Child Care Indoor Air Quality Evaluation Form

Safer Indoor Environments Through Purchasing Decisions

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Informed Green Solutions, Inc | Ph 802.626.8643 | www.informedgreensolutions.org

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CHILD CARE INDOOR AIR QUALITY

EVALUATION FORM Facility: Date:

Address:

Main Contact: Title:

Phone: Health Manager:

Total Square Footage: Email:

Hard Floor Areas SF: % Carpeted Areas SF: %

Number of Students: Number of Custodians:

Year Built: Number of Buildings:

SURVEY QUESTIONS COMMENTS, NOTES

Environmental Health & Safety Policies and Practices

Are you enrolled in an IAQ Program? Eco-Healthy Childcare? Greencare for Children? STARS Program?

Y Y Y Y

N N N N

Do you have a Health and Safety Committee Are meetings regularly scheduled?

Y N

Is a Hazard Communications Program in place? Is it current?

Y Y

N N

Is the No-idling Policy enforced? Signs posted?

Y Y

N N

Is a policy in place prohibiting animals in the building?

Y N

Do you have a policy for environmentally preferable purchasing of: Cleaning products? Art products? Office products? Others? Is there an Infection Control Plan? Is there a scent-free policy?

Y Y Y Y Y Y Y

N N N N N N N

Do you have a written IPM policy for buildings?


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For outdoor areas?

Is there a policy in place to address pest emergencies (example - agitated yellow jacket nest) when the immediate safety of the children is more important than prior notification?

Y Y Y

N N N

Indoor Air/Environmental Quality

Have there been any IAQ complaints? Are sensitive populations being accommodated?

Y Y

N N

Do you have mold problems? Are there leaks, repairs scheduled or complaints about musty smells?

Y Y

N N

Is there clutter in the classrooms? Does it interfere with the HVAC system or cleaning procedures?

Y Y

N N

Does carpet or VCT need replacing? Would you like information on alternatives?

Y Y

N N

Has the facility been tested for Radon? Y N

Do you have an HVAC system? Y N

Is the maintenance of the HVAC system contracted out?

Y N

Is there a schedule for changing HVAC filters? How often are filters changed? MERV rating for filters? __________________

Y

N

Has there been training on operation of the HVAC system?

Y N

Are there problems with temperature/humidity in the center?

Y N

Have you renovated your center? Are you planning to renovate? If so, when?

Y Y

N N

Does the custodial closet have an exhaust outlet?

Y N

Is the drinking water tested for lead and/or coliform?

Y N

Is routine maintenance up-to-date? Y N

How many students have asthma? Do you keep records of incidences? Do you have asthma action plans?

Y Y Y

N N N


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Verifiable Integrated Pest Management (IPM) Program

Do you have a written IPM plan describing roles and responsibilities for pest prevention, management, and communication?

Y N

Does the center have pest problems? If so what are they?

Y N

Do you contract with a pest control service? Y N

If so, is the pest control service certified in IPM?

Y N

Would you like more information about IPM certified pest control services?

Y N

Is there a notebook that contains all pest related information including a Pest Sighting Log, a Pesticide Use Log and any Service Tickets from Pest service providers?

Y N

Do you inspect and monitor for pest problems?

Y N

Do you use self-enclosed tamper-resistant baits and gels in cracks/crevices?

Y N

Do you mark the area that is being treated?

Y N

Are staff, parents, and guardians notified about an upcoming application of a pesticide (other than a 25(b) exempt product)?

Y N

Do you notify in writing or in person?

How many days ahead of time do you notify or do you notify once a year?

Do you follow state notification requirements? Y N

When using a product other than a 25(b) exempt product are signs posted in locations and entrances prior to and for a certain length of time after a pesticide application?

Y N

Do staff members bring in their own pesticides from home?

Y N

Is food allowed in areas not designed as dining areas?

Y N

Is there an IPM program in effect for turf management?

Y N

Solid Waste Practices


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Is there a recycling program? Y N

Do you recycle your e-waste (computers, cell phones etc.)?

Y N

Are you properly storing and recycling fluorescent bulbs?

Y N

Is a composting program in effect? Y N

Have you replaced and recycled mercury thermometers?

Y N

Cleaning Products and Practices

Do you use a cleaning service? Does your contract require the use of third-party certified products? If not do you know what products the cleaning service uses? If they use their own products, do you have the safety data sheets on site?

Y Y Y Y

N N N N

If you provide cleaning services, do you order with a group or from State Contracts? Who are your vendors? May we contact them for additional information if needed?

Y Y

N N

Do you use dilution stations? Y N

Is Personal Protective Equipment in use?

Y N

What areas are disinfected? How often? Do you combine cleaning and disinfecting?

Y

N

Do you use micro-fiber cloths? Is a color-coded system in place?

Y Y

N N

Do you use micro-fiber mops? Y N

Are mop buckets in use that separate clean and dirty water or require separate mop heads for each area?

Y N

Does the floor care equipment have a vacuum attachment? If so, is it high filtration?

Y Y

N N

Are high filtration vacuums in use? Y N

Are floors vacuumed daily? Y N


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Are rugs cleaned at least twice a year? Y N

Do you have VCT flooring? How often do you strip and recoat floors?

Y N

Are walk-off mats in use inside and outside of entries? Are they multi-level scraper mats? 15’ – 20’? Are they vacuumed daily?

Y Y Y Y

N N N N

Are recycled content paper products in use? Paper towels, toilet paper, tissues etc.

Y N

Do you have auto-flush valves on toilets? Are you planning on installing these?

Y Y

N N

Do staff members bring in their own products?

Y N

Are custodial closets kept closed and locked? Y N


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CLEANING/PESTICIDE PRODUCTS

Existing Products Suggested Alternatives All-purpose Cleaners Bathroom Cleaners Carpet Cleaners Disinfectants/Sanitizers Enzymes Floor Care Furniture Polish Glass Cleaners Hand Soaps and Sanitizers Heavy Duty Cleaner


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Miscellaneous Paper Products Pesticides Toilet Cleaner

Funding of the adaptation of this document for the Child Care audience was provided by the Northeastern IPM Center.

Child Care Indoor Air Quality Evaluation Form

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Transcript of Child Care Indoor Air Quality Evaluation Form