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    Energy $mart Schools

    NYSED Capital & Maintenance Planning Reports Toolbox

    (For Producing Comprehensive Maintenance Plans, Five-Year Capital Facilities Plans & Facility Report Cards)

    INTRD!CTIN

      ► Help improve occupant health, safety and comfort

    INSTR!CTINS

     2) Continue to fill out the other yellow tabs. Additional instructions highlighted at the top of each page.

    4) he blue Appendi! tabs are there as resources, but will not be included in reports unless selected.

    This template was designed by the New York State Energy Research and Development Authority and the New York State EducationDepartment to help New York Schools produce required annual reports easily and eectively! Ater you enter your schools" data once# itwill print out on three reports! The Toolbo$ also acts as a database that can be easily updated each year! Some o the appendices contained

    in the Toolbo$ provide templates or a %reventive &aintenance '%&( program!

    )n addition to reducing your paperwork# organi*ing your building data and your requests or e$penses between your +ive,Year -apital +acilities %lan#your +acility Report -ards and your -omprehensive &aintenance %lan '-&%(# this template tries to serve a variety o ob.ectives# including/

    ► "ulfill #$%&' Commissioner(s egulation *++.4d)2) to develop and annually update a Comprehensive -aintenance lan C-).

    ► Help ensure that all school buildings in #ew $or/ %tate are maintained in a state of good repair, combing data from the C- and eport Cards.

      ► Help %uperintendents of 0uildings and 1rounds %01s) manage operating costs energy, annual maintenance, and repairs) with effective maintenance.

      ► Help ustify capital e!penses that reduce energy or maintenance costs.

      ► "ocus preventive maintenance approaches to improve overall maintenance.

      ► 'ocument capital e!penses above and beyond annual costs for service contracts, supplies, and reoccurring costs) that will be included in the Five-YearCapital Facilities Plans. 0y showing the benefits of these capital e!penses in reducing maintenance and energy costs, it will help ustify each year3s capital costs.

    *) 0eginning with the yellow 1eneral nfo tab, fill in all information as prompted. he information provided on the 1eneral nfo tab will automatically transfer tothe other tabs in the spreadsheet, so the information only needs to be provided once.

    5) he green tabs are used only to review and print the "ive $ear Capital lan and the "acility eport Card. #o data needs to be entered on the green tabs, but anidividual school3s Capital lan budget or an individual school3s eport Card can be viewed before printing.

     +) 6hen information is entered, use the print button below to generate the reports. he individual tabs throughout the tool are also print7formatted, so each reportcan be printed as needed.

    PRINT REPRTS

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    Energy $mart Schools

    Comprehensi"e Maintenance Plan #CMP

    %ENER' IN(RMTIN

    Date) 01210334 Person Preparing this Plan) 5ohn Doe

    School District) Sample Town -SD Title*Position Superintendent o 6uildings and 7rounds

    +CES) 8alley 8iew 69-ES ,,ress) 232 &ain Street

    Plan Year) 0334 City) Albany

    N-mber o. Schools in District) : State) NY

    N-mber o. +-il,ings in District) : /ip) 20;:4

    Telephone)

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    Energy $mart SchoolsDistrict) Sample To1n CSD Prepare, by) 2ohn Doe Date) 34*35*4336

    (CI'ITIES IN7ENTRY

    Name o. School*(acility Example School 8 Example School 9 Example School 6 Example School :

    +EDS Co,e 54896:;

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    Energy $mart Schools

    District) Sample To1n CSD Prepare, by) 2ohn Doe Date) 34*35*4

    7ER7IEB

    S-mmary o. "erall Con,itions

    School Name %eneral Con,itions an, %oals

    6lementary 6lementary chool

    7nsert assessment here8

    5ood 5rades Middle chool7nsert assessment here8

    69ample chool #7nsert assessment here8

    69ample chool $7nsert assessment here8

    69ample chool .7nsert assessment here8

    69ample chool 07nsert assessment here8

    Bor r,er Systems:o help ith unplanned maintenance and repairs, do you have a or-order system in place;  Yes*N

    7< yes, appro9imately ho many or orders ere completed last year;

    Ser"ice Contracts

    7ndicate all systems that have preventive maintenance (PM) or service and repairs peracup Poer

    *?C Controls Yes 6lectrical istri+ution

    Fire Protection=uppression Yes Aighting

    Plum+ing Yes Aandscaping

    4ther Yes 4ther

    *as the istrict compared costs o< these contracts ith in-house costs to ascertain hether the service contracts are cost-

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    Energy $mart Schools

    District) Sample To1n CSD Prepare, by) 2ohn Doe Date) 34*35*4336

    DISTRICT 'E7E' +!D%ET S!MMRY

    Proecte, +-,get .or &M Costs

    Element -ost Estimate Notes -ost Estimate Notes -ost Estimate Notes

    %ite &lements 8 **,999 8 2,999 8 5,999

    oofing 8 *2,999 8 :,999 8 ;,999

    &nvelope &lements 8 7 8 7 8 7

    %tructural nterior 8 7 8 7 8 7

    &lements

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    Energy $mart Schools

    District) Sample To1n CSD Prepare, by) 2ohn Doe Date) 34*35*4336

    PRE7ENTI7E MINTENNCE P'N

    %reventive &aintenance '%&( typically provides signiicant beneits such as/

    pproach !se, in this District

    &!ample? 6e use a spreadsheet systems with all our maor e@uipment and the maintenance intervals recommended in the >- manuals. >ur >ffice -anager B

    'essons 'earne,

    6hat lessons have been learned in the 'istrict about the usefulness of - 6hat wor/s best and what doesn(t wor/ well that can be shared with other 'istricts

    Checlist o. Items +eing Ser"ice, Thro-gh PM

    @ ?ower overall maintenance costs versus correcting problems ater they occur

    @ Reduce equipment down time

    @ ?ower energy costs by maintaining systems in a more eicient operating condition

    @ ?ower replacement costs through longer equipment lie

    @ )mprove indoor environment and

    @ )mprove occupant comort# health and saety!

    'oes the 'istrict perform - f so, what types of systems do you use e.g., informal schedules, formal schedules with charts for maintenance intervals,computeriDed maintenance management systems C--%) with - assignments automatically generated)

    erforming - is one way of demonstrating that the 'istrict ta/es good care of e!isting systems and deserves %tate funding when those systems eventually wearout. he - Chec/list in Appendi! A can be used to show which systems are maintained with -. he list can also serve as a prompt to wor/ with systems thatmay have needed more regular -. he list should only be considered a starting point and how it is used will depend on the 'istrict3s specific needs.

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    Energy $mart Schools

    District) Sample To1n CSD Prepare, by) 2ohn Doe Date) 34*35*4336

    AE'TA & S(ETYDescription o Bealth and Saety -ommittee activities/ Yes1No

    'oes the district have a health and safety committee $es

    'oes the Health and %afety Committee have a chairperson  #o  7 #ame

    Eohn -ilton  7 hone #umber  2*27F;G7+59:  7 &mail

    'oes the Health and %afety Committee membership include?

      7 'istrict >fficials $es  7 %taff   #o  7 0argaining nits $es  7 arents  #o'id the Health and %afety Committee receive any type of training $es

      7 roect Architect $es  7 roect &ngineer  $es  7 Construction -anager   #o  7 Contractors $es

    "re@uency of Health and %afety Committee meetings chec/ one)? 57+ imes < %chool $ear 

    milty@schoolcom

    Health and %afety Committee membership e!panded during construction to include district officials, staff, bargaining units, parents and?

    mailto:[email protected]:[email protected]

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    EN7IRNMENT' BRENESS

    S-B99?1+A-)?)TY/

    Environmental Awareness Yes1No Yes1No Yes1No Yes1No Yes1N

    Has this building been tested for the presence of lead? paints, plumbing, etc.$es $es

     #o $es

    f yes, has this type of wor/ been done in accordance with the 1uidelines$es $es

     #o $es

    $es $es

    6hen was the AH&A management plan last updated 4

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    Energy $mart SchoolsDistrict) Sample To1n CSD Prepare, by) 2ohn Doe Date) 34*35*4336

    INTE%RTED PEST MN%EMENT

    S-B99?1+A-)?)TY/ E xample School 8 Example School 9 Example School 6 Example School

    Yes1No Yes1No Yes1No Yes1No Yes1No Yes1No

    $es $es

     #o $es

    $es $es

     #o $es

    ElementaryElementary School

    %oo, %ra,es Mi,,leSchool

    Status o measures to assure acceptableintegrated pest management/

    'oes this building have an ntegratedest -anagement program %eeAppendi! 0.

    'oes this building have a persondesignated to oversee the pestmanagement program

    Has this building established a list of persons to notify at least 4F hours priorto the application of pesticides

    Have pesticide application summaryreports been provided to all parentsand staff pursuant to C *++.24

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    Energy $mart SchoolsDistrict) Sample To1n CSD Prepare, by) 2ohn Doe Date) 34*35*4336

    INDR EN7IRNMENT' F!'ITY

    S-B99?1+A-)?)TY/

    Yes1No Yes1No Yes1No Yes1No Yes1No Yes1No

    $es #o

    $es #o

    $es #o

    $es #o

    $es #o

    $es $es

    $es $es

    $es $es

    f yes, describe for each building?

    &J description here.

    1ood 1rades -iddle %chool &J description here.

    &!ample %chool 5 &J description here.

    &!ample %chool 4 &J description here.

    &!ample %chool + &J description here.

    &!ample %chool ; &J description here.

    $es $es

    ElementaryElementary

    School

    %oo, %ra,esMi,,le School

    Example School8

    Example School9

    Example School6

    Example Sch:

    Status o actions and policies taken to assureacceptable indoor environmental quality/

    'oes this building use the % &nvironmentalrotection Agency(s Indoor Air Quality Tools for

    Schools Action Kit?

    'oes this building have a procedure in place forreporting indoor environmental @uality concerns

    s ventilation with outdoor air available in all occupiedspaces

    *) s all ventilation and e!haust e@uipmentoperational

    2) Are all outdoor air inta/es unobstructed and clearof foreign obects

    5) Are all outside air damper controls in place andoperational

    4) Have facilities operations been reviewed withrespect to impact on outside air inta/es i.e., vehicleemissions, waste storage, mowing, etc.)

    Are there any unresolved complaints regarding the

    indoor environment at this facility

    &lementary &lementary %chool

    Are the heating, ventilation, and air conditioninge@uipment cleaned and maintained in accordance withmanufacturer(s instructions e.g., filter changes, coilscleaned, etc.)

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    Energy $mart SchoolsDistrict) Sample To1n CSD Prepare, by) 2ohn Doe Date) 34*35*4336

    INDR EN7IRNMENT' F!'ITY

    S-B99?1+A-)?)TY/ElementaryElementary

    School

    %oo, %ra,esMi,,le School

    Example School8

    Example School9

    Example School6

    Example Sc:

     #o $es

    $es #o

     #o $es

    $es $es

     #o $es

    $es $es

    5+ G9

    $es $es

    $es $es

    $es $es

    'oes this facility follow green cleaning guidelines #o #o

    $es #o

    Has the interior of ductwor/ air passageways) beeninspected for cleanliness within the past year

    Have e!terior ductwor/ and rooftop air handling units

     been inspected for lea/s within the past year

    'oes the 'istrict have a policy encouraging the use ofenvironmentally friendly products

    'oes the 'istrict annually review products used in andaround the building with the intent of reducing oreliminating haDardous chemicals that occupants andvisitors are e!posed to, including volatile organiccompounds =>Cs), semi7volatile organic compounds,etc. cleaning supplies, repair and maintenancesupplies, materials, etc.)

    'oes the 'istrict perform an annual review to ensurehaDardous chemicals used as part of instructional

     programs are used and stored properly

    s each building inspected for roof lea/s, growth of

    mold and mildew, evidence of rodent infiltration, andother indicators of potential problems to acceptable&J

    6hat level d0) of ma!imum bac/ground accousticsettings has been set for classrooms

    'oes this facility regularly test and record levels of C>,C>2, total =>Cs, adon, mold spores, etc

    'oes this facility regularly measure and trac/ relativehumidity levels

    'oes this facility verify lighting levels meetlluminating &ngineering %ociety guidelines each year

    s this facility see/ing to comply with a whole buildingsustainable guideline, such as the .%. 1reen 0uildingCouncil3s I&&'B for &!isting 0uildings

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    Energy $mart Schools

    District) Sample To1n CSD Prepare, by) 2ohn Doe Date) 34*35*4

    ENER%Y +ENCAMRIN%

    S-B99?1+A-)?)TY/ E$ample School ; E$ample School : E$ample S

    ?ast Year ?ast Year ?ast Year ?ast Year

    ;9 +9 ;9 +9

    Yes1No Yes1No Yes1No Yes1No Yes1N

    $es #o

     #o #o

    85+,999.99 829,999.99

    849,999.99 89.99

    89.99 8*F,999.99

    85,999.99 8+,999.99

    2+9,999 499,999

    299,999 9

    9 49,999

    9 9

    ;9 ;9

    G+ G+

    ElementaryElementary School

    7ood 7rades &iddleSchool

    Status o measures taken to optimi*e

    energy use/

    -urrent

    Year

    -urrent

    Year

    -urrent

    Year

    -urrent

    Year

    -urrent

    Year

    6hat was this building(s score in the .%.&nvironmental rotection Agency(s EneryStar ! Portfolio "anaer 

    Has this building(s energy use been benchmar/ed using #$%&'A(s &nergy%mart %chools rogram against other #ew$or/ schools

    'o you follow the .%. &nvironmentalrotection Agency(s &1$ %A K and.%. 'epartment of &nergy(s "&- purchasing standards

    6ho manages the energy use for this building #ame and itle)

    &stimated electricity costs for current yearn 'ollars)?

    &stimated natural gas costs for current yearn 'ollars)?

    &stimated fuel oil costs for current year n'ollars)?

    &stimated other energy costs for currentyear n 'ollars)?

    &stimated electricity consumption for ne!tyear n /6h)?

    &stimated natural gas consumption for ne!tyear n herms)?

    &stimated fuel oil consumption for ne!tyear n 1allons)?

    &stimated other energy consumption forne!t year Iist nits Here)?

    6hat is the facility3s goal to score in theortfolio -anager in one year

    6hat is the facility3s goal to score in theortfolio -anager in three years

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    Energy $mart SchoolsDistrict) Sample To1n CSD Prepare, by) 2ohn Doe Date) 34*35*4336

    M2R PR2ECTS D!RIN% 'ST YER

    SED 'i applicable( 6rie %ro.ect Description %ro.ect Dates -osts %ro.ect 6eneits

    %&' L99799799799797999 +

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    Energy $mart SchoolsDistrict) Sample To1n CSD Prepare, by) 2ohn Doe Date) 34

    P'NNED CPIT' PR2ECTSSED Number %ro.ect Description Year %riority -onstruction Type %ro.ect Type -ost Annual 6eneit

    4559+45:9+5 #ew s 2 * #ew Construction -aor %ystem Capital 859,999.99

    *2*2*2*2*254*24 #ew 6indows + 5 Addition Health

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    School (acility Report Car,

    School District169-ES/ Sample Town -SD 6uilding Name/ E$ample Sc

    School 6uilding Address/  ,, #

    -ertiicate o 9ccupancy Status/ E$piration Date/

    ?ocation where certiicate o occupancy is posted/

    Section )/ School 6uilding 7eneral )normation

    *. erson completing this %chool "acility eport Card? Eohn 'oe 'ate? 2riginal Construction 'ate year)?

    5.b. resent siDe of school building %")? #umber of floors? 0asement $esverall condition?

    Section )))/ 6uilding -apital# &aintenance# and 9perations )normation

    :. Iist any current unsatisfactory building systems that have not been corrected since the previous 0uilding Condition %urvey. Add additional sheets as necessary)

    0uilding systems listed here.

    *9. &stimated remaining useful life of school building and systems can be viewed on the 0uilding Condition %urvey $es

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    School (acility Report Car,

    -ost Estimate -ost Estimate

    %ite &lements 9.99 9.99

    oofing 9.99 9.99

    &nvelope &lements 9.99 9.99

    %tructural nterior 9.99 9.99

    &lementsil? >ther?

    Total estimated energy costs/ >3!33

    Section )8/ Bealth and Saety

    *5. 'escription of Health and %afety Committee activities? Yes1No

    a. 'oes the district have a health and safety committee $es

     b. 'oes the Health and %afety Committee have a chairperson #o

    c. hone number of Health and %afety Committee Chairperson? 2*27F;G7+59:

    d. 0asic Health and %afety Committee membership?

      7 'istrict >fficials $es

      7 %taff #o

      7 0argaining nits $es

      7 arents #o

      7 roect Architect $es

      7 roect &ngineer $es

      7 Construction -anager #o

      7 Contractors $es

    Estimated -osts to Restore 6uildings to a State o 7oodRepair

    Estimated Annual -osts to Feep 6uildings in aState o 7ood Repair

    &mergency %ystems fire alarm, sprin/lers, publicaddress, etc.)

    T9TA? Estimated -ost

    include district officials, staff, bargaining units, parents and?

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    School (acility Report Car,f . "re@uency of Health and %afety Committee meetings chec/ one)? 57+ imes < %chool $ear 

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    School (acility Report Car,Section 8/ Environmental Awareness

    *4. Iead testing?

    a. Has this building been tested for the presence of lead? paints, plumbing, etc.

    c. f yes, has this type of wor/ been done in accordance with the 1uidelines

    *+. "ederal Asbestos HaDard &mergency esponse Act AH&A) lan?

    a. 'oes this building contain /nown or assumed asbestos containing building materials AC0-)

    c. 6hen was the AH&A management plan last updated

    *;. adon testing?

    -itigation activities described here.

    *G. ntegrated est -anagement rogram?

    *F. %tatus of measures ta/en to assure acceptable indoor air @uality?

     b. 0ased on the testing results, are there elements in this building that would re@uire construction or maintenanc proects to be conducted in accordance with the % 'epartment of Housing and rban 'evelopment 1uidelinefor the &valuation and Control of Iead 0ased aint HaDards in Housing

     b. f yes, has an original AH&A management plan been developed for this building he AH&A -anagemelan for this building may be viewed at the main office during normal business hours).

    a. Has the district reviewed the geological potential for the presence of radon from the #$%'>H adon-easurement 'atabase

     b. 'id the geological potential indicate testing this facility was necessary

    c. f yes, did the highest test in this building e!ceed 4pCi

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    School (acility Report Car,

    f yes , describe? &J description here .

    c. s ventilation with outdoor air available in all occupied spaces

    *. s all ventilation and e!haust e@uipment operational

    2. Are all outdoor air inta/es unobstructed and clear of foreign obects

    5. Are all outside air damper controls in place and operational

    4. Have facilities operations been reviewed with respect to impact on outside airinta/es i.e., vehicle emissions, waste storage, mowing, etc.)

    d. Are there any unresolved complaints regarding indoor air at this facility

    e. -aintenance? Heating, ventilation, and air conditioning e@uipment are cleaned and maintained inaccordance with manufacturer(s instructions i.e., filter changes, coils cleaned, etc.)

    f. Has the interior of ductwor/ air passageways) been inspected for cleanliness

    g. Have e!terior ductwor/ and rooftop air handling units been inspected for lea/s

    h. >perations and maintenance program?

    *. 'oes the 'istrict have a policy encouraging the use of environmentally friendly products

    2. roducts entering a school building are reviewed with the intent of reducing oreliminating haDardous chemicals, including volatile organic compounds =>Cs), semi7volatile organic compounds, etc. cleaning supplies, repair and maintenance supplies,materials, etc.).

    5. eview performed to ensure haDardous chemicals used as part of instructional

     program are used and stored properly.i. 0uildings are inspected for roof lea/s, growth of mold, evidence of rodent infiltration, and other potential

     problems to acceptable AJ.

     . s this facility see/ing to comply with a whole building sustainable guideline, such as the .%. 1reen 0uildinCouncil3s I&&'K for &!isting 0uildings

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    Sample To1n CSD

    7alley 7ie1 +CES

    (i"e0Year Capital (acilities Plan

    Submitted1Revised

    01210334

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    Table o. Contents7tem Page

    &!ecutive %ummary *

    0uilding nventories&lementary &lementary %chool 2

    1ood 1rades -iddle %chool 5

    &!ample %chool 5 4

    &!ample %chool 4 +

    &!ample %chool + ;

    &!ample %chool ; G

    'istrict Analysis and rioritiDation F

    &stimated &!penses

    &lementary &lementary %chool :

    1ood 1rades -iddle %chool *9

    &!ample %chool 5 **

    &!ample %chool 4 *2

    &!ample %chool + *5

    &!ample %chool ; *4

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    Exec-ti"e S-mmary

    +ollowing are the people who prepared this plan and the resources used/

    eople and resources here.

    +ollowing is a narrative o the general conditions o each acility/

    +acility Name Narrative

    Elementary Elementary School nsert assessment hereB

    7ood 7rades &iddle School nsert assessment hereB

    E$ample School ; nsert assessment hereB

    E$ample School : nsert assessment hereB

    E$ample School 4 nsert assessment hereB

    E$ample School C nsert assessment hereB

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    +-il,ing In"entory (orm

    6uilding Name/ E$ample School C

    6ed -odes Number/

    Address/ 77 ,

    Gse/ -urrent enrollment/

    Total square ootage/ Rated -apacity/

    9wnership/

    6uilding -ondition Survey Rating/

    6uilding Age/

    -onstruction Year Square +ootage

    9riginal

    Addition 2

    Addition 0

    Addition ;

    Addition :

    Addition 4Addition C

    Addition H

    Addition =

    Addition <

    Addition 23

    Beating System Energy Source/

    Energy -onsumption/ /6h electricity) therms natural gas)

    per year) gallons fuel oil) units other)

    %robable Gseul ?ie o 6uilding/  years Estimated Replacement 8alue/

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    District0Bi,e nalysis an, PrioritiGation

    District/ Sample Town -SD

    Year 2 SED Number %riority +acility Name

    2020202020;:20: 0 7ood 7rades &iddle School

    Year Total

    Year 0 SED Number %riority +acility Name

    ;0:0;3

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    (acility Estimate, Expenses

    District/ Sample Town -SD

    +acility Name/ E$ample School C NN select to change school

       #  e  w   C  o  n  s   t  r  u  c   t   i  o  n

       A   d   d   i   t   i  o

      n

       A   l   t  e  r  a   t   i  o  n  s

       -  a   2  o  r   %

      y  s   t  e  m

       -  a   2  o  r   )

      e  p  a   i  r

       &  n  e  r  g  y

       0  o  n   d

       C  a  p   i   t  a   l

    Year 2 %riority SED )tem Description -ost

    Year Total 89.99Year 0 %riority SED )tem Description -ost

    Year Total 89.99Year ; %riority SED )tem Description -ost

    Year Total 89.99Year : %riority SED )tem Description -ost

    Year Total 89.99Year 4

    %riority SED )tem Description

    -ost

    Year Total 89.99

    +acility Total 89.99

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    Ene

    Comprehens

    District) Sample To1n CSD

    E>School/ IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII Date Gpdated/ IIIIIIIIIIIIIIIIIIIIIIIIIIII 

    Beating Systems PHMH Re. ? Man-.act-rer Mo,el ? Serial ? SiGe (-el Type Installati

    0oilers H% 299479* 0 M+9970 *2574+;7GF +99,999 0tu 1as G+Q 2 *:GG,

    "urnaces

    Condenser pumps

    'eaerator tan/ 

    %team traps

    %team valves

    "uel tan/s distribution

    Heat e!changers

    erminal

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    School/ IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII Date Gpdated/ IIIIIIIIIIIIIIIIIIIIIIIIIIII 

    PHMH Re. ? Man-.act-rer Mo,el ? Serial ? SiGe (-el Type

    %prin/ler piping

    0ac/flow preventers

    %prin/ler heads

    "ire e!tinguishers

    "ire hose system

    %tandpipe connection

    "ire pumps

    1rease hood e!tinguisher 

    Alarms and detectors

    &echanical -ontrols PHMH Re. ? Man-.act-rer Mo,el ? Serial ? SiGe (-el Type

    Compressors

    neumatic valves

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    School/ IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII Date Gpdated/ IIIIIIIIIIIIIIIIIIIIIIIIIIII 

    elevision

    elephoneCloc/ system

    "ire alarms

    %ecurity alarm

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    School/ IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII Date Gpdated/ IIIIIIIIIIIIIIIIIIIIIIIIIIII 

    "acade integrity

    Cladding

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    School/ IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII Date Gpdated/ IIIIIIIIIIIIIIIIIIIIIIIIIIII 

    ?andscaping Systems PHMH Re. ? Man-.act-rer Mo,el ? Serial ? SiGe (-el Type

    rrigation

    urf

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    E>-ipment In"e

    School/ IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII Date Gpdated/ IIIIIIIIIIIIIIIIIIIIIIIIIIII 

    =aults

    %wimming pools

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    Energy $mart Schools

    Comprehensi"e Maintenance Plan #

    District) Sample To1n CSD Prepare, by) 2ohn Doe

    PM Checlist an, 'og

    School/ IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII Year/ IIIIIIIIIIIIIIII  7mplementor 3ey M D Maintenance Mechanic C D Custod

    Beating Systems PHMH Re. ? Implementor (re>-ency*Year 2an (eb Mar pr May

    0oilers H% 299479* M $ x

    0oiler water treatment !2

    "urnaces $

    Condenser pumps $

    'eaerator tan/  "

    %team traps $

    %team valves  !-$

    "uel tan/s distribution !

    Heat e!changers "

    erminal-ency*Year 2an (eb Mar pr MayAir handling units $

    nit ventilators $

    "ans ""ire dampers !

    "ilters  "-$

    Humidifiers "

    -ooling Systems PHMH Re. ? Implementor (re>-ency*Year 2an (eb Mar pr MayCondensing units $

    Air compressors !"

    Heat e!changers "

    ac/aged A

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    District) Sample To1n CSD Prepare, by) 2ohn

    PM Checlist an, 'o

    School/ IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII Year/ IIIIIIIIIIIIIIII  7mplementor 3ey M D Maintenance Mecha

    +ire %rotection1Suppression Systems

    %prin/ler piping

    0ac/flow preventers

    %prin/ler heads

    "ire e!tinguishers

    "ire hose system

    %tandpipe connection

    "ire pumps

    1rease hood e!tinguisher 

    Alarms and detectors

    &echanical -ontrols

    Compressors

    neumatic valves

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    District) Sample To1n CSD Prepare, by) 2ohn D

    PM Checlist an, 'og

    School/ IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII Year/ IIIIIIIIIIIIIIII  7mplementor 3ey M D Maintenance Mecha

    %ecurity alarm

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    District) Sample To1n CSD Prepare, by) 2ohn

    PM Checlist an, 'o

    School/ IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII Year/ IIIIIIIIIIIIIIII  7mplementor 3ey M D Maintenance Mecha

    rotective coating

    %ealants

    )nterior -onstruction

    "i!ed partitions

    'emountable partitions

    etractable partitions

    'oors

    Carpet

    esilient tile

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    District) Sample To1n CSD Prepare, by) 2ohn Doe

    PM Checlist an, 'og

    School/ IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII Year/ IIIIIIIIIIIIIIII  7mplementor 3ey M D Maintenance Mechanic C

    -ar/ings

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    Pre"enti"e Maintenance Bor r,er Sheet

    &@uipment to be 6or/ed on?

    %chool 'istrict? 'ate ssued?

    %chool? 'ate Completed?

    erformed 0y? - Code L?

    ype of - to be erformed? -onthly Juarterly %emi7Annual Annual >ther  

    ime to Allow for erform - 6or/? Hour s)

    ools e@uired?

    'escription of 6or/ to be erformed? emar/s?

    *.

    2.

    5.

    4.

    +.

    ;.

    G.

    F.

    :.

    *9.

    **.

    *2.

    Additional "ollow7up Activities #eeded?

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    &M Speci.ication 'ang-age

    H

    ! Maintenance manuals

    " Record documents

    # pare parts and materials

    $ :ools

    . Au+ricants

    0 Fuels

    1 7denti

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    +est Practices %-i,es an, Reso-rces

    ADD)T)9NA? RE+S T9 6E ADDED

    % &nvironmental rotection Agency &A) ndoor Air Juality ools for %chools Action Mit is available by callin  

    &S EPA Interated Pest "anae$ent 'IP"( in Schools resources are available online atwww.epa.gov