Carbon Monoxide is an odorless,
tasteless, colorless gas that is DEADLY. It is a by-product of a fuel burning
process. It can cause symptoms that can mimic flu, unconsciousness and
even death. Many appliances around the home are capable of producing Carbon
Monoxide when a faulty or unusual condition exists. Since the source
may be transient in nature, the source may not always be detectable.
The Tupelo Fire Department
responded to investigate a possible Carbon Monoxide problem at:
(Time)_________ (Location)______________________________,
on (Date)_____________
Carbon Monoxide ( ) was (
)was not found by our instruments. This does not mean that this was a false
alarm. Our instruments found the highest level of CO to be________ PPM(parts
per million).
9 PPM or less: Our instruments
did not detect elevated levels at this time. However, this does
not mean that higher levels did not exist prior to our arrival nor that
higher levels will not accumulate after our departure. Check your carbon
monoxide detector per the manufacturer's recommendations. Call the manufacturer
for additional information (number may be on the back of the unit). Replace
or reset detector as directed by the manufacturer's specifications.
More than 9 PPM: Our instruments
have detected potentially dangerous levels of carbon monoxide. We recommend
that you leave this building immediately. We feel that it is unsafe to
re-occupy this building until repairs are made and your detector is replaced
or reset according to the manufacturer's specifications.
35 PPM: Maximum allowable
concentration for continuous exposure in any 8 hour period according to
OSHA.
100 PPM or greater: We
have detected a potentially lethal level of carbon monoxide in your home.
Leave your building immediately. It is not safe until repairs are made
or the source is found and corrected. Have your sources of carbon monoxide
examined and if necessary, repaired by a qualified repair technician. Replace
or reset your detector according to manufacturer's specifications. Carbon
Monoxide affects individuals differently depending on size, age, and medical
history of the occupants. Therefore, families with young children or members
with medical conditions, or aged individuals should take extra precautions
in the event that Carbon Monoxide is detected.
Issued by:______________________________________
Date:_____________________
Received by:____________________________________ Date:_____________________