HomeMy WebLinkAboutSt. Stephens High School 40034 05 14 15.JH.PDFStatus Code:
INSTRUCTIONS Purpose: General Statute 130A-236 requires the Commission for Health Services to adopt rules governing the sanitation of public, private, and
religious schools. This form has been developed to record the results of such inspections. Preparation: Local environmental health specialists shall complete the form every time they conduct an inspection. Prepare an original and two copies for: 1. Original to be left with principal. 2. Copy for the local health department. 3. Copy for the Environmental Health Services Section, Division of Environmental Health. Disposition: Please refer to Records Retention and Disposition Schedule 8.B.6.,
Inspection Records for County/District Health Departments which is published by the North Carolina Division of Archives & History. Additional forms may be ordered
from: Division of Environmental Health, 1632 Mail Service Center, Raleigh, NC 27699-1632, (Courier 52-01-00)
Name Change
Verification of Closure
Status Change
Inspection
Re-inspection
VisitCommunityOn-Site System
Water Community
Transient Non-Community
Non-Transient Non-Community
Non-Public Water Supply
40
30
Current Facility ID
100
1. WATER SUPPLY: Approved water supply properly located,
constructed, and operated, adequate for all requirements 130*; well
house clean, no storage 15*; no cross connections 30* (.2405) ...........
2. SANITARY SEWAGE DISPOSAL: Sewage collected, treated, and
disposed of by an approved method 150*; system properly operated
and maintained 55* (.2407) ..................................................................
3. DRINKING FOUNTAINS: Clean and in good repair 40#; adequate
pressure, properly regulated 40# (.2406) ..............................................
4. TOILET FACILITIES: Walls and ceilings clean, nonabsorbent,
washable, and in good repair 30#; fixtures clean and in good repair
40#; floors impervious, kept clean 30# (.2408) .................................
5. LAVATORY FACILITIES: Fixtures clean and in good repair 30#; soap
and individual towels or approved hand-drying devices provided 40#
(.2409) ...............................................................................................
6. FLOORS: WALLS: AND CEILINGS: Floors, walls, and ceilings clean
and in good repair 30# (.2410) ............................................................
7. STORAGE SPACES: Clean 20#; storage off floor 20# (.2411) ............
8. LIGHTING AND VENTILATION: Fixtures, grills, vents, blinds, drapes,
etc., clean and in good repair 40# (.2412) ...............
9. DRESSING ROOMS AND SHOWERS: Floors, walls, and ceilings
clean, in good repair, washable, non-absorbent 30#; fixtures clean, in
good repair 40#; facilities for storage of clothes provided, kept clean
20#; soap and towel 10* (.2413) .....................................................
10. SOLID WASTE DISPOSAL: Impervious, cleanable containers with
lids, approved type 20*; clean and in good repair 20#; empties as
needed, properly disposed of 40# (.2414) ..............................
11. PREMISES: MISCELLANEOUS: Premises neat, clean 30#; no vector
breeding or harborage 20#; pesticides and other toxic materials
properly handled and stored 30* (.2415) ......................................
80
Inspection of School
205
Old Facility ID
175
Date of Insp/Chg:
N.C. Department of Environment and Natural Resources
Division of Environmental Health Health Department
Wastewater System:
Water sample taken today?
State: NCCity:Zip:City:State:Zip:
Location Address:Mailing Addr.
Comments
TOTAL
EHS 1163 (Revised 7/05)
Environmental Health Services Section (Review 7/08)
Score
Score
Additional Comment Sheet Attached
1000
80
80
100
40
70
Inspection by:EHS
Name of School:
1
2
3
4
1 2 V
1
2
** SEE COMMENT SHEET ATTACHED **
Yes No
Yes No
//
95.5 18
201844003405142015
A
ST STEPHENS HIGH SCHOOL
3205 34TH ST DR NE
HICKORY 28601
20
15
10
45
1654 - Huffman, Jason
100
Total Time:
N.C. Department of Environment and Natural Resources
Division of Environmental Health
COMMENT ADDENDUM
Time In:
Time Out:
City:
Street:
ID:
Name:am
pm
am
pm
:
:
ST STEPHENS HIGH SCHOOL
2018440034
3205 34TH ST DR NE
HICKORY
1 0 2 5
1 0 2 6
1 minute
4
6
7
REFINISH WALLS IN RESTROOMS AS NEEDED.
REFINISH WALLS AS NEEDED. EX: ROOM 302
PROVIDE PROPER SPACE FOR STORAGE
N.C. Department of Environment and Natural Resourses
Division of Environmental Health
COMMENT ADDENDUM City:
Street:
ID:
Name:
General Comments:
ST STEPHENS HIGH SCHOOL
2018440034
3205 34TH ST DR NE
HICKORY