ASBESTOS PERIODIC SURVEILLANCE CHECK LIST

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Jonah Lindsey
5 years ago
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1 DATE OF SCHOOL: Effingham County Board Office SURVEILLANCE 1. SURFACING: 2010 Plaster in hallway NO This building has been completely renovated for the board office. The plaster has been covered with paneling or non- asbestos containing sheetrock. This building was part of Effingham County Middle School Annex.

2 DATE OF SCHOOL: Effingham County Board Office SURVEILLANCE 1. SURFACING: Print Shop Plaster Has been abated and complete renovation. This building is no longer used as a Dining Room. The old floor tile was removed from this building and new non-asbestos containing floor tile was installed.

3 DATE OF SCHOOL: Effingham County Board Office SURVEILLANCE 1. SURFACING: 2050 Technology Program COMMENT The technology program has moved from this building. This building is being used for training purpose. All floor tile has been removed and replaced with carpet NO All floor tile has been removed and replaced with non acbm tile Carpet was installed in the classrooms. Bathroom has cermic tile. This building was part of Effingham County Middle School Annex.

4 DATE OF SCHOOL: Effingham County High School SURVEILLANCE 1. SURFACING: This school has been certified asbestos free by the architect, six portables have been added to this school.

5 DATE OF SCHOOL: Effingham County High School SURVEILLANCE 1. SURFACING: Six portables at this school. One portable is a Williams-Scotsman unit. Four portables were stick built on site. One portable was moved in from Effingham Middle School. All suspect materials in these units are non-friable Floor tile NO Floor tile was removed from ROTC portable. The old tile was bulk sampled and tested to be non-acm. If documentation from suppliers can be secured three of these units can be certified asbestos free.

6 DATE OF SCHOOL: Rincon Elementary School SURVEILLANCE ADDRESS: Rincon, Georgia SYSTEM: Effingham County Board of Ed. 1. SURFACING: Classroom and Hallway 12"x12" floor tile NO Ceiling tile NO The only remaining suspect AC floor tile is located in one storage room for audio visual equipment covered with carpet.

7 asbestos containing material or materials assumed to contain asbestos. The checklist must be completed biannually, and upon completion, a copy placed in the management plan (both in the local administrative office and system administrative office). DATE OF SCHOOL: South Effingham Elementary School SURVEILLANCE Lower Campus ADDRESS: Guyton, Georgia SYSTEM: Effingham County Board of Ed. 1. SURFACING: "x12" floor tile book room and vault YES Everthing has been removed in renovation and replaced with non acbm.

8 asbestos containing material or materials assumed to contain asbestos. The checklist must be completed biannually, and upon completion, a copy placed in the management plan (both in the local administrative office and system administrative office). DATE OF : SCHOOL: Springfield Central Learning Center SURVEILLANCE INSPECTION 1. SURFACING: 2010 Floor tile in room 101. NO The only suspect asbestos containing floor tile at this school is located in the Even Start Family Literacy Center. No longer owned by Effingham BOE. Now owned by Effingham County Commissioner's PERSON CONDUCTING SURVEILLANCE:

If the address on this form is different than the address of the building, submit a written explanation.

If the address on this form is different than the address of the building, submit a written explanation. ILLINOIS DEPARTMENT OF PUBLIC HEALTH AHERA THREE YEAR REINSPECTION ASBESTOS ABATEMENT PROGRAM SCHOOL INFORMATION FORM SECTION I NAME OF SCHOOL DISTRICT: SCHOOL ID NUMBER: ADDRESS OF SCHOOL: CITY: CHICAGO