Document Code:

Revision: 00
Quality Form Effectivity date: 07-28-2018
Name of Office:
STUDENT LED WATCHING AND School Governance Operations
HAZARD MAPPING CHECKLIST Division-DRRM

Name of School: PILA ELEMENTARY SCHOOL Date Conducted: Date Submitted:

Control No. SGOD-DRRM-AS-2018-__________ QM - Page 1 of 4

 Document Code:
Revision: 00
Quality Form Effectivity date: 07-28-2018
Name of Office:
STUDENT LED WATCHING AND School Governance Operations
HAZARD MAPPING CHECKLIST Division-DRRM

Broken Window
Slippery Pathway
Blocked Corridor
Heavy objects mounted on top of cabinets/shelves
Flooded area
Busted plugs/light bulbs/ electrical facilities
Exposed electrical wires
Protruding nails in chairs and tables
Broken door knobs
Warning sign: slippery pathways/ corridors
Plants mounted on the building railings
Flooding
Exposed chemicals and liquids
Lack/ absence of storage for equipment
Unlabeled chemicals
Dripping ceiling
Open pit
Stagnant water
Unpruned trees/ bushes/ shrubs
Open/ clogged canals
No ramps for elevated school buildings or other facilities
Swing in doors
Broken/ dilapidated ceiling
Open/ incomplete perimeter fence
Presence of stray animals inside the campus
Presence of electrical post/ transformer near or within the school perimeter
No system of release to parents during emergencies
No posted emergency hotlines around the school
Garbage area (Segregation of Non-biodegradable and Biodegradable)
Detached or peeled off GI sheet
Broken toilet bowl and/or sink
Broken chairs/ desks/ tables
Blocked/ no emergency exits
Unmounted cabinets/ shelves
Medical kits in every classrooms
Bells/ alarms
Condemnable building (i.e. very old structure, collapsing building and/or prominent cracks on classroom walls)
Others (List as many as possible)

Control No. SGOD-DRRM-AS-2018-__________ QM - Page 2 of 4

 Document Code:
Revision: 00
Quality Form Effectivity date: 07-28-2018
Name of Office:
STUDENT LED WATCHING AND School Governance Operations
HAZARD MAPPING CHECKLIST Division-DRRM

Broken Window
Slippery Pathway
Blocked Corridor
Heavy objects mounted on top of cabinets/shelves
Flooded area
Busted plugs/light bulbs/ electrical facilities
Exposed electrical wires
Protruding nails in chairs and tables
Broken door knobs
Warning sign: slippery pathways/ corridors
Plants mounted on the building railings
Flooding
Exposed chemicals and liquids
Lack/ absence of storage for equipment
Unlabeled chemicals
Dripping ceiling
Open pit
Stagnant water
Unpruned trees/ bushes/ shrubs
Open/ clogged canals
No ramps for elevated school buildings or other facilities
Swing in doors
Broken/ dilapidated ceiling
Open/ incomplete perimeter fence
Presence of stray animals inside the campus
Presence of electrical post/ transformer near or within the school perimeter
No system of release to parents during emergencies
No posted emergency hotlines around the school
Garbage area (Segregation of Non-biodegradable and Biodegradable)
Detached or peeled off GI sheet
Broken toilet bowl and/or sink
Broken chairs/ desks/ tables
Blocked/ no emergency exits
Unmounted cabinets/ shelves
Medical kits in every classrooms
Bells/ alarms
Condemnable building (i.e. very old structure, collapsing building and/or prominent cracks on classroom walls)
Others (List as many as possible)

Control No. SGOD-DRRM-AS-2018-__________ QM - Page 3 of 4

 Document Code:
Revision: 00
Quality Form Effectivity date: 07-28-2018
Name of Office:
STUDENT LED WATCHING AND School Governance Operations
HAZARD MAPPING CHECKLIST Division-DRRM

Broken Window
Slippery Pathway
√
Blocked Corridor
X
X Heavy objects mounted on top of cabinets/shelves

√ Flooded area
X Busted plugs/light bulbs/ electrical facilities
X Exposed electrical wires
X Protruding nails in chairs and tables
X Broken door knobs
√ Warning sign: slippery pathways/ corridors
√ Plants mounted on the building railings
√ Flooding
X Exposed chemicals and liquids
√ Lack/ absence of storage for equipment
X Unlabeled chemicals
X Dripping ceiling
X Open pit
√ Stagnant water
X Unpruned trees/ bushes/ shrubs
√ Open/ clogged canals
X No ramps for elevated school buildings or other facilities
X Swing in doors
X Broken/ dilapidated ceiling
Open/ incomplete perimeter fence
√
Presence of stray animals inside the campus
√
√ Presence of electrical post/ transformer near or within the school perimeter
No system of release to parents during emergencies
√
√ No posted emergency hotlines around the school

√ Garbage area (Segregation of Non-biodegradable and Biodegradable)

X Detached or peeled off GI sheet
X Broken toilet bowl and/or sink
X Broken chairs/ desks/ tables
X Blocked/ no emergency exits
X Unmounted cabinets/ shelves
√ Medical kits in every classrooms
√ Bells/ alarms
X Condemnable building (i.e. very old structure, collapsing building and/or prominent cracks on classroom walls)
Others (List as many as possible)

Prepared by: Approved by:

WINSTON E. GAVILAGA JEFFREY T. DELEON

SDRRM Coordinator School Head

Control No. SGOD-DRRM-AS-2018-__________ QM - Page 4 of 4