Valley Schools Insurance Trust

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

1.0 - Previous inspection

• 1.1 - School Photo

  Yes

  No

  Not Available

• 1.2 - Has the last inspection been reviewed?

  Yes

  No

  Not Available

• 1.3 - Outstanding actions.

  Minimal Risk

  Potential Risk

  At Risk

• Overall Risk<br><br>

  Minimal Risk

  Potential Risk

  At Risk

2.0 - Facilites

• 2.1 -AC / HVAC / Duct Work

  Minimal Risk

  Potential Risk

  At Risk

• 2.2 - Bleachers

  Minimal Risk

  Potential Risk

  At Risk

• 2.3 - Electrical

  Minimal Risk

  Potential Risk

  At Risk

• 2.4 - Entry / Exit / Labels and Markings

  Minimal Risk

  Potential Risk

  At Risk

• 2.5 - Handrails / Stairs / Platforms / Elevators

  Minimal Risk

  Potential Risk

  At Risk

• 2.6 - Fire Systems / Extinguishers

  Minimal Risk

  Potential Risk

  At Risk

• 2.7 - Defibrillators / Eye Flush / First Aid

  Minimal Risk

  Potential Risk

  At Risk

• 2.8 - Display Case / Storage Cabinets / Shelving

  Minimal Risk

  Potential Risk

  At Risk

• 2.9 - Flooring

  Minimal Risk

  Potential Risk

  At Risk

• 2.10 - Hazardous / Flammable / Ventilation / MSDS

  Minimal Risk

  Potential Risk

  At Risk

• 2.11 - Interior / Exterior Structure

  Minimal Risk

  Potential Risk

  At Risk

• 2.12 - Plumbing / Leaks

  Minimal Risk

  Potential Risk

  At Risk

• 2.13 - Restrooms

  Minimal Risk

  Potential Risk

  At Risk

• 2.14 - Stage / Lighting / Rigging

  Minimal Risk

  Potential Risk

  At Risk

• 2.15 - Wall Mount / TV / Speaker / Lighting

  Minimal Risk

  Potential Risk

  At Risk

• 2.16 - Misc

  Minimal Risk

  Potential Risk

  At Risk

3.0 - Grounds

• 3.1 - Bleachers / Stairs / Handrails<br><br>

  Minimal Risk

  Potential Risk

  At Risk

• 3.2 - Electrical

  Minimal Risk

  Potential Risk

  At Risk

• 3.3 - FDC / Water / Gas Mains

  Minimal Risk

  Potential Risk

  At Risk

• 3.4 - Fencing / Gates

  Minimal Risk

  Potential Risk

  At Risk

• 3.5 - Grades / Footings / Drainage

  Minimal Risk

  Potential Risk

  At Risk

• 3.6 - Plumbing / Leaks / Sprinklers

  Minimal Risk

  Potential Risk

  At Risk

• 3.7 - Posting / Curb Markings

  Minimal Risk

  Potential Risk

  At Risk

• 3.8 - Shade Structures

  Minimal Risk

  Potential Risk

  At Risk

• 3.9 - Sport Courts

  Minimal Risk

  Potential Risk

  At Risk

• 3.10 - Walkways / Sidewalks / Parking Lots

  Minimal Risk

  Potential Risk

  At Risk

• 3.11 - Misc

  Minimal Risk

  Potential Risk

  At Risk

4.0 - Playgrounds

• 4.1 - Fall Zones / Height Requirements

  Minimal Risk

  Potential Risk

  At Risk

• 4.2 - Fencing / Gates

  Minimal Risk

  Potential Risk

  At Risk

• 4.3 - Grades / Footings

  Minimal Risk

  Potential Risk

  At Risk

• 4.4 - Head Entrapments / Entanglement

  Minimal Risk

  Potential Risk

  At Risk

• 4.5 - Play Structure Condition

  Minimal Risk

  Potential Risk

  At Risk

• 4.6 - Shade Structure

  Minimal Risk

  Potential Risk

  At Risk

• 4.7 - Surface Material / Depth

  Minimal Risk

  Potential Risk

  At Risk

• 4.8 - Misc

  Minimal Risk

  Potential Risk

  At Risk

5.0 - Roofs

• 5.1 - AC / HVAC / Duct Work

  Minimal Risk

  Potential Risk

  At Risk

• 5.2 - Drainage / Gutters / Roof Edge

  Minimal Risk

  Potential Risk

  At Risk

• 5.3 - Hatches / Ladders

  Minimal Risk

  Potential Risk

  At Risk

• 5.4 - Sky Lights / Antennas

  Minimal Risk

  Potential Risk

  At Risk

• 5.5 - Surface Condition / Flashing

  Minimal Risk

  Potential Risk

  At Risk

• 5.6 - Unauthorized Access

  Minimal Risk

  Potential Risk

  At Risk

• 5.7 - Misc

  Minimal Risk

  Potential Risk

  At Risk

6.0 - Water Heaters

• 6.1

  Minimal Risk

  Potential Risk

  At Risk

• 6.2

  Minimal Risk

  Potential Risk

  At Risk

• 6.3

  Minimal Risk

  Potential Risk

  At Risk

• 6.4

  Minimal Risk

  Potential Risk

  At Risk

7.0 - At Risk Follow Ups

• 7.1 Facilities

  Minimal Risk

  Potential Risk

  At Risk

• 7.2 Grounds

  Minimal Risk

  Potential Risk

  At Risk

• 7.3 Playgrounds

  Minimal Risk

  Potential Risk

  At Risk

• 7.4 Roofs

  Minimal Risk

  Potential Risk

  At Risk

• 7.5 Water Heaters

  Minimal Risk

  Potential Risk

  At Risk

Sign Off

• On site representative

  Sign

• Auditor's signature

  Sign