common Areas: Elevators, signage, smoking area, interior trash, Outlets-
Switches-Cover Plates, Smoke & Carbon Monoxide detectors,
Walkways/steps, Ceiling, Floors
 Housing Unit: Bathroom, Ceiling-floors-walls, Doors, Electrical, Water
Heater, HVAC System, Kitchen, laundry, Lighting, Patio-Porch-Deck-
Balcony, Smoke-Carbon Monoxide, Stairs, Windows
 Other: Garbage& Debris, Injury Hazards, Childproofing, Poisoning, Pest
hazards, Moisture hazards, Swimming pool-spa-whirlpool, Other……

17. “Red Flag” Sub-Components of Both: Lead dust and paint
Questionnaire:
•Age of Property (1978)
•Children reside in Property
•Overall attitude of Maintenance
•Pregnant or to-be
•Nearby Industrial applications
•Paint condition (impact & Friction)
•Cleaning Habits
Visual:
•Paint Cond.
•Children's/Pregnant belongings
•Overall Cleanliness
•Cleaning supplies (HEPA vac)
Corrective Action:
•Presumption vs. Testing
•(Lab, XRF, Chemical)
•Interim Controls (<20yr, Interim)
•Abatement (20yr.-permanent )

18. Lead in Paint, Dust, and Soil
Why Do You Need to Be Concerned About Lead?
• Lead is a toxic metal that was used for many years in products
found in and around our homes. Lead also can be emitted into
the air from motor vehicles and industrial sources, and lead
can enter drinking water from plumbing materials. Lead may
cause a range of health effects, from behavioral problems and
learning disabilities, to seizures and death. Children six years
old and under are most at risk.
• Most Common Sources of Lead Poisoning:
• Deteriorating lead-based paint
• Lead contaminated dust
• Lead contaminated residential soil

19. “Red Flag” Sub-Components of Both: Asthma triggers
• Questionnaire: are you aware of
• Cockroaches-Pest free clean dry maintained (keep its)
• Rodents – Pest free maintained dry clean
• Mold – dry maintained clean ventilated (keep its)(this
list of ?’s is more extensive).
• Nitrogen Oxides – (combustion appliances) Ventilated
maintained
• Visual:
• Inside, above, behind … walls, ceilings, floors
• Exterior
• Moisture damage, water staining
• Cockroach/rodent droppings, nesting, fur

20. Spores
(conidia)
HyphaeCommon
household
roaches
A) German
cockroach
B) American
cockroach
C) Australian
cockroach
D&E) Oriental
cockroach

21. “Red Flag” Sub-Components of Both: Moisture intrusion
Questionnaire:
•Are you aware of Moisture intrusion
•Have there been any leaks, floods
•Smell Musty/Moldy
•Does any feel ?
Visual:
•Do you see any water staining
•Do you see any mold
•Are there missing/broken/short/clogged draining
pipes
Corrective Action:
•Find Moisture source
•Correct Moisture source
•Appropriately clean/wipe affected area
•Dry/Encapsulate/entomb
•Tape lift/swab/air sampling

22. “Red Flag” Sub-Components of Both: Moisture intrusion

24. How to Test Air
Biotest RCS Sampler

25. Anderson Impactor
How to Test Air
EMLAB - BioCassette

26. How to Test Air

27. Surface Sampling
Tape Sample

28. Surface Sampling
Swab Sample

29. How to Remediate Mold Contamination
• Guidance documents:
– IICRC: S520, Standard Reference Guide for Professional
Mold Remediation
– AIHA: Recognition, Evaluation, and Control of Indoor
Mold
– USNAVY: Remediation Wheel
– NYCDHMH: Guidelines on Assessment and
Remediation of Fungi in Indoor Environments

30. US Navy Remediation Wheel
http://www-nehc.med.navy.mil/IH/images/MR_wheel.gif

31. REMEDIATION
•Find Source of
Moisture
•Cure Source
•Wash area
•HEPA Vacuum
•Remove & Replace

32. “Red Flag” Sub-Components of Both: Radon
Questionnaire:
• Type of House Construction (slab, basement, crawl-
space)
• Is there a radon system in place
• Lowest Livable area used by family
• Radon History (area or actual prev. results)
• French drain, sump pump, cracks ?
Visual:
• Lowest room frequented by family members
• is there a French drain, sump pump, cracks in
foundation/walls.
• Ventilation
Corrective Action:
• Test-Charcoal Canister, Gas Continuous Monitor (4pcu-
action level)
• Improve Ventilation (fans on timers, open windows)
• Install a Radon remediation system (active of passive)

33. Radon - Chemical Symbol
Element Number: Rn222
Radon is a cancer-
causing radioactive
gas.
You cannot see, smell
or taste radon but it
may be a problem
The Surgeon General
has warned that radon
is the second leading
cause of lung cancer in
the United States
today.
Radon's primary hazard is
caused from inhalation of the
gas and its highly radioactive
heavy metallic decay products
(Polonium, Lead, and Bismuth)

34. How it gets into schools and homes

35. NJ/PA = RED has showed 20%
& greater have elevated radon
levels

36. Corrective Action – Remediation

37. Radon little issues
• Gas looks for path of least resistance
– Rainy day – inside levels go up
– Snow and ice – inside levels go up
– Hot dry season – inside levels go down
• Seal off slab or floor openings
• Seal off pump openings
• Ventilation is key – fans/pump on timers
• Air circulation

38. Sub-Components of Both: Asbestos
Questionnaire:
•Age of Property (1978)
Visual:
Corrective Action:

39. Friable vs. non-friable
Asbestos: What's the Dangerous Difference?
The legal definitions of "friable" and "non-friable" asbestos clearly depicts the
differences between dangerous and safe asbestos-containing materials (ACMs).
Friable ACM is any material that contains more than one percent asbestos by weight
or area, depending on whether it is a bulk or sheet material and can be crumbled,
pulverized, or reduced to powder by the pressure of an ordinary human hand.
•Non-friable ACM is any material that contains more than one percent asbestos, but
cannot be pulverized under hand pressure.

40. • Materials are slightly more confusing within the classification of non-
friable ACM:
• Category I non-friable includes asbestos packings, gaskets, resilient floor
covering, and asphalt roofing products.
• Category II is any non-friable ACM not included in Category I.
• The difference is which non-friable asbestos materials are "Regulated
Asbestos Containing Materials" (RACMs). The legal definition covers:
– All friable ACMs,
– Including category I non-friable asbestos materials that have become friable as
the other materials in them have broken down with age and weather.
– Category I non-friable asbestos materials that will be, or have been, subjected
to sanding, grinding, cutting, or abrading.
– Category II non-friable asbestos materials that have a high probability of
becoming or have become crumbled, pulverized, or powdered by the forces
expected to act on the material in the course of demolition or renovation
operations.
• Any asbestos-containing material can become friable and fall under
federal regulation.

41. How to identify & where
can it be Found
• Fireproofing material
• Sprayed on steel beams
• Concrete and concrete like products
• Cement products
• Siding
• Roofing shingles
• Wallboard
• Cladding
• Partitions
• Piping
• Asphalt products
• Vinyl products
• Floor tile
• Joint Compounds
• Adhesives
• Acoustical plaster
• Pipe insulation & packing
Asbestos has been
used in literally
hundreds of
products.
Collectively, these
are frequently
referred to as
asbestos-containing
material (ACM).

42. Cement Pipes
Elevator Brake Shoes
Cement Wallboard
HVAC Duct Insulation
Cement Siding
Boiler Insulation
Asphalt Floor Tile
Breeching Insulation
Vinyl Floor Tile
Ductwork Flexible Fabric Connections
Vinyl Sheet Flooring
Cooling Towers
Flooring Backing
Pipe Insulation (corrugated air-cell, block,
etc.)
Construction Mastics (floor tile, carpet,
ceiling tile, etc.)
Heating and Electrical Ducts
Acoustical Plaster
Electrical Panel Partitions
Decorative Plaster
Electrical Cloth
Textured Piants/Coatings
Electric Wiring Insulation
Ceiling Tiles and Lay-in Panels
Chalkboards
Spray-Applied Insulation
Roofing Shingles
Blown-in Insulation
Roofing Felt
Fireproofing Materials
Base Flashing
Taping Compounds (thermal)
Thermal Paper Products
Packing Materials (for wall/floor
penetrations)
Fire Doors
High Temperature Gaskets
Caulking/Putties
Laboratory Hoods/Table Tops
Adhesives
Laboratory Gloves
Wallboard
Fire Blankets
Joint Compounds
Fire Curtains
Vinyl Wall Coverings
Elevator Equipment Panels
Spackling Compounds
Where can it be found? (Cont.)

43. Sub-Components of Both: Insect and rodent infestation,
Dion Lerman will cover

44. Sub-Components of Both: Poor indoor air quality.
• Questionnaire:
• Visual:
• Corrective Action:

45. • Oil – UST, AST, VOC
• Not a healthy
neighborhood!

46. Healthy Homes Specialist
Credential
NCHH and the National Environmental Health Association (NEHA) offer a
“Healthy Homes Specialist” credential, designed for health and housing
professionals in the public, private, and nonprofit sectors.
To achieve the credential, must complete a comprehensive exam on the
seven principles of healthy housing, which include keeping homes: Dry,
Clean, Pest-Free, Contaminant-Free, Ventilated, Safe, and Maintained.
Individuals seeking the Healthy Homes Specialist credential must:
– Be at least 21 years of age;
– Have five years of experience in housing, environmental health, or
public health;
– Achieve a minimum score of 70% on the qualifying examination; and
– Successfully complete an online home assessment exercise.

47. • You may apply for the HHS credential by
completing an application.
• For more information go to
www.neha.org/credential/HHS.
• Cost of applying for and taking the HHS exam is
$150 NEHA members or $205 non-members.
• Credentialing Staff at 303.756.9090 x339.
Healthy Homes Specialist Credentialing

48. Healthy Homes Specialist Credential References
• Study Guide [PDF]
Contaminant Guide [PDF]
Healthy Homes Reference Manual by U.S. Centers for Disease Control and Prevention and U.S. Department of Health and
Urban Development (2006) (236 pages - 14 MB) [PDF]
Chapter 1 Housing History and Purpose (8 pages - 0.5 MB) [PDF]
Chapter 2 Basic Principles of Healthy Housing (11 pages - 0.5 MB) [PDF]
Chapter 3 Housing Regulations (13 pages - 0.5 MB) [PDF]
Chapter 4 Disease Vectors and Pests (18 pages - 1.8 MB) [PDF]
Chapter 5 Indoor Air Pollutants and Toxic Materials (23 pages - 1.1 MB) [PDF]
Chapter 6 Housing Structure (22 pages - 1.9 MB) [PDF]
Chapter 7 Environmental Barriers (7 pages - 1.2 MB) [PDF]
Chapter 8 Rural Water Supplies and Water Quality Issues (12 pages - 1.2 MB) [PDF]
Chapter 9 Plumbing (16 pages - 1.0 MB) [PDF]
Chapter 10 On-Site Wastewater Treatment (12 pages - 1.0 MB) [PDF]
Chapter 11 Electricity (17 pages - 1.3 MB) [PDF]
Chapter 12 Heating, Air Conditioning, and Ventilating (20 pages - 1.2 MB) [PDF]
Chapter 13 Energy Efficiency (12 pages - 0.7 MB) [PDF]
Chapter 14 Residential Swimming Pools and Spas (12 pages - 0.8 MB) [PDF]
Connections Between Health and Housing [PDF]
Laws, Rules and Codes for Healthier Housing [PDF]
Healthy Homes Assessment Tools [PDF]
General Resources and References [PDF]
Guidance on Integrated Pest Management - U.S. Department of Housing and Urban Development (2007) [PDF]
Selected Photos

49. Summarize Healthy Homes Process
• Interview Questionnaire
• Visual site inspection
– Focus on contaminants
• Especially “Red Flags”
• Combine Questionnaire data with Visual
observations
• Assessment areas of potential concern
• Recommend corrective action or additional
follow up
• Provide report of findings

50. Interactive Exercise
1. Distribute Exercise Questionnaire
2. Have complete with neighbor acting as
owner
3. Review pictures on overhead
4. Complete Visual field forms
5. Summarize Assessment

52. 7/24/2015