Title Page

  • School Name

  • Address
  • Conducted on

  • Prepared by

Safety Reports

  • The last fire inspection was conducted on:

  • The last food safety inspection was conducted on:

Classroom

  • The classroom is free of general sanitation issues.

  • The lighting survey is within minimum standards in the classroom.

  • The classroom is free of glare or shadows.

  • The ambient air temperature is acceptable in the classroom.

  • There is adequate ventilation in the classroom.

  • Potentially hazardous chemicals are accessible only to authorized personnel in the classroom.

  • The classroom is free of signs of insects, pests, and rodents.

  • The classroom is of free of insect, pest, and rodent harborage.

Library

  • The library is free of general sanitation issues.

  • The lighting survey is within minimum standards in the library.

  • The library is free of glare or shadows.

  • The ambient air temperature acceptable in the library.

  • There is adequate ventilation in the library.

Family & Consumer Studies (FACS) Classroom

  • The FACS room is free of food safety issues.

  • The lighting survey is within minimum standards in the FACS room.

  • The FACS room is free of glare or shadows.

  • The ambient air temperature is acceptable in the FACS room.

  • There is adequate ventilation in the FACS room.

  • The FACS room is free of signs of insects, pests, and rodents.

  • The FACS room is free of insect, pest, and rodent harborage.

Computer / Tech Classroom

  • The computer/tech room is free of general sanitation issues.

  • The lighting survey is within minimum standards in the computer/tech room.

  • The computer/tech room is free of glare or shadows.

  • The ambient air temperature is acceptable in the computer/tech room.

  • There is adequate ventilation in the computer/tech room.

Bathroom

  • The bathroom is free of general sanitation issues.

  • There is no evidence of water damage or mold in the bathroom.

  • There is adequate ventilation in the bathroom.

  • The are working toilets in the bathroom.

  • There is hot and cold running water in the bathroom.

  • The hot water temperature is less than 120 degrees Fahrenheit at the hand washing sink(s) in the bathroom.

  • The hand washing sinks are provided with soap in the bathroom.

  • The hand washing sinks have provisions for hand drying in the bathroom.

Locker Rooms / Showers

  • The locker rooms/showers are free of general sanitation issues.

  • There is no evidence of water damage or mold in the locker rooms/showers.

  • There is adequate ventilation in the locker rooms/showers.

  • There is hot and cold running water in the showers in the locker rooms.

  • The showers are well drained.

  • The shower tiles, both wall and floor, are disinfected daily.

Shop Classes (Wood/Auto/Welding)

  • The shop classes are free of general sanitation issues.

  • The lighting survey is within minimum standards in the shop classes.

  • The shop classes are free of glare or shadows.

  • The ambient air temperature is acceptable in the shop classes.

  • There is adequate ventilation (hood system) and the system is in good working order in the shop classes.

  • There are approved ear protectors provided in areas of high-risk noise levels over prolonged periods of time.

  • Eye protection is provided in the shop classes.

  • The shop classes are free of signs of insects, pests, and rodents.

  • The shop classes are free of insect, pest, and rodent harborage.

Science Labs & Chemical Storage Areas

  • The science labs and chemical storage areas are free of general sanitation issues.

  • The lighting survey is within minimum standards in the science labs and chemical storage areas.

  • The science labs and chemical storage areas are free of glare or shadows.

  • The ambient air temperature is acceptable in the science labs and chemical storage areas.

  • There is adequate ventilation (hood system) in the science labs and chemical storage areas.

  • Eye protection is provided in the science labs.

  • The science labs and chemical storage areas are free of signs of insects, pests, and rodents.

  • The science labs and chemical storage areas are free of insect, pest, and rodent harborage.

  • Potentially hazardous chemicals are accessible only to authorized personnel in the science labs and chemical storage areas.

Custodial Storage Area & Custodial Closets

  • The custodial storage area and some custodial closets are free of general sanitation issues.

  • There is adequate ventilation in the custodial storage area and some custodial closets.

  • The custodial storage area and some custodial closets are free of signs of insects, pests, and rodents.

  • The custodial storage area and some custodial closets are free of insect, pest, and rodent harborage.

  • 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

  • The PTO/PTA storage area is free of general sanitation issues.

  • The PTO/PTA storage area is free of signs of insects, pests, and rodents.

  • The PTO/PTA storage area is free of insect, pest, and rodent harborage.

  • The PTO/PTA storage area is free from food safety issues.

Exterior Building & Grounds

  • The exterior grounds are free of litter buildup.

  • The exterior grounds are free of standing water.

  • The exterior building is free of cracks in walls and doors.

  • The exterior building is free of other structural issues.

  • Exterior doors are solid with sweeps.

  • Opened exterior windows and doors are screened.

  • The exterior grounds are free of signs of insects, pests, and rodents.

  • The exterior grounds are free of insect, pest, and rodent harborage.

  • The exterior trash and recycling receptacles are covered.

Exit Interview Questions

  • Does this school have an integrated pest management system?

  • Do custodial staff members receive ongoing in-service and/or vo-tech training? Examples?

  • Are custodial duty schedules periodically reviewed by the administrative staff?

  • Do you know where the Safety Data Sheets (SDS) are for all chemicals (cleaning supplies and science)?

  • A list of chemical disposal service providers was issued to the school representative.

Verification

  • 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.

  • School Representative

  • Inspector

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.