On April 26 and 27, 2005, the National Institute for Occupational Safety and Health (NIOSH) conducted a site visit at the Indian River Memorial Hospital's Center for Emotional and Behavioral Health (CEBH). This visit was conducted as part of a health hazard evaluation requested by Teamsters Local Union 769 on behalf of its members who work at CEBH. This was the second request for an evaluation since February 2004. The first request concerned respiratory symptoms and illnesses, including asthma, that workers felt could be related to possible mold contamination in the ventilation system, ceilings, walls, and rugs due to roof leaks. In April 2004, NIOSH provided management with written recommendations and best practice guidelines for addressing and preventing indoor environmental quality problems due to water incursion (See Appendix). Teamsters Local Union 769 made a second request for a NIOSH evaluation of CEBH in March 2005 due to continued worker reports of building-related respiratory symptoms and asthma, and concerns that areas of potential mold contamination in the building had not been adequately addressed. While the roof was replaced in the spring of 2004, two hurricanes during the summer of 2004 led to additional water incursion into the building. The April 2005 site visit by NIOSH staff involved all sections of the building and included several offices, staff lounges, patient rooms, patient lounges, the gymnasium, and the cafeteria. A Q-trak indoor air quality monitor (TSI, Inc., Shoreview, MN) was used to measure temperature, relative humidity, and carbon dioxide (CO2) levels at several locations. The ceiling plenum space (i.e. area above the ceiling tiles) was examined at several locations in hallways, offices, lounges, and the cafeteria. The ceilings in patient rooms did not have removable ceiling tiles. The walkthrough also included the roof deck, where the inside of two heating, ventilation, and air conditioning (HVAC) units (one original to the building, one a newer unit) was examined, as well as the exterior of the building and grounds. Overall the CEBH facility appeared to be clean and well maintained. Carbon dioxide concentration and temperature measurements throughout the facility were within the limits recommended by the American Society of Heating, Refrigerating, and Air Conditioning Engineers (ASHRAE). At several locations, relative humidity exceeded the upper limit of 60% recommended by ASHRAE. NIOSH staff did not detect any odors that might indicate water-damaged materials and/or mold growth. In the areas of the building that NIOSH staff inspected, there was no visible evidence of moisture-damaged building materials or mold growth. However, no wall finishes were removed as part of this evaluation and no invasive examinations of wall cavities were performed. Limited inspection of the ventilation ducts revealed a lining material that appeared to be breaking down. This may be responsible for the dirty appearance of ventilation supply diffusers and returns that workers have reported in the past. The CEBH building has a history of water incursion from roof leaks over many months in 2003 and 2004 as well as through hall windows and the ventilation system attributed to damage from hurricanes in the summer of 2004. During and after this time period, workers reported experiencing eye, nose, and throat irritation, headaches, and the onset of asthma (or exacerbation of preexisting asthma). An inspection of the facility by NIOSH staff found the building to be predominantly clean and well maintained. Issues identified that should be addressed in order to minimize potential effects on health include: (1) deteriorating ventilation duct lining, and (2) moisture-damaged walls that have been painted and/or covered with another material such as fiberglass reinforced panels. CEBH management should follow the recommendations in this report in order to address these and other issues that could impact indoor air quality and potentially lead to health effects in workers.