School Site: _________________________________________________________

Date: ______________

Please note in the "Comments" section the type of building or structure, e.g., permanent building, portable building (classroom/office space), auxiliary building (cafeteria/multipurpose, gymnasium), structures (bleachers/playground equipment), being reviewed.

Criteria & Notes:

1. Restrooms - operable, supplied, clean	Yes / No
Comments:

2. Windows - operable, safe, clear, fire bars	Yes / No
Comments:

3. Adequate Lighting, Electrical, Heating, Ventilation, and Fire Alarms	Yes / No
Comments:

4. Emergency Fire and Earthquake Drills	Yes / No
Comments (e.g., frequency):

5. Playground Equipment, Landscaping, Litter	Yes / No
Comments (e.g., equipment maintained, plan, appearance, percentage of asphalt vs. lawns/playground):

6. Graffiti - Abatement Plan Present	Yes / No
Comments (e.g., plan, appearance, abatement materials are safe):

7. Drinking Water - good pressure, clean	Yes / No
Comments (e.g., obstructions, functional):

8. School Site Safety - plans, room telephones, HAZMAT symbols present	Yes / No
Comments:

9. Fire Extinguishers - exist in each building with current inspection	Yes / No
Comments:

10. Egress - exits clearly marked, illuminated, of sufficient size	Yes / No
Comments:

11. Sufficiency of Maintenance	Yes / No
Comments:

12. Safety of Arts and Science Rooms	Yes / No
Comments:

13. Extra Effort Evident - Creativity	Yes / No
Comments:

Number of Yes answers for this evaluation sheet:

 Additional Comments:
 
 
 
 
 
 
 

List Any Serious Safety/Health Findings:

1.

2.

3.

4.

5.

6.

7.

A => 13 - 11

B => 10 - 9

C => 8 - 7

D => 6

F => 5 - 0

Grade/Score: _________________

Reviewer's Signature: ____________________________________________________

Title: _____________________________________________________________________
(e.g., parent, community member, student, staff)

Team Leader's sign off:

FCMAT: ____________________________________________________________

Community: _________________________________________________________