Title Page
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School Name
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Address
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Conducted on
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Prepared by
Safety Reports
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The last fire inspection was conducted on:
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The last food safety inspection was conducted on:
Classroom
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The classroom is free of general sanitation issues.
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The lighting survey is within minimum standards in the classroom.
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The classroom is free of glare or shadows.
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The ambient air temperature is acceptable in the classroom.
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There is adequate ventilation in the classroom.
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Potentially hazardous chemicals are accessible only to authorized personnel in the classroom.
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The classroom is free of signs of insects, pests, and rodents.
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The classroom is of free of insect, pest, and rodent harborage.
Library
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The library is free of general sanitation issues.
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The lighting survey is within minimum standards in the library.
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The library is free of glare or shadows.
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The ambient air temperature acceptable in the library.
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There is adequate ventilation in the library.
Computer / Tech Classroom
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The computer/tech room is free of general sanitation issues.
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The lighting survey is within minimum standards in the computer/tech room.
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The computer/tech room is free of glare or shadows.
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The ambient air temperature is acceptable in the computer/tech room.
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There is adequate ventilation in the computer/tech room.
Bathroom
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The bathroom is free of general sanitation issues.
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There is no evidence of water damage or mold in the bathroom.
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There is adequate ventilation in the bathroom.
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The are working toilets in the bathroom.
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There is hot and cold running water in the bathroom.
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The hot water temperature is less than 120 degrees Fahrenheit at the hand washing sink(s) in the bathroom.
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The hand washing sinks are provided with soap in the bathroom.
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The hand washing sinks have provisions for hand drying in the bathroom.
Custodial Storage Area & Custodial Closets
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The custodial storage area and some custodial closets are free of general sanitation issues.
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The lighting survey is within minimum standards in the custodial storage area and in some custodial closets.
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There is adequate ventilation in the custodial storage area and some custodial closets.
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The custodial storage area and some custodial closets are free of signs of insects, pests, and rodents.
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The custodial storage area and some custodial closets are free of insect, pest, and rodent harborage.
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Potentially hazardous chemicals are accessible only to authorized personnel in the custodial storage area and some custodial closets.
Parent-Teacher Organization/Association (PTO/PTA) Storage Area
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The PTO/PTA storage area is free of general sanitation issues.
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The PTO/PTA storage area is free of signs of insects, pests, and rodents.
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The PTO/PTA storage area is free of insect, pest, and rodent harborage.
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The PTO/PTA storage area is free from food safety issues.
Exterior Building & Grounds
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The exterior grounds are free of litter buildup.
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The exterior grounds are free of standing water.
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The exterior building is free of cracks in walls and doors.
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The exterior building is free of other structural issues.
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Exterior doors are solid with sweeps.
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Opened exterior windows and doors are screened.
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The outdoor area is free of signs of insects, pests, and rodents.
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The outdoor area is free of insect, pest, and rodent harborage.
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The exterior trash and recycling receptacles are covered.
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PLAYGROUND: The outdoor play equipment is in sound condition.
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PLAYGROUND: There is sufficient impact-absorbing surfacing material under anchored climbing equipment, slides, and swings.
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PLAYGROUND: The outdoor play area is free of environmental hazards.
Exit Interview Questions
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Does this school have an integrated pest management system?
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Do custodial staff members receive ongoing in-service and/or vo-tech training? Examples?
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Are custodial duty schedules periodically reviewed by the administrative staff?
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Do you know where the Safety Data Sheets (SDS) are for all chemicals (cleaning supplies and science)?
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A list of chemical disposal service providers was issued to the school representative.
Verification
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KSA 65-202 requires inspection of each school building and grounds annually by the local health officer or designated alternate for the protection of the public health of the students of the school.
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School Representative
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Inspector
