Program Contact Person List

PROGRAM CONTACT PERSON LIST
AED...............................................................................Monica Neubauer
Asbestos Management..................................................................Brian Mohr
AWAIR.....................................................................................Brian Mohr
Bleacher Safety........................................................................ Brian Mohr
Bloodborne Pathogens.........................................................Monica Neubauer
Community Right-to-Know............................................................Brian Mohr
Compressed Gas Safety...............................................................Brian Mohr
Confined Space Entry..................................................................Brian Mohr
Emergency Action Planning..................................................Building Principals
Employee Right-to-Know/Hazard Communication................................Brian Mohr
Facilities Safety Management.........................................................Brian Mohr
First Aid/CPR ...................................................................Monica Neubauer
Hazardous Waste Management.......................................................Brian Mohr
Hearing Conservation..................................................................Brian Mohr
Indoor Air Quality......................................................................Brian Mohr
Integrated Pest Management.........................................................Brian Mohr
LaboratoryStandard/ChemicalHygiene.....................................Arlen DeBruyckere
Lead Management......................................................................Brian Mohr
Lockout/Tagout .......................................................................Brian Mohr
Machine Guarding ...................................................................Daryl Lundin
Personal Protective Equipment......................................................Brian Mohr
Playground Safety......................................................................Brian Mohr
Radon Gas Safety......................................................................Brian Mohr
Respiratory Protection................................................................Brian Mohr
USTs/ASTs...............................................................................Brian Mohr
Welding, Cutting, Brazing.............................................................Brian Mohr
Checklist of E/OHS Activities for Automatic External Defibrillator
Program Contact Person: Monica Newbauer
School policy for use adopted in place? Yes No N/A
Brand of AED? Phillips Heart Smart Model # M5066A-ABA
Name of Medical Director? The device was purchased through the Hutchinson Medical
Clinic. It is assumed the Medical Director of the clinic would serve in that capacity.
Year device was placed into use? 2006
Location(s) of devices:
Building Name Location in Building
West Elementary Foyer above fire extinguisher
Park Elementary Hall by main office near water
fountain
Middle School (1)Hall by office/(2) Auditorium
High School (1)Foyer/ (2)wrestling room
Have all software updates been installed? Yes No N/A
Date of update installation: Winter 2007-2008
Expiration date of pads? 4-2008
Expiration date of batteries? 08-20

(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:2006

(date
• Provider of training: Monica Neubauer
Location of operators manual: School nurse office and one at each building
Are battery checks documented? Yes, a check list is available at each AED station
Notes: The AED’s were purchased by the local medical clinic. The effort was
coordinated between the PTO and the clinic.
Checklist of E/OHS Activities for Asbestos Management
Program Contact Person: Brian Mohr
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: Each affected building.
Training for Asbestos Awareness was conducted Aug 5, 2007 .
New PT employees received training on during the hiring process.

(date)
Annual written notification has been prepared; Yes .

(date)
Notification appeared in the following publication(s):
Name of publication Date

Student Handbook/Parent Handbook Registration Days 2008
Three-year re-inspection Surveillance was conducted: 2006 .
6-month Periodic Surveillance was conducted: May 28, 2008

(first date)
Jan 5,2009
(second date)
All caution labels have been posted.

Label locations: Hard fittings
Lagging runs
Doorways to affected areas

Are supplies of repair materials adequate to meet the requirements of maintenance
and repair of ACM? Yes No N/A
Note: Recent years repairs and removals are outsourced.
Asbestos Maintenance Supplies on Hand
Is documentation of Operations and Maintenance available? N/A
Location: District Office, Buildings and Grounds
Status of the Asbestos repair and maintenance Work Order System:

N/A Established, Pending
Comments: Repairs and work orders are routinely out-sourced to contractors

specializing in asbestos repair and removal.
**For information regarding the medical review and questionnaire, see the
Respiratory Protection Program. **
Click Here to view asbestos inspection records
Note: asbestos containing tile is anticipated to be removed from room 112 in the High
School Building during the summer of 2009.
Checklist of E/OHS Activities for AWAIR
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 No N/A
Location: Buildings and Grounds office
Posted: not at this time
How is the program communicated to employees? All staff training is one method.
Intranet is also an additional vehicle
Who is the Contact Person for OSHA 300? Betty Nielsen
Is the OSHA 300A Log completed for the previous calendar year? Yes. Posted Feb.1
2008
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: Each building office bulletin board or staff work
room.
Is information on injuries recorded on the Log with five (5) working days? Yes No N/A
Note: The logs were posted as of February 1st and distributed to each building to be
posted in work rooms.
Minnesota Labor Law required postings
Unemployment Insurance
Minnesota OSHA
Age Discrimination
Workers' Compensation
Minimum Wage
Federal Labor Law required postings
Posting
Building Location FMLA EPPA FLSA EEO
District Break Room X X X
Office
High School Custodial
Middle Break Room X X X
School
West Custodians X X X
Elementary Room
Minnesota Labor Law required postings
Building Posting Unemployment Minnesota Age Workers' Minimum

location Insurance OSHA Discrimination Compensation Wage
District Break X X X
Office Room
High Custodial
School
Middle Break X X X X
School Room
West Custodians X X X
Elementary Room
Survey conducted April By Lee Carlson

Safety Committee – Meeting Schedule
Date Location Time
District Office Board Room 3:45 pm
1-5-09 District Office Board Room 2:45 pm
District Safety Committee Members
Member Position Building

Dr. Brian Pollman School Board Clerk
Brian Mohr Buildings /Grounds CO
Maggie Mueller Physical Ed. Park
Bernie Reinke Director Food Service CO
Jennifer Ellstrom
Sue Griep Secretary CO
Peggy Westlund Reading MS
Monica Neubauer School Nurse Park
Jayme Harlander
Bev Wambeke SPED West
Ronda Eckhart FACS HS
Paul Symanski Activities Director HS
Janet Mraz
Betsy Brown Grade 1 West
Deb Card Physical Ed. HS
Deb Marcotte Asst Superintendent CO
Note: is the lead person in coordinating Health & Wellness Committee.
Wellness minutes
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 and

submitted to the Minnesota Department of Labor and Industry? Yes No N/A
Note: The bleachers have been surveyed and photos taken. All bleachers were found
to be in compliance with current building code requirements. The paperwork has
been submitted for recertification.
On April 16, 2008 the bleacher tags received from MN Dept. of L&I were installed on
all bleachers. LC
Note: During the review of bleachers a section of the home bleachers were sagging
due to partial failure of a single support. Repairs have been purchased and installed
fall of 2008. LC 8-25-08
Openings and gaps:
X 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:
X They may contain openings of 9 inches or less
X If exempt from standards must have a safety management plan in place and an amortization
schedule to plan for their future replacement
Approved netting:
X Netting may be provided to prevent persons from falling through the bleachers between the
seat and footboards
X Chain link fencing may be used but must be secured tightly to the underside of the
bleachers.
Railings:
X Bleachers 55 inches and under are exempt from railing requirements

X Bleachers with guardrails over 55 inches above grade must not contain openings greater than
four inches, unless safety nets are installed.
X 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:
X 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
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
Note: All bleachers at the Hutchinson Public school consist of aluminum, poured concrete, or poly
with wood. Repairs will be required on the aluminum bleachers at the football field. Plans are to
repair during the summer of 2008.
Checklist of E/OHS Activities for Bloodborne Pathogens
Program Contact Person: Monica Neubauer
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:

Nurses /Health Aids Playground Supervisor
Custodian Bus Driver, Coaches
Secretaries Art, Industrial Arts
Phy. Ed. Instructors Food service personnel
Special Ed., PARA’s Science Instructors
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 considered “at risk” is offered no cost HBV vaccinations.
Is training provided at this school on methods and techniques to reduce exposure

incidents? Training is now provided on-line or during the hiring process. Records are
maintained in the B&G office.
New Employees: Upon employment
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 at each instructor’s desk
Status of Declination forms: These forms are maintained by the Lead School Nurse
(Monica Neubauer). The forms are available at the School Nurse’s Office at Park
Elementary.
How is blood or bodily-fluid-containing materials handled at this facility? Custodial

staff provides clean-up services. Staff is involved only on an emergency basis.
Policy regarding cleanup: The custodial staff are to be considered the first in
cleanup of bodily fluids.
Location of biohazard bags at school: Nurses office West Elementary
Approved disposal location for bio-hazardous waste: N/A at this time.

Checklist of E/OHS Activities for Compressed Gas Safety
Program Contact Person(s) Brian Mohr
Primary Contact Brian Mohr
Department Contacts: Position open
Art N/A
Custodial N/A
Metals Shop/Ag. FFA Position open
Science N/A
Transportation N/A
Is the Compressed Gas Plan in place? Yes No
Is the Plan current? Yes No
Has the facility been surveyed for compressed gas inventories? Yes No
Has training been conducted for affected personnel? Yes No
Are records established/maintained for gas inventory? Yes No
Note: the position of auto mechanics and agriculture shop are open and being taught
by technology staff.
Note: Chuck Platesha is in charge of maintenance of ac refrigerant units in the school

district. Chuck is required to maintain records on use and purchases. Software is
available and located on desk top of the custodial computer. Chuck purchases HCFC
in quantities of 300# lots.
Green colored containers are R22, Orange colored containers are 404. Yellow
containers are empty and used as container to capture and contain product. 1-7-09
COMPRESSED GAS FIELD REVIEW
Compressed Gas Inventory
Date: 06-05-2009 Program Contact Person: Position open
Department: Technology Department Responsible Person: Position open
Location: Metals Shop
Cylinders:
 O2 __6__________  CO2 ____________
 Acetyl _6___________  Argon __1__________
 NH4 ____________  Argon/CO2__6__________
 Helium ____________
Compliance Check List

Yes No
1. Are cylinders in well-ventilated area? X
2. Are cylinders stored separate from flammables by at least 20 feet? X
3. During storage are oxygen cylinders separated from fuel gas cylinders, X
unless on welding cart?
4. Are cylinders kept away from sources of heat (below 130 F)? X
5. Are safety chains used at all times on both full and empty X
cylinders? (2/3rds from top of cylinder)
6. Are empty cylinders maintained separate from full cylinders? X
7. Are cylinders kept away from sources of ignition such as electricity, X
excessive heat or oily rags?
8. Are carts designed specifically for gas cylinders available? X
9. Are damaged cylinders, valves/hoses removed from service? X
10. Are all cylinders properly labeled with the contents? X
Note: 4 empty, and labeled as such, CO2/argon cylinders were properly

stored. 3 acetylene were also empty and chained to wall. LC 6-5-09
Date: 01-07-2009 Program Contact Person: Position open
Department: Technology Department Responsible Person: Position open
Location: Metals Shop/Auto

Mechanics
Cylinders:
 R22 __(6), 90 lbs__________  CO2 ____________
 404,404Al _(2), 28lbs____  Argon ____________
 NH4 ____________  Argon/CO2___________
 Nitrogen _1___________

Yes No
4. During storage are oxygen cylinders separated from fuel gas cylinders, X
unless on welding cart?
Date: 06-05-09
Department: Tech Education Department Responsible Person: John Smith
Location: Technology Shop
Cylinders:
 O2 _1___________  CO2 ____________
 Acetyl 1____________  Argon ____________
 NH4 ____________  Argon/CO2__1__________
 Helium ____________

Yes No
5. During storage are oxygen cylinders separated from fuel gas X
cylinders, unless on welding cart?
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
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: Aug, 2008
Note: See Confined Space folder for photos and dimensions of confined spaces at all
buildings.
Confined Space Inventory
Building: All Buildings
Building Contact: Brian Mohr Program Contact: Brian Mohr
Date: Oct.1, 2007
Room Opening Dimension Potential Permit/ Labeled Photo

Identification Dimension Of Hazards Non- ID #
Name Given Space Confined Permit/Alternat
Space e
Confined Space Equipment Inventory
Equipment Item Manufacturer Serial number Calibration date
Note: Metering equipment is available through the consultant in the event of entry
into a confined space. The school also maintains testing devices to assist in
monitoring.
Employees Authorized to Enter Confined Spaces
Name Building or Buildings Training Date

Jim Benton All school Buildings Aug, 2007
Justin TenYeck All school Buildings Aug, 2007
Charles Platisha All school Buildings Aug, 2007
Hutchinson Public Schools
Building: West Elementary
Building Contact: Brian Mohr Program Contact: Lee Carlson
Completed By: Lee Carlson Date: 3-12-2008
Room Identification Opening Dimension Potential Permit/ Labeled Photo

Name Given Space Dimension Of Confined Hazards Non- ID #
Space Permit
Mechanical Room off 23”X33’ 65”X33”X33” LE Non- No 101-757

kitchen Permit
AHU required
Note: Roof top AHU contain access location designed for maintenance and repair. These confined
spaces typically are non-permit required in that no hazards could be identified.
Building: Middle School

Space Permit
Wood shop LE, Permit Yes No photo

Dust collector engulfment required
Pool 8’X20”X88” 9’88’X23’ Compressed Non- No 2416
AHU gas, heat, Permit
Pool 18” round 46” round Engulfment Permit No 2417
Sump , chemical required
Pool 40”X40” 40”X40”X6’ Engulfment Permit No 2418
Pool 5’X5’ 5’X5’X54” Engulfment Permit No 2419
Pool 14” 6’X6’X round Engulfment Permit No 2420
Tank , chemical required
Pool 14” 6’X6’ round Engulfment Permit No 2421
Tank , chemical required
Pool 24”X24” 10’X4’X8’ Engulfment Permit No 2422
Building: Park Elementary

Space Permit
Boiler Room 18” round 4’X5’X12’ LE, O2 Permit Yes 2423

Boiler required
Boiler Room 18” round 4’X5’X12’ LE, O2 Permit Yes 2424
Boiler required
Boiler Room 3’X4’ 3’X4’X>200’ Heat,elec., Permit Yes 2425
Tunnels steam required
Room 55 17”X50” 42”X60”X54” Non- No 2426
AHU X (3) Permit
Room 55 25”X64” 25”X64”X6’ Non- No 2427
AHU Permit
Multi-purpose 30”X36” 30”X36”X10’ Non- No 2428
AHU3 Permit
Building: High School

Space Permit
Boiler Room 12”X12” 8’X3’X4’ LE, O2 Permit Yes 101-766

Boiler required
Boiler Room 6’X5’ 6’X5’X>200’ O2, Elec., Permit Yes 101-765
Tunnel openings Heat required
Boiler Room 13” round 43”X77” LE Permit Yes 101-764
Water tank required
Boiler Room 3’X6’ 3’X6’X11’ Engulfment Permit Yes 101-763
Water tank Required 101-762
Softener room 39”X39” 39’X35’X44’ Elec. O2 Permit No 101-761
Sump Required
Pool 44”X5’ 44”X5’X>200 Elec. O2, Permit No 101-760
Tunnel heat Required
Pool 25”X50’ 62”X50”X80” Non- No 101-759
AHU Permit
Pool 47”X6’ 6’X6’X>200’ Elec., O2, Permit No 101-758
Tunnel heat Required
Pool 24’X24” 26”X40”X7’ Non No 101-757
AHU Permit
Note: access sites through the floor exist throughout the building. Entering at these
locations is considered permit required.
Click this link to confine space photos.

Checklist of E/OHS Activities for Community Right-to-Know
Is the Community Right-to-Know Plan in place? Yes No N/A
Are quantities of stored and used designated hazardous materials documented and
verified? Yes No N/A
Where are the documents stored? District Building and Grounds Office
Have the State Emergency Response Commission and local fire department been
notified of hazardous materials on school grounds? Yes No N/A
Note: Brian M. typically delivers the notification by hand to the local fire
department.
When were they notified? 11/24/2008
(date)
Has training been provided? Yes No N/A
Date: N/A
Presenter: N/A
Note: The Tier Two Form is completed by Brian Mohr online. The date of completion
was 5/25/2007
User Name: BrianMohr

Pass Word: iuytrewq
Website Access is:
http://minnesota.idsimaps.com/submit/T2_Menu.asp
Inventory Form
Client: Hutchinson Public Schools
Contact Person: Brian Mohr Date: Feb 20, 2007
Hazardous Reported on Installation

Material Quantity Location Tier Two Date(s)
Middle School YES
Chlorine 01 and High
School Pool
Rooms
Green Storage YES
Gasoline 01 Shed SE of High
School
Green Storage YES

#2 Diesel Fuel 01 Shed SE of High
School
Submissions Listing for HUTCHINSON HIGH SCHOOL (ID: 6919)
312 (Tier II)
Shown below is a listing of all Tier II Report submissions. Click on the reporting year to edit the Report for that year. The
link in the Reporting Year column will be enabled if you can edit the data for that year.
Reporting Submission Signed By Signed Date Submission Tier Submission Report Export to
Year Class Status II Type Status Tier II
Submit
2009
Not Started
[Edit]
HUTCHINSON PUBLIC
SCHOOLS, 3/16/2009 9:04:46
2008 Annual Completed Online Active
Director of Buildings and AM
Grounds
BRIAN MOHR,
2007 Revision 11/21/2008 Completed Hardcopy Active
DIR. OF FACILITIES
BRIAN MOHR,
11/24/2008
Annual Director of Buildings and Completed Online Active
8:51:31 AM
Grounds
Brian D. Mohr,
5/25/2006 3:13:58
2005 Annual Director of Buildings and Completed Online Active
PM
Grounds
Click here to request an edit for a Previous Reporting Year.
Click here for Tier Two 2008
Checklist of E/OHS Activities for Emergency Action Planning
Program Contact Person: Brian Mohr and Building Principals

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
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 by each classroom.
Are all drills timed and recorded? Yes No
Responsible person: Building Principals and or Assistant Principals time and

coordinate drills
Location of records: Records are primarily stored o the building office bulletin
board. An alternative is storage in the Principal’s office.
Forms provided: Yes No
Does this school coordinate drills with local government authorities to assure
sheltering in school, evacuating to their homes or use of congregate care centers? Yes
No N/A
Has this school completed the Fire Marshall required Fire Safety and Emergency
Evacuation Plan? Yes No N/A
Training provided for affected staff? Yes No N/A
Checklist of E/OHS Activities for Employee Right-to-Know/Hazard

Communication

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 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 Main Office
Custodians Yes No N/A Custodial Office
Food Service Yes No N/A Building kitchens
Science Rooms Yes No N/A Science instructor’s office
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
Note: Training was provided to custodial staff on Ergonomics, ERTK, machine operation and
PPE when servicing fluid acid batteries. 3-12-09. LC
Contact List for Employee Right-to-Know Program

Key Contact for Department
Department (person responsible for locating MSDS)
Rebecca Walling/ HS
Art
Mike Weisenberger/MS,
Biology Maria Nuthak//HS
Ronda Eckhart
Consumer Life Science
Jim Benton
Custodial/Maintenance
Bernie Reinke
Food Service
Arlyn DeBruyckere
Photo
Arlyn DeBruyckere/HS,
Chemistry/ Science Mike Weisenberger/MS
Daryl Lundin
Shop—Welding
Daryl Lundin/HS
Shop—Wood Michael Schultz/MS
Brian Mohr
Transportation
Other
Completed by: Lee Carlson Date: 9-24-08

Checklist of E/OHS Activities for Facilities Safety Management and Fire
Safety in Schools
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 Note: The District appoints its own Management Assistant. Brian Mohr provides
oversight and monitors the Health and Safety program.
If no, who is the designated person or persons? Brian Mohr
Fire and Life Safety in Schools

Is the Fire Marshal approved Emergency Evacuation Plan in place for each district
building? Yes No
Are emergency lights tested at least biannually? Yes No N/A
Science safety Checklist completed? Yes No N/A
Park Elementary: Sprinkler 9-23-08 Alarm 9-23-08, Extinguisher 8-08
DO Park TAP Middle HS West

Sprinkler N/A 9/23/08 N/A 7/23/08 7/27/08 7/23/08
Alarm N/A 7/23/08 N/A 7/23/08 7/16/08 7/23/08
Fume Hood N/A 8/27/08 N/A Sprinkled 8/27/08 8/27/08
Extinguishers 8/29/08 8/29/08 8/29/08 8/29/08 8/29/08 8/29/08
ECFE
Sprinkler N/A
Alarm 7/23/08
Fume Hood N/A
Extinguishers 8/07
Note: All communication and activities as they relate to the Fire Marshall are
contained in a white binder labeled “State Fire Marshal” located in the Buildings and
Grounds office.
Facilities Safety Review
Building: High School, West Elementary, Middle School, Park Elementary
Mock-OSHA Review Date Review

Area Completed N/A Recommendations
Art 1-15-2007 A detailed report has been provided to Brian for
his consideration.
Dark Room N/A
Wood Shop 1-15-2007
Kitchen 1-15-2007
Metal Shop 1-15-2007
Halls, Gym, etc. 1-15-2007
Graphic Arts 1-31-2007
Maintenance/Custodial 1-31-7-2007
Transportation 1-31-2007
Grounds/Garage 1-31-2007
Chemistry/Life 1-31-2007
Science
Note: this like takes you to results folder

Checklist of E/OHS Activities for First Aid/CPR
Program Contact Person(s): Monica Neubauer
Is the First Aid/CPR program in place? Yes No
Have the program and goals been approved by the School Board for the current
school year? Yes No
Has the District determined a provider in the event of a medical emergency? Yes No
The local provider determined travel time was estimated to be within the 4-8 minute
limit. Therefore Hutchinson Ambulance 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: Training is provided by the School Nurse, Monica Neubauer. A survey of first-
aid kits 10-22-07 indicated them to be in good condition and well supplied. Monica
will be reviewing the kits 2008-2009 to be sure all are properly supplied.
Checklist of E/OHS Activities for Hazardous Waste Management
Program Contact Person(s)Brian Mohr
Primary Contact Person: Brian Mohr
Secondary Contact Person: Jim Benton
Is the Hazardous Waste Management program in place? Yes No
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
Note: A survey of toxic wastes generated in spring of 2005 by MPCA Field Technician,
Kathy Gedde, determined the school to be a “minimum waste generator” ending the
need to continue licensing with the State of Minnesota. See Activities Manual for
report.
Evaluation of Hazardous Waste Generating Locations
(complete form for each facility)
Area N/A Type Quantity/Month Disposal Method
Chemistry/Biology Acetone N/A

Note: All lab Acids N/A
chemicals are Bases N/A
neutralized and Precipitated heavy N/A
sewered. metals
Graphic Arts, Paints N/A

Scene Shops, etc. Thinners N/A
Photography X Film/Paper
Fixer N/A
Art Printing Fluids N/A
Grounds and X Pesticides N/A

Maintenance
Custodial PCB Oil Ballast Retrofit

Bulbs Retrofit
Paint Stripper Recycled
Boiler Treatments N/A
Asbestos WM Waste
Management
Automotive-related Crankcase Oil 25 gal Recycled

Repairs Lead-balancing Weights varies Recycled
Used Batteries 2/month Recycled
Paint 1 gal. Meeker County
Recycling
Paint Thinners
Filters 4 ea.
Antifreeze 4 gal. N/A
Metal Shop Parts Washer Recycled
Wood Shop Degreaser N/A
Ag Shop Used Batteries N/A
Paint Recycled with county
Paint Thinners Recycled
Filters N/A
Paint Strippers N/A
Note: Middle school garage is the central collection point. Computer components are stored
in large green shed behind HS. Retrofit provides recycling services.
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 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
Has training been scheduled or completed for affected individuals this school year?
Yes No N/A
Date: N/A
Presenter: N/A
Have regulatory changes occurred that may affect this program? No
Note: While this program area does not meet the requirements for a full hearing
protection program for employees, the employer voluntarily provides its employees
access to various hearing protection devices for use. Hearing protection PPE is
located at the custodial offices in each building.
Sound surveys are taken from time to time. To access click this link
HearingConservationAcoustic
Sound Level Monitoring
Measuring Device: Center 325 Sound Level Calibration: Pre___________

Meter Post___________
Reason for Testing: General Survey
Affected Personnel: Band Custodial, Maintenance, Shop
Building Specific Area Results Recommendations

High School Dishwashing 77-80dBA Protection not
required
High School HS Boiler Room 86-87 dBA Provide protection
Park Elementary Boiler Room 80-82 dBA Protection not
required
Completed by Lee Carlson Date 3-31 -2009

Checklist of E/OHS Activities for Indoor Air Quality
Is the IAQ Plan in place? Yes No
Has an IAQ Committee been established? Yes No
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? Throughout 2008-2009 school year.
Who conducted the evaluation? Lee Carlson
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: All-staff 8/30/2005

(date)
Training has been scheduled for: 9/31/2006.

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

(date)
Results of technical services are located? __ ________

Checklist of E/OHS Activities for Integrated Pest Management
Is the IPM Plan in place? Yes No
Note: Plunkett’s also have a site specific plan for each school building. The plans can
be found in the Activities Manual.
Has the annual monitoring been conducted to determine location and degree of
infestation? Yes No
Note: Any unusual infestations noted by staff are reported and site specific
integrated plan for removal of the pest is developed.
A map of the problem area/areas has been developed. Yes No N/A
Has notice been given to parents regarding application activities? Yes No
Location or publication used to notify parents Student Parent Handbook, fall, 2008.
Each building develops its own specific handbook information and includes the
required parent notifications.
Note: Bill Mitchell provides pest control with Plunkett’s. Bill typically applies
pesticides after school hours or during the summer season.
All pest control activities are documented as to time and date in the Activities
Manual. Product used and location of placement are included on the work order.
Checklist of E/OHS Activities for Laboratory Standard/Chemical
Hygiene Plan
Program Contact Person: Arlyn DeBruyckere , CHO
Is the Laboratory Standard/Chemical Hygiene Plan in place? Yes No N/A
Fume hood was tested on _6-05-2009______________.

(date)
The results indicate air velocity to be: satisfactory, unsatisfactory.
Chemical inventory:
Date of most recent survey 6-05-2009
Location of inventory listing: Instructors chemistry office, HS Lab 310
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: New employee for 2007-2008
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: A chemical inventory is in the process of being taken by Mollie Taber. All
unneeded chemicals will be disposed of thru the U of M .LC 3-12-09
Note: The chemicals were identified and effectively neutralized prior to disposal. No
chemicals were found required to be removed by a hazardous waste contractor. LC 3-
31-09
The Science Safety Check list was reviewed today with Arlyn DeBruyckere. No changes
were noted from previous surveys. LC 6-5-09
General Science Safety Considerations

For All Rooms Where Science Laboratories Are Conducted
And/or Demonstrations Are Given
Room Number: WA 112
Description: A school science laboratory is defined as a classroom where

demonstrations and/or laboratory instructions are provided for individual or group
experiments. They are places where science is taught. In addition, any condition
listed under either the storage section or the chemical laboratory section that may
apply to any area, for instance, must keep inventories of all biology reagents and
chemicals.
CONDITION
ITEM CITATION EXISTS LACKING N/A
1) Laboratories must be equipped with adequate X
ventilation. For new labs (build after July 1990) an
UBC (97) 305.2.4,
manual shutoff control for the laboratory exhaust
307.5.2, & 1202.2.3
ventilation system must be provided outside of the
UFC (97) 8004.1.11 &
room, in a position adjacent to the access door to the
8003.1.4.2
room or in such other location as approved by the fire
chief.
2) At least one 2A-20BC, or larger, rated and approved X
portable fire extinguisher must be provided for each
3,000’ of laboratory. Travel distance must not exceed
UFC (97) 1002.1
50’ from anywhere in the lab. At least one fire
UFC Std. 10-1-3-2
extinguisher suitable for class D fires must be provided
in laboratories where combustible metals are used and
stored.
3) At least one approved fire blanket must be provided X
UFC (97) 1001.9
in each laboratory.
4) Students must be under the direct supervision of a NFPA 45 (91) 1-4 X
faculty member or an assistant at all times. In most
cases it is recommended that direct supervision means
direct eye contact. It is recommended that no more
than two students be assigned to a lab station, a place
in the room equipped with water, gas, and electricity,
or a place where students do labs.
5) Aisles serving work areas on two sides must be at X
least 42” wide; those serving work areas on one side UFC (97) 1204.2.2 (2)
only must be 36”.
6) Minimum of two means of exit access must be X
provided when:
Existing: lab exceeds 1,000 sq. feet NPFA 45 (91) 3-4.1
New: lab exceeds 200 sq. feet (built after 7/90) UBC (97) 1007.3.8
7) Labs must be separated from each other and other X
portions of the building by not less than a 1-hour
occupancy separation.*
Existing: labs located in buildings protected by UFC (97) Appendix 1-A
automatic extinguishing systems—only smoke 7.2 as amended
separation required
New: (built after 7/72) UBC (97), 305.2.4
*Recommend this be determined by a licensed design
professional
8) Labs must be equipped with automatic detection X
electrically interconnected with the building fire alarm UFC (97) 1007.2.4.2 &
system. Exception: labs protected by a complete 1007.2.4.1.1 as
automatic sprinkler system that is interconnected to amended
the building fire alarm require no additional detection.
9) All electrical outlets must be properly grounded and X
all fixed electrical equipment and appliances must be UFC (97) 8504
plugged in to grounded outlets as required by the 99NEC 250-112
electrical code.
CONDITION
10) Electrical receptacles, switches, and controls must X
NFPA 45 (91) 3-6.1
be located so as not to be subject to liquid spills.
11) Extension cords must not be used as a substitute X
UFC (97) 8506.1
for permanent wiring.
12) The use of multi-plug adapters, octopus X
arrangements, cube adapters, strip plugs, or any other
UFC (97) 8507
device that does not comply with the electrical code is
prohibited.
13) A minimum of 30” of clearance must be maintained X
UFC (97) 8509.2
in front of electrical control panels for access.
14) Written procedures for laboratory emergencies, X
including emergency evacuation, must be developed NFPA 45 (91) 4-6.3.1
for each lab.
15) Piping systems must comply with nationally X
NFPA 45 (91) 8-1.1
recognized standards.
16) Enough eye protection devices (goggles) must be X
provided for every student in the room, visitors, and MN Public Law, section
the teacher whenever potentially hazardous activities 126.20
are taking place.
17) Refrigerators, freezers, and other cooling X
equipment used to store or cool flammable liquids must NFPA 45 (91) 9-2.2.2
be of explosion-proof construction
18) Each refrigerator, freezer, or cooler must be X
prominently labeled to indicate whether it is or is not NFPA 45 (97) 9-2.2.1
suitable for storing flammable liquids.
19) Flammable liquids stored in refrigerated equipment X
NFPA 45 (91) 9-1.6.6
must be in closed containers.
For All Laboratories and/or Rooms Where Chemical Demonstrations Are Conducted
Room Number: High School112
Description: In addition to the provisions that are outlined for any science laboratory
area, the following provisions are specific for chemistry classes (but may apply to any
lab where similar activities are carried on).
CONDITION
1) Proper eyewash facilities must be installed that X
produce 25 psi of water for 15 minutes. Squeeze
bottles do not meet this specification. It is
recommended that eyewash fountains should be
ANSI Z-358.1-1981
located within 25’ of students in any area of the room.
The device must be plumbed into a drinkable water
supply. This rule applies to any rooms where labs are
conducted that are potentially harmful to the eyes.
2) Emissions generated at workstations must be X
confined to the area in which they are generated UBC (97) 1202.2.3
(laboratory hoods).
3) In new labs (build after 7/90) a manual shutoff
control for the laboratory exhaust ventilation system
UBC (97) 1202.2.3
must be provided outside of the room in a position
UFC (97) 8003.1.4.2
adjacent to the access door to the room or in such
other location as approved by the fire chief.
4) Chemicals stored in the open in the laboratory work X
area must be kept to the minimum necessary for the NFPA 45 (91) 7-2.3.1
work being done.
5) A complete inventory of chemicals on hand must be X
maintained and must be available to the fire chief. All UFC (97) 8001.6
materials must be dated upon receipt.
6) Persons responsible for each lab must be familiar X
with the chemical nature of the materials present in
UFC (97) 8001.11.1.1
the lab and the appropriate mitigating actions to be
taken in case of fire, leak, or spill.
7) Incoming shipments of chemicals must be X
transported and opened by school personnel familiar NFPA 45 (91) 7-2.2.1
with the potential hazards.
8) Neutralizing chemicals spill kits, dry sand, X
vermiculite, EM Absorbent, and other spill control
UFC (97) 8001.11.1
methods must be readily available while the lab is in
use.
9) Written maintenance procedures must be X
established, including regular inspection, testing, and
NFPA 45 (91) 4-6.2
maintenance of lab utilities, hood and exhaust
systems, pressure equipment (autoclaves, steam
sterilizers, etc.), and emergency equipment.
10) Lab hoods and special local exhaust systems must X
be labeled to indicate intended use. Hoods in which
NFPA 45 (91) 6-13
radioactive materials are handled must be identified
with the radiation hazard symbol.
11) Provide a properly marked, easily accessible main X
UFC (97) 8004.1.12
gas shutoff valve in the room.
12) Fume/exhaust hoods must be listed (e.g., UL or UFC (97) 8001.4.4 & X
FM) and maintained in proper operating condition. 8001.4.7.1
13) Heat sources (e.g., gas burners, hot plates, heating X
Recommendation
mantles, etc.) should never be left unattended.
CONDITION
14) It is recommended that due to the serious X
explosion hazard present, the following chemicals not
be used in an instructional setting:
Benzoyl Peroxide Percholoric Acid Recommendation
Carbon Disulfide Picric Acid
Ethyl Ether Potassium Metal
Magnesium Powdered Metal
15) Loose clothing (e.g., full cut blouses, neckties, X
etc.) and long hair should be properly restrained. Also,
Recommendation
some laboratory activities could be dangerous to
persons wearing contact lenses.
For Chemical Storage Facilities
Room Number: High School112
Description: Chemical Storage Facilities means any area or room where chemicals are
stored. Usually this refers to the chemistry storage area, but occasionally there may
be other facilities in the school, most likely located within a classroom, that store
chemicals. These rules apply to all areas where chemicals are stored.
CONDITION
1) Quantities of flammable and combustible liquids X
shall not exceed the amounts necessary for
demonstration, treatment, laboratory work,
UFC (97) 7902.5.7.2 #3
maintenance purposes, or operation of equipment. Not
in any case will it exceed the limits set forth in table
7902.5-A.
2) Quantities of flammable and combustible liquid in X
excess of 10 gallons must be stored in a flammable
UFC (97) 7902.5.8
liquids cabinet. Quantities not exceeding ten gallons
must be stored in an approved location.
3) The maximum quantity of flammable and X
combustible liquids in storage and use in a lab must not
exceed 120 gallons.
Exception: These quantities may be doubled in areas
UFC (97) table 7902.5-A
protected by an automatic extinguishing system.
Exception: These quantities may be doubled if stored in
approved storage cabinets.
(Both exceptions may apply.)
4) Class I flammable liquids may be stored in glass X
containers of not more than one-gallon capacity only if
the required liquid purity would be affected by storage
in a metal container, or if the liquid would cause
excessive corrosion of a metal container. Otherwise,
UFC (97) 7902.1-A
Class I-A liquids are restricted to glass containers not
exceeding one-pint capacity and Class 1-B liquids are
restricted to glass containers not exceeding one-quart
capacity. Class 1-C liquids are permitted to be stored in
containers up to one-gallon capacity.
5) No container for Class I or II liquids in any lab may X
exceed a capacity of one gallon. See table 7902.1-A for UFC (97) 7902.1-A
other limitations.
6) Materials that will react with water or other liquids X
to produce a hazard must not be stored in the same UFC (97) 7902.5.4
room with flammable or combustible liquids.
7) Stored gas cylinders shall have all protective devices X
UFC (97) 7401.7.1
on (caps, collars, and similar devices).
8) All gas cylinders must be secured in a place to X
UFC (97) 7401.6.4
prevent falling.
9) Material Safety Data Sheets (MSDS) must be readily X
UFC (97) 8001.6
available on the premises for all hazardous chemicals.
10) All chemicals must be stored in approved X
containers (if possible, chemicals should be stored in UFC (97) 8001.4.2
the original shipping package).
11) Incompatible materials shall be segregated to X
prevent accidental contact with one another. (Storage
UFC (97) 8001.11.8
of materials which are incompatible shall no be allowed
in the same cabinet or exhausted enclosure.)
CONDITION
12) All shelving must be of substantial construction and X
properly secured to prevent falling over. (Shelving
UFC (97) 8001.11.9
above work areas should be kept free of chemicals;
storage above eye level should be avoided.)
13) Shelving must be equipped with a lip or guard to X
UFC (97) 8001.11.9
avoid products rolling off.
14) Defective containers must be removed and X
UFC (97) 8001.4.7.3
disposed of in a proper manner.
15) Disposal of chemical wastes must be in accordance X
with applicable federal and state regulations and good UFC (97) 8001.5.1
safety practices.
16) All storage cabinets and storage rooms must be X
locked or otherwise secured against unauthorized UFC (97) 8001.11.2
entry.
17) All containers must be properly labeled to identify X
UFC (97) 8001.7
the contents.
18) Toxic and highly toxic compressed gas, Class IV X
liquid, solid oxidizers, unclassified detonable, Class I
UFC (97) 8001.15.2.4
organic peroxides, Class III and IV unstable and reactive
material shall not be allowed in the classroom.
19) When transferring flammable liquids between X
metal containers, the containers must be properly
bonded together. The practice of purchasing large UFC (97) 8001.11.5
containers and dispensing into smaller ones is
discouraged.
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.
1
Class I-A and I-B liquids are allowed to be stored in glass containers of not more than 1-gallon capacity if the required liquid
purity, such as American Chemical Society analytical reagent grade or higher, would be affected by storage in metal containers
or if the liquid would cause excessive corrosion of a metal container.
2
See Sections 7902.1.8.1.3 and 7902.5.10.2.2 for special limitations.
3
Polyethylene containers in accordance with nationally recognized standards. See Article 90, Standard u.3.3.
4
See Rows 2, 3, and 4.
TABLE 7902.5-A: EXEMPT AMOUNTS OF FLAMMABLE AND COMBUSTIBLE LIQUIDS—

MAXIMUM QUANTITIES STORED PER CONTROL AREA1,2,3
TYPE OF LIQUID EXEMPT AMOUNT (gallons)

Flammable
Class I-A 30
Class I-B 60
Class I-C 90
Combination I-A, I-B, I-C 1204
Combustible
Class II 120
Class III-A 330
Class III-B 13,2005
1
Control areas shall be separated from each other by not less than a one-hour fire-resistive occupancy separation. The number of
control areas within a building used for retail or wholesale sales shall not exceed two. The number of control areas in buildings
with other uses shall not exceed four. See Sections 204 and 8001.10.2.
2
Quantities are allowed to be increased 100 percent when stored in approved storage cabinets. When Note 3 applies, the increase
for each Note is allowed.
3
Quantities are allowed to be increased 100 percent in buildings equipped with an approved automatic sprinkler system. When
Note 2 applies, the increase for each Note is allowed.
4
Combinations shall not contain more than the exempt amounts of any individual class.
5
Quantities permitted in a building equipped with an approved automatic sprinkler system are not limited.
Carcinogen/Substances of Known High Chronic Toxicity
Standard Operating Procedures
Client: Inver Grove Heights Community Schools
Which carcinogens are present in district science laboratories?
KNOWN CARCINOGENS SUSPECT CARCINOGENS OTHERS

‫ٱ‬ Asbestos ‫ٱ‬ Cadmium/Cadmium Compounds ‫ٱ‬
‫ٱ‬ Arsenic ‫ٱ‬ Carbon Tetrachloride ‫ٱ‬
‫ٱ‬ Benzene ‫ٱ‬ Chloroform ‫ٱ‬
‫ٱ‬ Benzidine ‫ٱ‬ DDT ‫ٱ‬
‫ٱ‬ Bis (Chloromethyl) Ether ‫ٱ‬ 2,4D ‫ٱ‬
‫ٱ‬ Chloromethyl Methyl Ether ‫ٱ‬ Methylene Chloride ‫ٱ‬
‫ٱ‬ Chromium/Chromium Compounds ‫ٱ‬ Formaldehyde (Gas) ‫ٱ‬
‫ٱ‬ Mustard Gas ‫ٱ‬ Lead Acetate
‫ٱ‬ Vinyl Chloride ‫ٱ‬ Lead Phosphate
‫ٱ‬ Nickel/Nickel Compounds (Powder)
‫ٱ‬ Saccharin
‫ٱ‬ Urethane
List total time (in hours) employee is exposed to carcinogens (checked chemicals
above) per academic year.
hours per academic year
Are checked chemicals required, or could acceptable substitutes be implemented?
‫ ٱ‬Will retain carcinogen in curriculum ‫ ٱ‬Will discontinue use of chemicals
If retained in curriculum, use table to log/document usage:
CARCINOGENIC NAME(S) OF NUMBER OF

CHEMICAL AMOUNTS USED DATES USED USER(S) HOURS USED
Storage Guidelines
1. Store in a well-ventilated area.
2. Use secondary containers or trays with sufficient capacity > 100% primary
container.
3. Label with the following information:
WARNING!
HIGH CHRONIC TOXICITY

OR
CANCER-SUSPECT AGENT
4. Limited access should be provided for these chemicals.
5. Areas should be posted.
6. District Storage Location:
7. Guidelines (from above) that need to be implemented: 1 2 3 4 5

Handling Guidelines
1. Use a “controlled area” (an exhaust hood, glove box, designated area in a
laboratory with localized ventilation).
District Controlled Area: Fume hood
2. Controlled areas should possess the following signage, conspicuously posted:
WARNING!
TOXIC SUBSTANCE IN USE

OR
CANCER-SUSPECT AGENT:
AUTHORIZED PERSONNEL ONLY
3. Use of Personal Protective Equipment, like impermeable gloves, aprons, and face
shields.
4. Protect surfaces where carcinogens are handled by using chemically resistant trays
or pans that can be decontaminated.
5. On leaving a controlled area, laboratory workers should remove any protective

apparel that has been used and thoroughly wash hands, forearms, face, and neck.
If disposable apparel or absorbent paper liners have been used, these items should
be placed in a closed and impervious container that should then be labeled in
some manner such as the following: CAUTION—CONTENTS CONTAMINATED WITH
SUBSTANCES OF HIGH CHRONIC TOXICITY. Non-disposable protective apparel
should be thoroughly washed, and containers of disposable apparel and paper
liners should be incinerated.
6. Wastes and other contaminated materials from an experiment involving substances

of high chronic toxicity should be collected together with the washings from flasks
and such and either decontaminated chemically or placed in closed, suitable
labeled containers for incineration away from the controlled area. If chemical
decontamination is to be used, a method should be chosen that can reasonable by
expected to convert essentially all of the toxic materials into nontoxic materials.
For example, residues and wastes from experiments in which B-propiolactone, bis
(chloromethyl) ether, or methyl chloromethyl ether have been used should be
treated for 10 minutes with concentrated aqueous ammonia.
In the event that chemical decontamination is not feasible, wastes and residues
should be placed in an impervious container that should be closed and labeled in
some manner such as the following: CAUTION—COMPOUNDS OF HIGH CHRONIC
TOXICITY or CAUTION—CANCER-SUSPECT AGENT.
7. Transfer of contaminated wastes from the controlled area to the incinerator

should be done under the supervision of authorized personnel and in such a
manner as to prevent spill or loss. In general, liquid wastes containing such
compounds should be placed in glass or polyethylene (usually preferable) bottles
half-filled with vermiculite, and these should be transported in plastic or metal
pails of sufficient capacity to contain the material in case of accidental breakage
of the primary container.
8. Normal laboratory work should not be resumed in a space that has been used as a
controlled area until it has been adequately decontaminated. Work surfaces
should be thoroughly washed and rinsed. If experiments have involved the use of
finely divided solid materials, dry sweeping should not be done. In such cases,
surfaces should be cleaned by wet mopping or by use of a vacuum cleaner
equipped with a high efficiency particulate air (HEPA) filter. All equipment (e.g.,
glassware, vacuum traps, and containers) that is known or suspected to have been
in contact with substances of high chronic toxicity should be washed and rinsed
before they are removed from the controlled area.
9. In the event of continued experimentation with a substance of high chronic

toxicity (i.e., if a worker regularly uses toxicologically significant quantities of such a
substance three times a week), a qualified physician should be consulted to
determine whether it is advisable to establish a regular schedule of medical
surveillance or biological monitoring
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 11-12-2002

(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 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.
Note: Testing conducted in 3-10-1994 indicated lead paint present in some

painted areas. The lead paint has been covered with lead free paint.
Checklist of E/OHS Activities for Lockout/Tagout
Program Contact Person: Brian Mohr/Jim Benton
Is the Lockout/Tagout Plan in place? 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 at the High School
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:
Note: Chuck Platisha provides service for much of the HVAC work at the school.
Chuck uses LOTO during many of his work activities.
Checklist of E/OHS Activities for Machine Guarding
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? 1/15-16/2007
Who conducted the evaluation? Lee Carlson
How are corrections documented? Photographs and written report
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
Identified Fixed Equipment Locations
Location Building/Buildings Staff Affected # of item

Automotive Shop
Wood Shop
Custodial/Maintenanc
e
Welding Shop
Ag Shop
Bus Garage
Art
Scene shop
Science
Contracted technical services to review and recommend? 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 N/A
Training conducted 4/22/2002

.
(date)
Training has been scheduled for ____________.
(date)
Checklist of E/OHS Activities for Playground Safety
Note: City of Hutchinson inspects playgrounds. Records are maintained by the City.
Is the Playground Safety program in place? Yes No
Note: Playground equipment is inspected weekly. Documentation is maintained in

the Activities Manual.
Surfacing:
X The equipment has adequate protective surfacing under and around it and
the surfacing materials have not deteriorated
X Loose-fill surfacing materials have no foreign objects or debris
X Loose-fill surfacing materials are not compacted and do not have reduced
depth in heavy use areas such as under swings or at slide exits
General Hazards:
X There are no sharp points, corners, or edges on the equipment
X There are no missing or damaged protective caps or plugs
X There are no hazardous protrusions and projections
X There are no potential clothing entanglement hazards, such as open S-hooks

or protruding bolts
X There are no pinch, crush, and shearing points or exposed moving parts
X There are no trip hazards, such as exposed footings on anchoring devices and
rocks, roots, or any other environmental obstacles in the play area
Deterioration of the Equipment:
X The equipment has no rust, rot, cracks, or splinters, especially where it

comes in contact with the ground
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 use areas
such as under swings and at slide exits
General Upkeep of Playgrounds:
X The entire playground is free from miscellaneous debris or litter such as tree
branches, soda cans, bottles, glass, etc.
X There are no missing or full trash receptacles
Note: See current list of Play ground equipment.

Red set of playground equipment owned by the City of Hutchinson. The yellow and
blue set is owned by the Hutchinson School District.
Checklist of E/OHS Activities for Personal Protective Equipment
Is the Personal Protective Equipment Plan in place? Yes No N/A
Has a survey of potential workplace hazards been completed? Yes No N/A
Date(s) activity was conducted: 1-29-09
Have recommendations been completed for appropriate equipment? Yes No
Note: Currently PPE is carried with the employee for immediate use. However, I
recommend that additional reserve PPE be provided and stored in the designated PPE
locker located at the High School custodial dressing room. The other buildings may
also be in need of reserve supplies.
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
Building: Middle School
Location: Location: Location: Location:

Kitchen Boiler room Maintenance Tech Shop
Employee: Employee: Employee: Employee:

Suzy Affeldt Gail Jessen Jim Benton
Hot Glove X X
Latex
Hand Vinyl X
Leather X
Neoprene X X
Impact X X
Splash X X
Face
Shield
Respirator X
Muffs X
Ear
Plugs
Neo Apron X X
Body
Denim
Steel Toes
Foot
Metatarsal
Head Hard Hat X
Chemicals, Chemicals, Chemicals,
scalding water, scalding water, electricity, heat
Hazard(s) heat, Knives heat, hot Body fluids,
environment, impact
body fluids
Aprons could not
be located,
Cutting gloves
Comments on recommended,
Availability, no eyewash was
Condition, & observed.
Storage
Completed by Lee Carlson Date 10-22-08

Building: Park Elementary

Kitchen Boiler room Maintenance Tech Shop
Employee: Employee: Employee: Employee: N/A

Janet Schmidt Ronald Luebke Jim Benton
Marjorie Tews
Hot Glove X
Latex
Hand Vinyl X
Leather X
Neoprene X X X
Impact X
Splash X X
Face
Shield X
Respirator
Muffs
Ear
Plugs X
Neo Apron X X
Body
Denim
Steel Toes
Foot
Metatarsal
Head Hard Hat
Chemicals, Chemicals, Electrical,
scalding water, scalding water, chemical,
Hazard(s) heat, Knives heat, hot particulate
environment, matter
body fluids
Aprons could not
be located,
Cutting gloves
Comments on recommended,
Availability, no eyewash was
Condition, & observed.
Storage

Building: High School

Chemistry Boiler room, Maintenance Tech Shop
general building
Employee: Employee: Employee: Employee:
Arlyn Art Diaz-Valentin James B. Open position
DeBruyckere, Kathy F.
Brian Elwell Brandon M.
Heat X X
resistant
Latex
Hand Vinyl X
Leather X
Neoprene X X
Impact X X
Splash X
Face Shield X
X
Eyewash
Muffs X X X
Ear
Plugs X
Neo Apron X X
Body
Denim X
Steel Toes
Foot
Metatarsal
Head Hard Hat X
Heat, chemicals, Heat, chemicals, Heat, chemicals, Heat, chemicals,
splash, open splash, impact splash, impact, splash, impact,
Hazard(s) flame, biological noise noise
particulate
matter
Comments on
Availability,
Condition, &
Storage

Eyewash Worksheet
Date: Contact Person:

04-17-2008 Brian Mohr
Building Eyewash Location Reason for Use Comments
High School Chemistry Chemical spill Includes deluge shower
Room 401-402
Middle School Chemistry Chemical spill Includes deluge shower
Room 111, 104
High School Boiler Room Chemical spill Includes deluge shower
High School Food service Chemical splash Deminmalizers

Middle School Food service Chemical splash
Park Elementary Food service Chemical splash
Park Elementary Boiler room Chemical splash Boiler chemicals
West Elementary Boiler Room Chemical splash Boiler chemicals
High School Metals shop Particulate,
chemical
High School Auto Shop Particulate,
chemical
Food Disposer Worksheet
Date: Contact Person:

01-29-2009 Brian Mohr
Building Location Reason for Use Comments
High School Dish washing Food disposal Lockout notice posted at
sink 1-29-2009
High School Pots and Pans Sink Food disposal Oven cleaners and
mineral removers
Park Elementary Pot and Pans Sink Food disposal Oven cleaners and
mineral removers
Park Elementary Pots and Pans Sink Food disposal Oven cleaners and
mineral removers
Middle School Pots and Pans Sink Food disposal Lockout notice posted at
sink 1-29-2009
Middle School Dish washing Food disposal Lockout notice posted at
sink 1-29-2009
Middle School Vegetable Prep Sink Food disposal Lockout notice posted at
sink 1-29-2009
West Elementary Dish washing Food disposal Lockout notice posted at
sink 1-29-2009
Checklist of E/OHS Activities for Radon Gas Safety
Is the Radon Gas Safety Plan in place? Yes No N/A

Testing was last conducted: 1-25-02.

(date)
Results of tests:
Room Name & No. Level Tested Recommendation
Note: Training is not requirement of this program. However if elevated levels are
determined awareness training of affected persons is recommended.
Date training complete: N/A
Testing is / is not now in progress:
Note: All information regarding the results of radon testing has been posted in the
Activities Manual. Test results determined no elevated levels for radon gas.
Checklist of E/OHS Activities for Respiratory Protection
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
Date of review: Fall, 2008
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
Particulate NP95 N/A N/A N/A
All voluntary matter
use only
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 condition is good
Location(s): Only dust masks are used, they are in a like new condition.
Are the appropriate adequate accessories on hand? Yes No N/A
Verified by: Lee C. 10-22-07

Checklist of E/OHS Activities for Underground and Aboveground
Storage Tanks
Program Contact Person: N/A
Is the Underground and Aboveground Storage Tanks Plan in place? 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: The school has no underground storage tanks on its campus; therefore, no
formal program is required.
Checklist of E/OHS Activities for Welding and Brazing Safety
Program Contact Person(s) Brian Mohr
Department Contact:
• Metals Shop/Ag. FFA Brian Mohr
• 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?
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:

Program Contact Person List

Загружено:

Сведения о документе

Исходное описание:

Оригинальное название

Авторское право

Доступные форматы

Поделиться этим документом

Поделиться или встроить документ

Параметры публикации

Этот документ был вам полезен?

Это неприемлемый материал?

Авторское право:

Доступные форматы

Program Contact Person List

Загружено:

Авторское право:

Доступные форматы

PROGRAM CONTACT PERSON LIST

Program Contact Person: Monica Newbauer

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

Brand of AED? Phillips Heart Smart Model # M5066A-ABA

Year device was placed into use? 2006

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

Date of update installation: Winter 2007-2008

Expiration date of pads? 4-2008

Expiration date of batteries? 08-20

• Most recent date of training:2006

Program Contact Person: Brian Mohr

Is the Asbestos Management Plan in place? Yes No N/A

Is the Plan current for all buildings? Yes No N/A

The Plan is located at affected building: Each affected building.

Training for Asbestos Awareness was conducted Aug 5, 2007 .

New PT employees received training on during the hiring process.

Annual written notification has been prepared; Yes .

Name of publication Date

Three-year re-inspection Surveillance was conducted: 2006 .

6-month Periodic Surveillance was conducted: May 28, 2008

All caution labels have been posted.

Doorways to affected areas

Asbestos Maintenance Supplies on Hand

Is documentation of Operations and Maintenance available? N/A

Location: District Office, Buildings and Grounds

Status of the Asbestos repair and maintenance Work Order System:

Comments: Repairs and work orders are routinely out-sourced to contractors

Click Here to view asbestos inspection records

Program Contact Person: Brian Mohr

Is the AWAIR Plan in place? Yes No N/A

Is the Plan current? 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 No N/A

Location: Buildings and Grounds office

Posted: not at this time

Who is the Contact Person for OSHA 300? Betty Nielsen

Location: Activities Manual

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

Federal Labor Law required postings

Minnesota Labor Law required postings

Building Posting Unemployment Minnesota Age Workers' Minimum

Survey conducted April By Lee Carlson

Date Location Time

District Office Board Room 3:45 pm

1-5-09 District Office Board Room 2:45 pm

District Safety Committee Members

Member Position Building

Note: is the lead person in coordinating Health & Wellness Committee.

Program Contact Person: Brian Mohr

Is the BSM Plan in place? Yes No N/A

Is the Plan current? 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

Openings and gaps:

X They may contain openings of 9 inches or less

X Bleachers 55 inches and under are exempt from railing requirements

Program Contact Person: Monica Neubauer

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:

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