Tools for Schools Teachers Checklist Survey

The Indoor Air Quality (IAQ) Tools for Schools (TfS) Program was developed by the U.S. Environmental Protection Agency (EPA) to reduce exposures to indoor environmental contaminants in schools through the voluntary adoption of sound indoor air quality management practices. The IAQ Tools for Schools Program is a comprehensive resource to help schools maintain a healthy environment in school buildings by identifying, correcting, and preventing IAQ problems. Poor indoor air quality can impact the comfort and health of students and staff, which, in turn, can affect concentration, attendance, and student performance. School teams and all school nurses have had the first of two training sessions. They will meet with the School Administrator and their “School Health and Safety Committees” and then share the information with the staff and faculty. One of the first steps to the program is for teachers to complete the “Classroom Checklist” on Survey Monkey. The results will be reviewed by the Administrator and school teams and feedback will be shared with the staff.

Question Title

* 1. Select your school.

Adult and Continuing Education

AITE

ARTS

Cloonan Middle School

Davenport School

Dolan Middle School

Hart School

Julia Stark School

KT Murphy School

Newfield School

Northeast School

Rippowam Middle School

Rogers International School

Roxbury School

Scofield Middle School

Springdale School

Stamford High School

Stillmeadow School

Toquam School

Turn of River Middle School

Westhill High School

Westover School

Other (please specify)

Question Title

* 2. Classroom/Room

Question Title

* 3. General Cleanliness

	Yes	No	N/A
a.) Room is dusted regularly.	a.) Room is dusted regularly. Yes	a.) Room is dusted regularly. No	a.) Room is dusted regularly. N/A
b.) Room is vacuumed daily.	b.) Room is vacuumed daily. Yes	b.) Room is vacuumed daily. No	b.) Room is vacuumed daily. N/A
c.) Room is free of clutter.	c.) Room is free of clutter. Yes	c.) Room is free of clutter. No	c.) Room is free of clutter. N/A
d.) Trash is removed daily.	d.) Trash is removed daily. Yes	d.) Trash is removed daily. No	d.) Trash is removed daily. N/A
e.) All food is stored in tightly sealed containers.	e.) All food is stored in tightly sealed containers. Yes	e.) All food is stored in tightly sealed containers. No	e.) All food is stored in tightly sealed containers. N/A
f.) Room is free of pests and vermin.	f.) Room is free of pests and vermin. Yes	f.) Room is free of pests and vermin. No	f.) Room is free of pests and vermin. N/A
g.) Unscented, school-approved cleaners and air fresheners, if any, are used in rooms.	g.) Unscented, school-approved cleaners and air fresheners, if any, are used in rooms. Yes	g.) Unscented, school-approved cleaners and air fresheners, if any, are used in rooms. No	g.) Unscented, school-approved cleaners and air fresheners, if any, are used in rooms. N/A

Please explain if you have a "No" response.

Question Title

* 4. Animals in the Classroom. Please skip this question if you do not have any animals in the classroom.

	Yes	No	N/A
a.) Exposure to animal allergens is minimized .	a.) Exposure to animal allergens is minimized . Yes	a.) Exposure to animal allergens is minimized . No	a.) Exposure to animal allergens is minimized . N/A
b.) Animals are kept in cages (as much as possible).	b.) Animals are kept in cages (as much as possible). Yes	b.) Animals are kept in cages (as much as possible). No	b.) Animals are kept in cages (as much as possible). N/A
c.) Cages are cleaned regularly.	c.) Cages are cleaned regularly. Yes	c.) Cages are cleaned regularly. No	c.) Cages are cleaned regularly. N/A
d.) Animal cages are placed away from supply and return vents.	d.) Animal cages are placed away from supply and return vents. Yes	d.) Animal cages are placed away from supply and return vents. No	d.) Animal cages are placed away from supply and return vents. N/A
e.) School nurse is consulted about student allergies or sensitivities (Please note: Privacy laws may limit the information that health officials can disclose).	e.) School nurse is consulted about student allergies or sensitivities (Please note: Privacy laws may limit the information that health officials can disclose). Yes	e.) School nurse is consulted about student allergies or sensitivities (Please note: Privacy laws may limit the information that health officials can disclose). No	e.) School nurse is consulted about student allergies or sensitivities (Please note: Privacy laws may limit the information that health officials can disclose). N/A
f.) Potential allergies of students are identified.	f.) Potential allergies of students are identified. Yes	f.) Potential allergies of students are identified. No	f.) Potential allergies of students are identified. N/A
g.) Sensitive students are moved away from animals and habitats.	g.) Sensitive students are moved away from animals and habitats. Yes	g.) Sensitive students are moved away from animals and habitats. No	g.) Sensitive students are moved away from animals and habitats. N/A

Please explain if you have a "No" response.

Question Title

* 5. Drain Traps in the Classroom and Locker Rooms

	Yes	No	N/A
a.) Water is poured down floor drains once per week (approximately 1 quart of water).	a.) Water is poured down floor drains once per week (approximately 1 quart of water). Yes	a.) Water is poured down floor drains once per week (approximately 1 quart of water). No	a.) Water is poured down floor drains once per week (approximately 1 quart of water). N/A
b.) Water is run in sinks at least once per week (about 2 cups of water).	b.) Water is run in sinks at least once per week (about 2 cups of water). Yes	b.) Water is run in sinks at least once per week (about 2 cups of water). No	b.) Water is run in sinks at least once per week (about 2 cups of water). N/A
c.) Toilets are flushed once each week, especially if not used regularly.	c.) Toilets are flushed once each week, especially if not used regularly. Yes	c.) Toilets are flushed once each week, especially if not used regularly. No	c.) Toilets are flushed once each week, especially if not used regularly. N/A

Please explain if you have a "No" response.