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Form # 482-0651-0720114F

Form # 482-0651-0720114F-2026

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The document is an air balancing matrix form used by design engineers and air balance technicians to record and certify the testing and balancing of air conditioning and ventilation systems. It includes sections for design specifications, actual measurements of airflow (CFM), pressure relationships, and compliance with relevant standards such as NFPA 90A/90B and the Illinois Hospital Licensing Act.

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Click ‘Get Form’ to open it in the editor.
Begin by entering the IDPH number at the top of the form. This is essential for tracking and compliance.
In the 'To be completed by design engineer' section, input the Design CFM and VAV Min/Max values for accurate air balancing.
Fill in the Room number and Room use fields to specify where the air balancing is taking place.
Next, provide details on Space volume, Supply, Return, and Actual CFM values. Ensure these are precise as they impact system performance.
Indicate the Pressure relationship using the provided options (+0-, +, -) based on your measurements.
Complete the certification section with the air balance technician's name, company, signature, and date to validate your work.

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Form # 482-0651-0720114F-2026

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