PROGRAM CONTACT PERSON LIST

Asbestos Management........................................................Mitch Hoard

AED.......................................................................................N/A
AWAIR.....................................................................Sr. Kathy Kuchar
Bleacher Safety......................................................................... N/A
Bloodborne Pathogens..................................................Sr. Kathy Kuchar
Community Right-to-Know............................................................N/A
Compressed Gas Safety.................................................................N/A
Confined Space Entry........................................................Mitch Hoard
Emergency Action Planning..................................................Mitch Hoard
Employee Right-to-Know/Hazard Communication......................Mitch Hoard
Facilities Safety Management..........................................Sr. Kathy Kuchar
First Aid/CPR ............................................................Sr. Kathy Kuchar
Hazardous Waste Management........................................................N/A
Hearing Conservation........................................................Mitch Hoard
Indoor Air Quality.............................................................Mitch Hoard
Integrated Pest Management...............................................Mitch Hoard
Laboratory Standard/Chemical Hygiene Plan.......................................N/A
Lead Management............................................................Mitch Hoard
Lockout/Tagout ..............................................................Mitch Hoard
Machine Guarding ............................................................Mitch Hoard
Personal Protective Equipment............................................Mitch Hoard
Playground Safety............................................................Mitch Hoard
Radon Gas Safety.......................................................................N/A
Respiratory Protection.................................................................N/A
USTs/ASTs...............................................................................N/A
Welding Cutting Brazing...............................................................N/A
Checklist of E/OHS Activities for Asbestos Management

Program Contact Person: Mitch Hoard

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, principal’s office .

Training for Asbestos Awareness was conducted: 3-26-07 .

New PT employees received training on N/A .

(date)

Annual written notification has been prepared; fall, 2010 .

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

Name of publication Date

Fall newsletter fall, 2009

Three-year re-inspection Surveillance was conducted: 5/25/2011 .

6-month Periodic Surveillance was conducted: 3-26-07 10-3-2007

(first date)

10-08-08 5-27-2010
(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
Note: All repairs and removals are outsourced.

Asbestos Maintenance Supplies on Hand

Is documentation of Operations and Maintenance available?

Location:

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

Pending
Comments:

Note: Click here to view asbestos reports

Checklist of E/OHS Activities for AWAIR

Program Contact Person: Sr. Kathy Kuchar

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? Concurrently with the Building and Grounds
Committee.

Are minutes of the meeting maintained?

Location: Main office, Buildings and Grounds binder.

Posted: Main office

How is the program communicated to employees? Staff development meetings

Who is the Contact Person for OSHA 300? Sr. Kathy Kuchar, OSB

Is the OSHA 300A Log completed for the previous calendar year? No

Have the Logs been maintained for five (5) years? No

Location: Activity Manual

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

The location/s of the posted log: Main office and School Kitchen

Is information on injuries recorded on the Log within five (5) working days? Yes
No N/A
 Safety Committee – Meeting Schedule

Date Location Time

Parish Building and Grounds/ Safety Committee Members

Member Position Building

Art Heinze Parishioner Elementary (K-6)
Fr. Rick Lambert Pastor- Elementary (K
Superintendent
Dan Baumgarter Parishioner Elementary (K
Mitch Hoard Head Custodian Elementary (K
Sr. Kathy Principal Elementary (K-6)
Hillary Stoltman Parishioner Elementary (K
Jim Fisher Parishioner Elementary (K
Bernie Huot Parishioner Elementary (K
Joan Lubitz Parishioner Elementary (K
Checklist of E/OHS Activities for Bloodborne Pathogens

Program Contact Person: Sr. Kathy Kuchar

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: All-staff are considered at
risk of coming in contact bodily fluids.

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? Staff may use their wellness benefits through Blue Cross & Blue
Shield to receive the vaccination series.

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

exposure incidents? Training is provided during all-staff development days
either by use of a video tape or hired consultant.

New Employees: Trained during fall staff development days.

Have the employees identified as first aid responders been given at a minimum
Red Cross First Aid Training? Yes No N/A
Note: Those that wished , went for a refresher course at Northwest Medical
Center, fall, 2006.

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

Location(s): In each classroom and the Main Office.

Status of Declination forms:

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

Policy regarding cleanup: Custodians are considered first to respond to

events. Only in the absence of custodial staff are teaching staff required to
clean spills.

Location of biohazard bags at school: Each classroom and Main Office

 Approved disposal location for biohazard waste:

Note: Training was completed in10 October 2010 conducted by Lee Carlson
Checklist of E/OHS Activities for Confined Space Entry

Program Contact Person: Mitch Hoard

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: 5/25/11

 Confined Space Inventory

Building: St. Bernard’s School

Building Contact: Mitch Hoard Program Contact: Lee Carlson

Completed By: _Lee Carlson Date: 5/25.2011

Room Opening Dimension Potential Permit/ Labeled Photo

Identification Dimension Of Confined Hazards Non- ID #
Name Given Space Space Permit

Men’s lavatory 3’X2’ 12’X24”X12’ Limited entry Non- No

Pipe chase Permit
(basement) required
Janitor’s closet 24”X30” 20”X3’X80” LE, Asbestos. Non- No
Pipe Chase1st floor Permit
custodial required
Elevator pit 7’X3’ 4’X8’X8’ Entrapment, Permit No
1st Floor energy, required
Checklist of E/OHS Activities for Emergency Action Planning

Program Contact Person: Sr. Kathy Kuchar

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

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: Sr. Kathy Kuchar

Location of records: Main Office Activities Manual

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

Note: Training is typically provided during staff development days.

Sr. Kathy reviews and updates the plan annually. The Plan is included in the
staff handout provided at the beginning of the year.
Fire drills and lockdowns are recorded in the Activities manual. They have
been completed for 2010-2011 school year.
Checklist of E/OHS Activities for Employee Right-to-Know/Hazard
Communication

Program Contact Person: Mitch Hoard

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 chemical inventory been completed for the following functional areas?

Location of Chemical Inventory

Form

Art Instruction Yes No N/A

Custodians Yes No N/A Main Office

Food Service Yes No N/A Kitchen office/Main Office

Science Rooms Yes No N/A

Shop (metals, wood, auto) 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 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

Click here to view chemical inventory.

Checklist of E/OHS Activities for Facilities Safety Management
and Fire Safety in Schools

Program Contact Person: Sr. Kathy Kuchar

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? Lee Carlson

Fire and Life Safety in Schools

Program Contact Person: Sr. Kathy Kuchar

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: Jan, 2010_______ N/A

Most recent inspection of fire extinguishers: Jan, 2010___________ N/A

Most recent inspection of fume hoods with fire suppressant:________ N/A

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

Science safety Checklist completed? Yes No N/A

Note: There is no fire suppression system in the fume hoods located in the
basement kitchen. No grease laden foods are cooked in that area. The building
does not have a sprinkler system.
 Facilities Safety Review

Building: St. Bernard’s Parochial School

Mock-OSHA Review Date Review

Area Completed N/A Recommendations
Art X

Dark Room X

Wood Shop X

Kitchen 5-25-2011 See Facility Safety Report and photos

Metal Shop X

Halls, Gym, etc. 5-25-2011 See Facility Safety Report and photos

Graphic Arts X

Maintenance/Custodia 5-25-2011 See Facility Safety Report and photos

l

Transportation X

Grounds/Garage 5-25-2011 See Facility Safety Report and photos

Chemistry/Life X
Science
Checklist of E/OHS Activities for First Aid/CPR

Program Contact Person(s): Sr. Kathy Kuchar

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

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 Dakota Clinic/Hospitals, ALTRU 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

Note: Voluntary training is received at Northwest Medical Center.

Checklist of E/OHS Activities for Indoor Air Quality

Program Contact Person: Mitch Hoard

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?

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?

Who conducted the evaluation?

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 _______________.

(date)

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

Supportive technical services were conducted on: _Feb, 2010_______.

(date)
Results of technical services are located? __Click here to view ________

Checklist of E/OHS Activities for Integrated Pest Management

Program Contact Person: Mitch Hoard

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__________________________.

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

Program Contact Person: Sr. Kathy Kuchar

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 __3-14-03.

(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: Sr. Kathy Kuchar

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: Mitch Hoard

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? _________________________

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: Mitch Hoard

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? 5-27-2010

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 N/A
Note: Only one stationary tool was located during the survey. The stationary
grinder should be maintained with guarding in place. LC 5-27-2010
Checklist of E/OHS Activities for Playground Safety

Program Contact Person: Mitch Hoard

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
Note: Pea rock was noted thin in some locations 5-13-08
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

Note: the playground was checked on 5-14-08 and found to meet standards of
this program.

The playground has a very thin layer of pea rock in some locations. I
recommend that retaining barriers be provided and additional rock be added.
LC 5-27-2010
The playground was reviewed on this date and found to be in good condition.
Lee Carlson 5/25/2011
Checklist of E/OHS Activities for Personal Protective Equipment

Program Contact Person: Mitch Hoard

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: 5/25/2011

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