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School Facilities Survey State Of Connecticut
EDO050, Rev August 2013 Department of Administrative Services
Statutory Ref: C.G.S. 10-220 Department Of Education
Office of School Facilities
165 Capitol Avenue
Hartford, CT 06106-1630
Town: _028-Colchester Contact Person: _Kendall Jackson
Phone: 860-537-2296 Fax: 860-537-1252
E-Mail: _kjackson @colchesterct.org
District-wide facility planning/maintenance: (see instructions)
Dt
D2
D3
D6
D7
D8
Dg
aocm
Long-Range Building Plan 3 D4 Building Maintenance Plan
Building Plan Implementation 2 D5 Maintenance Plan implementation
Equipment Repair/Replacement iL
{AQ Maintenance Program 2
Has the district conducted a uniform inspection and evaluation of the indoor air quality (AQ)?
Are the results of the [AQ inspection and evaluation made available for public inspection at a regularly scheduled
board or education meeting?
Are the results of the [AQ inspection and evaluation posted on the board's or each individual school's Web site?
Indicate any additional actions that have been taken to implement the long-term [AQ program (check all that apply):
_... Adopted district policy regarding custodial/maintenance staff training for |AQ
____ Established a staff 1AQ coordinator position
_x_ Established a formal reporting/response procedure for |AQ issues
Green Cleaning Program 4.
Have custodial/maintenance staff been trained in the proper use of cleaning products?
District Security Risk Assessment: (Scale for Risk Assessment: Y = Yes. N = No See instructions for additional information.)
Has the district conducted a security and vulnerability assessment at each school?
Have all of the schools in the district developed school safety and security plans? (Required by July 1, 2014)
Has the district established a school security and safety committee at each school? Required by July 1, 2014)
Has the district given Department of Emergency Services and Public Protection (DESPP) their annual
fire and crisis drill reports for each school? (Required by July 1, 2014)
Data has been certified.
ae OF
Bei
School Facilities Survey State Of Connecticut
EDO50, Rev August 2013 Department of Administrative Services
Statutory Ref: C.G.S. 10-220 Department Of Education
Office of Schoo! Facilities
165 Capitol Avenue
Hartford, CT 06106-1630
Town: 028-Colchester Schoot: 002-Jack Jackter Elementary Page 1 of 3
Check box if this facility is no longer used for school purposes ___ Year facility closed
Section 1: Using the instruction booklet accompanying this survey, review the description of each item and respond accordingly.
1 Year of original construction: 1966 5 Number of general classrooms (perm):
2 Year of last major renovation: 2005 7 Handicap accessibility (check one):
3 Total square footage: 178000 8 Major code update since 1988:
4 Total site acreage: 18.03 3 Building Capacity:
6 Portable buildings with classrooms (Y/N): No 10 Schoo! Enrollment:
6a Year portable buildings installed: 0 6b Number of portable classrooms:
Section 2: Using the instruction booklet accompanying this survey, review the description of the choices that are
provided for each item and select the one that best describes your school. Select one answer only for each item and
report the number associated with that choice in the space provided.
Building Features: (Scale: 0 = missing, 1 = poor, 2 = fair, 3 = good and 4 = excellent. See instructions for additional information):
Dedicated Specialty Areas Rating
1 Art Room(s): 4A 20 Language Lab(s)
12 Music Room(s): 4 21 Special Education:
13 Multipurpose Room (Gym/Aud/Caf.) 4A 22 Technical/Career Education
14 Gymnasium: A 23 Office/Administrative Space
15 Auditorium: 0 24 Guidance/Student Services
16 Cafeteria: A 25 Playground/Playscape:
17 Technology in the classroom 3 26 Multipurpose Fields:
18 Library Media Center 4 27 Outdoor Athletic Facilities
19 Science Lab(s) oO
Systems
28 Internal Communications A 32 Interior Lighting
29 Technology Infrastructure 4 £33 Exterior Lighting
30 Air Conditioning 4A 34 Roadways and Walkways
31 Heating 4 35 Plumbing
Appearance/Upkeep
36 Building Facade 4 40 Entrance/Hallways
37 Grounds/Landscaping 3 4 Lighting/Fixtures
38 Classrooms 4A 42 Cafeteria
39 Lavatories/Fountains A
43 Code Compliance
Building Conditions
44 Has carbon monoxide (CO) detection and warning equipment been installed at this facility?
Indoor Air Quality (IAQ)
45 Has the local or regional board of education adopted and implemented an IAQ program for this facility?
40
AllAreas
-No_
850
614
0
Rating
ebb bbb
Iebiel>
eee
Yes
No
if this facility was constructed, extended, renovated or replaced on or after January 1, 2003, please continue, if not, please proceed to question 50.
46 Has the local or regional board of education provided for a uniform inspection and evaluation program of the
indoor air quality within this building? If yes, please continue. if no, go to question 50.
47 {s the uniform [AQ inspection and evaluation program used by this facility the Environmental Protection Agency's (EPA)
JAQ Tools for Schools (TfS) Program?
If yes, please answer a and b and then proceed to question 49. !f no, go to question 48.
a) Has staff received TiS implementation training from the State Department of Public Health/CSIERT?
b) Has staff received TfS refresher training from the State Department of Public Health/CSIERT?
if yes, please enter most recent training date. {(MM/DD/YYYY)
Yes
Yes
School Facilities Survey State Of Connecticut
ED050, Rev August 2013 Department of Administrative Services
Statutory Ref: C.G.S. 10-220 Department Of Education
Office of School Facilities
165 Capitol Avenue
Hartford, CT 06106-1630
Town: 028-Coichester School: 002-Jack Jackter Elementary Page 2 of 3
1AQ Continued
If the uniform IAQ inspection and evaluation program is not TfS, does the alternative program provide for review, inspection, and
48
evaluation of each of the following (check all that apply):
HVAC Systems ___ Radon levels in air
___ Ventilation systems ___ Microbiological particles
Pest infestation ___ Hazardous substances
Structural elements ____Use of space
Moisiure incursion ___ Overall cleanliness
49 Is [AQ maintenance training provided for building staff at this facility?
50 For each of the following issues relative to [AQ, please indicate either
1) A problem has been identified and has not yet been addressed (Poor);
2) A problem has been identified and is scheduled for repair (Fair);
3) A problem has been identified and corrected (Good); or
4) No problem (Excellent).
Ventilation Source Reduction
_4_ Obstructions of air vents _4_ Radon remediation needed
_4. Filters need upgrading or replacing _4. Asbestos remediation needed
4. HVAC units/ventilators need cleaning _4_ General cleaning improvement
_4_ Arts/sciences room(s) need ventilating 4_ Carpet cleaning or removal needed
_4_ Outdoor air intakes need improving _4_ Pests or pesticide use remediation
_4_ Bus exhaust 4. Classroom animal dander exposure
Green Cleaning
51
Degree of pesticide usage
Chemical compounds
Plumbing
Staff maintenance training
Moisture Issues
sist >
Leaks (other than roof), spills, moisture
Plumbing problems
Roof problems
Basement or crawlspace needs upgrading
Removal of water-damaged materials needed
Has the local or regional board of education adopted and implemented a Green Cleaning Program for this facility? Yes.
If yes, please continue. If no, go to Question 55.
Does the local or regional board of education have a written statement of the Green Cleaning Program for this facility? Yes.
If yes, please continue. If no, go to Question 55.
Does the written statement for this facility include the following:
Types and names of environmentally preferable cleaning products Yes.
Locations of the application of cleaning products within the facility Yes
A schedule of when green cleaning products are applied in the facility Yes.
A statement prohibiting a parent, guardian, teacher or staff member from bringing into the facility any Yes
consumer product which is intended to clean, deodorize, sanitize or disinfect
Has the local or regional board of education distributed the written statement of its green cleaning program to the following:
Schoo! staff on an annual basis Yes c) Upon request, parents or guardians of each child enrolled Yes
New staff hired during the school year Yes d) Parents or guardians of students transferred during the year Yes
Does the local or regional board of education provide for the procurement and use of environmentally preferable cleaning products that
meet guidelines or environmental standards set by a national or international environmental certification program approved by
Department of Administrative Services (DAS), which may include but is not limited to (Y/N):
General purpose cleaners Yes Glass cleaners Yes
Bathroom cleaners Yes Carpet cleaners Yes
Floor finishes Yes Floor strippers Yes
Hand cleaners and soaps Yes
Does the local or regional board of education use the DAS procurement system to purchase No
preferable cleaning products?
Does the local or regional board of education have a Web site? If yes, please continue. If no, go to Question 59. Yes
Has the local or regional board of education posted the written statement on the:
School Web site Yes b) Board of Education Web site Yes
Has the local or regional board of education posted the School Facilities Survey (Form ED050) on the:
School Web site Yes b) Board of Education Web site Yes.
lf a Web site for the local or regional board of education does not exist, has the board made the following publicly available:
Written statement of the school district's green cleaning program No
The School Facilities Survey (Form ED050) No
School Facilities Survey State Of Connecticut
EDOS50, Rev August 2013 Department of Administrative Services
Statutory Ref: C.G.S. 10-220 Department Of Education
Office of School Facilities
165 Capitol Avenue
Hartford, CT 06106-1630
Town: 028-Coichester School: 002-Jack Jackter Elementary Page 3 of 3
Security
60 Has a uniform security and vulnerability assessment been performed for this facility?
61 Has a school security and safety committee been established for this facility?
62 Has a school security and safety plan been developed for established for this facility?
a) Was the school security and safety plan developed with the involvement of local officiais?
b) Have school employees been provided an orientation on the school security and safety plan?
63 Have crisis management procedures been developed for this facility?
a) Do the procedures have a command center organization structure based on the
federal National incident Management System (NIMS)?
64 Are procedures in place for managing other various types of emergencies?
65 Are fire drills and crisis response drills practiced periodically?
a) Has local law enforcement and other loca! public safety officials evaluated,
scored and provided fire drills and crisis response drills?
66 Has a safe school climate committee been established at this facility?
67 Has the school personnel been trained in the operation and maintenance of school security infrastructure?
Data has been certified.
School Facilities Survey State Of Connecticut
EDO50, Rev August 2013 Department of Administrative Services
Statutory Ref: C.G.S. 10-220 Department Of Education
Office of School Facilities
165 Capitol Avenue
Hartford, CT 06106-1630
Town: 028-Coichester School: 004-Colchester Elementary School Page 1 of 3
Check box if this facility is no longer used for school purposes Year facility closed
Section 1: Using the instruction booklet accompanying this survey, review the description of each item and respond accordingly.
1 Year of original construction: 2006 5 Number of general classrooms (perm):
2 Year of last major renovation: 2006 7 Handicap accessibility (check one):
3 Total square footage: 108685 8 . Major code update since 1988:
4 Total site acreage: 11.00 9g Building Capacity:
6 Portable buildings with classrooms (Y/N): No 10 School Enrollment:
6a Year portable buildings installed: 0 6b Number of portable classrooms:
Section 2: Using the instruction booklet accompanying this survey, review the description of the choices that are
provided for each item and select the one that best describes your school. Select one answer only for each item and
report the number associated with that choice in the space provided.
Building Features: (Scale: 0 = missing, 1 = poor, 2 = fair, 3 = good and 4 = excellent. See instructions for additional information):
Dedicated Specialty Areas Rating
11 Art Room(s): 4 20 Language Lab(s)
12 Music Room(s): 4 21 Special Education:
13 Multipurpose Room (Gym/Aud/Caf.) 4 22 Technical/Career Education
14 Gymnasium: A 23 Office/Administrative Space
15 Auditorium: 0. 24 Guidance/Student Services
16 Cafeteria: A 26 Playground/Playscape:
17 Technology in the classroom 4A 26 Multipurpose Fields:
18 Library Media Center 4 27 Outdoor Athletic Facilities
19 Science Lab(s) oO
Systems
28 Internal Communications 4 32 Interior Lighting
29 Technology Infrastructure A 33 Exterior Lighting
30 Air Conditioning 4A 34 Roadways and Walkways
31 Heating 4 35 Plumbing
Appearance/Upkeep
36 Building Facade — 40 Entrance/Hallways
37 Grounds/Landscaping — 41 Lighting/Fixtures
38 Classrooms — 42 Cafeteria
39 Lavatories/Fountains — £& Code Compliance
Building Conditions
44 Has carbon monoxide (CO) detection and warning equipment been installed at this facility?
Indoor Air Quality (1AQ)
45 Has the local or regional board of education adopted and implemented an IAQ program for this facility?
40
AllAreas
No
833
554
0
Rating
lel lelsle
nell
[ltl
Yes
No
if this facility was constructed, extended, renovated or replaced on or after January 1, 2003, please continue, if not, please proceed to question 50.
46 Has the local or regional board of education provided for a uniform inspection and evaluation program of the
indoor air quality within this building? If yes, please continue. If no, go to question 50.
47 is the uniform [AQ inspection and evaluation program used by this facility the Environmental Protection Agency's (EPA)
IAQ Tools for Schools (TfS) Program?
If yes, please answer a and b and then proceed to question 49. if no, go to question 48.
a) Has staff received TfS implementation training from the State Department of Public Health/CSIERT?
b) Has staff received TfS refresher training from the State Department of Public Health/CSIERT?
If yes, please enter most recent training date. (MM/DD/YYYY)
Yes
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School Facilities Survey
EDOS50, Rev August 2013
Statutory Ref: C.G.S, 10-220
Town: 028-Coichester
IAQ Continued
48
School: 004-Colchester Elementary School
State Of Connecticut
Department of Administrative Servi
Department Of Education
Office of School Facilities
165 Capito! Avenue
Hartford, CT 06106-1630
Page 2 of 3
ices
if the uniform IAQ inspection and evaluation program is not TfS, does the alternative program provide for review, inspection, and
evaluation of each of the following (check all that apply):
HVAC Systems
Ventilation systems
Pest infestation
Structural elements
Moisture incursion
___ Radon levels in air
___. Microbiological particles
____ Hazardous substances
Use of space
Overall cleanliness
Radon remediation needed
Asbestos remediation needed
General cleaning improvement
Carpet cleaning or removal needed
Pests or pesticide use remediation
49 Is [AQ maintenance training provided for building staff at this facility?
50 For each of the following issues relative to |AQ, please indicate either
1) A problem has been identified and has not yet been addressed (Poor);
2) A problem has been identified and is scheduled for repair (Fair);
3) A problem has been identified and corrected (Good); or
4) No problem (Excellent).
Ventilation Source Reduction
_4 Obstructions of air vents 4
_4_ Filters need upgrading or replacing 4
_4_ HVAC units/ventilators need cleaning 4
_4_ Arts/sciences room(s) need ventilating 4A
_4 Outdoor air intakes need improving A
-4_ Bus exhaust 4
Green Cleaning
51
52
54
a)
b)
55
Classroom animal dander exposure
__. Degree of pesticide usage
Chemical compounds
Plumbing
Staff maintenance training
Moisture Issues
_4_ Leaks (other than roof), spills, moisture
4_ Plumbing problems
_3_ Roof problems
_4_ Basement or crawlspace needs upgrading
_4_ Removal of water-damaged materials needed
Has the local or regional board of education adopted and implemented a Green Cleaning Program for this facility? Yes.
If yes, please continue. If no, go to Question 55.
Does the local or regional board of education have a written statement of the Green Cleaning Program for this facility? Yes
if yes, please continue. If no, go to Question 55.
Does the written statement for this facility include the following:
Types and names of environmentally preferable cleaning products Yes
Locations of the application of cleaning products within the facility Yes
A schedule of when green cleaning products are applied in the facility Yes
A statement prohibiting a parent, guardian, teacher or staff member from bringing into the facility any Yes
consumer product which is intended to clean, deodorize, sanitize or disinfect
Has the local or regional board of education distributed the written statement of its green cleaning program to the following:
Schoo! staff on an annual basis Yes c) Upon request, parents or guardians of each child enrolled Yes
New staff hired during the school year Yes d) Parents or guardians of students transferred during the year Yes
Does the local or regional board of education provide for the procurement and use of environmentally preferable cleaning products that
meet guidelines or environmental standards set by a national or international environmental certification program approved by
Department of Administrative Services (DAS), which may include but is not limited to (Y/N):
General purpose cleaners Yes Glass cleaners Yes
Bathroom cleaners Yes Carpet cleaners Yes
Floor finishes Yes. Floor strippers Yes,
Hand cleaners and soaps Yes
Does the local or regional board of education use the DAS procurement system to purchase No
preferable cleaning products?
Does the local or regional board of education have a Web site? If yes, please continue. If no, go to Question 59. Yes
Has the local or regional board of education posted the written statement on the:
School Web site Yes b)} Board of Education Web site Yes
Has the local or regional board of education posted the School Facilities Survey (Form ED050) on the:
School Web site Yes b) Board of Education Web site Yes
If a Web site for the local or regional board of education does not exist, has the board made the following publicly available:
Written statement of the school district's green cleaning program No
The School Facilities Survey (Form ED050) No
School Facilities Survey State Of Connecticut
ED050, Rev August 2013 Department of Administrative Services
Statutory Ref: C.G.S. 10-220 Department Of Education
Office of School Facilities
165 Capitol Avenue
Hartford, CT 06106-1630
Town: 028-Colchester School: 004-Colchester Elementary School Page 3 of 3
Security
60 Has a uniform security and vuinerability assessment been performed for this facility?
61 Has a schoo! security and safety committee been established for this facility?
62 Has a school security and safety plan been developed for established for this facility?
a) Was the school security and safety plan developed with the involvement of local officiais?
b) Have school employees been provided an orientation on the school security and safety plan?
63 Have crisis management procedures been developed for this facility?
a) Do the procedures have a command center organization structure based on the
federal National Incident Management System (NIMS)?
64 Are procedures in place for managing other various types of emergencies?
65 Are fire drills and crisis response drills practiced periodically?
a) Has local law enforcement and other local public safety officials evaluated,
scored and provided fire drills and crisis response drills?
66 Has a safe school climate committee been established at this facility?
67 Has the schoo! personnel been trained in the operation and maintenance of school security infrastructure?
Data has been certified.
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School Facilities Survey State Of Connecticut
EDOS50, Rev August 2013 Department of Administrative Services
Statutory Ret: C.G.S. 10-220 Department Of Education
Office of School Facilities
165 Capitol Avenue
Hartford, CT 06106-1630
Town: 028-Colchester Schoot: 051-Wm. J. Johnston School Page 1 of 3
Check box if this facility is no longer used for school purposes Year facility closed
Section 1: Using the instruction booklet accompanying this survey, review the description of each item and respond accordingly.
1 Year of original construction: 1954 5 Number of general classrooms (perm):
2 Year of last major renovation: 1989 7 Handicap accessibility (check one):
3 Total square footage: 135200 8 Major code update since 1988:
4 Total site acreage: 29.00 9 Building Capacity:
6 Portable buildings with classrooms (Y/N): Yes 10 Schoo! Enrollment:
6a Year portable buildings installed: 2001 6b Number of portable classrooms:
Section 2: Using the instruction booklet accompanying this survey, review the description of the choices that are
provided for each item and select the one that best describes your school. Select one answer only for each item and
report the number associated with that choice in the space provided.
Building Features: (Scale: 0 = missing, 1 = poor, 2 = fair, 3 = good and 4 = excellent. See instructions for additional information):
Dedicated Specialty Areas Rating
1 Art Room(s): 2 20 Language Lab(s)
12 Music Room(s): 2 2 Special Education:
13 Multipurpose Room (Gym/Aud/Caf.) 3 22 Technical/Career Education
14 Gymnasium: 3 23 Office/Administrative Space
15 Auditorium: 0 24 Guidance/Student Services
16 Cafeteria: 1 2 Playground/Playscape:
17 Technology in the classroom 2 2 Multipurpose Fields:
18 Library Media Center 3 27 Outdoor Athletic Facilities
19 Science Lab(s) 2
Systems
28 Internal Communications 2 32 Interior Lighting
29 Technology Infrastructure 2 33 Exterior Lighting
30 Air Conditioning 2. 34 Roadways and Walkways
31 Heating 1 3 Plumbing
Appearance/Upkeep
36 Building Facade 3 40 Entrance/Hallways
37 Grounds/Landscaping 3 41 Lighting/Fixtures
38 Classrooms 2 42 Cafeteria
39 Lavatories/Fountains 1 & Code Compliance
Building Conditions
44 Has carbon monoxide (CO) detection and warning equipment been installed at this facility?
Indoor Air Quality (IAQ)
45 Has the local or regional board of education adopted and implemented an IAQ program for this facility?
54
AllPgms
Yes_
1020
667
18
Rating
FPP ER PRI
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No
if this facility was constructed, extended, renovated or replaced on or after January 1, 2003, please continue, if not, please proceed to question 50.
46 Has the local or regional board of education provided for a uniform inspection and evaluation program of the
indoor air quality within this building? If yes, please continue. If no, go to question 50.
47 Is the uniform IAQ inspection and evaluation program used by this facility the Environmental Protection Agency's (EPA)
{AQ Tools for Schools (TfS) Program?
If yes, please answer a and b and then proceed to question 49. If no, go to question 48.
a) Has staff received TfS implementation training from the State Department of Public Health/CSIERT?
b) Has staff received TfS refresher training from the State Department of Public Health/CSIERT?
ff yes, please enter most recent training date. (MM/DD/YYYY)
Yes
Yes
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FF
School Facilities Survey
ED050, Rev August 2013
Statutory Ref: C.G.S. 10-220
Town: 028-Colchester
1AQ Continued
48
49
50
School: 054-Wm. J. Johnston School
State Of Connecticut
Department of Administrative Services
Department Of Education
Office of School Facilities
165 Capitol Avenue
Hartford, CT 06106-1630
Page 2 of 3
If the uniform 1AQ inspection and evaluation program is not TfS, does the alternative program provide for review, inspection, and
evaluation of each of the following (check ail that apply):
HVAC Systems
Ventilation systems
Pest infestation
Structural elements
Moisture incursion
___. Radon levels in air
___ Microbiological particles
__. Hazardous substances
___ Use of space
__. Overall cleanliness
Is IAQ maintenance training provided for building staff at this facility?
For each of the following issues relative to IAQ, please indicate either
1) A problem has been identified and has not yet been addressed (Poor);
2)
3)
4) No problem (Excellent).
Ventilation
PPP ee
Obstructions of air vents
Filters need upgrading or replacing
HVAC units/ventilators need cleaning
Arts/sciences room(s) need ventilating
Outdoor air intakes need improving
Bus exhaust
Green Cleaning
51
52
A problem has been identified and is scheduled for repair (Fair);
A problem has been identified and corrected (Good); or
Source Reduction
Radon remediation needed
Asbestos remediation needed
General cleaning improvement
Carpet cleaning or removal needed
Pests or pesticide use remediation
Classroom animal dander exposure
lsl=hola [>
___. Degree of pesticide usage
Chemical compounds
Plumbing
Staff maintenance training
Moisture Issues
Leaks (other than roof), spills, moisture
Plumbing problems
Roof problems
Basement or crawispace needs upgrading
Removal of water-damaged materials needed
hehe
Has the local or regional board of education adopted and implemented a Green Cleaning Program for this facility? Yes
If yes, please continue. If no, go to Question 55.
Does the local or regional board of education have a written statement of the Green Cleaning Program for this facility? Yes
If yes, please continue. If no, go to Question 55.
Does the written statement for this facility include the following:
Types and names of environmentally preferable cleaning products Yes
Locations of the application of cleaning products within the facility Yes
A schedule of when green cleaning products are applied in the facility Yes
A statement prohibiting a parent, guardian, teacher or staff member from bringing into the facility any Yes
consumer product which is intended to clean, deodorize, sanitize or disinfect
Has the loca! or regional board of education distributed the written statement of its green cleaning program to the following:
Schoo! staff on an annual basis Yes c) Upon request, parents or guardians of each child enrolled Yes
New staff hired during the school year Yes d) Parents or guardians of students transferred during the year Yes,
Does the local or regional board of education provide for the procurement and use of environmentally preferable cleaning products that
meet guidelines or environmental standards set by a national or international environmental certification program approved by
Department of Administrative Services (DAS), which may include but is not limited to (Y/N):
General purpose cleaners Yes Glass cleaners Yes
Bathroom cleaners Yes Carpet cleaners Yes.
Floor finishes Yes Floor strippers Yes
Hand cleaners and soaps Yes.
Does the local or regional board of education use the DAS procurement system to purchase No
preferable cleaning products?
Does the local or regional board of education have a Web site? If yes, please continue. If no, go to Question 59. Yes
Has the local or regional board of education posted the written statement on the:
Schoo! Web site Yes b} Board of Education Web site Yes.
Has the local or regional board of education posted the Schoo! Facilities Survey (Form ED050) on the:
School Web site Yes b) Board of Education Web site Yes
If a Web site for the focal or regional board of education does not exist, has the board made the following publicly available:
Written statement of the school district's green cleaning program lo
The School Facilities Survey (Form ED050) lo.
School Facilities Survey State Of Connecticut
EDO50, Rev August 2013 Department of Administrative Services
Statutory Ref: C.G.S. 10-220 . Department Of Education
Office of School Facilities
165 Capitol Avenue
Hartford, CT 06106-1630
Town: 028-Colchester School: 051-Wm. J. Johnston School Page 3 of 3
Security
60 Has a uniform security and vulnerability assessment been performed for this facility?
61 Has a school security and safety committee been established for this facility?
62 Has a school security and safety plan been developed for established for this facility?
a) Was the school security and safety plan developed with the involvement of local officials?
b) Have school employees been provided an orientation on the school security and safety plan?
63 Have crisis management procedures been developed for this facility?
a) Do the procedures have a command center organization structure based on the
federal National incident Management System (NIMS)?
64 Are procedures in place for managing other various types of emergencies?
65 Are fire drills and crisis response drills practiced periodically?
a) Has local law enforcement and other local public safety officials evaluated,
scored and provided fire drills and crisis response drills?
66 Has a safe school climate committee been established at this facility?
67 Has the school personnel been trained in the operation and maintenance of school security infrastructure?
Data has been certified.
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School Facilities Survey State Of Connecticut
EDOSO, Rev August 2013 Department of Administrative Services
Statutory Ref: C.G.S. 10-220 Department Of Education
Office of Schoo! Facilities
165 Capitol Avenue
Hartford, CT 06106-1630
Town: 028-Coichester School: 061-Bacon Academy Page 1 of 3
Check box if this facility is no longer used for school purposes Year facility closed
Section 1: Using the instruction booklet accompanying this survey, review the description of each item and respond accordingly.
1 Year of original construction: 1993 5 Number of general classrooms (perm):
2 Year of fast major renovation: 0 7 Handicap accessibility (check one):
3 Total square footage: 192564 8 Major code update since 1988:
4 Total site acreage: 40.00 9 Building Capacity:
6 Portable buildings with classrooms (Y/N): Yes 10 Schoo! Enrollment:
6a Year portable buildings installed: 2001 6b Number of portable classrooms:
Section 2: Using the instruction booklet accompanying this survey, review the description of the choices that are
provided for each item and select the one that best describes your school. Select one answer only for each item and
report the number associated with that choice in the space provided.
Building Features: (Scale: 0 = missing, 1 = poor, 2 = fair, 3 = good and 4 = excellent. See instructions for additional information):
Dedicated Specialty Areas Rating
1 Art Room(s): 3 20 Language Lab(s)
12 Music Room(s): 3 21 Special Education:
13 Multipurpose Room (Gym/Aud/Caf.} Oo 22 Technical/Career Education
14 Gymnasium: 3 2 Office/Administrative Space
15 Auditorium: 3 24 Guidance/Student Services
16 Cafeteria: 2. 25 Playground/Playscape:
17 Technology in the classroom 2 2 Multipurpose Fields:
18 Library Media Center 4 27 Outdoor Athletic Facilities
19 Science Lab(s) 3
Systems
28 Internal Communications 1 32 Interior Lighting
29 Technology Infrastructure 2 3 Exterior Lighting
30 Air Conditioning 3 34 Roadways and Walkways
31 Heating 3 3 Plumbing
Appearance/Upkeep
36 Building Facade 4 40 Entrance/Hallways
37 Grounds/Landscaping 3 41 Lighting/Fixtures
38 Classrooms 4 42 Cafeteria
39 Lavatories/Fountains A 43 Code Compliance
Building Conditions
44 Has carbon monoxide (CO) detection and warning equipment been installed at this facility?
indoor Air Quality (IAQ)
45 Has the local or regional board of education adopted and implemented an [AQ program for this facility?
48
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if this facility was constructed, extended, renovated or replaced on or after January 1, 2003, please continue, if not, please proceed to question 50.
46 Has the local or regional board of education provided for a uniform inspection and evaluation program of the
indoor air quality within this building? If yes, please continue. if no, go to question 50.
47 Is the uniform IAQ inspection and evaluation program used by this facility the Environmental Protection Agency's (EPA)
IAQ Tools for Schools (TfS) Program?
lf yes, please answer a and b and then proceed to question 49. If no, go to question 48.
a) Has staff received TIS implementation training from the State Department of Public Health/CSIERT?
b) Has staff received TiS refresher training from the State Department of Public Health/CSIERT?
If yes, please enter most recent training date. (MM/DD/YYYY)
Yes
Yes
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School Facilities Survey State Of Connecticut
ED050, Rev August 2013 Department of Administrative Services
Statutory Ref: C.G.S. 10-220 Department Of Education
Office of School Facilities
165 Capitol Avenue
Hartford, CT 06106-1630
Town: 028-Coichester School: 061-Bacon Academy Page 2 of 3
1AQ Continued
48 if the uniform IAQ inspection and evaluation program is not TfS, does the alternative program provide for review, inspection, and
evaluation of each of the following (check ail that apply):
____ HVAC Systems ___ Radon levels in air __ Degree of pesticide usage
__.. Ventilation systems ___. Microbiological particles ___. Chemical compounds
__.. Pest infestation ____ Hazardous substances ___ Plumbing
Structural elements __.. Use of space __— Staff maintenance training
Moisture incursion _— Overall cleanliness
49 Is IAQ maintenance training provided for building staff at this facility? No.
50 For each of the following issues relative to IAQ, please indicate either
1) A problem has been identified and has not yet been addressed (Poor);
2) A problem has been identified and is scheduled for repair (Fair);
38) A problem has been identified and corrected (Good); or
4) No problem (Excellent).
Ventilation Source Reduction Moisture Issues
_4_ Obstructions of air vents _4_ Radon remediation needed 4. Leaks (other than roof), spills, moisture
4. Filters need upgrading or replacing 4. Asbestos remediation needed _4_ Piumbing problems
4. HVAC units/ventilators need cleaning _4_ General cleaning improvement 2. Roof problems
_4_ Arts/sciences room(s) need ventilating _4_ Carpet cleaning or removal needed _4_ Basement or crawispace needs upgrading
_4_ Outdoor air intakes need improving _4 Pests or pesticide use remediation 4. Removal of water-damaged materials needed
_4_ Bus exhaust _4_ Classroom animal dander exposure
Green Cleaning
51
52
Has the local or regional board of education adopted and implemented a Green Cleaning Program for this facility?
If yes, please continue. If no, go to Question 55.
Does the local or regional board of education have a written statement of the Green Cleaning Program for this facility?
If yes, please continue. If no, go to Question 55.
Does the written statement for this facility include the following:
Types and names of environmentally preferable cleaning products
Locations of the application of cleaning products within the facility
A schedule of when green cleaning products are applied in the facility
A statement prohibiting a parent, guardian, teacher or staff member from bringing into the facility any
consumer product which is intended to clean, deodorize, sanitize or disinfect
Has the local or regional board of education distributed the written statement of its green cleaning program to the following:
School staff on an annual basis Yes c) Upon request, parents or guardians of each child enrolled
New staff hired during the school year Yes d) Parents or guardians of students transferred during the year
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Does the local or regional board of education provide for the procurement and use of environmentally preferable cleaning products that
meet guidelines or environmental standards set by a national or international environmental certification program approved by
Department of Administrative Services (DAS), which may include but is not limited to (Y/N):
General purpose cleaners Yes _ Glass cleaners
Bathroom cleaners Yes | Carpet cleaners
Floor finishes Yes Floor strippers
Hand cleaners and soaps Yes_
Does the local or regional board of education use the DAS procurement system to purchase
preferable cleaning products?
Does the local or regional board of education have a Web site? If yes, please continue. If no, go to Question 59.
Has the local or regional board of education posted the written statement on the:
Schoo! Web site Yes b) Board of Education Web site
Has the local or regional board of education posted the School Facilities Survey (Form ED050) on the:
Schoo! Web site Yes b) Board of Education Web site
If a Web site for the local or regional board of education does not exist, has the board made the following publicly available:
Written statement of the school district's green cleaning program
The Schoo! Facilities Survey (Form ED050)
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School Facilities Survey State Of Connecticut
EDO50, Rev August 2013 Depariment of Adminisirative Services
Statutory Ref: C.G.S. 10-220 Department Of Education
Office of Schooi Facilities
165 Capitol Avenue
Hartford, CT 06106-1630
Town: 028-Colchester School: 061-Bacon Academy Page 3 of 3
Security
60 Has a uniform security and vulnerability assessment been performed for this facility?
61 Has a school security and safety committee been established for this facility?
62 Has a school security and safety plan been developed for established for this facility?
a) Was the school security and safety plan developed with the involvement of local officials?
b) Have school employees been provided an orientation on the school security and safety plan?
63 Have crisis management procedures been developed for this facility?
a) Do the procedures have a command center organization structure based on the
federal National Incident Management System (NIMS)?
64 Are procedures in place for managing other various types of emergencies?
65 Are fire drills and crisis response drills practiced periodically?
a) Has local law enforcement and other local public safety officials evaluated,
scored and provided fire drills and crisis response drills?
66 Has a safe school climate committee been established at this facility?
67 Has the school personnel been trained in the operation and maintenance of school security infrastructure?
Data has been certified.
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