MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH 
105 C.M.R. 675.000 

MODEL MASSACHUSETTS ICE SKATING RINK AIR QUALITY 
RECORD KEEPING LOG

The intent of this document is to provide a model log book for keeping records that are required by 105 CMR 675.007: Record Keeping Requirements.  If this model log book is filled out completely, accurately, and current, compliance with this section of the regulations will be deemed complete. 

_______________________________________________________________________________________
Name of the Skating Rink

_______________________________________________________________________________________
Owner of the Skating Rink

_______________________________________________________________________________________
Operator of the Skating Rink

Rink Information 
Name of Rink: ___________________________________________________________________________ 
Street: _________________________________________________________________________________ 
City: ______________________________________, Massachusetts 
Zip Code: __________________ Telephone number:  ___________________________________________ 

Owner Information 
Name of Owner of Rink: __________________________________________________________________ 
Street: _________________________________________________________________________________ 
City: __________________________________________________________________________________ 
State: _________ Zip Code:_____________________ 
Contact: _______________________________________________________________________________ 
Telephone Number: ______________________________________________________________________ 
Manager of Rink: ________________________________________________________________________ 
Telephone Number: ______________________________________________________________________ 

Operator Information (if different) 
Name of Operator of the Rink: _____________________________________________________________ 
Street: ________________________________________________________________________________ 
State: _________ Zip Code: _____________________ 
Telephone Number: _____________________________________________________________________ 

Section One 

Ice Resurfacing Equipment

Primary Ice Resurfacer Information 
Brand of ice resurfacer: ____________________________________________________________________ 
Age of Resurfacer (in years): _____________ 
Fuel (Circle one): Gasoline Propane Natural Gas Other___________________________________________ 
Exhaust Pipe Discharge at (Circle one): 	Ice Level 	Above Ice 
Catalytic Converter (if applicable) 
Type of Catalytic Converter: _______________________________________________________________ 
Manufacturer: ______________________________________ Date of Installation: _____ /_____ /_____ 
Name of Installer: ________________________________________________________________________ 

Signature of Installer: _______________________________________________________ 

Secondary Ice Resurfacer Information (if applicable)
Brand of ice resurfacer: ___________________________________________________________________ 
Age of Resurfacer (in years): _____________ 
Fuel (Circle one): Gasoline  Propane  Natural  Gas  Other_________________________________________ 
Exhaust Pipe Discharge at (Circle one): 	Ice Level 	Above Ice 
Catalytic Converter (if applicable) 
Type of Catalytic Converter: _______________________________________________________________ 
Manufacturer: _______________________________________Date of Installation: _____ /_____ /_____
Name of Installer: ________________________________________________________________________ 

Signature of Installer: __________________________________________ 

Edger Information 
Brand of Edger: ______________________________________Age of Edger (in years): ________________ 
Fuel (Circle one): Gasoline  Propane  Natural  Gas  Other_________________________________________ 
Catalytic Converter (if applicable) 
Type of Catalytic Converter: ________________________________________________________________ 
Manufacturer: ______________________________________ Date of Installation: _____ /_____ /_____
Name of Installer: ________________________________________________________________________ 

Signature of Installer: __________________________________________ 

Ice Resurfacing Equipment 
Repair and Tuning Documentation Sheet 

This form must be filled out after any repair or tuning of ice resurfacing equipment
(i.e. resurfacers and/or edgers) [105 CMR 675.007(C)]

Date	Equipment	Work Performed	Signature	Conducted By	
				Company: 	
				Address: 	
				Company: 	
				Address: 	
				Company: 	
				Address: 	
				Company: 	
				Address: 	
				Company: 	
				Address: 	
				Company: 	
				Address: 	
				Company: 	
				Address: 	

Section Two 

Results of Air Sampling

Ice Rink Ventilation 
Type of mechanical ventilation: _____________________________________________________________ 
Maximum airflow capacity (in cubic feet per minute): ___________________________________________ 
Date of Last Maintenance: _____ /_____ /_____ 

Air Monitoring Equipment 
Type of air monitoring equipment for carbon monoxide: __________________________________________ 
Date of Last Calibration: _____ /_____ /_____
Type of air monitoring equipment for nitrogen dioxide: __________________________________________ 
Date of Last Calibration: _____ /_____ /_____

Indoor Air Test Results for Skating Rinks  (Copy as needed) 

Name of Rink: _____________________________________ Town:________________________________ 

Date 	Time 	Carbon Monoxide * ppm 	Nitrogen Dioxide * ppm 	Air Sample Device 	Lot # (if applicable) 	Air Sampling Location (Circle) 	Signature 	
					CO -	Center ice 		
					NO2 -	Redline 		
					CO -	Center ice 		
					NO2 -	Redline 		
					CO -	Center ice 		
					NO2 -	Redline 		
					CO -	Center ice 		
					NO2 -	Redline 		
					CO -	Center ice 		
					NO2 -	Redline  		
					CO -	Center ice 		
					NO2 -	Redline 		
					CO -	Center ice 		
					NO2 -	Redline 		
					CO -	Center ice 		
					NO2 -	Redline 		
					CO -	Center ice 		
					NO2 -	Redline 		
					CO -	Center ice 		
					NO2 -	Redline  		
					CO -	Center ice 		
					NO2 -	Redline 		
					CO -	Center ice 		
					NO2 -	Redline 		
					CO -	Center ice 		
					NO2 -	Redline 		
					CO -	Center ice 		
					NO2 -	Redline 		
					CO -	Center ice 		
					NO2-	Redline  		
*ppm = parts per million of air 

Indoor Air Levels for Carbon Monoxide and Nitrogen Dioxide 

If an air sample equals or exceeds 30 ppm for carbon monoxide or 0.5 ppm for nitrogen dioxide, you must take positive measures to decrease air concentrations of these contaminants below these standards as described in 105 C.M.R. 675.009. 

If an air sample equals or exceeds 30 ppm for carbon monoxide or 0.5 ppm for nitrogen dioxide for six (6) consecutive air samples, you must notify the local fire department within one hour, local board of health and the Bureau of Environmental Health Assessment within 24 hours of sampling. 

If an air sample equals or exceeds 60 ppm for carbon monoxide or 1 ppm for nitrogen dioxide, you must notify the local fire department within one hour, as well as the local board of health and the Bureau of Environmental Health Assessment within 24 hours of sampling. 

If an air sample equals or exceeds 125 ppm for carbon monoxide or 2 ppm for nitrogen dioxide, YOU MUST EVACUATE THE RINK, notify the local fire department as soon as possible, the local board of health upon completion of the evacuation, and the Bureau of Environmental Health Assessment within two hours. 

The Bureau of Environmental Health Assessment can be contacted at (617) 624-5757 during work hours, or at (617) 522-3700 during the night or weekend. 

Actions Taken to Reduce Air Concentrations of Carbon Monoxide or 
Nitrogen Dioxide if Air Testing Exceeds Correction Levels 
(Copy as Needed) 

Name of Rink: ___________________________________________________________________________ 

Town: _____________________________________________ Date: _____ /_____ /_____ 

If air testing exceeds correction levels, the regulations require air testing every 20 minutes subsequent to the initial air test to determine if corrective measures are reducing concentrations of carbon dioxide or nitrogen dioxide.
 
Time of Follow Up Air Sample 	Carbon Monoxide * ppm 	Nitrogen Dioxide * ppm 	Corrective Measure(s) Employed 	
20 minutes after resurfacing 				
40 minutes after resurfacing 				
60 minutes after resurfacing 				
80 minutes after resurfacing 				
100 minutes after resurfacing 				
120 minutes after resurfacing 				
140 minutes after resurfacing 				
*ppm = parts per million of air 
Form: ice4/1999