U.S. Environmental Protection Agency
[District Address] Assessment Checklist
Assessment Date: Assessor: Facility: Address: Primary Contact: Facility Contact: Assessment Type
Routine Incident Response Complaint/Other Re-Assessment Construction/Renovation Area/Topic Subtopic
Central Office -- Chemical Management Chemical Purchasing Chemical Purchasing Inventory Assessment Action Problems/Comments All chemicals are purchased in quantities that will be used during the current school year. School is purchasing chemicals in a manner that is consistent with the District's purchasing policy. School has conducted an inventory of all of the chemicals on-site, including school maintenance (cleaning, pesticides, repairs), science classrooms and labs, art classrooms, shop classrooms, etc. All chemicals on the premises can be identified on the approved products list. All chemicals are stored properly. School updates its chemical inventory list at least annually to reflect removal of chemicals from school. School has conducted a chemical clean-out, identifying and removing unnecessary hazardous materials through appropriate recycling and/or disposal methods. School employees and students are properly trained to handle chemicals and lab equipment. Only trained employees are permitted to transport chemicals within the building, and only after school hours or when students are within classrooms. Food and drink are prohibited in areas where chemicals are handled or stored. School has a written hazard communication plan. Yes / No / NA Yes / No / NA Yes / No / NA Inventory Storage and Labeling Clean-out Clean-out Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Training and Handling Training and Handling Yes / No / NA Yes / No / NA Training and Handling Hazard Communication Plan Yes / No / NA Yes / No / NA Tuesday, November 22, 2005 Page 1 of 27 Area/Topic Subtopic
Central Office -- Energy Energy Star Energy Star Energy Star Assessment Action
School is aware of the district's energy efficiency policy/program goals. Monitor power management software on computer networks is installed. School tracks whole building energy use, assesses energy performance using EPA's Energy Performance Rating System, sets whole building energy performance improvement target, and reassesses energy performance to measure improvement. Procurement policy in place that favors the purchase of products carrying the ENERGY STAR, including Compact Fluorescent Lamps, kitchen equipment, office equipment, computers and others. Problems/Comments Yes / No / NA Yes / No / NA Yes / No / NA Energy Star Yes / No / NA Tuesday, November 22, 2005 Page 2 of 27 Area/Topic Subtopic
Central Office -- Hazardous Materials Asbestos Management Plan Assessment Action Problems/Comments School has an up-to- date asbestos management plan on file containing designation of a contact person who ensures that the responsibilities of the local education agency are properly implemented. School has an up-to-date asbestos management plan on file that contains documentation of the steps to be taken by the Local Education Agency to provide written notification to parent, teacher, and employee organizations regarding the availability of the Asbestos Management Plan and any response actions taken or planned once annually. School has an up to date asbestos management plan on file containing records for periodic surveillance of known or suspected asbestos containing building material (ACBM). School has an up to date asbestos management plan on file containing a blueprint, diagram, or written description of each school building that identifies clearly each location where material was sampled for ACM, the exact location where each bulk sample was collected, date of collection, and where suspected ACBM is assumed to be ACM. Local education agency provides asbestos awareness training to all of its maintenance and custodial staff who work in buildings that contain asbestos. An initial asbestos inspection has been conducted. Follow-up re-inspections to the initial asbestos inspection have been performed every three years. School maintains records of each preventive measure and response action taken for friable and nonfriable asbestos-containing building material as well as records of the persons performing the actions. School has an inventory of all combustion appliances that are potential sources of carbon monoxide. Staff is trained to recognize the signs and symptoms of carbon monoxide exposure. School places restrictions on the placement and use of gasoline powered engines or tools inside the building. School inspects all combustion appliances that are potential sources of carbon monoxide on an annual basis. School maintains a file of lead paint inspection reports for all schools built prior to 1992. Yes / No / NA Asbestos Management Plan Yes / No / NA Asbestos Management Plan Yes / No / NA Asbestos Management Plan Yes / No / NA Asbestos Awareness Training Yes / No / NA Initial Asbestos Inspections Follow Up Asbestos Reinspections Asbestos Records Yes / No / NA Yes / No / NA Yes / No / NA Carbon Monoxide Carbon Monoxide Carbon Monoxide Carbon Monoxide Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Lead Paint Yes / No / NA Tuesday, November 22, 2005 Page 3 of 27 Area/Topic Subtopic
Central Office -- Hazardous Materials Lead Paint Assessment Action Problems/Comments School has a policy in place to manage any activity (e.g., renovation work) that may disturb areas containing lead paint hazards. All staff are trained to recognize and report potential lead paint hazards. Plumbing survey has been conducted to locate areas of high risk for lead sources. Drinking fountains have been checked against EPA's list of known lead-containing models; listed fountains have been permanently taken out of service or removed. School has a policy of flushing out at the start of each school day all drinking and cooking water outlets with high lead levels where other remediation actions have not been taken (replace outlet or disconnect outlet). Drinking water taps have been tested for lead in the past year. Lead concentrations at all drinking water taps are below the EPA action level. School prohibits the purchase of mercury products. School has conducted and maintains an up-to-date inventory list of all devices containing elemental mercury, mercury compounds, and mercury solutions. School has a policy to replace all unnecessary mercury containing devices with non-mercury devices. Ensure that the chemical hygiene plan has a spill control policy for mercury, that the staff is trained to clean up mercury spills, and has a mercury spill recovery kit. Ensure the school recycles or disposes of unwanted mercury laboratory chemicals, mercury thermometers, gauges, and other devices in accordance with federal, state and local environmental regulations. Yes / No / NA Lead Paint Lead in Drinking Water Lead in Drinking Water Yes / No / NA Yes / No / NA Yes / No / NA Lead in Drinking Water Yes / No / NA Lead in Drinking Water Lead in Drinking Water Mercury Assessment and Removal Mercury Assessment and Removal Mercury Assessment and Removal Mercury Spills Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Mercury Recycling or Disposal Yes / No / NA Polychlorinated Biphenyls (PCBs) School has determined applicability and compliance with PCB regulations. Radon Radon Storage Tanks -- Aboveground All classrooms in contact with the ground have been tested for radon, if school located in Zone 1. If test results show radon levels of 4 pCi/L or greater, mitigation strategies have been implemented. If above-ground storage tanks are present, aggregate quantity of storage capacity is less than 1320 gallons, OR school has a Spill Prevention, Containment, and Countermeasure (SPCC) plan on file. Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Tuesday, November 22, 2005 Page 4 of 27 Area/Topic Subtopic
Central Office -- Hazardous Materials Storage Tanks -- Underground Assessment Action Problems/Comments If any school vehicles are fueled on school owned property, school is in compliance with Underground Storage Tank regulations. If any school vehicles are fueled on school owned property, school maintains leak detection reports. School has a written non-smoking policy. Yes / No / NA Storage Tanks -- Underground Tobacco Smoke Central Office -- Hazardous Waste Generation Generator Identification Number Yes / No / NA Yes / No / NA School has determined its hazardous waste generation status. If the school generates regulated quantities of hazardous waste, the school has obtained a RCRA site-specific identification number. If the school is a CESQG, the school complies with the limited requirements applicable to a CESQG. If the school is a Small- or Large Quantity Generator of hazardous waste, the school complies with more stringent requirements. Yes / No / NA Yes / No / NA Conditionally Exempt Small Quantity Generator (CESQG) Requirements Small Quantity Generator (SQG)/ Large Quantity Generator (LQG) requirements Central Office -- Indoor Air Quality IAQ Coordinator Indoor Air Quality Profile Ventilation System Indoor Air Quality Management Plan Yes / No / NA Yes / No / NA School has an identified IAQ coordinator who maintains a file documenting IAQ activities. School has developed an indoor air quality profile based on a walkthrough assessment. School has records of ventilation system inspections on file (if mechanical ventilation system present). School has an IAQ management plan. Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Tuesday, November 22, 2005 Page 5 of 27 Area/Topic Subtopic
Central Office -- Mold/Moisture Mold Prevention Mold Prevention Assessment Action
No wet or damp areas. Indoor relative humidity is maintained below 60% (ideally between 30% and 50%, except in cold climates during freezing temperatures, when relative humidity levels between 20-30% are normal). All school structures (including portable structures) are inspected for visible mold, moldy odors, moisture, stains or discoloration, and water leakage on a regular basis. Communication with all building occupants occurs at each stage of the mold remediation process, as appropriate. If visible mold is present, a remediation plan has been developed. All moisture and mold problems have been investigated and evaluated. If visible mold is present, a remediation plan has been implemented. Problems/Comments Yes / No / NA Yes / No / NA Mold Prevention Yes / No / NA Mold Containment and Clean-up Yes / No / NA Mold Containment and Clean-up Mold Containment and Clean-up Mold Containment and Clean-up Central Office -- Non-hazardous Waste Food Waste Recycling Yes / No / NA Yes / No / NA Yes / No / NA School has a program in place to minimize food waste from cafeteria food production. School has recycling bins for: 1) plastic; 2) office paper/newspaper/cardboard; 3) aluminum/tin; and 4) glass. School purchases supplies and equipment made with recycled content materials (e.g. paper products, engine oil, paints). School has implemented a waste education program, such as EPA's Waste Wise Program. Yes / No / NA Yes / No / NA Recycling Yes / No / NA Waste Reduction Yes / No / NA Tuesday, November 22, 2005 Page 6 of 27 Area/Topic Subtopic
Central Office -- Outdoor Air Pollution Air Quality Index Advisories School Bus Idling School Bus Idling School Bus Idling Refrigeration and AirConditioning Refrigeration and AirConditioning Assessment Action Problems/Comments School has procedures in place for responding to Air Quality Index advisories. School has an anti-idling policy on file. Signs are posted stating that all vehicles are prohibited from idling on school premises. School bus schedules are designed to minimize school bus caravanning. School's air-conditioning or refrigeration systems contain LESS THAN a fifty-pound charge of CFC or HCFC refrigerant. If school personnel perform any type of repair, service, or maintenance on any air conditioning or refrigeration equipment, personnel are properly certified as a section 608 EPA-approved technician. Refrigerant Inventory conducted to determine if the school's refrigeration equipment uses regulated ozonedepleting refrigerant. Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Refrigeration and AirConditioning Central Office -- Pest Control Integrated Pest Management Plan Pesticide Use Yes / No / NA School is implementing an integrated pest management plan. School provides notification of their pest control policies, methods of application, and requirements for posting and pre-notification to parents and school employees. School maintains annual summaries of pesticide applications, copies of pesticide labels, copies of notices, and MSDSs in an accessible location. Children are prohibited from entering the pesticide area for at least 8 hours following the application or longer, if feasible, or if required by the pesticide label. Yes / No / NA Yes / No / NA Pesticide Use Yes / No / NA Pesticide Use Yes / No / NA Central Office -- Ultraviolet Radiation SunWise School uses the SunWise program or otherwise follows CDC's Guidelines for School Programs to Prevent Skin Cancer. Yes / No / NA Tuesday, November 22, 2005 Page 7 of 27 Area/Topic Subtopic
Central Office -- Water Drinking Water Quality Drinking Water Quality Drinking Water Quality Water Efficiency Assessment Action
Drinking water source is protected if school acquires drinking water from its own well. No pathways exist for drinking water contamination or unintentional water loss. On-site drinking water storage is protected from contamination. All water-using equipment is checked regularly for leaks to prevent damage to building structure and mold formation. Water-using equipment that is purchased is in the top 25% of efficiency. All building systems (e.g. chillers, Cooling towers, boilers, plumbing fixtures, cafeteria equipment) are operating efficiently (based on the results from the water audit). School has conducted a water audit to determine its water usage. School prohibits the dumping of gasoline, oil, chemicals, and lawn and garden pesticides down the drain, into surface water, onto the ground, or in the trash. Problems/Comments Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Water Efficiency Water Efficiency Yes / No / NA Yes / No / NA Water Efficiency Waste Water Yes / No / NA Yes / No / NA Central Office -- Safety and Health Policies Policies Central Office -- Safety and Security Emergency Response and Crisis Management Fire Prevention and Detection and Emergency Action Plans Traffic and Pedestrian Safety School has crisis management plans in place addressing: 1) preparedness, 2) prevention and mitigation, 3) response, and 4) recovery. School has emergency action and fire detection and prevention plans. "Safe Pedestrian Routes" to school have been designated, distributed to parents and posted in the main office. Student drop-off and pick-up points are designated and supervised. Students, parents and employees provided with: traffic safety and pedestrian brochures; bicycle and bus safety rules; information on pedestrian routes to and from school; student drop-off/pickup procedures; and seat belt/car safety information. School has written policies that address the eight components of the Coordinated School Health Program. Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Traffic and Pedestrian Safety Traffic and Pedestrian Safety Yes / No / NA Yes / No / NA Tuesday, November 22, 2005 Page 8 of 27 Area/Topic Subtopic
Central Office -- Injury and Illness Prevention Occupational Injury and Illness Reporting Assessment Action Problems/Comments School (employer) maintains a log and summary of recordable occupational injuries and illnesses (OSHA Form No. 300 or equivalent) that reflects separately the illness and injury experience of each establishment (i.e., school). School has a bloodborne pathogens exposure control plan. Yes / No / NA Bloodborne Pathogens Exposure Control Plan Yes / No / NA Tuesday, November 22, 2005 Page 9 of 27 Area/Topic Subtopic
Classrooms General General General General General General General Safety Walls Fire Safety Fire Safety Fire Safety Floors -- General Floors -- General Floors -- Carpet Floors -- Carpet Floors -- Carpet Floors -- Carpet Floors -- Resilient Floors -- Resilient Ceilings Ceilings Windows Assessment Action
Food stored in sealed, vermin-proof containers. Free of signs of moisture problems or water damage on any interior surface. Drapes and curtains clean with no noticeable dust accumulation. Overall clean and sanitary conditions. Free of evidence of pests or obvious food sources. Free of visible mold on any interior surface. Stored items do not inhibit or restrict routine maintenance or cleaning. Chemicals & cleaning products inaccessible to children. Chipped or peeling paint or plaster not present. Fire extinguishers checked monthly and serviced annually, clearly marked, and easily accessible. All exits and exit corridors free of obstructions that would restrict or prevent emergency egress from the building. All exits properly marked. Smooth, wear resistant, and easily cleanable. Free of obstructions to cleaning and maintenance Clean and dry with no noticeable odors. Not installed in areas with plumbing. Free of evidence of staining. Secure to floor with no loose edges, tears, holes or other tripping hazards. Clean and dry. Smooth, intact and secure. Clean with no water stains, rust stains, water damage or visible mold. Free of chipping/peeling paint or loose, cracked, or falling ceiling materials. Free of chipped or peeling paint or plaster. Problems/Comments Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Tuesday, November 22, 2005 Page 10 of 27 Area/Topic Subtopic
Classrooms Other Horizontal Surfaces HVAC Systems -- General HVAC Systems -- General HVAC Systems -- General HVAC Systems -- General HVAC Systems -- General HVAC Systems -- General HVAC Systems -- General HVAC Systems -- General HVAC System -- Air Supply and Return Diffusers HVAC System -- Air Supply and Return Diffusers Assessment Action
Free of visible accumulation of dust/debris on high or low surfaces. Free of excessive noise or vibration from any system component. Air filters not excessively loaded with particulate debris. Air filters properly sized and installed. Pleated paper air filtration media in use. Free of offensive odors from any system component. Thermostatic controls set to operate fan continuously during occupied periods. Fans operating continuously during all occupied periods. Free of visible mold or other debris on any system component. Air supply diffusers and return grilles unobstructed. Free of rigged baffles, deflectors or barriers affixed to existing diffusers. Problems/Comments Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA HVAC Systems -- Unit Ventilators Air outlets & inlets unobstructed by books, boxes, or other items. Indoor Air Quality Indoor Air Quality Indoor Air Quality Indoor Air Quality Building positively pressurized (i.e. air flows out). Free of objectionable/unusual odors (mold, mildew, VOCs, sewer gas, ETS, etc.). Temperature & relative humidity within acceptable ranges (ASHRAE comfort zone). Design outdoor ventilation rate and current operational set point are known and delivering appropriate amounts of outside air. Animals in classrooms are selected and managed to minimize exposure of students and staff to allergens and disease agents. Hand washing facilities available in rooms with animals. All art material conforms to ASTM D-4236. Hot and cold water available at all lavatories. Hot water temperature does not exceed 120 degrees (F). Sinks clean. Animal Management Yes / No / NA Animal Management Art Supplies Sinks Sinks Sinks Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Page 11 of 27 Tuesday, November 22, 2005 Area/Topic Subtopic
Classrooms Sinks Sinks Hallways and Stairwells General Drinking Fountains Floors -- Carpet Restrooms General General Sinks Sinks Sinks Sinks Sinks Toilets Toilets Toilets Toilets Toilets Indoor Air Quality Indoor Air Quality Assessment Action
Drains unclogged. Soap and disposable hand towels or air drier present. Problems/Comments Yes / No / NA Yes / No / NA Furniture or other items not stored on the floor. Drinking water dispensers are sanitary, capable of being closed, and equipped with a tap. Not installed in areas likely to get wet. Yes / No / NA Yes / No / NA Yes / No / NA All fixtures in good repair and operating properly. Floors clean and dry. Hot and cold water available at all lavatories. Hot water temperature does not exceed 120 degrees (F). Sinks clean. Drains unclogged. Soap and disposable hand towels or air dryer present. Toilet seats secure and properly fitted. Toilet partitions clean and secure. Flush properly. Clean (top and undersides). Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Toilet paper provided for each toilet in proper dispensers. Yes / No / NA No excessive odors. Exhaust fan on throughout school day. Yes / No / NA Yes / No / NA Tuesday, November 22, 2005 Page 12 of 27 Area/Topic Subtopic
Custodial Closets General General General Hazard Communication Assessment Action
Closet door equipped with operable lock. Access restricted to authorized individuals at all times. Equipped with continuously operating exhaust fans. Material Safety Data Sheets (MSDS) readily accessible to staff for all hazardous chemicals used or stored in custodial closet. Containers of hazardous materials, including mercury products, are labeled with the identity of the material, the date the material was acquired, the words "hazardous material" and the hazard associated with the material (e.g., toxicity, corrosivity, ignitability, reactivity). Problems/Comments Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Hazard Communication Yes / No / NA Tuesday, November 22, 2005 Page 13 of 27 Area/Topic Subtopic
Science Rooms and Laboratories General General General General General General General Chemical Hygiene Plan Hazard Communication Assessment Action
Master gas shutoff valve located in room and clearly labeled. Food or drinks prohibited. First aid kit accessible to staff. Lab kept locked and inaccessible to students during unoccupied periods. Lab door(s) equipped with operable lock(s). Adult supervision present throughout all instructional periods. Placards posted indicating the location of all safety & emergency equipment. Ensure the school has a written and complete chemical hygiene plan. Material Safety Data Sheets (MSDS) readily accessible to staff & students for all hazardous chemicals used or stored in the lab. Containers of hazardous materials, including mercury products, are labeled with the identity of the material, the date the material was acquired, the words "hazardous material" and the hazard associated with the material (e.g., toxicity, corrosivity, ignitability, reactivity). Anti-roll lips on all chemical storage shelves. Free of chemicals stored in fume hoods or on floors. Chemical storage rooms vented via mechanical exhaust system. Flammable and corrosive liquids stored separately in approved cabinets. Chemicals kept locked during non-class periods. Chemical storage room door or individual cabinets equipped with operable locks. Comprehensive chemical inventory list and disposal log on hand and updated within past year. Chemical spill kit accessible to instructor. All chemicals stored according to chemically compatible families. Located within 50' of all lab workstations. Problems/Comments Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Hazard Communication Yes / No / NA Chemical Storage Chemical Storage Chemical Storage Chemical Storage Chemical Storage Chemical Storage Chemical Storage Chemical Storage Chemical Storage Emergency Equipment -- Safety Showers Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Tuesday, November 22, 2005 Page 14 of 27 Area/Topic Subtopic
Science Rooms and Laboratories Emergency Equipment -- Safety Showers Emergency Equipment -Eyewash Stations Emergency Equipment -Eyewash Stations Personal Protective Equipment Personal Protective Equipment Personal Protective Equipment Ventilation Assessment Action
Showers operational. Within 25' of all lab workstations. Eyewash operational. Goggles worn during demonstrations and experiments. Other personal protective equipment worn whenever appropriate. Appropriate personal protective equipment accessible to all students and staff. Exhaust fans on during chemical demonstrations, lab experiments and other activity periods where airborne contaminants generated. Local exhaust systems (including dust collection systems, paint booths, fume hoods) installed at all airborne contaminant sources. Exhaust fans operable. Exhaust ventilation provided where hazardous chemicals generated, used or stored. Problems/Comments Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Ventilation Yes / No / NA Ventilation Ventilation Yes / No / NA Yes / No / NA Tuesday, November 22, 2005 Page 15 of 27 Area/Topic Subtopic
Visual Arts, Industrial Arts & Vocational Ed. Rooms General General General General General General General General General Sinks Sinks Sinks Sinks Sinks Chemical Hygiene Plan Hazard Communication Assessment Action Problems/Comments Room kept locked and inaccessible to students during unoccupied periods. Placards posted indicating the location of all safety & emergency equipment. Food or drinks prohibited. Master gas shutoff valve and electric panel clearly marked and accessible. All machines appropriately guarded. Equipment danger zones clearly marked. No paints, glazes or other finishes containing lead, cadmium, or other heavy metals. Personal protective equipment accessible and in use when appropriate. Door(s) equipped with operable lock(s). Drains unclogged. Soap and disposable hand towels or air dryer present. Sinks clean. Hot water temperature does not exceed 120 degrees (F). Hot and cold water available at all lavatories. School has a written chemical hygiene plan. Material Safety Data Sheets (MSDS) readily accessible to staff & students for all hazardous chemicals used or stored in the classroom. Containers of hazardous materials, including mercury products, are labeled with the identity of the material, the date the material was acquired, the words "hazardous material" and the hazard associated with the material (e.g., toxicity, corrosivity, ignitability, reactivity). Comprehensive chemical inventory list and disposal log on hand and updated within past year. Chemical storage room door or individual cabinets equipped with operable locks. Chemicals kept locked during non-class periods. All chemicals stored according to chemically compatible families. Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Hazard Communication Yes / No / NA Chemical Storage Chemical Storage Chemical Storage Chemical Storage Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Page 16 of 27 Tuesday, November 22, 2005 Area/Topic Subtopic
Visual Arts, Industrial Arts & Vocational Ed. Rooms Chemical Storage Chemical Storage Ventilation Ventilation Ventilation Assessment Action Problems/Comments Flammable and corrosive materials stored separately in approved cabinets. Chemicals not stored in fume hoods or on floors. Exhaust fans operable. Kiln exhaust fan operational and on during kiln operation. Local exhaust systems (including dust collection systems, paint booths, fume hoods) installed at all airborne contaminant sources. Local exhaust systems on during activity periods where airborne contaminants generated. Exhaust ventilation provided where hazardous chemicals generated, used or stored. Maintained for all chemicals. All art material conforms to ASTM D-4236. Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Ventilation Ventilation Chemical Disposal Logs Art Supplies Home Economic Rooms General General General Cooking Area Cooking Area Waste Management Sinks Sinks Sinks Sinks Sinks Combustion Appliances Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Free of signs of vermin or pests. Food service area is clean. First aid kit stocked and accessible. Exhaust fans on during cooking, dishwashing, and cleaning. Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Gas appliances vented to outdoors and working properly. Yes / No / NA Waste stored in appropriate containers. Hot and cold water available at all lavatories. Soap and disposable hand towels or air dryer present. Drains unclogged. Hot water temperature does not exceed 120 degrees (F). Sinks clean. Air monitored regularly for CO where combustion appliances are present. Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Tuesday, November 22, 2005 Page 17 of 27 Area/Topic Subtopic
Computer and CADD Labs Energy Star Music Rooms General Auditoriums General General Assessment Action
Monitor power management software on computer networks is installed. Problems/Comments Yes / No / NA Cleaning supplies provided for instrument maintenance and headphones. Yes / No / NA All risers, platforms, and guardrails structurally intact. Guardrails present at every open-sided floor, platform or balcony 30" or more above adjacent floor excepting stage fronts. Stage curtains clean. Yes / No / NA Yes / No / NA General Cafeterias and Student Dining Areas General General Cooking Area Cooking Area Waste Management Receiving Receiving Library / Media Center General General Energy Star Yes / No / NA Food service area is clean. Free of signs of vermin or pests. Yes / No / NA Yes / No / NA Gas appliances vented to outdoors and working properly. Yes / No / NA Exhaust fans on during cooking, dishwashing, and cleaning. Waste stored in appropriate containers. Idling vehicles not present in receiving area. Doors to receiving area kept closed. Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Free of visible mold or dust accumulations on books or shelves. Free of excessive accumulation of dust on library shelves. Power management software on computer networks is installed. Yes / No / NA Yes / No / NA Yes / No / NA Tuesday, November 22, 2005 Page 18 of 27 Area/Topic Subtopic
Indoor Athletic Facilities Gymnasiums Gymnasiums Gymnasiums Gymnasiums Locker Rooms Locker Rooms Locker Rooms Locker Rooms Locker Rooms Attics / Mezzanines General General Mechanical Rooms General General General General General General Assessment Action
Cleaning supplies provided for mat cleaning. Appropriate protective matting behind basketball hoops. Exercise mats in good condition. Gym equipment safe and in proper working order. Free of visible mold or mildew on any surfaces. Drain traps servicing floors, sinks, and toilets fully wet at all times. Shower and toilet areas equipped with operable exhaust fan(s). Operational showers not used for storage. Hot & cold running water supplied to all showers and faucets. Problems/Comments Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Free of evidence of roof or plumbing leaks. Free of animal or insect nests, waste, or debris. Yes / No / NA Yes / No / NA Floors free from slips, trips and fall hazards. Boiler certificate on file. Free of storage of items that inhibit or restrict routine maintenance or cleaning. Door(s) equipped with operable lock(s). Access restricted to authorized individuals at all times. Door kept locked and inaccessible to students. Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Tuesday, November 22, 2005 Page 19 of 27 Area/Topic Subtopic
Clinics / Health Officer / School Nurse Facilities Facilities Facilities Facilities Sinks Sinks Sinks Sinks Sinks Equipment and Durable Supplies Equipment and Durable Supplies Equipment and Durable Supplies Equipment and Durable Supplies Ventilation Administrative Areas Copy Rooms Copy Rooms Break Rooms Outside Entrances and Exits Walk-off Mats Walk-off Mats Walk-off Mats Floors -- Carpet Assessment Action Problems/Comments Cot and mattress with waterproof cover. Telephone Locked storage for medications and syringes. Handicapped accessible toilet. Hot and cold water available at all lavatories Hot water temperature does not exceed 120 degrees (F). Sinks clean. Drains unclogged. Soap and disposable hand towels or air dryer present. Current National American Red Cross First Aid Manual or equivalent. Non-mercury thermometer/ sphygmomanometers. First aid kit stocked and accessible. Sharps container. Ventilation system is properly operating. Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Room equipped with functioning exhaust fan. Exhaust fan on during work periods where airborne contaminants are generated. All food stored in refrigerator or in sealed containers. Yes / No / NA Yes / No / NA Yes / No / NA 5-step walk-off mats at every building entrance. Clean and dry. Flat on floor with no slippage. Not installed in areas likely to get wet. Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Tuesday, November 22, 2005 Page 20 of 27 Area/Topic Subtopic
Building Exterior Adjacent Grounds Adjacent Grounds Adjacent Grounds Adjacent Grounds Adjacent Grounds Adjacent Grounds Adjacent Grounds -- No air contaminants within 25' of building envelope Adjacent Grounds -- No air contaminants within 25' of building envelope Adjacent Grounds -- No air contaminants within 25' of building envelope Outside Air Intakes Outside Air Intakes Outside Air Intakes Gutters, Downspouts, Scuppers and Storm Drains Gutters, Downspouts, Scuppers and Storm Drains Gutters, Downspouts, Scuppers and Storm Drains Gutters, Downspouts, Scuppers and Storm Drains Walls Walls Walls Walls Walls Assessment Action
Grass clippings or other organic debris not accumulating adjacent to foundation. 18" non-vegetation border around building perimeter. Irrigation water spray lines not on building or within 3' of foundation. Visible slope to grade within 10' of building foundation. Free of evidence of water ponding within 10' of building foundation. Vegetation not in contact with building. Idling vehicles not present. Problems/Comments Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Free of bird, animal, or insect nests. Yes / No / NA Paint, roofing materials, or other sealants/coatings applied during unoccupied periods. Air contaminant sources not within 25' of outside air intake. Intake screens intact & unobstructed (boards, leaves, vegetation, snow, etc.). Areas in an around air intakes free of bird or animal nests or droppings. Free of evidence of storm water overflow or obstruction. Free of excessive debris or standing water in gutters. Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Downspouts drain to storm sewer or visibly sloped grade. Yes / No / NA Intact and properly connected. Bricks and mortar joints intact. Wood siding & trim intact. Edge joints properly caulked & sealed. Walls free of peeling, cracked, or blistering paint. Walls free of visible mold. Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Page 21 of 27 Tuesday, November 22, 2005 Area/Topic Subtopic
Building Exterior Walls Windows Windows Windows Windows Windows Roof -- General Roof -- Exhaust Stacks / Vents / Chimney Flues Roof -- Exhaust Stacks / Vents / Chimney Flues Roof -- Roof Deck Roof -- Roof Deck Roof -- Roof Deck Roof -- Roof Deck Roof -- Roof Deck Assessment Action
Free of visible bowing or structural cracks. Properly caulked and sealed. Panes & frames intact. Glazed/caulked joints intact. Weather stripping intact. Window surfaces free of visible mold. Roof coatings not applied during occupied periods. Located away from outside air intakes, windows, and doors. Stack heights to extend above outdoor air intakes located within 25' of stack. Free of excessive water ponding. Free of accumulations of organic material or visible mold growth. Deck material intact and in good condition with no cracks, gaps, or openings. Flashings intact. Patches and seals intact. Problems/Comments Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Tuesday, November 22, 2005 Page 22 of 27 Area/Topic Subtopic
Grounds General General General General Parking Areas and Driveways Parking Areas and Driveways Bus Loading and Unloading Areas Bus Loading and Unloading Areas Bus Loading and Unloading Areas Sidewalks, Walkways and Stairs Sidewalks, Walkways and Stairs Lawn Areas, Plant Beds and Athletic Fields Solid Waste Disposal Areas Solid Waste Disposal Areas Solid Waste Disposal Areas Solid Waste Disposal Areas Assessment Action
All areas of the school have sufficient lighting. Free of excessively cracked or uneven pavement. Free of excessive litter or trash on school grounds. All school grounds clean, orderly, and in a sanitary condition. Vehicles not idling on school grounds. PARKING and NO PARKING areas clearly marked. Buses not idling on school grounds. Away from building outside air intakes. Loading/unloading zones clearly marked. Intact with no significant cracks, uneven pavement or other tripping hazards. Pedestrian walkways across roads, driveways and other areas open to vehicular traffic clearly marked. Grass mowed frequently enough so that only one third the height of the grass is removed at each mowing. Recycling containers clearly and properly labeled and conveniently located. Trash dumpsters located at least 25 ft. away from building exterior. Refuse containers equipped with tight-fitting lids. Refuse container lids kept closed. Problems/Comments Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Tuesday, November 22, 2005 Page 23 of 27 Area/Topic Subtopic
Playgrounds General Safety General Safety Playground Materials -Chromated Copper Arsenate (CCA) Playground Materials -Chromated Copper Arsenate (CCA) Playground Materials and Coatings Playground Materials and Coatings Protective Surfacing Fall Zones Fall Zones Fall Zones Swing Safety Swing Safety Swing Safety Assessment Action
Equipment structurally sound and in good overall condition. Students supervised by staff. Wooden decks or playground equipment treated with Chromated Copper Arsenate have been identified. CCA-treated decks and playground structures have been sealed within the past 12 months. Materials of construction to be non-toxic. Lead based paints not used. Depth of shock absorbing material appropriate for height of equipment and material used to absorb shock. Stationary equipment includes appropriate use zones. Appropriate fall zones for single and double axis swings. Appropriate platform heights on all slides. "S" hooks closed. Swing types conform to CPSC recommendations. Free of protruding mounting bracket bolts or other components on the suspended members of swing assemblies. No openings between 3.5" and 9" All equipment free of protrusion hazards. All equipment free of pinch, crush or shearing points. Playground free of tripping hazards. All equipment free of sharp points, edges and splinters. Guardrails on platforms and ramps. Problems/Comments Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Head Entrapment Protrusion Hazards Protrusion Hazards Tripping Hazards Sharp Points and Edges Guardrails Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Tuesday, November 22, 2005 Page 24 of 27 Area/Topic Subtopic
Outdoor Athletic Facilities Stadiums, Bleachers and Grandstands Stadiums, Bleachers and Grandstands Stadiums, Bleachers and Grandstands Stadiums, Bleachers and Grandstands Stadiums, Bleachers and Grandstands Relocatable/Portable Classrooms Specifications Commissioning Assessment Action
Any opening between seating components should prevent the passage of a 4" diameter sphere. Bleacher and guardrail components structurally sound and operational. Guardrails present on the backs and the open ends of bleachers where the footboard, seatboard, or aisle is 30 inches or more above the floor or ground level. Top rail of the guardrail located at least 42" above the leading edge of the footboard, seatboard, or aisle, whichever is adjacent. Any openings between, under or around guardrail components should prevent the passage of a 4" diameter sphere. Problems/Comments Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Purchasing specifications include provisions to ensure adequate ventilation and minimize pollutant sources. New portable/relocatable classrooms are occupied only after a commissioning period, during which HVAC and systems are tested and contaminants introduced during the manufacturing process are flushed out. School has on file a plan for testing, inspecting, and performing specific maintenance tasks for all relocatable/portable classrooms located on school grounds. Teachers and staff have received instruction on proper use and settings of thermostat and ventilation controls and each relocatable/portable classroom contains hardcopy (plastic-covered) instruction sheets. Yes / No / NA Yes / No / NA Operations and Maintenance Yes / No / NA Operations and Maintenance Yes / No / NA Tuesday, November 22, 2005 Page 25 of 27 Area/Topic Subtopic
Construction and Renovation Siting Assessment Action
The site selection process or decision to renovate/ expand existing building has taken into account community goals and needs. Smart Growth principles have been considered and integrated into the site selection process. ASTM Phase I site assessment completed before site acquisition. Pre-construction self-audit storm water environmental checklist has been completed. Pre-construction self-audit dredge and fill/wetlands environmental checklist has been completed. Pre-construction self-audit hazardous waste checklist has been completed. Pre-construction self-audit oil spill prevention checklist has been completed. Pre-construction self-audit hazardous substance (Superfund liability) checklist has been completed. Problems/Comments Yes / No / NA Siting Stormwater Dredge and Fill/Wetlands Hazardous Waste Oil Spill Prevention Hazardous Substances Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Yes / No / NA Polychlorinated Biphenyls (PCBs) Pre-construction self-audit polychlorinated biphenyls (PCBs) checklist has been completed. Asbestos Lead Paint Pre-construction self-audit asbestos checklist has been completed. If built prior to 1978, school has taken measures to ensure that applicable lead regulations as well as nonregulatory recommendations will be complied with prior to any renovation activity that may disturb paint. Recommendations in EPA's Indoor Air Quality Design Tools for Schools have been considered and integrated into the school renovation or construction design process. High performance goals (including superior indoor air quality) are included in new school construction specifications. Requirements for limiting all potential indoor air pollution sources are included in all pre-design, design and construction documents. HVAC system design provides for use of natural ventilation and/or energy recovery equipment, where appropriate, and ensures appropriate amounts of outside air are delivered to occupied spaces. Requirements for controlling moisture from precipitation, condensation, building materials, humidity, and building envelope migration are included in all pre-design, design and construction documents. Indoor Air Quality Yes / No / NA Indoor Air Quality Yes / No / NA Indoor Air Quality Yes / No / NA Indoor Air Quality Yes / No / NA Indoor Air Quality Yes / No / NA Tuesday, November 22, 2005 Page 26 of 27 Area/Topic Subtopic
Construction and Renovation Indoor Air Quality Indoor Air Quality Indoor Air Quality Radon -- Prevention Assessment Action
Requirements for 5-step walk-off mats at every building entrance included in design documents. Problems/Comments Yes / No / NA Indoor air quality construction management plan in place. Yes / No / NA Occupied classrooms and school facilities are isolated from construction areas. If renovation or construction is taking place in an area with a high potential for radon, radon resistant features have been incorporated into the building design. Key building systems (e.g., HVAC, building envelope, electrical, life safety) have been commissioned. Target Finder has been used to estimate energy performance and set goals during the design process. Yes / No / NA Yes / No / NA Commissioning Energy Management Yes / No / NA Yes / No / NA Signature: ___________________________________________ Print Name: __________________________________________ Tuesday, November 22, 2005 Page 27 of 27