SCHOOL RISK MANAGEMENT SURVEY
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1 SCHOOL RISK MANAGEMENT SURVEY Name of School School No. Address: Date of visit: Phone number: Loss Control Contact: Principal: Assistant Principal: Building Engineer: NTA/Security Person: Teachers: Clerical: Food Service: Custodians: Nurse: Counselors: Total Number of Students: Grades: Hours: Summer School Programs: After School Activities: Capacity: School Used by Others: Adopt a School Program: Parent Association: Transportation: Students Dropped Off at: Pest Control is: Workers Compensation injuries are most likely to occur: Greatest Liability Exposures are: FUN:App3:04/08 Page 113
2 Elevators: Freight: Passenger: Operator: Problems: Asbestos: (location): Sealed or Removed (when): Special Education: 1. How many students: 2. Type of (physical, TMR): 3. ADA (physical characteristics): School Safety Plan: FUN:App3:04/08 Page 114
3 SECURITY AND FIRE SAFETY Number of Security Personnel: NTA S: City of Philadelphia Police Officer Assigned: Closest Fire Department: Closest Police Department: Approximate Number of Weapons confiscated during the year: Most Common Weapon: Weapons are kept where: Number of break-ins last year: Stolen Items last year: School Security System (door contacts) working: Motion detectors (location): Security lights working: Stolen or damaged vehicles in school lots: Are trespassers a problem: House Phones/PA system working: (manual or timer) Automatic Sprinkler System: wet dry (where): Valves (locked, inspected, no blocked): Pull stations (local or fire dept.): Heat/smoke detectors: False Alarms: 1. How many per year? 2. Students Caught: 3. Any preventative measures? Extinguishers: 1. Discharged by students: 2. Inspected: 3. Water type recharged on site: 4. Fire hoses: Fire Department make inspection of school: Last Fire Drill: Designated Smoking Areas: (when) Standpipes (where): Siamese: Fire towers (how many): FUN:App3:04/08 Page 115
4 Fire Hydrants (where): Emergency generator: (tested) (location) Emergency lights 9battery or electric): (tested) FUN:App3:04/08 Page 116
5 BUILDINGS Building A. Exterior Year built: Foundation walls: Exterior walls: Windows: Doors: Security Screening: 1. Front: 2. Side A: 3. Side B: 4. Rear: Sidewalks: 1. Condition: 2. Construction: 3. Snow & ice removal: FUN:App3:04/08 Page 117
6 BUILDINGS Building B. Exterior Year built: Foundation walls: Exterior walls: Windows: Doors: Security Screening: 1. Front: 2. Side A: 3. Side B: 4. Rear: Sidewalks: 1. Condition: 2. Construction: 3. Snow & ice removal: FUN:App3:04/08 Page 118
7 BUILDINGS Building C. Exterior Year built: Foundation walls: Exterior walls: Windows: Doors: Security Screening: 1. Front: 2. Side A: 3. Side B: 4. Rear: Sidewalks: 1. Condition: 2. Construction: 3. Snow & ice removal: FUN:App3:04/08 Page 119
8 BUILDINGS Building D. Exterior Year built: Foundation walls: Exterior walls: Windows: Doors: Security Screening: 1. Front: 2. Side A: 3. Side B: 4. Rear: Sidewalks: 1. Condition: 2. Construction: 3. Snow & ice removal: FUN:App3:04/08 Page 120
9 GROUNDS Grass, Shrubs, trees: Fencing: Pillars and posts: Steps: Parking lot: 1. Surface: 2. Gates/openings: 3. Drains: 4. Fences: 5. School District signs: School yard: 1. Surface: 2. Gates/openings: 3. Drains: 4. Fences: 5. School District signs: 6. Playground/equipment: Adjacent properties: FUN:App3:04/08 Page 121
10 INTERIOR CONDITIONS Hallway: Heating units: 6. Obstructions: 7. Lockers: Classroom doors: 1. Fire glass: 2. Construction: Stair wells: 1. Number of: 2. Handrails: 3. Steps: 4. Exit lighting: 5. Doors (hardware & fire glass): FUN:App3:04/08 Page 122
11 MECHANICAL ROOMS Boiler Room: Steps: Number of boilers: Fuel Storage (where & capacity): Certification (where kept): Air compressors (how many & type): Pumps (type & leaks): Fire Extinguisher: Fan Room: Steps: Number of fan rooms: Guards on machines: Storage: Fire extinguisher: Electrical Room: Steps: PECO transformer (located): Warning signage posted on door: Anti shock mat in place: Voltage labeled: Storage: Fire extinguisher (type): Main Storage Room: Steps: Equipment: MSDS: Chemical Inventory (Hazardous Substance Survey): Chemical Stored in: FUN:App3:04/08 Page 123
12 FUN:App3:04/08 Page 124
13 CLASSROOMS Steps: Classroom Number Variations FUN:App3:04/08 Page 125
14 COMPUTER CLASSROOM(S) Screened fire glass on exterior door: Interior security bars: Location of electrical power: Air conditioning: Halon fire extinguisher: Number of thefts: Classroom number Number of computers Variations TYPING CLASSROOM(S) Screened fire glass on exterior door: Location of electrical power: Number of thefts: Classroom number Number of typewriters Variations FUN:App3:04/08 Page 126
15 OFFICES Steps: Office Name/number Variations FUN:App3:04/08 Page 127
16 BATHROOMS Steps: Bathroom Location Variations Storage Closet Location Variations FUN:App3:04/08 Page 128
17 LIBRARY/IMC Doors: Windows: Fire extinguisher: Storage room: Bookshelves secured: Furnishings: FUN:App3:04/08 Page 129
18 GYMNASIUM(S) Gym A Floor: Doors: Windows: Heating Units: Equipment: 1. Basketball hoops: 2. Ropes & rings: 3. Climbing board/chin up bar: 4. Mats on Walls (if needed): 5. Bleachers: Locker Rooms (Boys) Lockers: Benches: Showers: Bathroom: (Girls) Lockers: Benches: Showers: Bathroom: Storage Rooms Number of rooms: Equipment Stored: Phys Ed Office(s) Number of: Doors: Windows: FUN:App3:04/08 Page 130
19 Bathrooms: First aid kit: Fire extinguisher: Refrigerator: FUN:App3:04/08 Page 131
20 GYMNASIUM(S) Gym B Floor: Doors: Windows: Heating Units: Equipment: 1. Basketball hoops: 2. Ropes & rings: 3. Climbing board/chin up bar: 4. Mats on Walls (if needed): 5. Bleachers: Locker Rooms (Boys) Lockers: Benches: Showers: Bathroom: (Girls) Lockers: Benches: Showers: Bathroom: Storage Rooms Number of rooms: Equipment Stored: Phys Ed Office(s) Number of: Doors: Windows: FUN:App3:04/08 Page 132
21 Bathrooms: First aid kit: Fire extinguisher: Refrigerator: FUN:App3:04/08 Page 133
22 GYMNASIUM(S) Gym C Floor: Doors: Windows: Heating Units: Equipment: 1. Basketball hoops: 2. Ropes & rings: 3. Climbing board/chin up bar: 4. Mats on Walls (if needed): 5. Bleachers: Locker Rooms (Boys) Lockers: Benches: Showers: Bathroom: (Girls) Lockers: Benches: Showers: Bathroom: Storage Rooms Number of rooms: Equipment Stored: Phys Ed Office(s) Number of: Doors: Windows: FUN:App3:04/08 Page 134
23 Bathrooms: First aid kit: Fire extinguisher: Refrigerator: FUN:App3:04/08 Page 135
24 WEIGHT ROOM Door (locked): Used by: Supervised by: Equipment: Emergency Procedure (house phone): FUN:App3:04/08 Page 136
25 HEALTH SERVICES Windows: Doors: Bathroom: Waiting area: Examination room: Equipment: Medication stored (location/secured): EM2 s: Who distributes medication when nurse is unavailable: Closest health facility (emergency treatment): Wheel chair available: Full or part time nurse: Hours: Fire extinguisher: FUN:App3:04/08 Page 137
26 FOOD SERVICE Manager: Other Staff: Hour of operation: Total number of students fed: Breakfast: Lunch: Tokens: Universal Feed Program: Kitchen Steps: Ventilation: Equipment: Ansul System (inspection date): Fire Extinguisher: Pull Stations: Pest Control: Knives sharpened by: Knives kept in: Cash Registers: Safe: Slip mats in kitchen: Storage Food items separate from cleaning materials: Food items dated/priced: Items stored on: Delivery process: Serving Line Access from kitchen to line via: Line equipment: Anti slip mats on line: FUN:App3:04/08 Page 138
27 Ventilation: Adequate Line Space: Fire extinguisher: Cafeteria Steps: Windows: Doors: Ventilation: Heating units: Seating: Tables: Vending Machines: Refund Program: Faculty Cafeteria Steps: Ventilation: Number served for breakfast: Lunch: Cafeteria Furniture: Vending Machines: Fire Extinguisher: Serving line equipment: Anti slip mats: FUN:App3:04/08 Page 139
28 AUDITORIUM Ventilation: Seating capacity: Doors: Windows: Exit lighting: Seating (type/condition): Side curtains: Fire extinguishers: Pull Stations: Distance between stage and seating: Equipment in auditorium: Stage Elevation to floor of auditorium: Steps to stage: Stage lighting: Curtains/liners: Fire extinguishers: Storage: Exits: Balcony Steps/ramps: Railing: Seating: Exit lighting: Fire extinguisher: Elevation to auditorium floor: FUN:App3:04/08 Page 140
29 ROOF Type (flat, peaked): Construction: Drains: 1. Number of: 2. Free & Clear: Chimney(s): 1. Number of: 2. Lightning arrestors: 3. Ladder to top: Satellite dish: Other items on roof: Leaks: Elevator penthouse: 1. Steps: 2. Door: 3. Fire extinguisher: 4. Storage: FUN:App3:04/08 Page 141
30 ART DEPARTMENT Ventilation: Fire extinguisher: Sinks: Chemicals: 1. Storage: 2. Cabinet: 3. MSDS: PPE available: FUN:App3:04/08 Page 142
31 HOME ECONOMICS Floor: Number of stoves: gas: Electric: Chemicals labeled: Knives area sharpened by: Number of washers: GFCI near wet areas: Extension cords being used: Fire extinguisher: Sewing machines: Iron/ironing boards: Number of dryers: Number of refrigerators: FUN:App3:04/08 Page 143
32 WOOD SHOP Equipment 1. Jointer: 2. Table saw: 3. Radial arm saw: 4. Planer: 5. Band saw: 6. Drill press: 7. : 8. : 9. : Number of worktables: Personal protective equipment: Goggles: Respirators: Aprons: Other: Dust bags/cydiones: 1. Number of (indoor/outdoor) 2. Statically grounded: Flammables: 1. Inventory/MSDS: 2. Storage: 3. Cabinets/shelving: Products made for School District or public: FUN:App3:04/08 Page 144
33 SCIENCE LABS Lab A Floor: Ventilation: Fire extinguisher: Fire blanket: Exits marked: Pull station: 1 st Aid kit: Eye wash: Shower: Fumehood: (PPE) Eye/face protectors: Aprons: Gloves: Respirator: Other: GFCI (near wet areas): MSDS: Inventory(copy): Other: Gas: Furniture: (Chemical Storage) Door (locked): Ventilation: Cabinets: Shelving: Fire extinguisher: FUN:App3:04/08 Page 145
34 SCIENCE LABS Lab B Floor: Ventilation: Fire extinguisher: Fire blanket: Exits marked: Pull station: 1 st Aid kit: Eye wash: Shower: Fumehood: (PPE) Eye/face protectors: Aprons: Gloves: Respirator: Other: GFCI (near wet areas): MSDS: Inventory(copy): Other: Gas: Furniture: (Chemical Storage) Door (locked): Ventilation: Cabinets: Shelving: Fire extinguisher: FUN:App3:04/08 Page 146
35 SCIENCE LABS Lab C Floor: Ventilation: Fire extinguisher: Fire blanket: Exits marked: Pull station: 1 st Aid kit: Eye wash: Shower: Fumehood: (PPE) Eye/face protectors: Aprons: Gloves: Respirator: Other: GFCI (near wet areas): MSDS: Inventory(copy): Other: Gas: Furniture: (Chemical Storage) Door (locked): Ventilation: Cabinets: Shelving: Fire extinguisher: FUN:App3:04/08 Page 147
36 SCIENCE LABS Lab D Floor: Ventilation: Fire extinguisher: Fire blanket: Exits marked: Pull station: 1 st Aid kit: Eye wash: Shower: Fumehood: (PPE) Eye/face protectors: Aprons: Gloves: Respirator: Other: GFCI (near wet areas): MSDS: Inventory(copy): Other: Gas: Furniture: (Chemical Storage) Door (locked): Ventilation: Cabinets: Shelving: Fire extinguisher: FUN:App3:04/08 Page 148
37 FUN:App3:04/08 Page 149
38 PRINT SHOP/DARK ROOM Ventilation: Equipment: Chemicals: 1. MSDS/inventory: 2. Storage: 3. Cabinet: 4. Fire extinguisher: 5. Safety cans: Personal protective equipment 1. Goggles: 2. Gloves: 3. Aprons: 4. Respirators: 5. Other: FUN:App3:04/08 Page 150
39 AUTOMOTIVE Floor: Ventilation: Doors: Windows: Drains: Number of overhead doors: 1. Electrical or manual: 2. Secured at night: 3. Ventilation openings: Service bays: 1. Number of: 2. Hydraulic lifts: 3. Hoists: Personal protective equipment: 1. Goggles: 2. Respirators: 3. Shoes: 4. Others: First aid kit: Eyewash/shower: Fire extinguishers: Pull stations: Absorbent materials: Spill kit: Air compressor: 1. Location: 2. Type/number: 3. Maintenance: Equipment: 1. Diagnostic: 2. Grinder: 3. Drill press: 4. : 5. : 6. : Painting: 1. Booth/room: 2. Automatic sprinklered: 3. Shut off solenoid: 4. Amount of pain in room/booth: Tool crib: FUN:App3:04/08 Page 151
40 Parts rooms: Parts wash (w/ fusible link): Safety cans: Who dispose of rags: Bulk storage room: 1. Location: 2. Inventory/MSDS: 3. Fire extinguisher: Vehicles: 1. Number of public vehicles serviced (monthly): 2. Any donated vehicles: 3. Any School District vehicles serviced: FUN:App3:04/08 Page 152
41 STUDENT RESTAURANT/FOOD SERVICE MANAGEMENT Kitchen Ventilation: Windows: Doors: Equipment: Ansul System (inspection date): Fire extinguishers: Pull stations: Pest control: Knives sharpened by: Knives kept in: Safe: Slip mats: First aid kits: MSDS: Restaurant Floor: Ventilation: Hours of operation: Number of instructors: Cash register: Any thefts: Furnishing and equipment in restaurant: Catering: Who: What: Where: Any outside contractors: FUN:App3:04/08 Page 153
42 Injuries to students: FUN:App3:04/08 Page 154
43 HORTICULTURE Equipment: Chemicals: 1. Storage: 2. Cabinet: 3. MSDS: 4. Warning posted: Fire extinguisher: Greenhouse: Approximate dimensions: length width weight Fans number of: Doors: Sprinklered: Sale to the public: FUN:App3:04/08 Page 155
44 COSMETOLOGY Number of stations: Air conditioning: Maintenance of equipment by: Chemicals: 1. Stored (location): 2. MSDS/inventory: 3. Cabinet/shelving: Electricity provided by: 1 st aid kit: Fire extinguisher: PPE provided: Average number of public patrols: FUN:App3:04/08 Page 156
45 WELDING Ventilation: Number of booths: Number of welding units: O 2 & acetylene: Hoists: Electric: Cylinders Secured/stored: PPE 1. Goggles/shields: 2. Gloves: 3. Shoes: 4. Signs posted (observers): First Aid kit (burn ointment): Eye wash: MSDS/inventory: Fire Extinguisher: Any welding done for the School District or the public: FUN:App3:04/08 Page 157
46 SWIMMING POOLS Hours of operation: Weekend use: Summer use: Sports: Number of lifeguards: Pool: Dimensions: length width to depth Drains: Ladders: 1. Number of: 2. Construction: 3. Secured: Diving boards: 1. Number of: 2. Height of each: 3. Ladders (construction/secured): Lifeguard chairs: Pool Area: Ventilation: Heating provided by: Flooring around pool: Rules/signs posted: Lifesaving devices: First aid kit: Emergency phone: Chemicals: 1. Storage: 2. Inventory/MSDS: 3. Signs posted: Pool office(s): Doors: Windows: Other: FUN:App3:04/08 Page 158
47 Locker rooms (Boys) Lockers: Benches: Showers: Bathrooms: (Girls) Lockers: Benches: Showers: Bathrooms: Seating: Construction: Steps: Railings: Condition: Use by other: Any injuries in the current year: FUN:App3:04/08 Page 159
48 SHOP Equipment 1. : 2. : 3. : 4. : 5. : 6. : 7. : 8. : 9. : Guarded Worktables: Personal Protective Equipment: Goggles: Respirators: Gloves: Other: Flammables: 1. Inventory/MSDS: 2. Storage: 3. Cabinets/Shelving: Products made for School District or public: FUN:App3:04/08 Page 160
49 DAY CARE Comprehensive: Child Care: Get Set: Head Start: (Other): Director/Coordinator: Hours: Average number of children: Number of teachers: Total staff number: Whose children (S.D., public, students): Room numbers: Floor location: Emergency evacuation procedures: Equipment: Cribs: Toys Wheeled toys: Climbing Apparatus: Kitchen: Parents/Volunteers (how many): Any trespassers: Serious incidents: FUN:App3:04/08 Page 161
50 FIELDS Number of: Type: Sports: Football: Baseball: Soccer: Track/Field: Soft ball: Other: Others who use fields: Condition: Track: Field: Backstop: Drains: Base paths: Scoreboard: Goal posts: Long jump/pole vault: Foul ball protection: Benches: Fencing: Signs: Seating: (Home) (Visitors) Stadium: Lights: Press Box: FUN:App3:04/08 Page 162
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