Resources High school boy carving in art class and cafeteria worker getting bucket of water

Forms and Checklists

WAIVERS AND AUTHORIZATION FORMS

SIA recommends that districts use the following forms available in English, Spanish, Russian, Ukrainian, Hmong, Hindi, Punjabi, Tagalog and Vietnamese. These forms have been formatted with space at the top to allow for printing on district letterhead. The purpose and use guideline is provided for each of the available forms.

Purpose and use guidelines for Waivers and Authorization Forms - descriptions

PDF DocumentDownload Waivers and Authorization Forms "Cheat Sheet" (pdf)

Use of Facilities Forms

  • Use of Facilities, Indemnity and Insurance Agreement (Education Code)
  • Use of Facilities, Indemnity and Insurance Agreement (Non-Education Code)
  • Use of Facilities Agreement Between Public Agencies

Participation Forms

  • PDF DocumentSports-Related Form "Cheat Sheet" (pdf)
  • Agreement for Activity Participation
  • Contract for Adult Activity Participation
  • Agreement for Team Participation
  • Sports Physical Examination Form
  • Student Field Trip Authorization
  • Student Field Trip (Outside California) Authorization

Transportation Forms

  • Volunteer Personal Automobile Use Form
  • Student Personal Automobile Use Form
  • Student Alternate Transportation Form
     
AMERICANS WITH DISABILITIES ACT (ADA)

 

COMPLIANCE

Injury and lllness Prevention Program

Stormwater

Word DocumentChecklist for 2018-2019 monitoring year

Excel DocumentWet-Weather Storm Water Inspection Report Form.  (Use this form when collecting your samples)

Excel DocumentMonthly Non-Storm Water Discharge Inspection Report Form.  (Use this form to record your monthly visual observations)

ACFCE Annual Inspection Form

 

DRIVING SAFETY

SPAB Checklist  PDF DocumentDownload SPAB Checklist (pdf)

What Employers Need to Know About DOT Drug and Alcohol Testing

 

FIRE SAFETY AND ARSON PREVENTION

Arson Prevention Tips Checklist  Word DocumentDownload Arson Prevention Checklist (doc)

 

HEALTH AND WELLNESS

Golden Carrot Fund

CPR Posters

Request CPR Poster

 

PLAYGROUND SAFETY

Playground Signage
School playgrounds are often available for use by the public during non-school hours. These labels were designed to help the public use your equipment safely. The labels indicate the appropriate age range of the user, suggestions for safe play and direction for adult supervision and concerns. Each label is 5x7 inches and can be affixed directly onto the equipment. There are three age range options 2 to 5 years, 5 to 12 years and 2 to 12 years. Select the label that is most appropriate for the design of your equipment.

Playground Label Order Form (pdf)

Resources

uuWord DocumentPlayground Audit/Inspection form

SCHOOL, EMPLOYEE AND WORKPLACE SAFETY

Warning Labels
The following Warning Labels are available upon email request to Prevention Services. Be sure to indicate the specific label you are interested in.

  • "Do Not Remove Paperguard from this Papercutter"
  • "AV Cart Tipover Hazard"
  • "Folding Table Tipover Hazard" (1 1/2" x 10")
  • "Warning! Alarm System Electronically Protected" 4" x 4" (specify front adhesive or back adhesive)
  • Tall Fire Extinguisher "Do Not Block" for interior (4" x 15")
  • Square "Fire Extinguisher Inside" for exterior (5" x 5")
  • Electrical Panel, Maintain 36" Clearance (7" x 7")
  • Metal Ladder, Electrical Shock Warning (4-1/2" x 3")
  • Step Ladder Safety (2" x 11")
  • Ladder, "Danger Do Not Stand Above This Rung..." (6" x 1-1/2")
  • "NOTICE This Property is Protected by Video Surveillance" (7" x 7") (specifiy front adhesive or back adhesive)
  • SIA Playground Signage (5" x 7")
  • Always Anchor Goals (3.5" x 3.5")
  • Warning - Never Climb on Goal (3" x 6")

Sample Labels:  Ladder labels / Cafeteria table labels / Soccer Goal labels / Other labels

Word DocumentDownload Warning Labels Form (pdf)

Email to Request Warning Label