________________________________________________________________________________


What type of equipment is being used in the room (Define equipment traffic?).
_____________________________________________________________________________________

What number of people are working in the cleanroom at one time?________________________________

How often will people be entering or exiting the cleanroom (frequency per day?).
Seldom (1-3 times per day)
Moderate (4-8 times per day)
Often (9 or more times per day)

What is the occupancy rating of this area? (F1, H6, H3, etc.)

List any flammable or hazardous materials being used or stored in the cleanroom?
_____________________________________________________________________________________

_____________________________________________________________________________________

Do you have a need for explosion proof HEPAs or lights? If so, what Class and Division?
_____________________________________________________________________________________


CLEANROOM DESIGN CRITERIA:

Overall Cleanroom Size: __________ (W) x __________ (L) x __________ (H) (inside dimensions)
Ext./Interior Gown Area: __________ (W) x __________ (L) x __________ (H) (inside dimensions)

Exterior Room Walls:
__________ (W) x __________ (H)
(Type) _____________________
Exterior Curtains:
__________ (W) x __________ (H)
(Type) ______________________

Interior Separating Walls: __________ (W) x __________ (H)
(Type) _____________________
Interior Curtains:
__________ (W) x __________ (H)
(Type) ______________________

Number of Single Doors: ___________
Type: Hinged, latching, locking, or push/pull
Number of Double Doors: ___________
Type: Hinged, latching, locking, or push/pull

Type of Rigidpanel inset: (Sentra Panel)

(Clear Polycarbonate)
(Polypropylene) (Other)
(White
honeycomb)
(Black
honeycomb)
(Foam
Board)

Viewing windows:
(Tempered Glass)
(Clear Polycarbonate)
(UV laminated)
Nominal window size:
________ (W) x ________ (H)
How many Linear Feet? ______________ What is the distance (AFF)?_________________



CleanAir Solutions, Inc.

Needs Analysis Worksheet



CLEANROOM ENVIRONMENT:

Air Classification Requirement (circle):

Gown Room:
Class 100K
Class 10K
Class 1K
Class 100
Class 10/1
Cleanroom:
Class 100K
Class 10K
Class 1K
Class 100
Class 10/1

Type of Air Flow Required (circle):


Direction of Air Flow (circle):

Gown Room: Re-circulating Single
Pass

Gown Room: Vertical Horizontal
Cleanroom: Re-circulating
Single
Pass
Cleanroom: Vertical Horizontal

Lighting Level Requirements:


Typically designed at 100 ft. candles at work
surface.

Special Lighting Requirements (circle):
UV lighting Flow Thru Teardrop Elect.T-8 Ballast



FACILITY INTEGRATION:

HVAC Requirement:


YES NO

Cleanroom Temperature Requirement:

__________�F
(+/-) __________�F
Typical Ambient Temperature Range:
(Min.) __________�F
(Max.) __________�F

Relative Humidity Requirement:

__________%RH
(+/-)
__________%
Typical Ambient Humidity Range:

__________%RH
(+/-)
__________%

Cooling System Requirements (circle):
Air Cooled
Water Cooled


Is chilled water available?

YES
NO

Location of HVAC unit:

Roof
Floor
Other________________



Distance from Cleanroom:______________Linear Feet.


Fire Protection Requirements:


YES NO

Number of Sprinkler Heads Required Per Code:
(Qty)__________

Is there an ACTIVE Sprinkler line available near the cleanroom:
YES
NO

What is the size of the existing ACTIVE city water line?

1
1 �
2
3

Does the existing active line need to be resized?
YES NO What
size?_______________




CleanAir Solutions, Inc.

Needs Analysis Worksheet




Flooring Requirements:


YES NO

What is the customers existing floor (circle): Concrete
VCT Tile
Rug
Vinyl

What are the necessary flooring preparations: Demolition ____ Floating____ Moisture Test____
(check all that apply)

What type of new flooring (circle):
Epoxy Paint Seamless Vinyl Raised (tile or grated)


Electrical Requirements:


YES NO

Central On/Off control switch panel
YES
NO


Hardwire fan filters and lights

YES
NO
Voltage
of
filters
(circle)


120V 220V 277V DC
Voltage of lights (circle)

115V
277V

Number of 110V duplex outlets

____
Number of 220V outlets

____
Number other outlets (type______ )
____

Molding strip required


YES
NO
If yes, how many feet between outlets
____
List any other special electrical needs:
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
___


Process Piping Requirements:


YES NO

What type of pipe (circle preference): Stainless
Steel
Copper
PVC
Nitrogen Air Requirements:

# of Stubs_______
# of Valves________
CDA Requirements:


# of Stubs_______
# of Valves________
Drain
Requirements:
#
of
Drains_______
Type:_____________
Waste Disposal Requirements:_______________________________________________

Type of Valves or Fittings:
___________________________________________________________







CleanAir Solutions, Inc.

Needs Analysis Worksheet

CERTIFICATION/CLEANING:

Micro-Cleaning Service

YES NO

Floor Scrubbing


YES NO
Floor
Waxing

YES NO
Filter
vacuum

YES NO

Equipment wipe-down

YES NO



Certification Testing:

YES NO

Per Federal Standards 209E
YES NO
Per ISO Standards 14004

YES NO
Pressurization


YES NO

Velocity
YES NO
Particles
YES NO
Leak
Scanning

YES NO
Air
Balancing

YES NO
Fogging
Test

YES NO
Video Documentation

YES NO

ACCESSORIES:

Tables / Work surfaces (state size and circle preference):

Size:______________________ Perforated / Solid
Stainless / Formica
Undershelf
Size:______________________ Perforated / Solid
Stainless / Formica
Undershelf
Size:______________________ Perforated / Solid
Stainless / Formica
Undershelf

Benches (state size and circle preference):

Size:______________________ Tubular / Solid
Stainless / Chrome
Foot Levelers
Size:______________________ Tubular / Solid
Stainless / Chrome
Foot Levelers

Pass-Thrus (state size and circle preference):

Size:______________________ PVC / Formica
Interlock
(manual / auto)
Fire
Rated
Size:______________________ PVC / Formica
Interlock
(manual / auto)
Fire
Rated








CleanAir Solutions, Inc.

Needs Analysis Worksheet

SITE PLANNER:


Job site location:

Floor #________
Bldg. #_________



Building Type:

One Story______
Two Story______

Equipment Available:
Elevator
Scissor Lift
Fork Lift
Ladder _______H.

Is electrical service available at job-site?
YES NO
Volts_____ Phase_____ Amps_____

Building Permits Required?

YES NO

Wet-stamped Drawings & Calculations?
YES NO

Are Existing Building Plans Available?
YES NO





Sketch Cleanroom Layout


North










































































































































































































South





CleanAir Solutions, Inc.

Needs Analysis Worksheet


Other Useful Information:

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