ActivitiesCheclisto7-08_2

8/4/2019 ActivitiesCheclisto7-08_2

1/41

Checklist of E/OHS Activities for Automatic External Defibrillator

Program Contact Person: Carol Loch

School policy for use adopted in place? Yes No N/A

Brand of AED? Phillips Heart Smart Model # M5066A-ABA

Name of Medical Director? The device was purchased through the HutchinsonMedical Clinic. It is assumed the Medical Director of the clinic would serve inthat capacity.

Year device was placed into use? 2006

Location(s) of devices:Building Name Location in Building

West Elementary Foyer above fire extinguisherPark Elementary Hall by main office near water

fountain

Middle School (1)Hall by office/(2) Auditorium

High School (1)Foyer/ (2)wrestling room

Have all software updates been installed? Yes No N/A

Date of update installation: Winter 2007-2008

Expiration date of pads? 4-2008

Expiration date of batteries? 08-20(date)

Has staff been trained on operation of the device? Yes, all school nurses andEmergency responders are trained biannually.

Most recent date of training:2006(date

Provider of training: Carol Loch

Location of operators manual: School nurse office and one at each building

Are battery checks documented? Yes, a check list is available at each AEDstationNotes: The AEDs were purchased by the local medical clinic. The effort wascoordinated between the PTO and the clinic.


2/41

Checklist of E/OHS Activities for Asbestos Management

Program Contact Person: Jo Pyle

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: the original plans along with updatesare located at each building_.

Training for Asbestos Awareness was conducted 3/3/06 .

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

Annual written notification has been prepared; Fall of 2007 .

(date)

Notification appeared in the following publication(s):

Name of publication DateSpotlight August 2007

Three-year re-inspection Surveillance was conducted: 7/12/07.

6-month Periodic Surveillance was conducted: 5/07(first date)

11/07(second date)

All caution labels have been posted.Label locations: Boiler room tunnels

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


3/41

Asbestos Maintenance Supplies on Hand

Bags Glove bags 6 mil

sheeting

Respirators Respirator

filters

Is documentation of Operations and Maintenance available?

Location: Yes

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

Comments:All repairs are outsourced. Repair materials are notroutinely used.

**For information regarding the medical review and questionnaire, see theRespiratory Protection Program. **


4/41

Checklist of E/OHS Activities for AWAIR


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?Attempt quarterly

Are minutes of the meeting maintained?

Location: teachers work rooms

Posted: District office

How is the program communicated to employees?All staff developmentmeetings

Who is the Contact Person for OSHA 300?Jeanette H.

Is the OSHA 300A Log completed for the previous calendar year? Yes

Have the Logs been maintained for five (5) years? Yes

Location:Jeanettes office and the Activities Manual

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

The location/s of the posted log: Staff lounges

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


5/41

Safety Committee Meeting Schedule

Date Location Time

.

.

District Safety Committee Members

Member Position Building


6/41

Checklist of E/OHS Activities for Bleacher safety


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



Has an annual survey of school bleachers been conducted? Yes No N/A

Is the five-year recertification required by December 31, 2007 complete andsubmitted to the Minnesota Department of Labor and Industry? Yes No N/A

Openings and gaps:

Openings limited to four-inch gap between the railings and between the footboardsand seat boards, starting at a height of 56 inches or more.

Retractable bleachers:

They may contain openings of 9 inches or less

If exempt from standards must have a safety management plan in place and anamortization schedule to plan for their future replacement

Approved netting:

Netting may be provided to prevent persons from falling through the bleachersbetween the seat and footboards

Chain link fencing may be used but must be secured tightly to the underside of thebleachers.

Railings:

Bleachers 55 inches and under are exempt from railing requirements

Bleachers with guardrails over 30 inches above grade must not contain openingsgreater than four inches, unless safety nets are installed.State building inspectors shall determine whether the safety nets and guardrail climbability meet the requirements of the alternate design section of the State Building

Code.

Periodic inspections:

Bleacher footboards and guardrails must at a minimum be reinspected at least everyfive years and a structural inspection at least every ten years. The equipment has norust, rot, cracks, or splinters, especially where it comes in contact with the ground


7/41

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 damagedfences, benches, or signs on the playground


8/41

Checklist of E/OHS Activities for Bloodborne Pathogens

Program Contact Person: Mary Carter

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:School nurse Playground supervisorCustodians ArtSecretaries Industrial ArtsBus drivers Special edCoaches

What is this schools policy regarding Hepatitis B vaccinations for employeesconsidered at risk versus employees considered not at risk in the ExposureControl Plan?All staff are given the opportunity to receive the 3 part HBVvaccine at no cost.

Is training provided at this school on methods and techniques to reduceexposure incidents?Annual training is provided by the school nurse.

New Employees: _within ten days of employment____

Have the employees identified as first aid responders been given at a minimumRed Cross First Aid Training? Yes No N/A

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

Location(s): all rooms are provided kits

Status of Declination forms: the forms are maintained by the school nurse

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

Policy regarding cleanup: Custodial staff routinely clean up all fluid spills.


9/41

Location of biohazard bags at school: Nurses office

Approved disposal location for biohazardous waste: Tracy Hospital


10/41

Checklist of E/OHS Activities for Compressed Gas Safety

Program Contact Person(s) Jo Pyle

Department Contacts:

Maintenance Jo Pyle

Metals Shop John Lanoue

Industrial Tech. John Lanoue

Bus Garage Bob Bruder

Is the Compressed Gas Plan in place? Yes No N/A



Has the facility been surveyed for compressed gas inventories? Yes No N/A

Has training been conducted for affected personnel? Yes No N/ADate: summer 2008

Are records established/maintained to monitor gas inventory? Yes No N/A


11/41

COMPRESSED GAS FIELD REVIEW

Compressed Gas Inventory

Date: Feb. 13, 2008 Program Contact Person : Lee Carlson

Department: Metals Shop Department Responsible Person: Paul Skoglund

Location: Metals Shop Room

Cylinders: O2 ___(5)_________ Acetyl _(2)___________

NH4 ____________

CO2 __(4)__________ Argon __(2)__________

Argon/CO2__(5)__________ Other( helium) __(1)__________

Compliance Check List

No Yes1. Are cylinders in well-ventilated area? X

2. Are cylinders stored separate from flammable by at least 20feet?

X

3. During storage are oxygen cylinders separated from fuel gas

cylinders, unless on welding cart?

X

4. Are cylinders kept away from sources of heat (below 130 F)? X

5. Are safety chains used at all times on both full and emptycylinders? (2/3rds from top of cylinder)

X

6. Are empty cylinders maintained separate from full cylinders? X

7. Are cylinders kept away from sources of ignition such aselectricity,excessive heat or oily rags?

X

8. Are carts designed specifically for gas cylinders available? X

9. Are damaged cylinders, valves/hoses removed from service? X

10. Are all cylinders properly labeled with the contents? X


12/41

Checklist of E/OHS Activities for Confined Space Entry


Is the Confined Space Entry Plan in place? 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: Activities 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: 2/25/05

Note: Confined space entry at this school is limited to licensed contractorsonly.


13/41

Confined Space Inventory

Building: Tracy High School

Building Contact: Jo Pyle Program Contact: Lee Carlson

Date: 2-13-08

RoomIdentificationName GivenSpace

OpeningDimension

DimensionOf Confined

Space

Potential

HazardsPermit/Non-Permit/Alternate

Labeled PhotoID #

Boiler room 18 7X3X3.5 Ele.O2, Heat Permit Yes

Boiler #1Boiler Room 18 7X3X3.5 Ele.O2, Heat Permit Yes

Boiler #2

Boiler Room 4X15 100X15X4 Heat,electricity

Non-permit Yes

Tunnel


14/41

Checklist of E/OHS Activities for Community Right-to-Know


Is the Community Right-to-Know Plan in place? Yes No N/A



Are quantities of stored and used designated hazardous materials documentedand verified? Yes No N/A

Where are the documents stored? Custodial office /Activities Manual

Have the State Emergency Response Commission and local fire departmentbeen notified of hazardous materials on school grounds? Yes No N/A

When were they notified? Winter, 2006(date)

Has training been provided? Yes No N/A

Date: 2/25/05

Presenter: Steve Musser


15/41

Inventory Form

Client: Tracy Public Schools

Contact Person: Jo Pyle Date:2-13-08

HazardousMaterial Quantity Location

Reported onTier Two

InstallationDate(s)

#2 Fuel Oil 10,000 gal High School YesMid90s

#2 Fuel Oil 10,000 gal Elementary Yes02


16/41

Checklist of E/OHS Activities for Emergency Action Planning

Program Contact Person: Chad Anderson

Is the Emergency Action Planning program in place and as outlined in the

Minnesota Executive Order 93-27 and Model Crisis Management Plan? Yes No

Is the Plan current? Yes No


Have the program and goals been approved by the School Board for the currentschool 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: Chad Anderson, High School, Scott Lesley,Elementary School

Location of records:At the principals respective offices_______________

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


17/41

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


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



Has the program been approved by the School Board for the current schoolyear? 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 Board room/ Custodial office

Food Service Yes No N/A Lead cooks desk

Science Rooms Yes No N/A Lab prep room

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


18/41

Checklist of E/OHS Activities for Facilities Safety Managementand Fire Safety in Schools


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?

Fire and Life Safety in Schools


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_________ N/A

Most recent inspection of fire extinguishers__8-30-07__________ N/A

Most recent inspection of fume hoods with fire suppressant__9-06______ N/A

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

Science safety Checklist completed? Yes No N/A


19/41

Facilities Safety Review

Building:

Mock-OSHA ReviewArea Date ReviewCompleted N/A Recommendations

Art

Dark Room

Wood Shop

Kitchen

Metal Shop

Halls, Gym, etc.

Graphic Arts

Maintenance/Custodial

Transportation

Grounds/Garage

Chemistry/Life Science

Fire and Life Safety Checklist

ARTX Emergency phone numbers posted and MSDS availableX Flammable liquids and combustibles stored properly

COMPRESSED GASX Cylinders chained in place so they cannot fall overX Valve covers in place when cylinder not in use

SPRAY BOOTH


20/41

X Fire control sprinkler heads kept cleanX Mechanical ventilation provided when spraying is done in enclosed areaX NO SMOKING signs posted in spray areas, paint rooms, booths, and storageX Spray area at least 20 from flames, sparks, operating electrical motors

BOILER ROOMX Fire extinguisher mounted and accessibleX No combustibles stored in boiler roomX Two exits

CORRIDORS, ENTRANCES, STAIRSX All decorations, artwork in corridors limited to 25% of wall surfaceX All EXIT corridors and hallways free of obstructionsX All EXIT doors open in the direction of exit without effortX All EXIT doors posted as exits with letters 5 high and wide

X All EXIT signs visible and with working lights, if lightedX Appropriate fire extinguishers are mounted within 75 of outside areas

containing flammable liquids and within 10 of any inside storage area forsuch materials

X Buildings over two levels have doors that close automatically in stair towerX Fire extinguishers free from obstruction or blockageX Fire extinguishers provided for the types of materials in the area whereused

Class A Ordinary combustible material firesClass B Flammable liquid, gas, or grease firesClass C Energized-electrical equipment fires

X Fire extinguishers serviced, maintained, and tagged every yearX No dead-end corridor >20X Non-exit doors, passages, and stairways labeled, NOT AN EXITX Panic hardware on all exit doors and rooms with occupancy of 50 or moreX Sprinkler heads protected by metal guards, when exposed to physicaldamage

ELECTRICALX Extension cords used for permanent wiringX 36 clear access to all electrical control panels for emergency shutdown

EXTERIORX Dumpsters stored at least 5 from any combustible buildings, doors, and

windows

GYM


21/41

X Stage curtain must be flame retardant

HOME ECX Outlets within 6 of a water source must be GFC

KITCHENX Exhaust hood, ducts, and filters clear of any grease accumulation

X Fire extinguisher within 30 of cooking equipment (min. 40BC)X Hood with auto fire extinguishing system inspected every 6 monthsX Means to shut off gas supply to the cooking equipment for emergencyX MSDS availableX Outlets within 6 of a water source must be GFC

SCIENCE LABSCHEMICALSX Chemicals stored in open lab work area kept to a minimumX Neutralizing chemicals and spill kits readily available

FIRE SAFETYX Aisles serving work areas on 2 sides at least 42 wide; those serving workareas on one side only must be 36X Flammable liquids stored in refrigerated equipment in closed containersX Flammable/combustible liquids and chemicals must not be stored in fume

hoods or on the floor, except in original containerX Refrigerators, freezers, or coolers that store or cool flammable liquids must

be of explosion-proof construction and properly labeledX 2A-20BC or larger rated fire extinguisher for each 3,000 feet of lab; travel

distance must not exceed 50 from anywhere in room

STORAGEX Acids stored in approved cabinetsX Chemical storage area must have inventoryX Chemical storage area properly ventilatedX Chemicals properly labeled

X Chemicals stored in approved containers (original shipping package)X Flammable liquids stored in approved cabinetsX Shelves used for chemical storage should have lip or guard to prevent

chemicals from falling offX Storage cabinets and rooms locked against unauthorized entry

VENTILATION


22/41

X Hood tested every yearX Lab hoods achieve 100 lfmX Means provided for manually shutting down ventilation equipment

STORAGE ROOMSX Room used for storage of combustibles must have 1-hour fire-rated walls

(sheet rock or plaster) and fire-rated doors (or solid core 1.75 thick wooddoors) with self-closer (or automatic fire sprinklers in them)

TECHNICAL LAB AREASX Compressed gas cylinders (oxygen, acetylene, propane, etc.) secured so

they cannot fall overX Emergency stop buttons colored red

X Fire extinguishers located within 30 of hazardous processes (painting,welding, and woodworking)mounted and inspectedX Flammable liquids stored in approved cabinetsX Oil-soaked, greasy, or paint-soaked rags stored in metal containers with lidsX Solvent wastes and flammable liquids are kept in fire-resistant, covered

containers until they are removed from the worksiteX Worksite clean and orderly with clear paths to exit

Completed by ___________________________Date


23/41

Checklist of E/OHS Activities for First Aid/CPR

Program Contact Person(s): Mary Carter

Is the First Aid/CPR program in place? 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 Tracy Ambulance will bethe 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: Training is provided alternative years. One year is dedicated to first-aidand the next to CPR.


24/41

Checklist of E/OHS Activities for Hazardous Waste Management

Program Contact Person(s)

Primary Contact Person: Jo Pyle

Secondary Contact Person: Richard Hanson

Is the Hazardous Waste Management program in place? Yes No




Did this school generate ten gallons of waste per year? Yes No

Note: In Greater Minnesota, schools generating ten gallons of waste per year orless do not need a license.

Did this school generate 220 pounds or less per month hazardous waste (about drum or less liquid)? Yes No

Note: Wastes that do not count include antifreeze, cathode ray tubes,fluorescent lamps, lead acid batteries, pcb ballasts, photo fixer reclaimed onsite, used oil and oil filters.

Training for VSQGs do not have training requirements however MPCA stronglyrecommends persons handling wastes be given training on best handling andsafety risks associated.Has training been provided for affected persons? Yes No N/A

Date Conducted: N/A

Date Scheduled: N/A

Has annual report and license application sent in? Yes No N/A


25/41

Checklist of E/OHS Activities for Hearing Conservation


Is the Hearing Conservation Plan in place? Yes No



Has the program been approved by the School Board for the current schoolyear? Yes No

Has the school been surveyed for noise hazards? Yes No

Have sound level measurements been collected? Yes No

Have the results been documented? Yes No

Location: Activities Manual

Has training been scheduled or completed for affected individuals this schoolyear? Yes No N/A

Date:

Presenter:

Have regulatory changes occurred that may affect this program? No


26/41

Checklist of E/OHS Activities for Indoor Air Quality


Is the IAQ Plan in place? Yes No



Has an IAQ Committee beenestablished? Yes No


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

Havethedistrictskeybuilding systems been evaluated? Yes No

When was the evaluation completed? Aug, 1999

Who conducted the evaluation? MacNeil Environmental

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

Teachers check list? An information fact sheet was provided all staff.# of forms distributed 30 # of Forms returned: 30

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: May 15, 2000. (date)

Results of technical services are located? Activities manual


27/41

Checklist of E/OHS Activities for Integrated Pest Management


Is the IPM Plan in place? 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: Spotlight, Aug, 2007.


28/41

Checklist of E/OHS Activities for Laboratory Standard/ChemicalHygiene Plan

Program Contact Person: Monica Headlee , CHO

Is the Laboratory Standard/Chemical Hygiene Plan in place? Yes No N/A



Fume hood was tested on _______________.(date)

The results indicate air velocity to be: satisfactory, unsatisfactory.

Chemical inventory:

Date of most recent survey: fall, 2007

Location of inventory listing: Chemistry lab

Are Material Safety Data Sheets (MSDSs) located with inventory? Yes No N/A

Are the MSDS readily accessible? Yes No N/A

Has the DCFL Science Lab Checklist been completed? Yes No N/A

Is training for affected personnel complete? Yes No N/A

Date(s) of instruction:

Roster signed? Yes No N/A

Lesson plan outline available with roster? Yes No N/A

Status of Emergency Eye Wash/Deluge Shower:

Is flushing conducted weekly? Yes No N/A

Is descriptive signage properly posted? Yes No N/A

Is flushing activity documented? Yes No N/A


29/41

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


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



This school completed testing of water supply taps _7/13/2000.(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


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



Testing for lead in paint on playground equipment: Note: All playgroundequipment has been replaced 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


30/41

Checklist of E/OHS Activities for Lockout/Tagout


Is the Lockout/Tagout Plan in place? 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? Custodial office

Is the equipment maintained in an orderly and readily usable condition?Yes No N/A

Have affected personnel been trained as to methods and technique of use?Yes No 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:


31/41

Checklist of E/OHS Activities for Machine Guarding

Program Contact Person: Jo Pyle/Mike Peterreins

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

Is the plan/plans current? Yes No


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

When was the evaluation completed?_______________________

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


32/41

Identified Fixed Equipment Locations

Location Building/Buildings Staff Affected # of itemAutomotive ShopWood Shop

Custodial/Maintenance

Welding Shop

Ag Shop

Bus Garage

Art

Scene shop

Science

Contracted technical services to review and recommend?__________________.

Name of person or contractor conducting survey? ___________________.(date)

Results of technical services located where? ________________________

Checklist for minimum requirements:

Power outage protection provided for required equipment

Emergency stops provided for required equipment

Safe work practice placards at applicable fixed tool stations

Proper guards provided and used

Color coding as prescribed by OSHA standards

Non-slip surfaces by each piece of equipment

Fixed equipment secured to prevent walking or movement

Has a log of employee accidents and near misses been established and used?

Yes No

Annual training for affected staff is provided? Yes No

Training conducted ____________. (date)

Training has been scheduled for ____________.(date)


33/41

Checklist of E/OHS Activities for Playground Safety


Is the Playground Safety program in place? 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

General 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


34/41

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


35/41

Checklist of E/OHS Activities for Personal Protective Equipment


Is the Personal Protective Equipment Plan in place? Yes No N/A



Has a survey of potential workplace hazards been completed? Yes No N/A

Date(s) activity was conducted:__________________________

Have recommendations been completed for appropriate equipment? Yes No

Has training been completed for the following departments?

Art and Photo Yes No N/A

Custodial Yes No N/A

Grounds keeping/Garage Yes No N/A

Kitchen Yes No N/A

Maintenance Yes No N/A

Science Laboratories Yes No N/A

Technical Education Yes No N/A

Transportation Yes No N/A


36/41

Personal Protective Equipment AssessmentBuilding: High School_______

Location:Kitchen

Location:Boiler room

Location:Maintenance

Location:Tech Shop

Location:ScienceRooms

Employee: Employee:Jo Pyle

Employee:Joe Pyle

Employee:PaulSkoglund,MikePeterreins

Employee:MonicaHeadlee,JacobScandrett

Hand

Hot Glove X X X XLatex

Vinyl XLeather X XNeoprene X X

Face

Impact X X X

Splash X X XShieldRespirator X

EarMuffs X XPlugs

BodyNeo Apron X X XDenim X

FootSteel Toes XMetatarsal

Head Hard Hat X

Hazard(s)

Chemicals,

scaldingwater, heat,Knives,

Chemicals,

scaldingwater, heat,hotenvironment,body fluids

Chemicals,

electricity,heat

Body fluids,impact

body fluids,

gascylinders,

heat, impact

body fluids,

chemicals,open flame,

Comments onAvailability,Condition, &Storage

.

Completed by __Lee Carlson______________Date 3-25-2008


37/41

Checklist of E/OHS Activities for Respiratory Protection


Does this school provide respirators for voluntary use? Yes No N/AIf the school allows employees to use respirators voluntarily the following ismandatory.

1. Read and follow instructions provided by manufacturer.2. Choose respirators certified for use against contaminants of concern.3. Do not wear respirators in atmospheres containing contaminants not

designed to protect from those contaminants.4. Keep track of respirators so that you do not mistakenly wear someone

elses respirator.

Is the Respiratory Protection program in place? Yes No N/A



Date of review: __2-13-08_____________

Are all employees in this program identified? Yes No N/A

Employee IntendedUse Type ofRespirator Medical Exam/Questionnaire Date ofMedical Date ofFit Test

Jo Pyle Misc.voluntary

mask N/A N/A N/A

Fit testing was completed on N/A.(date)

Type of testing protocol; Irritant Smoke (Stannic Chloride) orBitrex (Denatonium Benzoate)


38/41

Condition and location of respirators:

Condition:____new__________

Location(s):__custodial area__________________

Are the appropriate adequate accessories on hand? Yes No N/A

Verified by: Lee Carlson

Note: The respirators were checked on 3-25-2008 and found to be in like newcondition. The respirators are located in the gray cabinet in the boiler room.

The particulate filters are also located in the same area. LC


39/41

Checklist of E/OHS Activities for Underground and AbovegroundStorage Tanks


Is the Underground and Aboveground Storage Tanks Plan in place? Yes No



Have forms for inventory tracking been provided? Yes No N/A

Do existing records accurately reflect purchase use correlation? Yes No N/A

Are all USTs registered with the Minnesota Pollution Control Agency? Yes NoN/A

Are removals or additions of tanks anticipated in this facility? Yes No N/A

Notes:


40/41

Underground/Aboveground Storage Tank Status

Tank No. Location Size Contents Registered Install date

#1 Bus garage 1000 gal #2 diesel fuel ? 2006

#2 Bus Garage 400 gal gasoline ? 2006

#3 High School 10,000 gal #2 fuel oil Yes 1995?

#4 ElementarySchool

10,000 gal #2 fuel oil Yes 2002

Regulated Tanks:Motor fuel tanks larger than 110 gallons

Non-regulated Tanks:Heating oil tanks

Requirements for All USTs: Tank must be registered with MPCA

Requirements for Regulated Tanks:Annual tightness testing and inventorycontrol Tank must be updated, replaced, or removed by December 22, 1998

Upgrades:--Overfill protection--Corrosion protection STPI approved

--Leak detection

Tightness Testing Results on File:

Dates of past testing:____________________

Records on file:________________________


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