PROGRAM CONTACT PERSON LIST

Asbestos Management.....................................................Larry Schueler

AED..........................................................................Sheryl Jacobson
AWAIR........................................................................Larry Schueler
Bleacher Safety......................................................................... N/A
Bloodborne Pathogens...................................................Sheryl Jacobson
Community Right-to-Know...............................................Larry Schueler
Compressed Gas Safety..................................................Bruce Anderson
Confined Space Entry.....................................................Larry Schueler
Emergency Action Planning...................................................Lynn Kuehn
Employee Right-to-Know/Hazard Communication...................Larry Schueler
Facilities Safety Management............................................Larry Schueler
First Aid/CPR ............................................................Sheryl Jacobson
Hazardous Waste Management..........................................Larry Schueler
Hearing Conservation.....................................................Larry Schueler
Indoor Air Quality..........................................................Larry Schueler
Integrated Pest Management............................................Larry Schueler
Laboratory Standard/Chemical Hygiene Plan.......................................N/A
Lead Management.........................................................Larry Schueler
Lockout/Tagout ...........................................................Larry Schueler
Machine Guarding ..........................................................Larry Schueler
Personal Protective Equipment..........................................Larry Schueler
Playground Safety.........................................................Larry Schueler
Radon Gas Safety............................................................Bernie Cruser
Respiratory Protection.....................................................Bernie Cruser
USTs/ASTs...............................................................................N/A
Welding Cutting Brazing.................................................Bruce Anderson
Checklist of E/OHS Activities for Automatic External Defibrillator

Program Contact Person: Sheryl Jacobson

School policy for use adopted in place? Yes No N/A

Brand of AED? Medtronic Model # LifePac CR Plus Ref# 3200731-002

Name of Medical Director?

Year device was placed into use? September 28, 2008

Location(s) of devices:
Building Name Location in Building
ECHO K-12 Staff lounge

Have all software updates been installed? Yes No N/A

Date of update installation:

Expiration date of pads? Adult pads 8-28-2011, Infant 09-28-10

Expiration date of batteries? (date)

Has staff been trained on operation of the device? Yes, all school nurses and
Emergency responders are trained biannually.

• Most recent date of training August 2010

(date
Note: Training is planned for summer of 2008.
• Provider of training: Gene Hughes Ambulance at Granite Falls

Location of operators manual :It is located with the device in the staff work
room.

Are battery checks documented? Yes, The checks are documented monthly.
The check sheet is located in the AED storage box.

Notes: The AED’s were purchased through Pac 4 monies.

Checklist of E/OHS Activities for Asbestos Management

Program Contact Person: Bernie Cruser/Larry Schueler

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 _Main office.

Training for Asbestos Awareness was conducted: annual refresher .

New PT employees received training on: no new part time staff hired.
(date)

Annual written notification has been prepared: yes .

(date)
Notification appeared in the following publication(s):

Name of publication Date

Fall, 2009

Three-year re-inspection Surveillance was conducted: 6/20/2007 .

6-month Periodic Surveillance was conducted:04/09

(first date)

03-10-10
(second date)

All caution labels have been posted.

Label locations:

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

Tyvek AO Particulate 8mill

suits respirator filters bags
2 3 2 cases ½ roll

Is documentation of Operations and Maintenance available?

Location: Main office

Status of the Asbestos repair and maintenance Work Order System: N/A
Established, Pending

Comments: asbestos repairs and removals are conducted by out sourced

contractors.

Note: All steam tunnels were repaired during the summer of 2009. Dislodged
insulation was reattached and reinforced. Missing pipe insulation was replaced.
A pipe that reportedly carried rain water from the roof was determined to be
leaking during rain events. The pipe was capped to prevent buildup of water in
the tunnel floor. It is believed that this moisture was the cause of insulation
failure. LC 9-29-09

Note: Samples were taken of the ceiling spray-on and soft plaster for analysis.
Significant damage has occurred and O&M is recommended. 11-9-09 LC

The results determined the ceiling and plaster contain asbestos. Larry has
asked for methods to abate or contain. Brian will review and submit a bid for
containment. LC 4-13-2010

Click here to view 6month periodics

Checklist of E/OHS Activities for AWAIR

Program Contact Person: Larry Schueler

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? This remains a goal for 2009-2010.

Location:

Posted:

How is the program communicated to employees?

Who is the Contact Person for OSHA 300? Toni Fredrickson

Is the OSHA 300A Log completed for the previous calendar year? Yes

Have the Logs been maintained for five (5) years? Yes

Location: Files in safe and the Activities Manual

Is the Log posted from February 1 until April 30? Yes

The location/s of the posted log: Staff work room

Is information on injuries recorded on the Log with five (5) working days? Yes
No N/A

Note: click here to view Berkley Management and Procedure Guidelines for
ECHO Charter School 2-17-09

Note: The chemical inventory (12-10-09) was brought up to date. LC

Safety Committee – Meeting Schedule

Date Location Time

District Safety Committee Members

Member Position Building

Larry Schueler Lead Teacher 1-12
Betty Lecy Nursing 1-12
Cindy Skulstad Nursing Consulting 1-12
Lynn Kuehn Secretary 1-12
Pat Jacobson Teacher 1-12
Bernie Cruser Maintenance 1-12
Bruce Anderson Ind-tech Instructor 1-12
Marsha Lecy Kindergarten 1-12

Note: As a specific safety committee is not required I recommend the Wellness

Committee be combined with the Health and Safety Committee.
Checklist of E/OHS Activities for Bleacher safety

Program Contact Person: Larry Schueler

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: The school has no known bleachers that are required to be certified.

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

Note: the school now has two sets of aluminum bleachers for school events.
The bleachers are less than 56inches high so are exempt from bleacher safety
requirements. LC 4-19-2010

..\Bleachersafety
Checklist of E/OHS Activities for Bloodborne Pathogens

Program Contact Person: Cindy Skulstad/Betty Lecy

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:

Due of the size of the school “all staff” are considered “at risk”. Custodial
support is available during the morning sessions of school.

What is this school’s policy regarding Hepatitis B vaccinations for employees

considered at risk versus employees considered not at risk in the Exposure
Control Plan? All staff are offered HBV vaccine at no cost. The public health
nurse Cindy Skulstad provides vaccination services.

Is training provided at this school on methods and techniques to reduce

exposure incidents? Training is provided annually during staff development
sessions.

New Employees: within days 10 of hiring

Have the employees identified as first aid responders been given at a minimum
Red Cross First Aid Training? Yes No N/A

Are Exposure Control Kits available to staff? Yes No N/A

Location(s): Kits are located in each desk. The janitors closet also contains
clean-up materials but is often locked.

Status of Declination forms: The forms remain on file in each employee

personnel file. They are also stored in the Country side Public Health office.

How is blood or bodily-fluid-containing materials handled at this facility?

 Policy regarding cleanup: When custodial help is available they typically will
clean fluid spills. More often staff are required to clean affected spill areas.

Location of biohazard bags at school: Nurses office and library office.

Approved disposal location for biohazardous waste: Countryside Public

Health

Note: Bloodborne pathogen training was conducted for all staff on 8-25-09. LC

Note: Brian P provided train to all-staff during staff development days Aug.
2010. LC
Checklist of E/OHS Activities for Confined Space Entry

Program Contact Person: Larry Schueler

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: Tunnel openings, boiler room and gym tunnel

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: 2-17-2009

Confined Space Folder

 Confined Space Inventory

Building: E.C.H.O. Charter School

Building Contact: Bernard Cruzer Program Contact: Larry Schuler

Completed By: Lee Carlson Date: 4/19/2010

Room Opening Dimension Potential Permit/ Labeled Photo

Identification Dimension Of Confined Hazards Non- ID #
Name Given Space Permit
Space
Old Kitchen 32”X22” 32”X13’ LO2, Electrical Non- no
Area above Permit
kitchen
Boiler Room 16” round 9’X43”X48” LO2,Electrical, Permit Yes
Boilers #1 heat required
Boiler Room 16” round 9’X43”X48” LO2,Electrical, Permit Yes
Boiler #2 heat required
Boiler Room 46”X46” 30”X53”Xlength LE, A Permit Yes
Tunnel of run Required
Gymnasium 30”X24” 8’X12’X48” LE, A Non- No
Above stage Permit
Required
Tunnel by old 3’ X 3’ LE, electrical, Non- No
gym permit

Elevator pit 5’X5’ Electrical, Non- No

hydraulic permit

Furnace stack 24”X30” Gases, dust, Permit No

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

Program Contact Person: Larry Schueler

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

Note: (2) Tanks are located in custodial office. They are less than the required
quantity to be reported.
Where are the documents stored? Activity 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? N/A

(date)

Has training been provided? Yes No N/A

Date: N/A

Presenter: N/A

A review of facilities revealed quantities of all know hazardous chemical falls

below reporting requirements. Therefore, no report was submitted to the
Emergency Response Commission during 2007-2008 school year.

No changes have been noted for school year 2010-2011. This program may
change with the addition of the gymnasium and classrooms slated for 2011. LC
 Inventory Form

Client: ECHO Charter School

Contact Person: Larry Schueler Date: Sept. 5, 2007

Hazardous Reported on Installation

Material Quantity Location Tier Two Date(s)
# 2 Fuel oil 260 gal X 2 Custodial N/A
520 total room next to
gallons boiler room

Note: The minimum quantity of reportable chemicals is 10,000 lbs. The above
fuel remains less than required for reporting. LC 9/5/2007

No changes in school year 2009-2010. LC

Checklist of E/OHS Activities for Emergency Action Planning

Program Contact Person: _Lynn Kuehn

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: Lynn Kuehn

Location of records: At Lynn’s desk and also a copy is maintained in the

safe.

Forms provided: Yes No Sept 5, 2009

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: Larry Schueler

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 Yes No N/A N/A

Custodians Yes No N/A Activities Manual

Food Service Yes No N/A Kitchen/Activities Manual

Science Rooms Yes No N/A A survey revealed no chemicals

Shop (metals, wood, auto) Yes No N/A Activities Manual

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 Yes No N/A Science Yes No N/A

Custodians Yes No N/A Shop Yes No N/A

Food Service Yes No N/A Transportation Yes No N/A

 Date of training: Aug, 2010

Checklist of E/OHS Activities for Facilities Safety Management

and Fire Safety in Schools

Program Contact Person: Larry Schueler

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: Larry Schueler

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 :_Aug, 2010________ N/A

Most recent inspection of fire extinguishers: Aug. 2010 N/A

Most recent inspection of fume hoods with fire suppressant :_Aug. 2010 N/A

Are emergency lights tested at least biannually? Yes No N/A

Science safety Checklist completed? Yes No N/A

Note: Click to review Fire Safety Plan.

 Facilities Safety Review

Building: E.C.H.O. Charter School

Mock-OSHA Review Date Review

Area Completed N/A Recommendations
Art 4-19-2010

Dark Room X

Wood Shop 4-19-2010

Kitchen 4-19-2010

Metal Shop 4-19-2010

Halls, Gym, etc. 4-19-2010

Graphic Arts X

Maintenance/Custodial 4-19-2010

Transportation 4-19-2010

Grounds/Garage 4-19-2010

Chemistry/Life 4-19-2010
Science

Click here to view Facility Safety Report 2010

Checklist of E/OHS Activities for First Aid/CPR

Program Contact Person(s): Sheryl Jacobson

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

Cottonwood Ambulance will be dispatched , however

The local provider determined travel time was estimated to be in excess of the
4-8 minute limit. Therefore Betty Lecy/ Pam Williams/Sara Dunphy will
be the designated emergency response persons located within the district.

Has training been provided for affected staff? Yes No

Entire staff was trained Aug of 2006. The trainer was Gene Hughes.

Date of training: Aug. 2010

Note: Training for CPR will again be offered to all-staff August of 2008.

Note: Gene Hughes provided Training on CPR. Gene is from the Granite Falls
Ambulance Assn. and provided training during staff development fall of 2010. In
addition 11 persons attended training on the AED.

The school nurse will be checking on the contents and condition of the first-aid
kits located in the shop, boiler room and central office. LC 10/25/2010
Suggested Items to Be Included In Each Kit Suggested Number
of Kits

ITEM 1-50 51-100 101-200

Gloves, 4-pack 1 2 2
Gauze roller bandage 1” and 2” x 10-yds. 2 2 2
Gauze compress bandage 3” x 3” individually packaged 10 20 30
Adhesive bandages, assorted sizes, individually packaged 16 32 64
Adhesive tape rolls 2 2 3
Scissors, blunt-nosed 1 1 1
Tweezers 1 1 1
Packaged antiseptic, aqueous mercury preferred 1 1 1
(Mercurochrome)
Mild soap, capped squeeze bottle 1 1 1
Elastic bandage, 4” 1 1 1
Resuscitation mouthpiece 1 1 1
Eyewash container and neutral sterile solution 1 1 1
Empty plastic bag for application of ice (include “chemical 1 1 1
ice” if ice is not available)
ABC’s of First Aid 1 1 1
Bold instructions on how to call 911 1 1 1
Telephone numbers of the Poison Information Center and the 1 1 1
consulting health care provider.

Status of First Aid Kits: note a first-aid kit is located in each class room.

Location Contents Condition of Contents

Custodial Closet Band aids, gauze, gloves, Good

cleanup supplies, antiseptic
Class rooms Good

Nurses Office Good

Main Office Good

Shop
Checklist of E/OHS Activities for Hazardous Waste Management

Program Contact Person(s)

Primary Contact Person: Larry Schueler

Secondary Contact Person: Bernie Cruser

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
½ 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 VSQG’s 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
Checklist of E/OHS Activities for Hearing Conservation

Program Contact Person: Larry Schueler

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: Lee Carlson

Have regulatory changes occurred that may affect this program? No

Note: The ceiling was lined with tin in the wood shop during the summer of
2010. Testing should be conducted to determine dBa at various locations in the
room and at stationary tool locations. Soundproofing is recommended if noise
levels exceed the plan standards. LC 10/25/2010
 Sound Level Monitoring

Client: E.C.H.O. Charter Schools

Measuring Device: Digital Sound Level Meter Calibration: Pre___________ Post___________

Reason for Testing: General Survey

Affected Personnel: Custodial, maintenance

Location Equipment Results Recommendations

Completed by: Date:

Checklist of E/OHS Activities for Indoor Air Quality

Program Contact Person: Larry Schueler

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? 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? 3-2-2010

Who conducted the evaluation? Advanced Safety and Security

Were occupied areas of the district evaluated using the EPA’s 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?

• Building ventilation checklist?

Training conducted
(date)

Training has been scheduled for _fall 2010______________.

(date)

Has the District determined the mechanical ventilation rate of each occupied
space? Yes No.

Supportive technical services were conducted on: _3-2-2010.

(date)

Results of technical services are located? _Activities Manual

Click here to view CO2 testing report

 IAQ Survey Review Form

E.C.H.O. Charter Schools

Building:

Building Contact: Program Contact:

Room Identification Water Ventilation Building failures Cleanliness/ O&M

Contact individual Intrusion proble i.e. foundation or Proper Carpets
ms roof problems storage

Recommendations:

Walk-through conducted by ______________________Date ___________________

Checklist of E/OHS Activities for Integrated Pest Management

Program Contact Person: Bernie Cruser

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: Student Handbook_________.

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

Program Contact Person :______N/A_____, 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 _______________.

(date)

Chemical inventory:

Date of most recent survey

Location of inventory listing

Are Material Safety Data Sheets (MSDSs) located with inventory? Yes No N/A

Are the MSDS readily accessible? Yes No N/A

Has the DCFL 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

Note: No significant reportable quantities of chemicals were noted in the
science rooms. LC 2/8/08
No changes to this program for 2010-2011. LC

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

Program Contact Person: Larry Schueler

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 12/21/2000.

(date)
Note: No copies of test results could be located. A vague reference to testing
that may have occurred during 1990 was located. The results apparently were
satisfactory at that time.LC
Note: Documents located indicate that the Elementary Building water fountains
were tested for lead 12-29-89 by Jim Dolan, ECSU. The results were found to
be less than 2ppb. The original documents are now filed in the Activities
Manual. LC

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: Larry Schueler

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 replaced with lead free.

Note: paint throughout building is in very good condition. Little peeling or

flaking of paint can be documented.

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 _Some
damage_____________ condition

Checklist of E/OHS Activities for Lockout/Tagout

Program Contact Person: Bernie Cruser

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? Custodial Office

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: Bruce Anderson

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

If replaced, was “best practices,” bid specification criteria used for

procurement? Yes No

Note: The wood shop tools were reviewed for guarding 4-19-2010. The
equipment seems to meets OSHA standards.
 Identified Fixed Equipment Locations

Location Building/Buildings Staff Affected # of item

Bus Garage
Wood Shop
Custodial/Maintenanc
e
Welding Shop

Contracted technical services to review and recommend?

_____N/A_____________.

Name of person or contractor conducting survey? ____N/A_______________.

(date)

Results of technical services located where? __N/A______________________

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 ____________.

(date)
Training has been scheduled for ____________.
(date)
Checklist of E/OHS Activities for Playground Safety

Program Contact Person: Bernie Cruser

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:

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:

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 S-

hooks 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:

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:

There are no loose fastening devices or worn connections, such as S-

hooks

Moving components, such as swing hangers or merry-go-round bearings,

are not worn

Drainage:

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

Leaded Paint:

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:

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 file.

Checklist of E/OHS Activities for Personal Protective Equipment

Program Contact Person: Bernie Cruser

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:04-19-2010_______________________

Have recommendations been completed for appropriate equipment? Yes No

Has training been completed for the following departments?

Art and Photo Yes No N/A

Custodial Yes No N/A
Grounds keeping/Garage Yes No N/A
Kitchen Yes No N/A
Maintenance Yes No N/A
Science Laboratories Yes No N/A
Technical Education Yes No N/A
Transportation Yes No N/A
 Personal Protective Equipment Assessment

Location: Location: Location: Location:

Custodial/Maintenance Shops, Kitchen
metal/wood
Employee: B Cruser Employee: Employee: Employee:
Bruce Joyce Lecy
Anderson
Cutting X
Latex
Hand Vinyl X X
Leather X X
Neoprene X
Impact X
Face Splash X X
Shield X
Muffs X
Ear
Plugs
Neo Apron X
Body
Denim X
Steel Toes
Foot
Metatarsal
Head Hard Hat
Sound, heat, Sound, Heat, Heat,
impact, chemical, chemical, chemical
Hazard(s)
body fluids impact,
vapor
Good Good Good

Comments on
Availability,
Condition, &
Storage

Completed by Lee Carlson Date 4/19/10

Checklist of E/OHS Activities for Radon Gas Safety

Program Contact Person: Bernie Cruser

Is the Radon Gas Safety Plan in place? Yes No

Is the Plan current? Yes No

Has the Plan been reviewed this school year? Yes No

Testing was last conducted: 11-07-2000 through 06-06-2001.

(date)

Results of tests:

Room Name & No. Avg. Radon Conc. pCi/l Recommendation

Music Room C 0.3

Vera’s Room H 0.2

Monitor returned No results

damaged little gym

Cafeteria 0.6

Library Room L 0.2

Marsha’s Room E 0.3

Testing was also previously conducted: 03-05-1990 through 02-20-1991.

(date)

Results of tests:

Room Name & No. Avg. Radon Conc. pCi/l Recommendation

Custodians Office 4.1 Exceeds recommended
4.0 level
Head Start 1.3

Gymnasium 1.1

Training is not requirement of this program. However if elevated levels are

determined training of affected persons is recommended.
 Date training complete: N/A

Testing is / is not now in progress:

Checklist of E/OHS Activities for Respiratory Protection

Program Contact Person: Larry Schueler/Bernie Cruzer

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
else’s 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: 11-6-09

Are all employees in this program identified? Yes No N/A

Employee Intended Type of Medical Exam/ Date of Date of

Use Respirator Questionnaire Medical Fit Test
Bernie Cruser Light duty AO STAR, ½ N/A N/A N/A
dust, est. mask
Larry Schuler Voluntary AO STAR, ½ N/A N/A N/A
use mask
Bryan Nielson

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: The respirator was disassembled and cleaned. Valve flaps

were found in good condition. Straps were serviceable. 12-10-2009

Location(s): Metal cabinet custodial room

Are the appropriate adequate accessories on hand? Yes No N/A

Verified by L. Carlson

Equipment on Hand

Cartridges
Respirator Respirator Valve
Type Brand Location Flaps? Straps? Organic Particulate Combination
½ mask AO Metal Good Good (1) box (1) box None
American cabinet
Optical custodial
room
½ mask 3m Next to Good Good Installed
metal
cabinet

Note: I could not locate replacement filters for the AO ½ mask respirator. Two
boxes of filters are available for a 3M respirator are available but no respirator
to fit. 12-10-09 LC

Respirators were checked today and found in good condition. LC 4-19-2010

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

NO UNDERGROUND OR ABOVE GROUND FUEL STORAGE TANKS AT THIS

LOCATION.

Program Contact Person: ___N/A________________________

Is the Underground and Aboveground Storage Tanks 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 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:
Checklist of E/OHS Activities for Welding and Brazing Safety

Program Contact Person(s) Bruce Anderson

Department Contact: Bruce Anderson

• Metals Shop Bruce Anderson

• Art (jewelry) N/A

• Custodial 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? None

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

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:

Note: The welding shop does not have adequate ventilation. It is recommended
that ventilation be provided.
A used fume hood has been located at Hutchinson. It is hoped it can be
installed the summer of 2010.Bruce has talked with Airtech of Redwood falls
about installation. LC