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PROGRAM CONTACT PERSON LIST
Asbestos Management.....................................................Art Schweitzer
AED..........................................................................George Berndt
AWAIR........................................................................Art Schweitzer
Bleacher Safety............................................................ Art Schweitzer
Bloodborne Pathogens......................................................Judy Huisman
Community Right-to-Know...............................................Art Schweitzer
Compressed Gas Safety...................................................Art Schweitzer
Confined Space Entry.....................................................Art Schweitzer
Emergency Action Planning...............................................Art Schweitzer
Employee Right-to-Know/Hazard Communication...................Art Schweitzer
Facilities Safety Management............................................Art Schweitzer
First Aid/CPR ................................................................Judy Huisman
Hazardous Waste Management..........................................Art Schweitzer
Hearing Conservation.....................................................Art Schweitzer
Indoor Air Quality..........................................................Art Schweitzer
Integrated Pest Management............................................Art Schweitzer
Laboratory Standard/Chemical Hygiene Plan......................................Matt
McDowell
Lead Management.........................................................Art Schweitzer
Lockout/Tagout ...........................................................Art Schweitzer
Machine Guarding .........................................................Art Schweitzer
Personal Protective Equipment.........................................Art Schweitzer
Playground Safety.........................................................Art Schweitzer
Radon Gas Safety..........................................................Art Schweitzer
Respiratory Protection...................................................Art Schweitzer
USTs/ASTs...................................................................Art Schweitzer
Welding Cutting Brazing....................................................Darrel Mayer
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Checklist of E/OHS Activities for Asbestos Management
Program Contact Person: Art Schweitzer
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.
Training for Asbestos Awareness was conducted October 24, 2008 .
New PT employees received training on 10-24-2007 .
(date)
Annual written notification has been prepared; Yes .
(date)
Notification appeared in the following publication(s):
Name of publication DateFall News letter Fall, 2010
Three-year re-inspection Surveillance was conducted: 6/29/2010 .
6-month Periodic Surveillance was conducted: 6/29/2010(first date)
02/15/2011(second date)
All caution labels have been posted.Label locations: Boiler room
Tunnels
Hard lagging
Are supplies of repair materials adequate to meet the requirements ofmaintenance and repair of ACM? Yes No N/A
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Asbestos Maintenance Supplies on Hand
Bags Respirators Wrap-n-cure
Is documentation of Operations and Maintenance available?
Location: District Office
Status of the Asbestos repair and maintenance Work Order System: N/AEstablished, Pending
Comments: Repairs to asbestos are limited to replacement of damagedfloor tile.
**For information regarding the medical review and questionnaire, see theRespiratory Protection Program.**
Note: click here this link to review 6 month periodics.
The tunnels were cleaned and maintained during the summer of 2009. Thiswork was conducted as O&M activities. LC
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Checklist of E/OHS Activities for Automatic External Defibrillator
Program Contact Person: George Berndt
School policy for use adopted in place? Yes No N/A
Brand of AED? Heart Start FRx Model: IP55
Name of Medical Director? The director is yet to be determined.
Year device was placed into use? 2010
Location(s) of devices:Building Name Location in Building
Ellsworth Public School Gym entrance
Have all software updates been installed? Yes No N/A
Date of update installation: 12-2010
Expiration date of pads? 12-2012
Expiration date of batteries? 01-2016(date)
Has staff been trained on operation of the device? Yes, all school staff.
Most recent date of training:12-2010(date
Provider of training: Mary Lubben,
Location of operators manual:
Are battery checks documented? Yes, a check list is available at each AEDstationNotes:
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Checklist of E/OHS Activities for AWAIR
Program Contact Person: George Berndt
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? Quarterly
Are minutes of the meeting maintained? Yes
Location: File in Mr. Berndts office
Posted:
How is the program communicated to employees? All Staff training duringfall orientation
Who is the Contact Person for OSHA 300? Darcy Groen
Is the OSHA 300A Log completed for the previous calendar year? Yes
Have the Logs been maintained for five (5) years? Yes
Location: Activities Manual
Is the Log posted from February 1 until April 30? Yes
The location/s of the posted log: Main School Office.
Is information on injuries recorded on the Log with five (5) working days? YesNo N/A
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Safety Committee Meeting Schedule
Date Location Time
Jan. 12, 2011 Principals office 3:00pm
Oct. 6, 2010 Principals office 3:00pm
April 15, 2010 Principals office 3:00pm
Jan. 18, 2010 Principles office 3:00pm
District Safety Committee Members
Member Position BuildingGeorge Berndt Principal Ellsworth Public
Judy Huisman Lead Secretary Ellsworth Public
Art Schweitzer Custodian Ellsworth Public
Mike Palm Staff Ellsworth Public
Darin DeBoer Staff Ellsworth Public
Molly Schilling Staff Ellsworth Public
Darrel Mayer Staff Ellsworth Public
Dianne Johnson Food Service Ellsworth Public
Darcey Groen Secretary Ellsworth Public
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Checklist of E/OHS Activities for Bleacher safety
Program Contact Person: Art Schweitzer
Is the BSM 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
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/ANote: Prepared 10-8-07 and sent.
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Inspection Check List
Openings and gaps:
Openings limited to four-inch gap between the railings and between the footboards
and 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 BuildingCode.
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
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
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Checklist of E/OHS Activities for Bloodborne Pathogens
Program Contact Person: Judy Huisman
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:Bus driversParas, Special EdCustodiansSchool NurseSecretaries
What is this schools policy regarding Hepatitis B vaccinations for employeesconsidered at risk versus employees considered not at risk in the ExposureControl Plan?Custodians provide clean up fluid spills.
Is training provided at this school on methods and techniques to reduceexposure incidents? All staff is trained during the fall faculty developmentdays. The employee sign in log is posted in the Activities Manual
New Employees: within ten days of employment
Have the employees identified as first aid responders been given at a minimum
Red Cross First Aid Training? Yes No N/ANote: Not recently.
Are Exposure Control Kits available to staff? Yes No N/A
Location(s): Each classroom is supplied with a clean-up kit. Kits are alsolocated in the janitors closet and also in the School Main Office.
Status of Declination forms: Judy will be working organizing acceptance/declination forms. New forms will be distributed and previous vaccinationinformation will be gathered and recorded.
How is blood or bodily-fluid-containing materials handled at this facility?Custodial staff typically responds to blood spills that occur when on campus.
Location of biohazard bags at school: Nurses office and the custodial office
Approved disposal location for biohazardous waste:Worthington Regional Hospital
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Hepatitis B Vaccination Consent Form
I have been given a copy of and have read or have had explained to me the
information about hepatitis B and hepatitis B vaccine. I have had a chance to
ask questions which were answered to my satisfaction. I believe I understand
the benefits and risks of the hepatitis B vaccine, and request that it be given to
me or to the person named below for whom I am authorized to make this
request.
Please Print:
Name_________________________________________Date of Birth_________________
Social Security or Visa #__________________________Employee #__________________
Department and Lab room #__________________________________________________
Principal Investigator________________________________________________________
Signature______________________________________Date________________________
Note: I have previously participated in an HBV vaccination program.
Employer at time of vaccination _____________________________Date ___________Record maintained where __________________________________
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Checklist of E/OHS Activities for Compressed Gas Safety
Program Contact Person(s) Darrel Meyer
Department Contacts:
Maintenance Art Schweitzer
Metals Shop Darrel Meyer
Technology Ed. Darrel Meyer
Is the Compressed Gas 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
Has the facility been surveyed for compressed gas inventories? Yes No N/A
Has training been conducted for affected personnel? Yes No N/A
Are records established and maintained to monitor gas inventory? Yes No N/A
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COMPRESSED GAS FIELD REVIEW
Compressed Gas Inventory
Date:04-12-2011 Program Contact Person: Brian Parrie
Department: Metals Shop Department Responsible Person: Darrel Meyer
Location: Wood Shop
Cylinders: O2 ___1_________
Acetyl ____1________ NH4 ____________
CO2 ____________
Argon ____________ Argon/CO2_____1_______ Other ____________
Compliance Check List
1. Are cylinders in well-ventilated area? X
2. Are cylinders stored separate from flammable by at least 20 feet? X
3. During storage are oxygen cylinders separated from fuel gascylinders, 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 as electricity,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
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Checklist of E/OHS Activities for Confined Space Entry
Program Contact Person: Art Schweitzer
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: 10-24-09
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Confined Space Inventory
Ellsworth Public School
Building: Combined Elementary, Middle School, High School
Building Contact: Art Schweitzer Program Contact: Brian Parrie
Completed By:Brian Parrie Date:2-15-2011
Room IdentificationName Given Space
OpeningDimension
DimensionOf ConfinedSpace
PotentialHazards
Permit/Non-Permit
Labeled PhotoID #
Boiler Room 24X18 4X4X8 LE,heat,O2deficient
PermitRequired
Yes
Boiler #1
Boiler Room 24X18 4X4X8 LE, A PermitRequired
No
Boiler #2Boiler Room 4X4 4X4X>200 LE, A Permit
RequiredYes
Tunnel accessBoiler Room 4X4 4X4X>200 LE, A Permit
RequiredYes
Water Tank #2
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Checklist of E/OHS Activities for Community Right-to-Know
Program Contact Person: George Berndt/ Art Schweitzer
Is the Community Right-to-Know 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
Are quantities of stored and used designated hazardous materials documentedand verified? Yes No N/A
Where are the documents stored? 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? 2-16- 2011(date)
Has training been provided? Yes No N/A
Date: N/A
Presenter: N/A
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Inventory Form
Client: Ellsworth Public School
Contact Person: Art Schweitzer Date: 10-8-07
HazardousMaterial Quantity Location
Reported onTier Two
InstallationDate(s)
#2 Fuel Oil 5,000 galWest sidebetweenbldgs.
yes 1975
Note: a 6,000 gal tank was removed from service during the summer of 2006.The tank was approximately installed in 1975.The tank remains in place but has been pumped and filled with water. The tankhad never knowingly leaked product into the ground.The remaining tank has been reported on the Tier II form. Sent 2-14-2008
The Tier Two can be managed on line see web site:http://minnesota.idsimaps.com/submit/T2_Menu.asp
Login: dgroen25Password: igloo55
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Checklist of E/OHS Activities for Emergency Action Planning
Program Contact Person: George Berndt/
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
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: Art Schweitzer_________________________________
Location of records: District Office__________________________________
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
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Checklist of E/OHS Activities for Employee Right-to-Know/HazardCommunication
Program Contact Person: Art Schweitzer
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 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 Custodial Room
Food Service Yes No N/A Head cooks desk drawer
Science Rooms Yes No N/A Chemistry Lab
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
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Contact List for Employee Right-to-Know Program
Client: Ellsworth Public School
DepartmentKey Contact for Department
(person responsible for making MSDSs)
ArtMrs. Steinmetz
Biology/chemistryMolly Shilling
Consumer Life ScienceJill Christensen
Custodial/MaintenanceArt Schweitzer
Food ServiceMargaret LarsonDianne Johnson
PhotoN/A
ShopWelding
Darrel Meyer
Completed by: Brian Parrie Date: 2-15-2011
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Checklist of E/OHS Activities for Facilities Safety Managementand Fire Safety in Schools
Program Contact Person: George Berndt
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
Program Contact Person: George Berndt/ Art Schweitzer
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: July, 2010
Most recent inspection of fire extinguisher: June, 2010
Most recent inspection of fume hood with fire suppressant: N/A
Are emergency lights tested at least monthly? Yes No N/A
Science safety Checklist completed? Yes No N/A
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Facilities Safety Review
Building: Ellsworth Public School
Mock-OSHA ReviewArea
Date ReviewCompleted Recommendations
Art N/A
Dark Room N/A
Wood Shop 1/15/2010 See written report
Kitchen 1/15/2010
Metal Shop 1/15/2010
Halls, Gym, etc. 1/15/2010
Graphic Arts 1/15/2010 N/A
Maintenance/Custodial
1/15/2010
Transportation 1/15/2010 N/A
Grounds/Garage 1/15/2010
Chemistry/Life
Science
1/15/2010
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Checklist of E/OHS Activities for First Aid/CPR
Program Contact Person(s): Judy Huisman
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
Have the program and goals been approved by the School Board for the currentschool 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 Ellsworth Rescue Squad
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
CPR training held 12-2010 for all staff. Training provided by Mary Lubbenfrom Fulda, certified CPR trainer.
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Checklist of E/OHS Activities for Hazardous Waste Management
Program Contact Person(s)
Primary Contact Person:_Art Schweitzer
Secondary Contact Person: _George Berndt
Is the Hazardous Waste Management program in place? Yes No
Is the Plan current? Yes No
Has the Plan been reviewed this school year? Yes No
Have the program and goals been approved by the School Board for the currentschool year? 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
Note: A Hazardous Waste License Application was sent in on Jan. 9, 2009. Theschool is declaring that it is a VSQG and will not be required to pay a license
fee. The science lab was cleaned this summer and the U of M removed theunneeded chemicals. It was reported that about 20 kilograms was removed.1-9-2009 LC
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Note: The school has continued to meet the VSQG criteria during the 2009-2010 school year. They are not required to report their waste generatingactivities. LC 4-5-2010
Note: The school has continued to meet the VSQG criteria during the 2010-
2011 school year. They are not required to report their waste generatingactivities. LC 10-26-2010
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Checklist of E/OHS Activities for Hearing Conservation
Program Contact Person: Art Schweitzer
Is the Hearing Conservation Plan in place? Yes No
Is the Plan current? Yes No
Has the Plan been reviewed this school year? 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
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Client: Ellsworth Public Schools
Measuring Device: Center 325 Sound LevelMeter
Calibration: Pre___________Post___________
Reason for Testing: General Survey
Affected Personnel: Band Custodial, Maintenance, Shop
Location Equipment Results Recommendations
Shop Chop Saw 99.5.dBA Provide Protection
Shop Jet Router 84.9 dBA Provide Protection
Shop Delta Band Saw 82.7 dBA
Shop StationaryBelt/Disk Sander
83.3 dBA
Shop Radial Arm Saw 84.4 dBA Provide Protection
Shop Joiner 86.3-87.7 dBA Provide Protection
Shop Sander Planner 80.7 dBA
Completed by Lee Carlson Date 3-13 -2009
Note: No over limit exposures could be determined. However due to theexceptionally loud readings for short periods it is recommended that hearingprotection be provided to affected staff. LC
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Checklist of E/OHS Activities for Indoor Air Quality
Program Contact Person: George Berndt
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? Yes No
Have the program and goals been approved by the School Board for the currentschool year? Yes No
Has the annual cursory walk-through been conducted? Yes No
Havethedistrictskeybuilding systems been evaluated? Yes No
When was the evaluation completed? 3-17-1999
Who conducted the evaluation? Musser Environmental Inc.
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? Yes
Building ventilation checklist? Yes
Training conducted Aug 29, 2007 (date)
Training has been scheduled for ____N/A___________. (date)
Has the District determined the mechanical ventilation rate of each occupiedspace? Yes No.
Supportive technical services were conducted on: 2/26/2010. (date)
Results of technical services are located? See IAQ Report
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Checklist of E/OHS Activities for Integrated Pest Management
Program Contact Person: Art Schweitzer
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: fall news letter.
Note: the school has had cockroach infestations in the past. Plunkets nowprovides monthly services to control insects and mice. The staff reports goodsuccess.
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Checklist of E/OHS Activities for Laboratory Standard/ChemicalHygiene Plan
Program Contact Person: Matt McDowell, CHO
Is the Laboratory Standard/Chemical Hygiene 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
Fume hood was tested on ____N/A___________.(date)
The results indicate air velocity to be: satisfactory, unsatisfactory, N/A.
Chemical inventory:
Date of most recent survey: 2009-2010 school year
Location of inventory listing: Science Room
Are Material Safety Data Sheets (MSDSs) located with inventory? Yes No N/AThe MSDS are listed at the following website:http://www.flinnsci.com/search_MSDS.asp
Are the MSDS readily accessible? Yes No N/A
Has the Minnesota Dept of Ed Science Lab Checklist been completed? Yes NoN/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
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General Science Safety ConsiderationsFor All Rooms Where Science Laboratories Are Conducted
And/or Demonstrations Are Given
Client: Ellsworth Public School
Room Number(s):
Description: A school science laboratory is defined as a classroom wheredemonstrations and/or laboratory instructions are provided for individual or groupexperiments. They are places where science is taught. In addition, any conditionlisted under either the storage section or the chemical laboratory section thatmay apply to any area, for instance, must keep inventories of all biology reagentsand chemicals.
ITEM CITATIONCONDITION
EXISTS LACKING N/A
1) Laboratories must be equipped with adequateventilation. For new labs (build after July 1990) anmanual shutoff control for the laboratory exhaustventilation system must be provided outside of the room,in a position adjacent to the access door to the room orin such other location as approved by the fire chief.
UBC (97) 305.2.4,307.5.2, & 1202.2.3UFC (97) 8004.1.11 &8003.1.4.2
2) At least one 2A-20BC, or larger, rated and approvedportable fire extinguisher must be provided for each3,000 of laboratory. Travel distance must not exceed 50from anywhere in the lab. At least one fire extinguishersuitable for class D fires must be provided in laboratorieswhere combustible metals are used and stored.
UFC (97) 1002.1UFC Std. 10-1-3-2
X
3) At least one approved fire blanket must be provided in
each laboratory.
UFC (97) 1001.9 X
4) Students must be under the direct supervision of afaculty member or an assistant at all times. In mostcases it is recommended that direct supervision meansdirect eye contact. It is recommended that no more thantwo students be assigned to a lab station, a place in theroom equipped with water, gas, and electricity, or aplace where students do labs.
NFPA 45 (91) 1-4
X
5) Aisles serving work areas on two sides must be atleast 42 wide; those serving work areas on one sideonly must be 36.
UFC (97) 1204.2.2 (2)X
6) Minimum of two means of exit access must beprovided when:Existing: lab exceeds 1,000 sq. feetNew: lab exceeds 200 sq. feet (built after 7/90)
NPFA 45 (91) 3-4.1UBC (97) 1007.3.8
X
7) Labs must be separated from each other and otherportions of the building by not less than a 1-houroccupancy separation.*Existing: labs located in buildings protected by automaticextinguishing systemsonly smoke separation requiredNew: (built after 7/72)*Recommend this be determined by a licensed designprofessional
UFC (97) Appendix 1-A7.2 as amended
UBC (97), 305.2.4
8) Labs must be equipped with automatic detectionelectrically interconnected with the building fire alarmsystem. Exception: labs protected by a completeautomatic sprinkler system that is interconnected to thebuilding fire alarm require no additional detection.
UFC (97) 1007.2.4.2 &1007.2.4.1.1 asamended
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9) All electrical outlets must be properly grounded and allfixed electrical equipment and appliances must beplugged in to grounded outlets as required by theelectrical code.
UFC (97) 850499NEC 250-112
X
ITEM CITATIONCONDITION
EXISTS LACKING N/A
10) Electrical receptacles, switches, and controls mustbe located so as not to be subject to liquid spills.
NFPA 45 (91) 3-6.1 X
11) Extension cords must not be used as a substitute forpermanent wiring.
UFC (97) 8506.1 X12) The use of multi-plug adapters, octopusarrangements, cube adapters, strip plugs, or any otherdevice that does not comply with the electrical code isprohibited.
UFC (97) 8507
X
13) A minimum of 30 of clearance must be maintainedin front of electrical control panels for access.
UFC (97) 8509.2
14) Written procedures for laboratory emergencies,including emergency evacuation, must be developed foreach lab.
NFPA 45 (91) 4-6.3.1X
15) Piping systems must comply with nationallyrecognized standards.
NFPA 45 (91) 8-1.1
16) Enough eye protection devices (goggles) must beprovided for every student in the room, visitors, and theteacher whenever potentially hazardous activities are
taking place.
MN Public Law, section126.20
X
17) Refrigerators, freezers, and other cooling equipmentused to store of cool flammable liquids must be ofexplosion-proof construction
NFPA 45 (91) 9-2.2.2
18) Each refrigerator, freezer, or cooler must beprominently labeled to indicate whether it is or is notsuitable for storing flammable liquids.
NFPA 45 (97) 9-2.2.1
19) Flammable liquids stored in refrigerated equipmentmust be in closed containers.
NFPA 45 (91) 9-1.6.6
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General Science Safety ConsiderationsFor All Laboratories And/or Rooms Where Chemical Demonstrations Are
Conducted
Client: Ellsworth Public School
Room Number(s):
Description: In addition to the provisions that are outlined for any sciencelaboratory area, the following provisions are specific for chemistry classes (butmay apply to any lab where similar activities are carried on).
ITEM CITATIONCONDITION
EXISTS LACKING N/A
1) Proper eyewash facilities must be installed thatproduce 25 psi of water for 15 minutes. Squeeze bottlesdo not meet this specification. It is recommended that
eyewash fountains should be located within 25 ofstudents in any area of the room. The device must beplumbed into a drinkable water supply. This rule appliesto any rooms where labs are conducted that arepotentially harmful to the eyes.
ANSI Z-358.1-1981 X
2) Emissions generated at workstations must beconfined to the area in which they are generated(laboratory hoods).
UBC (97) 1202.2.3X
3) In new labs (build after 7/90) a manual shutoff controlfor the laboratory exhaust ventilation system must beprovided outside of the room in a position adjacent to theaccess door to the room or in such other location asapproved by the fire chief.
UBC (97) 1202.2.3UFC (97) 8003.1.4.2
4) Chemicals stored in the open in the laboratory workarea must be kept to the minimum necessary for thework being done.
NFPA 45 (91) 7-2.3.1X
5) A complete inventory of chemicals on hand must bemaintained and must be available to the fire chief. Allmaterials must be dated upon receipt.
UFC (97) 8001.6
6) Persons responsible for each lab must be familiar withthe chemical nature of the materials present in the laband the appropriate mitigating actions to be taken incase of fire, leak, or spill.
UFC (97) 8001.11.1.1
X
7) Incoming shipments of chemicals must be transportedan opened by school personnel familiar with the potentialhazards.
NFPA 45 (91) 7-2.2.1X
8) Neutralizing chemicals spill kits, dry sand, vermiculite,EM Absorbent, and other spill control methods must bereadily available while the lab is in use.
UFC (97) 8001.11.1X
9) Written maintenance procedures must be established,including regular inspection, testing, and maintenance oflab utilities, hood and exhaust systems, pressureequipment (autoclaves, steam sterilizers, etc.), and
emergency equipment.
NFPA 45 (91) 4-6.2
10) Lab hoods and special local exhaust systems mustbe labeled to indicate intended use. Hoods in whichradioactive materials are handled must be identified withthe radiation hazard symbol.
NFPA 45 (91) 6-13
X
11) Provide a properly marked, easily accessible maingas shutoff valve in the room.
UFC (97) 8004.1.12 X
12) Fume/exhaust hoods must be listed (e.g., UL or FM)and maintained in proper operating condition.
UFC (97) 8001.4.4 &8001.4.7.1
X
13) Heat sources (e.g., gas burners, hot plates, heatingmantles, etc.) should never be left unattended.
Recommendation X
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ITEM CITATIONCONDITION
EXISTS LACKING N/A
14) It is recommended that due to the serious explosionhazard present, the following chemicals not be used inan instructional setting:
Benzoyl Peroxide Percholoric AcidCarbon Disulfide Picric AcidEthyl Ether Potassium Metal
Magnesium Powdered Metal
Recommendation
X
15) Loose clothing (e.g., full cut blouses, neckties, etc.)and long hair should be properly restrained. Also, somelaboratory activities could be dangerous to personswearing contact lenses.
Recommendation
X
Note: Potassium metal is handled by the instructor only.
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General Science Safety ConsiderationsFor Chemical Storage Facilities
Client: Ellsworth Public School
Room Number(s):
Description: Chemical Storage Facilities means any area or room wherechemicals are stored. Usually this refers to the chemistry storage area, butoccasionally there may be other facilities in the school, most likely located withina classroom, that store chemicals. These rules apply to all areas wherechemicals are stored.
ITEM CITATIONCONDITION
EXISTS LACKING N/A
1) Quantities of flammable and combustible liquids shall
not exceed the amounts necessary fro demonstration,treatment, laboratory work, maintenance purposes, oroperation of equipment. Not in any case will it exceedthe limits set forth in table 7902.5-A.
UFC (97) 7902.5.7.2 #3
X
2) Quantities of flammable and combustible liquid inexcess of 10 gallons must be stored in a flammableliquids cabinet. Quantities not exceeding ten gallonsmust be stored in an approved location.
UFC (97) 7902.5.8
X
3) The maximum quantity of flammable and combustibleliquids in storage and use in a lab must not exceed 120gallons.Exception: These quantities may be doubled in areasprotected by an automatic extinguishing system.Exception: These quantities may be doubled if stored inapproved storage cabinets.(Both exceptions may apply.)
UFC (97) table 7902.5-A
X
4) Class I flammable liquids may be stored in glass
containers of not more than one-gallon capacity only ifthe required liquid purity would be affected by storage ina metal container, or if the liquid would cause excessivecorrosion of a metal container. Otherwise, Class I-Aliquids are restricted to glass containers not exceedingone-pint capacity and Class 1-B liquids are restricted toglass containers not exceeding one-quart capacity.Class 1-C liquids are permitted to be stored in containersup to one-gallon capacity.
UFC (97) 7902.1-A
5) No container for Class I or II liquids in any lab mayexceed a capacity of one gallon. See table 7902.1-A forother limitations.
UFC (97) 7902.1-A
6) Materials that will react with water or other liquids toproduce a hazard must not be stored in the same roomwith flammable or combustible liquids.
UFC (97) 7902.5.4X
7) Stored gas cylinders shall have all protective devices
on (caps, collars, and similar devices).
UFC (97) 7401.7.1 X
8) All gas cylinders must be secured in a place toprevent falling.
UFC (97) 7401.6.4 X
9) Material Safety Data Sheets (MSDS) must be readilyavailable on the premises for all hazardous chemicals.
UFC (97) 8001.6 X
10) All chemicals must be stored in approved containers(if possible, chemicals should be stored in the originalshipping package).
UFC (97) 8001.4.2X
11) Incompatible materials shall be segregated toprevent accidental contact with one another. (Storage ofmaterials which are incompatible shall no be allowed inthe same cabinet or exhausted enclosure.)
UFC (97) 8001.11.8
X
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ITEM CITATIONCONDITION
EXISTS LACKING N/A
12) All shelving must be of substantial construction andproperly secured to prevent falling over. (Shelving abovework areas should be kept free of chemicals; storageabove eye level should be avoided.)
UFC (97) 8001.11.9
X
13) Shelving must be equipped with a lip or guard toavoid products rolling off. UFC (97) 8001.11.9 X14) Defective containers must be removed and disposedof in a proper manner.
UFC (97) 8001.4.7.3 X
15) Disposal of chemical wastes must be in accordancewith applicable federal and state regulations and goodsafety practices.
UFC (97) 8001.5.1X
16) All storage cabinets and storage rooms must belocked or otherwise secured against unauthorized entry.
UFC (97) 8001.11.2 X
17) All containers must be properly labeled to identify thecontents.
UFC (97) 8001.7 X
18) Toxic and highly toxic compressed gas, Class IVliquid, solid oxidizers, unclassified detonable, Class Iorganic peroxides, Class III and IV unstable and reactivematerial shall not be allowed in the classroom.
UFC (97) 8001.15.2.4
X
19) When transferring flammable liquids between metalcontainers, the containers must be properly bonded
together. The practice of purchasing large containersand dispensing into smaller ones is discouraged.
UFC (97) 8001.11.5
X
TABLE 7902.1-A: MAXIMUM SIZE OF CONTAINERS AND PORTABLE TANKS
CONTAINER TYPE CLASS I-A CLASS I-B CLASS I-C CLASS II CLASS III
1. Glass1 1 pt. 1 qt. 1 gal. 1 gal. 5 gal.
2. Metal or listed approved plastic2 1 gal. 5 gal. 5 gal. 5 gal. 5 gal.
3. Approved plastic 0 gal. 0 gal. 0 gal. 0 gal. 5 gal.
4. Safety cans 2 gal. 5 gal. 5 gal. 5 gal. 5 gal.
5. Metal drum 60 gal. 60 gal. 60 gal. 60 gal. 60 gal.
6. Approved portable tanks 660 gal. 660 gal. 660 gal. 660 gal. 660 gal.
7. Polyethylene3 Note 4 Note 4 Note 4 60 gal. 60 gal.
TABLE 7902.5-A: EXEMPT AMOUNTS OF FLAMMABLE AND COMBUSTIBLE LIQUIDSMAXIMUM QUANTITIES STORED PER CONTROL AREA1,2,3
TYPE OF LIQUID EXEMPT AMOUNT (gallons)
FlammableClass I-AClass I-BClass I-CCombination I-A, I-B, I-C
306090
1204
CombustibleClass IIClass III-AClass III-B
120330
13,2005
1Control areas shall be separated from each other by not less than a one-hour fire-resistive occupancy separation. Thenumber of control areas within a building used for retail or wholesale sales shall not exceed two. The number of control
areas in buildings with other uses shall not exceed four. See Sections 204 and 8001.10.2.2Quantities are allowed to be increased 100 percent when stored in approved storage cabinets. When Note 3 applies, theincrease for each Note is allowed.3Quantities are allowed to be increased 100 percent in buildings equipped with an approved automatic sprinkler system.When Note 2 applies, the increase for each Note is allowed.4Combinations shall not contain more than the exempt amounts of any individual class.5Quantities permitted in a building equipped with an approved automatic sprinkler system are not limited.
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Carcinogen/Substances of Known High Chronic ToxicityStandard Operating Procedures
Client: Ellsworth Public School
Which carcinogens are present in district science laboratories?
KNOWN CARCINOGENS SUSPECT CARCINOGENS OTHERS
Asbestos Cadmium/Cadmium Compounds
Arsenic Carbon Tetrachloride
Benzene Chloroform
Benzidine DDT
Bis (Chloromethyl) Ether 2,4D
Chloromethyl Methyl Ether Methylene Chloride
Chromium/Chromium Compounds Formaldehyde (Gas)
Mustard Gas Lead Acetate Vinyl Chloride Lead Phosphate
Nickel/Nickel Compounds (Powder)
Saccharin
Urethane
List total time (in hours) employee is exposed to carcinogens (checkedchemicals above) per academic year.
N/A hours per academic year
Are checked chemicals required, or could acceptable substitutes beimplemented?
Will retain carcinogen in curriculum Will discontinue use ofchemicals
If retained in curriculum, use table to log/document usage:
CARCINOGENICCHEMICAL AMOUNTS
USEDDATES USED
NAME(S) OFUSER(S)
NUMBER OFHOURS USED
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Carcinogen/Substances of Known High Chronic ToxicityStorage Guidelines
1. Store in a well-ventilated area. N/A
2. Use secondary containers or trays with sufficient capacity > 100% primarycontainer.
3. Label with the following information:
WARNING!
HIGH CHRONIC TOXICITY
ORCANCER-SUSPECT AGENT
4. Limited access should be provided for these chemicals.
5. Areas should be posted.
6. District Storage Location: N/A
7. Guidelines (from above) that need to be implemented: 1 2 3 4 5
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Carcinogen/Substances of Known High Chronic ToxicityHandling Guidelines
1. Use a controlled area (an exhaust hood, glove box, designated area in a
laboratory with localized ventilation).
District Controlled Area: N/A, however, fume hoods are available should needarise.
2. Controlled areas should possess the following signage, conspicuouslyposted:
WARNING!
TOXIC SUBSTANCE IN USE
ORCANCER-SUSPECT AGENT:
AUTHORIZED PERSONNEL ONLY
3. Use of Personal Protective Equipment, like impermeable gloves, aprons, andface shields.
4. Protect surfaces where carcinogens are handled by using chemically resistanttrays or pans that can be decontaminated.
5. On leaving a controlled area, laboratory workers should remove anyprotective apparel that has been used and thoroughly wash hands, forearms,face, and neck. If disposable apparel or absorbent paper liners have beenused, these items should be placed in a closed and impervious container thatshould then be labeled in some manner such as the following: CAUTIONCONTENTS CONTAMINATED WITH SUBSTANCES OF HIGH CHRONICTOXICITY. Non-disposable protective apparel should be thoroughly washed,and containers of disposable apparel and paper liners should be incinerated.
6. Wastes and other contaminated materials from an experiment involvingsubstances of high chronic toxicity should be collected together with the
washings from flasks and such and either decontaminated chemically orplaced in closed, suitable labeled containers for incineration away from thecontrolled area. If chemical decontamination is to be used, a method shouldbe chosen that can reasonable by expected to convert essentially all of thetoxic materials into nontoxic materials. For example, residues and wastesfrom experiments in which B-propiolactone, bis (chloromethyl) ether, ormethyl chloromethyl ether have been used should be treated for 10 minuteswith concentrated aqueous ammonia.
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In the event that chemical decontamination is not feasible, wastes andresidues should be placed in an impervious container that should be closedand labeled in some manner such as the following: CAUTIONCOMPOUNDS OF HIGH CHRONIC TOXICITY or CAUTIONCANCER-
SUSPECT AGENT.
7. Transfer of contaminated wastes from the controlled area to the incineratorshould be done under the supervision of authorized personnel and in such amanner as to prevent spill or loss. In general, liquid wastes containing suchcompounds should be placed in glass or polyethylene (usually preferable)bottles half-filled with vermiculite, and these should be transported in plasticor metal pails of sufficient capacity to contain the material in case ofaccidental breakage of the primary container.
8. Normal laboratory work should not be resumed in a space that has been used
as a controlled area until it has been adequately decontaminated. Worksurfaces should be thoroughly washed and rinsed. If experiments haveinvolved the use of finely divided solid materials, dry sweeping should not bedone. In such cases, surfaces should be cleaned by wet mopping or by use ofa vacuum cleaner equipped with a high efficiency particulate air (HEPA) filter.All equipment (e.g., glassware, vacuum traps, and containers) that is knownor suspected to have been in contact with substances of high chronic toxicityshould be washed and rinsed before they are removed from the controlledarea.
8. In the event of continued experimentation with a substance of high chronic
toxicity (i.e., if a worker regularly uses toxicologically significant quantitiesof such a substance three times a week), a qualified physician should beconsulted to determine whether it is advisable to establish a regularschedule of medical surveillance or biological monitoring.
Note: Chemical MSDS may be obtained at the following website:
http://www.flinnsci.com/search_MSDS.asp
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Checklist of E/OHS Activities for Lead-in-Water Management
Program Contact Person: Art Schweitzer
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 _5-1-1996_.(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: Art Schweitzer
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 playground
equipment 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: Art Schweitzer
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? __Boiler room_______________
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: Darrel Mayer __
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?_______________________
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 N/A
If replaced, was best practices, bid specification criteria used forprocurement? Yes No
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Identified Fixed Equipment Locations
Location Building/Buildings Staff Affected # of itemAutomotive Shop
Wood ShopCustodial/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)
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Checklist of E/OHS Activities for Playground Safety
Program Contact Person: Art Schweitzer
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:
X The equipment has adequate protective surfacing under and around itand the surfacing materials have not deteriorated
X Loose-fill surfacing materials have no foreign objects or debris
X 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:
X There are no sharp points, corners, or edges on the equipment
X There are no missing or damaged protective caps or plugs
X There are no hazardous protrusions and projections
X There are no potential clothing entanglement hazards, such as open S-hooks or protruding bolts
X There are no pinch, crush, and shearing points or exposed moving parts
X 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:
X The equipment has no rust, rot, cracks, or splinters, especially whereit comes in contact with the ground
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X 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
X All equipment is securely anchored
Security of Hardware:
X There are no loose fastening devices or worn connections, such as S-hooks
X Moving components, such as swing hangers or merry-go-round bearings,are not worn
Drainage:
X The entire play area has satisfactory drainage, especially in heavy useareas such as under swings and at slide exits
Leaded Paint:
X The leaded paint used on the playground equipment has notdeteriorated as noted by peeling, cracking, chipping, or chalking
X There are no areas of visible leaded paint chips or accumulation oflead dust
General Upkeep of Playgrounds:
X The entire playground is free from miscellaneous debris or litter suchas tree branches, soda cans, bottles, glass, etc.
X There are no missing or full trash receptacles
Click here to view playground equipment.
Note: Recommend replacing trip hazard wood retainers with plastic retainers.LC 4-7-2010
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Checklist of E/OHS Activities for Personal Protective Equipment
Program Contact Person: Art Schweitzer
Is the Personal Protective Equipment 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
Has a survey of potential workplace hazards been completed? Yes No N/A
Date(s) activity was conducted:4/06/2010
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
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Physical Hazard Assessment
Hazard(Heat, Noise,Radiation)
Building Location Labeled
Heat, chemical, bodyfluids, noise, asbestos
K-12 Custodial N/A
Noise, chemical, hotwater,
K-12 Kitchen N/A
Heat, chemical, bodyfluids, noise
K-12 Science Room N/A
Noise, impact,compressed gas, dust
K-12 Wood Shop N/A
Affected Employees
Name Department
Art SchweitzerCustodial/Maintenance
Margaret L. Food Service
Dianne J. Food Service
Molly Shilling Education (science)
Darrel Meyer Tech Ed
Completed by Lee Carlson ________Date_4-06-10_____________
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Personal Protective Equipment Assessment
Location:
Chemistry
Location:
Food Service
Location:
Custodian
Location:
Tech Shop,wood/metalEmployee:Molly Gort
Employee:Margaret LDianne J.
Employee:Art Schweitzer
Employee:Darrel Meyer
Hand
Nitrile
Latex X XVinyl XLeather X X XNeoprene X X
Face
Impact XSplash X X X XShieldRespirator X
EarMuffs X X XPlugs X X X X
BodyNeo Apron X XDenim X
FootSteel Toes
Metatarsal
Head Hard Hat
Hazard(s)
Heat, chemical,body fluids,
Noise, chemical,hot water, blood
Heat, chemical,body fluids,
noise, openflame, impact
Heat, chemical,body fluids, noise,
open flame,impact
Comments onAvailability,Condition, &Storage
Suggestadditionalhearing
protection forfood service staff
Suggest additionalhearing protection
for students
Completed by Brian Parrie Date 2/15/2011
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Checklist of E/OHS Activities for Radon Gas Safety
Program Contact Person: Art Schweitzer
Is the Radon Gas Safety Plan in place? Yes No N/A
Is the Plan current? Yes No N/AHas the Plan been reviewed this school year? Yes No N/A
Testing was last conducted: No records on file.(date)
Results of tests:
Room Name & No. Level Tested Recommendation
Has training is not requirement of this program. However if elevated levels aredetermine present training of affected persons is recommended.
Date training complete: N/A
Testing is / is not now in progress:
Note: No records could be located that indicated testing for radon in the past.I recommend that areas below grade be tested.
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Checklist of E/OHS Activities for Respiratory Protection
Program Contact Person: Art Schweitzer
Does this school provide respirators for voluntary use? Yes No N/A
If 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
Is the Plan current? Yes No N/A
Has the Plan been reviewed this school year? Yes No N/A
Date of review: _Sept, 2010
Are all employees in this program identified? Yes No N/A
Employee IntendedUse
Type ofRespirator
Medical Exam/Questionnaire
Date ofMedical
Date ofFit Test
Art Schweitzer Misc.voluntary
Mask yes 1/2009 1/2009
Fit testing was completed on N/A.(date)
Type of testing protocol; Irritant Smoke (Stannic Chloride) orBitrex (Denatonium Benzoate)
Condition and location of respirators:
Condition: Good condition
Location(s): In metal cabinet next to desk in boiler room.
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Are the appropriate adequate accessories on hand? Yes No N/A
Verified by Lee Carlson
Respirator Equipment Inventory
Cartridges
RespiratorType
RespiratorBrand Location
ValveFlaps? Straps? Organic Particulate Combination
PAPRPowerFlow
PAPRPowerFlow
mask AOS Boiler room
yes yes yes
mask
mask
Full face Wilson Boiler room
yes yes yes
Full face
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The respirators were cleaned and checked 1-4-10. LCArt is no longer fit checked and having physicals completed as a requirement ofthe local fire department. Future use will be on a voluntary basis.1-4-10
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Checklist of E/OHS Activities for Underground and AbovegroundStorage Tanks
Program Contact Person: Art Schweitzer
Is the Underground and Aboveground Storage Tanks Plan in place? Yes No
Is the Plan current? Yes No
Has the Plan been reviewed this school year? 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:
Underground/Aboveground Storage Tank Status
Tank No. Location Size Contents Registered Install date
#1 West sidebetweenbuildings
5,000 #2 fuel oil yes
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
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--Leak detection
Tightness Testing Results on File:
Dates of past testing:_____N/A_______________
Records on file:_____N/A___________________
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Checklist of E/OHS Activities for Welding and Brazing Safety
Program Contact Person(s) Darrel Mayer
Department Contact:
Metals Shop/Ag. FFA Darrel Mayer
Art (jewelry) N/A
Custodial N/A
Is the Welding and Brazing Plan in place? Yes No
Is the Plan current? Yes No
Has the Plan been reviewed this school year? Yes No
Method or methods used to control airborne particulate matter? Externalnegative air and internal filters
Has training been conducted for affected personnel? Yes No
Type of welding equipment available
Electric arch. Yes No N/A
Wire feed/TIG MIG. Yes No N/A
Electric spot weld Yes No N/A
Personal Protective Equipment: availability and condition
Gloves Yes No N/A
Goggles Yes No N/A
Welding mask Yes No N/A
Apron Yes No N/A
Steel toed shoes Yes No N/A
Describe location of welding activities, example; out-of-doors, booth, floor, allof the above:
Welding can conducted indoors or out. The air filter is adequate to handle asignificant particle load.
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