2007 Annual Visual Inspection Instrument (Updated 10-19-07)
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1. |
Name of |
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2. |
SED
District Number |
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District BEDS Code
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3. |
Building Name |
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4. |
SED Control Number (Bldg.
ID) |
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5. |
Survey Inspection Date |
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6. |
Building 911 Address |
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7. |
City |
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8. |
Zip Code |
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9. |
Certificate of Occupancy
Status |
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10. |
Certificate Expiration Date |
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11. |
Year
of |
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12. |
Gross
Sq. Ft. of Building as Currently Configured |
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13. |
Number
of Floors |
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14. |
Question
deleted |
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15. |
Building
Ownership (check one): |
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a. |
Owned
and used by district |
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b. |
Owned
by District and leased to non-district entity |
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c. |
Owned
by district, part used by district, part leased to non-district entity |
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d. |
Owned
by non-district entity and leased to district |
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16. |
For
which of the following purposes is the building currently used? (check all that apply) |
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a. |
Used
for student instructional purposes |
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b. |
Used
for district administration |
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c. |
Used
for other district purposes
Describe: |
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d. |
Used
by other organization(s) |
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19. |
Grades
Housed: |
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20. |
For
how many instructional days during the 2005-06 school year (July 1 through
June 30, was the building closed due to facilities failures, system
malfunctions, structural problems, etc?
(if none, enter “0”) |
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21. |
Is
the building used for instructional purposes in the summer? |
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Yes |
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No |
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22. |
Have
there been renovations or construction in the building during the past 12
months? |
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Yes |
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No |
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23. |
Number of general purpose
classrooms: |
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24. |
Gross Square Footage of all
general purpose classrooms (combined): |
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25. Question Deleted
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26. |
Rating of space adequacy |
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Good |
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Fair |
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Failing |
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Comments: |
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27. Question Deleted
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28. |
Overall building rating (to
be answered after the building inspection is complete) |
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Excellent |
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Satisfactory |
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Unsatisfactory |
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Poor |
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29. |
Was overall building rating
established after consultation with Health and Safety Committee? |
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Yes |
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No |
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E |
Excellent |
All
systems classified as health and safety or structural rated “excellent,” no
systems rated below “satisfactory,” preventive maintenance plan in place. |
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S |
Satisfactory |
All
systems categorized as health and safety or structural rated “satisfactory”
or better. No system rates
“non-functioning” or “critical failure.” |
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U |
Unsatisfactory |
Any system categorized as
health and safety or structural rated “unsatisfactory.” No health and safety or structural system
rated “non-functioning” or “critical failure.” |
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F |
Failing |
Any system categorized as
health and safety or structural rated “non-functioning” or “critical
failure.” Building Certificate of
Occupancy may be rescinded. |
Architect, Engineer and Firm Information
Questions 30 – 35 deleted
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NOTE: Visual
inspection of all structural systems is required. Please use the “comments”
section for each building feature to note limitations to visual inspections
of structural elements and actions taken to overcome these limitations. Please see the Building Condition Survey
guide for additional information. |
Building System Condition
Ratings and Definitions:
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E |
Excellent |
System
is in new or like-new condition and functioning optimally; only routine
maintenance and repair is needed. |
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S |
Satisfactory |
System
functioning reliably; routine maintenance and repair is needed. |
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U |
Unsatisfactory |
System
is functioning unreliably or has exceeded its useful life. Repair or
replacement of some or all components is needed. |
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NF |
Non-Functioning |
System
is non-functioning, not functioning as designed, or is unreliable in ways
that could endanger occupant health and/or safety. Repair or replacement of some or all
components is needed. |
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CF |
Critical Failure |
Same
as “NF” with the addition that the condition of at least one component is so
poor that at least part of the building or grounds should not be occupied
pending needed repairs/replacement or some or all components is needed. |
Building System Type
Definitions:
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H |
Health and Safety |
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S |
Structural |
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NOTE: Cost
estimates are required ONLY for systems/features rated “U”, “NF”, or
“CF.” Cost estimates are NOT REQUIRED
for systems rated “E” or “S.” These
estimates are for state and local planning purposes only. |
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36. |
Water (H) |
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a. |
Type of service: |
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Municipal or Utility
provided |
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Well |
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Other |
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b. |
Condition |
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Excellent |
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Satisfactory |
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Unsatisfactory |
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Non-Functioning |
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Critical failure |
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c. |
Year of last major
reconstruction/replacement |
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d. |
Expected Remaining Useful
life (years) |
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e. |
Cost to Reconstruct/Replace |
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f. |
Comments |
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37. |
Site Sanitary (H) |
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a. |
Type of service: |
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Municipal or Utility sewer |
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Site septic |
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Other |
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b. |
Condition |
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Excellent |
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Satisfactory |
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Unsatisfactory |
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Non-Functioning |
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Critical failure |
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c. |
Year of last major
reconstruction/replacement |
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d. |
Expected Remaining Useful
life (years) |
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e. |
Cost to Reconstruct/Replace |
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f. |
Comments |
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38. |
Site Gas ((H) |
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a. |
Does the building have gas
service or use liquid petroleum gas? |
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Yes |
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No (skip to next section) |
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b. |
Condition |
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Excellent |
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Satisfactory |
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Unsatisfactory |
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Non-Functioning |
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Critical failure |
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c. |
Year of last major
reconstruction/replacement |
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d. |
Expected Remaining Useful
life (years) |
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e. |
Cost to Reconstruct/Replace |
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f. |
Comments |
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