Energy $mart Schools

NYSED Capital & Maintenance Planning Reports Toolbox

(For Producing Comprehensive Maintenance Plans, Five-Year Capital Facilities Plans & Facility Report Cards)
INTRODUCTION
This template was designed by the New York State Energy Research and Development Authority and the New York State Education
Department to help New York Schools produce required annual reports easily and effectively. After you enter your schools' data once, it
will print out on three reports. The Toolbox also acts as a database that can be easily updated each year. Some of the appendices
contained in the Toolbox provide templates for a Preventive Maintenance (PM) program.

In addition to reducing your paperwork, organizing your building data and your requests for expenses between your Five-Year Capital Facilities Plan,
your Facility Report Cards and your Comprehensive Maintenance Plan (CMP), this template tries to serve a variety of objectives, including:

► Fulfill NYSED Commissioner’s Regulation 155.4(d)(2) to develop and annually update a Comprehensive Maintenance Plan (CMP).
► Help ensure that all school buildings in New York State are maintained in a state of good repair, combing data from the CMP and Report Cards.

► Help Superintendents of Buildings and Grounds (SBGs) manage operating costs (energy, annual maintenance, and repairs) with effective maintenance.

► Help improve occupant health, safety and comfort

► Help justify capital expenses that reduce energy or maintenance costs.
► Focus preventive maintenance approaches to improve overall maintenance.

► Document capital expenses above and beyond annual costs (for service contracts, supplies, and reoccurring costs) that will be included in the Five-Year
Capital Facilities Plans. By showing the benefits of these capital expenses in reducing maintenance and energy costs, it will help justify each year's capital costs.

INSTRUCTIONS

1) Beginning with the yellow General Info tab, fill in all information as prompted. The information provided on the General Info tab will automatically transfer to
the other tabs in the spreadsheet, so the information only needs to be provided once.
2) Continue to fill out the other yellow tabs. Additional instructions highlighted at the top of each page.
3) The green tabs are used only to review and print the Five Year Capital Plan and the Facility Report Card. No data needs to be entered on the green tabs, but an
idividual school's Capital Plan budget or an individual school's Report Card can be viewed before printing.
4) The blue Appendix tabs are there as resources, but will not be included in reports unless selected.
5) When information is entered, use the print button below to generate the reports. The individual tabs throughout the tool are also print-formatted, so each report
can be printed as needed.

PRINT REPORTS
 Energy $mart Schools
Comprehensive Maintenance Plan (CMP)
GENERAL INFORMATION

Date: 2/1/2005 Person Preparing this Plan: John Doe

School District: Sample Town CSD Title/Position Superintendent of Buildings and Grounds

BOCES: Valley View BOCES Address: 101 Main Street

Plan Year: 2005 City: Albany

Number of Schools in District: 4 State: NY

Number of Buildings in District: 4 Zip: 12345

Telephone: 999-999-9999

Fax: 888-888-8888

E-mail: test@imagine.com
 Energy $mart Schools
District: Sample Town CSD Prepared by: John Doe Date: 02/01/2005
FACILITIES INVENTORY
Elementary
Good Grades
Name of School/Facility Elementary Example School 3 Example School 4 Example School 5 Example School 6
Middle School
School
BEDS Code 123456789 987654321
Street Address 1234 Willow Road 9 Chain Road
City Sacketts Harbor Albany
State NY NY
ZIP 12345 12345
Year Built 1958 1967
Square Footage 95,000 100,300
# of Floors 2 1
Basement? Yes No
Enrollment 1,175 1,200
Capacity 1,200 1,500
Grades K-6 6-8
Ownership Type: Owned Operated
Primary Heat Source: Natural Gas Oil
 Energy $mart Schools
District: Sample Town CSD Prepared by: John Doe Date: 02

OVERVIEW
Summary of Overall Conditions
School Name General Conditions and Goals
Insert assessment here…
Elementary Elementary School

Insert assessment here…

Good Grades Middle School

Insert assessment here…

Example School 3

Insert assessment here…

Example School 4

Insert assessment here…

Example School 5

Insert assessment here…

Example School 6

Work Order Systems

To help with unplanned maintenance and repairs, do you have a work-order system in place?

If yes, approximately how many work orders were completed last year?

Service Contracts
Indicate all systems that have preventive maintenance (PM) or service and repairs performed under service contracts w

Yes/No

Heating Yes Computer/P

Air Handling Yes Roof

Cooling Yes Backup Pow

HVAC Controls Yes Electrical Distrib

Fire Protection/Suppression Yes Lighting

Plumbing Yes Landscapin

Other Yes Other

Has the District compared costs of these contracts with in-house costs to ascertain whether the service contracts are
y $mart Schools
Prepared by: John Doe Date: 02/01/2005

OVERVIEW
of Overall Conditions
General Conditions and Goals
ment here…

ment here…

ment here…

ment here…

ment here…

ment here…

k Order Systems
 Yes/No

rvice Contracts
vice and repairs performed under service contracts with outside contractors.

Yes/No

Computer/PA Yes

Roof Yes

Backup Power No

Electrical Distribution Yes

Lighting Yes

Landscaping No

Other No

e costs to ascertain whether the service contracts are cost-effective? Yes

 Energy $mart Schools
District: Sample Town CSD Prepared by: John Doe Date: 02/01/2005

DISTRICT LEVEL BUDGET SUMMARY

Estimated Costs to Restore Estimated Annual Costs to Keep
Projected Budget for O&M Costs
Buildings to a State of Good Repair Buildings in a State of Good Repair

Element Cost Estimate Notes Cost Estimate Notes Cost Estimate Notes

Site Elements $ 11,000 $ 2,000 $ 3,000

Roofing $ 12,000 $ 9,000 $ 6,000

Envelope Elements $ - $ - $ -

Structural Interior $ - $ - $ -

Elements/Finishes $ - $ - $ -

Electrical $ - $ - $ -

Plumbing $ - $ - $ -

HVAC $ - $ - $ -

Special Construction $ - $ - $ -

Emergency Systems (fire $ - $ - $ -

alarm, sprinklers, public
address, etc.)

Other $ - $ - $ -

TOTAL Estimated Cost $ 23,000 $ 11,000 $ 9,000

 Energy $mart Schools
District: Sample Town CSD Prepared by: John Doe Date: 02/01/2005

PREVENTIVE MAINTENANCE PLAN

Preventive Maintenance (PM) typically provides significant benefits such as:
· Lower overall maintenance costs versus correcting problems after they occur;
· Reduce equipment down time;
· Lower energy costs by maintaining systems in a more efficient operating condition;
· Lower replacement costs through longer equipment life;
· Improve indoor environment; and
· Improve occupant comfort, health and safety.

Approach Used in this District

Does the District perform PM? If so, what types of systems do you use (e.g., informal schedules, formal schedules with charts for maintenance intervals,
computerized maintenance management systems (CMMS) with PM assignments automatically generated)?
Example: We use a spreadsheet systems with all our major equipment and the maintenance intervals recommended in the O&M manuals. Our Office Manager …

Lessons Learned
What lessons have been learned in the District about the usefulness of PM? What works best and what doesn’t work well that can be shared with other Districts?

Checklist of Items Being Serviced Through PM

Performing PM is one way of demonstrating that the District takes good care of existing systems and deserves State funding when those systems eventually wear
out. The PM Checklist in Appendix A can be used to show which systems are maintained with PM. The list can also serve as a prompt to work with systems that
may have needed more regular PM. The list should only be considered a starting point and how it is used will depend on the District's specific needs.
 Energy $mart Schools
District: Sample Town CSD Prepared by: John Doe Date: 02/01/2005
HEALTH & SAFETY
Description of Health and Safety Committee activities: Yes/No
Does the district have a health and safety committee? Yes
Does the Health and Safety Committee have a chairperson? No
- Name John Milton
- Phone Number 212-867-5309
- Email milty@school.com
Does the Health and Safety Committee membership include:
- District Officials Yes
- Staff No
- Bargaining Units Yes
- Parents No
Did the Health and Safety Committee receive any type of training? Yes
Health and Safety Committee membership expanded during construction to include district officials, staff,
bargaining units, parents and:
- Project Architect Yes
- Project Engineer Yes
- Construction Manager No
- Contractors Yes
Frequency of Health and Safety Committee meetings (check one): 3-5 Times / School Year
 ENVIRONMENTAL AWARENESS
Elementary
Good Grades Example Example Example
SCHOOL/FACILITY: Elementary
Middle School School 3 School 4 School 5
School

Environmental Awareness Yes/No Yes/No Yes/No Yes/No Yes/No

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

Based on the testing results, are there elements in this building that would
require construction or maintenance projects to be conducted in accordance No Yes
with the US Department of Housing and Urban Development Guidelines for
the Evaluation and Control of Lead Based Paint Hazards in Housing?

Yes Yes
If yes, has this type of work been done in accordance with the Guidelines?
Does this building contain known or assumed Asbestos Containing Building No Yes
Materials? (ACBM)
If yes, has an original Asbestos Hazard Emergency Response Act (AHERA)
management plan been developed for this building? (The AHERA Yes Yes
Management Plan for this building must be able to be viewed at the main
office during normal business hours).
When was the AHERA management plan last updated? 4/4/2004 3/3/2003
Has the district reviewed the geological potential for the presence of radon
from the New York State Dept. of Health Radon Measurement Database? Yes Yes

Did the geological potential indicate testing this facility was necessary? No Yes
If yes, did the highest test in this building exceed 4pCi/L? Yes Yes
If yes, describe mitigation activities:
Elementary Elementary School Mitigation activities described here.

Good Grades Middle School Mitigation activities described here.

Example School 3 Mitigation activities described here.

Example School 4 Mitigation activities described here.

Example School 5 Mitigation activities described here.

Example School 6 Mitigation activities described here.
y $mart Schools
Prepared by: John Doe Date: 02/01/2005
EALTH & SAFETY
NMENTAL AWARENESS
Example
School 6

Yes/No

Mitigation activities described here.

Mitigation activities described here.

Mitigation activities described here.

Mitigation activities described here.

Mitigation activities described here.

Mitigation activities described here.
 Energy $mart Schools
District: Sample Town CSD Prepared by: John Doe Date: 02/01/2005
INTEGRATED PEST MANAGEMENT
Elementary Good Grades Middle
SCHOOL/FACILITY: Example School 3 Example School 4 Example School 5 Example School 6
Elementary School School

Status of measures to assure acceptable

Yes/No Yes/No Yes/No Yes/No Yes/No Yes/No
integrated pest management:

Does this building have an Integrated

Pest Management program? See Yes Yes
Appendix B.

Does this building have a person

designated to oversee the pest No Yes
management program?

Has this building established a list of

persons to notify at least 48 hours Yes Yes
prior to the application of pesticides?

Have pesticide application summary

reports been provided to all parents No Yes
and staff pursuant to CR 155.24?
 Energy $mart Schools
District: Sample Town CSD Prepared by: John Doe Date: 02/01/2005
INDOOR ENVIRONMENTAL QUALITY
Elementary
Good Grades Example School Example School Example School Example School
SCHOOL/FACILITY: Elementary
Middle School 3 4 5 6
School

Status of actions and policies taken to assure

Yes/No Yes/No Yes/No Yes/No Yes/No Yes/No
acceptable indoor environmental quality:
Does this building use the US Environmental
Protection Agency’s Indoor Air Quality Tools for Yes No
Schools Action Kit?
Does this building have a procedure in place for
Yes No
reporting indoor environmental quality concerns?
Is ventilation with outdoor air available in all occupied
Yes No
spaces?
1) Is all ventilation and exhaust equipment
Yes No
operational?
2) Are all outdoor air intakes unobstructed and clear
Yes No
of foreign objects?
3) Are all outside air damper controls in place and
Yes Yes
operational?
4) Have facilities operations been reviewed with
respect to impact on outside air intakes (i.e., vehicle Yes Yes
emissions, waste storage, mowing, etc.)?
Are there any unresolved complaints regarding the
Yes Yes
indoor environment at this facility?
If yes, describe for each building:
Elementary
IEQ description here.
Elementary
School
Good Grades IEQ description here.
Middle School
Example School 3 IEQ description here.
Example School 4 IEQ description here.
Example School 5 IEQ description here.
Example School 6 IEQ description here.
Are the heating, ventilation, and air conditioning
equipment cleaned and maintained in accordance with
Yes Yes
manufacturer’s instructions (e.g., filter changes, coils
cleaned, etc.)?
 Energy $mart Schools
District: Sample Town CSD Prepared by: John Doe Date: 02/01/2005
INDOOR ENVIRONMENTAL QUALITY
Elementary
Good Grades Example School Example School Example School Example School
SCHOOL/FACILITY: Elementary
Middle School 3 4 5 6
School

Has the interior of ductwork (air passageways) been

No Yes
inspected for cleanliness within the past year?
Have exterior ductwork and rooftop air handling units
Yes No
been inspected for leaks within the past year?
Does the District have a policy encouraging the use of
No Yes
environmentally friendly products?
Does the District annually review products used in and
around the building with the intent of reducing or
eliminating hazardous chemicals that occupants and
visitors are exposed to, including volatile organic Yes Yes
compounds (VOCs), semi-volatile organic compounds,
etc. (cleaning supplies, repair and maintenance
supplies, materials, etc.)?

Does the District perform an annual review to ensure

hazardous chemicals used as part of instructional No Yes
programs are used and stored properly?

Is each building inspected for roof leaks, growth of

mold and mildew, evidence of rodent infiltration, and
Yes Yes
other indicators of potential problems to acceptable
IEQ?
What level (dB) of maximum background accoustic 35 70
settings has been set for classrooms?
Does this facility regularly test and record levels of CO, Yes Yes
CO2, total VOCs, Radon, mold spores, etc?
Does this facility regularly measure and track relative Yes Yes
humidity levels?

Does this facility verify lighting levels meet Yes Yes

Illuminating Engineering Society guidelines each year?

No No
Does this facility follow green cleaning guidelines?
Is this facility seeking to comply with a whole building
sustainable guideline, such as the U.S. Green Building Yes No
Council's LEED® for Existing Buildings?
 Energy $mart Schools
District: Sample Town CSD Prepared by: John Doe Date: 02/01/2005

ENERGY BENCHMARKING
Elementary Good Grades Middle
SCHOOL/FACILITY: Example School 3 Example School 4 Example School 5 Example School 6
Elementary School School

Status of measures taken to optimize Current Last Year Current Last Year Current Last Year Current Last Year Current Last Year Current Last Year
energy use: Year Year Year Year Year Year

What was this building’s score in the U.S.

Environmental Protection Agency’s Energy
Star® Portfolio Manager? 60 50 60 50

Yes/No Yes/No Yes/No Yes/No Yes/No Yes/No

Has this building’s energy use been
benchmarked using NYSERDA’s Energy
Smart Schools Program against other New Yes No
York schools?

Do you follow the U.S. Environmental

Protection Agency’s ENERGY STAR® and
U.S. Department of Energy’s FEMP No No
purchasing standards?

Who manages the energy use for this

building (Name and Title)?

Estimated electricity costs for current year

(In Dollars): $35,000.00 $20,000.00

Estimated natural gas costs for current year

(In Dollars): $40,000.00 $0.00

Estimated fuel oil costs for current year (In

Dollars): $0.00 $18,000.00

Estimated other energy costs for current

year (In Dollars): $3,000.00 $5,000.00
Estimated electricity consumption for next
year (In kWh): 250,000 400,000
Estimated natural gas consumption for next
year (In Therms): 200,000 0
Estimated fuel oil consumption for next
year (In Gallons): 0 40,000
Estimated other energy consumption for
next year (List Units Here): 0 0
What is the facility's goal to score in the
Portfolio Manager in one year ? 60 60
What is the facility's goal to score in the
Portfolio Manager in three years? 75 75
 Energy $mart Schools
District: Sample Town CSD Prepared by: John Doe Date: 02/01/2005
MAJOR PROJECTS DURING LAST YEAR
SED # (if applicable) Brief Project Description Project Dates Costs Project Benefits
Example: New Boiler Controls Reduce energy costs $150/year, eliminate
SED #00-00-00-00-0-000 5/5/03 to 9/5/03 $120,000
frequent repairs.

TOTAL $120,000
 Energy $mart Schools
District: Sample Town CSD Prepared by: John Doe Date: 02/01/2005
PLANNED CAPITAL PROJECTS
Funding
Facility Name SED Number Project Description Year Priority Construction Type Project Type Cost Annual Benefits Notes
Source

Elementary Elementary
School 43305439053 New RTUs 2 1 New Construction Major System Capital $30,000.00

Elementary Elementary
School 121212121234124 New Windows 5 3 Addition Health/Safety Capital $20,000.00

Elementary Elementary Treat pest problems in 36

School 34059384535 classrooms 2 3 Alteration Health/Safety Bond $10,000.00
Lower energy costs, reduced service contract,
Good Grades Middle and defer planned replacement (est repl cost
School 121212121234124 Example 1 2 Alteration Energy Bond $15,600.00 $12,000.00 $250K) by 5-8 years.

Good Grades Middle

School 10294958771729 Remove remaining asbestos 4 2 Addition Health/Safety Capital $60,000.00

Elementary Elementary
School 3242309482 Example 2 2 Alteration Major Repair Bond $20,000.00 $4,000.00
 School Facility Report Card

School District/BOCES: Sample Town CSD Building Name: Example School 6

School Building Address: -- ,
Certificate of Occupancy Status: 0 Expiration Date: 12/30/1899
Location where certificate of occupancy is posted: 0

Section I: School Building General Information

1. Person completing this School Facility Report Card: John Doe Date: 2/1/2005
2. Right-to-Know designee concerning this school building and School Facility Report Card:
Name: John Doe Telephone: 999-999-9999
Position: Superintendent of Buildings and Grounds Fax: 888-888-8888 E-mail:
Address: 101 Main Street City: Albany Zip:
3.a. Original Construction Date (year): 0
3.b. Present size of school building (SF): 0 Number of floors: 0 Basement? (Yes/No): 0
4. Grade levels currently housed in this building: 0 Current enrollment: 0
5. Upgrades to school building systems can be viewed on the Building Condition Survey? 0
6. Number of different types of program spaces currently in this school building can be viewed on the Building Condition Survey? 0

Section II: School Building Ratings

7. Date current 5-year building condition survey conducted: 12/30/1899
Overall school building safety rating from Building Condition Survey as certified by the Board of Education: 0
8. Date current year annual visual inspection conducted: 12/30/1899
Overall condition: 0

Section III: Building Capital, Maintenance, and Operations Information

9. List any current unsatisfactory building systems that have not been corrected since the previous Building Condition Survey. (Add additional sheets as necessary)
Building systems listed here.

10. Estimated remaining useful life of school building and systems can be viewed on the Building Condition Survey? (Yes/No) 0
11. The need for routine maintenance, repairs, rehabilitation, reconstruction, and construction can be viewed on the Capital Facilities Plan? (Yes/No) 0
List prioritized health and safety improvements for this facility as indicated in the five year plan:
 School Facility Report Card
Year Priority Description
 School Facility Report Card
Estimated Costs to Restore Buildings to a State of Good Estimated Annual Costs to Keep Buildings in a
Projected Budget fo
Repair State of Good Repair
Cost Estimate Cost Estimate Cost Estim
Site Elements 0.00 0.00 0.00
Roofing 0.00 0.00 0.00
Envelope Elements 0.00 0.00 0.00
Structural Interior 0.00 0.00 0.00
Elements/Finishes 0.00 0.00 0.00
Electrical 0.00 0.00 0.00
Plumbing 0.00 0.00 0.00
HVAC 0.00 0.00 0.00
Special Construction 0.00 0.00 0.00
Emergency Systems (fire alarm, sprinklers, public 0.00 0.00 0.00
address, etc.)
Other 0.00 0.00 0.00
TOTAL Estimated Cost 0.00 0.00 0.00

12. Estimated energy costs for current school year by type:

Electricity: $0.00 Gas: $0.00

Fuel Oil: $0.00 Other: $0.00

Total estimated energy costs: $0.00

Section IV: Health and Safety

13. Description of Health and Safety Committee activities: Yes/No
a. Does the district have a health and safety committee? Yes
b. Does the Health and Safety Committee have a chairperson? No Name:
c. Phone number of Health and Safety Committee Chairperson: 212-867-5309 Email:

d. Basic Health and Safety Committee membership:

- District Officials Yes
- Staff No
- Bargaining Units Yes
 School Facility Report Card
e.- Health
Parentsand Safety Committee membership expanded during construction to No
include district officials, staff, bargaining units, parents and:
- Project Architect Yes
- Project Engineer Yes

- Construction Manager No
- Contractors Yes
f. Frequency of Health and Safety Committee meetings (check one): 3-5 Times / School Year
 School Facility Report Card
Section V: Environmental Awareness
14. Lead testing:
a. Has this building been tested for the presence of lead: paints, plumbing, etc.?
b. Based on the testing results, are there elements in this building that would require construction or maintenance
projects to be conducted in accordance with the US Department of Housing and Urban Development Guidelines
for the Evaluation and Control of Lead Based Paint Hazards in Housing?
c. If yes, has this type of work been done in accordance with the Guidelines?

15. Federal Asbestos Hazard Emergency Response Act (AHERA) Plan:

a. Does this building contain known or assumed asbestos containing building materials? (ACBM)
b. If yes, has an original AHERA management plan been developed for this building? (The AHERA Management
Plan for this building may be viewed at the main office during normal business hours).
c. When was the AHERA management plan last updated?
16. Radon testing:
a. Has the district reviewed the geological potential for the presence of radon from the NYSDOH Radon
Measurement Database?
b. Did the geological potential indicate testing this facility was necessary?
c. If yes, did the highest test in this building exceed 4pCi/L?
d. If yes, describe mitigation activities:
Mitigation activities described here.

17. Integrated Pest Management Program:

a. Does this school have an integrated pest management program?
b. Does this school have a person designated to oversee the pest management program?

c. Has this school established a list of persons to notify at least 48 hours prior to the application of pesticides?

d. Have pesticide application summary reports been provided to all parents and staff pursuant to CR 155.24?

18. Status of measures taken to assure acceptable indoor air quality:

a. Does this school utilize the EPA Indoor Air Quality Tools for Schools Action Kit?
 School Facility Report Card
b. Does this school have a procedure in place for reporting indoor air quality concerns?
 School Facility Report Card
c. Is ventilation with outdoor air available in all occupied spaces?
1. Is all ventilation and exhaust equipment operational?
2. Are all outdoor air intakes unobstructed and clear of foreign objects?
3. Are all outside air damper controls in place and operational?
4. Have facilities operations been reviewed with respect to impact on outside air
intakes (i.e., vehicle emissions, waste storage, mowing, etc.)?
d. Are there any unresolved complaints regarding indoor air at this facility?
If yes, describe: IEQ description here.

e. Maintenance: Heating, ventilation, and air conditioning equipment are cleaned and maintained in
accordance with manufacturer’s instructions (i.e., filter changes, coils cleaned, etc.)
f. Has the interior of ductwork (air passageways) been inspected for cleanliness?
g. Have exterior ductwork and rooftop air handling units been inspected for leaks?
h. Operations and maintenance program:
1. Does the District have a policy encouraging the use of environmentally friendly
products?
2. Products entering a school building are reviewed with the intent of reducing or
eliminating hazardous chemicals, including volatile organic compounds (VOCs), semi-
volatile organic compounds, etc. (cleaning supplies, repair and maintenance supplies,
materials, etc.).

3. Review performed to ensure hazardous chemicals used as part of instructional

program are used and stored properly.
i. Buildings are inspected for roof leaks, growth of mold, evidence of rodent infiltration, and other potential
problems to acceptable IAQ.
j. Is this facility seeking to comply with a whole building sustainable guideline, such as the U.S. Green Building
Council's LEED® for Existing Buildings?
cility Report Card

<< Select to change school

12/30/1899

test@imagine.com
12345
cility Report Card
Description
cility Report Card
Projected Budget for O&M Costs

Cost Estimate
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00

0.00
0.00

John Milton
milty@school.com
cility Report Card
cility Report Card
Yes/No
0

0
0

0
12/30/1899

0
0
0

s described here.

0
0

0
cility Report Card
0
cility Report Card
0
0
0
0
0

0
re.

0
0

0
 Sample Town CSD
Valley View BOCES

Five-Year Capital Facilities

Submitted/Revised

2/1/2005
 Table of Contents
Item

Executive Summary

Building Inventories
Elementary Elementary School
Good Grades Middle School
Example School 3
Example School 4
Example School 5
Example School 6

District Analysis and Prioritization

Estimated Expenses
Elementary Elementary School
Good Grades Middle School
Example School 3
Example School 4
Example School 5
Example School 6
 Executive Summary
Following are the people who prepared this plan and the resources used:
People and resources here.

Following is a narrative of the general conditions of each facility:

Facility Name Narrative

Elementary Elementary SchoolInsert assessment here…

Good Grades Middle School Insert assessment here…

Example School 3 Insert assessment here…

Example School 4 Insert assessment here…

Example School 5 Insert assessment here…

Example School 6 Insert assessment here…

 Building Inventory Form

Building Name: Example School 6

Bed Codes Number: 0

Address: -- ,

Use: 0 Current enrollment:

Total square footage: 0 Rated Capacity:

Ownership: 0

Building Condition Survey Rating: 0

Building Age:

Construction Year Square Footage

Original 0 0
Addition #1 0 0
Addition #2 0 0
Addition #3 0 0
Addition #4 0 0
Addition #5 0 0
Addition #6 0 0
Addition #7 0 0
Addition #8 0 0
Addition #9 0 0
Addition #10 0 0

Heating System Energy Source: 0

Energy Consumption: 0 kWh (electricity)

(per year) 0 gallons (fuel oil)

Probable Useful Life of Building: 0 years Estimated Replacement Value:

 District-Wide Analysis and Prioritization
District: Sample Town CSD

Year 1 SED Number Priority Facility Name

121212121234124 2 Good Grades Middle School

Year 2 SED Number Priority Facility Name

3242309482 2 Elementary Elementary School

34059384535 3 Elementary Elementary School

43305439053 1 Elementary Elementary School

Year 3 SED Number Priority Facility Name

Year 4 SED Number Priority Facility Name

10294958771729 2 Good Grades Middle School

Year 5 SED Number Priority Facility Name

121212121234124 3 Elementary Elementary School

mple Town CSD
y View BOCES

Capital Facilities Plan

ubmitted/Revised

2/1/2005
Table of Contents
Page

2
3
4
5
6
7

9
10
11
12
13
14
Executive Summary
plan and the resources used:

ions of each facility:

here…

here…

here…

here…

here…

here…
uilding Inventory Form

Example School 6

-- ,

Current enrollment: 0

0
 0 therms (natural gas)

0 units (other)

Estimated Replacement Value: $0.00

ct-Wide Analysis and Prioritization

Costs

Good Grades Middle School $15,600.00

Year Total $15,600.00

Costs

Elementary Elementary School $20,000.00

Elementary Elementary School $10,000.00

Elementary Elementary School $30,000.00

Year Total $60,000.00

Costs

Year Total $0.00

Costs

Good Grades Middle School $60,000.00

Year Total $60,000.00

Costs

Elementary Elementary School $20,000.00

Year Total $20,000.00

District Total $155,600.00

 Facility Estimated Expenses
District: Sample Town CSD
Facility Name: Example School 6 << select to change school

New Construction

Major System

Major Repair
Alterations
Addition

Capital
Energy

Bond
Year 1 Priority SED # Item Description Cost

Year Total $0.00

Year 2 Priority SED # Item Description Cost

Year Total $0.00

Year 3 Priority SED # Item Description Cost

Year Total $0.00

Year 4 Priority SED # Item Description Cost

Year Total $0.00

Year 5 Priority SED # Item Description Cost

Year Total $0.00

Facility Total $0.00
 Energy $mart Schools
Comprehensive Maintenance Plan (CMP)
District: Sample Town CSD Prepared by: John Doe Date: 02/01/2005

Equipment Inventory
School: ________________________________ Date Updated: ____________________________

Expected Suggested Annual

Efficiency Number in Service Life Maint Interval (# Maintenance
Heating Systems P.M. Ref # Manufacturer Model # Serial # Size Fuel Type Rating Building Installation Date (yrs) Location per year) Special Tools Required Cost ($) Notes
No. 14 3-headed left-handed propane-
Boilers HS 2004-01 IBR K500-B 123-456-78 500,000 Btu Gas 75% 2 1977, 1992 35 Boiler room next to loading dock 4 powered pneumatic sprocket $1,200
Furnaces
Condenser pumps
Deaerator tank
Steam traps
Steam valves
Fuel tanks & distribution
Heat exchangers
Terminal/package units
Fin tubes/radiators
Dampers/draft control
Ductwork
Stacks
Insulation
Piping
Valves
Control sensors

Expected Suggested Annual

Efficiency Number in Service Life Maint Interval (# Maintenance
Air Handling Systems P.M. Ref # Manufacturer Model # Serial # Size Fuel Type Rating Building Installation Date (yrs) Location per year) Special Tools Required Cost ($) Notes

Air handling units

Unit ventilators
Fans
Fire dampers
Filters
Humidifiers

Expected Suggested Annual

Efficiency Number in Service Life Maint Interval (# Maintenance
Cooling Systems P.M. Ref # Manufacturer Model # Serial # Size Fuel Type Rating Building Installation Date (yrs) Location per year) Special Tools Required Cost ($) Notes

Condensing units
Air compressors
Heat exchangers
Packaged A/C units
Chillers
CHW Pumps
Heat pumps
 Equipment Inventory
School: ________________________________ Date Updated: ____________________________

Expected Suggested Annual

Fire Protection/ Efficiency Number in Service Life Maint Interval (# Maintenance
Suppression Systems P.M. Ref # Manufacturer Model # Serial # Size Fuel Type Rating Building Installation Date (yrs) Location per year) Special Tools Required Cost ($) Notes

Sprinkler piping
Backflow preventers
Sprinkler heads
Fire extinguishers
Fire hose system
Standpipe connection
Fire pumps

Grease hood extinguisher

Alarms and detectors

Expected Suggested Annual

Efficiency Number in Service Life Maint Interval (# Maintenance
Mechanical Controls P.M. Ref # Manufacturer Model # Serial # Size Fuel Type Rating Building Installation Date (yrs) Location per year) Special Tools Required Cost ($) Notes
Compressors
Pneumatic valves/levers
Pneumatic tubing
Electronic controls

Expected Suggested Annual

Efficiency Number in Service Life Maint Interval (# Maintenance
Plumbing Systems P.M. Ref # Manufacturer Model # Serial # Size Fuel Type Rating Building Installation Date (yrs) Location per year) Special Tools Required Cost ($) Notes

Cold water piping

Water heaters
Hot water piping
Circulation pumps
Sump pumps
Valves and traps
Septic tanks

Expected Suggested Annual

Efficiency Number in Service Life Maint Interval (# Maintenance
Lighting Systems P.M. Ref # Manufacturer Model # Serial # Size Fuel Type Rating Building Installation Date (yrs) Location per year) Special Tools Required Cost ($) Notes

Fluorescent fixtures
Incandescent fixtures
HID fixtures
Lighting panels
Emergency lighting
Exterior lighting
Occupancy controls
Daylight controls
Other controls

Expected Suggested Annual

Efficiency Number in Service Life Maint Interval (# Maintenance
Signal Systems P.M. Ref # Manufacturer Model # Serial # Size Fuel Type Rating Building Installation Date (yrs) Location per year) Special Tools Required Cost ($) Notes
Computer data
 Equipment Inventory
School: ________________________________ Date Updated: ____________________________

Public address
Television
Telephone
Clock system
Fire alarms
Security alarm/devices

Expected Suggested Annual

Foundation and Efficiency Number in Service Life Maint Interval (# Maintenance
Substructure P.M. Ref # Manufacturer Model # Serial # Size Fuel Type Rating Building Installation Date (yrs) Location per year) Special Tools Required Cost ($) Notes
Footings
Foundation walls
Slab/beams on grade
Piling/Posts How?
Waterproofing How?
Insulation
Underdrains How?

Expected Suggested Annual

Efficiency Number in Service Life Maint Interval (# Maintenance
Superstructure P.M. Ref # Manufacturer Model # Serial # Size Fuel Type Rating Building Installation Date (yrs) Location per year) Special Tools Required Cost ($) Notes

Columns
Beams
Floor structure
Roof structure
Monolithic bearing walls
Stairs and railings
Structural bracing
Welds/connectors

Expected Suggested Annual

Efficiency Number in Service Life Maint Interval (# Maintenance
Roof Systems P.M. Ref # Manufacturer Model # Serial # Size Fuel Type Rating Building Installation Date (yrs) Location per year) Special Tools Required Cost ($) Notes

Roofing
Insulation
Paving and ballast
Paving? On a roof?
Curbs/supports
Expansion/seismic joints
Drains, gutters, etc.
Drywells
Flashing and trim
Fasteners
Snow stops
Roof openings
Parapet caps
 Equipment Inventory
School: ________________________________ Date Updated: ____________________________

Expected Suggested Annual

Efficiency Number in Service Life Maint Interval (# Maintenance
Exterior Wall Systems P.M. Ref # Manufacturer Model # Serial # Size Fuel Type Rating Building Installation Date (yrs) Location per year) Special Tools Required Cost ($) Notes

Facade integrity
Cladding/sheathing
Doors
Window systems
Balcony walls/railings
Louvers and screens
Expansion/seismic joints
Insulation
Protective coating
Sealants

Expected Suggested Annual

Efficiency Number in Service Life Maint Interval (# Maintenance
Interior Construction P.M. Ref # Manufacturer Model # Serial # Size Fuel Type Rating Building Installation Date (yrs) Location per year) Special Tools Required Cost ($) Notes

Fixed partitions
Demountable partitions
Retractable partitions
Doors
Carpet
Resilient tile/sheet
Ceramic/clay tile
Terrazzo
Paint
Vinyl/fabric wall cover
Ceiling system

Expected Suggested Annual

Efficiency Number in Service Life Maint Interval (# Maintenance
Power Generation P.M. Ref # Manufacturer Model # Serial # Size Fuel Type Rating Building Installation Date (yrs) Location per year) Special Tools Required Cost ($) Notes

Generators
Transfer switches
Transformers
Service wiring
Substation
Switchgear
Overcurrent protection

Expected Suggested Annual

Power Distribution Efficiency Number in Service Life Maint Interval (# Maintenance
Systems P.M. Ref # Manufacturer Model # Serial # Size Fuel Type Rating Building Installation Date (yrs) Location per year) Special Tools Required Cost ($) Notes

Main distribution panel

Wiring, conduits, &
distribution panels
Electrical receptacles
Circuit breakers
 Equipment Inventory
School: ________________________________ Date Updated: ____________________________

Electric baseboard heaters

Heat trace

Expected Suggested Annual

Efficiency Number in Service Life Maint Interval (# Maintenance
Landscaping Systems P.M. Ref # Manufacturer Model # Serial # Size Fuel Type Rating Building Installation Date (yrs) Location per year) Special Tools Required Cost ($) Notes

Irrigation
Tree/shrub/flower bed
plantings
Turf/lawn
Walks/plazas

Expected Suggested Annual

Playfields and Efficiency Number in Service Life Maint Interval (# Maintenance
Playground Systems P.M. Ref # Manufacturer Model # Serial # Size Fuel Type Rating Building Installation Date (yrs) Location per year) Special Tools Required Cost ($) Notes

Athletic fields
Hard surface courts
Swings
Safety mats
Gravel and containment
Markings/painting

Expected Suggested Annual

Efficiency Number in Service Life Maint Interval (# Maintenance
Vehicular Systems P.M. Ref # Manufacturer Model # Serial # Size Fuel Type Rating Building Installation Date (yrs) Location per year) Special Tools Required Cost ($) Notes

Parking lots
Roads/drives
Curbs
Fire lanes

Expected Suggested Annual

Efficiency Number in Service Life Maint Interval (# Maintenance
Site Utilities P.M. Ref # Manufacturer Model # Serial # Size Fuel Type Rating Building Installation Date (yrs) Location per year) Special Tools Required Cost ($) Notes
Fuel tanks
Fuel distribution piping
Storm drainage
Fire hydrant systems

Expected Suggested Annual

Efficiency Number in Service Life Maint Interval (# Maintenance
Specialties P.M. Ref # Manufacturer Model # Serial # Size Fuel Type Rating Building Installation Date (yrs) Location per year) Special Tools Required Cost ($) Notes

Toilet partitions
Display boards
Projection screens
Display cases
Lockers
Elevators
Waste handling equipment
 Equipment Inventory
School: ________________________________ Date Updated: ____________________________

Food service equipment

Woodworking shop
equipment
Auto/engine shop
equipment
Vaults
Swimming pools
 Energy $mart Schools
Comprehensive Maintenance Plan (CMP)
District: Sample Town CSD Prepared by: John Doe Date: 02/01/2005

PM Checklist and Log

School: ____________________________________ Year: ________________ Implementor Key: M = Maintenance Mechanic C = Custodian/on-site staff G = Grounds crew CC = Contracted to others

Heating Systems P.M. Ref # Implementor Frequency/Year Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
Boilers HS 2004-01 M 4 x x x x
Boiler water treatment 10
Furnaces 4
Condenser pumps 4
Deaerator tank 2
Steam traps 4
Steam valves 1-4
Fuel tanks & distribution 1
Heat exchangers 2
Terminal/package units 4
Fin tubes/radiators 4
Dampers/draft control 4
Ductwork 2
Stacks 4
Insulation 2
Piping 4
Valves 1
Control sensors 2

Air Handling Systems P.M. Ref # Implementor Frequency/Year Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
Air handling units 4
Unit ventilators 4
Fans 2
Fire dampers 1
Filters 2-4
Humidifiers 2

Cooling Systems P.M. Ref # Implementor Frequency/Year Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
Condensing units 4
Air compressors 12
Heat exchangers 2
Packaged A/C units 4
Chillers: oil levels and operation 52
Chillers: other 12
CHW Pumps 2-4
Heat pumps 4
 District: Sample Town CSD Prepared by: John Doe Date: 02/01/2005

PM Checklist and Log

School: ____________________________________ Year: ________________ Implementor Key: M = Maintenance Mechanic C = Custodian/on-site staff G = Grounds crew CC = Contracted to others

Fire Protection/Suppression Systems

Sprinkler piping
Backflow preventers
Sprinkler heads
Fire extinguishers
Fire hose system
Standpipe connection
Fire pumps
Grease hood extinguisher
Alarms and detectors

Mechanical Controls
Compressors
Pneumatic valves/levers
Pneumatic tubing
Electronic controls

Plumbing Systems
Cold water piping
Water heaters
Hot water piping
Circulation pumps
Sump pumps
Valves and traps
Septic tanks

Lighting Systems
Fluorescent fixtures
Incandescent fixtures
HID fixtures
Lighting panels
Emergency lighting
Exterior lighting
Occupancy controls
Daylight controls
Other controls

Signal Systems
Computer data
Public address
Television
 District: Sample Town CSD Prepared by: John Doe Date: 02/01/2005

PM Checklist and Log

School: ____________________________________ Year: ________________ Implementor Key: M = Maintenance Mechanic C = Custodian/on-site staff G = Grounds crew CC = Contracted to others

Telephone
Clock system
Fire alarms
Security alarm/devices

Foundation and Substructure

Footings How?
Foundation walls
Slab/beams on grade
Piling/Posts How?
Waterproofing How?
Insulation
Underdrains How?

Superstructure
Columns
Beams
Floor structure
Roof structure
Monolithic bearing walls
Stairs and railings
Structural bracing
Welds/connectors

Roof Systems
Roofing
Insulation
Paving and ballast Paving? On a roof?
Curbs/supports
Expansion/seismic joints
Drains, gutters, etc.
Drywells
Flashing and trim
Fasteners
Snow stops
Roof openings
Parapet caps

Exterior Wall Systems

Facade integrity
Cladding/sheathing
Doors
 District: Sample Town CSD Prepared by: John Doe Date: 02/01/2005

PM Checklist and Log

School: ____________________________________ Year: ________________ Implementor Key: M = Maintenance Mechanic C = Custodian/on-site staff G = Grounds crew CC = Contracted to others

Window systems
Balcony walls/railings
Louvers and screens
Expansion/seismic joints
Insulation
Protective coating
Sealants

Interior Construction
Fixed partitions
Demountable partitions
Retractable partitions
Doors
Carpet
Resilient tile/sheet
Ceramic/clay tile
Terrazzo
Paint
Vinyl/fabric wall cover
Ceiling system

Power Generation
Generators
Transfer switches
Transformers
Service wiring
Substation
Switchgear
Overcurrent protection

Power Distribution Systems

Main distribution panel
Wiring, conduits, & distribution panels
Electrical receptacles
Circuit breakers
Electric baseboard heaters
Heat trace

Landscaping Systems
Irrigation
Tree/shrub/flower bed plantings
Turf/lawn
Walks/plazas
 District: Sample Town CSD Prepared by: John Doe Date: 02/01/2005

PM Checklist and Log

School: ____________________________________ Year: ________________ Implementor Key: M = Maintenance Mechanic C = Custodian/on-site staff G = Grounds crew CC = Contracted to others

Playfields and Playground Systems

Athletic fields
Hard surface courts
Swings
Safety mats
Gravel and containment
Markings/painting

Vehicular Systems
Parking lots
Roads/drives
Curbs
Fire lanes

Site Utilities
Fuel tanks
Fuel distribution piping
Storm drainage
Fire hydrant systems

Specialties
Toilet partitions
Display boards
Projection screens
Display cases
Lockers
Elevators
Waste handling equipment
Food service equipment
Woodworking shop equipment
Auto/engine shop equipment
Vaults
Swimming pools
Raised computer flooring
 Preventive Maintenance Work Order Sheet

Equipment to be Worked on:

School District: Date Issued:

School: Date Completed:

Performed By: PM Code #:

Type of PM to be Performed: Monthly Quarterly Semi-Annual Annual Other

Time to Allow for Perform PM Work: Hour (s)

Tools Required:

Description of Work to be Performed: Remarks:

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

Additional Follow-up Activities Needed:

 O&M Specification Language
A.
Operation and Maintenance Instructions: Arrange for each Installer of equipment that requires regular maintenance to meet
with the Owner's personnel to provide instruction in proper operation and maintenance of the installed equipment. Provide
instruction by manufacturer's representatives if installers are not experienced in operation and maintenance procedures.
Include a detailed review of the following items:

1 Maintenance manuals.
2 Record documents.
3 Spare parts and materials.
4 Tools.
5 Lubricants.
6 Fuels.
7 Identification systems.
8 Control sequences.
9 Hazards.
10 Cleaning.
11 Warranties and bonds.
12 Maintenance agreements and similar continuing commitments.

B. Maintenance Manuals: Organize operation and maintenance data into suitable sets of manageable size. Bind properly
indexed data in individual, heavy-duty, 3-ring, vinyl-covered binders, with pocket folders for folded sheet information. Mark
appropriate identification on front and spine of each binder. Include the following types of information:

1 PM intervals
2 Emergency instructions.
3 Spare parts list.
4 Copies of warranties.
5 Wiring diagrams.
6 Inspection procedures.
7 Shop Drawings and Product Data.
8 Replacement schedules for filters, seals, lubricants, etc.

C. Training: As part of instruction for operating equipment, demonstrate the following procedures:

1 Startup.
2 Shutdown.
3 Emergency operations.
4 Noise and vibration adjustments.
5 Safety procedures.
6 Economy and efficiency adjustments.
7 Effective energy utilization.
8 Periodic PM procedures.
 Best Practices Guides and Resources

US Environmental Protection Agency (EPA) Indoor Air Quality Tools for Schools Action Kit is available by calling 1-800-438-4318

US EPA Integrated Pest Management (IPM) in Schools resources are available online at
www.epa.gov/pesticides/ipm/index.htm . The popular EPA booklet, "Pest Control in the School
Environment: Adopting IPM" is designed to encourage and assist school officials in examining and
improving their pest management practices. It identifies ways to reduce the use of pesticides in school
buildings and landscapes, as well as alternative methods of managing pests commonly found in schools. A
copy of the booklet may be obtained on-line by contacting the National Service Center for Environmental
Publications , or by phone at 1-800-490-9198. The EPA publication number is EPA 735-F-93-012.

US EPA Energy Star Portfolio Manager and the New York State Energy Research and Development
Authority (NYSERDA) Energy Smart Schools Program free energy benchmarking service is available by
calling 1-866-NYSERDA.

US Department of Energy, Energy Smart Schools Program has numerous resources available at www.rebuild.org/sectors/ess/index.a

School Operations and Maintenance: BEST PRACTICES FOR CONTROLLING ENERGY

COSTS, A Guidebook for K-12 School System Business Officers and Facilities Managers. U.S.
Department of Energy Office of Energy Efficiency and Renewable Energy Weatherization and
Intergovenmental Program, Rebuild America EnergySmart Schools Program, August 2004.

ADDITIONAL REFS TO BE ADDED