Minnesota Department of Health Asthma Program
Asthma Environmental School Walkthrough
Date of Walkthrough
School/District Contact
Participants
School Building Information
School name
Address
Number of students
Year built
Grades in school
Number of floors
Renovations (years if known)
HVAC type
Air conditioning (all / sections)
Most common pest(s)
Cleaning staff per square feet, if known
Cleaning frequency (times per week)
Walk-off mats at all entrances (Y/N)
Proximity of air intake locations to sources
Proximity to busy roads or other air quality concerns
District Information
Indoor Air Quality Management Plan (Y/N)
Indoor Air Quality Coordinator (Name)
Integrated Pest Management notification (Y/N)
Animals in classroom policy (Y/N)
Tobacco policy posted (Y/N)
Use “green” cleaning products” (Y/N)
Air Quality Index electronic notification (Y/N)
School bus idling policy (Y/N)
Policy on items from home such as furniture, cleaning products, appliances (Y/N)
March 2009
How to Complete the MDH Asthma Program School Building Information Form
Date of Walkthrough: Document for follow-up report to school
School/District Contact: Fill in name of person who receives follow-up report
Participants/School name/Address: Document for follow-up report to school
Number of students/Grades in school/Number of floors: Grade levels may influence the
types of asthma triggers found during a walkthrough
Year built & Renovations (years if known): Document for follow-up report to school
HVAC type & Air conditioning (all / sections): Document for follow-up to school
Most common pest(s): Look for evidence of these pests and control techniques such as baits
Cleaning staff per square feet, if known: Schools have seen a decrease in custodial staff
Cleaning frequency (times per week): Staff may vacuum or sweep classrooms less often
Walk-off mats at all entrances (Y/N): Mats reduce amount of dirt brought into school
Proximity of air intake locations to sources: What is the surrounding land use? Look for
commercial, industrial, or farming activities
Proximity to busy roads or other air quality concerns: Poor outdoor air quality may trigger
asthma episodes
Indoor Air Quality Management Plan (Y/N): Minnesota law (Section 123B.57) requires
public school districts to adopt a plan to monitor and improve indoor air quality
Indoor Air Quality Coordinator (Name): Document if needed for follow-up report to school
Integrated Pest Management notification (Y/N): Required by Minnesota law (Section
121A.30)
Tobacco policy posted (Y/N): Smoking is prohibited in all Minnesota K-12 schools
Animals in classroom policy (Y/N): Furry and feathered animals may trigger asthma
Use “green” cleaning products” (Y/N): Chemicals and strong odors may trigger asthma
Air Quality Index electronic notification (Y/N): If not, provide sign-up information
School bus idling policy (Y/N): Required by Minnesota law (Section 123B.885)
Policy on items from home such as furniture, cleaning products, appliances (Y/N): Furniture
may contain dust mites; cleaning products may release irritants or strong odors; and appliances
may generate moisture or food crumbs
March 2009