Attachment 1 – Survey Instrument

Fast Response Survey System (FRSS) 105: Condition of 

Public School Facilities

OMB# 1850-0733 v. 27

October 22, 2012

National Center for Education Statistics

U.S. Department of Education
U.S. DEPARTMENT OF EDUCATION

NATIONAL CENTER FOR EDUCATION STATISTICS

WASHINGTON, D.C. 20006–5651

CONDITION OF PUBLIC SCHOOL FACILITIES: 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). While 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 (Education Sciences Reform Act of 2002, 20 U.S.C. § 9573).

Please provide information only about the school that is indicated on 

the front of this survey.

This survey is designed to be completed by district-level personnel who are very familiar with the 

school facilities in this district.

You may wish to 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 year, even if the selected school is new.

NAME AND ADDRESS OF SAMPLED SCHOOL HERE

IF ABOVE SCHOOL INFORMATION IS INCORRECT, PLEASE UPDATE DIRECTLY ON LABEL.

Name of person completing this form: ___________________________________________________________________

Title/position: ______________________________________________________________________________________

Telephone number: ___________________________________ E-mail:______________________________________

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

Grades taught at this school: Lowest grade taught ________ Highest grade taught ________

THANK YOU. PLEASE KEEP A COPY OF THIS SURVEY FOR YOUR RECORDS.

PLEASE RETURN COMPLETED FORM TO: IF YOU HAVE ANY QUESTIONS OR COMMENTS, CONTACT:

Mail: Debbie Alexander (8599.13.13.02) Debbie Alexander at Westat

Westat 800-937-8281, Ext. 2088 or 301-294-2088

1600 Research Boulevard E-mail: debbiealexander@westat.com

Rockville, Maryland 20850-3129

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 OMB 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, gather the data needed, and 

complete and review the information collection. If you have any comments concerning the accuracy of the time estimate or suggestions for improving 

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, Washington, 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 more than one permanent or portable building on site, consider all of them in providing a rating.

In questions 2 and 3, use the following rating scale to indicate the condition of building systems/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 system 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 system/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 condition.

Poor means that a particular feature or system as it exists is inadequate to meet even the minimal needs of the school.

In 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 minimal 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 management 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 systems or

building automation systems.

Life safety features: Includes sprinklers, fire alarms, and smoke detectors.

Security systems: includes surveillance cameras, perimeter intrusion alarms, metal detectors, and door controllers.

Internal communications: Intercom and/or phone systems enabling communication with academic and administrative 

areas of the school individually and collectively.

Technology infrastructure: Facility access to voice, video, and data transmission in classrooms and administrative areas

of the school. Includes wiring for computer workstations and other electronic equipment in program areas.

Long-range Educational Facilities Plan: These plans may be referred to as a Capital Improvement Plan, 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. What 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 indicate 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 system/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 system/feature

Part A. Permanent buildings

(Circle one on each line)

Part B. Portable (temporary) buildings

(Circle one on each line)

School 

does not 

have 

system/

feature 

Excellent Good Fair Poor

School 

does not 

have 

system/

feature 

Excellent Good Fair Poor

a. Roofs 0 1 2 3 4 0 1 2 3 4

b. Framing, 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. Window, 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. Plumbing/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 system 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 systems 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. What 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 4
4. What 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 type

School does not 

have building 

type Excellent Good Fair Poor

a. Permanent buildings 0 1 2 3 4

b. Portable (temporary) buildings 0 1 2 3 4

5. What 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 years by licensed professionals ............... 1

b. Repair/renovation/modernization work already being performed 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 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 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

satisfactorySatisfactoryUnsatisfactory

Very

unsatisfactory

School 

does not 

have

factor

Very

satisfactorySatisfactoryUnsatisfactory

Very

unsatisfactory

a. Artificial lighting 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. In 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. Which 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 gymnasium)....................................................................................... 1 2

b. Major repairs, renovations, or modernization of existing permanent buildings ................................... 1 2
13. Which of the following building systems 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 is the main reason for the planned major repair, renovation, or replacement?

 In Part A, circle one response on each line to indicate major repair, renovation, or replacement plans for each 

building system or feature. Do not include preventive maintenance or minor repairs.

 Complete Part B for any building system or feature for which major repair, renovation, or replacement is 

planned in the next 2 years. Circle one response to indicate the main reason for any planned major repairs, 

renovations, or replacements for a building system or feature.

Building system/feature

Part A. Plans for major repair, 

renovation, or replacement

in the next 2 years

(Circle one on each line)

Part B. Main reason for planned major

repair, renovation, or replacement

(Circle one for each system/feature with major

repair, renovation, or replacement planned)

School does 

not have 

building 

system/ 

feature

No major 

repair, 

renovation, or 

replacement 

planned

Major repair or 

renovation 

planned

Replacement

planned

Functional 

problem in 

existing 

system or 

feature

Improved 

operational 

or energy

efficiency

Replacement 

cycle

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. Window, 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. Inspection of the condition of the physical features of the facility (e.g., roofs, foundations)................ 1 2

b. Evaluation of energy 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. Installed motion-sensors for lighting .................................................................................................... 1 2

c. Upgraded insulation, 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 more 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: ________________________________________________________________________

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