# Attachment 1 **– Survey Instrument**  Fast Response Survey System (FRSS) 105 : Condition of Public School Facilities OMB# 1850
-0 73 3 v. 27

October 22, 2012 National Center for Education Statistics U.S. Department of EducationU.S. DEPARTMENT OF EDUCATION NATIONAL CENTER FOR EDUCATION STATISTICS

WASHINGTON, D.C. 20006

–5651 **CONDITION OF PUBLIC SCHOOL FA CILITIES**  **: 2012 -**  **13**

FAST RESPONSE SURVEY SYSTEM FORM APPROVED O.M.B. No.: 1850

–0733 EXPIRATION DATE: 05/2015 **Draft 10 -**  **19 -**  **12** This survey is authorized by law (Education Sciences Reform Act of 2002, 20 U.S.C. § 9543). Wh ile participation in this survey is voluntary, your cooperation is critical to make the results of this survey comprehensive, accurate, and timely. Your answers may

be used only for statistical purposes and may not be disclosed, or used, in identifiable form for any other purpose unless otherwise compelled by law (Educati on Sciences Reform Act of 2002, 20 U.S.C. § 9573). 

# Please **prov ide**  **information only** **a bout**  **the school**  **that is**  **indicated on**  **the front of this sur** **ve y** **. This**  **survey is**  **designed to**  **be completed**  **by district** **- level**  **personnel who**  **are very**  **f amiliar**  **with the**  **school facilities in this district.**  **You may** 

**wish t** **o consult with**  **other district** **- level**  **personnel or with**  **school -** **level personnel, such**  **as the**  **principal of**  **the selected**  **school, in**  **answering some**  **questions. Please**  **respond about**  **the selected**  **school for the current 2012 -**  **13 school y ear,**  **even if the selected school is ne w.** 



### NA**ME AN**  **D ADDRESS**  **OF SA** **MPLED SCHOOL**  **HERE**

IF ABOVE **SCHOOL** INFORMATION IS INCORRECT, PLEASE UPDATE DIRECTLY ON LABEL. Name of person completing this form:

________________________________ ________________________________ ___ Title/position:

________________________________ ________________________________ ______________________ Telephone number:

________________________________ ___ E
- ma il:

________________________________ ______ Best days and times to reach you (in case of questions):

________________________________ ___________________ **Grades taught at this school: Low est**  **grade taught** 

**________ High**  **est grade**  **taught**

**________**

**THA NK YOU.**  **PLEA SE KEEP A**  **COPY OF THIS SURVEY FOR YOUR RECORDS.**  **PLEASE RETURN COMPLETED FORM TO: IF YOU HAVE ANY QUESTIONS OR COMMENTS, CONTACT:**  **Ma il:**  Debbie Alexander (8599. 13 .1 3 .02) Debbie Alexander at W estat Westat 800
-937
-8281, Ext. 2088 or 301
-294
-20 88 1600 Research Boulevard E
- ma il: debbiealexander@westat.com Rockville, Maryland 20850
- 31 29 **Fax:** 800
-254
-0984 According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid O MB control number for this information collection is 1850

–0733. The time required to complete this information collection is estimated to average 30 minutes per response, including the time to review instructions, search existing data resources, gath er the data needed, and complete and review the information collection. If you have any comments concerning the accuracy of the time estimate or sugg estions for im proving this form, please write to: U.S. Department of Education, Washington, DC 20202

–4537. If you have any comments or concerns regarding the status of your individual submission of this form, write directly to: National Center for Education Statistics, 1990 K Street, NW, Wash ington, DC 20006. FRSS Form No. 105 , 01/2013

### Instructions and Definitions Page Please provide information only about the school that is indicated on the front of this survey. Respond about the selected school for the current 2012

– 13 school year, even if the selected school is new. If the school has mo re than one permanent or portable building on site , consider all of them in providing a rating.
I n **question s**  **2 and**  **3 ,**  u se the following rating scale to indicate the condition of building s ystems/features and outdoor features :
**“ School does not have**  **”** means that a building system/feature does not exist within that type of building, or that the school does not have that outdoor feature. **Excellent** means that a particular feature or s ystem meets all the reasonable needs of the school pertaining to that item, yet goes well beyond adequate. Relatively minor enhancements may be necessary. **Good** means a feature or system meets all the reasonable needs of the school, is most often in good condition, and generally meets some, but not all, of the characteristics of an excellent s ystem/feature. **Fair** means that a feature or system meets minimal conditions but is not dependable, breaks down frequently, or has other limitations. It is a feature or system that would require some upgrading to be considered in good con dition. **Poor** means that a particular feature or system as it exists is inadequate to meet even the minimal needs of the school.

I n **question 4 ,**  use the following rating scale to indicate the overall condition of each type of onsite building at this school:

**“ School does not have**  **”** means that the school does not have that type of building. **Excellent** means that the facility meets all the reasonable needs for normal school performance, yet goes well beyond adequate. Relatively minor enhancements may be necessary. **Good** means that the facility meets all the reasonable needs for normal school performance, is most often in good condition, and generally meets some, but not all, of the characteristics of an excellent facility. **Fair** means that the facility meets m inim al needs for normal school performance but requires frequent maintenance or has other limitations. It requires some upgrading to be considered in good condition. **Poor** means that the facility does not meet minimal requirements for normal school performance. 

### Definitions **Energy m**  **anagement system**  **:** A control system (often computerized) designed to regulate the energy consumption of a building by

controlling the operation of energy consuming systems, such as the heating, ventilation , and air conditioning (HVAC), lighting , and water heating systems. These systems are sometimes referred to as mechanical control system s or building automation system s . **Life safety feature** **s:** Incl udes sprinklers, fire alarms, and smoke detectors. **Security s** **ystems:** includes surveillance cameras, perimeter intrusion alarms, metal detectors, and door controllers. **Internal communications:**  Intercom and/or phone systems enabling communication with academic and adm inistrative areas of the school individually and collectively. **Technology infrastructure:**  F acility access to voice, video , and data transmission in classrooms and adm inistrative areas of the school

. Includes wiring for computer workstations and other electronic equipment in program areas. **Long -** **range Educ ational Facilities Plan:**  These plans may be referred to as a Capital Im provement P lan, Capital Facilities Plan, or Facilities Master Plan.

# See rating scales on instructions and definitions page.

1. Does this school have the following types of onsite buildings? ( Indicate yes or no for each type of building.) **Yes No**  a. Permanent buildings

......................... 1 2 b. Portable (temporary) buildings

......... 1 2 2. Wh at is the **condition of each building system/feature** for the permanent and portable (temporary) onsite buildings at this school? (See instructions and definitions page.)

 In **Part A** , circle one rating on each line to i ndicate the condition of each system /feature for the **permanent buildings**  at this school

. If the school has more than one permanent building, consider all of them in providing a rating. **Leave Part**  **A blank if this school does not have any permanent buildings**

.  In **Part B**  , circle one rating on each line to indicate the condition of each s ystem /feature for the **portable (temporary) buildings**  at this school

. If the school has more than one temporary building, consider all of them in providing a rating. **Leave Part**  **B blank if this school does not have any portable (temporary) buildings**

.

**Building sy**

**s tem/feature**  **Part A. Permanent buildings**  **(Circle one on each line) Part**  **B. Portable (temporary** **) buildings (Circle one on each line)**  **School does not**  **have sy** **stem/ feature**  **Excel**  

** lent** **Good Fair**  **Poor School**  **does not have**  **sy stem/**  **feature Excel**  ****

**lent Good**  **Fair Poor**  a. Roofs 0 1 2 3 4 0 1 2 3 4 b. Fram ing , floors, foundations 0 1 2 3 4 0 1 2 2 4 c. Exterior walls, finishes 0 1 2 3 4 0 1 2 3 4 d. Wi ndow, doors 0 1 2 3 4 0 1 2 3 4 e. Interior finishes, trim 0 1 2 3 4 0 1 2 3 4 f. Plum bing/lavatories 0 1 2 3 4 0 1 2 3 4 g. Heating system 0 1 2 3 4 0 1 2 3 4 h. Air conditioning system 0 1 2 3 4 0 1 2 3 4 i. Ventilation/filtration s ystem 0 1 2 3 4 0 1 2 3 4 j. Electrical system 0 1 2 3 4 0 1 2 3 4 k. Interior lighting 0 1 2 3 4 0 1 2 3 4 l. Exterior lighting 0 1 2 3 4 0 1 2 3 4 m. Energy management system 0 1 2 3 4 0 1 2 3 4 n. Life safety features 0 1 2 3 4 0 1 2 3 4 o. Security s ystems 0 1 2 3 4 0 1 2 3 4 p. Internal communication systems 0 1 2 3 4 0 1 2 3 4 q. Technology infrastructure 0 1 2 3 4 0 1 2 3 4 3. Wh at is the condition of the following outdoor features at this school? (Circle one rating on each line.)

**Outdoor feature School does**  **not have feature**  **Excellent Good**  **Fair Poor**  a. School parking lots and roadways 0 1 2 3 4 b. Bus lanes and drop
-off areas 0 1 2 3 4 c. School sidewalks and walkways 0 1 2 3 4 d. Outdoor play areas/playgrounds 0 1 2 3 4 e. Outdoor athletic facilities 0 1 2 3 4 f. Covered walkways 0 1 2 3 4 g. Fencing 0 1 2 3 44. Wh at is the **overall condition** of the permanent and portable (temporary) onsite buildings at this school ? If the school

has more than one building of a particular type, consider all of them in providing a rating. (Circle one on each line.)

**Building ty pe**  **School does not have**  **building t** **yp e**  **Excellent Good**  **Fair Poor**  a. Permanent buildings 0 1 2 3 4 b. Portable (temporary) buildings 0 1 2 3 4 5. Wh at would probably be the total cost of all repairs/renovations/modernizations required to put this school’s **onsite buildings**  in good overall condition? (Give your best estimate. **If this school’s onsite**  **buildings are already in good**  **or excellent overall condition, enter zero.** ) $________________ 6. On which of the sources listed below is this cost estimate based? (Circle all that apply.) a . Facilities inspection(s)/assessment(s) performed within the last 3 ye ars by licensed professionals

............... 1 b

. Repair/renovation/modernization work already being pe rformed and/or contracted for

................................ .. 2 c . Capital improvement/facilities master plan, schedule, or budget

................................ ................................ ..... 3 d

. My best professional judgment

................................ ................................ ................................ ......................... 4 e . Opinions of other district or school administrators

................................ ................................ ............................ 5 f

. Other (specify)

________________________________ ________________________________ ________ 6 7. How **satisfactory** is each environmental factor in the permanent and portable (temporary) onsite buildings at this school ?
 In **Part A** , circle one rating on each line to indicate the overall satisfaction with each environmental factor for the **permanent buildings** at this school

. If the school has more than one permanent building, consider all of them in providing a ratin g. **Leave Part**  **A blank if this school does not have any permanent buildings**

.  In **Part B**  , circle one rating on each line to indicate the overall satisfaction with each environmental factor for the **portable (temporary) buildings** at this school

. If the school has more than one temporary building, consider all of them in providing a rating. **Leave Part**  **B blank if this school does not have any portable (temporary) buildings.** 

**Environmental factor**  **Part A. Permanent buildings**  **(Circle one on each line) Part B.**  **Portable (temporary ) buildings**  **(Circle one on each line) School**  **does not have**  **factor Very** 

**satis**   ** factory** **Satis**  

** factory** **Unsatis**  

** factory** **Very**

**unsatis**   ** factory** **School**

**does not have**  **factor Very** 

**satis**   ** factory** **Satis**  

** factory** **Unsatis**  

** factory** **Very**

**unsatis**   ** factory** a. Artificial l ighting 0 1 2 3 4 0 1 2 3 4 b. Natural lighting 0 1 2 3 4 0 1 2 3 4 c. Heating 0 1 2 3 4 0 1 2 3 4 d. Air conditioning 0 1 2 3 4 0 1 2 3 4 e. Ventilation 0 1 2 3 4 0 1 2 3 4 f. Indoor air quality 0 1 2 3 4 0 1 2 3 4 g. Water quality 0 1 2 3 4 0 1 2 3 4 h. Acoustics or noise control 0 1 2 3 4 0 1 2 3 4 8. I n what year was this school’s **main instructional building** constructed?

____________ 9. In what year was the last major renovation of the **main instructional building** ?

____________ Check here if the main instructional building has never undergone a major renovation 10. In what year was the last major building replacement or addition made to this school ?

____________ Check here if the school has never had a major addition or replacement 11. Is any major repair/renovation/modernization work currently being performed at this school? Yes

...... 1 No

...... 2 12. Wh ich of the following construction projects, if any, are planned for this school in the next 2 years? ( Indicate yes or no for each item.) **Yes No**  a. Build new permanent buildings or permanent additions to buildings (e.g., a new classroom wing or gymn asium)

................................ ................................ ....................... 1 2 b. Major repairs, renovations , or modernization of existing permanent buildings

................................ ... 1 213. Wh ich of the following building s ystems or features at this school , if any, have major repairs, renovations, or

replacements planned for the next 2 years? If major repairs, renovations, or replacements are planned for a building system or feature, what i s the main reason for the planned major repair, renovation, or replacement?

 In **Part A** , circle one response on each line to indicate ma jor repair, renovation , or replacement plan s for each building s ystem or feature. Do not include preventive maintenance or mi nor repairs.

 **Complete Part B for any building system or feature for which major repair, renovation, or replacement is planned**  **in the next 2 years .**  C ircle one response to indicate the ma in reason for any planned ma

jor repairs, renovations, or replacements for a building s ystem or feature.

**Building sy**

**stem/feature Part A.**  **Plans for major repair,**  **renovation, or replacement in the next 2 y** **ears (Circle one on each line)**  **Part B. Main reason for planned major**  **repair, renovation, or replacement (Ci**  **rcle one for each system/feature with major**  **repair, renovation, or replacement planned)**  **School does**  **not have building**  **sy stem/**  **feature No major** 

**repair, renovation, or**  **replacement planned**  **Major repair or**

**renovation planned**  **Replace**  

** ment** **planned Functional** 

**problem in existing**  **sy stem or**  **feature Improved** 

**operational or energy**  **efficiency Replace**  ****

**ment cy** **cle Other** 

**reason (If work is planned,**  **continue to Part B )** a. Roofs 0 1 2 3 1 2 3 4 b. Framing, floors, foundations 0 1 2 3 1 2 3 4 c. Exterior walls, finishes 0 1 2 3 1 2 3 4 d. Wi ndow, doors 0 1 2 3 1 2 3 4 e. Interior finishes, trim 0 1 2 3 1 2 3 4 f. Plumbing/lavatories 0 1 2 3 1 2 3 4 g. Heating system 0 1 2 3 1 2 3 4 h. Air conditioning system 0 1 2 3 1 2 3 4 i. Ventilation/filtration system 0 1 2 3 1 2 3 4 j. Electrical system 0 1 2 3 1 2 3 4 k. Interior lighting 0 1 2 3 1 2 3 4 l. Exterior lighting 0 1 2 3 1 2 3 4 m. Energy management system 0 1 2 3 1 2 3 4 n. Life safety features 0 1 2 3 1 2 3 4 o. Security systems 0 1 2 3 1 2 3 4 p. Internal communication systems 0 1 2 3 1 2 3 4 q. Technology infrastructure 0 1 2 3 1 2 3 4 14. Is there a written long
- range educational facilities plan for this school? (See definition.) Yes......... 1 No

.......... 2 15. Has this school had the following performed by qualified professionals within the last 5 years ? ( Indicate yes or no for each item.) **Yes No**  a. I nspection of the condition of the physical features of the facility (e.g., roofs, foundations)

................ 1 2 b. Evaluation of e nergy use (e.g., energy audit)

................................ ................................ ...................... 1 2 c. Evaluation of indoor environmental hazards (e.g., air quality, asbestos, lead paint)

........................... 1 2 16. Have any of the following been done within the last 5 years **to improve energy efficiency** at this school? ( Indicate yes or no for each item.) **Yes No**  a. Replaced lighting fixtures , lighting ballasts, or bulbs

................................ ................................ ........... 1 2 b. I nstalled motion
-sensors for lighting

................................ ................................ ................................ .... 1 2 c. Upgraded i nsulation , outer walls, and/or siding (building envelopes)

................................ .................. 1 2 d. Replaced windows and/or doors

................................ ................................ ................................ ......... 1 2 e. Installed or upgraded a reflective roof coating

................................ ................................ ..................... 1 2 f. Installed mo re efficient HVAC systems

................................ ................................ ................................ 1 2 g. Installed or upgraded an energy management system

................................ ................................ ........ 1 2 17. Are there significant problems with the facilities at this school that are not covered in this survey? Yes......... 1 No

.......... 2 If yes, please briefly describe those problems on the back of the questionnaire.Comments for question 17 :

________________________________ ________________________________ ________

________________________________ ________________________________ ______________________________

________________________________ ________________________________ ______________________________

________________________________ ________________________________ ______________________________

________________________________ ________________________________ ______________________________