Homepage Fill in Your Florida Dh 1777 Form
Article Map

The Florida DH 1777 form is a crucial document for ensuring the safety and health of nonresidential buildings in the state. This form is specifically designed for facilities other than single or multi-family dwellings, such as hospitals, schools, and assisted living facilities. It requires detailed information about the facility and its owner, including the facility's name, physical location, and contact details. Additionally, the form collects data on the building's characteristics, such as its age, foundation type, and HVAC system. The DH 1777 also mandates the reporting of radon measurement results, which are essential for identifying potential health risks associated with radon exposure. The form includes sections for recording the type of measurements taken, the dates of those measurements, and the credentials of the individuals or businesses conducting the testing. Completing this form accurately and submitting it to the Department of Health is not just a regulatory requirement; it is a vital step in safeguarding public health. Timely submission can prevent serious health issues related to radon exposure, making it imperative for facility owners and operators to prioritize this task.

Documents used along the form

The Florida DH 1777 form is essential for reporting radon measurements in nonresidential buildings. Alongside this form, several other documents may be required to ensure compliance with state regulations and to provide comprehensive information regarding radon testing and mitigation. Below is a list of commonly used forms and documents that complement the DH 1777.

  • Florida DH 1765: This form is used to report radon testing results for single-family homes. It provides a standardized way to submit measurement data and is crucial for residential properties.
  • Florida DH 1766: This document is utilized for radon mitigation system installation. It outlines the necessary steps and requirements for effectively reducing radon levels in a building.
  • Radon Measurement Business Certification: This certification is required for businesses that conduct radon measurements. It ensures that the business meets state standards and employs qualified personnel.
  • Radon Mitigation Business Certification: Similar to the measurement certification, this document certifies businesses that install radon mitigation systems. Compliance with state regulations is essential for these companies.
  • Radon Measurement Device Log: This log tracks the devices used for radon measurement, including their calibration and maintenance history. It is important for ensuring accurate results.
  • Radon Testing Protocol: This protocol outlines the procedures for conducting radon tests. It includes guidelines for placement, duration, and conditions necessary for accurate measurements.
  • Radon Awareness Information: This document provides educational materials about radon, its health risks, and the importance of testing. It is often distributed to facility owners and occupants.
  • Facility Owner Certification: This certification is signed by the facility owner, confirming that they understand their responsibilities regarding radon testing and mitigation.
  • Radon Measurement Report: This report summarizes the findings of the radon tests conducted. It includes results, dates, and any follow-up actions required.

Understanding these documents can help ensure compliance with Florida's radon regulations. Proper documentation supports transparency and safety in managing radon levels in nonresidential buildings.

Similar forms

The Florida DH 1777 form is similar to the Environmental Protection Agency (EPA) Radon Measurement Report. Both documents serve the purpose of documenting radon measurement results in various types of buildings. They require detailed information about the facility, including its name, location, and owner, as well as specifics about the measurement process and results. The EPA report also emphasizes compliance with federal standards, similar to how the DH 1777 adheres to Florida regulations. Both forms aim to ensure that radon levels are monitored and reported accurately to protect public health.

Another document that resembles the Florida DH 1777 is the State of California Radon Measurement Report. Like the DH 1777, this report collects essential facility and owner information while documenting radon measurement results. Both forms require the identification of the type of building being tested and the methods used for measurement. The California report, much like the Florida form, is designed to ensure that radon testing is performed in accordance with state regulations, promoting transparency and safety for the occupants of the buildings.

The New Jersey Radon Testing Report also shares similarities with the Florida DH 1777. Both documents are intended for nonresidential buildings and require comprehensive information about the facility and the radon measurement process. They both include sections for documenting the dates of measurement and the results obtained. Furthermore, both reports require certification from the individual or business conducting the measurements, ensuring accountability and adherence to state standards.

The Massachusetts Radon Measurement Report is another document that parallels the Florida DH 1777. This report, like the DH 1777, collects detailed information about the building and the radon testing performed. Both documents require the same kind of data regarding the facility type, measurement methods, and results. Additionally, both forms emphasize the importance of compliance with state regulations, thereby safeguarding the health of individuals in the tested environments.

Lastly, the Minnesota Radon Measurement Report is similar to the Florida DH 1777 in its structure and purpose. Both forms gather information about the facility and the radon measurement process. They require details about the testing conditions and results, ensuring a thorough record is kept. Both documents are also designed to meet state regulatory requirements, reinforcing the commitment to monitoring radon levels in various types of buildings to protect public health.

Obtain Answers on Florida Dh 1777

  1. What is the purpose of the Florida DH 1777 form?

    The Florida DH 1777 form is used to report radon measurements for nonresidential buildings. This includes facilities such as hospitals, nursing homes, and schools. The form collects essential information about the facility, the measurements taken, and the results. It ensures compliance with state regulations regarding radon exposure, which is crucial for the health and safety of occupants.

  2. Who needs to fill out the DH 1777 form?

    Any nonresidential facility that conducts radon measurements must complete the DH 1777 form. This includes various types of buildings, such as assisted living facilities, correctional facilities, and public or private schools. If multiple facilities are located at the same site, each one must be reported separately. The form should be filled out by an authorized representative of the facility or a certified radon measurement specialist.

  3. How do I submit the DH 1777 form?

    Once the DH 1777 form is completed, it should be sent to the Department of Health, specifically the Bureau of Environmental Health Radon Program. You can mail the form to the address provided on the form: 4052 Bald Cypress Way, Bin #A12, Tallahassee, FL 32399-1720. Alternatively, you may scan the completed report and email it to RadonReports@FLhealth.gov.

  4. What information is required on the DH 1777 form?

    The form requires detailed information about the facility, including the facility name, physical address, and owner details. It also asks for specifics about the building, such as its age, type of foundation, and HVAC system. Additionally, the form collects data on the radon measurements taken, including the dates, results, and the person or business that conducted the measurements. Accurate and complete information is essential for effective reporting and compliance.

Document Preview

Bureau of Environmental Health

Radon Program

Mandatory Measurements

NONRESIDENTIAL RADON MEASUREMENT REPORT

FOR BUILDINGS OTHER THAN SINGLE OR MULTI FAMILY DWELLING

Page ___ of ___

SECTION 1: FACILITY AND OWNER INFORMATION

Facility Information:

Owner Information:

Facility Name (as licensed, registered, or listed with state)

Physical location (Street Address) of Facility Site

City

County

Zip

Name of Contact Person

Name of Owner

Street Address

City

State

Zip

()

Phone Number

()

TitlePhone Number

Facility type as licensed or registered (Submit individual facilities separate. I.E. A Day Care and School at the same place):

Assisted Living Facility (previously ACLF)

Hospitals (Acute Care, Physical Rehab., Psychiatric, or Intensive

Alcohol, Drug Abuse or Mental Health

Residential Treatment)

Correctional Facility or Jail

Nursing Home/Skilled Nursing Facility

Day Care Center (pre kindergarden)

Public School (K-12)

Delinquency Program (Ex: Start Center, Training School)

Private School (K-12)

OTHER (specify)

 

 

 

 

 

 

 

 

 

 

SECTION 2: BUILDING INFORMATION

Building Name or ID Number (If Applicable)Street Address of Building (If Different From Facility Site)

Buildings per address ___; Building No. ___ of ___ requiring testing.

Number of measurements required in this building during this testing period: ______ initial or 5 year retest, ______ follow-up

Cumulative number of measurements reported for this testing period: ______ initial or 5 year retest, ______ follow-up

____ No. of Stories, ____ No. of Stories Occupied, ________ Age of Building in Years (or year built)

Foundation/Floor

System:

Slab

Crawlspace

Pier

Floored Basement

Bare Earth Basement

Other(specify)

 

CHECK ALL THAT APPLY

 

HVAC System:

 

 

HVAC:

Non-ventilating HAC:

Other HVAC:

(system with fresh air intake)

(system without fresh air intake)

Window/Wall Unit

Single Zone / single

Central Ducted A/C

No A/C

return

Central Ducted

No Heat

Multiple Zones /

Heat

Other (specify)

multiple returns

Space Heater

 

 

 

 

 

For Official Use Only:

 

Date

Reviewed

Entered

 

 

Received

By

By

 

 

 

 

 

 

DH 1777, Edition 7/15 (Replaces Jan 93 Edition)

 

 

 

 

 

 

 

SECTION 3: RESULTS

 

 

 

 

Measurement Type: Initial or 5 Year Retest, Follow-up

 

 

 

 

Dates of Measurement: FROM

/ /

 

TO

/ /

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name of Person who performed Measurement (Placed Device)

 

 

 

Certificate No. (If Applicable)

 

 

 

 

 

 

 

 

 

 

 

 

 

Story

 

Room

Result

 

Units

 

Device

 

 

Time in Hours

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

P for pCi/L or W for WL

AC-Activated Carbon Adsorption, AT-Alpha Track, CR-Continuous Radon Monitor, CW-Continuous Working Level Monitor, EL-Electret Ion Chamber Long Term, ES-Electret Ion Chamber Short Term, LS- Liquid Scintillation, RP-RPISU, UT-Unfiltered Alpha Track

SECTION 4

COMPLETE ONLY IF MEASUREMENTS ARE PERFORMED BY A RADON MEASUREMENT BUSINESS

Name of Business and Cert. No.

Name of Specialist and Cert. No.

Signature of Specialist

SECTION 5

COMPLETE ONLY IF MEASUREMENTS ARE PERFORMED BY STAFF EMPLOYED BY THE FACILITY

I hereby certify that the Radon measurements reported herein have been performed in accordance with Chapter 64E-5, Florida Administrative Code, and Chapter 404, Florida Statutes.

Authorized Representative of Facility

 

Date

Upon completion of this form, send to:

Department of Health

Bureau of Environmental Health / Radon Program

4052 Bald Cypress Way, Bin #A12

Tallahassee, FL 32399-1720

You may scan the report and email it to RadonReports@FLhealth.gov

For Assistance in Completing this Form call 1-800-543-8279

Dos and Don'ts

When filling out the Florida DH 1777 form, there are several important dos and don’ts to keep in mind. Here’s a clear guide to help you navigate the process smoothly.

  • Do ensure that all facility and owner information is accurate and complete.
  • Do specify the type of facility correctly, as this impacts testing requirements.
  • Do provide clear contact information for the person responsible for the measurements.
  • Do indicate the building's age and type of foundation accurately.
  • Don't leave any sections blank; incomplete forms can lead to delays.
  • Don't forget to sign and date the form if you are the authorized representative.
  • Don't submit the form without verifying that all measurements and results are reported correctly.