PROGRAM CONTACT PERSON LIST

Asbestos Management.....................................................Art Schweitzer AED..........................................................................George Berndt AWAIR........................................................................Art Schweitzer Bleacher Safety............................................................ Art Schweitzer Bloodborne Pathogens......................................................Judy Huisman Community Right-to-Know...............................................Art Schweitzer Compressed Gas Safety...................................................Art Schweitzer Confined Space Entry.....................................................Art Schweitzer Emergency Action Planning...............................................Art Schweitzer Employee Right-to-Know/Hazard Communication...................Art Schweitzer Facilities Safety Management............................................Art Schweitzer First Aid/CPR ................................................................Judy Huisman Hazardous Waste Management..........................................Art Schweitzer Hearing Conservation.....................................................Art Schweitzer Indoor Air Quality..........................................................Art Schweitzer Integrated Pest Management............................................Art Schweitzer Laboratory Standard/Chemical Hygiene Plan......................................Matt McDowell Lead Management.........................................................Art Schweitzer Lockout/Tagout ...........................................................Art Schweitzer Machine Guarding .........................................................Art Schweitzer Personal Protective Equipment.........................................Art Schweitzer Playground Safety.........................................................Art Schweitzer Radon Gas Safety..........................................................Art Schweitzer Respiratory Protection...................................................Art Schweitzer USTs/ASTs...................................................................Art Schweitzer Welding Cutting Brazing....................................................Darrel Mayer

Checklist of E/OHS Activities for Asbestos Management

Program Contact Person: Art Schweitzer Is the Asbestos Management Plan in place? Yes No N/A Is the Plan current for all buildings? Yes No N/A Has the Plan (or Plans) been reviewed this school year? Yes No N/A The Plan is located at affected building: Yes. Training for Asbestos Awareness was conducted October 24, 2008 New PT employees received training on 10-24-2007
(date)

. . .

Annual written notification has been prepared; Yes

(date)

Notification appeared in the following publication(s): Name of publication Fall News letter Date Fall, 2010 .

Three-year re-inspection Surveillance was conducted: 6/29/2010 6-month Periodic Surveillance was conducted: 6/29/2010
(first date)

02/15/2011
(second date)

All caution labels have been posted. Label locations: Boiler room Tunnels Hard lagging

Are supplies of repair materials adequate to meet the requirements of maintenance and repair of ACM? Yes No N/A

Asbestos Maintenance Supplies on Hand Bags Respirators Wrap-ncure

Is documentation of Operations and Maintenance available? Location: District Office

Status of the Asbestos repair and maintenance Work Order System: N/A Established, Pending Comments: Repairs to asbestos are limited to replacement of damaged floor tile. **For information regarding the medical review and questionnaire, see the Respiratory Protection Program.** Note: click here this link to review 6 month periodics. The tunnels were cleaned and maintained during the summer of 2009. This work was conducted as O&M activities. LC

Checklist of E/OHS Activities for Automatic External Defibrillator

Program Contact Person: George Berndt School policy for use adopted in place? Yes No N/A Brand of AED? Heart Start FRx Model: IP55 Name of Medical Director? The director is yet to be determined. Year device was placed into use? 2010 Location(s) of devices: Building Name Location in Building

Ellsworth Public School

Gym entrance

Have all software updates been installed? Yes No N/A Date of update installation: 12-2010 Expiration date of pads? 12-2012 Expiration date of batteries? 01-2016
(date)

Has staff been trained on operation of the device? Yes, all school staff. Most recent date of training:12-2010
(date

Provider of training: Mary Lubben,

Location of operators manual: Are battery checks documented? Yes, a check list is available at each AED station Notes:

Checklist of E/OHS Activities for AWAIR

Program Contact Person: George Berndt Is the AWAIR Plan in place? Yes No N/A Is the Plan current? Yes No N/A Has the Plan been reviewed this school year? Yes No N/A Is the Safety Committee organized? Yes No N/A How often are meetings held? Quarterly Are minutes of the meeting maintained? Yes Location: File in Mr. Berndts office Posted: How is the program communicated to employees? fall orientation All Staff training during

Who is the Contact Person for OSHA 300? Darcy Groen Is the OSHA 300A Log completed for the previous calendar year? Yes Have the Logs been maintained for five (5) years? Location: Activities Manual Is the Log posted from February 1 until April 30? Yes Yes

The location/s of the posted log: Main School Office. Is information on injuries recorded on the Log with five (5) working days? Yes No N/A

Safety Committee Meeting Schedule

Date
Jan. 12, 2011 Oct. 6, 2010 April 15, 2010 Jan. 18, 2010

Location
Principals office Principals office Principals office Principles office

Time
3:00pm 3:00pm 3:00pm 3:00pm

District Safety Committee Members Member George Berndt Judy Huisman Art Schweitzer Mike Palm Darin DeBoer Molly Schilling Darrel Mayer Dianne Johnson Darcey Groen Position Principal Lead Secretary Custodian Staff Staff Staff Staff Food Service Secretary Building Ellsworth Public Ellsworth Public Ellsworth Public Ellsworth Public Ellsworth Public Ellsworth Public Ellsworth Public Ellsworth Public Ellsworth Public

Checklist of E/OHS Activities for Bleacher safety

Program Contact Person: Art Schweitzer Is the BSM Plan in place? Yes No N/A Is the Plan current? Yes No N/A Has the Plan been reviewed this school year? Yes No N/A Has an annual survey of school bleachers been conducted? Yes No N/A Is the five-year recertification required by December 31, 2007 complete and submitted to the Minnesota Department of Labor and Industry? Yes No N/A Note: Prepared 10-8-07 and sent.

Inspection Check List

Openings and gaps: Openings limited to four-inch gap between the railings and between the footboards and seat boards, starting at a height of 56 inches or more. Retractable bleachers: They may contain openings of 9 inches or less If exempt from standards must have a safety management plan in place and an amortization schedule to plan for their future replacement Approved netting: Netting may be provided to prevent persons from falling through the bleachers between the seat and footboards Chain link fencing may be used but must be secured tightly to the underside of the bleachers. Railings: Bleachers 55 inches and under are exempt from railing requirements Bleachers with guardrails over 30 inches above grade must not contain openings greater than four inches, unless safety nets are installed. State building inspectors shall determine whether the safety nets and guardrail climb ability meet the requirements of the alternate design section of the State Building Code. Periodic inspections: Bleacher footboards and guardrails must at a minimum be reinspected at least every five years and a structural inspection at least every ten years. The equipment has no rust, rot, cracks, or splinters, especially where it comes in contact with the ground There are no broken or missing components on the equipment (e.g., handrails, guardrails, protective barriers, steps, or rungs on ladders) and there are no damaged fences, benches, or signs on the playground

Checklist of E/OHS Activities for Bloodborne Pathogens

Program Contact Person: Judy Huisman Is the Bloodborne Pathogens Written Plan in place? Yes No Has the Plan been reviewed this school year? Yes No List job categories that may be at risk to exposure: Bus drivers Paras, Special Ed Custodians School Nurse Secretaries What is this schools policy regarding Hepatitis B vaccinations for employees considered at risk versus employees considered not at risk in the Exposure Control Plan? Custodians provide clean up fluid spills. Is training provided at this school on methods and techniques to reduce exposure incidents? All staff is trained during the fall faculty development days. The employee sign in log is posted in the Activities Manual New Employees: within ten days of employment Have the employees identified as first aid responders been given at a minimum Red Cross First Aid Training? Yes No N/A Note: Not recently. Are Exposure Control Kits available to staff? Yes No N/A Location(s): Each classroom is supplied with a clean-up kit. Kits are also located in the janitors closet and also in the School Main Office. Status of Declination forms: Judy will be working organizing acceptance/ declination forms. New forms will be distributed and previous vaccination information will be gathered and recorded. How is blood or bodily-fluid-containing materials handled at this facility? Custodial staff typically responds to blood spills that occur when on campus. Location of biohazard bags at school: Nurses office and the custodial office Approved disposal location for biohazardous waste: Worthington Regional Hospital

Hepatitis B Vaccination Consent Form

I have been given a copy of and have read or have had explained to me the information about hepatitis B and hepatitis B vaccine. I have had a chance to ask questions which were answered to my satisfaction. I believe I understand the benefits and risks of the hepatitis B vaccine, and request that it be given to me or to the person named below for whom I am authorized to make this request.

Please Print: Name_________________________________________Date of Birth_________________ Social Security or Visa #__________________________Employee #__________________ Department and Lab room #__________________________________________________ Principal Investigator________________________________________________________

Signature______________________________________Date________________________ Note: I have previously participated in an HBV vaccination program. Employer at time of vaccination _____________________________ Date ___________ Record maintained where __________________________________

Checklist of E/OHS Activities for Compressed Gas Safety

Program Contact Person(s) Darrel Meyer Department Contacts: Maintenance Art Schweitzer Metals Shop Darrel Meyer Technology Ed. Darrel Meyer Is the Compressed Gas Plan in place? Yes No N/A Is the Plan current? Yes No N/A Has the Plan been reviewed this school year? Yes No N/A Has the facility been surveyed for compressed gas inventories? Yes No N/A Has training been conducted for affected personnel? Yes No N/A Are records established and maintained to monitor gas inventory? Yes No N/A

COMPRESSED GAS FIELD REVIEW

Compressed Gas Inventory
Date:04-12-2011 Department: Metals Shop Location: Wood Shop Cylinders: O2 ___1_________ Acetyl ____1________ NH4 ____________ Program Contact Person: Brian Parrie Department Responsible Person: Darrel Meyer

CO2 ____________ Argon ____________ Argon/CO2_____1_______ Other ____________

Compliance Check List

1. Are cylinders in well-ventilated area? 2. Are cylinders stored separate from flammable by at least 20 feet? 3. During storage are oxygen cylinders separated from fuel gas cylinders, unless on welding cart? 4. Are cylinders kept away from sources of heat (below 130 F)? 5. Are safety chains used at all times on both full and empty cylinders? (2/3rds from top of cylinder) 6. Are empty cylinders maintained separate from full cylinders? 7. Are cylinders kept away from sources of ignition such as electricity, excessive heat or oily rags? 8. Are carts designed specifically for gas cylinders available? 9. Are damaged cylinders, valves/hoses removed from service? 10. Are all cylinders properly labeled with the contents? X X X X X X X X X X

Checklist of E/OHS Activities for Confined Space Entry

Program Contact Person: Art Schweitzer Is the Confined Space Entry Plan in place? Yes No N/A Is the Plan current? Yes No N/A Has the Plan been reviewed this school year? Yes No N/A Have confined space areas been identified? Yes No N/A Have measurements to include CCI/ft been completed? Yes No N/A Are permit entry forms in place? Yes No N/A Location: Activity Manual Are confined space labels in the proper locations? Yes No N/A Is a list of employees eligible to enter confined spaces complete? Yes No N/A Has training for affected employees completed? Yes No Date of completion: 10-24-09

Confined Space Inventory

Ellsworth Public School Building: Combined Elementary, Middle School, High School Building Contact: Art Schweitzer Completed By: Brian Parrie
Room Identification Name Given Space Opening Dimension

Program Contact: Brian Parrie

Date: 2-15-2011
Dimension Of Confined Space 4X4X8 4X4X8 4X4X>200 4X4X>200 Potential Hazards Permit/ NonPermit Permit Required Permit Required Permit Required Permit Required Labeled Photo ID #

Boiler Room Boiler #1 Boiler Room Boiler #2 Boiler Room Tunnel access Boiler Room Water Tank #2

24X18 24X18 4X4 4X4

LE, heat,O2 deficient LE, A LE, A LE, A

Yes No Yes Yes

Checklist of E/OHS Activities for Community Right-to-Know

Program Contact Person: George Berndt/ Art Schweitzer Is the Community Right-to-Know Plan in place? Yes No N/A Is the Plan current? Yes No N/A Has the Plan been reviewed this school year? Yes No N/A Are quantities of stored and used designated hazardous materials documented and verified? Yes No N/A Where are the documents stored? Activities Manual Have the State Emergency Response Commission and local fire department been notified of hazardous materials on school grounds? Yes No N/A When were they notified? 2-16- 2011
(date)

Has training been provided? Yes No N/A Date: N/A Presenter: N/A

Inventory Form
Client: Ellsworth Public School
Contact Person: Art Schweitzer Hazardous Material Quantity Date: 10-8-07 Location Reported on Tier Two Installation Date(s)

#2 Fuel Oil

5,000 gal

West side between bldgs.

yes

1975

Note: a 6,000 gal tank was removed from service during the summer of 2006. The tank was approximately installed in 1975. The tank remains in place but has been pumped and filled with water. The tank had never knowingly leaked product into the ground. The remaining tank has been reported on the Tier II form. Sent 2-14-2008 The Tier Two can be managed on line see web site: http://minnesota.idsimaps.com/submit/T2_Menu.asp Login: dgroen25 Password: igloo55

Checklist of E/OHS Activities for Emergency Action Planning

Program Contact Person: George Berndt/ Is the Emergency Action Planning program in place and as outlined in the Minnesota Executive Order 93-27 and Model Crisis Management Plan? Yes No Is the Plan current? Yes No Has the Plan been reviewed this school year? Yes No Have the program and goals been approved by the School Board for the current school year? Yes No Are information maps posted to indicate travel routes in the event of fire, tornado shelter locations, and procedures during lockdown? Yes No Located where? Maps are located in each classroom. Are all drills timed and recorded? Yes No Responsible person: Art Schweitzer_________________________________ Location of records: District Office__________________________________ Forms provided: Yes No Does this school coordinate drills with local government authorities to assure sheltering in school, evacuating to their homes or use of congregate care centers? Yes No N/A Has this school completed the Fire Marshall required Fire Safety and Emergency Evacuation Plan? Yes No N/A Training provided for affected staff? Yes No N/A

Checklist of E/OHS Activities for Employee Right-to-Know/Hazard Communication

Program Contact Person: Art Schweitzer Is the Employee Right-to-Know/Hazard Communication Plan in place? Yes No Is the Plan current? Yes No Has the Plan been reviewed this school year? Yes No Has the program been approved by the School Board for the current school year? Yes No Has the chemical inventory been completed for the following functional areas? Location of Chemical Inventory Form Art Instruction Custodians Food Service Science Rooms Shop (metals, wood, auto) Yes No N/A Yes No N/A Custodial Room Yes No N/A Head cooks desk drawer Yes No N/A Chemistry Lab Yes No N/A

Are MSDS available and located with the chemical inventory? Yes No Do the MSDS concur with the chemical inventory? Yes No Has training been provided for the following staff?
Art Instructors Custodians Food Service

Yes No N/A Science Yes No N/A Shop

Yes No N/A Yes No N/A

Yes No N/A Transportation Yes No N/A

Contact List for Employee Right-to-Know Program

Client: Ellsworth Public School
Key Contact for Department (person responsible for making MSDSs) Mrs. Steinmetz Molly Shilling Jill Christensen Consumer Life Science Custodial/Maintenance Food Service Photo Darrel Meyer ShopWelding Art Schweitzer Margaret Larson Dianne Johnson N/A

Department Art Biology/chemistry

Completed by: Brian Parrie

Date: 2-15-2011

Checklist of E/OHS Activities for Facilities Safety Management and Fire Safety in Schools
Program Contact Person: George Berndt Is the Facilities Safety Management program in place? Yes No Does this school use contracted services for the Management Assistant Program? Yes No N/A If no, who is the designated person or persons?

Fire and Life Safety in Schools

Program Contact Person: George Berndt/ Art Schweitzer Is the Fire Marshal approved Emergency Evacuation Plan in place for each district building? Yes No Most recent date of sprinkler electronics inspection N/A Most recent date of alarm inspection: July, 2010 Most recent inspection of fire extinguisher: June, 2010 Most recent inspection of fume hood with fire suppressant: N/A Are emergency lights tested at least monthly? Yes No N/A Science safety Checklist completed? Yes No N/A

Facilities Safety Review

Building: Ellsworth Public School
Mock-OSHA Review Area Art Dark Room Wood Shop Kitchen Metal Shop Halls, Gym, etc. Graphic Arts Maintenance/Custodia l Transportation Grounds/Garage Chemistry/Life Science 1/15/2010 1/15/2010 1/15/2010 1/15/2010 1/15/2010 1/15/2010 1/15/2010 1/15/2010 1/15/2010 N/A N/A Date Review Completed N/A N/A See written report

Recommendations

Checklist of E/OHS Activities for First Aid/CPR

Program Contact Person(s): Judy Huisman Is the First Aid/CPR program in place? Yes No Is the Plan current? Yes No Has the Plan been reviewed this school year? Yes No Have the program and goals been approved by the School Board for the current school year? Yes No Has the District determined a provider in the event of a medical emergency? Yes No The local provider determined travel time was estimated to be within the 4-8 minute limit. Therefore Ellsworth Rescue Squad will be the designated emergency response provider. The local provider determined travel time was estimated to be in excess of the 4-8 minute limit. Therefore N/A will be the designated emergency response person located within the district. Has training been provided for affected staff? Yes No CPR training held 12-2010 for all staff. Training provided by Mary Lubben from Fulda, certified CPR trainer.

Checklist of E/OHS Activities for Hazardous Waste Management

Program Contact Person(s) Primary Contact Person:_ Art Schweitzer Secondary Contact Person: _ George Berndt Is the Hazardous Waste Management program in place? Yes No Is the Plan current? Yes No Has the Plan been reviewed this school year? Yes No Have the program and goals been approved by the School Board for the current school year? Yes No Did this school generate ten gallons of waste per year? Yes No Note: In Greater Minnesota, schools generating ten gallons of waste per year or less do not need a license. Did this school generate 220 pounds or less per month hazardous waste (about drum or less liquid)? Yes No Note: Wastes that do not count include antifreeze, cathode ray tubes, fluorescent lamps, lead acid batteries, pcb ballasts, photo fixer reclaimed on site, used oil and oil filters. Training for VSQGs do not have training requirements however MPCA strongly recommends persons handling wastes be given training on best handling and safety risks associated. Has training been provided for affected persons? Yes No N/A Date Conducted: N/A Date Scheduled: N/A

Has annual report and license application sent in? Yes No N/A Note: A Hazardous Waste License Application was sent in on Jan. 9, 2009. The school is declaring that it is a VSQG and will not be required to pay a license fee. The science lab was cleaned this summer and the U of M removed the unneeded chemicals. It was reported that about 20 kilograms was removed. 1-9-2009 LC

Note: The school has continued to meet the VSQG criteria during the 20092010 school year. They are not required to report their waste generating activities. LC 4-5-2010 Note: The school has continued to meet the VSQG criteria during the 20102011 school year. They are not required to report their waste generating activities. LC 10-26-2010

Checklist of E/OHS Activities for Hearing Conservation

Program Contact Person: Art Schweitzer Is the Hearing Conservation Plan in place? Yes No Is the Plan current? Yes No Has the Plan been reviewed this school year? Yes No Has the program been approved by the School Board for the current school year? Yes No Has the school been surveyed for noise hazards? Yes No Have sound level measurements been collected? Yes No Have the results been documented? Yes No Location: Activities Manual Has training been scheduled or completed for affected individuals this school year? Yes No N/A Date: Presenter: Have regulatory changes occurred that may affect this program? No

Client: Ellsworth Public Schools

Measuring Device: Center 325 Sound Level Meter Calibration: Pre___________ Post___________

Reason for Testing: General Survey Affected Personnel: Band Custodial, Maintenance, Shop Location Equipment Results Recommendations

Shop Shop Shop Shop Shop Shop Shop

Chop Saw Jet Router Delta Band Saw Stationary Belt/Disk Sander Radial Arm Saw Joiner Sander Planner

99.5.dBA 84.9 dBA 82.7 dBA 83.3 dBA 84.4 dBA 86.3-87.7 dBA 80.7 dBA

Provide Protection Provide Protection

Provide Protection Provide Protection

Completed by Lee Carlson

Date 3-13 -2009

Note: No over limit exposures could be determined. However due to the exceptionally loud readings for short periods it is recommended that hearing protection be provided to affected staff. LC

Checklist of E/OHS Activities for Indoor Air Quality

Program Contact Person: George Berndt Is the IAQ Plan in place? Yes No Is the Plan current? Yes No Has the Plan been reviewed this school year? Yes No Has an IAQ Committee been established? Yes No Have the program and goals been approved by the School Board for the current school year? Yes No Has the annual cursory walk-through been conducted? Yes No Have the districts key building systems been evaluated? Yes No When was the evaluation completed? 3-17-1999 Who conducted the evaluation? Musser Environmental Inc. Were occupied areas of the district evaluated using the EPAs Tools for Schools check list or equivalent? Teachers check list? An information fact sheet was provided all staff. # of forms distributed # of Forms returned: Building maintenance checklist? Yes Building ventilation checklist? Yes
(date)

Training conducted Aug 29, 2007 Training has been scheduled for ____N/A___________.
(date)

Has the District determined the mechanical ventilation rate of each occupied space? Yes No. Supportive technical services were conducted on: 2/26/2010.
(date)

Results of technical services are located? See IAQ Report

Checklist of E/OHS Activities for Integrated Pest Management

Program Contact Person: Art Schweitzer Is the IPM Plan in place? Yes No Is the Plan current? Yes No Has the Plan been reviewed this school year? Yes No Has the annual monitoring been conducted to determine location and degree of infestation? Yes No A map of the problem area/areas has been developed. Yes No Has notice been given to parents regarding application activities? Yes No Location or publication used to notify parents: fall news letter. Note: the school has had cockroach infestations in the past. Plunkets now provides monthly services to control insects and mice. The staff reports good success.

Checklist of E/OHS Activities for Laboratory Standard/Chemical Hygiene Plan

Program Contact Person: Matt McDowell, CHO Is the Laboratory Standard/Chemical Hygiene Plan in place? Yes No N/A Is the Plan current? Yes No N/A Has the Plan been reviewed this school year? Yes No N/A Fume hood was tested on ____N/A___________.
(date)

The results indicate air velocity to be: satisfactory, unsatisfactory, N/A. Chemical inventory: Date of most recent survey: 2009-2010 school year Location of inventory listing: Science Room Are Material Safety Data Sheets (MSDSs) located with inventory? Yes No N/A The MSDS are listed at the following website: http://www.flinnsci.com/search_MSDS.asp Are the MSDS readily accessible? Yes No N/A Has the Minnesota Dept of Ed Science Lab Checklist been completed? Yes No N/A Is training for affected personnel complete? Yes No N/A Date(s) of instruction: Roster signed? Yes No N/A Lesson plan outline available with roster? Yes No N/A Status of Emergency Eye Wash/Deluge Shower: Is flushing conducted weekly? Yes No N/A Is descriptive signage properly posted? Yes No N/A Is flushing activity documented? Yes No N/A

General Science Safety Considerations

For All Rooms Where Science Laboratories Are Conducted And/or Demonstrations Are Given Client: Ellsworth Public School Room Number(s): Description: A school science laboratory is defined as a classroom where demonstrations and/or laboratory instructions are provided for individual or group experiments. They are places where science is taught. In addition, any condition listed under either the storage section or the chemical laboratory section that may apply to any area, for instance, must keep inventories of all biology reagents and chemicals.
ITEM 1) Laboratories must be equipped with adequate ventilation. For new labs (build after July 1990) an manual shutoff control for the laboratory exhaust ventilation system must be provided outside of the room, in a position adjacent to the access door to the room or in such other location as approved by the fire chief. 2) At least one 2A-20BC, or larger, rated and approved portable fire extinguisher must be provided for each 3,000 of laboratory. Travel distance must not exceed 50 from anywhere in the lab. At least one fire extinguisher suitable for class D fires must be provided in laboratories where combustible metals are used and stored. 3) At least one approved fire blanket must be provided in each laboratory. 4) Students must be under the direct supervision of a faculty member or an assistant at all times. In most cases it is recommended that direct supervision means direct eye contact. It is recommended that no more than two students be assigned to a lab station, a place in the room equipped with water, gas, and electricity, or a place where students do labs. 5) Aisles serving work areas on two sides must be at least 42 wide; those serving work areas on one side only must be 36. 6) Minimum of two means of exit access must be provided when: Existing: lab exceeds 1,000 sq. feet New: lab exceeds 200 sq. feet (built after 7/90) 7) Labs must be separated from each other and other portions of the building by not less than a 1-hour occupancy separation.* Existing: labs located in buildings protected by automatic extinguishing systemsonly smoke separation required New: (built after 7/72) *Recommend this be determined by a licensed design professional 8) Labs must be equipped with automatic detection electrically interconnected with the building fire alarm system. Exception: labs protected by a complete automatic sprinkler system that is interconnected to the building fire alarm require no additional detection. CITATION UBC (97) 305.2.4, 307.5.2, & 1202.2.3 UFC (97) 8004.1.11 & 8003.1.4.2 EXISTS CONDITION LACKING N/A

UFC (97) 1002.1 UFC Std. 10-1-3-2

X X X

UFC (97) 1001.9

NFPA 45 (91) 1-4

UFC (97) 1204.2.2 (2)

X X

NPFA 45 (91) 3-4.1 UBC (97) 1007.3.8

UFC (97) Appendix 1-A 7.2 as amended UBC (97), 305.2.4 UFC (97) 1007.2.4.2 & 1007.2.4.1.1 as amended

9) All electrical outlets must be properly grounded and all fixed electrical equipment and appliances must be plugged in to grounded outlets as required by the electrical code. ITEM 10) Electrical receptacles, switches, and controls must be located so as not to be subject to liquid spills. 11) Extension cords must not be used as a substitute for permanent wiring. 12) The use of multi-plug adapters, octopus arrangements, cube adapters, strip plugs, or any other device that does not comply with the electrical code is prohibited. 13) A minimum of 30 of clearance must be maintained in front of electrical control panels for access. 14) Written procedures for laboratory emergencies, including emergency evacuation, must be developed for each lab. 15) Piping systems must comply with nationally recognized standards. 16) Enough eye protection devices (goggles) must be provided for every student in the room, visitors, and the teacher whenever potentially hazardous activities are taking place. 17) Refrigerators, freezers, and other cooling equipment used to store of cool flammable liquids must be of explosion-proof construction 18) Each refrigerator, freezer, or cooler must be prominently labeled to indicate whether it is or is not suitable for storing flammable liquids. 19) Flammable liquids stored in refrigerated equipment must be in closed containers.

UFC (97) 8504 99NEC 250-112 CITATION NFPA 45 (91) 3-6.1 UFC (97) 8506.1 UFC (97) 8507 UFC (97) 8509.2 NFPA 45 (91) 4-6.3.1 NFPA 45 (91) 8-1.1 MN Public Law, section 126.20 NFPA 45 (91) 9-2.2.2 NFPA 45 (97) 9-2.2.1 NFPA 45 (91) 9-1.6.6

X
CONDITION LACKING

EXISTS

N/A

X X X

General Science Safety Considerations

For All Laboratories And/or Rooms Where Chemical Demonstrations Are Conducted Client: Ellsworth Public School Room Number(s): Description: In addition to the provisions that are outlined for any science laboratory area, the following provisions are specific for chemistry classes (but may apply to any lab where similar activities are carried on).
ITEM 1) Proper eyewash facilities must be installed that produce 25 psi of water for 15 minutes. Squeeze bottles do not meet this specification. It is recommended that eyewash fountains should be located within 25 of students in any area of the room. The device must be plumbed into a drinkable water supply. This rule applies to any rooms where labs are conducted that are potentially harmful to the eyes. 2) Emissions generated at workstations must be confined to the area in which they are generated (laboratory hoods). 3) In new labs (build after 7/90) a manual shutoff control for the laboratory exhaust ventilation system must be provided outside of the room in a position adjacent to the access door to the room or in such other location as approved by the fire chief. 4) Chemicals stored in the open in the laboratory work area must be kept to the minimum necessary for the work being done. 5) A complete inventory of chemicals on hand must be maintained and must be available to the fire chief. All materials must be dated upon receipt. 6) Persons responsible for each lab must be familiar with the chemical nature of the materials present in the lab and the appropriate mitigating actions to be taken in case of fire, leak, or spill. 7) Incoming shipments of chemicals must be transported an opened by school personnel familiar with the potential hazards. 8) Neutralizing chemicals spill kits, dry sand, vermiculite, EM Absorbent, and other spill control methods must be readily available while the lab is in use. 9) Written maintenance procedures must be established, including regular inspection, testing, and maintenance of lab utilities, hood and exhaust systems, pressure equipment (autoclaves, steam sterilizers, etc.), and emergency equipment. 10) Lab hoods and special local exhaust systems must be labeled to indicate intended use. Hoods in which radioactive materials are handled must be identified with the radiation hazard symbol. 11) Provide a properly marked, easily accessible main gas shutoff valve in the room. 12) Fume/exhaust hoods must be listed (e.g., UL or FM) and maintained in proper operating condition. 13) Heat sources (e.g., gas burners, hot plates, heating mantles, etc.) should never be left unattended. CITATION EXISTS CONDITION LACKING N/A

ANSI Z-358.1-1981

UBC (97) 1202.2.3

UBC (97) 1202.2.3 UFC (97) 8003.1.4.2

NFPA 45 (91) 7-2.3.1 UFC (97) 8001.6

X
UFC (97) 8001.11.1.1

NFPA 45 (91) 7-2.2.1 UFC (97) 8001.11.1

X X

NFPA 45 (91) 4-6.2

X
NFPA 45 (91) 6-13 UFC (97) 8004.1.12 UFC (97) 8001.4.4 & 8001.4.7.1 Recommendation

X X X

ITEM 14) It is recommended that due to the serious explosion hazard present, the following chemicals not be used in an instructional setting: Benzoyl Peroxide Percholoric Acid Carbon Disulfide Picric Acid Ethyl Ether Potassium Metal Magnesium Powdered Metal 15) Loose clothing (e.g., full cut blouses, neckties, etc.) and long hair should be properly restrained. Also, some laboratory activities could be dangerous to persons wearing contact lenses.

CITATION

EXISTS

CONDITION LACKING

N/A

X
Recommendation

X
Recommendation

Note: Potassium metal is handled by the instructor only.

General Science Safety Considerations

For Chemical Storage Facilities Client: Ellsworth Public School Room Number(s): Description: Chemical Storage Facilities means any area or room where chemicals are stored. Usually this refers to the chemistry storage area, but occasionally there may be other facilities in the school, most likely located within a classroom, that store chemicals. These rules apply to all areas where chemicals are stored.
ITEM 1) Quantities of flammable and combustible liquids shall not exceed the amounts necessary fro demonstration, treatment, laboratory work, maintenance purposes, or operation of equipment. Not in any case will it exceed the limits set forth in table 7902.5-A. 2) Quantities of flammable and combustible liquid in excess of 10 gallons must be stored in a flammable liquids cabinet. Quantities not exceeding ten gallons must be stored in an approved location. 3) The maximum quantity of flammable and combustible liquids in storage and use in a lab must not exceed 120 gallons. Exception: These quantities may be doubled in areas protected by an automatic extinguishing system. Exception: These quantities may be doubled if stored in approved storage cabinets. (Both exceptions may apply.) 4) Class I flammable liquids may be stored in glass containers of not more than one-gallon capacity only if the required liquid purity would be affected by storage in a metal container, or if the liquid would cause excessive corrosion of a metal container. Otherwise, Class I-A liquids are restricted to glass containers not exceeding one-pint capacity and Class 1-B liquids are restricted to glass containers not exceeding one-quart capacity. Class 1-C liquids are permitted to be stored in containers up to one-gallon capacity. 5) No container for Class I or II liquids in any lab may exceed a capacity of one gallon. See table 7902.1-A for other limitations. 6) Materials that will react with water or other liquids to produce a hazard must not be stored in the same room with flammable or combustible liquids. 7) Stored gas cylinders shall have all protective devices on (caps, collars, and similar devices). 8) All gas cylinders must be secured in a place to prevent falling. 9) Material Safety Data Sheets (MSDS) must be readily available on the premises for all hazardous chemicals. 10) All chemicals must be stored in approved containers (if possible, chemicals should be stored in the original shipping package). 11) Incompatible materials shall be segregated to prevent accidental contact with one another. (Storage of materials which are incompatible shall no be allowed in the same cabinet or exhausted enclosure.) CITATION UFC (97) 7902.5.7.2 #3 EXISTS CONDITION LACKING N/A

X
UFC (97) 7902.5.8

X
UFC (97) table 7902.5-A

UFC (97) 7902.1-A

UFC (97) 7902.1-A UFC (97) 7902.5.4 UFC (97) 7401.7.1 UFC (97) 7401.6.4 UFC (97) 8001.6 UFC (97) 8001.4.2

X X X X X X

UFC (97) 8001.11.8

ITEM 12) All shelving must be of substantial construction and properly secured to prevent falling over. (Shelving above work areas should be kept free of chemicals; storage above eye level should be avoided.) 13) Shelving must be equipped with a lip or guard to avoid products rolling off. 14) Defective containers must be removed and disposed of in a proper manner. 15) Disposal of chemical wastes must be in accordance with applicable federal and state regulations and good safety practices. 16) All storage cabinets and storage rooms must be locked or otherwise secured against unauthorized entry. 17) All containers must be properly labeled to identify the contents. 18) Toxic and highly toxic compressed gas, Class IV liquid, solid oxidizers, unclassified detonable, Class I organic peroxides, Class III and IV unstable and reactive material shall not be allowed in the classroom. 19) When transferring flammable liquids between metal containers, the containers must be properly bonded together. The practice of purchasing large containers and dispensing into smaller ones is discouraged.

CITATION UFC (97) 8001.11.9 UFC (97) 8001.11.9 UFC (97) 8001.4.7.3 UFC (97) 8001.5.1 UFC (97) 8001.11.2 UFC (97) 8001.7 UFC (97) 8001.15.2.4

EXISTS

CONDITION LACKING

N/A

X X X X X X X X
UFC (97) 8001.11.5

TABLE 7902.1-A: MAXIMUM SIZE OF CONTAINERS AND PORTABLE TANKS

CONTAINER TYPE 1. Glass1 2. Metal or listed approved plastic2 3. Approved plastic 4. Safety cans 5. Metal drum 6. Approved portable tanks 7. Polyethylene3 CLASS I-A 1 pt. 1 gal. 0 gal. 2 gal. 60 gal. 660 gal. Note 4 CLASS I-B 1 qt. 5 gal. 0 gal. 5 gal. 60 gal. 660 gal. Note 4 CLASS I-C 1 gal. 5 gal. 0 gal. 5 gal. 60 gal. 660 gal. Note 4 CLASS II 1 gal. 5 gal. 0 gal. 5 gal. 60 gal. 660 gal. 60 gal. CLASS III 5 gal. 5 gal. 5 gal. 5 gal. 60 gal. 660 gal. 60 gal.

TABLE 7902.5-A: EXEMPT AMOUNTS OF FLAMMABLE AND COMBUSTIBLE LIQUIDS MAXIMUM QUANTITIES STORED PER CONTROL AREA1,2,3
TYPE OF LIQUID EXEMPT AMOUNT (gallons) Flammable Class I-A 30 Class I-B 60 Class I-C 90 Combination I-A, I-B, I-C 1204 Combustible Class II 120 Class III-A 330 Class III-B 13,2005 1 Control areas shall be separated from each other by not less than a one-hour fire-resistive occupancy separation. The number of control areas within a building used for retail or wholesale sales shall not exceed two. The number of control areas in buildings with other uses shall not exceed four. See Sections 204 and 8001.10.2. 2 Quantities are allowed to be increased 100 percent when stored in approved storage cabinets. When Note 3 applies, the increase for each Note is allowed. 3 Quantities are allowed to be increased 100 percent in buildings equipped with an approved automatic sprinkler system. When Note 2 applies, the increase for each Note is allowed. 4 Combinations shall not contain more than the exempt amounts of any individual class. 5 Quantities permitted in a building equipped with an approved automatic sprinkler system are not limited.

Carcinogen/Substances of Known High Chronic Toxicity

Standard Operating Procedures Client: Ellsworth Public School Which carcinogens are present in district science laboratories?
KNOWN CARCINOGENS Asbestos Arsenic Benzene Benzidine Bis (Chloromethyl) Ether Chloromethyl Methyl Ether Chromium/Chromium Compounds Mustard Gas Vinyl Chloride

SUSPECT CARCINOGENS Cadmium/Cadmium Compounds Carbon Tetrachloride Chloroform DDT 2,4D Methylene Chloride Formaldehyde (Gas) Lead Acetate Lead Phosphate Nickel/Nickel Compounds (Powder) Saccharin Urethane

OTHERS

List total time (in hours) employee is exposed to carcinogens (checked chemicals above) per academic year. N/A hours per academic year

Are checked chemicals required, or could acceptable substitutes be implemented? Will retain carcinogen in curriculum chemicals Will discontinue use of

If retained in curriculum, use table to log/document usage:

CARCINOGENIC CHEMICAL AMOUNTS USED DATES USED NAME(S) OF USER(S) NUMBER OF HOURS USED

Carcinogen/Substances of Known High Chronic Toxicity

Storage Guidelines 1. Store in a well-ventilated area. N/A 2. Use secondary containers or trays with sufficient capacity > 100% primary container. 3. Label with the following information: WARNING! HIGH CHRONIC TOXICITY OR CANCER-SUSPECT AGENT 4. Limited access should be provided for these chemicals. 5. Areas should be posted. 6. District Storage Location: N/A 2 3 4 5

7. Guidelines (from above) that need to be implemented: 1

Carcinogen/Substances of Known High Chronic Toxicity

Handling Guidelines 1. Use a controlled area (an exhaust hood, glove box, designated area in a laboratory with localized ventilation). District Controlled Area: N/A, however, fume hoods are available should need arise. 2. Controlled areas should possess the following signage, conspicuously posted: WARNING! TOXIC SUBSTANCE IN USE OR CANCER-SUSPECT AGENT:
AUTHORIZED PERSONNEL ONLY

3. Use of Personal Protective Equipment, like impermeable gloves, aprons, and face shields. 4. Protect surfaces where carcinogens are handled by using chemically resistant trays or pans that can be decontaminated. 5. On leaving a controlled area, laboratory workers should remove any protective apparel that has been used and thoroughly wash hands, forearms, face, and neck. If disposable apparel or absorbent paper liners have been used, these items should be placed in a closed and impervious container that should then be labeled in some manner such as the following: CAUTION CONTENTS CONTAMINATED WITH SUBSTANCES OF HIGH CHRONIC TOXICITY. Non-disposable protective apparel should be thoroughly washed, and containers of disposable apparel and paper liners should be incinerated. 6. Wastes and other contaminated materials from an experiment involving substances of high chronic toxicity should be collected together with the washings from flasks and such and either decontaminated chemically or placed in closed, suitable labeled containers for incineration away from the controlled area. If chemical decontamination is to be used, a method should be chosen that can reasonable by expected to convert essentially all of the toxic materials into nontoxic materials. For example, residues and wastes from experiments in which B-propiolactone, bis (chloromethyl) ether, or methyl chloromethyl ether have been used should be treated for 10 minutes with concentrated aqueous ammonia.

In the event that chemical decontamination is not feasible, wastes and residues should be placed in an impervious container that should be closed and labeled in some manner such as the following: CAUTION COMPOUNDS OF HIGH CHRONIC TOXICITY or CAUTIONCANCERSUSPECT AGENT. 7. Transfer of contaminated wastes from the controlled area to the incinerator should be done under the supervision of authorized personnel and in such a manner as to prevent spill or loss. In general, liquid wastes containing such compounds should be placed in glass or polyethylene (usually preferable) bottles half-filled with vermiculite, and these should be transported in plastic or metal pails of sufficient capacity to contain the material in case of accidental breakage of the primary container. 8. Normal laboratory work should not be resumed in a space that has been used as a controlled area until it has been adequately decontaminated. Work surfaces should be thoroughly washed and rinsed. If experiments have involved the use of finely divided solid materials, dry sweeping should not be done. In such cases, surfaces should be cleaned by wet mopping or by use of a vacuum cleaner equipped with a high efficiency particulate air (HEPA) filter. All equipment (e.g., glassware, vacuum traps, and containers) that is known or suspected to have been in contact with substances of high chronic toxicity should be washed and rinsed before they are removed from the controlled area. 8. In the event of continued experimentation with a substance of high chronic toxicity (i.e., if a worker regularly uses toxicologically significant quantities of such a substance three times a week), a qualified physician should be consulted to determine whether it is advisable to establish a regular schedule of medical surveillance or biological monitoring. Note: Chemical MSDS may be obtained at the following website: http://www.flinnsci.com/search_MSDS.asp

Checklist of E/OHS Activities for Lead-in-Water Management

Program Contact Person: Art Schweitzer Is the Lead-in-Water Management Plan in place? Yes No Is the Plan current? Yes No Has the Plan been reviewed this school year? Yes No This school completed testing of water supply taps _5-1-1996_.
(date)

Is a map of all potable water taps available for review? Yes No N/A

Checklist of E/OHS Activities for Lead-in-Paint Management

Program Contact Person: Art Schweitzer Is the Lead-in-Paint Management Plan in place? Yes No Is the Plan current? Yes No Has the Plan been reviewed this school year? Yes No Testing for lead in paint on playground equipment: Note: All playground equipment has been replace with lead free. Date completed: N/A Yet to be tested: N/A Results of evaluation for paint condition in rooms K-1: Building constructed post-1978; facility not applicable Building constructed prior to 1978; paint determined to be in ____good__________ condition

Checklist of E/OHS Activities for Lockout/Tagout

Program Contact Person: Art Schweitzer Is the Lockout/Tagout Plan in place? Yes No N/A Is the Plan current? Yes No N/A Has the Plan been reviewed this school year? Yes No N/A Is LO/TO equipment available? Yes No N/A Is the equipment appropriate for application? Yes No N/A If available, where is the equipment located? __Boiler room_______________ Is the equipment maintained in an orderly and readily usable condition? Yes No N/A Have affected personnel been trained as to methods and technique of use? Yes No N/A Are written procedures available for affected staff? Yes No N/A If available, the procedures are located where? __Activities Manual________ Has the annual audit of energy control procedures been completed? Yes No Date or dates of completion:

Checklist of E/OHS Activities for Machine Guarding

Program Contact Person: Darrel Mayer __

Is the Machine Guarding Plan for each affected work area in place? Yes No Is the plan/plans current? Yes No Has the Plan been reviewed this school year? Yes No Has a survey of all district fixed equipment been conducted? Yes No When was the evaluation completed? _______________________ Who conducted the evaluation? _______________________ How are corrections documented? _______________________________ Is all fixed equipment safeguarded to meet OSHA criteria? Yes No Has the alternative MDE best practices criteria used to safeguard equipment? Yes No Has equipment determined not in compliance scheduled for repair or replacement? Yes No N/A If replaced, was best practices, bid specification criteria used for procurement? Yes No

Identified Fixed Equipment Locations Location Building/Buildings Staff Affected # of item

Automotive Shop Wood Shop Custodial/Maintenanc e Welding Shop Ag Shop Bus Garage Art Scene shop Science Contracted technical services to review and recommend? __________________. Name of person or contractor conducting survey? ___________________.
(date)

Results of technical services located where? ________________________ Checklist for minimum requirements: Power outage protection provided for required equipment Emergency stops provided for required equipment Safe work practice placards at applicable fixed tool stations Proper guards provided and used Color coding as prescribed by OSHA standards Non-slip surfaces by each piece of equipment Fixed equipment secured to prevent walking or movement Has a log of employee accidents and near misses been established and used? Yes No Annual training for affected staff is provided? Yes No Training conducted ____________. Training has been scheduled for ____________. (date)
(date)

Checklist of E/OHS Activities for Playground Safety

Program Contact Person: Art Schweitzer Is the Playground Safety program in place? Yes No Is the Plan current? Yes No Has the Plan been reviewed this school year? Yes No Surfacing: X X X The equipment has adequate protective surfacing under and around it and the surfacing materials have not deteriorated Loose-fill surfacing materials have no foreign objects or debris Loose-fill surfacing materials are not compacted and do not have reduced depth in heavy use areas such as under swings or at slide exits

General Hazards: X X X X X X There are no sharp points, corners, or edges on the equipment There are no missing or damaged protective caps or plugs There are no hazardous protrusions and projections There are no potential clothing entanglement hazards, such as open Shooks or protruding bolts There are no pinch, crush, and shearing points or exposed moving parts There are no trip hazards, such as exposed footings on anchoring devices and rocks, roots, or any other environmental obstacles in the play area

Deterioration of the Equipment: X The equipment has no rust, rot, cracks, or splinters, especially where it comes in contact with the ground

There are no broken or missing components on the equipment (e.g., handrails, guardrails, protective barriers, steps, or rungs on ladders) and there are no damaged fences, benches, or signs on the playground All equipment is securely anchored

Security of Hardware: X X There are no loose fastening devices or worn connections, such as Shooks Moving components, such as swing hangers or merry-go-round bearings, are not worn

Drainage: X The entire play area has satisfactory drainage, especially in heavy use areas such as under swings and at slide exits

Leaded Paint: X X The leaded paint used on the playground equipment has not deteriorated as noted by peeling, cracking, chipping, or chalking There are no areas of visible leaded paint chips or accumulation of lead dust

General Upkeep of Playgrounds: X X The entire playground is free from miscellaneous debris or litter such as tree branches, soda cans, bottles, glass, etc. There are no missing or full trash receptacles

Click here to view playground equipment. Note: Recommend replacing trip hazard wood retainers with plastic retainers. LC 4-7-2010

Checklist of E/OHS Activities for Personal Protective Equipment

Program Contact Person: Art Schweitzer Is the Personal Protective Equipment Plan in place? Yes No N/A Is the Plan current? Yes No N/A Has the Plan been reviewed this school year? Yes No N/A Has a survey of potential workplace hazards been completed? Yes No N/A Date(s) activity was conducted:4/06/2010 Have recommendations been completed for appropriate equipment? Yes No Has training been completed for the following departments? Art and Photo Custodial Kitchen Maintenance Science Laboratories Technical Education Transportation Yes No N/A Yes No N/A Yes No N/A Yes No N/A Yes No N/A Yes No N/A Yes No N/A

Grounds keeping/Garage Yes No N/A

Physical Hazard Assessment

Hazard (Heat, Noise, Radiation) Heat, chemical, body fluids, noise, asbestos Noise, chemical, hot water, Heat, chemical, body fluids, noise Noise, impact, compressed gas, dust

Building K-12 K-12 K-12 K-12

Location Custodial Kitchen Science Room Wood Shop

Labeled N/A N/A N/A N/A

Affected Employees Name Art Schweitzer Margaret L. Dianne J. Molly Shilling Darrel Meyer Department Custodial/Maintenance Food Service Food Service Education (science) Tech Ed

Completed by Lee Carlson

________ Date_4-06-10_____________

Personal Protective Equipment Assessment

Location: Chemistry Employee: Molly Gort Nitrile Latex Vinyl Leather Neoprene Impact Splash Shield Respirator Muffs Plugs Neo Apron Denim Steel Toes Metatarsal Hard Hat

Location: Food Service Employee: Margaret L Dianne J.

Location: Custodian Employee: Art Schweitzer

Location: Tech Shop, wood/metal Employee: Darrel Meyer

X X X X X X X

X X X X X X X X X X X X X X

Hand

Face

Ear Body Foot Head

X X X

Hazard(s)

Heat, chemical, body fluids,

Noise, chemical, hot water, blood

Heat, chemical, body fluids, noise, open flame, impact

Heat, chemical, body fluids, noise, open flame, impact Suggest additional hearing protection for students

Comments on Availability, Condition, & Storage

Suggest additional hearing protection for food service staff

Completed by Brian Parrie

Date 2/15/2011

Checklist of E/OHS Activities for Radon Gas Safety

Program Contact Person: Art Schweitzer Is the Radon Gas Safety Plan in place? Yes No N/A Is the Plan current? Yes No N/A Has the Plan been reviewed this school year? Yes No N/A Testing was last conducted: No records on file.
(date)

Results of tests:
Room Name & No. Level Tested Recommendation

Has training is not requirement of this program. However if elevated levels are determine present training of affected persons is recommended. Date training complete: N/A Testing is / is not now in progress: Note: No records could be located that indicated testing for radon in the past. I recommend that areas below grade be tested.

Checklist of E/OHS Activities for Respiratory Protection

Program Contact Person: Art Schweitzer Does this school provide respirators for voluntary use? Yes No N/A If the school allows employees to use respirators voluntarily the following is mandatory. 1. Read and follow instructions provided by manufacturer. 2. Choose respirators certified for use against contaminants of concern. 3. Do not wear respirators in atmospheres containing contaminants not designed to protect from those contaminants. 4. Keep track of respirators so that you do not mistakenly wear someone elses respirator. Is the Respiratory Protection program in place? Yes No N/A Is the Plan current? Yes No N/A Has the Plan been reviewed this school year? Yes No N/A Date of review: _Sept, 2010 Are all employees in this program identified? Yes No N/A
Employee Art Schweitzer Intended Use Misc. voluntary Type of Respirator Mask Medical Exam/ Questionnaire yes Date of Medical 1/2009 Date of Fit Test 1/2009

Fit testing was completed on

N/A.
(date)

Type of testing protocol; Irritant Smoke (Stannic Chloride) or Bitrex (Denatonium Benzoate)

Condition and location of respirators: Condition: Good condition Location(s): In metal cabinet next to desk in boiler room.

Are the appropriate adequate accessories on hand? Yes No N/A Verified by Lee Carlson

Respirator Equipment Inventory Cartridges Respirator Type PAPR Power Flow PAPR Power Flow mask mask mask Full face Full face Wilson Boiler room yes yes yes Respirator Brand Location Valve Flaps? Straps? Organic Particulate Combination

AOS

Boiler room

yes

yes

yes

The respirators were cleaned and checked 1-4-10. LC Art is no longer fit checked and having physicals completed as a requirement of the local fire department. Future use will be on a voluntary basis.1-4-10

Checklist of E/OHS Activities for Underground and Aboveground Storage Tanks

Program Contact Person: Art Schweitzer Is the Underground and Aboveground Storage Tanks Plan in place? Yes No Is the Plan current? Yes No Has the Plan been reviewed this school year? Yes No Have forms for inventory tracking been provided? Yes No N/A Do existing records accurately reflect purchase use correlation? Yes No N/A Are all USTs registered with the Minnesota Pollution Control Agency? Yes No N/A Are removals or additions of tanks anticipated in this facility? Yes No N/A Notes:

Underground/Aboveground Storage Tank Status

Tank No.

Location

Size

Contents

Registered

Install date

#1

West side between buildings

5,000

#2 fuel oil

yes

Regulated Tanks:Motor fuel tanks larger than 110 gallons Non-regulated Tanks:Heating oil tanks Requirements for All USTs: Tank must be registered with MPCA Requirements for Regulated Tanks:Annual tightness testing and inventory control Tank must be updated, replaced, or removed by December 22, 1998 Upgrades: --Overfill protection --Corrosion protection STPI approved

--Leak detection Tightness Testing Results on File: Dates of past testing:_____N/A_______________ Records on file:_____N/A___________________

Checklist of E/OHS Activities for Welding and Brazing Safety

Program Contact Person(s) Darrel Mayer Department Contact: Metals Shop/Ag. FFA Darrel Mayer Art (jewelry) Custodial N/A N/A

Is the Welding and Brazing Plan in place? Yes No Is the Plan current? Yes No Has the Plan been reviewed this school year? Yes No Method or methods used to control airborne particulate matter? negative air and internal filters Has training been conducted for affected personnel? Yes No Type of welding equipment available Electric arch. Yes No N/A Wire feed/TIG MIG. Yes No N/A Electric spot weld Yes No N/A External

Personal Protective Equipment: availability and condition Gloves Yes No N/A Goggles Yes No N/A Welding mask Yes No N/A Apron Yes No N/A Steel toed shoes Yes No N/A

Describe location of welding activities, example; out-of-doors, booth, floor, all of the above: Welding can conducted indoors or out. The air filter is adequate to handle a significant particle load.