Official Florida Dh 1777 Template

What is the Florida DH 1777 form used for?

The Florida DH 1777 form, also known as the Nonresidential Radon Measurement Report, is utilized for reporting radon measurements in buildings other than single or multi-family dwellings. Facilities such as schools, day care centers, hospitals, correctional facilities, and others are required to submit this form to report initial, 5-year retest, or follow-up radon measurements as part of an ongoing effort to monitor and manage radon levels within nonresidential buildings across the state.

Who is required to complete the DH 1777 form?

Any entity responsible for the management or ownership of a nonresidential facility, where radon measurements are mandated by state regulations, must complete the DH 1777 form. This includes, but is not limited to, administrators of assisted living facilities, hospitals, schools (both public and private), correctional facilities, and any other specified facility type that falls under the requirements for radon measurement and reporting in Florida.

What types of buildings need to submit the DH 1777 form?

The DH 1777 form must be submitted for a wide range of nonresidential buildings including, but not limited to, assisted living facilities, hospitals, correctional facilities, nursing homes, day care centers, both public and private schools (K-12), and any other buildings as specified by the Florida Department of Health that are not single or multi-family dwellings.

What information is required on the DH 1777 form?

Completing the DH 1777 form requires detailed information about the facility and owner, building specifics such as name or ID, address, number of stories, age of building, foundation type, and HVAC system details, as well as comprehensive results from the radon measurements performed, including the type of measurement, dates, result units, and certification numbers of the individuals or businesses conducting the measurements.

How often should the DH 1777 be submitted?

The DH 1777 form should be submitted following the initial radon measurement and then every 5 years for a retest, in addition to any follow-up measurements that may be required. The frequency of submission ensures ongoing compliance with Chapter 64E-5, Florida Administrative Code, and Chapter 404, Florida Statutes, concerning radon safety measures.

Where do I send the completed DH 1777 form?

Once completed, the DH 1777 form should be sent to the Department of Health Bureau of Environmental Health / Radon Program at 4052 Bald Cypress Way, Bin #A12, Tallahassee, FL 32399-1720. Alternatively, the form can be scanned and emailed to RadonReports@FLhealth.gov for convenience.

Is there assistance available for completing the DH 1777 form?

Yes, assistance for completing the DH 1777 form is available. You can call 1-800-543-8279 for help with any questions or concerns you might have regarding filling out the form or understanding your obligations under Florida's radon measurement and reporting regulations.

What happens if I do not comply with the requirements of the DH 1777 form?

Failure to comply with the requirements for radon measurement and reporting, including proper completion and submission of the DH 1777 form, may lead to regulatory actions against the noncompliant entity. This could include fines, penalties, or other enforcement actions as deemed necessary by the Florida Department of Health to ensure public safety and adherence to state laws governing radon management.

When filling out the Florida DH 1777 form, which is essential for reporting nonresidential radon measurements, individuals often make errors that can affect the submission process. Being aware of these mistakes can help ensure the form is completed accurately and submitted efficiently. Here’s a list of common errors:

1. Failing to provide complete facility and owner information, including the name of the facility as licensed and the full physical location. This comprehensive data is crucial for accurately identifying the site in question.
2. Omitting the contact person’s title or phone number, which can lead to communication issues if clarification or further information is needed regarding the report.
3. Incorrectly identifying the facility type. As facilities vary greatly in their needs and regulations regarding radon measurement, correctly specifying the type is crucial for compliance with Florida's health and safety standards.
4. Providing incomplete or incorrect building information, such as the number of stories or the age of the building, can impact the understanding of potential radon exposure and mitigation requirements.
5. Not checking all applicable foundation/floor systems and HVAC systems that apply to the building. This oversight might affect the interpretation of radon measurement results and subsequent actions.
6. Errors in the Results section, including inaccurate dates of measurement, incorrect unit designation (pCi/L for picocuries per liter or W for working level), or misidentifying the measurement type. Precise data here are crucial for assessing radon levels and determining if action is necessary.
7. Failing to include certification numbers for the person or business that performed the measurement. This information is essential for verifying that the measurements were conducted by qualified professionals.
8. Skipping the section completed by radon measurement businesses, if applicable, leaving out critical details about the business and specialist, including certification numbers and signatures.
9. Incomplete certification in the section for measurements performed by staff employed by the facility. This certification attests that the measurements comply with Florida regulations, so omission could question the validity of the data reported.
10. Finally, not sending the completed form to the correct address or email provided by the Department of Health can delay processing and compliance verification.

Addressing these mistakes during form completion can lead to more accurate data collection and ensure regulatory compliance, ultimately contributing to a safer environment within Florida's nonresidential buildings.

When it comes to ensuring the safety and compliance of nonresidential buildings in Florida, especially concerning radon levels, the Florida DH 1777 form plays a crucial role. However, this form is often just a part of a larger set of documents necessary for a comprehensive approach to compliance and safety. Here’s a look at up to seven other forms and documents that are frequently used alongside the Florida DH 1777 form, each serving its unique purpose in the broader context of environmental health and safety regulations.

• Building Permit Application: Before any construction or renovation that might affect radon levels, a building permit application is required. This document ensures that all proposed work meets local building codes and safety standards.
• Radon Disclosure Form: For certain transactions, a radon disclosure form is necessary to inform potential occupants of the radon levels previously measured in the building and any mitigation actions taken.
• Environmental Assessment Report: This document provides an in-depth analysis of the building’s environment, including potential radon sources. It's vital for understanding how the building interacts with its surrounding environment.
• Radon Mitigation System Installation Form: If high levels of radon are detected, this form documents the installation of any radon mitigation systems, detailing the method of mitigation and ensuring compliance with regulations.
• Post-Mitigation Radon Test Results: Following the installation of a mitigation system, it’s crucial to perform another radon test. This document records the results to verify the effectiveness of the mitigation efforts.
• Occupational Safety and Health Administration (OSHA) Form 300: For workplaces, the OSHA Form 300 logs work-related injuries and illnesses. Since radon exposure can have health implications, this log may include related incidents, ensuring workplace safety compliance.
• Property Inspection Report: Often, a thorough property inspection is conducted, which includes checking for radon mitigation systems and potential radon entry points. This report offers a comprehensive overview of the property's condition.

Together, these documents complement the Florida DH 1777 form to provide a full picture of a building’s radon safety and compliance status. From initial construction and radon measurement to mitigation and ongoing compliance, each document plays a key role in ensuring a safe environment for all occupants.

• The OSHA Form 300 is similar to the Florida DH 1777 form as it also involves recording specific incidents; however, the OSHA Form 300 focuses on work-related injuries and illnesses within workplaces. Both forms require detailed site and incident information, emphasizing regulatory compliance and safety.

• Environmental Impact Statements (EIS) share similarities with the DH 1777 form through their focus on assessing how certain actions may affect the environment, including public health. Both documents require detailed information about the premises and potentially involve follow-up actions based on the findings.

• The EPA Hazardous Waste Manifest is akin to the DH 1777 form as it requires detailed tracking and reporting of hazardous materials. Both forms serve as official records, ensuring compliance with federal and state regulations, and involve detailed information about the substances and the responsible parties.

• Hospital Infection Control Reports resemble the DH 1777 form in their focus on health and safety within nonresidential facilities. Both forms necessitate comprehensive data collection regarding safety measures and outcomes, emphasizing the protection of public health.

• The Joint Commission's Life Safety Code® Documentation is akin to the DH 1777 form by requiring facilities to meet specific safety standards. Both documents gather facility information to ensure compliance with health and safety standards, aiming to protect individuals within the buildings.

• Centers for Medicare & Medicaid Services (CMS) Compliance Forms are similar to the DH 1777 form as they both ensure facilities meet certain regulatory requirements. Each document collects details on operations and adherence to standards, ensuring that facilities provide a safe and compliant environment.

• The Food Service Inspection Reports parallel the DH 1777 form in their purpose to protect public health through regulation compliance within nonresidential settings. Both involve a thorough review of the facility and operational practices to ensure safety and health standards are met.

• Building Permit Applications share commonalities with the DH 1777 form due to the detailed building and owner information required. Both forms are part of regulatory compliance processes, ensuring that structures are safe for use and meet specific codes and standards.

• The Fire Safety Inspection Reports are similar to the DH 1777 form as they both involve the inspection and evaluation of nonresidential buildings for compliance with safety regulations. Each report requires detailed information about the building's safety features and adherence to regulations to ensure the well-being of occupants.

When filling out the Florida DH 1777 form, it's important to remember that this document is crucial for reporting radon measurements in various nonresidential buildings. Below are the dos and don'ts that will help ensure the accuracy and completeness of your submission.

• Do ensure that you fill out every section of the form that applies to your facility. Incomplete forms may not be processed.
• Do verify the accuracy of the facility and owner information, including the facility name, physical location, and contact details.
• Do correctly identify the type of facility from the provided list in SECTION 1, such as Assisted Living Facility, Public School, etc., and specify if your facility type is "OTHER."
• Do include the accurate building name or ID number, and ensure the address matches the facility site if it's different.
• Do record the proper dates of measurement in SECTION 3, making sure they accurately reflect the period during which testing was performed.
• Don't leave the measurement type section blank. Specify whether it is an initial, 5 year retest, or follow-up.
• Don't forget to sign the form in SECTION 5 if measurements are performed by staff employed by the facility, certifying compliance with Florida regulations.
• Don't submit the form without double-checking that all information is complete and correct. Errors or omissions may delay processing and can affect compliance with state laws.

Correctly filling out the Florida DH 1777 form is not just about compliance. It's also about ensuring the safety and well-being of individuals in nonresidential buildings by properly reporting and addressing radon levels. Take the time to review each section, seek clarification if needed, and submit the form as directed to the Department of Health.

When it comes to the Florida DH 1777 form, misunderstandings abound. Let's clarify some of these misconceptions to help individuals navigate its purpose and requirements more effectively.

• It's Only for Residential Buildings: Contrary to popular belief, the DH 1777 form is specifically designed for reporting radon measurements in nonresidential buildings. This includes a wide range of facilities like schools, day care centers, and hospitals, not just homes or apartments.
• Any Property Owner Can Complete It: While property owners are responsible for ensuring the form is completed, the measurements and reporting must be conducted by professionals certified in radon measurement. This is crucial for ensuring the accuracy and reliability of the data.
• It's a One-Time Requirement: Some might think you only need to submit this form once. However, radon levels can change over time due to structural changes, environmental shifts, and other factors. Therefore, facilities are required to conduct and report radon measurements initially and every five years thereafter, or follow up measurements as necessary.
• All Buildings Must Be Tested: Actually, the number of buildings and rooms tested will depend on the specific characteristics of the facility, including its size and use. The form guides facilities on the scope of testing required.
• Results Are Immediately Reported to the Public: Although transparency is critical, there's a process in place. Submitted forms are reviewed by the Department of Health's Bureau of Environmental Health/Radon Program before any action is taken or information is made public.
• Filling Out is Complicated: The form might seem daunting at first glance, but it's structured to be as straightforward as possible. Help is available for those who need assistance completing it, including a dedicated phone line for support.
• It's Only About Measuring Radon Levels: While measuring radon levels is the primary goal, the form also collects information on the tested building's characteristics, such as foundation type and HVAC systems. This comprehensive approach helps in evaluating radon exposure risks more accurately.
• Email Is the Only Submission Method: While digital submission is encouraged for efficiency, facilities have the option to mail in their completed forms. This flexibility ensures that facilities with varying resources can comply with the reporting requirement.

Understanding the DH 1777 form is crucial for facilities across Florida to comply with regulations and ensure a safe environment for employees, customers, and the general public. Dispelling these misconceptions is the first step towards better compliance and radon awareness.

Understanding the Florida DH 1777 form is crucial for ensuring compliance with state regulations regarding radon measurement in nonresidential buildings. Here are four key takeaways to consider when filling out and using this form:

• Distinct Reporting for Different Facility Types: The Florida DH 1777 form requires specific information based on the type of facility being reported. It is important to accurately identify the facility type from the provided list, which includes options such as Day Care Centers, Hospitals, Correctional Facilities, and more. This classification impacts how the form is processed and the required radon measurement protocols.
• Comprehensive Building Information is Mandatory: Section 2 of the form demands detailed information about the building undergoing radon testing, including its name or ID number, location, number of stories, age, foundation type, and HVAC system details. Accurate and thorough information ensures the radon measurement results are appropriately contextualized and accurately recorded for each specific building.
• Measurement Results and Methodology: The form differentiates between initial, 5-year retests, and follow-up measurements, requiring dates, results, units of measurement, and testing methods used. It is essential to document the name of the person or business performing the measurement and their certification number (if applicable), to validate the test's credibility and compliance with the Florida Administrative Code and Statutes.
• Compliance and Reporting Procedures: Completing the Florida DH 1777 form accurately is a part of adhering to Chapter 64E-5, Florida Administrative Code, and Chapter 404, Florida Statutes. All measurements must be reported to the Department of Health's Bureau of Environmental Health/Radon Program. The form can be submitted either by mail or email, and assistance is available via a provided contact number for those needing help with the form.