PECI Classroom

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Classroom

• Room # or description:

• Select date

  Date

• Is the emergency/lockdown information posted?

  Yes

  No

  N/A

• Is the fire exit/alternate fire exit information posted?

  Yes

  No

  N/A

• Is emergency exit information available (e.g. red emergency binder, class lists, emergency medical information...)?

  Yes

  Not Seen

• Is there a current latex-free blood kit at the entry?

  Compliant

  Non-compliant

  Not Seen

• If non-compliant, what is missing?

  Select Non-latex gloves Sealable plastic bag Absorbent material Up-to-date

  • Non-latex gloves
  • Sealable plastic bag
  • Absorbent material
  • Up-to-date

• Are black-out materials available for all exterior lines of sight?

  Safe

  At Risk

  N/A

• Is there a functional intercom/telephone?

  Select Compliant No dial tone/call out No emerg. #s posted Not seen

  • Compliant
  • No dial tone/call out
  • No emerg. #s posted
  • Not seen

• Are ceiling tiles/coverings sound, without damage, mould or watermarks?

  Safe

  At Risk

  N/A

• Is the lighting adequate, and in good repair?

  Select Yes Bulbs/tubes out/missing Ballasts damaged/corroded Fluorescent lights missing cages or tube protectors

  • Yes
  • Bulbs/tubes out/missing
  • Ballasts damaged/corroded
  • Fluorescent lights missing cages or tube protectors

• Attach photo, if needed.

  Media

• Are heat detectors present/functional?

  Safe

  At Risk

  N/A

• Are overhead screens, curtains/blinds, & media equipment secured?

  Safe

  At Risk

  N/A

• Are bookshelves and large (>3 drawer) filing cabinets secured?

  Safe

  At Risk

  N/A

• Are heavy and bulky items stored on lower shelves?

  Yes

  No

  N/A

• Is equipment stored in such a way as to prevent trips/cuts/personal injury?

  Safe

  At Risk

  N/A

• Are safeguards provided for hazardous equipment (e.g. scissors, paper cutters)?

  Compliant

  Non-compliant

  Not Seen

• If non-compliant, affix photo(s).

  Media

• Is a CSA-approved stepladder available to reach high shelves/bulletin boards?

  Yes

  No

  N/A

• Are walls & doors free of fire bridges?

  Safe

  At Risk

  N/A

• Are heater intakes free of obstructions?

  Safe

  At Risk

  N/A

• Are insulating pipe wraps and/or 9" floor tiles present?

  Yes

  No

  N/A

• If yes, is there any sign of damage or potential for friable material?

  Safe

  At Risk

  N/A

• Are floor tiles and rugs clean and in good repair?

  Safe

  At Risk

  N/A

• Is there any evidence of punctures or damage to ceiling tiles, wall materials, or floors?

  Yes

  No

  Unknown

• If the answer is affirmative, record the damage in a photograph, and refer to the asbestos log to ensure that the affected area is asbestos-free.

  Media

• Asbestos log checked?

• Are there issues involving windows?

Windows

• Check any that apply:

  Select Window does not stay open. Screen missing. Screen in need of repair. Glass pane broken or missing. Leakage around frame.

  • Window does not stay open.
  • Screen missing.
  • Screen in need of repair.
  • Glass pane broken or missing.
  • Leakage around frame.

• Add a photo if appropriate.

  Media

• Are there issues involving electrical devices?

Issue

• Name the device or area of the issue:

• Indicate the relevant issues (check all that apply wrt a single device):

  Select Double ext. cords/power bars Frayed or cracked cords Missing ground pin or polarized prong Exposed wire Cord poses tripping hazard Damaged plate covers Missing/malfunctioning GFI/polarized outlets

  • Double ext. cords/power bars
  • Frayed or cracked cords
  • Missing ground pin or polarized prong
  • Exposed wire
  • Cord poses tripping hazard
  • Damaged plate covers
  • Missing/malfunctioning GFI/polarized outlets

• Add a photo, if appropriate.

  Media

• Is there a minimum 1 m clearance in front of electrical panels?

  Yes

  No

  N/A

• Are all breakers/fuses properly labeled?

  Yes

  No

  N/A

• Are chemicals, including cleaning agents/sanitizers, present in this room?

• Provide details of any chemicals present:

Chemical

• Name (and formula, if available) of chemical:

• Does the chemical have an appropriate workplace label (name of product, information on safe handling, MSDS reference, relevant WHMIS hazard symbol(s)).

  Safe

  At Risk

  N/A

• Is there a current (within 3 y) MSDS sheet available?

  Yes

  No

  N/A

• Use this area to record additional comments and/or concerns of staff using this room:

Storage areas

• Would you like to add a storage facility associated with this classroom?

Storage Area

• Are black-out materials available for all exterior lines of sight?

  Safe

  At Risk

  N/A

• Are ceiling tiles/coverings sound, without damage, mould or watermarks?

  Safe

  At Risk

  N/A

• Is the lighting adequate, and in good repair?

  Select Yes Bulbs/tubes out/missing Ballasts damaged/corroded Fluorescent lights missing cages or tube protectors

  • Yes
  • Bulbs/tubes out/missing
  • Ballasts damaged/corroded
  • Fluorescent lights missing cages or tube protectors

• Attach photo, if needed.

  Media

• Are bookshelves and large (>3 drawer) filing cabinets secured?

  Safe

  At Risk

  N/A

• Are heavy and bulky items stored on lower shelves?

  Yes

  No

  N/A

• Is equipment stored in such a way as to prevent trips/cuts/personal injury?

  Safe

  At Risk

  N/A

• Is a CSA-approved stepladder available to reach high shelves/bulletin boards?

  Yes

  No

  N/A

• Are walls & doors free of fire bridges?

  Safe

  At Risk

  N/A

• Are heater intakes free of obstructions?

  Safe

  At Risk

  N/A

• Are insulating pipe wraps and/or 9" floor tiles present?

  Yes

  No

  N/A

• If yes, is there any sign of damage or potential for friable material?

  Safe

  At Risk

  N/A

• Are floor tiles and rugs clean and in good repair?

  Safe

  At Risk

  N/A

• Is there any evidence of punctures or damage to ceiling tiles, wall materials, or floors?

  Yes

  No

  Unknown

• If the answer is affirmative, record the damage in a photograph, and refer to the asbestos log to ensure that the affected area is asbestos-free.

  Media

• Asbestos log checked?

• Are there issues involving windows?

Windows

• Check any that apply:

  Select Window does not stay open. Screen missing. Screen in need of repair. Glass pane broken or missing. Leakage around frame.

  • Window does not stay open.
  • Screen missing.
  • Screen in need of repair.
  • Glass pane broken or missing.
  • Leakage around frame.

• Add a photo if appropriate.

  Media

• Are there issues involving electrical devices?

Issue

• Name the device or area of the issue:

• Indicate the relevant issues (check all that apply wrt a single device):

  Select Double ext. cords/power bars Frayed or cracked cords Missing ground pin or polarized prong Exposed wire Cord poses tripping hazard Damaged plate covers Missing/malfunctioning GFI/polarized outlets

  • Double ext. cords/power bars
  • Frayed or cracked cords
  • Missing ground pin or polarized prong
  • Exposed wire
  • Cord poses tripping hazard
  • Damaged plate covers
  • Missing/malfunctioning GFI/polarized outlets

• Add a photo, if appropriate.

  Media

• Is there a minimum 1 m clearance in front of electrical panels?

  Yes

  No

  N/A

• Are all breakers/fuses properly labeled?

  Yes

  No

  N/A

• Are chemicals, including cleaning agents/sanitizers, present in this room?

• Provide details of any chemicals present:

Chemical

• Name (and formula, if available) of chemical:

• Does the chemical have an appropriate workplace label (name of product, information on safe handling, MSDS reference, relevant WHMIS hazard symbol(s)).

  Safe

  At Risk

  N/A

• Is there a current (within 3 y) MSDS sheet available?

  Yes

  No

  N/A

• Use this area to record additional comments and/or concerns of staff using this room: