ActivitiesCheclist08-09_3

8/3/2019 ActivitiesCheclist08-09_3

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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, 2007 .

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 DateFall News letter Fall, 2008

Three-year re-inspection Surveillance was conducted: 7-10-07 .

6-month Periodic Surveillance was conducted: 11-20-08(first date)

04-20-09(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 ofmaintenance and repair of ACM? Yes No N/A


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Asbestos Maintenance Supplies on Hand

Bags Respirators Wrap-n-cure

Is documentation of Operations and Maintenance available?

Location: District Office

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

Comments: Repairs to asbestos are limited to replacement of damaged

floor tile.

**For information regarding the medical review and questionnaire, see theRespiratory Protection Program.**

Note: click here this link to review 6 month periodics.
http://opt/scribd/conversion/tmp/AsbestosFolderhttp://opt/scribd/conversion/tmp/AsbestosFolder


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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? All Staff training duringfall orientation

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? Yes

Location: Activities Manual

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

The location/s of the posted log: Main School Office.

Is information on injuries recorded on the Log with five (5) working days? YesNo N/A


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Safety Committee Meeting Schedule

Date Location Time

Principals office

Principals office

Principals office

District Safety Committee Members

Member Position BuildingGeorge Berndt Principal Ellsworth Public

Judy Huisman Lead Secretary Ellsworth Public

Art Schweitzer Custodian Ellsworth Public

Pat D Staff Ellsworth Public

Justin Hendricks Staff Ellsworth Public


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Checklist of E/OHS Activities for Bleacher safety


Is the BSM Plan in place? 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 andsubmitted to the Minnesota Department of Labor and Industry? Yes No N/ANote: Prepared 10-8-07 and sent.

Openings and gaps:

Openings limited to four-inch gap between the railings and between the footboardsand 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 anamortization schedule to plan for their future replacement

Approved netting:

Netting may be provided to prevent persons from falling through the bleachersbetween the seat and footboards

Chain link fencing may be used but must be secured tightly to the underside of thebleachers.

Railings:

Bleachers 55 inches and under are exempt from railing requirements

Bleachers with guardrails over 30 inches above grade must not contain openingsgreater than four inches, unless safety nets are installed.State building inspectors shall determine whether the safety nets and guardrail climbability meet the requirements of the alternate design section of the State BuildingCode.

Periodic inspections:

Bleacher footboards and guardrails must at a minimum be reinspected at least everyfive years and a structural inspection at least every ten years. The equipment has norust, rot, cracks, or splinters, especially where it comes in contact with the ground


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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 damagedfences, benches, or signs on the playground


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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 driversParas, Special EdCustodiansSchool NurseSecretaries

What is this schools policy regarding Hepatitis B vaccinations for employeesconsidered at risk versus employees considered not at risk in the ExposureControl Plan?Custodians provide clean up fluid spills.

Is training provided at this school on methods and techniques to reduceexposure incidents?All staff are trained during the Fall faculty developmentdays.

New Employees: within ten days of employment

Have the employees identified as first aid responders been given at a minimumRed Cross First Aid Training? Yes No N/ANote: 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 alsolocated 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 vaccinationinformation 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.


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Location of biohazard bags at school: Nurses office and the custodial office

Approved disposal location for biohazardous waste: Worthington RegionalHospital


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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 __________________________________


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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



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/maintained to monitor gas inventory? Yes No N/A


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Checklist of E/OHS Activities for Confined Space Entry


Is the Confined Space Entry Plan in place? 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: 10-24-07


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Confined Space Inventory

Ellsworth Public School

Building: Combined Elementary, Middle School, High School

Building Contact: Art Schweitzer Program Contact: Lee Carlson

Completed By:Lee Carlson Date:3-17-2008

Room IdentificationName Given Space

OpeningDimension

DimensionOf ConfinedSpace

PotentialHazards

Permit/Non-Permit

Labeled PhotoID #

Boiler Room 24X18 4X4X8 LE,heat,O2deficient

PermitRequired

Yes

Boiler #1

Boiler Room 24X18 4X4X8 LE, A PermitRequired

No

Boiler #2Boiler Room 4X4 4X4X>200 LE, A Permit

RequiredYes

Tunnel accessBoiler Room 4X4 4X4X>200 LE, A Permit

RequiredYes

Water Tank #2

Click here for confined space photos.

Tunnel entry
http://opt/scribd/conversion/tmp/Confined%20spaceProgramhttp://opt/scribd/conversion/tmp/Confined%20spaceProgram


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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



Are quantities of stored and used designated hazardous materials documentedand verified? Yes No N/A

Where are the documents stored? Activities Manual

Have the State Emergency Response Commission and local fire departmentbeen notified of hazardous materials on school grounds? Yes No N/A

When were they notified? 2-14-2008(date)

Has training been provided? Yes No N/A

Date: N/A

Presenter: N/A


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Inventory Form

Client: Ellsworth Public School

Contact Person: Art Schweitzer Date: 10-8-07

HazardousMaterial Quantity Location

Reported onTier Two

InstallationDate(s)

#2 Fuel Oil 5,000 galWest sidebetweenbldgs.

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 tankhad 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

The 2008 Tier Two was prepared and sent 3-17-2009. Art Schweitzer will deliver a hardcopy to the Ellsworth Fire Department. LC 3-17-09


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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 theMinnesota Executive Order 93-27 and Model Crisis Management Plan? Yes No

Is the Plan current? Yes No


Have the program and goals been approved by the School Board for the currentschool year? Yes No

Are information maps posted to indicate travel routes in the event of fire,

tornado shelter locations, and procedures during lockdown? YesNo

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 assuresheltering in school, evacuating to their homes or use of congregate carecenters? Yes No N/A

Has this school completed the Fire Marshall required Fire Safety and EmergencyEvacuation Plan? Yes No N/A

Training provided for affected staff? Yes No N/A

Note: A new IP camera has been installed in the main office. The purpose is toprevent future break-ins of the school safe. LC 3-18-2009


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


Is the Employee Right-to-Know/Hazard Communication Plan in place? Yes No



Has the program been approved by the School Board for the current schoolyear?

Yes No

Has the chemical inventory been completed for the following functional areas?

Location of Chemical InventoryForm

Art Instruction Yes No N/A

Custodians Yes No N/A Custodial Room

Food Service Yes No N/A Head cooks desk drawer

Science Rooms Yes No N/A Chemistry Lab

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


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Contact List for Employee Right-to-Know Program


DepartmentKey Contact for Department

(person responsible for making MSDSs)

ArtMrs. Steinmetz

Biology/chemistryMolly Grot

Consumer Life Science

Sally Oltmanns

Custodial/MaintenanceArt Schweitzer

Food ServiceMargaret LarsonDianne Johnson

PhotoN/A

ShopWelding

Darrel Meyer

Completed by: Lee Carlson Date: 5-13-2008


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Checklist of E/OHS Activities for Facilities Safety Managementand 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 AssistantProgram? 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 eachdistrict building? Yes No

Most recent date of sprinkler electronics inspection N/A

Most recent date of alarm inspection: July, 2007

Most recent inspection of fire extinguisher: June, 2007

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


21/54

Facilities Safety Review

Building: Ellsworth Public School

Mock-OSHA ReviewArea

Date ReviewCompleted N/A Recommendations

Art

Dark Room N/A

Wood Shop

Kitchen

Metal Shop

Halls, Gym, etc.

Graphic Arts N/A

Maintenance/Custodia

Transportation N/A

Grounds/Garage

Chemistry/LifeScience

Click here for Fire and Life Safety Reports
http://opt/scribd/conversion/tmp/FireSafetyPlanEllsworth.dochttp://opt/scribd/conversion/tmp/FireSafetyPlanEllsworth.doc


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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



Have the program and goals been approved by the School Board for the currentschool 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 4-8minute 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 the4-8 minute limit. Therefore N/A will be thedesignated emergency response person located within the district.

Has training been provided for affected staff? Yes No

Note: It has been several years since training has been offered. I will discussoffering training for affected staff.


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Checklist of E/OHS Activities for Hazardous Waste Management

Program Contact Person(s)

Primary Contact Person:_Art SchweitzerSecondary Contact Person: _George Berndt

Is the Hazardous Waste Management program in place? 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 orless 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 onsite, used oil and oil filters.

Training for VSQGs do not have training requirements however MPCA stronglyrecommends persons handling wastes be given training on best handling andsafety 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. Theschool 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 theunneeded chemicals. It was reported that about 20 kilograms was removed.1-9-2009 LC


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Checklist of E/OHS Activities for Hearing Conservation


Is the Hearing Conservation Plan in place? Yes No



Has the program been approved by the School Board for the current schoolyear?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:

Has training been scheduled or completed for affected individuals this schoolyear?Yes No N/A

Date:

Presenter:

Have regulatory changes occurred that may affect this program? No


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Checklist of E/OHS Activities for Integrated Pest Management


Is the IPM Plan in place? Yes No



Has the annual monitoring been conducted to determine location and degree ofinfestation? 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 nowprovides monthly services to control insects and mice. The staff reports goodsuccess.


28/54

Checklist of E/OHS Activities for Laboratory Standard/ChemicalHygiene Plan

Program Contact Person: Molly Grot, CHO

Is the Laboratory Standard/Chemical Hygiene Plan in place? 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: 2006-2007 school year

Location of inventory listing: Science Room

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


29/54

General Science Safety ConsiderationsFor All Rooms Where Science Laboratories Are Conducted

And/or Demonstrations Are Given


Room Number(s):

Description: A school science laboratory is defined as a classroom wheredemonstrations and/or laboratory instructions are provided for individual or groupexperiments. They are places where science is taught. In addition, any conditionlisted under either the storage section or the chemical laboratory section thatmay apply to any area, for instance, must keep inventories of all biology reagentsand chemicals.

ITEM CITATIONCONDITION

EXISTS LACKING N/A

1) Laboratories must be equipped with adequateventilation. For new labs (build after July 1990) anmanual shutoff control for the laboratory exhaustventilation system must be provided outside of the room,in a position adjacent to the access door to the room orin such other location as approved by the fire chief.

UBC (97) 305.2.4,307.5.2, & 1202.2.3UFC (97) 8004.1.11 &8003.1.4.2

2) At least one 2A-20BC, or larger, rated and approvedportable fire extinguisher must be provided for each3,000 of laboratory. Travel distance must not exceed 50from anywhere in the lab. At least one fire extinguishersuitable for class D fires must be provided in laboratorieswhere combustible metals are used and stored.

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

X

3) At least one approved fire blanket must be provided ineach laboratory.

UFC (97) 1001.9 X

4) Students must be under the direct supervision of a

faculty member or an assistant at all times. In mostcases it is recommended that direct supervision meansdirect eye contact. It is recommended that no more thantwo students be assigned to a lab station, a place in theroom equipped with water, gas, and electricity, or aplace where students do labs.

NFPA 45 (91) 1-4

X

5) Aisles serving work areas on two sides must be atleast 42 wide; those serving work areas on one sideonly must be 36.

UFC (97) 1204.2.2 (2)X

6) Minimum of two means of exit access must beprovided when:Existing: lab exceeds 1,000 sq. feetNew: lab exceeds 200 sq. feet (built after 7/90)

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

X

7) Labs must be separated from each other and otherportions of the building by not less than a 1-houroccupancy separation.*

Existing: labs located in buildings protected by automaticextinguishing systemsonly smoke separation requiredNew: (built after 7/72)*Recommend this be determined by a licensed designprofessional

UFC (97) Appendix 1-A7.2 as amended

UBC (97), 305.2.4

8) Labs must be equipped with automatic detectionelectrically interconnected with the building fire alarmsystem. Exception: labs protected by a completeautomatic sprinkler system that is interconnected to thebuilding fire alarm require no additional detection.

UFC (97) 1007.2.4.2 &1007.2.4.1.1 asamended

9) All electrical outlets must be properly grounded and allfixed electrical equipment and appliances must be

UFC (97) 850499NEC 250-112

X


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General Science Safety ConsiderationsFor All Laboratories And/or Rooms Where Chemical Demonstrations Are

Conducted


Room Number(s):

Description: In addition to the provisions that are outlined for any sciencelaboratory area, the following provisions are specific for chemistry classes (butmay apply to any lab where similar activities are carried on).


EXISTS LACKING N/A

1) Proper eyewash facilities must be installed thatproduce 25 psi of water for 15 minutes. Squeeze bottlesdo not meet this specification. It is recommended that

eyewash fountains should be located within 25 ofstudents in any area of the room. The device must beplumbed into a drinkable water supply. This rule appliesto any rooms where labs are conducted that arepotentially harmful to the eyes.

ANSI Z-358.1-1981 X

2) Emissions generated at workstations must beconfined to the area in which they are generated(laboratory hoods).

UBC (97) 1202.2.3X

3) In new labs (build after 7/90) a manual shutoff controlfor the laboratory exhaust ventilation system must beprovided outside of the room in a position adjacent to theaccess door to the room or in such other location asapproved by the fire chief.

UBC (97) 1202.2.3UFC (97) 8003.1.4.2

4) Chemicals stored in the open in the laboratory workarea must be kept to the minimum necessary for thework being done.

NFPA 45 (91) 7-2.3.1X

5) A complete inventory of chemicals on hand must bemaintained and must be available to the fire chief. Allmaterials must be dated upon receipt.

UFC (97) 8001.6

6) Persons responsible for each lab must be familiar withthe chemical nature of the materials present in the laband the appropriate mitigating actions to be taken incase of fire, leak, or spill.

UFC (97) 8001.11.1.1

X

7) Incoming shipments of chemicals must be transportedan opened by school personnel familiar with the potentialhazards.

NFPA 45 (91) 7-2.2.1X

8) Neutralizing chemicals spill kits, dry sand, vermiculite,EM Absorbent, and other spill control methods must bereadily available while the lab is in use.

UFC (97) 8001.11.1X

9) Written maintenance procedures must be established,including regular inspection, testing, and maintenance oflab utilities, hood and exhaust systems, pressureequipment (autoclaves, steam sterilizers, etc.), and

emergency equipment.

NFPA 45 (91) 4-6.2

10) Lab hoods and special local exhaust systems mustbe labeled to indicate intended use. Hoods in whichradioactive materials are handled must be identified withthe radiation hazard symbol.

NFPA 45 (91) 6-13

X

11) Provide a properly marked, easily accessible maingas shutoff valve in the room.

UFC (97) 8004.1.12 X

12) Fume/exhaust hoods must be listed (e.g., UL or FM)and maintained in proper operating condition.

UFC (97) 8001.4.4 &8001.4.7.1

X

13) Heat sources (e.g., gas burners, hot plates, heatingmantles, etc.) should never be left unattended.

Recommendation X


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General Science Safety ConsiderationsFor Chemical Storage Facilities


Room Number(s):

Description: Chemical Storage Facilities means any area or room wherechemicals are stored. Usually this refers to the chemistry storage area, butoccasionally there may be other facilities in the school, most likely located withina classroom, that store chemicals. These rules apply to all areas wherechemicals are stored.


EXISTS LACKING N/A

1) Quantities of flammable and combustible liquids shall

not exceed the amounts necessary fro demonstration,treatment, laboratory work, maintenance purposes, oroperation of equipment. Not in any case will it exceedthe limits set forth in table 7902.5-A.

UFC (97) 7902.5.7.2 #3

X

2) Quantities of flammable and combustible liquid inexcess of 10 gallons must be stored in a flammableliquids cabinet. Quantities not exceeding ten gallonsmust be stored in an approved location.

UFC (97) 7902.5.8

X

3) The maximum quantity of flammable and combustibleliquids in storage and use in a lab must not exceed 120gallons.Exception: These quantities may be doubled in areasprotected by an automatic extinguishing system.Exception: These quantities may be doubled if stored inapproved storage cabinets.(Both exceptions may apply.)

UFC (97) table 7902.5-A

X

4) Class I flammable liquids may be stored in glass

containers of not more than one-gallon capacity only ifthe required liquid purity would be affected by storage ina metal container, or if the liquid would cause excessivecorrosion of a metal container. Otherwise, Class I-Aliquids are restricted to glass containers not exceedingone-pint capacity and Class 1-B liquids are restricted toglass containers not exceeding one-quart capacity.Class 1-C liquids are permitted to be stored in containersup to one-gallon capacity.

UFC (97) 7902.1-A

5) No container for Class I or II liquids in any lab mayexceed a capacity of one gallon. See table 7902.1-A forother limitations.

UFC (97) 7902.1-A

6) Materials that will react with water or other liquids toproduce a hazard must not be stored in the same roomwith flammable or combustible liquids.

UFC (97) 7902.5.4X

7) Stored gas cylinders shall have all protective devices

on (caps, collars, and similar devices).

UFC (97) 7401.7.1 X

8) All gas cylinders must be secured in a place toprevent falling.

UFC (97) 7401.6.4 X

9) Material Safety Data Sheets (MSDS) must be readilyavailable on the premises for all hazardous chemicals.

UFC (97) 8001.6 X

10) All chemicals must be stored in approved containers(if possible, chemicals should be stored in the originalshipping package).

UFC (97) 8001.4.2X

11) Incompatible materials shall be segregated toprevent accidental contact with one another. (Storage ofmaterials which are incompatible shall no be allowed inthe same cabinet or exhausted enclosure.)

UFC (97) 8001.11.8

X


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EXISTS LACKING N/A

12) All shelving must be of substantial construction andproperly secured to prevent falling over. (Shelving abovework areas should be kept free of chemicals; storageabove eye level should be avoided.)

UFC (97) 8001.11.9

X

13) Shelving must be equipped with a lip or guard toavoid products rolling off. UFC (97) 8001.11.9 X14) Defective containers must be removed and disposedof in a proper manner.

UFC (97) 8001.4.7.3 X

15) Disposal of chemical wastes must be in accordancewith applicable federal and state regulations and goodsafety practices.

UFC (97) 8001.5.1X

16) All storage cabinets and storage rooms must belocked or otherwise secured against unauthorized entry.

UFC (97) 8001.11.2 X

17) All containers must be properly labeled to identify thecontents.

UFC (97) 8001.7 X

18) Toxic and highly toxic compressed gas, Class IVliquid, solid oxidizers, unclassified detonable, Class Iorganic peroxides, Class III and IV unstable and reactivematerial shall not be allowed in the classroom.

UFC (97) 8001.15.2.4

X

19) When transferring flammable liquids between metalcontainers, the containers must be properly bonded

together. The practice of purchasing large containersand dispensing into smaller ones is discouraged.

UFC (97) 8001.11.5

X

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

CONTAINER TYPE CLASS I-A CLASS I-B CLASS I-C CLASS II CLASS III

1. Glass1 1 pt. 1 qt. 1 gal. 1 gal. 5 gal.

2. Metal or listed approved plastic2 1 gal. 5 gal. 5 gal. 5 gal. 5 gal.

3. Approved plastic 0 gal. 0 gal. 0 gal. 0 gal. 5 gal.

4. Safety cans 2 gal. 5 gal. 5 gal. 5 gal. 5 gal.

5. Metal drum 60 gal. 60 gal. 60 gal. 60 gal. 60 gal.

6. Approved portable tanks 660 gal. 660 gal. 660 gal. 660 gal. 660 gal.

7. Polyethylene3 Note 4 Note 4 Note 4 60 gal. 60 gal.

TABLE 7902.5-A: EXEMPT AMOUNTS OF FLAMMABLE AND COMBUSTIBLE LIQUIDSMAXIMUM QUANTITIES STORED PER CONTROL AREA1,2,3

TYPE OF LIQUID EXEMPT AMOUNT (gallons)

FlammableClass I-AClass I-BClass I-CCombination I-A, I-B, I-C

306090

1204

CombustibleClass IIClass III-AClass III-B

120330

13,2005

1Control areas shall be separated from each other by not less than a one-hour fire-resistive occupancy separation. Thenumber 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 8001.10.2.2Quantities are allowed to be increased 100 percent when stored in approved storage cabinets. When Note 3 applies, theincrease for each Note is allowed.3Quantities 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.4Combinations shall not contain more than the exempt amounts of any individual class.5Quantities permitted in a building equipped with an approved automatic sprinkler system are not limited.


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Carcinogen/Substances of Known High Chronic ToxicityStandard Operating Procedures


Which carcinogens are present in district science laboratories?

KNOWN CARCINOGENS SUSPECT CARCINOGENS OTHERS

Asbestos Cadmium/Cadmium Compounds

Arsenic Carbon Tetrachloride

Benzene Chloroform

Benzidine DDT

Bis (Chloromethyl) Ether 2,4D

Chloromethyl Methyl Ether Methylene Chloride

Chromium/Chromium Compounds Formaldehyde (Gas)

Mustard Gas Lead Acetate Vinyl Chloride Lead Phosphate

Nickel/Nickel Compounds (Powder)

Saccharin

Urethane

List total time (in hours) employee is exposed to carcinogens (checkedchemicals above) per academic year.

N/A hours per academic year

Are checked chemicals required, or could acceptable substitutes beimplemented?

Will retain carcinogen in curriculum Will discontinue use ofchemicals

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

CARCINOGENICCHEMICAL AMOUNTS

USEDDATES USED

NAME(S) OFUSER(S)

NUMBER OFHOURS USED


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Carcinogen/Substances of Known High Chronic ToxicityStorage Guidelines

1. Store in a well-ventilated area. N/A

2. Use secondary containers or trays with sufficient capacity > 100% primarycontainer.

3. Label with the following information:

WARNING!

HIGH CHRONIC TOXICITY

ORCANCER-SUSPECT AGENT

4. Limited access should be provided for these chemicals.

5. Areas should be posted.

6. District Storage Location: N/A

7. Guidelines (from above) that need to be implemented: 1 2 3 4 5


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In the event that chemical decontamination is not feasible, wastes andresidues should be placed in an impervious container that should be closedand labeled in some manner such as the following: CAUTIONCOMPOUNDS OF HIGH CHRONIC TOXICITY or CAUTIONCANCER-

SUSPECT AGENT.

7. Transfer of contaminated wastes from the controlled area to the incineratorshould be done under the supervision of authorized personnel and in such amanner as to prevent spill or loss. In general, liquid wastes containing suchcompounds should be placed in glass or polyethylene (usually preferable)bottles half-filled with vermiculite, and these should be transported in plasticor metal pails of sufficient capacity to contain the material in case ofaccidental 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. Worksurfaces should be thoroughly washed and rinsed. If experiments haveinvolved the use of finely divided solid materials, dry sweeping should not bedone. In such cases, surfaces should be cleaned by wet mopping or by use ofa vacuum cleaner equipped with a high efficiency particulate air (HEPA) filter.All equipment (e.g., glassware, vacuum traps, and containers) that is knownor suspected to have been in contact with substances of high chronic toxicityshould be washed and rinsed before they are removed from the controlledarea.

8. In the event of continued experimentation with a substance of high chronic

toxicity (i.e., if a worker regularly uses toxicologically significant quantitiesof such a substance three times a week), a qualified physician should beconsulted to determine whether it is advisable to establish a regularschedule of medical surveillance or biological monitoring.

Note: Chemical MSDS may be obtained at the following website:http://www.flinnsci.com/search_MSDS.asp
http://www.flinnsci.com/search_MSDS.asphttp://www.flinnsci.com/search_MSDS.asp


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


Is the Lead-in-Water Management Plan in place? 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


Is the Lead-in-Paint Management Plan in place? Yes No



Testing for lead in paint on playground equipment: Note: All playgroundequipment 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______________ condition


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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 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 orreplacement? Yes No

If replaced, was best practices, bid specification criteria used forprocurement? Yes No


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Identified Fixed Equipment Locations

Location Building/Buildings Staff Affected # of itemAutomotive Shop

Wood ShopCustodial/Maintenance

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 ____________. (date)

Training has been scheduled for ____________.(date)


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X 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

X All equipment is securely anchored

Security of Hardware:

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

X 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 useareas such as under swings and at slide exits

Leaded Paint:

X The leaded paint used on the playground equipment has notdeteriorated as noted by peeling, cracking, chipping, or chalking

X There are no areas of visible leaded paint chips or accumulation oflead dust

General Upkeep of Playgrounds:

X The entire playground is free from miscellaneous debris or litter suchas tree branches, soda cans, bottles, glass, etc.

X There are no missing or full trash receptacles


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Physical Hazard Assessment

Hazard(Heat, Noise,Radiation)

Building Location Labeled

Heat, chemical, bodyfluids, noise, asbestos

K-12 Custodial N/A

Noise, chemical, hotwater,

K-12 Kitchen N/A

Heat, chemical, bodyfluids, noise

K-12 Science Room N/A

Noise, impact,compressed gas, dust

K-12 Wood Shop N/A

Affected Employees

Name Department

Art SchweitzerCustodial/Maintenance

Margaret L. Food Service

Dianne J. Food Service

Molly Grant Education (science)

Darrel Meyer Tech Ed

Completed by Lee Carlson ________Date_3-17-09_____________


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Personal Protective Equipment Assessment

Location:

Chemistry

Location:

Food Service

Location:

Custodian

Location:

Tech Shop,wood/metalEmployee:Molly Gort

Employee:Margaret LDianne J.

Employee:Art Schweitzer

Employee:Darrel Meyer

Hand

Nitrile

Latex X XVinyl XLeather X X XNeoprene X X

Face

Impact XSplash X X X XShieldRespirator X

EarMuffs X X XPlugs X X X X

BodyNeo Apron X XDenim X

FootSteel Toes

Metatarsal

Head Hard Hat

Hazard(s)

Heat, chemical,body fluids,

Noise, chemical,hot water, blood

Heat, chemical,body fluids,

noise, openflame, impact

Heat, chemical,body fluids, noise,

open flame,impact

Comments onAvailability,Condition, &Storage

Suggestadditionalhearing

protection forfood service staff

Suggest additionalhearing protection

for students

Completed by Lee Carlson Date Nov, 15, 2007


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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

RespiratorType

RespiratorBrand Location

ValveFlaps? Straps? Organic Particulate Combination

PAPRPowerFlow

PAPRPower

Flow mask AOS Boiler

roomyes yes yes

mask

mask

Full face Wilson Boiler room

yes yes yes

Full face


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Checklist of E/OHS Activities for Underground and AbovegroundStorage Tanks


Is the Underground and Aboveground Storage Tanks Plan in place? 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 sidebetweenbuildings

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 inventorycontrol Tank must be updated, replaced, or removed by December 22, 1998

Upgrades:--Overfill protection--Corrosion protection STPI approved--Leak detection


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Tightness Testing Results on File:

Dates of past testing:_____N/A_______________

Records on file:_____N/A___________________


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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) N/A

Custodial N/A

Is the Welding and Brazing Plan in place? Yes No



Method or methods used to control airborne particulate matter? Externalnegative 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

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, allof the above:

Welding can conducted indoors or out. The air filter is adequate to handle aig ifi t ti l l d

ActivitiesCheclist08-09_3

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