ActivitiesCheclist10-11St

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    PROGRAM CONTACT PERSON LIST

    Asbestos Management........................................................Mitch Hoard

    AED.......................................................................................N/A

    AWAIR.....................................................................Sr. Kathy Kuchar

    Bleacher Safety......................................................................... N/A

    Bloodborne Pathogens..................................................Sr. Kathy Kuchar

    Community Right-to-Know............................................................N/A

    Compressed Gas Safety.................................................................N/A

    Confined Space Entry........................................................Mitch Hoard

    Emergency Action Planning..................................................Mitch Hoard

    Employee Right-to-Know/Hazard Communication......................Mitch Hoard

    Facilities Safety Management..........................................Sr. Kathy Kuchar

    First Aid/CPR ............................................................Sr. Kathy Kuchar

    Hazardous Waste Management........................................................N/A

    Hearing Conservation........................................................Mitch Hoard

    Indoor Air Quality.............................................................Mitch Hoard

    Integrated Pest Management...............................................Mitch Hoard

    Laboratory Standard/Chemical Hygiene Plan.......................................N/A

    Lead Management............................................................Mitch Hoard

    Lockout/Tagout ..............................................................Mitch Hoard

    Machine Guarding ............................................................Mitch Hoard

    Personal Protective Equipment............................................Mitch Hoard

    Playground Safety............................................................Mitch Hoard

    Radon Gas Safety.......................................................................N/A

    Respiratory Protection.................................................................N/A

    USTs/ASTs...............................................................................N/A

    Welding Cutting Brazing...............................................................N/A

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    Checklist of E/OHS Activities for Asbestos Management

    Program Contact Person: Mitch Hoard

    Is the Asbestos Management Plan in place? Yes No N/A

    Is the Plan current for all buildings? Yes No N/A

    Has the Plan (or Plans) been reviewed this school year? Yes No N/A

    The Plan is located at affected building: yes, principals office .

    Training for Asbestos Awareness was conducted: 3-26-07 .

    New PT employees received training on N/A .(date)

    Annual written notification has been prepared; fall, 2010 .

    (date)

    Notification appeared in the following publication(s):

    Name of publication DateFall newsletter fall, 2009

    Three-year re-inspection Surveillance was conducted: 5/25/2011 .

    6-month Periodic Surveillance was conducted: 3-26-07 10-3-2007(first date)

    10-08-08 5-27-2010(second date)

    All caution labels have been posted.Label locations:

    Are supplies of repair materials adequate to meet the requirements ofmaintenance and repair of ACM? Yes No N/A

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    Note: All repairs and removals are outsourced.

    Asbestos Maintenance Supplies on Hand

    Is documentation of Operations and Maintenance available?

    Location:

    Status of the Asbestos repair and maintenance Work Order System: N/AEstablished,

    PendingComments:

    Note: Click here to view asbestos reports

    http://opt/scribd/conversion/tmp/AsbestosFolderhttp://opt/scribd/conversion/tmp/AsbestosFolder
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    Checklist of E/OHS Activities for AWAIR

    Program Contact Person: Sr. Kathy Kuchar

    Is the AWAIR Plan in place? Yes No N/A

    Is the Plan current? Yes No N/A

    Has the Plan been reviewed this school year? Yes No N/A

    Is the Safety Committee organized? Yes No N/A

    How often are meetings held? Concurrently with the Building and GroundsCommittee.

    Are minutes of the meeting maintained?

    Location: Main office, Buildings and Grounds binder.

    Posted: Main office

    How is the program communicated to employees? Staff development meetings

    Who is the Contact Person for OSHA 300? Sr. Kathy Kuchar, OSB

    Is the OSHA 300A Log completed for the previous calendar year? No

    Have the Logs been maintained for five (5) years? No

    Location: Activity Manual

    Is the Log posted from February 1 until April 30? Yes,

    The location/s of the posted log: Main office and School Kitchen

    Is information on injuries recorded on the Log within five (5) working days? YesNo N/A

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    Safety Committee Meeting Schedule

    Date Location Time

    Parish Building and Grounds/ Safety Committee Members

    Member Position BuildingArt Heinze Parishioner Elementary (K-6)

    Fr. Rick Lambert Pastor-Superintendent

    Elementary (K

    Dan Baumgarter Parishioner Elementary (K

    Mitch Hoard Head Custodian Elementary (K

    Sr. Kathy Principal Elementary (K-6)

    Hillary Stoltman Parishioner Elementary (K

    Jim Fisher Parishioner Elementary (KBernie Huot Parishioner Elementary (K

    Joan Lubitz Parishioner Elementary (K

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    Checklist of E/OHS Activities for Bloodborne Pathogens

    Program Contact Person: Sr. Kathy Kuchar

    Is the Bloodborne Pathogens Written Plan in place? Yes No

    Has the Plan been reviewed this school year? Yes No

    List job categories that may be at risk to exposure: All-staff are considered atrisk of coming in contact bodily fluids.

    What is this schools policy regarding Hepatitis B vaccinations for employeesconsidered at risk versus employees considered not at risk in the ExposureControl Plan? Staff may use their wellness benefits through Blue Cross & BlueShield to receive the vaccination series.

    Is training provided at this school on methods and techniques to reduceexposure incidents? Training is provided during all-staff development dayseither by use of a video tape or hired consultant.

    New Employees: Trained during fall staff development days.

    Have the employees identified as first aid responders been given at a minimumRed Cross First Aid Training? Yes No N/ANote: Those that wished , went for a refresher course at Northwest MedicalCenter, fall, 2006.

    Are Exposure Control Kits available to staff? Yes No N/A

    Location(s): In each classroom and the Main Office.

    Status of Declination forms:

    How is blood or bodily-fluid-containing materials handled at this facility?

    Policy regarding cleanup: Custodians are considered first to respond toevents. Only in the absence of custodial staff are teaching staff required toclean spills.

    Location of biohazard bags at school: Each classroom and Main Office

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    Approved disposal location for biohazard waste:

    Note: Training was completed in10 October 2010 conducted by Lee Carlson

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    Checklist of E/OHS Activities for Confined Space Entry

    Program Contact Person: Mitch Hoard

    Is the Confined Space Entry Plan in place? Yes No N/A

    Is the Plan current? Yes No N/A

    Has the Plan been reviewed this school year? Yes No N/A

    Have confined space areas been identified? Yes No N/A

    Have measurements to include CCI/ft been completed? Yes No N/A

    Are permit entry forms in place? Yes No N/A

    Location: Activity Manual

    Are confined space labels in the proper locations? Yes No N/A

    Is a list of employees eligible to enter confined spaces complete? Yes No N/A

    Has training for affected employees completed? Yes No

    Date of completion: 5/25/11

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    Confined Space Inventory

    Building: St. Bernards School

    Building Contact: Mitch Hoard Program Contact: Lee Carlson

    Completed By: _Lee Carlson Date: 5/25.2011

    RoomIdentificationName Given Space

    OpeningDimension

    DimensionOf ConfinedSpace

    PotentialHazards

    Permit/Non-Permit

    Labeled PhotoID #

    Mens lavatory 3X2 12X24X12 Limited entry Non-Permitrequired

    NoPipe chase(basement)Janitors closet 24X30 20X3X80 LE, Asbestos. Non-

    Permitrequired

    No

    Pipe Chase1st floorcustodialElevator pit 7X3 4X8X8 Entrapment,

    energy,Permitrequired

    No

    1st Floor

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    Checklist of E/OHS Activities for Emergency Action Planning

    Program Contact Person: Sr. Kathy Kuchar

    Is the Emergency Action Planning program in place and as outlined in theMinnesota Executive Order 93-27 and Model Crisis Management Plan? Yes No

    Is the Plan current? Yes No

    Has the Plan been reviewed this school year? Yes No

    Are information maps posted to indicate travel routes in the event of fire,tornado shelter locations, and procedures during lockdown? YesNo

    Located where? Maps are located in each classroom.

    Are all drills timed and recorded? Yes No

    Responsible person: Sr. Kathy Kuchar

    Location of records: Main Office Activities Manual

    Forms provided: Yes No

    Does this school coordinate drills with local government authorities to assuresheltering in school, evacuating to their homes or use of congregate carecenters? Yes No N/A

    Has this school completed the Fire Marshall required Fire Safety and EmergencyEvacuation Plan? Yes No N/A

    Training provided for affected staff? Yes No N/A

    Note: Training is typically provided during staff development days.

    Sr. Kathy reviews and updates the plan annually. The Plan is included in thestaff handout provided at the beginning of the year.Fire drills and lockdowns are recorded in the Activities manual. They havebeen completed for 2010-2011 school year.

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    Checklist of E/OHS Activities for Employee Right-to-Know/HazardCommunication

    Program Contact Person: Mitch Hoard

    Is the Employee Right-to-Know/Hazard Communication Plan in place? Yes No

    Is the Plan current? Yes No

    Has the Plan been reviewed this school year? Yes No

    Has the chemical inventory been completed for the following functional areas?

    Location of Chemical InventoryForm

    Art Instruction Yes No N/A

    Custodians Yes No N/A Main Office

    Food Service Yes No N/A Kitchen office/Main Office

    Science Rooms Yes No N/A

    Shop (metals, wood, auto) Yes No N/A

    Are MSDS available and located with the chemical inventory? Yes No

    Do the MSDS concur with the chemical inventory? Yes No

    Has training been provided for the following staff?

    Art Instructors Yes No N/A Science Yes No N/A

    Custodians Yes No N/A Shop Yes No N/A

    Food Service Yes No N/A Transportation Yes No N/A

    Click here to view chemical inventory.

    http://opt/scribd/conversion/tmp/ChemicalInventoryTRhttp://opt/scribd/conversion/tmp/ChemicalInventoryTR
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    Checklist of E/OHS Activities for Facilities Safety Managementand Fire Safety in Schools

    Program Contact Person: Sr. Kathy Kuchar

    Is the Facilities Safety Management program in place? Yes No

    Does this school use contracted services for the Management AssistantProgram? Yes No N/A

    If no, who is the designated person or persons? Lee Carlson

    Fire and Life Safety in Schools

    Program Contact Person: Sr. Kathy Kuchar

    Is the Fire Marshal approved Emergency Evacuation Plan in place for eachdistrict building? Yes No

    Most recent date of sprinkler electronics inspection:_________ N/A

    Most recent date of alarm inspection: Jan, 2010_______ N/A

    Most recent inspection of fire extinguishers: Jan, 2010___________ N/A

    Most recent inspection of fume hoods with fire suppressant:________ N/A

    Are emergency lights tested at least biannually? Yes No N/A

    Science safety Checklist completed? Yes No N/A

    Note: There is no fire suppression system in the fume hoods located in thebasement kitchen. No grease laden foods are cooked in that area. The buildingdoes not have a sprinkler system.

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    Facilities Safety Review

    Building: St. Bernards Parochial School

    Mock-OSHA ReviewArea

    Date ReviewCompleted N/A Recommendations

    Art X

    Dark Room X

    Wood Shop X

    Kitchen 5-25-2011 See Facility Safety Report and photos

    Metal Shop X

    Halls, Gym, etc. 5-25-2011 See Facility Safety Report and photos

    Graphic Arts X

    Maintenance/Custodial

    5-25-2011 See Facility Safety Report and photos

    Transportation X

    Grounds/Garage 5-25-2011 See Facility Safety Report and photos

    Chemistry/LifeScience

    X

    http://opt/scribd/conversion/tmp/FacilitySafetyhttp://opt/scribd/conversion/tmp/FacilitySafety
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    Checklist of E/OHS Activities for First Aid/CPR

    Program Contact Person(s): Sr. Kathy Kuchar

    Is the First Aid/CPR program in place? Yes No

    Is the Plan current? Yes No

    Has the Plan been reviewed this school year? Yes No

    Has the District determined a provider in the event of a medical emergency?Yes No

    The local provider determined travel time was estimated to be within the 4-8minute limit. Therefore Dakota Clinic/Hospitals, ALTRU will be the

    designated emergency response provider.

    The local provider determined travel time was estimated to be in excess of the4-8 minute limit. Therefore N/A will be thedesignated emergency response person located within the district.

    Has training been provided for affected staff? Yes No

    Note: Voluntary training is received at Northwest Medical Center.

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    Checklist of E/OHS Activities for Indoor Air Quality

    Program Contact Person: Mitch Hoard

    Is the IAQ Plan in place? Yes No

    Is the Plan current? Yes No

    Has the Plan been reviewed this school year? Yes No

    Has an IAQ Committee beenestablished?

    Have the program and goals been approved by the School Board for the current

    school year? Yes No

    Has the annual cursory walk-through been conducted? Yes No

    Havethedistrictskeybuilding systems been evaluated? Yes No

    When was the evaluation completed?

    Who conducted the evaluation?

    Wereoccupied areas of the district evaluated using the EPAs Tools For Schoolscheck list or equivalent?

    Teachers check list? An information fact sheet was provided all staff.# of forms distributed # of Forms returned:

    Building maintenance checklist?

    Building ventilation checklist?

    Training conducted(date)

    Training has been scheduled for _______________. (date)

    Has the District determined the mechanical ventilation rate of each occupiedspace? Yes No.

    Supportive technical services were conducted on: _Feb, 2010_______. (date)

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    Results of technical services are located? __Click here to view ________

    Checklist of E/OHS Activities for Integrated Pest Management

    Program Contact Person: Mitch Hoard

    Is the IPM Plan in place? Yes No

    Is the Plan current? Yes No

    Has the Plan been reviewed this school year? Yes No

    Has the annual monitoring been conducted to determine location and degree ofinfestation? Yes No

    A map of the problem area/areas has been developed. Yes No

    Has notice been given to parents regarding application activities? Yes No

    Location or publication used to notify parents__________________________.

    http://opt/scribd/conversion/tmp/IAQReportLetterStBer2010.dochttp://opt/scribd/conversion/tmp/IAQReportLetterStBer2010.doc
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    Checklist of E/OHS Activities for Lead-in-Water Management

    Program Contact Person: Sr. Kathy Kuchar

    Is the Lead-in-Water Management Plan in place? Yes No

    Is the Plan current? Yes No

    Has the Plan been reviewed this school year? Yes No

    This school completed testing of water supply taps __3-14-03.(date)

    Is a map of all potable water taps available for review? Yes No N/A

    Checklist of E/OHS Activities for Lead-in-Paint Management

    Program Contact Person: Sr. Kathy Kuchar

    Is the Lead-in-Paint Management Plan in place? Yes No

    Is the Plan current? Yes No

    Has the Plan been reviewed this school year? Yes No

    Testing for lead in paint on playground equipment: Note: All playgroundequipment has been replace with lead free.

    Date completed: N/A

    Yet to be tested: N/A

    Results of evaluation for paint condition in rooms K-1:Building constructed post-1978; facility not applicableBuilding constructed prior to 1978; paint determined to be in

    ___good___________ condition

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    Checklist of E/OHS Activities for Lockout/Tagout

    Program Contact Person: Mitch Hoard

    Is the Lockout/Tagout Plan in place? Yes No N/A

    Is the Plan current? Yes No N/A

    Has the Plan been reviewed this school year? Yes No N/A

    Is LO/TO equipment available? Yes No N/A

    Is the equipment appropriate for application? Yes No N/A

    If available, where is the equipment located? _________________________

    Is the equipment maintained in an orderly and readily usable condition? Yes NoN/A

    Have affected personnel been trained as to methods and technique of use? YesNo N/A

    Are written procedures available for affected staff? Yes No N/A

    If available, the procedures are located where? Activities Manual

    Has the annual audit of energy control procedures been completed? Yes No

    Date or dates of completion:

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    Checklist of E/OHS Activities for Machine Guarding

    Program Contact Person: Mitch Hoard

    Is the Machine Guarding Plan for each affected work area in place? Yes No

    Is the plan/plans current? Yes No

    Has the Plan been reviewed this school year? Yes No

    Has a survey of all district fixed equipment been conducted?Yes No

    When was the evaluation completed? 5-27-2010

    Who conducted the evaluation?

    How are corrections documented? ------------------------

    Is all fixed equipment safeguarded to meet OSHA criteria? Yes No

    Has the alternative MDE best practices criteria used to safeguard equipment?Yes No

    Has equipment determined not in compliance scheduled for repair orreplacement? Yes No

    If replaced, was best practices, bid specification criteria used forprocurement? Yes No N/A

    Note: Only one stationary tool was located during the survey. The stationarygrinder should be maintained with guarding in place. LC 5-27-2010

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    Checklist of E/OHS Activities for Playground Safety

    Program Contact Person: Mitch Hoard

    Is the Playground Safety program in place? Yes No

    Is the Plan current? Yes No

    Has the Plan been reviewed this school year? Yes No

    Surfacing:

    The equipment has adequate protective surfacing under and around itand the surfacing materials have not deteriorated

    Loose-fill surfacing materials have no foreign objects or debris

    Loose-fill surfacing materials are not compacted and do not havereduced depth in heavy use areas such as under swings or at slide exits

    Note: Pea rock was noted thin in some locations 5-13-08General Hazards:

    There are no sharp points, corners, or edges on the equipment

    There are no missing or damaged protective caps or plugs

    There are no hazardous protrusions and projections

    There are no potential clothing entanglement hazards, such as open S-hooks or protruding bolts

    There are no pinch, crush, and shearing points or exposed moving parts

    There are no trip hazards, such as exposed footings on anchoringdevices and rocks, roots, or any other environmental obstacles in theplay area

    Deterioration of the Equipment:

    The equipment has no rust, rot, cracks, or splinters, especially whereit comes in contact with the ground

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    There are no broken or missing components on the equipment (e.g.,handrails, guardrails, protective barriers, steps, or rungs on ladders)and there are no damaged fences, benches, or signs on the playground

    All equipment is securely anchored

    Security of Hardware:

    There are no loose fastening devices or worn connections, such as S-hooks

    Moving components, such as swing hangers or merry-go-round bearings,are not worn

    Drainage:

    The entire play area has satisfactory drainage, especially in heavy useareas such as under swings and at slide exits

    Leaded Paint:

    The leaded paint used on the playground equipment has notdeteriorated as noted by peeling, cracking, chipping, or chalking

    There are no areas of visible leaded paint chips or accumulation oflead dust

    General Upkeep of Playgrounds:

    The entire playground is free from miscellaneous debris or litter suchas tree branches, soda cans, bottles, glass, etc.

    There are no missing or full trash receptacles

    Note: the playground was checked on 5-14-08 and found to meet standards ofthis program.

    The playground has a very thin layer of pea rock in some locations. I

    recommend that retaining barriers be provided and additional rock be added.LC 5-27-2010The playground was reviewed on this date and found to be in good condition.Lee Carlson 5/25/2011

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