SCHOOL INSPECTION

PURPOSE:
√ ROUTINE - CONSTRUCT COMPLAINT QA SURVEY PREOPENING

SCHOOL INSPECTION
TYPE:
12 √ 22 23 24 Private School Public School Charter School Vocational School College/University Other

-

REINSPECTION CHANGE OF OWNER CONSULTATION EMDEMIOLOGY OTHER

STATE OF FLORIDA DEPARTMENT OF HEALTH COUNTY HEALTH DEPARTMENT
PUBLIC/PRIVATE SCHOOL INSPECTION REPORT

NAME OF FACILITY ADDRESS OWNER

Alexander W. Dreyfoos, Jr. School
CITY ZIP

CENSUS

RESULTS
√ -

501 S Sapodilla Avenue Palm Beach County School Board

West Palm Beach 33401 () 802-6000

1296 ▬ 2000 3000 100 10 1 2 3 4 5 6 7 8 9 20

Satisfactory

PERSON IN CHARGE BEGIN END

PHONE

Incomplete Unsatisfactory Correct Violations by √ Next Inspection
-

8:00 AM on:

9
1 2 3 4 5 6 7 8 00 05 AM 10 PM 15 20 25 30 35

1020
1 2 3 4 5 6 7 8 9 00 05 AM 10 PM 15 ▬ 25 30 35 40

300 30

DATE
0 0 1 1 2 3 4 5 6 7 8 9 0 1 2 3 0 1 2 3 4 5 6 7 8 9 05 06 07 08 09 10 11 12 13 14

DATE

POSITION #

PERMIT NUMBER
50-51-00044
0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 0 0 0 0 0 1 1 1 1 1 2 2 2 2 2 3 3 3 3 3 4 4 4 4 4 5 5 5 5 5 6 6 6 6 6 7 7 7 7 7 8 8 8 8 8 9 9 9 9 9

400 40 500 50 600 60 700 70 800 80 900 90

0 4
▬0 1 1 2 3 ▬ 5 6 7 8 9

0 6
▬ 0 1 2 3 1 2 3 4 5 ▬ 7 8 9

1

0
05 06 07 08 09

6 9 8
0 0 0 1 1 1 2 2 2 3 3 3 4 4 4 5 5 5 ▬ 6 6 7 7 7 9 ▬ 9

3 7
0 1 2 4 5 6 7 9 0 1 2 4 5 6 ▬ 8 9

▬ 3

▬ 10 11 12 13 14

FEMALES

▬ 40 10 45 11 50 12 55

▬ 45 11 50 12 55

8 8 ▬ 8

MALES

OUT OF BUSINESS

As per section 120.695 of the Florida Statutes (FS), this form will serve as a "Notice of Non-Compliance" for any violations noted. Items marked below violate the requirements of Chapters 64E-13 and 64E-11 of the Florida Administrative Code (FAC) and must be corrected within the time period indicated in the "Results " section above. Continued operation of this facility without making these corrections is a violation of Chpater 64E-13 and 64E-11, FAC, and Chapters 381, FS. Failure to correct violations may result in an administrative fine or other legal action being initiated or continued.

SCHOOL SANITATION - 1. School Site
-

- 8. Natural Ventilation √ 9. Mechanical Ventilation

√ 15. Handwash Facilities - 16. Showers/Fixtures - 17. Shower Water Temp.

LIQUID/SOLID WASTE - 21. Sewage Disposal
-

MISC. - 26. First Aid Kit FOOD
- 27. Food Insp. Rpt.

2. Playground Equipment 3. Athletic Equipment

22. Solid Waste

BUILDINGS - 4. Construction
√ √ -

SANITARY FACILITIES - 10. Provided/Accessible
√ 11. Cleanliness & Repair - 12. Toilet Facilities - 13. Separation of Sexes - 14. Fixture Ratio

WATER SUPPLY
- 18. Installed/Operated/

VECTOR/VERMIN CONTROL
√ -

5. Maintenance & Repair 6. Lighting/Foot-Candles 7. Heating, Ventilation, A/C

Maintained
√ 19. Drinking Fountains - 20. Approved Source

OTHER √ 28. 23. Infestation/Control √ 29. 24. Brush/Trash 25. Water Collection/Drainage

ITEM NUMBERS

COMMENTS AND INSTRUCTIONS (continue on attached sheet)

HEALTH DEPARTMENT INSPECTOR: COPY OF REPORT RECEIVED BY:
DH 4030, 01/05 (Obsoletes Previous Editions)

Kai Jones

PHONE: DATE:

() 274-5334

CHD / HEADQUARTERS

SCHOOL INSPECTION
PURPOSE:
√ ROUTINE - CONSTRUCT COMPLAINT QA SURVEY PREOPENING

SCHOOL INSPECTION
TYPE:
12 √ 22 23 24 Private School Public School Charter School Vocational School College/University Other

-

REINSPECTION CHANGE OF OWNER CONSULTATION EMDEMIOLOGY OTHER

STATE OF FLORIDA DEPARTMENT OF HEALTH COUNTY HEALTH DEPARTMENT
PUBLIC/PRIVATE SCHOOL INSPECTION REPORT

NAME OF FACILITY ADDRESS OWNER

Bear Lakes Middle School
CITY ZIP

CENSUS

RESULTS
√ -

3505 Shenandoah Boulevard Pbc School Board x

West Palm Beach 33409 () 615-7700

785 1000 2000 3000 100 10 1 2 3 4 5 6 ▬ 8 9 200 20 300 30

Satisfactory

PERSON IN CHARGE BEGIN END

PHONE

Incomplete Unsatisfactory Correct Violations by √ Next Inspection
-

8:00 AM on:

9
1 2 3 4 5 6 7 8 00 10 PM 15 20 ▬ 30 35

2 30
1 3 4 5 6 7 8 9 00 10 PM 15 20 25 ▬ 35 40 05 AM ▬ 05 AM

DATE
0 0 1 1 2 3 4 5 6 7 8 9 0 1 2 3 0 1 2 3 4 5 6 7 8 9 05 06 07 08 09 10 11 12 13 14

DATE

POSITION #

PERMIT NUMBER
50-51-00105
0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 0 0 0 0 0 1 1 1 1 1 2 2 2 2 2 3 3 3 3 3 4 4 4 4 4 5 5 5 5 5 6 6 6 6 6 7 7 7 7 7 8 8 8 8 8 9 9 9 9 9

400 40 ▬ 50 600 60 700 70 800 ▬ 900 90

0 5
▬0 1 1 2 3 4 ▬ 6 7 8 9

2 4
0 1 3 0 1 3 ▬ 5 6 7 8 9

1

0
05 06 07 08 09

6 9 3
0 0 0 1 1 1 2 2 2 4 4 4 5 5 5 ▬ 6 6 7 7 7 8 8 8 9 ▬ 9

7 0
0 1 2 4 5 6 8 9 ▬ 1 2 3 4 5 6 8 9

▬ 2

3 3 ▬ 3

▬ 10 11 12 13 14

FEMALES

▬ 40 10 45 11 50 12 55

10 45 11 50 12 55

▬ 7

MALES

OUT OF BUSINESS

As per section 120.695 of the Florida Statutes (FS), this form will serve as a "Notice of Non-Compliance" for any violations noted. Items marked below violate the requirements of Chapters 64E-13 and 64E-11 of the Florida Administrative Code (FAC) and must be corrected within the time period indicated in the "Results " section above. Continued operation of this facility without making these corrections is a violation of Chpater 64E-13 and 64E-11, FAC, and Chapters 381, FS. Failure to correct violations may result in an administrative fine or other legal action being initiated or continued.

SCHOOL SANITATION - 1. School Site
-

- 8. Natural Ventilation - 9. Mechanical Ventilation

√ 15. Handwash Facilities - 16. Showers/Fixtures - 17. Shower Water Temp.

LIQUID/SOLID WASTE - 21. Sewage Disposal
-

MISC. - 26. First Aid Kit FOOD
- 27. Food Insp. Rpt.

2. Playground Equipment 3. Athletic Equipment

22. Solid Waste

BUILDINGS √ 4. Construction
√ √ -

SANITARY FACILITIES - 10. Provided/Accessible
- 11. Cleanliness & Repair - 12. Toilet Facilities - 13. Separation of Sexes - 14. Fixture Ratio

WATER SUPPLY
- 18. Installed/Operated/

VECTOR/VERMIN CONTROL
√ -

5. Maintenance & Repair 6. Lighting/Foot-Candles 7. Heating, Ventilation, A/C

Maintained
√ 19. Drinking Fountains - 20. Approved Source

OTHER - 28. 23. Infestation/Control - 29. 24. Brush/Trash 25. Water Collection/Drainage

ITEM NUMBERS

COMMENTS AND INSTRUCTIONS (continue on attached sheet)

HEALTH DEPARTMENT INSPECTOR: COPY OF REPORT RECEIVED BY:

Jaime Morales x
CHD / HEADQUARTERS

PHONE: DATE:

05/24/2010

DH 4030, 01/05 (Obsoletes Previous Editions)

SCHOOL INSPECTION
PURPOSE:
√ ROUTINE - CONSTRUCT COMPLAINT QA SURVEY PREOPENING

SCHOOL INSPECTION
TYPE:
12 √ 22 23 24 Private School Public School Charter School Vocational School College/University Other

-

REINSPECTION CHANGE OF OWNER CONSULTATION EMDEMIOLOGY OTHER

STATE OF FLORIDA DEPARTMENT OF HEALTH COUNTY HEALTH DEPARTMENT
PUBLIC/PRIVATE SCHOOL INSPECTION REPORT

NAME OF FACILITY ADDRESS OWNER

Canal Point Elementary
CITY ZIP

CENSUS

RESULTS

37000 Main Street Pbc School Board

Canal Point 33438 () 924-5673

500 1000 2000 3000 100 10 1 2 3 4 ▬ 6 7 8 9 200 20 300 30

Satisfactory

PERSON IN CHARGE BEGIN END

PHONE

Incomplete Unsatisfactory Correct Violations by Next Inspection

8:00 AM on:

10 30
1 2 3 4 5 6 7 8 9 00 05 AM 10 PM 15 20 25 ▬ 35 40

1200
1 2 3 4 5 6 7 8 9 ▬ 05 AM 10 PM 15 20 25 30 35 40

DATE
0 4 2 0 1 0
▬0 1 1 2 3 ▬ 5 6 7 8 9 0 1 3 ▬ 1 3 4 5 6 7 8 9 05 06 07 08 09 ▬ 10 11 12 13 14

DATE

POSITION #

PERMIT NUMBER
50-51-00204
0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 0 0 0 0 0 1 1 1 1 1 2 2 2 2 2 3 3 3 3 3 4 4 4 4 4 5 5 5 5 5 6 6 6 6 6 7 7 7 7 7 8 8 8 8 8 9 9 9 9 9

400 40 500 50 600 60 700 70 800 80 900 90

0 3
▬0 1 1 2 4 5 6 7 8 9

2 3
0 1 0 1 ▬ 4 5 6 7 8 9

1

0
05 06 07 08 09

2 8 8
0 0 0 1 1 1 ▬ 2 2 3 3 3 4 4 4 5 5 5 6 6 6 7 7 7 9 9 9

3 2
0 1 2 4 5 6 7 9 0 1 ▬ 4 5 6 7 8 9

▬ 2

▬ 2

▬ 3

▬ 3

▬ 10 11 12 13 14

FEMALES

▬ 45 11 50 12 55

10 45 11 50 ▬ 55

8 ▬ ▬ 8

MALES

OUT OF BUSINESS

As per section 120.695 of the Florida Statutes (FS), this form will serve as a "Notice of Non-Compliance" for any violations noted. Items marked below violate the requirements of Chapters 64E-13 and 64E-11 of the Florida Administrative Code (FAC) and must be corrected within the time period indicated in the "Results " section above. Continued operation of this facility without making these corrections is a violation of Chpater 64E-13 and 64E-11, FAC, and Chapters 381, FS. Failure to correct violations may result in an administrative fine or other legal action being initiated or continued.

SCHOOL SANITATION - 1. School Site
-

- 8. Natural Ventilation - 9. Mechanical Ventilation

- 15. Handwash Facilities - 16. Showers/Fixtures - 17. Shower Water Temp.

LIQUID/SOLID WASTE - 21. Sewage Disposal
-

MISC. - 26. First Aid Kit FOOD
- 27. Food Insp. Rpt.

2. Playground Equipment 3. Athletic Equipment

22. Solid Waste

BUILDINGS - 4. Construction
-

SANITARY FACILITIES - 10. Provided/Accessible
- 11. Cleanliness & Repair - 12. Toilet Facilities - 13. Separation of Sexes - 14. Fixture Ratio

WATER SUPPLY
- 18. Installed/Operated/

VECTOR/VERMIN CONTROL
√ -

5. Maintenance & Repair 6. Lighting/Foot-Candles 7. Heating, Ventilation, A/C

Maintained
- 19. Drinking Fountains - 20. Approved Source

OTHER - 28. 23. Infestation/Control - 29. 24. Brush/Trash 25. Water Collection/Drainage

ITEM NUMBERS

COMMENTS AND INSTRUCTIONS (continue on attached sheet)

HEALTH DEPARTMENT INSPECTOR: COPY OF REPORT RECEIVED BY:
DH 4030, 01/05 (Obsoletes Previous Editions)

Quinn Bass

PHONE: DATE:

CHD / HEADQUARTERS

SCHOOL INSPECTION
PURPOSE:
ROUTINE CONSTRUCT COMPLAINT QA SURVEY PREOPENING

SCHOOL INSPECTION
TYPE:
12 √ 22 23 24 Private School Public School Charter School Vocational School College/University Other

√ REINSPECTION - CHANGE OF OWNER CONSULTATION EMDEMIOLOGY OTHER

STATE OF FLORIDA DEPARTMENT OF HEALTH COUNTY HEALTH DEPARTMENT
PUBLIC/PRIVATE SCHOOL INSPECTION REPORT

NAME OF FACILITY ADDRESS OWNER

Canal Point Elementary
CITY ZIP

CENSUS

RESULTS
√ -

37000 Main Street Pbc School Board

Canal Point 33438 () 924-5673

450 1000 2000 3000 100 10 1 2 3 ▬ 5 6 7 8 9 200 20 300 30

Satisfactory

PERSON IN CHARGE BEGIN END

PHONE

Incomplete Unsatisfactory Correct Violations by √ Next Inspection
-

8:00 AM on:

1
2 3 4 5 6 7 8 9

00

2 30
1 3 4 5 6 7 8 9 00 10 PM 15 20 25 ▬ 35 40

DATE
0 0 1 1 2 3 4 5 6 7 8 9 0 1 2 3 0 1 2 3 4 5 6 7 8 9 05 06 07 08 09 10 11 12 13 14

▬ ▬ 10 PM 15 20 25 30 35 40

DATE

POSITION #

PERMIT NUMBER
50-51-00204
0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 0 0 0 0 0 1 1 1 1 1 2 2 2 2 2 3 3 3 3 3 4 4 4 4 4 5 5 5 5 5 6 6 6 6 6 7 7 7 7 7 8 8 8 8 8 9 9 9 9 9

400 40 500 ▬ 600 60 700 70 800 80 900 90

05 AM ▬ 05 AM

0 4
▬0 1 1 2 3 ▬ 5 6 7 8 9

3 0
0 1 2 ▬ 1 2 4 5 6 7 8 9

1

0
05 06 07 08 09

2 8 8
0 0 0 1 1 1 ▬ 2 2 3 3 3 4 4 4 5 5 5 6 6 6 7 7 7 9 9 9

3 2
0 1 2 4 5 6 7 9 0 1 ▬ 4 5 6 7 8 9

▬ 3

▬ 3

▬ 10 11 12 13 14

FEMALES

10 45 11 50 12 55

10 45 11 50 12 55

8 ▬ ▬ 8

MALES

OUT OF BUSINESS

As per section 120.695 of the Florida Statutes (FS), this form will serve as a "Notice of Non-Compliance" for any violations noted. Items marked below violate the requirements of Chapters 64E-13 and 64E-11 of the Florida Administrative Code (FAC) and must be corrected within the time period indicated in the "Results " section above. Continued operation of this facility without making these corrections is a violation of Chpater 64E-13 and 64E-11, FAC, and Chapters 381, FS. Failure to correct violations may result in an administrative fine or other legal action being initiated or continued.

SCHOOL SANITATION - 1. School Site
-

- 8. Natural Ventilation - 9. Mechanical Ventilation

- 15. Handwash Facilities - 16. Showers/Fixtures - 17. Shower Water Temp.

LIQUID/SOLID WASTE - 21. Sewage Disposal
-

MISC. - 26. First Aid Kit FOOD
- 27. Food Insp. Rpt.

2. Playground Equipment 3. Athletic Equipment

22. Solid Waste

BUILDINGS - 4. Construction
√ -

SANITARY FACILITIES - 10. Provided/Accessible
- 11. Cleanliness & Repair - 12. Toilet Facilities - 13. Separation of Sexes - 14. Fixture Ratio

WATER SUPPLY
- 18. Installed/Operated/

VECTOR/VERMIN CONTROL
√ -

5. Maintenance & Repair 6. Lighting/Foot-Candles 7. Heating, Ventilation, A/C

Maintained
- 19. Drinking Fountains - 20. Approved Source

OTHER - 28. 23. Infestation/Control - 29. 24. Brush/Trash 25. Water Collection/Drainage

ITEM NUMBERS

COMMENTS AND INSTRUCTIONS (continue on attached sheet)

HEALTH DEPARTMENT INSPECTOR: COPY OF REPORT RECEIVED BY:
DH 4030, 01/05 (Obsoletes Previous Editions)

Quinn Bass

PHONE: DATE:

CHD / HEADQUARTERS

SCHOOL INSPECTION
PURPOSE:
√ ROUTINE - CONSTRUCT COMPLAINT QA SURVEY PREOPENING

SCHOOL INSPECTION
TYPE:
12 √ 22 23 24 Private School Public School Charter School Vocational School College/University Other

-

REINSPECTION CHANGE OF OWNER CONSULTATION EMDEMIOLOGY OTHER

STATE OF FLORIDA DEPARTMENT OF HEALTH COUNTY HEALTH DEPARTMENT
PUBLIC/PRIVATE SCHOOL INSPECTION REPORT

NAME OF FACILITY ADDRESS OWNER

Cholee Lake Elementary
CITY ZIP

CENSUS

RESULTS
√ -

6680 Dillman Road School Dist of PB County Eugina Feaman

Greenacres 33413 (561) 681-2200

1012 ▬ 2000 3000 100 10 1 2 3 4 5 6 7 8 9 200 20 300 30

Satisfactory

PERSON IN CHARGE BEGIN END

PHONE

Incomplete Unsatisfactory Correct Violations by √ Next Inspection
-

8:00 AM on:

10 15
1 2 3 4 5 6 7 8 9 00 05 AM 10 PM ▬ 20 25 30 35 40

1130
1 2 3 4 5 6 7 8 9 00 05 AM 10 PM 15 20 25 ▬ 35 40

DATE
0 0 1 1 2 3 4 5 6 7 8 9 0 1 2 3 0 1 2 3 4 5 6 7 8 9 05 06 07 08 09 10 11 12 13 14

DATE

POSITION #

PERMIT NUMBER
50-51-02631
0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 0 0 0 0 0 1 1 1 1 1 2 2 2 2 2 3 3 3 3 3 4 4 4 4 4 5 5 5 5 5 6 6 6 6 6 7 7 7 7 7 8 8 8 8 8 9 9 9 9 9

400 40 500 50 600 60 700 70 800 80 900 90

0 7
▬0 1 1 2 3 4 5 6 ▬ 8 9

2 8
0 1 3 0 1 3 4 5 6 7 ▬ 9

1

0
05 06 07 08 09

6 1 0
1 ▬ 1 2 2 2 3 3 3 4 4 4 5 5 5 ▬ 6 6 7 7 7 8 8 8 9 9 9

3 4
0 1 2 ▬ 5 6 7 8 9 1 2 4 5 6 7 8 9

0 0 ▬ 0

▬ 2

▬ 3

▬ 10 11 12 13 14

FEMALES

▬ 45 11 50 12 55

10 45 ▬ 50 12 55

MALES

OUT OF BUSINESS

As per section 120.695 of the Florida Statutes (FS), this form will serve as a "Notice of Non-Compliance" for any violations noted. Items marked below violate the requirements of Chapters 64E-13 and 64E-11 of the Florida Administrative Code (FAC) and must be corrected within the time period indicated in the "Results " section above. Continued operation of this facility without making these corrections is a violation of Chpater 64E-13 and 64E-11, FAC, and Chapters 381, FS. Failure to correct violations may result in an administrative fine or other legal action being initiated or continued.

SCHOOL SANITATION - 1. School Site
-

- 8. Natural Ventilation - 9. Mechanical Ventilation

- 15. Handwash Facilities - 16. Showers/Fixtures - 17. Shower Water Temp.

LIQUID/SOLID WASTE - 21. Sewage Disposal
-

MISC. - 26. First Aid Kit FOOD
- 27. Food Insp. Rpt.

2. Playground Equipment 3. Athletic Equipment

22. Solid Waste

BUILDINGS - 4. Construction
√ -

SANITARY FACILITIES - 10. Provided/Accessible
- 11. Cleanliness & Repair - 12. Toilet Facilities - 13. Separation of Sexes - 14. Fixture Ratio

WATER SUPPLY
- 18. Installed/Operated/

VECTOR/VERMIN CONTROL
√ -

5. Maintenance & Repair 6. Lighting/Foot-Candles 7. Heating, Ventilation, A/C

Maintained
√ 19. Drinking Fountains - 20. Approved Source

OTHER √ 28. 23. Infestation/Control - 29. 24. Brush/Trash 25. Water Collection/Drainage

ITEM NUMBERS

COMMENTS AND INSTRUCTIONS (continue on attached sheet)

HEALTH DEPARTMENT INSPECTOR: COPY OF REPORT RECEIVED BY:

Kenny Wilson Eugina Feaman
CHD / HEADQUARTERS

PHONE: DATE:

07/28/2010

DH 4030, 01/05 (Obsoletes Previous Editions)

SCHOOL INSPECTION
PURPOSE:
√ ROUTINE - CONSTRUCT COMPLAINT QA SURVEY PREOPENING

SCHOOL INSPECTION
TYPE:
12 √ 22 23 24 Private School Public School Charter School Vocational School College/University Other

-

REINSPECTION CHANGE OF OWNER CONSULTATION EMDEMIOLOGY OTHER

STATE OF FLORIDA DEPARTMENT OF HEALTH COUNTY HEALTH DEPARTMENT
PUBLIC/PRIVATE SCHOOL INSPECTION REPORT

NAME OF FACILITY ADDRESS OWNER

Christa McAuliffe Middle School
CITY ZIP

CENSUS

RESULTS

6500 Le Chalet Boulevard Pbc School Board

Boynton Beach 33437 () 369-7060

1197 ▬ 2000 3000 10 1 2 3 4 5 6 7 8 9 200 20 300 30

Satisfactory

PERSON IN CHARGE BEGIN END

PHONE

Incomplete Unsatisfactory Correct Violations by Next Inspection

8:00 AM on:

10 20
1 2 3 4 5 6 7 8 9 00 05 AM 10 PM 15 ▬ 25 30 35 40

1 00
▬ ▬ 2 3 4 5 6 7 8 9 05 AM 10 PM 15 20 25 30 35 40

DATE
0 5 0 6 1 0
▬0 1 1 2 3 4 ▬ 6 7 8 9 ▬ 0 1 2 3 1 2 3 4 5 ▬ 7 8 9 05 06 07 08 09 ▬ 10 11 12 13 14

DATE

POSITION #

PERMIT NUMBER
50-51-00249
0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 0 0 0 0 0 1 1 1 1 1 2 2 2 2 2 3 3 3 3 3 4 4 4 4 4 5 5 5 5 5 6 6 6 6 6 7 7 7 7 7 8 8 8 8 8 9 9 9 9 9

400 40 500 50 600 60 700 70 800 80 900 90

0 4
▬0 1 1 2 3 ▬ 5 6 7 8 9

2 9
0 1 3 0 1 3 4 5 6 7 8 ▬

1

0
05 06 07 08 09

2 8 8
0 0 0 1 1 1 ▬ 2 2 3 3 3 4 4 4 5 5 5 6 6 6 7 7 7 9 9 9

5 5
0 1 2 3 4 6 7 9 0 1 2 3 4 6 7 8 9

▬ 2

▬ 10 11 12 13 14

▬ ▬

FEMALES

▬ 45 11 50 12 55

10 45 11 50 12 55

8 ▬ ▬ 8

MALES

OUT OF BUSINESS

As per section 120.695 of the Florida Statutes (FS), this form will serve as a "Notice of Non-Compliance" for any violations noted. Items marked below violate the requirements of Chapters 64E-13 and 64E-11 of the Florida Administrative Code (FAC) and must be corrected within the time period indicated in the "Results " section above. Continued operation of this facility without making these corrections is a violation of Chpater 64E-13 and 64E-11, FAC, and Chapters 381, FS. Failure to correct violations may result in an administrative fine or other legal action being initiated or continued.

SCHOOL SANITATION - 1. School Site
-

- 8. Natural Ventilation - 9. Mechanical Ventilation

- 15. Handwash Facilities - 16. Showers/Fixtures - 17. Shower Water Temp.

LIQUID/SOLID WASTE - 21. Sewage Disposal

MISC. - 26. First Aid Kit FOOD
- 27. Food Insp. Rpt.

2. Playground Equipment 3. Athletic Equipment

22. Solid Waste

BUILDINGS - 4. Construction
√ √ -

SANITARY FACILITIES - 10. Provided/Accessible
√ 11. Cleanliness & Repair - 12. Toilet Facilities - 13. Separation of Sexes - 14. Fixture Ratio

WATER SUPPLY
- 18. Installed/Operated/

VECTOR/VERMIN CONTROL
√ -

5. Maintenance & Repair 6. Lighting/Foot-Candles 7. Heating, Ventilation, A/C

Maintained
√ 19. Drinking Fountains - 20. Approved Source

OTHER - 28. 23. Infestation/Control - 29. 24. Brush/Trash 25. Water Collection/Drainage

ITEM NUMBERS

COMMENTS AND INSTRUCTIONS (continue on attached sheet)

HEALTH DEPARTMENT INSPECTOR: COPY OF REPORT RECEIVED BY:
DH 4030, 01/05 (Obsoletes Previous Editions)

Herbert Al Wilson

PHONE: DATE:

CHD / HEADQUARTERS

SCHOOL INSPECTION
PURPOSE:
√ ROUTINE - CONSTRUCT COMPLAINT QA SURVEY PREOPENING

SCHOOL INSPECTION
TYPE:
12 √ 22 23 24 Private School Public School Charter School Vocational School College/University Other

-

REINSPECTION CHANGE OF OWNER CONSULTATION EMDEMIOLOGY OTHER

STATE OF FLORIDA DEPARTMENT OF HEALTH COUNTY HEALTH DEPARTMENT
PUBLIC/PRIVATE SCHOOL INSPECTION REPORT

NAME OF FACILITY ADDRESS OWNER

Conniston Middle School
CITY ZIP

CENSUS

RESULTS
√ -

673 Conniston Road P.B. Co. School Board

West Palm Beach 33405 () 802-5400

966 1000 2000 3000 100 10 1 2 3 4 5 6 7 8 ▬ 200 20 300 30

Satisfactory

PERSON IN CHARGE BEGIN END

PHONE

Incomplete Unsatisfactory Correct Violations by √ Next Inspection
-

8:00 AM on:

10 40
1 2 3 4 5 6 7 8 9 00 05 AM 10 PM 15 20 25 30 35 ▬

1 30
▬ 00 2 3 4 5 6 7 8 9 05 AM 10 PM 15 20 25 ▬ 35 40

DATE
0 0 1 1 2 3 4 5 6 7 8 9 0 1 2 3 0 1 2 3 4 5 6 7 8 9 05 06 07 08 09 10 11 12 13 14

DATE

POSITION #

PERMIT NUMBER
50-51-00293
0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 0 0 0 0 0 1 1 1 1 1 2 2 2 2 2 3 3 3 3 3 4 4 4 4 4 5 5 5 5 5 6 6 6 6 6 7 7 7 7 7 8 8 8 8 8 9 9 9 9 9

400 40 500 50 ▬ ▬ 700 70 800 80 900 90

0 6
▬0 1 1 2 3 4 5 ▬ 7 8 9

1 4
0 2 3 0 2 3 ▬ 5 6 7 8 9 ▬ 1

1

0
05 06 07 08 09

6 9 8
0 0 0 1 1 1 2 2 2 3 3 3 4 4 4 5 5 5 ▬ 6 6 7 7 7 9 ▬ 9

3 7
0 1 2 4 5 6 7 9 0 1 2 4 5 6 ▬ 8 9

▬ 3

▬ 10 11 12 13 14

FEMALES

▬ 45 11 50 12 55

10 45 11 50 12 55

8 8 ▬ 8

MALES

OUT OF BUSINESS

As per section 120.695 of the Florida Statutes (FS), this form will serve as a "Notice of Non-Compliance" for any violations noted. Items marked below violate the requirements of Chapters 64E-13 and 64E-11 of the Florida Administrative Code (FAC) and must be corrected within the time period indicated in the "Results " section above. Continued operation of this facility without making these corrections is a violation of Chpater 64E-13 and 64E-11, FAC, and Chapters 381, FS. Failure to correct violations may result in an administrative fine or other legal action being initiated or continued.

SCHOOL SANITATION - 1. School Site
-

- 8. Natural Ventilation - 9. Mechanical Ventilation

√ 15. Handwash Facilities √ 16. Showers/Fixtures - 17. Shower Water Temp.

LIQUID/SOLID WASTE - 21. Sewage Disposal
-

MISC. - 26. First Aid Kit FOOD
- 27. Food Insp. Rpt.

2. Playground Equipment 3. Athletic Equipment

22. Solid Waste

BUILDINGS - 4. Construction
√ √ -

SANITARY FACILITIES - 10. Provided/Accessible
√ 11. Cleanliness & Repair - 12. Toilet Facilities - 13. Separation of Sexes - 14. Fixture Ratio

WATER SUPPLY
- 18. Installed/Operated/

VECTOR/VERMIN CONTROL
√ -

5. Maintenance & Repair 6. Lighting/Foot-Candles 7. Heating, Ventilation, A/C

Maintained
√ 19. Drinking Fountains - 20. Approved Source

OTHER √ 28. 23. Infestation/Control - 29. 24. Brush/Trash 25. Water Collection/Drainage

ITEM NUMBERS

COMMENTS AND INSTRUCTIONS (continue on attached sheet)

HEALTH DEPARTMENT INSPECTOR: COPY OF REPORT RECEIVED BY:
DH 4030, 01/05 (Obsoletes Previous Editions)

Kai Bonner Jones

PHONE: DATE:

() 274-5334

CHD / HEADQUARTERS

SCHOOL INSPECTION
PURPOSE:
√ ROUTINE - CONSTRUCT COMPLAINT QA SURVEY PREOPENING

SCHOOL INSPECTION
TYPE:
12 √ 22 23 24 Private School Public School Charter School Vocational School College/University Other

-

REINSPECTION CHANGE OF OWNER CONSULTATION EMDEMIOLOGY OTHER

STATE OF FLORIDA DEPARTMENT OF HEALTH COUNTY HEALTH DEPARTMENT
PUBLIC/PRIVATE SCHOOL INSPECTION REPORT

NAME OF FACILITY ADDRESS OWNER

Crestwood Middle School
CITY ZIP

CENSUS

RESULTS
√ -

64 Sparrow Drive Pbc School Board

Royal Palm Beach 33411 () 753-5000

1270 ▬ 2000 3000 100 10 1 2 3 4 5 6 7 8 9 20

Satisfactory

PERSON IN CHARGE BEGIN END

PHONE

Incomplete Unsatisfactory Correct Violations by √ Next Inspection
-

8:00 AM on:

9
1 2 3 4 5 6 7 8

30
00 05 AM 15 20 25 ▬ 35

3 15
1 2 4 5 6 7 8 9 00 05 AM ▬ 20 25 30 35 40

300 30

DATE
0 0 1 1 2 3 4 5 6 7 8 9 0 1 2 3 0 1 2 3 4 5 6 7 8 9 05 06 07 08 09 10 11 12 13 14

DATE

POSITION #

PERMIT NUMBER
50-51-00313
0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 0 0 0 0 0 1 1 1 1 1 2 2 2 2 2 3 3 3 3 3 4 4 4 4 4 5 5 5 5 5 6 6 6 6 6 7 7 7 7 7 8 8 8 8 8 9 9 9 9 9

400 40 500 50 600 60 700 70 800 80 900 90

0 5
▬0 1 1 2 3 4 ▬ 6 7 8 9

1 7
0 2 3 0 2 3 4 5 6 ▬ 8 9 ▬ 1

1

0
05 06 07 08 09 0 0 0 1 1 1 2 2 2 3 3 3 4 4 4 5 5 5 6 6 6 7 7 7 8 8 8 9 9 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9

10 PM ▬ 10 PM

▬ 10 11 12 13 14

FEMALES

▬ 40 10 45 11 50 12 55

10 45 11 50 12 55

MALES

OUT OF BUSINESS

As per section 120.695 of the Florida Statutes (FS), this form will serve as a "Notice of Non-Compliance" for any violations noted. Items marked below violate the requirements of Chapters 64E-13 and 64E-11 of the Florida Administrative Code (FAC) and must be corrected within the time period indicated in the "Results " section above. Continued operation of this facility without making these corrections is a violation of Chpater 64E-13 and 64E-11, FAC, and Chapters 381, FS. Failure to correct violations may result in an administrative fine or other legal action being initiated or continued.

SCHOOL SANITATION - 1. School Site
-

- 8. Natural Ventilation - 9. Mechanical Ventilation

√ 15. Handwash Facilities - 16. Showers/Fixtures - 17. Shower Water Temp.

LIQUID/SOLID WASTE - 21. Sewage Disposal
-

MISC. - 26. First Aid Kit FOOD
- 27. Food Insp. Rpt.

2. Playground Equipment 3. Athletic Equipment

22. Solid Waste

BUILDINGS - 4. Construction
√ √ -

SANITARY FACILITIES - 10. Provided/Accessible
- 11. Cleanliness & Repair - 12. Toilet Facilities - 13. Separation of Sexes - 14. Fixture Ratio

WATER SUPPLY
- 18. Installed/Operated/

VECTOR/VERMIN CONTROL
√ -

5. Maintenance & Repair 6. Lighting/Foot-Candles 7. Heating, Ventilation, A/C

Maintained
√ 19. Drinking Fountains - 20. Approved Source

OTHER - 28. 23. Infestation/Control - 29. 24. Brush/Trash 25. Water Collection/Drainage

ITEM NUMBERS

COMMENTS AND INSTRUCTIONS (continue on attached sheet)

HEALTH DEPARTMENT INSPECTOR: COPY OF REPORT RECEIVED BY:
DH 4030, 01/05 (Obsoletes Previous Editions)

v VACANT ESII AIR

PHONE: DATE:

() 355-3015

CHD / HEADQUARTERS

SCHOOL INSPECTION
PURPOSE:
√ ROUTINE - CONSTRUCT COMPLAINT QA SURVEY PREOPENING

SCHOOL INSPECTION
TYPE:
12 √ 22 23 24 Private School Public School Charter School Vocational School College/University Other

-

REINSPECTION CHANGE OF OWNER CONSULTATION EMDEMIOLOGY OTHER

STATE OF FLORIDA DEPARTMENT OF HEALTH COUNTY HEALTH DEPARTMENT
PUBLIC/PRIVATE SCHOOL INSPECTION REPORT

NAME OF FACILITY ADDRESS OWNER

Dr. Mary McLeod Bethune Elementary
CITY ZIP

CENSUS

RESULTS
√ -

1501 Ave U P B C School Board

Riviera Beach 33404 (561) 494-2600

492 1000 2000 3000 100 10 1 2 3 ▬ 5 6 7 8 9 20

Satisfactory

PERSON IN CHARGE BEGIN END

PHONE

Incomplete Unsatisfactory Correct Violations by √ Next Inspection
-

8:00 AM on:

11 50
1 2 3 4 5 6 7 8 9 00 10 PM 15 20 25 30 35 40

2 15
1 3 4 5 6 7 8 9 00 10 PM ▬ 20 25 30 35 40

300 30

DATE
0 0 1 1 2 3 4 5 6 7 8 9 0 1 2 3 0 1 2 3 4 5 6 7 8 9 05 06 07 08 09 10 11 12 13 14

DATE

POSITION #

PERMIT NUMBER
50-51-01955
0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 0 0 0 0 0 1 1 1 1 1 2 2 2 2 2 3 3 3 3 3 4 4 4 4 4 5 5 5 5 5 6 6 6 6 6 7 7 7 7 7 8 8 8 8 8 9 9 9 9 9

400 40 500 50 600 60 700 70 800 80 900 ▬

05 AM ▬ 05 AM

1 1
0 0 2 3 4 5 6 7 8 9

1 9
0 2 3 0 2 3 4 5 6 7 8 ▬

1

0
05 06 07 08 09

6 9 8
0 0 0 1 1 1 2 2 2 3 3 3 4 4 4 5 5 5 ▬ 6 6 7 7 7 9 ▬ 9

3 7
0 1 2 4 5 6 7 9 0 1 2 4 5 6 ▬ 8 9

▬▬ ▬ 1

▬ 3

▬ 10 11 12 13 14

FEMALES

10 45 ▬ ▬ 12 55

10 45 11 50 12 55

8 8 ▬ 8

MALES

OUT OF BUSINESS

As per section 120.695 of the Florida Statutes (FS), this form will serve as a "Notice of Non-Compliance" for any violations noted. Items marked below violate the requirements of Chapters 64E-13 and 64E-11 of the Florida Administrative Code (FAC) and must be corrected within the time period indicated in the "Results " section above. Continued operation of this facility without making these corrections is a violation of Chpater 64E-13 and 64E-11, FAC, and Chapters 381, FS. Failure to correct violations may result in an administrative fine or other legal action being initiated or continued.

SCHOOL SANITATION - 1. School Site
-

- 8. Natural Ventilation - 9. Mechanical Ventilation

√ 15. Handwash Facilities - 16. Showers/Fixtures - 17. Shower Water Temp.

LIQUID/SOLID WASTE - 21. Sewage Disposal
-

MISC. - 26. First Aid Kit FOOD
- 27. Food Insp. Rpt.

2. Playground Equipment 3. Athletic Equipment

22. Solid Waste

BUILDINGS - 4. Construction
√ √ -

SANITARY FACILITIES - 10. Provided/Accessible
√ 11. Cleanliness & Repair - 12. Toilet Facilities - 13. Separation of Sexes - 14. Fixture Ratio

WATER SUPPLY
- 18. Installed/Operated/

VECTOR/VERMIN CONTROL
√ -

5. Maintenance & Repair 6. Lighting/Foot-Candles 7. Heating, Ventilation, A/C

Maintained
√ 19. Drinking Fountains - 20. Approved Source

OTHER √ 28. 23. Infestation/Control - 29. 24. Brush/Trash 25. Water Collection/Drainage

ITEM NUMBERS

COMMENTS AND INSTRUCTIONS (continue on attached sheet)

HEALTH DEPARTMENT INSPECTOR: COPY OF REPORT RECEIVED BY:
DH 4030, 01/05 (Obsoletes Previous Editions)

Kai Bonner Jones

PHONE: DATE:

() 274-5334

CHD / HEADQUARTERS

SCHOOL INSPECTION
PURPOSE:
√ ROUTINE - CONSTRUCT COMPLAINT QA SURVEY PREOPENING

SCHOOL INSPECTION
TYPE:
12 √ 22 23 24 Private School Public School Charter School Vocational School College/University Other

-

REINSPECTION CHANGE OF OWNER CONSULTATION EMDEMIOLOGY OTHER

STATE OF FLORIDA DEPARTMENT OF HEALTH COUNTY HEALTH DEPARTMENT
PUBLIC/PRIVATE SCHOOL INSPECTION REPORT

NAME OF FACILITY ADDRESS OWNER

Forest Hill Elementary
CITY ZIP

CENSUS

RESULTS
√ -

5555 Purdy Lane P.B.Co. School Board

West Palm Beach 33415 () 641-1258

758 1000 2000 3000 100 10 1 2 3 4 5 6 ▬ 8 9 200 20 300 30

Satisfactory

PERSON IN CHARGE BEGIN END

PHONE

Incomplete Unsatisfactory Correct Violations by √ Next Inspection
-

8:00 AM on:

9
1 2 3 4 5 6 7 8

20
00 05 AM 15 ▬ 25 30 35

3 40
1 2 4 5 6 7 8 9 00 05 AM 15 20 25 30 35 ▬

DATE
0 0 1 1 2 3 4 5 6 7 8 9 0 1 2 3 0 1 2 3 4 5 6 7 8 9 05 06 07 08 09 10 11 12 13 14

DATE

POSITION #

PERMIT NUMBER
50-51-00451
0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 0 0 0 0 0 1 1 1 1 1 2 2 2 2 2 3 3 3 3 3 4 4 4 4 4 5 5 5 5 5 6 6 6 6 6 7 7 7 7 7 8 8 8 8 8 9 9 9 9 9

400 40 500 ▬ 600 60 700 70 ▬ 80 900 90

0 4
▬0 1 1 2 3 ▬ 5 6 7 8 9

2 2
0 1 3 0 1 3 4 5 6 7 8 9

1

0
05 06 07 08 09 0 0 0 1 1 1 2 2 2 3 3 3 4 4 4 5 5 5 6 6 6 7 7 7 8 8 8 9 9 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9

10 PM ▬ 10 PM

▬ ▬

▬ 10 11 12 13 14

FEMALES

▬ 40 10 45 11 50 12 55

10 45 11 50 12 55

MALES

OUT OF BUSINESS

As per section 120.695 of the Florida Statutes (FS), this form will serve as a "Notice of Non-Compliance" for any violations noted. Items marked below violate the requirements of Chapters 64E-13 and 64E-11 of the Florida Administrative Code (FAC) and must be corrected within the time period indicated in the "Results " section above. Continued operation of this facility without making these corrections is a violation of Chpater 64E-13 and 64E-11, FAC, and Chapters 381, FS. Failure to correct violations may result in an administrative fine or other legal action being initiated or continued.

SCHOOL SANITATION - 1. School Site
√ -

- 8. Natural Ventilation - 9. Mechanical Ventilation

√ 15. Handwash Facilities - 16. Showers/Fixtures - 17. Shower Water Temp.

LIQUID/SOLID WASTE - 21. Sewage Disposal
-

MISC. - 26. First Aid Kit FOOD
- 27. Food Insp. Rpt.

2. Playground Equipment 3. Athletic Equipment

22. Solid Waste

BUILDINGS - 4. Construction
√ -

SANITARY FACILITIES - 10. Provided/Accessible
- 11. Cleanliness & Repair - 12. Toilet Facilities - 13. Separation of Sexes - 14. Fixture Ratio

WATER SUPPLY
- 18. Installed/Operated/

VECTOR/VERMIN CONTROL
√ -

5. Maintenance & Repair 6. Lighting/Foot-Candles 7. Heating, Ventilation, A/C

Maintained
√ 19. Drinking Fountains - 20. Approved Source

OTHER √ 28. 23. Infestation/Control √ 29. 24. Brush/Trash 25. Water Collection/Drainage

ITEM NUMBERS

COMMENTS AND INSTRUCTIONS (continue on attached sheet)

HEALTH DEPARTMENT INSPECTOR: COPY OF REPORT RECEIVED BY:
DH 4030, 01/05 (Obsoletes Previous Editions)

v VACANT ESII AIR

PHONE: DATE:

() 355-3015

CHD / HEADQUARTERS

SCHOOL INSPECTION
PURPOSE:
√ ROUTINE - CONSTRUCT COMPLAINT QA SURVEY PREOPENING

SCHOOL INSPECTION
TYPE:
12 √ 22 23 24 Private School Public School Charter School Vocational School College/University Other

-

REINSPECTION CHANGE OF OWNER CONSULTATION EMDEMIOLOGY OTHER

STATE OF FLORIDA DEPARTMENT OF HEALTH COUNTY HEALTH DEPARTMENT
PUBLIC/PRIVATE SCHOOL INSPECTION REPORT

NAME OF FACILITY ADDRESS OWNER

Forest Hill Elementary
CITY ZIP

CENSUS

RESULTS
√ -

5555 Purdy Lane P.B.Co. School Board

West Palm Beach 33415 () 641-1258

735 1000 2000 3000 100 10 1 2 3 4 5 6 ▬ 8 9 200 20 300 ▬

Satisfactory

PERSON IN CHARGE BEGIN END

PHONE

Incomplete Unsatisfactory Correct Violations by √ Next Inspection
-

8:00 AM on:

9
1 2 3 4 5 6 7 8

45
00 05 AM 10 PM 15 20 25 30 35

1220
1 2 3 4 5 6 7 8 9 00 05 AM 10 PM 15 ▬ 25 30 35 40

DATE
0 0 1 1 2 3 4 5 6 7 8 9 0 1 2 3 0 1 2 3 4 5 6 7 8 9 05 06 07 08 09 10 11 12 13 14

DATE

POSITION #

PERMIT NUMBER
50-51-00451
0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 0 0 0 0 0 1 1 1 1 1 2 2 2 2 2 3 3 3 3 3 4 4 4 4 4 5 5 5 5 5 6 6 6 6 6 7 7 7 7 7 8 8 8 8 8 9 9 9 9 9

400 40 ▬ 50 600 60 700 70 800 80 900 90

0 9
▬0 1 1 2 3 4 5 6 7 8 ▬

1 7
0 2 3 0 2 3 4 5 6 ▬ 8 9 ▬ 1

1

0
05 06 07 08 09 0 0 0 1 1 1 2 2 2 3 3 3 4 4 4 5 5 5 6 6 6 7 7 7 8 8 8 9 9 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9

▬ 10 11 12 13 14

FEMALES

▬ 40 10 ▬ 11 50 12 55

10 45 11 50 ▬ 55

MALES

OUT OF BUSINESS

As per section 120.695 of the Florida Statutes (FS), this form will serve as a "Notice of Non-Compliance" for any violations noted. Items marked below violate the requirements of Chapters 64E-13 and 64E-11 of the Florida Administrative Code (FAC) and must be corrected within the time period indicated in the "Results " section above. Continued operation of this facility without making these corrections is a violation of Chpater 64E-13 and 64E-11, FAC, and Chapters 381, FS. Failure to correct violations may result in an administrative fine or other legal action being initiated or continued.

SCHOOL SANITATION - 1. School Site
-

- 8. Natural Ventilation - 9. Mechanical Ventilation

- 15. Handwash Facilities - 16. Showers/Fixtures - 17. Shower Water Temp.

LIQUID/SOLID WASTE - 21. Sewage Disposal
-

MISC. - 26. First Aid Kit FOOD
- 27. Food Insp. Rpt.

2. Playground Equipment 3. Athletic Equipment

22. Solid Waste

BUILDINGS - 4. Construction
√ √

SANITARY FACILITIES - 10. Provided/Accessible
- 11. Cleanliness & Repair - 12. Toilet Facilities - 13. Separation of Sexes - 14. Fixture Ratio

WATER SUPPLY
- 18. Installed/Operated/

VECTOR/VERMIN CONTROL
√ -

5. Maintenance & Repair 6. Lighting/Foot-Candles √ 7. Heating, Ventilation, A/C

Maintained
√ 19. Drinking Fountains - 20. Approved Source

OTHER √ 28. 23. Infestation/Control - 29. 24. Brush/Trash 25. Water Collection/Drainage

ITEM NUMBERS

COMMENTS AND INSTRUCTIONS (continue on attached sheet)

HEALTH DEPARTMENT INSPECTOR: COPY OF REPORT RECEIVED BY:
DH 4030, 01/05 (Obsoletes Previous Editions)

v VACANT ESII AIR

PHONE: DATE:

() 355-3015

CHD / HEADQUARTERS

SCHOOL INSPECTION
PURPOSE:
√ ROUTINE - CONSTRUCT COMPLAINT QA SURVEY PREOPENING

SCHOOL INSPECTION
TYPE:
12 √ 22 23 24 Private School Public School Charter School Vocational School College/University Other

-

REINSPECTION CHANGE OF OWNER CONSULTATION EMDEMIOLOGY OTHER

STATE OF FLORIDA DEPARTMENT OF HEALTH COUNTY HEALTH DEPARTMENT
PUBLIC/PRIVATE SCHOOL INSPECTION REPORT

NAME OF FACILITY ADDRESS OWNER

Gladeview Elementary
CITY ZIP

CENSUS

RESULTS
√ -

1100 SW Avenue "G" Pbc School Board

Belle Glade 33430 () 996-4980

0 1000 2000 3000 100 10 1 2 3 4 5 6 7 8 9 200 20 300 30

Satisfactory

PERSON IN CHARGE BEGIN END

PHONE

Incomplete Unsatisfactory Correct Violations by √ Next Inspection
-

8:00 AM on:

12 15
1 2 3 4 5 6 7 8 9 00 05 AM 10 PM ▬ 20 25 30 35 40

1 30
▬ 00 2 3 4 5 6 7 8 9 05 AM 10 PM 15 20 25 ▬ 35 40

DATE
0 0 1 1 2 3 4 5 6 7 8 9 0 1 2 3 0 1 2 3 4 5 6 7 8 9 05 06 07 08 09 10 11 12 13 14

DATE

POSITION #

PERMIT NUMBER
50-51-00499
0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 0 0 0 0 0 1 1 1 1 1 2 2 2 2 2 3 3 3 3 3 4 4 4 4 4 5 5 5 5 5 6 6 6 6 6 7 7 7 7 7 8 8 8 8 8 9 9 9 9 9

400 40 500 50 600 60 700 70 800 80 900 90

0 5
▬0 1 1 2 3 4 ▬ 6 7 8 9

2 5
0 1 3 0 1 3 4 ▬ 6 7 8 9

1

0
05 06 07 08 09

2 8 9
0 0 0 1 1 1 ▬ 2 2 3 3 3 4 4 4 5 5 5 6 6 6 7 7 7 8 ▬ 8

5 0
0 1 2 3 4 6 7 8 ▬ 1 2 3 4 6 7 8 9

▬ 2

▬ 10 11 12 13 14

▬ 5

FEMALES

10 45 11 50 ▬ 55

10 45 11 50 12 55

MALES

9 9 ▬ 9

OUT OF BUSINESS

As per section 120.695 of the Florida Statutes (FS), this form will serve as a "Notice of Non-Compliance" for any violations noted. Items marked below violate the requirements of Chapters 64E-13 and 64E-11 of the Florida Administrative Code (FAC) and must be corrected within the time period indicated in the "Results " section above. Continued operation of this facility without making these corrections is a violation of Chpater 64E-13 and 64E-11, FAC, and Chapters 381, FS. Failure to correct violations may result in an administrative fine or other legal action being initiated or continued.

SCHOOL SANITATION - 1. School Site
-

- 8. Natural Ventilation - 9. Mechanical Ventilation

- 15. Handwash Facilities - 16. Showers/Fixtures - 17. Shower Water Temp.

LIQUID/SOLID WASTE - 21. Sewage Disposal
-

MISC. - 26. First Aid Kit FOOD
- 27. Food Insp. Rpt.

2. Playground Equipment 3. Athletic Equipment

22. Solid Waste

BUILDINGS - 4. Construction
√ -

SANITARY FACILITIES - 10. Provided/Accessible
- 11. Cleanliness & Repair - 12. Toilet Facilities - 13. Separation of Sexes - 14. Fixture Ratio

WATER SUPPLY
- 18. Installed/Operated/

VECTOR/VERMIN CONTROL
√ -

5. Maintenance & Repair 6. Lighting/Foot-Candles 7. Heating, Ventilation, A/C

Maintained
- 19. Drinking Fountains - 20. Approved Source

OTHER - 28. 23. Infestation/Control - 29. 24. Brush/Trash 25. Water Collection/Drainage

ITEM NUMBERS

COMMENTS AND INSTRUCTIONS (continue on attached sheet)

HEALTH DEPARTMENT INSPECTOR: COPY OF REPORT RECEIVED BY:
DH 4030, 01/05 (Obsoletes Previous Editions)

James Threlkeld

PHONE: DATE:

CHD / HEADQUARTERS

SCHOOL INSPECTION
PURPOSE:
√ ROUTINE - CONSTRUCT COMPLAINT QA SURVEY PREOPENING

SCHOOL INSPECTION
TYPE:
12 √ 22 23 24 Private School Public School Charter School Vocational School College/University Other

-

REINSPECTION CHANGE OF OWNER CONSULTATION EMDEMIOLOGY OTHER

STATE OF FLORIDA DEPARTMENT OF HEALTH COUNTY HEALTH DEPARTMENT
PUBLIC/PRIVATE SCHOOL INSPECTION REPORT

NAME OF FACILITY ADDRESS OWNER

Gladeview Elementary
CITY ZIP

CENSUS

RESULTS
√ -

1100 SW Avenue "G" Pbc School Board Edgecomb

Belle Glade 33430 () 996-4980

385 1000 2000 3000 100 10 1 2 ▬ 4 5 6 7 8 9 200 20 300 30

Satisfactory

PERSON IN CHARGE BEGIN END

PHONE

Incomplete Unsatisfactory Correct Violations by √ Next Inspection
-

8:00 AM on:

12 45
1 2 3 4 5 6 7 8 9 00 05 AM 10 PM 15 20 25 30 35 40

1 45
▬ 00 2 3 4 5 6 7 8 9 05 AM 10 PM 15 20 25 30 35 40

DATE
0 0 1 1 2 3 4 5 6 7 8 9 0 1 2 3 0 1 2 3 4 5 6 7 8 9 05 06 07 08 09 10 11 12 13 14

DATE

POSITION #

PERMIT NUMBER
50-51-00499
0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 0 0 0 0 0 1 1 1 1 1 2 2 2 2 2 3 3 3 3 3 4 4 4 4 4 5 5 5 5 5 6 6 6 6 6 7 7 7 7 7 8 8 8 8 8 9 9 9 9 9

400 40 ▬ 50 600 60 700 70 800 ▬ 900 90

1 1
0 0 2 3 4 5 6 7 8 9

3 0
0 2 ▬ 1 2 4 5 6 7 8 9

1

0
05 06 07 08 09

2 8 9
0 0 0 1 1 1 ▬ 2 2 3 3 3 4 4 4 5 5 5 6 6 6 7 7 7 8 ▬ 8

5 0
0 1 2 3 4 6 7 8 ▬ 1 2 3 4 6 7 8 9

▬▬ 1

▬ 3

▬ 10 11 12 13 14

▬ 5

FEMALES

10 ▬ 11 50 ▬ 55

10 ▬ 11 50 12 55

MALES

9 9 ▬ 9

OUT OF BUSINESS

As per section 120.695 of the Florida Statutes (FS), this form will serve as a "Notice of Non-Compliance" for any violations noted. Items marked below violate the requirements of Chapters 64E-13 and 64E-11 of the Florida Administrative Code (FAC) and must be corrected within the time period indicated in the "Results " section above. Continued operation of this facility without making these corrections is a violation of Chpater 64E-13 and 64E-11, FAC, and Chapters 381, FS. Failure to correct violations may result in an administrative fine or other legal action being initiated or continued.

SCHOOL SANITATION - 1. School Site
-

- 8. Natural Ventilation - 9. Mechanical Ventilation

- 15. Handwash Facilities - 16. Showers/Fixtures - 17. Shower Water Temp.

LIQUID/SOLID WASTE - 21. Sewage Disposal
-

MISC. - 26. First Aid Kit FOOD
- 27. Food Insp. Rpt.

2. Playground Equipment 3. Athletic Equipment

22. Solid Waste

BUILDINGS - 4. Construction
√ -

SANITARY FACILITIES - 10. Provided/Accessible
- 11. Cleanliness & Repair - 12. Toilet Facilities - 13. Separation of Sexes - 14. Fixture Ratio

WATER SUPPLY
- 18. Installed/Operated/

VECTOR/VERMIN CONTROL
√ -

5. Maintenance & Repair 6. Lighting/Foot-Candles 7. Heating, Ventilation, A/C

Maintained
- 19. Drinking Fountains - 20. Approved Source

OTHER - 28. 23. Infestation/Control - 29. 24. Brush/Trash 25. Water Collection/Drainage

ITEM NUMBERS

COMMENTS AND INSTRUCTIONS (continue on attached sheet)

HEALTH DEPARTMENT INSPECTOR: COPY OF REPORT RECEIVED BY:

James Threlkeld Edgecomb
CHD / HEADQUARTERS

PHONE: DATE:

11/30/2010

DH 4030, 01/05 (Obsoletes Previous Editions)

SCHOOL INSPECTION
PURPOSE:
√ ROUTINE - CONSTRUCT COMPLAINT QA SURVEY PREOPENING

SCHOOL INSPECTION
TYPE:
12 √ 22 23 24 Private School Public School Charter School Vocational School College/University Other

-

REINSPECTION CHANGE OF OWNER CONSULTATION EMDEMIOLOGY OTHER

STATE OF FLORIDA DEPARTMENT OF HEALTH COUNTY HEALTH DEPARTMENT
PUBLIC/PRIVATE SCHOOL INSPECTION REPORT

NAME OF FACILITY ADDRESS OWNER

Gold Coast Community School
CITY ZIP

CENSUS

RESULTS
√ -

4260 Westgate Avenue School Board of P.B.C.

West Palm Beach 33409 (561) 640-5091

141 1000 2000 3000 10 ▬ 2 3 4 5 6 7 8 9 200 20 300 30

Satisfactory

PERSON IN CHARGE BEGIN END

PHONE

Incomplete Unsatisfactory Correct Violations by √ Next Inspection
-

8:00 AM on:

10 20
1 2 3 4 5 6 7 8 9 00 05 AM 10 PM 15 ▬ 25 30 35 40

1210
1 2 3 4 5 6 7 8 9 00 05 AM ▬ PM 15 20 25 30 35 40

DATE
0 0 1 1 2 3 4 5 6 7 8 9 0 1 2 3 0 1 2 3 4 5 6 7 8 9 05 06 07 08 09 10 11 12 13 14

DATE

POSITION #

PERMIT NUMBER
50-51-00502
0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 0 0 0 0 0 1 1 1 1 1 2 2 2 2 2 3 3 3 3 3 4 4 4 4 4 5 5 5 5 5 6 6 6 6 6 7 7 7 7 7 8 8 8 8 8 9 9 9 9 9

400 ▬ 500 50 600 60 700 70 800 80 900 90

0 2
▬0 1 1 3 4 5 6 7 8 9

1 6
0 0 2 3 4 5 ▬ 7 8 9 ▬ 1 3

1

0
05 06 07 08 09 0 0 0 1 1 1 2 2 2 3 3 3 4 4 4 5 5 5 6 6 6 7 7 7 8 8 8 9 9 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9

▬ 2

▬ 10 11 12 13 14

FEMALES

▬ 45 11 50 12 55

10 45 11 50 ▬ 55

MALES

OUT OF BUSINESS

As per section 120.695 of the Florida Statutes (FS), this form will serve as a "Notice of Non-Compliance" for any violations noted. Items marked below violate the requirements of Chapters 64E-13 and 64E-11 of the Florida Administrative Code (FAC) and must be corrected within the time period indicated in the "Results " section above. Continued operation of this facility without making these corrections is a violation of Chpater 64E-13 and 64E-11, FAC, and Chapters 381, FS. Failure to correct violations may result in an administrative fine or other legal action being initiated or continued.

SCHOOL SANITATION - 1. School Site
-

- 8. Natural Ventilation - 9. Mechanical Ventilation

- 15. Handwash Facilities - 16. Showers/Fixtures - 17. Shower Water Temp.

LIQUID/SOLID WASTE - 21. Sewage Disposal
-

MISC. - 26. First Aid Kit FOOD
- 27. Food Insp. Rpt.

2. Playground Equipment 3. Athletic Equipment

22. Solid Waste

BUILDINGS - 4. Construction
√ √ -

SANITARY FACILITIES - 10. Provided/Accessible
- 11. Cleanliness & Repair √ 12. Toilet Facilities - 13. Separation of Sexes - 14. Fixture Ratio

WATER SUPPLY
- 18. Installed/Operated/

VECTOR/VERMIN CONTROL
√ -

5. Maintenance & Repair 6. Lighting/Foot-Candles 7. Heating, Ventilation, A/C

Maintained
- 19. Drinking Fountains - 20. Approved Source

OTHER √ 28. 23. Infestation/Control √ 29. 24. Brush/Trash 25. Water Collection/Drainage

ITEM NUMBERS

COMMENTS AND INSTRUCTIONS (continue on attached sheet)

HEALTH DEPARTMENT INSPECTOR: COPY OF REPORT RECEIVED BY:
DH 4030, 01/05 (Obsoletes Previous Editions)

v VACANT ESII AIR

PHONE: DATE:

() 355-3015

CHD / HEADQUARTERS

SCHOOL INSPECTION
PURPOSE:
√ ROUTINE - CONSTRUCT COMPLAINT QA SURVEY PREOPENING

SCHOOL INSPECTION
TYPE:
12 √ 22 23 24 Private School Public School Charter School Vocational School College/University Other

-

REINSPECTION CHANGE OF OWNER CONSULTATION EMDEMIOLOGY OTHER

STATE OF FLORIDA DEPARTMENT OF HEALTH COUNTY HEALTH DEPARTMENT
PUBLIC/PRIVATE SCHOOL INSPECTION REPORT

NAME OF FACILITY ADDRESS OWNER

Gold Coast Community School
CITY ZIP

CENSUS

RESULTS
√ -

4260 Westgate Avenue School Board of P.B.C.

West Palm Beach 33409 (561) 640-5091

152 1000 2000 3000 100 10 ▬ 2 3 4 5 6 7 8 9 20

Satisfactory

PERSON IN CHARGE BEGIN END

PHONE

Incomplete Unsatisfactory Correct Violations by √ Next Inspection
-

8:00 AM on:

11 40
1 2 3 4 5 6 7 8 9 00 10 PM 15 20 25 30 35 ▬

2 00
1 3 4 5 6 7 8 9 ▬ 10 PM 15 20 25 30 35 40

300 30

DATE
0 0 1 1 2 3 4 5 6 7 8 9 0 1 2 3 0 1 2 3 4 5 6 7 8 9 05 06 07 08 09 10 11 12 13 14

DATE

POSITION #

PERMIT NUMBER
50-51-00502
0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 0 0 0 0 0 1 1 1 1 1 2 2 2 2 2 3 3 3 3 3 4 4 4 4 4 5 5 5 5 5 6 6 6 6 6 7 7 7 7 7 8 8 8 8 8 9 9 9 9 9

400 40 500 ▬ 600 60 700 70 800 80 900 90

05 AM ▬ 05 AM

0 7
▬0 1 1 2 3 4 5 6 ▬ 8 9

1 4
0 2 3 0 2 3 ▬ 5 6 7 8 9 ▬ 1

1

0
05 06 07 08 09 0 0 0 1 1 1 2 2 2 3 3 3 4 4 4 5 5 5 6 6 6 7 7 7 8 8 8 9 9 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9

▬ 10 11 12 13 14

FEMALES

10 45 ▬ 50 12 55

10 45 11 50 12 55

MALES

OUT OF BUSINESS

As per section 120.695 of the Florida Statutes (FS), this form will serve as a "Notice of Non-Compliance" for any violations noted. Items marked below violate the requirements of Chapters 64E-13 and 64E-11 of the Florida Administrative Code (FAC) and must be corrected within the time period indicated in the "Results " section above. Continued operation of this facility without making these corrections is a violation of Chpater 64E-13 and 64E-11, FAC, and Chapters 381, FS. Failure to correct violations may result in an administrative fine or other legal action being initiated or continued.

SCHOOL SANITATION - 1. School Site
-

- 8. Natural Ventilation - 9. Mechanical Ventilation

- 15. Handwash Facilities - 16. Showers/Fixtures - 17. Shower Water Temp.

LIQUID/SOLID WASTE - 21. Sewage Disposal
-

MISC. - 26. First Aid Kit FOOD
- 27. Food Insp. Rpt.

2. Playground Equipment 3. Athletic Equipment

22. Solid Waste

BUILDINGS - 4. Construction
√ √ -

SANITARY FACILITIES - 10. Provided/Accessible
- 11. Cleanliness & Repair - 12. Toilet Facilities - 13. Separation of Sexes - 14. Fixture Ratio

WATER SUPPLY
- 18. Installed/Operated/

VECTOR/VERMIN CONTROL
√ -

5. Maintenance & Repair 6. Lighting/Foot-Candles 7. Heating, Ventilation, A/C

Maintained
- 19. Drinking Fountains - 20. Approved Source

OTHER - 28. 23. Infestation/Control - 29. 24. Brush/Trash 25. Water Collection/Drainage

ITEM NUMBERS

COMMENTS AND INSTRUCTIONS (continue on attached sheet)

HEALTH DEPARTMENT INSPECTOR: COPY OF REPORT RECEIVED BY:
DH 4030, 01/05 (Obsoletes Previous Editions)

v VACANT ESII AIR

PHONE: DATE:

() 355-3015

CHD / HEADQUARTERS

SCHOOL INSPECTION
PURPOSE:
√ ROUTINE - CONSTRUCT COMPLAINT QA SURVEY PREOPENING

SCHOOL INSPECTION
TYPE:
12 √ 22 23 24 Private School Public School Charter School Vocational School College/University Other

-

REINSPECTION CHANGE OF OWNER CONSULTATION EMDEMIOLOGY OTHER

STATE OF FLORIDA DEPARTMENT OF HEALTH COUNTY HEALTH DEPARTMENT
PUBLIC/PRIVATE SCHOOL INSPECTION REPORT

NAME OF FACILITY ADDRESS OWNER

Gove Elementary
CITY ZIP

CENSUS

RESULTS
√ -

900 SE Avenue "G" Palm Beach County School Board Anne Turner

Belle Glade 33430 () 996-4985

934 1000 2000 3000 100 10 1 2 3 4 5 6 7 8 ▬ 200 20 300 ▬

Satisfactory

PERSON IN CHARGE BEGIN END

PHONE

Incomplete Unsatisfactory Correct Violations by √ Next Inspection
-

8:00 AM on:

12 00
1 2 3 4 5 6 7 8 9 ▬ 05 AM 10 PM 15 20 25 30 35 40

1 30
▬ 00 2 3 4 5 6 7 8 9 05 AM 10 PM 15 20 25 ▬ 35 40

DATE
0 0 1 1 2 3 4 5 6 7 8 9 0 1 2 3 0 1 2 3 4 5 6 7 8 9 05 06 07 08 09 10 11 12 13 14

DATE

POSITION #

PERMIT NUMBER
50-51-00516
0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 0 0 0 0 0 1 1 1 1 1 2 2 2 2 2 3 3 3 3 3 4 4 4 4 4 5 5 5 5 5 6 6 6 6 6 7 7 7 7 7 8 8 8 8 8 9 9 9 9 9

40

0 5
▬0 1 1 2 3 4 ▬ 6 7 8 9

2 4
0 1 3 0 1 3 ▬ 5 6 7 8 9

1

0
05 06 07 08 09

2 8 9
0 0 0 1 1 1 ▬ 2 2 3 3 3 4 4 4 5 5 5 6 6 6 7 7 7 8 ▬ 8

5 0
0 1 2 3 4 6 7 8 ▬ 1 2 3 4 6 7 8 9

500 50 600 60 700 70 800 80 900 90

▬ 2

▬ 10 11 12 13 14

▬ 5

FEMALES

10 45 11 50 ▬ 55

10 45 11 50 12 55

MALES

9 9 ▬ 9

OUT OF BUSINESS

As per section 120.695 of the Florida Statutes (FS), this form will serve as a "Notice of Non-Compliance" for any violations noted. Items marked below violate the requirements of Chapters 64E-13 and 64E-11 of the Florida Administrative Code (FAC) and must be corrected within the time period indicated in the "Results " section above. Continued operation of this facility without making these corrections is a violation of Chpater 64E-13 and 64E-11, FAC, and Chapters 381, FS. Failure to correct violations may result in an administrative fine or other legal action being initiated or continued.

SCHOOL SANITATION √ 1. School Site
-

- 8. Natural Ventilation - 9. Mechanical Ventilation

- 15. Handwash Facilities - 16. Showers/Fixtures - 17. Shower Water Temp.

LIQUID/SOLID WASTE - 21. Sewage Disposal
-

MISC. - 26. First Aid Kit FOOD
- 27. Food Insp. Rpt.

2. Playground Equipment 3. Athletic Equipment

22. Solid Waste

BUILDINGS - 4. Construction
√ √ -

SANITARY FACILITIES - 10. Provided/Accessible
- 11. Cleanliness & Repair - 12. Toilet Facilities - 13. Separation of Sexes - 14. Fixture Ratio

WATER SUPPLY
- 18. Installed/Operated/

VECTOR/VERMIN CONTROL
√ -

5. Maintenance & Repair 6. Lighting/Foot-Candles 7. Heating, Ventilation, A/C

Maintained
- 19. Drinking Fountains - 20. Approved Source

OTHER - 28. 23. Infestation/Control - 29. 24. Brush/Trash 25. Water Collection/Drainage

ITEM NUMBERS

COMMENTS AND INSTRUCTIONS (continue on attached sheet)

HEALTH DEPARTMENT INSPECTOR: COPY OF REPORT RECEIVED BY:

James Threlkeld Anne Turner
CHD / HEADQUARTERS

PHONE: DATE:

05/24/2010

DH 4030, 01/05 (Obsoletes Previous Editions)

SCHOOL INSPECTION
PURPOSE:
√ ROUTINE - CONSTRUCT COMPLAINT QA SURVEY PREOPENING

SCHOOL INSPECTION
TYPE:
12 √ 22 23 24 Private School Public School Charter School Vocational School College/University Other

-

REINSPECTION CHANGE OF OWNER CONSULTATION EMDEMIOLOGY OTHER

STATE OF FLORIDA DEPARTMENT OF HEALTH COUNTY HEALTH DEPARTMENT
PUBLIC/PRIVATE SCHOOL INSPECTION REPORT

NAME OF FACILITY ADDRESS OWNER

Gove Elementary
CITY ZIP

CENSUS

RESULTS
√ -

900 SE Avenue "G" Palm Beach County School Board

Belle Glade 33430 () 996-4985

901 1000 2000 3000 10 1 2 3 4 5 6 7 8 ▬ 200 20 300 30

Satisfactory

PERSON IN CHARGE BEGIN END

PHONE

Incomplete Unsatisfactory Correct Violations by √ Next Inspection
-

8:00 AM on:

1
2 3 4 5 6 7 8 9

00

2 00
1 3 4 5 6 7 8 9 ▬ 10 PM 15 20 25 30 35 40

DATE
0 0 1 1 2 3 4 5 6 7 8 9 0 1 2 3 0 1 2 3 4 5 6 7 8 9 05 06 07 08 09 10 11 12 13 14

▬ ▬ 10 PM 15 20 25 30 35 40

DATE

POSITION #

PERMIT NUMBER
50-51-00516
0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 0 0 0 0 0 1 1 1 1 1 2 2 2 2 2 3 3 3 3 3 4 4 4 4 4 5 5 5 5 5 6 6 6 6 6 7 7 7 7 7 8 8 8 8 8 9 9 9 9 9

400 40 500 50 600 60 700 70 800 80 900 90

05 AM ▬ 05 AM

1 1
0 0 2 3 4 5 6 7 8 9

0 5
▬ 0 1 2 3 4 ▬ 6 7 8 9 2 3

1

0
05 06 07 08 09

2 8 9
0 0 0 1 1 1 ▬ 2 2 3 3 3 4 4 4 5 5 5 6 6 6 7 7 7 8 ▬ 8

5 0
0 1 2 3 4 6 7 8 ▬ 1 2 3 4 6 7 8 9

▬▬ 1

▬ 10 11 12 13 14

▬ 5

FEMALES

10 45 11 50 12 55

10 45 11 50 12 55

MALES

9 9 ▬ 9

OUT OF BUSINESS

As per section 120.695 of the Florida Statutes (FS), this form will serve as a "Notice of Non-Compliance" for any violations noted. Items marked below violate the requirements of Chapters 64E-13 and 64E-11 of the Florida Administrative Code (FAC) and must be corrected within the time period indicated in the "Results " section above. Continued operation of this facility without making these corrections is a violation of Chpater 64E-13 and 64E-11, FAC, and Chapters 381, FS. Failure to correct violations may result in an administrative fine or other legal action being initiated or continued.

SCHOOL SANITATION √ 1. School Site
-

- 8. Natural Ventilation - 9. Mechanical Ventilation

- 15. Handwash Facilities - 16. Showers/Fixtures - 17. Shower Water Temp.

LIQUID/SOLID WASTE - 21. Sewage Disposal
-

MISC. - 26. First Aid Kit FOOD
- 27. Food Insp. Rpt.

2. Playground Equipment 3. Athletic Equipment

22. Solid Waste

BUILDINGS √ 4. Construction
√ -

SANITARY FACILITIES - 10. Provided/Accessible
- 11. Cleanliness & Repair - 12. Toilet Facilities - 13. Separation of Sexes - 14. Fixture Ratio

WATER SUPPLY
- 18. Installed/Operated/

VECTOR/VERMIN CONTROL
√ -

5. Maintenance & Repair 6. Lighting/Foot-Candles 7. Heating, Ventilation, A/C

Maintained
- 19. Drinking Fountains - 20. Approved Source

OTHER - 28. 23. Infestation/Control - 29. 24. Brush/Trash 25. Water Collection/Drainage

ITEM NUMBERS

COMMENTS AND INSTRUCTIONS (continue on attached sheet)

HEALTH DEPARTMENT INSPECTOR: COPY OF REPORT RECEIVED BY:
DH 4030, 01/05 (Obsoletes Previous Editions)

James Threlkeld

PHONE: DATE:

CHD / HEADQUARTERS

SCHOOL INSPECTION
PURPOSE:
√ ROUTINE - CONSTRUCT COMPLAINT QA SURVEY PREOPENING

SCHOOL INSPECTION
TYPE:
12 √ 22 23 24 Private School Public School Charter School Vocational School College/University Other

-

REINSPECTION CHANGE OF OWNER CONSULTATION EMDEMIOLOGY OTHER

STATE OF FLORIDA DEPARTMENT OF HEALTH COUNTY HEALTH DEPARTMENT
PUBLIC/PRIVATE SCHOOL INSPECTION REPORT

NAME OF FACILITY ADDRESS OWNER

Grassy Waters Elementary
CITY

CENSUS

RESULTS
√ -

3550 N Jog Road

West Palm Beach 33411 (555) 555-5555

690 1000 2000 3000 100 10 1 2 3 4 5 ▬ 7 8 9 200 20 300 30

Satisfactory

The School District of Palm Beach County ZIP

PERSON IN CHARGE BEGIN END

PHONE

Incomplete Unsatisfactory Correct Violations by √ Next Inspection
-

8:00 AM on:

9
1 2 3 4 5 6 7 8

45
00 05 AM 10 PM 15 20 25 30 35

1200
1 2 3 4 5 6 7 8 9 ▬ 05 AM 10 PM 15 20 25 30 35 40

DATE
0 0 1 1 2 3 4 5 6 7 8 9 0 1 2 3 0 1 2 3 4 5 6 7 8 9 05 06 07 08 09 10 11 12 13 14

DATE

POSITION #

PERMIT NUMBER
50-51-03153
0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 0 0 0 0 0 1 1 1 1 1 2 2 2 2 2 3 3 3 3 3 4 4 4 4 4 5 5 5 5 5 6 6 6 6 6 7 7 7 7 7 8 8 8 8 8 9 9 9 9 9

400 40 500 50 600 60 700 70 800 80 900 ▬

0 5
▬0 1 1 2 3 4 ▬ 6 7 8 9

2 1
0 1 3 0 ▬ 3 4 5 6 7 8 9

1

0
05 06 07 08 09 0 0 0 1 1 1 2 2 2 3 3 3 4 4 4 5 5 5 6 6 6 7 7 7 8 8 8 9 9 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9

▬ 2

▬ 10 11 12 13 14

FEMALES

▬ 40 10 ▬ 11 50 12 55

10 45 11 50 ▬ 55

MALES

OUT OF BUSINESS

As per section 120.695 of the Florida Statutes (FS), this form will serve as a "Notice of Non-Compliance" for any violations noted. Items marked below violate the requirements of Chapters 64E-13 and 64E-11 of the Florida Administrative Code (FAC) and must be corrected within the time period indicated in the "Results " section above. Continued operation of this facility without making these corrections is a violation of Chpater 64E-13 and 64E-11, FAC, and Chapters 381, FS. Failure to correct violations may result in an administrative fine or other legal action being initiated or continued.

SCHOOL SANITATION - 1. School Site
-

- 8. Natural Ventilation - 9. Mechanical Ventilation

√ 15. Handwash Facilities - 16. Showers/Fixtures - 17. Shower Water Temp.

LIQUID/SOLID WASTE - 21. Sewage Disposal
-

MISC. - 26. First Aid Kit FOOD
- 27. Food Insp. Rpt.

2. Playground Equipment 3. Athletic Equipment

22. Solid Waste

BUILDINGS - 4. Construction
√ √

SANITARY FACILITIES - 10. Provided/Accessible
√ 11. Cleanliness & Repair - 12. Toilet Facilities - 13. Separation of Sexes - 14. Fixture Ratio

WATER SUPPLY
- 18. Installed/Operated/

VECTOR/VERMIN CONTROL
√ -

5. Maintenance & Repair 6. Lighting/Foot-Candles √ 7. Heating, Ventilation, A/C

Maintained
√ 19. Drinking Fountains - 20. Approved Source

OTHER - 28. 23. Infestation/Control √ 29. 24. Brush/Trash 25. Water Collection/Drainage

ITEM NUMBERS

COMMENTS AND INSTRUCTIONS (continue on attached sheet)

HEALTH DEPARTMENT INSPECTOR: COPY OF REPORT RECEIVED BY:
DH 4030, 01/05 (Obsoletes Previous Editions)

v VACANT ESII AIR

PHONE: DATE:

() 355-3015

CHD / HEADQUARTERS

SCHOOL INSPECTION
PURPOSE:
√ ROUTINE - CONSTRUCT COMPLAINT QA SURVEY PREOPENING

SCHOOL INSPECTION
TYPE:
√ 13 22 23 24 Private School Public School Charter School Vocational School College/University Other

-

REINSPECTION CHANGE OF OWNER CONSULTATION EMDEMIOLOGY OTHER

STATE OF FLORIDA DEPARTMENT OF HEALTH COUNTY HEALTH DEPARTMENT
PUBLIC/PRIVATE SCHOOL INSPECTION REPORT

NAME OF FACILITY ADDRESS OWNER

Hillel Day School of Boca Raton
CITY ZIP

CENSUS

RESULTS
√ -

21011 95th Avenue S Hillel Day School of Boca Raton

Boca Raton 33428 (561) 470-5000

353 1000 2000 3000 100 10 1 2 ▬ 4 5 6 7 8 9 200 20 ▬ 30

Satisfactory

PERSON IN CHARGE BEGIN END

PHONE

Incomplete Unsatisfactory Correct Violations by √ Next Inspection
-

8:00 AM on:

2
1 3 4 5 6 7 8 9

30
00

3 30
1 2 4 5 6 7 8 9 00 05 AM 15 20 25 ▬ 35 40

DATE
0 0 1 1 2 3 4 5 6 7 8 9 0 1 2 3 0 1 2 3 4 5 6 7 8 9 05 06 07 08 09 10 11 12 13 14

DATE

POSITION #

PERMIT NUMBER
50-51-01678
0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 0 0 0 0 0 1 1 1 1 1 2 2 2 2 2 3 3 3 3 3 4 4 4 4 4 5 5 5 5 5 6 6 6 6 6 7 7 7 7 7 8 8 8 8 8 9 9 9 9 9

400 40 500 ▬ 600 60 700 70 800 80 900 90

▬ 05 AM 15 20 25 ▬ 35 40

0 3
▬0 1 1 2 4 5 6 7 8 9

2 3
0 1 0 1 ▬ 4 5 6 7 8 9

1

0
05 06 07 08 09

8 1 4
0 0 0 1 ▬ 1 2 2 2 3 3 3 5 5 5 6 6 6 7 7 7 ▬ 8 8 9 9 9

3 4
0 1 2 0 1 2 ▬ 5 6 7 8 9

10 PM ▬ 10 PM

▬ 2

▬ 3

▬ 3 5 6 7 8 9

4 4 ▬ 4

▬ 10 11 12 13 14

FEMALES

10 45 11 50 12 55

10 45 11 50 12 55

MALES

OUT OF BUSINESS

As per section 120.695 of the Florida Statutes (FS), this form will serve as a "Notice of Non-Compliance" for any violations noted. Items marked below violate the requirements of Chapters 64E-13 and 64E-11 of the Florida Administrative Code (FAC) and must be corrected within the time period indicated in the "Results " section above. Continued operation of this facility without making these corrections is a violation of Chpater 64E-13 and 64E-11, FAC, and Chapters 381, FS. Failure to correct violations may result in an administrative fine or other legal action being initiated or continued.

SCHOOL SANITATION - 1. School Site
-

- 8. Natural Ventilation - 9. Mechanical Ventilation

- 15. Handwash Facilities - 16. Showers/Fixtures - 17. Shower Water Temp.

LIQUID/SOLID WASTE - 21. Sewage Disposal
-

MISC. - 26. First Aid Kit FOOD
- 27. Food Insp. Rpt.

2. Playground Equipment 3. Athletic Equipment

22. Solid Waste

BUILDINGS - 4. Construction
-

SANITARY FACILITIES - 10. Provided/Accessible
- 11. Cleanliness & Repair √ 12. Toilet Facilities - 13. Separation of Sexes - 14. Fixture Ratio

WATER SUPPLY
- 18. Installed/Operated/

VECTOR/VERMIN CONTROL
√ -

5. Maintenance & Repair 6. Lighting/Foot-Candles 7. Heating, Ventilation, A/C

Maintained
- 19. Drinking Fountains - 20. Approved Source

OTHER √ 28. 23. Infestation/Control - 29. 24. Brush/Trash 25. Water Collection/Drainage

ITEM NUMBERS

COMMENTS AND INSTRUCTIONS (continue on attached sheet)

HEALTH DEPARTMENT INSPECTOR: COPY OF REPORT RECEIVED BY:
DH 4030, 01/05 (Obsoletes Previous Editions)

Manjit Singh

PHONE: DATE:

CHD / HEADQUARTERS

SCHOOL INSPECTION
PURPOSE:
ROUTINE CONSTRUCT COMPLAINT QA SURVEY PREOPENING

SCHOOL INSPECTION
TYPE:
12 √ 22 23 24 Private School Public School Charter School Vocational School College/University Other

√ REINSPECTION - CHANGE OF OWNER CONSULTATION EMDEMIOLOGY OTHER

STATE OF FLORIDA DEPARTMENT OF HEALTH COUNTY HEALTH DEPARTMENT
PUBLIC/PRIVATE SCHOOL INSPECTION REPORT

NAME OF FACILITY ADDRESS OWNER

Imagine Schools-Chancellar Campus
CITY ZIP

CENSUS

RESULTS

3333 Highridge Road Imagine Schools-Chancellar Campus

Boynton Beach 33426 (561) 585-1189

912 1000 2000 3000 100 ▬ 1 2 3 4 5 6 7 8 ▬ 20

Satisfactory

PERSON IN CHARGE BEGIN END

Mary Salas, Facility ManagerPHONE

Incomplete Unsatisfactory Correct Violations by Next Inspection

8:00 AM on:

2
1 3 4 5 6 7 8 9

45
00

3 45
1 2 4 5 6 7 8 9 00 05 AM 15 20 25 30 35 40

300 30

DATE
1 1 1 9 1 0
0 0 2 3 4 5 6 7 8 9 0 2 3 0 2 3 4 5 6 7 8 ▬ 05 06 07 08 09 ▬ 10 11 12 13 14 ▬▬ ▬ 1

DATE

POSITION #

PERMIT NUMBER
50-51-1282943
0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 0 0 0 0 0 1 1 1 1 1 2 2 2 2 2 3 3 3 3 3 4 4 4 4 4 5 5 5 5 5 6 6 6 6 6 7 7 7 7 7 8 8 8 8 8 9 9 9 9 9

400 40 500 50 600 60 700 70 800 80 900 90

▬ 05 AM 15 20 25 30 35 40

1 0
▬1 2 3 4 5 6 7 8 9

2 1
0 ▬ 3 4 5 6 7 8 9 1 3

1

0
05 06 07 08 09

4 3 5
0 0 0 1 1 1 2 2 2 3 ▬ 3 ▬ 4 4 6 6 6 7 7 7 8 8 8 9 9 9

8 1
0 1 2 3 4 6 7 9 0 ▬ 2 3 4 5 6 7 9

10 PM ▬ 10 PM

0 ▬ 0

▬ 2

▬ 10 11 12 13 14

5 5 ▬ 5

FEMALES

10 ▬ 11 50 12 55

10 ▬ 11 50 12 55

▬ 8

MALES

OUT OF BUSINESS

As per section 120.695 of the Florida Statutes (FS), this form will serve as a "Notice of Non-Compliance" for any violations noted. Items marked below violate the requirements of Chapters 64E-13 and 64E-11 of the Florida Administrative Code (FAC) and must be corrected within the time period indicated in the "Results " section above. Continued operation of this facility without making these corrections is a violation of Chpater 64E-13 and 64E-11, FAC, and Chapters 381, FS. Failure to correct violations may result in an administrative fine or other legal action being initiated or continued.

SCHOOL SANITATION - 1. School Site
-

- 8. Natural Ventilation - 9. Mechanical Ventilation

- 15. Handwash Facilities - 16. Showers/Fixtures - 17. Shower Water Temp.

LIQUID/SOLID WASTE - 21. Sewage Disposal
-

MISC. - 26. First Aid Kit FOOD
- 27. Food Insp. Rpt.

2. Playground Equipment 3. Athletic Equipment

22. Solid Waste

BUILDINGS - 4. Construction
√ -

SANITARY FACILITIES - 10. Provided/Accessible
- 11. Cleanliness & Repair - 12. Toilet Facilities - 13. Separation of Sexes - 14. Fixture Ratio

WATER SUPPLY
- 18. Installed/Operated/

VECTOR/VERMIN CONTROL
√ -

5. Maintenance & Repair 6. Lighting/Foot-Candles 7. Heating, Ventilation, A/C

Maintained
- 19. Drinking Fountains - 20. Approved Source

OTHER - 28. 23. Infestation/Control - 29. 24. Brush/Trash 25. Water Collection/Drainage

ITEM NUMBERS

COMMENTS AND INSTRUCTIONS (continue on attached sheet)

HEALTH DEPARTMENT INSPECTOR: COPY OF REPORT RECEIVED BY:

Rebekah Lejeune Mary Salas, Facility Manager
CHD / HEADQUARTERS

PHONE: DATE:

10/21/2010

DH 4030, 01/05 (Obsoletes Previous Editions)

SCHOOL INSPECTION
PURPOSE:
√ ROUTINE - CONSTRUCT COMPLAINT QA SURVEY PREOPENING

SCHOOL INSPECTION
TYPE:
12 √ 22 23 24 Private School Public School Charter School Vocational School College/University Other

-

REINSPECTION CHANGE OF OWNER CONSULTATION EMDEMIOLOGY OTHER

STATE OF FLORIDA DEPARTMENT OF HEALTH COUNTY HEALTH DEPARTMENT
PUBLIC/PRIVATE SCHOOL INSPECTION REPORT

NAME OF FACILITY ADDRESS OWNER

Indian Pine Elementary School
CITY ZIP

CENSUS

RESULTS

6000 Oak Royal Drive School Board of Pbc

Lake Worth 33463 () 641-1295

955 1000 2000 3000 100 10 1 2 3 4 5 6 7 8 ▬ 200 20 300 30

Satisfactory

PERSON IN CHARGE BEGIN END

PHONE

Incomplete Unsatisfactory Correct Violations by Next Inspection

8:00 AM on:

9
1 2 3 4 5 6 7 8

30
00 10 PM 15 20 25 ▬ 35

2 00
1 3 4 5 6 7 8 9 ▬ 10 PM 15 20 25 30 35 40

DATE
0 6 0 8 1 0
▬0 1 1 2 3 4 5 ▬ 7 8 9 ▬ 0 1 2 3 1 2 3 4 5 6 7 ▬ 9 05 06 07 08 09 ▬ 10 11 12 13 14

DATE

POSITION #

PERMIT NUMBER
50-51-00648
0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 0 0 0 0 0 1 1 1 1 1 2 2 2 2 2 3 3 3 3 3 4 4 4 4 4 5 5 5 5 5 6 6 6 6 6 7 7 7 7 7 8 8 8 8 8 9 9 9 9 9

400 40 ▬ ▬ 600 60 700 70 800 80 900 90

05 AM ▬ 05 AM

0 5
▬0 1 1 2 3 4 ▬ 6 7 8 9

2 6
0 1 3 0 1 3 4 5 ▬ 7 8 9

1

0
05 06 07 08 09

2 8 8
0 0 0 1 1 1 ▬ 2 2 3 3 3 4 4 4 5 5 5 6 6 6 7 7 7 9 9 9

2 8
0 1 3 4 5 6 7 9 0 1 3 4 5 6 7 ▬ 9

▬ 2

▬ 2

▬ 10 11 12 13 14

FEMALES

▬ 40 10 45 11 50 12 55

10 45 11 50 12 55

8 ▬ ▬ 8

MALES

OUT OF BUSINESS

As per section 120.695 of the Florida Statutes (FS), this form will serve as a "Notice of Non-Compliance" for any violations noted. Items marked below violate the requirements of Chapters 64E-13 and 64E-11 of the Florida Administrative Code (FAC) and must be corrected within the time period indicated in the "Results " section above. Continued operation of this facility without making these corrections is a violation of Chpater 64E-13 and 64E-11, FAC, and Chapters 381, FS. Failure to correct violations may result in an administrative fine or other legal action being initiated or continued.

SCHOOL SANITATION - 1. School Site
-

- 8. Natural Ventilation √ 9. Mechanical Ventilation

- 15. Handwash Facilities - 16. Showers/Fixtures - 17. Shower Water Temp.

LIQUID/SOLID WASTE - 21. Sewage Disposal
-

MISC. - 26. First Aid Kit FOOD
- 27. Food Insp. Rpt.

2. Playground Equipment 3. Athletic Equipment

22. Solid Waste

BUILDINGS - 4. Construction
√ -

SANITARY FACILITIES - 10. Provided/Accessible
- 11. Cleanliness & Repair - 12. Toilet Facilities - 13. Separation of Sexes - 14. Fixture Ratio

WATER SUPPLY
- 18. Installed/Operated/

VECTOR/VERMIN CONTROL
√ -

5. Maintenance & Repair 6. Lighting/Foot-Candles 7. Heating, Ventilation, A/C

Maintained
- 19. Drinking Fountains - 20. Approved Source

OTHER - 28. 23. Infestation/Control - 29. 24. Brush/Trash 25. Water Collection/Drainage

ITEM NUMBERS

COMMENTS AND INSTRUCTIONS (continue on attached sheet)

HEALTH DEPARTMENT INSPECTOR: COPY OF REPORT RECEIVED BY:
DH 4030, 01/05 (Obsoletes Previous Editions)

Ranjit Madisetty

PHONE: DATE:

CHD / HEADQUARTERS

SCHOOL INSPECTION
PURPOSE:
√ ROUTINE - CONSTRUCT COMPLAINT QA SURVEY PREOPENING

SCHOOL INSPECTION
TYPE:
12 √ 22 23 24 Private School Public School Charter School Vocational School College/University Other

-

REINSPECTION CHANGE OF OWNER CONSULTATION EMDEMIOLOGY OTHER

STATE OF FLORIDA DEPARTMENT OF HEALTH COUNTY HEALTH DEPARTMENT
PUBLIC/PRIVATE SCHOOL INSPECTION REPORT

NAME OF FACILITY ADDRESS OWNER

Jupiter Elementary
CITY ZIP

CENSUS

RESULTS
√ -

200 S Loxahatchee Drive P.B.C. School Board Mr. Smith

Jupiter 33458 () 744-7979

686 1000 2000 3000 100 10 1 2 3 4 5 ▬ 7 8 9 200 20 300 30

Satisfactory

PERSON IN CHARGE BEGIN END

PHONE

Incomplete Unsatisfactory Correct Violations by √ Next Inspection
-

8:00 AM on:

10 00
1 2 3 4 5 6 7 8 9 ▬ 05 AM 10 PM 15 20 25 30 35 40

1115
1 2 3 4 5 6 7 8 9 00 05 AM 10 PM ▬ 20 25 30 35 40

DATE
0 0 1 1 2 3 4 5 6 7 8 9 0 1 2 3 0 1 2 3 4 5 6 7 8 9 05 06 07 08 09 10 11 12 13 14

DATE

POSITION #

PERMIT NUMBER
50-51-00694
0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 0 0 0 0 0 1 1 1 1 1 2 2 2 2 2 3 3 3 3 3 4 4 4 4 4 5 5 5 5 5 6 6 6 6 6 7 7 7 7 7 8 8 8 8 8 9 9 9 9 9

400 40 500 50 ▬ 60 700 70 800 ▬ 900 90

0 8
▬0 1 1 2 3 4 5 6 7 ▬ 9

2 5
0 1 3 0 1 3 4 ▬ 6 7 8 9

1

0
05 06 07 08 09

4 5 8
0 0 0 1 1 1 2 2 2 3 3 3 ▬ 4 4 5 ▬ 5 6 6 6 7 7 7 9 9 9

0 5
▬ 0 1 2 3 4 5 6 7 9 1 2 3 4 ▬ 6 7 8 9

▬ 2

▬ 10 11 12 13 14

FEMALES

▬ 45 11 50 12 55

10 45 ▬ 50 12 55

8 8 ▬ 8

MALES

OUT OF BUSINESS

As per section 120.695 of the Florida Statutes (FS), this form will serve as a "Notice of Non-Compliance" for any violations noted. Items marked below violate the requirements of Chapters 64E-13 and 64E-11 of the Florida Administrative Code (FAC) and must be corrected within the time period indicated in the "Results " section above. Continued operation of this facility without making these corrections is a violation of Chpater 64E-13 and 64E-11, FAC, and Chapters 381, FS. Failure to correct violations may result in an administrative fine or other legal action being initiated or continued.

SCHOOL SANITATION - 1. School Site
-

- 8. Natural Ventilation - 9. Mechanical Ventilation

- 15. Handwash Facilities - 16. Showers/Fixtures - 17. Shower Water Temp.

LIQUID/SOLID WASTE - 21. Sewage Disposal
-

MISC. √ 26. First Aid Kit FOOD
- 27. Food Insp. Rpt.

2. Playground Equipment 3. Athletic Equipment

22. Solid Waste

BUILDINGS - 4. Construction
√ -

SANITARY FACILITIES - 10. Provided/Accessible
- 11. Cleanliness & Repair - 12. Toilet Facilities - 13. Separation of Sexes - 14. Fixture Ratio

WATER SUPPLY
- 18. Installed/Operated/

VECTOR/VERMIN CONTROL
√ -

5. Maintenance & Repair 6. Lighting/Foot-Candles 7. Heating, Ventilation, A/C

Maintained
√ 19. Drinking Fountains - 20. Approved Source

OTHER √ 28. 23. Infestation/Control - 29. 24. Brush/Trash 25. Water Collection/Drainage

ITEM NUMBERS

COMMENTS AND INSTRUCTIONS (continue on attached sheet)

HEALTH DEPARTMENT INSPECTOR: COPY OF REPORT RECEIVED BY:

Julia Holtzhausen Mr. Smith
CHD / HEADQUARTERS

PHONE: DATE:

08/25/2010

DH 4030, 01/05 (Obsoletes Previous Editions)

SCHOOL INSPECTION
PURPOSE:
√ ROUTINE - CONSTRUCT COMPLAINT QA SURVEY PREOPENING

SCHOOL INSPECTION
TYPE:
12 √ 22 23 24 Private School Public School Charter School Vocational School College/University Other

-

REINSPECTION CHANGE OF OWNER CONSULTATION EMDEMIOLOGY OTHER

STATE OF FLORIDA DEPARTMENT OF HEALTH COUNTY HEALTH DEPARTMENT
PUBLIC/PRIVATE SCHOOL INSPECTION REPORT

NAME OF FACILITY ADDRESS OWNER

Jupiter High School
CITY ZIP

CENSUS

RESULTS
√ -

500 N Military Trail PBC School District Mr. Stafford

Jupiter 33458 () 744-7900

2897 1000 ▬ 3000 100 10 1 2 3 4 5 6 7 8 9 200 20 300 30

Satisfactory

PERSON IN CHARGE BEGIN END

PHONE

Incomplete Unsatisfactory Correct Violations by √ Next Inspection
-

8:00 AM on:

9
1 2 3 4 5 6 7 8

35
00 05 AM 10 PM 15 20 25 30 ▬

1 00
▬ ▬ 2 3 4 5 6 7 8 9 05 AM 10 PM 15 20 25 30 35 40

DATE
0 0 1 1 2 3 4 5 6 7 8 9 0 1 2 3 0 1 2 3 4 5 6 7 8 9 05 06 07 08 09 10 11 12 13 14

DATE

POSITION #

PERMIT NUMBER
50-51-00697
0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 0 0 0 0 0 1 1 1 1 1 2 2 2 2 2 3 3 3 3 3 4 4 4 4 4 5 5 5 5 5 6 6 6 6 6 7 7 7 7 7 8 8 8 8 8 9 9 9 9 9

400 40 500 50 600 60 700 70 ▬ 80 900 90

0 8
▬0 1 1 2 3 4 5 6 7 ▬ 9

2 4
0 1 3 0 1 3 ▬ 5 6 7 8 9

1

0
05 06 07 08 09

6 9 8
0 0 0 1 1 1 2 2 2 3 3 3 4 4 4 5 5 5 ▬ 6 6 7 7 7 9 ▬ 9

3 7
0 1 2 4 5 6 7 9 0 1 2 4 5 6 ▬ 8 9

▬ 2

▬ 3

▬ 10 11 12 13 14

FEMALES

▬ 40 10 45 11 50 12 55

10 45 11 50 12 55

8 8 ▬ 8

MALES

OUT OF BUSINESS

As per section 120.695 of the Florida Statutes (FS), this form will serve as a "Notice of Non-Compliance" for any violations noted. Items marked below violate the requirements of Chapters 64E-13 and 64E-11 of the Florida Administrative Code (FAC) and must be corrected within the time period indicated in the "Results " section above. Continued operation of this facility without making these corrections is a violation of Chpater 64E-13 and 64E-11, FAC, and Chapters 381, FS. Failure to correct violations may result in an administrative fine or other legal action being initiated or continued.

SCHOOL SANITATION - 1. School Site
-

- 8. Natural Ventilation - 9. Mechanical Ventilation

- 15. Handwash Facilities - 16. Showers/Fixtures - 17. Shower Water Temp.

LIQUID/SOLID WASTE - 21. Sewage Disposal
-

MISC. √ 26. First Aid Kit FOOD
- 27. Food Insp. Rpt.

2. Playground Equipment 3. Athletic Equipment

22. Solid Waste

BUILDINGS - 4. Construction
√ -

SANITARY FACILITIES - 10. Provided/Accessible
- 11. Cleanliness & Repair √ 12. Toilet Facilities - 13. Separation of Sexes - 14. Fixture Ratio

WATER SUPPLY
- 18. Installed/Operated/

VECTOR/VERMIN CONTROL
√ -

5. Maintenance & Repair 6. Lighting/Foot-Candles 7. Heating, Ventilation, A/C

Maintained
√ 19. Drinking Fountains - 20. Approved Source

OTHER - 28. 23. Infestation/Control - 29. 24. Brush/Trash 25. Water Collection/Drainage

ITEM NUMBERS

COMMENTS AND INSTRUCTIONS (continue on attached sheet)

HEALTH DEPARTMENT INSPECTOR: COPY OF REPORT RECEIVED BY:

Kai Bonner Jones Mr. Stafford
CHD / HEADQUARTERS

PHONE: DATE:

() 274-5334 08/24/2010

DH 4030, 01/05 (Obsoletes Previous Editions)

SCHOOL INSPECTION
PURPOSE:
√ ROUTINE - CONSTRUCT COMPLAINT QA SURVEY PREOPENING

SCHOOL INSPECTION
TYPE:
12 √ 22 23 24 Private School Public School Charter School Vocational School College/University Other

-

REINSPECTION CHANGE OF OWNER CONSULTATION EMDEMIOLOGY OTHER

STATE OF FLORIDA DEPARTMENT OF HEALTH COUNTY HEALTH DEPARTMENT
PUBLIC/PRIVATE SCHOOL INSPECTION REPORT

NAME OF FACILITY ADDRESS OWNER

Liberty Park Elementary
CITY ZIP

CENSUS

RESULTS
√ -

6601 Constitution Way Pbc School Board

Greenacres 33413 () 642-1035

876 1000 2000 3000 100 10 1 2 3 4 5 6 7 ▬ 9 200 20 300 30

Satisfactory

PERSON IN CHARGE BEGIN END

PHONE

Incomplete Unsatisfactory Correct Violations by √ Next Inspection
-

8:00 AM on:

10 20
1 2 3 4 5 6 7 8 9 00 05 AM 10 PM 15 ▬ 25 30 35 40

1130
1 2 3 4 5 6 7 8 9 00 05 AM 10 PM 15 20 25 ▬ 35 40

DATE
0 0 1 1 2 3 4 5 6 7 8 9 0 1 2 3 0 1 2 3 4 5 6 7 8 9 05 06 07 08 09 10 11 12 13 14

DATE

POSITION #

PERMIT NUMBER
50-51-00786
0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 0 0 0 0 0 1 1 1 1 1 2 2 2 2 2 3 3 3 3 3 4 4 4 4 4 5 5 5 5 5 6 6 6 6 6 7 7 7 7 7 8 8 8 8 8 9 9 9 9 9

400 40 500 50 ▬ 60 700 ▬ 800 80 900 90

1 0
▬1 2 3 4 5 6 7 8 9

1 4
0 2 3 ▬ 5 6 7 8 9 ▬ 1 2 3

1

0
05 06 07 08 09

6 1 0
1 ▬ 1 2 2 2 3 3 3 4 4 4 5 5 5 ▬ 6 6 7 7 7 8 8 8 9 9 9

3 4
0 1 2 ▬ 5 6 7 8 9 1 2 4 5 6 7 8 9

0 ▬ 0

0 0 ▬ 0

▬ 3

▬ 10 11 12 13 14

FEMALES

▬ 45 11 50 12 55

10 45 ▬ 50 12 55

MALES

OUT OF BUSINESS

As per section 120.695 of the Florida Statutes (FS), this form will serve as a "Notice of Non-Compliance" for any violations noted. Items marked below violate the requirements of Chapters 64E-13 and 64E-11 of the Florida Administrative Code (FAC) and must be corrected within the time period indicated in the "Results " section above. Continued operation of this facility without making these corrections is a violation of Chpater 64E-13 and 64E-11, FAC, and Chapters 381, FS. Failure to correct violations may result in an administrative fine or other legal action being initiated or continued.

SCHOOL SANITATION - 1. School Site
-

- 8. Natural Ventilation - 9. Mechanical Ventilation

√ 15. Handwash Facilities - 16. Showers/Fixtures - 17. Shower Water Temp.

LIQUID/SOLID WASTE - 21. Sewage Disposal
-

MISC. - 26. First Aid Kit FOOD
- 27. Food Insp. Rpt.

2. Playground Equipment 3. Athletic Equipment

22. Solid Waste

BUILDINGS - 4. Construction
-

SANITARY FACILITIES - 10. Provided/Accessible
√ 11. Cleanliness & Repair - 12. Toilet Facilities - 13. Separation of Sexes - 14. Fixture Ratio

WATER SUPPLY
- 18. Installed/Operated/

VECTOR/VERMIN CONTROL
√ -

5. Maintenance & Repair 6. Lighting/Foot-Candles 7. Heating, Ventilation, A/C

Maintained
√ 19. Drinking Fountains - 20. Approved Source

OTHER √ 28. 23. Infestation/Control - 29. 24. Brush/Trash 25. Water Collection/Drainage

ITEM NUMBERS

COMMENTS AND INSTRUCTIONS (continue on attached sheet)

HEALTH DEPARTMENT INSPECTOR: COPY OF REPORT RECEIVED BY:
DH 4030, 01/05 (Obsoletes Previous Editions)

Kenny Wilson

PHONE: DATE:

CHD / HEADQUARTERS

SCHOOL INSPECTION
PURPOSE:
√ ROUTINE - CONSTRUCT COMPLAINT QA SURVEY PREOPENING

SCHOOL INSPECTION
TYPE:
12 √ 22 23 24 Private School Public School Charter School Vocational School College/University Other

-

REINSPECTION CHANGE OF OWNER CONSULTATION EMDEMIOLOGY OTHER

STATE OF FLORIDA DEPARTMENT OF HEALTH COUNTY HEALTH DEPARTMENT
PUBLIC/PRIVATE SCHOOL INSPECTION REPORT

NAME OF FACILITY ADDRESS OWNER

Lighthouse Elementary
CITY ZIP

CENSUS

RESULTS
√ -

4750 Dokota Drive Pbc School Board David Hatcher

Jupiter 33458 (561) 745-7261

818 1000 2000 3000 100 ▬ 1 2 3 4 5 6 7 ▬ 9 200 20 300 30

Satisfactory

PERSON IN CHARGE BEGIN END

PHONE

Incomplete Unsatisfactory Correct Violations by √ Next Inspection
-

8:00 AM on:

9
1 2 3 4 5 6 7 8

15
00 05 AM 10 PM ▬ 20 25 30 35

1100
1 2 3 4 5 6 7 8 9 ▬ 05 AM 10 PM 15 20 25 30 35 40

DATE
0 0 1 1 2 3 4 5 6 7 8 9 0 1 2 3 0 1 2 3 4 5 6 7 8 9 05 06 07 08 09 10 11 12 13 14

DATE

POSITION #

PERMIT NUMBER
50-51-00789
0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 0 0 0 0 0 1 1 1 1 1 2 2 2 2 2 3 3 3 3 3 4 4 4 4 4 5 5 5 5 5 6 6 6 6 6 7 7 7 7 7 8 8 8 8 8 9 9 9 9 9

400 40 500 50 600 60 700 70 ▬ 80 900 90

1 1
0 0 2 3 4 5 6 7 8 9

1 6
0 2 3 0 2 3 4 5 ▬ 7 8 9

1

0
05 06 07 08 09

4 5 8
0 0 0 1 1 1 2 2 2 3 3 3 ▬ 4 4 5 ▬ 5 6 6 6 7 7 7 9 9 9

0 5
▬ 0 1 2 3 4 5 6 7 9 1 2 3 4 ▬ 6 7 8 9

▬▬ ▬ 1

▬ 10 11 12 13 14

FEMALES

▬ 40 10 45 11 50 12 55

10 45 ▬ 50 12 55

8 8 ▬ 8

MALES

OUT OF BUSINESS

As per section 120.695 of the Florida Statutes (FS), this form will serve as a "Notice of Non-Compliance" for any violations noted. Items marked below violate the requirements of Chapters 64E-13 and 64E-11 of the Florida Administrative Code (FAC) and must be corrected within the time period indicated in the "Results " section above. Continued operation of this facility without making these corrections is a violation of Chpater 64E-13 and 64E-11, FAC, and Chapters 381, FS. Failure to correct violations may result in an administrative fine or other legal action being initiated or continued.

SCHOOL SANITATION - 1. School Site
-

- 8. Natural Ventilation - 9. Mechanical Ventilation

√ 15. Handwash Facilities - 16. Showers/Fixtures - 17. Shower Water Temp.

LIQUID/SOLID WASTE - 21. Sewage Disposal
-

MISC. - 26. First Aid Kit FOOD
- 27. Food Insp. Rpt.

2. Playground Equipment 3. Athletic Equipment

22. Solid Waste

BUILDINGS - 4. Construction
√ -

SANITARY FACILITIES √ 10. Provided/Accessible
√ 11. Cleanliness & Repair - 12. Toilet Facilities - 13. Separation of Sexes - 14. Fixture Ratio

WATER SUPPLY
- 18. Installed/Operated/

VECTOR/VERMIN CONTROL
√ -

5. Maintenance & Repair 6. Lighting/Foot-Candles 7. Heating, Ventilation, A/C

Maintained
√ 19. Drinking Fountains - 20. Approved Source

OTHER √ 28. 23. Infestation/Control - 29. 24. Brush/Trash 25. Water Collection/Drainage

ITEM NUMBERS

COMMENTS AND INSTRUCTIONS (continue on attached sheet)

HEALTH DEPARTMENT INSPECTOR: COPY OF REPORT RECEIVED BY:

Julia Holtzhausen David Hatcher
CHD / HEADQUARTERS

PHONE: DATE:

11/16/2010

DH 4030, 01/05 (Obsoletes Previous Editions)

SCHOOL INSPECTION
PURPOSE:
√ ROUTINE - CONSTRUCT COMPLAINT QA SURVEY PREOPENING

SCHOOL INSPECTION
TYPE:
12 √ 22 23 24 Private School Public School Charter School Vocational School College/University Other

-

REINSPECTION CHANGE OF OWNER CONSULTATION EMDEMIOLOGY OTHER

STATE OF FLORIDA DEPARTMENT OF HEALTH COUNTY HEALTH DEPARTMENT
PUBLIC/PRIVATE SCHOOL INSPECTION REPORT

NAME OF FACILITY ADDRESS OWNER

Lincoln Elementary School
CITY ZIP

CENSUS

RESULTS
√ -

1160 W 10th Street Pbc School Board JoAnne Rogers

Riviera Beach 33404 (561) 881-4712

487 1000 2000 3000 100 10 1 2 3 ▬ 5 6 7 8 9 200 20 300 30

Satisfactory

PERSON IN CHARGE BEGIN END

PHONE

Incomplete Unsatisfactory Correct Violations by √ Next Inspection
-

8:00 AM on:

12 45
1 2 3 4 5 6 7 8 9 00 05 AM 15 20 25 30 35 40

3 10
1 2 4 5 6 7 8 9 00 05 AM 15 20 25 30 35 40

DATE
0 0 1 1 2 3 4 5 6 7 8 9 0 1 2 3 0 1 2 3 4 5 6 7 8 9 05 06 07 08 09 10 11 12 13 14

DATE

POSITION #

PERMIT NUMBER
50-51-00794
0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 0 0 0 0 0 1 1 1 1 1 2 2 2 2 2 3 3 3 3 3 4 4 4 4 4 5 5 5 5 5 6 6 6 6 6 7 7 7 7 7 8 8 8 8 8 9 9 9 9 9

400 40 500 50 600 60 ▬ 70 800 ▬ 900 90

1 1
0 0 2 3 4 5 6 7 8 9

1 5
0 2 3 0 2 3 4 ▬ 6 7 8 9

1

0
05 06 07 08 09

6 9 8
0 0 0 1 1 1 2 2 2 3 3 3 4 4 4 5 5 5 ▬ 6 6 7 7 7 9 ▬ 9

3 7
0 1 2 4 5 6 7 9 0 1 2 4 5 6 ▬ 8 9

10 PM ▬ ▬ PM

▬▬ ▬ 1

▬ 3

▬ 10 11 12 13 14

FEMALES

10 ▬ 11 50 ▬ 55

10 45 11 50 12 55

8 8 ▬ 8

MALES

OUT OF BUSINESS

As per section 120.695 of the Florida Statutes (FS), this form will serve as a "Notice of Non-Compliance" for any violations noted. Items marked below violate the requirements of Chapters 64E-13 and 64E-11 of the Florida Administrative Code (FAC) and must be corrected within the time period indicated in the "Results " section above. Continued operation of this facility without making these corrections is a violation of Chpater 64E-13 and 64E-11, FAC, and Chapters 381, FS. Failure to correct violations may result in an administrative fine or other legal action being initiated or continued.

SCHOOL SANITATION - 1. School Site
-

- 8. Natural Ventilation - 9. Mechanical Ventilation

√ 15. Handwash Facilities - 16. Showers/Fixtures - 17. Shower Water Temp.

LIQUID/SOLID WASTE - 21. Sewage Disposal
-

MISC. - 26. First Aid Kit FOOD
- 27. Food Insp. Rpt.

2. Playground Equipment 3. Athletic Equipment

22. Solid Waste

BUILDINGS - 4. Construction
√ √ -

SANITARY FACILITIES - 10. Provided/Accessible
- 11. Cleanliness & Repair √ 12. Toilet Facilities - 13. Separation of Sexes - 14. Fixture Ratio

WATER SUPPLY
- 18. Installed/Operated/

VECTOR/VERMIN CONTROL
√ -

5. Maintenance & Repair 6. Lighting/Foot-Candles 7. Heating, Ventilation, A/C

Maintained
√ 19. Drinking Fountains - 20. Approved Source

OTHER √ 28. 23. Infestation/Control √ 29. 24. Brush/Trash 25. Water Collection/Drainage

ITEM NUMBERS

COMMENTS AND INSTRUCTIONS (continue on attached sheet)

HEALTH DEPARTMENT INSPECTOR: COPY OF REPORT RECEIVED BY:

Kai Bonner Jones JoAnne Rogers
CHD / HEADQUARTERS

PHONE: DATE:

() 274-5334 11/15/2010

DH 4030, 01/05 (Obsoletes Previous Editions)

SCHOOL INSPECTION
PURPOSE:
√ ROUTINE - CONSTRUCT COMPLAINT QA SURVEY PREOPENING

SCHOOL INSPECTION
TYPE:
12 √ 22 23 24 Private School Public School Charter School Vocational School College/University Other

-

REINSPECTION CHANGE OF OWNER CONSULTATION EMDEMIOLOGY OTHER

STATE OF FLORIDA DEPARTMENT OF HEALTH COUNTY HEALTH DEPARTMENT
PUBLIC/PRIVATE SCHOOL INSPECTION REPORT

NAME OF FACILITY ADDRESS OWNER

Loxahatchee Groves Elementary
CITY ZIP

CENSUS

RESULTS

16020 Okeechobee Road P.B. Co. School Board

Loxahatchee 33470 () 795-4961

641 1000 2000 3000 10 1 2 3 4 5 ▬ 7 8 9 200 20 300 30

Satisfactory

PERSON IN CHARGE BEGIN END

PHONE

Incomplete Unsatisfactory Correct Violations by Next Inspection

8:00 AM on:

10 45
1 2 3 4 5 6 7 8 9 00 05 AM 10 PM 15 20 25 30 35 40

4 30
1 2 3 5 6 7 8 9 00 05 AM 10 PM 20 25 ▬ 35 40

DATE
0 2 0 5 1 0
▬0 1 1 3 4 5 6 7 8 9 ▬ 0 1 3 1 2 3 4 6 7 8 9 05 06 07 08 09 11 12 13 14

DATE

POSITION #

PERMIT NUMBER
50-51-00828
0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 0 0 0 0 0 1 1 1 1 1 2 2 2 2 2 3 3 3 3 3 4 4 4 4 4 5 5 5 5 5 6 6 6 6 6 7 7 7 7 7 8 8 8 8 8 9 9 9 9 9

400 ▬ 500 50 600 60 700 70 800 80 900 90

0 1
▬0 2 3 4 5 6 7 8 9

1 1
0 2 3 0 2 3 4 5 6 7 8 9

1

0
05 06 07 08 09

2 8 9
0 0 0 1 1 1 ▬ 2 2 3 3 3 4 4 4 5 5 5 6 6 6 7 7 7 8 ▬ 8

2 1
0 1 3 4 5 6 7 8 0 ▬ 3 4 5 6 7 8 9

▬ 15

1 ▬ ▬ ▬

▬ 2

▬ 2

▬ 10 11 12 13 14

FEMALES

▬ ▬ 10

▬ ▬ 11 50 12 55

10 45 11 50 12 55

MALES

9 9 ▬ 9

OUT OF BUSINESS

As per section 120.695 of the Florida Statutes (FS), this form will serve as a "Notice of Non-Compliance" for any violations noted. Items marked below violate the requirements of Chapters 64E-13 and 64E-11 of the Florida Administrative Code (FAC) and must be corrected within the time period indicated in the "Results " section above. Continued operation of this facility without making these corrections is a violation of Chpater 64E-13 and 64E-11, FAC, and Chapters 381, FS. Failure to correct violations may result in an administrative fine or other legal action being initiated or continued.

SCHOOL SANITATION - 1. School Site
-

- 8. Natural Ventilation - 9. Mechanical Ventilation

√ 15. Handwash Facilities - 16. Showers/Fixtures - 17. Shower Water Temp.

LIQUID/SOLID WASTE - 21. Sewage Disposal
-

MISC. - 26. First Aid Kit FOOD
- 27. Food Insp. Rpt.

2. Playground Equipment 3. Athletic Equipment

22. Solid Waste

BUILDINGS - 4. Construction
√ -

SANITARY FACILITIES - 10. Provided/Accessible
- 11. Cleanliness & Repair - 12. Toilet Facilities √ 13. Separation of Sexes - 14. Fixture Ratio

WATER SUPPLY
- 18. Installed/Operated/

VECTOR/VERMIN CONTROL
√ -

5. Maintenance & Repair 6. Lighting/Foot-Candles 7. Heating, Ventilation, A/C

Maintained
√ 19. Drinking Fountains - 20. Approved Source

OTHER √ 28. 23. Infestation/Control √ 29. 24. Brush/Trash 25. Water Collection/Drainage

ITEM NUMBERS

COMMENTS AND INSTRUCTIONS (continue on attached sheet)

HEALTH DEPARTMENT INSPECTOR: COPY OF REPORT RECEIVED BY:
DH 4030, 01/05 (Obsoletes Previous Editions)

Alphonse Jovin

PHONE: DATE:

CHD / HEADQUARTERS

SCHOOL INSPECTION
PURPOSE:
√ ROUTINE - CONSTRUCT COMPLAINT QA SURVEY PREOPENING

SCHOOL INSPECTION
TYPE:
12 √ 22 23 24 Private School Public School Charter School Vocational School College/University Other

-

REINSPECTION CHANGE OF OWNER CONSULTATION EMDEMIOLOGY OTHER

STATE OF FLORIDA DEPARTMENT OF HEALTH COUNTY HEALTH DEPARTMENT
PUBLIC/PRIVATE SCHOOL INSPECTION REPORT

NAME OF FACILITY ADDRESS OWNER

North Palm Beach Elementary
CITY ZIP

CENSUS

RESULTS
√ -

401 Anchorage Drive P B Co School Board Teresa Stoupas

North Palm Beach 33408 () 881-4747

456 1000 2000 3000 100 10 1 2 3 ▬ 5 6 7 8 9 200 20 300 30

Satisfactory

PERSON IN CHARGE BEGIN END

PHONE

Incomplete Unsatisfactory Correct Violations by √ Next Inspection
-

8:00 AM on:

10 30
1 2 3 4 5 6 7 8 9 00 05 AM 10 PM 15 20 25 ▬ 35 40

1230
1 2 3 4 5 6 7 8 9 00 05 AM 10 PM 15 20 25 ▬ 35 40

DATE
0 0 1 1 2 3 4 5 6 7 8 9 0 1 2 3 0 1 2 3 4 5 6 7 8 9 05 06 07 08 09 10 11 12 13 14

DATE

POSITION #

PERMIT NUMBER
50-51-00955
0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 0 0 0 0 0 1 1 1 1 1 2 2 2 2 2 3 3 3 3 3 4 4 4 4 4 5 5 5 5 5 6 6 6 6 6 7 7 7 7 7 8 8 8 8 8 9 9 9 9 9

400 40 500 ▬ ▬ 60 700 70 800 80 900 90

0 7
▬0 1 1 2 3 4 5 6 ▬ 8 9

2 9
0 1 3 0 1 3 4 5 6 7 8 ▬

1

0
05 06 07 08 09

4 5 8
0 0 0 1 1 1 2 2 2 3 3 3 ▬ 4 4 5 ▬ 5 6 6 6 7 7 7 9 9 9

0 5
▬ 0 1 2 3 4 5 6 7 9 1 2 3 4 ▬ 6 7 8 9

▬ 2

▬ 10 11 12 13 14

FEMALES

▬ 45 11 50 12 55

10 45 11 50 ▬ 55

8 8 ▬ 8

MALES

OUT OF BUSINESS

As per section 120.695 of the Florida Statutes (FS), this form will serve as a "Notice of Non-Compliance" for any violations noted. Items marked below violate the requirements of Chapters 64E-13 and 64E-11 of the Florida Administrative Code (FAC) and must be corrected within the time period indicated in the "Results " section above. Continued operation of this facility without making these corrections is a violation of Chpater 64E-13 and 64E-11, FAC, and Chapters 381, FS. Failure to correct violations may result in an administrative fine or other legal action being initiated or continued.

SCHOOL SANITATION - 1. School Site
-

- 8. Natural Ventilation - 9. Mechanical Ventilation

- 15. Handwash Facilities - 16. Showers/Fixtures - 17. Shower Water Temp.

LIQUID/SOLID WASTE - 21. Sewage Disposal
-

MISC. - 26. First Aid Kit FOOD
- 27. Food Insp. Rpt.

2. Playground Equipment 3. Athletic Equipment

22. Solid Waste

BUILDINGS - 4. Construction
√ -

SANITARY FACILITIES - 10. Provided/Accessible
√ 11. Cleanliness & Repair - 12. Toilet Facilities - 13. Separation of Sexes - 14. Fixture Ratio

WATER SUPPLY
- 18. Installed/Operated/

VECTOR/VERMIN CONTROL
√ -

5. Maintenance & Repair 6. Lighting/Foot-Candles 7. Heating, Ventilation, A/C

Maintained
- 19. Drinking Fountains - 20. Approved Source

OTHER - 28. 23. Infestation/Control - 29. 24. Brush/Trash 25. Water Collection/Drainage

ITEM NUMBERS

COMMENTS AND INSTRUCTIONS (continue on attached sheet)

HEALTH DEPARTMENT INSPECTOR: COPY OF REPORT RECEIVED BY:

Julia Holtzhausen Teresa Stoupas
CHD / HEADQUARTERS

PHONE: DATE:

07/29/2010

DH 4030, 01/05 (Obsoletes Previous Editions)

SCHOOL INSPECTION
PURPOSE:
√ ROUTINE - CONSTRUCT COMPLAINT QA SURVEY PREOPENING

SCHOOL INSPECTION
TYPE:
12 √ 22 23 24 Private School Public School Charter School Vocational School College/University Other

-

REINSPECTION CHANGE OF OWNER CONSULTATION EMDEMIOLOGY OTHER

STATE OF FLORIDA DEPARTMENT OF HEALTH COUNTY HEALTH DEPARTMENT
PUBLIC/PRIVATE SCHOOL INSPECTION REPORT

NAME OF FACILITY ADDRESS OWNER

Northmore Elementary
CITY ZIP

CENSUS

RESULTS
√ -

4111 N Terrace Drive Pbc School Board Nancy Robinson

West Palm Beach 33407 () 881-4759

501 1000 2000 3000 10 1 2 3 4 ▬ 6 7 8 9 200 20 300 30

Satisfactory

PERSON IN CHARGE BEGIN END

PHONE

Incomplete Unsatisfactory Correct Violations by √ Next Inspection
-

8:00 AM on:

9
1 2 3 4 5 6 7 8

55
00 05 AM 10 PM 15 20 25 30 35

11
1 2 3 4 5 6 7 8 9 00 05 AM 10 PM 15 20 ▬ 30 35 40

DATE
0 0 1 1 2 3 4 5 6 7 8 9 0 1 2 3 0 1 2 3 4 5 6 7 8 9 05 06 07 08 09 10 11 12 13 14

DATE

POSITION #

PERMIT NUMBER
50-51-00962
0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 0 0 0 0 0 1 1 1 1 1 2 2 2 2 2 3 3 3 3 3 4 4 4 4 4 5 5 5 5 5 6 6 6 6 6 7 7 7 7 7 8 8 8 8 8 9 9 9 9 9

400 40 500 50 600 60 700 70 800 80 900 90

0 6
▬0 1 1 2 3 4 5 ▬ 7 8 9

2 3
0 1 3 0 1 ▬ 4 5 6 7 8 9

1

0
05 06 07 08 09

6 9 8
0 0 0 1 1 1 2 2 2 3 3 3 4 4 4 5 5 5 ▬ 6 6 7 7 7 9 ▬ 9

3 7
0 1 2 4 5 6 7 9 0 1 2 4 5 6 ▬ 8 9

▬ 2

▬ 3

▬ 10 11 12 13 14

FEMALES

▬ 40 10 45 11 50 12 ▬

10 45 ▬ 50 12 55

8 8 ▬ 8

MALES

OUT OF BUSINESS

As per section 120.695 of the Florida Statutes (FS), this form will serve as a "Notice of Non-Compliance" for any violations noted. Items marked below violate the requirements of Chapters 64E-13 and 64E-11 of the Florida Administrative Code (FAC) and must be corrected within the time period indicated in the "Results " section above. Continued operation of this facility without making these corrections is a violation of Chpater 64E-13 and 64E-11, FAC, and Chapters 381, FS. Failure to correct violations may result in an administrative fine or other legal action being initiated or continued.

SCHOOL SANITATION - 1. School Site
-

- 8. Natural Ventilation - 9. Mechanical Ventilation

√ 15. Handwash Facilities - 16. Showers/Fixtures - 17. Shower Water Temp.

LIQUID/SOLID WASTE - 21. Sewage Disposal
-

MISC. √ 26. First Aid Kit FOOD
- 27. Food Insp. Rpt.

2. Playground Equipment 3. Athletic Equipment

22. Solid Waste

BUILDINGS - 4. Construction
√ -

SANITARY FACILITIES - 10. Provided/Accessible
- 11. Cleanliness & Repair √ 12. Toilet Facilities - 13. Separation of Sexes - 14. Fixture Ratio

WATER SUPPLY
- 18. Installed/Operated/

VECTOR/VERMIN CONTROL
√ -

5. Maintenance & Repair 6. Lighting/Foot-Candles 7. Heating, Ventilation, A/C

Maintained
√ 19. Drinking Fountains - 20. Approved Source

OTHER √ 28. 23. Infestation/Control - 29. 24. Brush/Trash 25. Water Collection/Drainage

ITEM NUMBERS

COMMENTS AND INSTRUCTIONS (continue on attached sheet)

HEALTH DEPARTMENT INSPECTOR: COPY OF REPORT RECEIVED BY:

Kai Bonner Jones Nancy Robinson
CHD / HEADQUARTERS

PHONE: DATE:

() 274-5334 06/23/2010

DH 4030, 01/05 (Obsoletes Previous Editions)

SCHOOL INSPECTION
PURPOSE:
√ ROUTINE - CONSTRUCT COMPLAINT QA SURVEY PREOPENING

SCHOOL INSPECTION
TYPE:
12 √ 22 23 24 Private School Public School Charter School Vocational School College/University Other

-

REINSPECTION CHANGE OF OWNER CONSULTATION EMDEMIOLOGY OTHER

STATE OF FLORIDA DEPARTMENT OF HEALTH COUNTY HEALTH DEPARTMENT
PUBLIC/PRIVATE SCHOOL INSPECTION REPORT

NAME OF FACILITY ADDRESS OWNER

Palm Beach Lakes High
CITY ZIP

CENSUS

RESULTS
√ -

3505 Shiloh Drive School Board of Pbc x

West Palm Beach 33409 () 640-5000

1926 ▬ 2000 3000 100 10 1 2 3 4 5 6 7 8 9 200 20 300 30

Satisfactory

PERSON IN CHARGE BEGIN END

PHONE

Incomplete Unsatisfactory Correct Violations by √ Next Inspection
-

8:00 AM on:

9
1 2 3 4 5 6 7 8

35
00 05 AM 10 PM 15 20 25 30 ▬

1210
1 2 3 4 5 6 7 8 9 00 05 AM ▬ PM 15 20 25 30 35 40

DATE
0 0 1 1 2 3 4 5 6 7 8 9 0 1 2 3 0 1 2 3 4 5 6 7 8 9 05 06 07 08 09 10 11 12 13 14

DATE

POSITION #

PERMIT NUMBER
50-51-01042
0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 0 0 0 0 0 1 1 1 1 1 2 2 2 2 2 3 3 3 3 3 4 4 4 4 4 5 5 5 5 5 6 6 6 6 6 7 7 7 7 7 8 8 8 8 8 9 9 9 9 9

400 40 500 50 600 60 700 70 800 80 ▬ 90

1 0
▬1 2 3 4 5 6 7 8 9

0 4
1 2 3 1 2 3 ▬ 5 6 7 8 9

1

0
05 06 07 08 09

0 2 4
▬ 0 0 1 1 1 2 ▬ 2 3 3 3 5 5 5 6 6 6 7 7 7 8 8 8 9 9 9

0 9
▬ 0 1 2 3 5 6 7 8 9 1 2 3 4 5 6 7 8 ▬

0 ▬ ▬ 0

4 4 ▬ 4

▬ 10 11 12 13 14

FEMALES

▬ 40 10 45 11 50 12 55

10 45 11 50 ▬ 55

MALES

OUT OF BUSINESS

As per section 120.695 of the Florida Statutes (FS), this form will serve as a "Notice of Non-Compliance" for any violations noted. Items marked below violate the requirements of Chapters 64E-13 and 64E-11 of the Florida Administrative Code (FAC) and must be corrected within the time period indicated in the "Results " section above. Continued operation of this facility without making these corrections is a violation of Chpater 64E-13 and 64E-11, FAC, and Chapters 381, FS. Failure to correct violations may result in an administrative fine or other legal action being initiated or continued.

SCHOOL SANITATION - 1. School Site
-

- 8. Natural Ventilation - 9. Mechanical Ventilation

- 15. Handwash Facilities √ 16. Showers/Fixtures - 17. Shower Water Temp.

LIQUID/SOLID WASTE - 21. Sewage Disposal

MISC. - 26. First Aid Kit FOOD
- 27. Food Insp. Rpt.

2. Playground Equipment 3. Athletic Equipment

22. Solid Waste

BUILDINGS - 4. Construction
√ √ -

SANITARY FACILITIES - 10. Provided/Accessible
√ 11. Cleanliness & Repair - 12. Toilet Facilities - 13. Separation of Sexes - 14. Fixture Ratio

WATER SUPPLY
- 18. Installed/Operated/

VECTOR/VERMIN CONTROL
√ -

5. Maintenance & Repair 6. Lighting/Foot-Candles 7. Heating, Ventilation, A/C

Maintained
- 19. Drinking Fountains - 20. Approved Source

OTHER √ 28. 23. Infestation/Control √ 29. 24. Brush/Trash 25. Water Collection/Drainage

ITEM NUMBERS

COMMENTS AND INSTRUCTIONS (continue on attached sheet)

HEALTH DEPARTMENT INSPECTOR: COPY OF REPORT RECEIVED BY:

Roy (Mike) McGinnis x
CHD / HEADQUARTERS

PHONE: DATE:

10/04/2010

DH 4030, 01/05 (Obsoletes Previous Editions)

SCHOOL INSPECTION
PURPOSE:
√ ROUTINE - CONSTRUCT COMPLAINT QA SURVEY PREOPENING

SCHOOL INSPECTION
TYPE:
12 13 √ 23 24 Private School Public School Charter School Vocational School College/University Other

-

REINSPECTION CHANGE OF OWNER CONSULTATION EMDEMIOLOGY OTHER

STATE OF FLORIDA DEPARTMENT OF HEALTH COUNTY HEALTH DEPARTMENT
PUBLIC/PRIVATE SCHOOL INSPECTION REPORT

NAME OF FACILITY ADDRESS OWNER

Palm Beach School For Autism Elementary
CITY ZIP

CENSUS
34 1000 2000 3000 100 10 1 2 3 4 5 6 7 8 9 200 20 300 ▬ √ -

RESULTS
Satisfactory Incomplete Unsatisfactory Correct Violations by √ Next Inspection
-

1199 W Lantana Road Palm Beach School For Autism, Inc.

Lantana 33462 (561) 582-1645

PERSON IN CHARGE BEGIN END

PHONE

8:00 AM on:

1
2 3 4 5 6 7 8 9

35

2 10
1 3 4 5 6 7 8 9 00 ▬ PM 15 20 25 30 35 40

DATE
0 0 1 1 2 3 4 5 6 7 8 9 0 1 2 3 0 1 2 3 4 5 6 7 8 9 05 06 07 08 09 10 11 12 13 14

▬ 00 10 PM 15 20 25 30 ▬ 40

DATE

POSITION #

PERMIT NUMBER
50-51-03537
0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 0 0 0 0 0 1 1 1 1 1 2 2 2 2 2 3 3 3 3 3 4 4 4 4 4 5 5 5 5 5 6 6 6 6 6 7 7 7 7 7 8 8 8 8 8 9 9 9 9 9

40

05 AM ▬ 05 AM

0 5
▬0 1 1 2 3 4 ▬ 6 7 8 9

1 7
0 2 3 0 2 3 4 5 6 ▬ 8 9 ▬ 1

1

0
05 06 07 08 09

4 3 5
0 0 0 1 1 1 2 2 2 3 ▬ 3 ▬ 4 4 6 6 6 7 7 7 8 8 8 9 9 9

8 1
0 1 2 3 4 6 7 9 0 ▬ 2 3 4 5 6 7 9

500 50 600 60 700 70 800 80 900 90

▬ 10 11 12 13 14

5 5 ▬ 5

FEMALES

10 45 11 50 12 55

10 45 11 50 12 55

▬ 8

MALES

OUT OF BUSINESS

As per section 120.695 of the Florida Statutes (FS), this form will serve as a "Notice of Non-Compliance" for any violations noted. Items marked below violate the requirements of Chapters 64E-13 and 64E-11 of the Florida Administrative Code (FAC) and must be corrected within the time period indicated in the "Results " section above. Continued operation of this facility without making these corrections is a violation of Chpater 64E-13 and 64E-11, FAC, and Chapters 381, FS. Failure to correct violations may result in an administrative fine or other legal action being initiated or continued.

SCHOOL SANITATION - 1. School Site
-

- 8. Natural Ventilation - 9. Mechanical Ventilation

- 15. Handwash Facilities - 16. Showers/Fixtures - 17. Shower Water Temp.

LIQUID/SOLID WASTE - 21. Sewage Disposal
-

MISC. - 26. First Aid Kit FOOD
- 27. Food Insp. Rpt.

2. Playground Equipment 3. Athletic Equipment

22. Solid Waste

BUILDINGS - 4. Construction
√ -

SANITARY FACILITIES - 10. Provided/Accessible
- 11. Cleanliness & Repair - 12. Toilet Facilities - 13. Separation of Sexes - 14. Fixture Ratio

WATER SUPPLY
- 18. Installed/Operated/

VECTOR/VERMIN CONTROL
√ -

5. Maintenance & Repair 6. Lighting/Foot-Candles 7. Heating, Ventilation, A/C

Maintained
- 19. Drinking Fountains - 20. Approved Source

OTHER - 28. 23. Infestation/Control - 29. 24. Brush/Trash 25. Water Collection/Drainage

ITEM NUMBERS

COMMENTS AND INSTRUCTIONS (continue on attached sheet)

HEALTH DEPARTMENT INSPECTOR: COPY OF REPORT RECEIVED BY:
DH 4030, 01/05 (Obsoletes Previous Editions)

Rebekah Lejeune

PHONE: DATE:

CHD / HEADQUARTERS

SCHOOL INSPECTION
PURPOSE:
√ ROUTINE - CONSTRUCT COMPLAINT QA SURVEY PREOPENING

SCHOOL INSPECTION
TYPE:
12 13 √ 23 24 Private School Public School Charter School Vocational School College/University Other

-

REINSPECTION CHANGE OF OWNER CONSULTATION EMDEMIOLOGY OTHER

STATE OF FLORIDA DEPARTMENT OF HEALTH COUNTY HEALTH DEPARTMENT
PUBLIC/PRIVATE SCHOOL INSPECTION REPORT

NAME OF FACILITY ADDRESS OWNER

Palm Beach School For Autism Elementary
CITY ZIP

CENSUS
30 1000 2000 3000 100 10 1 2 3 4 5 6 7 8 9 200 20 300 ▬ √ -

RESULTS
Satisfactory Incomplete Unsatisfactory Correct Violations by √ Next Inspection
-

1199 W Lantana Road Palm Beach School For Autism, Inc.

Lantana 33462 (561) 582-1645

PERSON IN CHARGE BEGIN END

PHONE

8:00 AM on:

3
1 2 4 5 6 7 8 9

00
▬ 05 AM 15 20 25 30 35 40

3 30
1 2 4 5 6 7 8 9 00 05 AM 15 20 25 ▬ 35 40

DATE
0 0 1 1 2 3 4 5 6 7 8 9 0 1 2 3 0 1 2 3 4 5 6 7 8 9 05 06 07 08 09 10 11 12 13 14

DATE

POSITION #

PERMIT NUMBER
50-51-03537
0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 0 0 0 0 0 1 1 1 1 1 2 2 2 2 2 3 3 3 3 3 4 4 4 4 4 5 5 5 5 5 6 6 6 6 6 7 7 7 7 7 8 8 8 8 8 9 9 9 9 9

400 40 500 50 600 60 700 70 800 80 900 90

0 9
▬0 1 1 2 3 4 5 6 7 8 ▬

1 5
0 2 3 0 2 3 4 ▬ 6 7 8 9 ▬ 1

1

0
05 06 07 08 09

4 3 5
0 0 0 1 1 1 2 2 2 3 ▬ 3 ▬ 4 4 6 6 6 7 7 7 8 8 8 9 9 9

8 1
0 1 2 3 4 6 7 9 0 ▬ 2 3 4 5 6 7 9

▬ 10 PM ▬ 10 PM

▬ 10 11 12 13 14

5 5 ▬ 5

FEMALES

10 45 11 50 12 55

10 45 11 50 12 55

▬ 8

MALES

OUT OF BUSINESS

As per section 120.695 of the Florida Statutes (FS), this form will serve as a "Notice of Non-Compliance" for any violations noted. Items marked below violate the requirements of Chapters 64E-13 and 64E-11 of the Florida Administrative Code (FAC) and must be corrected within the time period indicated in the "Results " section above. Continued operation of this facility without making these corrections is a violation of Chpater 64E-13 and 64E-11, FAC, and Chapters 381, FS. Failure to correct violations may result in an administrative fine or other legal action being initiated or continued.

SCHOOL SANITATION - 1. School Site
-

- 8. Natural Ventilation - 9. Mechanical Ventilation

- 15. Handwash Facilities - 16. Showers/Fixtures - 17. Shower Water Temp.

LIQUID/SOLID WASTE - 21. Sewage Disposal
-

MISC. - 26. First Aid Kit FOOD
- 27. Food Insp. Rpt.

2. Playground Equipment 3. Athletic Equipment

22. Solid Waste

BUILDINGS - 4. Construction
√ -

SANITARY FACILITIES - 10. Provided/Accessible
√ 11. Cleanliness & Repair - 12. Toilet Facilities - 13. Separation of Sexes - 14. Fixture Ratio

WATER SUPPLY
- 18. Installed/Operated/

VECTOR/VERMIN CONTROL
√ -

5. Maintenance & Repair 6. Lighting/Foot-Candles 7. Heating, Ventilation, A/C

Maintained
- 19. Drinking Fountains - 20. Approved Source

OTHER - 28. 23. Infestation/Control - 29. 24. Brush/Trash 25. Water Collection/Drainage

ITEM NUMBERS

COMMENTS AND INSTRUCTIONS (continue on attached sheet)

HEALTH DEPARTMENT INSPECTOR: COPY OF REPORT RECEIVED BY:
DH 4030, 01/05 (Obsoletes Previous Editions)

Rebekah Lejeune

PHONE: DATE:

CHD / HEADQUARTERS

SCHOOL INSPECTION
PURPOSE:
√ ROUTINE - CONSTRUCT COMPLAINT QA SURVEY PREOPENING

SCHOOL INSPECTION
TYPE:
12 √ 22 23 24 Private School Public School Charter School Vocational School College/University Other

-

REINSPECTION CHANGE OF OWNER CONSULTATION EMDEMIOLOGY OTHER

STATE OF FLORIDA DEPARTMENT OF HEALTH COUNTY HEALTH DEPARTMENT
PUBLIC/PRIVATE SCHOOL INSPECTION REPORT

NAME OF FACILITY ADDRESS OWNER

Palmetto Elementary (West)
CITY ZIP

CENSUS

RESULTS
√ -

5801 Parker Avenue Pbc School Board Raul Iribarren

West Palm Beach 33405 (561) 533-6374

594 1000 2000 3000 100 10 1 2 3 4 ▬ 6 7 8 9 200 20 300 30

Satisfactory

PERSON IN CHARGE BEGIN END

PHONE

Incomplete Unsatisfactory Correct Violations by √ Next Inspection
-

8:00 AM on:

10 10
1 2 3 4 5 6 7 8 9 00 05 AM ▬ PM 15 20 25 30 35 40

1100
1 2 3 4 5 6 7 8 9 ▬ 05 AM 10 PM 15 20 25 30 35 40

DATE
0 0 1 1 2 3 4 5 6 7 8 9 0 1 2 3 0 1 2 3 4 5 6 7 8 9 05 06 07 08 09 10 11 12 13 14

DATE

POSITION #

PERMIT NUMBER
50-51-01054
0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 0 0 0 0 0 1 1 1 1 1 2 2 2 2 2 3 3 3 3 3 4 4 4 4 4 5 5 5 5 5 6 6 6 6 6 7 7 7 7 7 8 8 8 8 8 9 9 9 9 9

40

0 6
▬0 1 1 2 3 4 5 ▬ 7 8 9

2 9
0 1 3 0 1 3 4 5 6 7 8 ▬

1

0
05 06 07 08 09

6 9 8
0 0 0 1 1 1 2 2 2 3 3 3 4 4 4 5 5 5 ▬ 6 6 7 7 7 9 ▬ 9

3 7
0 1 2 4 5 6 7 9 0 1 2 4 5 6 ▬ 8 9

500 50 600 60 700 70 800 80 900 ▬

▬ 2

▬ 3

▬ 10 11 12 13 14

FEMALES

▬ 45 11 50 12 55

10 45 ▬ 50 12 55

8 8 ▬ 8

MALES

OUT OF BUSINESS

As per section 120.695 of the Florida Statutes (FS), this form will serve as a "Notice of Non-Compliance" for any violations noted. Items marked below violate the requirements of Chapters 64E-13 and 64E-11 of the Florida Administrative Code (FAC) and must be corrected within the time period indicated in the "Results " section above. Continued operation of this facility without making these corrections is a violation of Chpater 64E-13 and 64E-11, FAC, and Chapters 381, FS. Failure to correct violations may result in an administrative fine or other legal action being initiated or continued.

SCHOOL SANITATION - 1. School Site
√ -

- 8. Natural Ventilation - 9. Mechanical Ventilation

√ 15. Handwash Facilities - 16. Showers/Fixtures - 17. Shower Water Temp.

LIQUID/SOLID WASTE - 21. Sewage Disposal
-

MISC. - 26. First Aid Kit FOOD
- 27. Food Insp. Rpt.

2. Playground Equipment 3. Athletic Equipment

22. Solid Waste

BUILDINGS - 4. Construction
√ -

SANITARY FACILITIES - 10. Provided/Accessible
√ 11. Cleanliness & Repair √ 12. Toilet Facilities - 13. Separation of Sexes - 14. Fixture Ratio

WATER SUPPLY
- 18. Installed/Operated/

VECTOR/VERMIN CONTROL
√ -

5. Maintenance & Repair 6. Lighting/Foot-Candles 7. Heating, Ventilation, A/C

Maintained
√ 19. Drinking Fountains - 20. Approved Source

OTHER √ 28. 23. Infestation/Control - 29. 24. Brush/Trash 25. Water Collection/Drainage

ITEM NUMBERS

COMMENTS AND INSTRUCTIONS (continue on attached sheet)

HEALTH DEPARTMENT INSPECTOR: COPY OF REPORT RECEIVED BY:

Kai Bonner Jones Raul Iribarren
CHD / HEADQUARTERS

PHONE: DATE:

() 274-5334 06/29/2010

DH 4030, 01/05 (Obsoletes Previous Editions)

SCHOOL INSPECTION
PURPOSE:
√ ROUTINE - CONSTRUCT COMPLAINT QA SURVEY PREOPENING

SCHOOL INSPECTION
TYPE:
12 √ 22 23 24 Private School Public School Charter School Vocational School College/University Other

-

REINSPECTION CHANGE OF OWNER CONSULTATION EMDEMIOLOGY OTHER

STATE OF FLORIDA DEPARTMENT OF HEALTH COUNTY HEALTH DEPARTMENT
PUBLIC/PRIVATE SCHOOL INSPECTION REPORT

NAME OF FACILITY ADDRESS OWNER

Pine Grove Elementary School
CITY ZIP

CENSUS

RESULTS
√ -

400 SW 10th Street Pbc School Board Dr. M. Campbell

Delray Beach 33444 () 243-1554

446 1000 2000 3000 100 10 1 2 3 ▬ 5 6 7 8 9 200 20 300 30

Satisfactory

PERSON IN CHARGE BEGIN END

PHONE

Incomplete Unsatisfactory Correct Violations by √ Next Inspection
-

8:00 AM on:

12 15
1 2 3 4 5 6 7 8 9 00 10 PM ▬ 20 25 30 35 40

2
1 3 4 5 6 7 8 9 00 10 PM 15 20 ▬ 30 35 40

DATE
0 0 1 1 2 3 4 5 6 7 8 9 0 1 2 3 0 1 2 3 4 5 6 7 8 9 05 06 07 08 09 10 11 12 13 14

DATE

POSITION #

PERMIT NUMBER
50-51-01083
0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 0 0 0 0 0 1 1 1 1 1 2 2 2 2 2 3 3 3 3 3 4 4 4 4 4 5 5 5 5 5 6 6 6 6 6 7 7 7 7 7 8 8 8 8 8 9 9 9 9 9

400 ▬ 500 50 ▬ 60 700 70 800 80 900 90

05 AM ▬ 05 AM

0 1
▬0 2 3 4 5 6 7 8 9

2 0
0 ▬ 1 3 4 5 6 7 8 9

1

0
05 06 07 08 09

0 0 1
▬ ▬ 0 2 2 2 3 3 3 4 4 4 5 5 5 6 6 6 7 7 7 8 8 8 9 9 9

8 2
0 2 3 4 5 6 7 9 0 1 ▬ 3 4 5 6 7 9

1 ▬ 1 3

1 1 ▬ 1

▬ 2

▬ 10 11 12 13 14

FEMALES

10 45 11 50 ▬ 55

10 45 11 50 12 55

▬ 8

MALES

OUT OF BUSINESS

As per section 120.695 of the Florida Statutes (FS), this form will serve as a "Notice of Non-Compliance" for any violations noted. Items marked below violate the requirements of Chapters 64E-13 and 64E-11 of the Florida Administrative Code (FAC) and must be corrected within the time period indicated in the "Results " section above. Continued operation of this facility without making these corrections is a violation of Chpater 64E-13 and 64E-11, FAC, and Chapters 381, FS. Failure to correct violations may result in an administrative fine or other legal action being initiated or continued.

SCHOOL SANITATION - 1. School Site
-

- 8. Natural Ventilation - 9. Mechanical Ventilation

- 15. Handwash Facilities - 16. Showers/Fixtures - 17. Shower Water Temp.

LIQUID/SOLID WASTE - 21. Sewage Disposal
-

MISC. - 26. First Aid Kit FOOD
- 27. Food Insp. Rpt.

2. Playground Equipment 3. Athletic Equipment

22. Solid Waste

BUILDINGS - 4. Construction
√ √ -

SANITARY FACILITIES - 10. Provided/Accessible
- 11. Cleanliness & Repair - 12. Toilet Facilities - 13. Separation of Sexes - 14. Fixture Ratio

WATER SUPPLY
- 18. Installed/Operated/

VECTOR/VERMIN CONTROL
√ -

5. Maintenance & Repair 6. Lighting/Foot-Candles 7. Heating, Ventilation, A/C

Maintained
√ 19. Drinking Fountains - 20. Approved Source

OTHER - 28. 23. Infestation/Control - 29. 24. Brush/Trash 25. Water Collection/Drainage

ITEM NUMBERS

COMMENTS AND INSTRUCTIONS (continue on attached sheet)

HEALTH DEPARTMENT INSPECTOR: COPY OF REPORT RECEIVED BY:

James Carroll Dr. M. Campbell
CHD / HEADQUARTERS

PHONE: DATE:

01/20/2010

DH 4030, 01/05 (Obsoletes Previous Editions)

SCHOOL INSPECTION
PURPOSE:
√ ROUTINE - CONSTRUCT COMPLAINT QA SURVEY PREOPENING

SCHOOL INSPECTION
TYPE:
12 √ 22 23 24 Private School Public School Charter School Vocational School College/University Other

-

REINSPECTION CHANGE OF OWNER CONSULTATION EMDEMIOLOGY OTHER

STATE OF FLORIDA DEPARTMENT OF HEALTH COUNTY HEALTH DEPARTMENT
PUBLIC/PRIVATE SCHOOL INSPECTION REPORT

NAME OF FACILITY ADDRESS OWNER

Pioneer Park Elementary
CITY ZIP

CENSUS

RESULTS
√ -

39500 Pioneer Park Road Pbc School Board Susanne Matuella

Belle Glade 33430 (555) 555-5555

374 1000 2000 3000 100 10 1 2 ▬ 4 5 6 7 8 9 200 20 300 30

Satisfactory

PERSON IN CHARGE BEGIN END

PHONE

Incomplete Unsatisfactory Correct Violations by √ Next Inspection
-

8:00 AM on:

12 15
1 2 3 4 5 6 7 8 9 00 05 AM 10 PM ▬ 20 25 30 35 40

1 30
▬ 00 2 3 4 5 6 7 8 9 05 AM 10 PM 15 20 25 ▬ 35 40

DATE
0 0 1 1 2 3 4 5 6 7 8 9 0 1 2 3 0 1 2 3 4 5 6 7 8 9 05 06 07 08 09 10 11 12 13 14

DATE

POSITION #

PERMIT NUMBER
50-51-01087
0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 0 0 0 0 0 1 1 1 1 1 2 2 2 2 2 3 3 3 3 3 4 4 4 4 4 5 5 5 5 5 6 6 6 6 6 7 7 7 7 7 8 8 8 8 8 9 9 9 9 9

40

0 5
▬0 1 1 2 3 4 ▬ 6 7 8 9

2 6
0 1 3 0 1 3 4 5 ▬ 7 8 9

1

0
05 06 07 08 09

2 8 9
0 0 0 1 1 1 ▬ 2 2 3 3 3 4 4 4 5 5 5 6 6 6 7 7 7 8 ▬ 8

5 0
0 1 2 3 4 6 7 8 ▬ 1 2 3 4 6 7 8 9

500 50 600 60 700 ▬ 800 80 900 90

▬ 2

▬ 10 11 12 13 14

▬ 5

FEMALES

10 45 11 50 ▬ 55

10 45 11 50 12 55

MALES

9 9 ▬ 9

OUT OF BUSINESS

As per section 120.695 of the Florida Statutes (FS), this form will serve as a "Notice of Non-Compliance" for any violations noted. Items marked below violate the requirements of Chapters 64E-13 and 64E-11 of the Florida Administrative Code (FAC) and must be corrected within the time period indicated in the "Results " section above. Continued operation of this facility without making these corrections is a violation of Chpater 64E-13 and 64E-11, FAC, and Chapters 381, FS. Failure to correct violations may result in an administrative fine or other legal action being initiated or continued.

SCHOOL SANITATION - 1. School Site
-

- 8. Natural Ventilation - 9. Mechanical Ventilation

- 15. Handwash Facilities - 16. Showers/Fixtures - 17. Shower Water Temp.

LIQUID/SOLID WASTE - 21. Sewage Disposal
-

MISC. - 26. First Aid Kit FOOD
- 27. Food Insp. Rpt.

2. Playground Equipment 3. Athletic Equipment

22. Solid Waste

BUILDINGS - 4. Construction
√ -

SANITARY FACILITIES - 10. Provided/Accessible
- 11. Cleanliness & Repair - 12. Toilet Facilities - 13. Separation of Sexes - 14. Fixture Ratio

WATER SUPPLY
- 18. Installed/Operated/

VECTOR/VERMIN CONTROL
√ -

5. Maintenance & Repair 6. Lighting/Foot-Candles 7. Heating, Ventilation, A/C

Maintained
- 19. Drinking Fountains - 20. Approved Source

OTHER - 28. 23. Infestation/Control - 29. 24. Brush/Trash 25. Water Collection/Drainage

ITEM NUMBERS

COMMENTS AND INSTRUCTIONS (continue on attached sheet)

HEALTH DEPARTMENT INSPECTOR: COPY OF REPORT RECEIVED BY:

James Threlkeld Susanne Matuella
CHD / HEADQUARTERS

PHONE: DATE:

05/26/2010

DH 4030, 01/05 (Obsoletes Previous Editions)

SCHOOL INSPECTION
PURPOSE:
√ ROUTINE - CONSTRUCT COMPLAINT QA SURVEY PREOPENING

SCHOOL INSPECTION
TYPE:
12 √ 22 23 24 Private School Public School Charter School Vocational School College/University Other

-

REINSPECTION CHANGE OF OWNER CONSULTATION EMDEMIOLOGY OTHER

STATE OF FLORIDA DEPARTMENT OF HEALTH COUNTY HEALTH DEPARTMENT
PUBLIC/PRIVATE SCHOOL INSPECTION REPORT

NAME OF FACILITY ADDRESS OWNER

Pioneer Park Elementary
CITY ZIP

CENSUS

RESULTS
√ -

39500 Pioneer Park Road Pbc School Board Adam Miller

Belle Glade 33430 (555) 555-5555

379 1000 2000 3000 100 10 1 2 ▬ 4 5 6 7 8 9 200 20 300 30

Satisfactory

PERSON IN CHARGE BEGIN END

PHONE

Incomplete Unsatisfactory Correct Violations by √ Next Inspection
-

8:00 AM on:

10 30
1 2 3 4 5 6 7 8 9 00 05 AM 10 PM 15 20 25 ▬ 35 40

1115
1 2 3 4 5 6 7 8 9 00 05 AM 10 PM ▬ 20 25 30 35 40

DATE
0 2 1 6 1 1
▬0 1 1 3 4 5 6 7 8 9 0 0 2 3 4 5 7 8 9 05 06 07 08 09 10 12 13 14 ▬ 1 3

DATE

POSITION #

PERMIT NUMBER
50-51-01087
0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 0 0 0 0 0 1 1 1 1 1 2 2 2 2 2 3 3 3 3 3 4 4 4 4 4 5 5 5 5 5 6 6 6 6 6 7 7 7 7 7 8 8 8 8 8 9 9 9 9 9

400 40 500 50 600 60 700 ▬ 800 80 ▬ 90

1 1
0 0 2 3 4 5 6 7 8 9

1 6
0 2 3 0 2 3 4 5 ▬ 7 8 9

1

0
05 06 07 08 09

2 8 9
0 0 0 1 1 1 ▬ 2 2 3 3 3 4 4 4 5 5 5 6 6 6 7 7 7 8 ▬ 8

5 0
0 1 2 3 4 6 7 8 ▬ 1 2 3 4 6 7 8 9

▬▬ ▬ 1

▬ 2

▬ 10 11 12 13 14

▬ 5

FEMALES

▬ ▬ 11

▬ 45 11 50 12 55

10 45 ▬ 50 12 55

MALES

9 9 ▬ 9

OUT OF BUSINESS

As per section 120.695 of the Florida Statutes (FS), this form will serve as a "Notice of Non-Compliance" for any violations noted. Items marked below violate the requirements of Chapters 64E-13 and 64E-11 of the Florida Administrative Code (FAC) and must be corrected within the time period indicated in the "Results " section above. Continued operation of this facility without making these corrections is a violation of Chpater 64E-13 and 64E-11, FAC, and Chapters 381, FS. Failure to correct violations may result in an administrative fine or other legal action being initiated or continued.

SCHOOL SANITATION - 1. School Site
-

- 8. Natural Ventilation - 9. Mechanical Ventilation

- 15. Handwash Facilities - 16. Showers/Fixtures - 17. Shower Water Temp.

LIQUID/SOLID WASTE - 21. Sewage Disposal
-

MISC. - 26. First Aid Kit FOOD
- 27. Food Insp. Rpt.

2. Playground Equipment 3. Athletic Equipment

22. Solid Waste

BUILDINGS - 4. Construction
√ -

SANITARY FACILITIES - 10. Provided/Accessible
- 11. Cleanliness & Repair - 12. Toilet Facilities - 13. Separation of Sexes - 14. Fixture Ratio

WATER SUPPLY
- 18. Installed/Operated/

VECTOR/VERMIN CONTROL
√ -

5. Maintenance & Repair 6. Lighting/Foot-Candles 7. Heating, Ventilation, A/C

Maintained
- 19. Drinking Fountains - 20. Approved Source

OTHER - 28. 23. Infestation/Control - 29. 24. Brush/Trash 25. Water Collection/Drainage

ITEM NUMBERS

COMMENTS AND INSTRUCTIONS (continue on attached sheet)

HEALTH DEPARTMENT INSPECTOR: COPY OF REPORT RECEIVED BY:

James Threlkeld Adam Miller
CHD / HEADQUARTERS

PHONE: DATE:

11/16/2010

DH 4030, 01/05 (Obsoletes Previous Editions)

SCHOOL INSPECTION
PURPOSE:
√ ROUTINE - CONSTRUCT COMPLAINT QA SURVEY PREOPENING

SCHOOL INSPECTION
TYPE:
12 13 √ 23 24 Private School Public School Charter School Vocational School College/University Other

-

REINSPECTION CHANGE OF OWNER CONSULTATION EMDEMIOLOGY OTHER

STATE OF FLORIDA DEPARTMENT OF HEALTH COUNTY HEALTH DEPARTMENT
PUBLIC/PRIVATE SCHOOL INSPECTION REPORT

NAME OF FACILITY ADDRESS OWNER

Potentials Charter School
CITY ZIP

CENSUS

RESULTS
√ -

1201 N Australian Avenue The Arc of Palm Beach County Inc

Riviera Beach 33404 (561) 842-3213

24 1000 2000 3000 100 10 1 2 3 4 5 6 7 8 9 200 ▬ 300 30

Satisfactory

PERSON IN CHARGE BEGIN END

PHONE

Incomplete Unsatisfactory Correct Violations by √ Next Inspection
-

8:00 AM on:

11 35
1 2 3 4 5 6 7 8 9 00 05 AM 10 PM 15 20 25 30 ▬ 40

12
1 2 3 4 5 6 7 8 9 00 05 AM 10 PM 15 20 25 30 35 40

DATE
0 0 1 1 2 3 4 5 6 7 8 9 0 1 2 3 0 1 2 3 4 5 6 7 8 9 05 06 07 08 09 10 11 12 13 14

DATE

POSITION #

PERMIT NUMBER
50-51-01647
0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 0 0 0 0 0 1 1 1 1 1 2 2 2 2 2 3 3 3 3 3 4 4 4 4 4 5 5 5 5 5 6 6 6 6 6 7 7 7 7 7 8 8 8 8 8 9 9 9 9 9

40

0 8
▬0 1 1 2 3 4 5 6 7 ▬ 9

2 3
0 1 3 0 1 ▬ 4 5 6 7 8 9

1

0
05 06 07 08 09

0 2 4
▬ 0 0 1 1 1 2 ▬ 2 3 3 3 5 5 5 6 6 6 7 7 7 8 8 8 9 9 9

0 9
▬ 0 1 2 3 5 6 7 8 9 1 2 3 4 5 6 7 8 ▬

500 50 600 60 700 70 800 80 900 90

▬ 2

4 4 ▬ 4

▬ 10 11 12 13 14

FEMALES

10 45 ▬ 50 12 55

10 45 11 50 ▬ 55

MALES

OUT OF BUSINESS

As per section 120.695 of the Florida Statutes (FS), this form will serve as a "Notice of Non-Compliance" for any violations noted. Items marked below violate the requirements of Chapters 64E-13 and 64E-11 of the Florida Administrative Code (FAC) and must be corrected within the time period indicated in the "Results " section above. Continued operation of this facility without making these corrections is a violation of Chpater 64E-13 and 64E-11, FAC, and Chapters 381, FS. Failure to correct violations may result in an administrative fine or other legal action being initiated or continued.

SCHOOL SANITATION - 1. School Site
-

- 8. Natural Ventilation - 9. Mechanical Ventilation

- 15. Handwash Facilities - 16. Showers/Fixtures - 17. Shower Water Temp.

LIQUID/SOLID WASTE - 21. Sewage Disposal
-

MISC. - 26. First Aid Kit FOOD
- 27. Food Insp. Rpt.

2. Playground Equipment 3. Athletic Equipment

22. Solid Waste

BUILDINGS - 4. Construction
√ -

SANITARY FACILITIES - 10. Provided/Accessible
- 11. Cleanliness & Repair - 12. Toilet Facilities - 13. Separation of Sexes - 14. Fixture Ratio

WATER SUPPLY
- 18. Installed/Operated/

VECTOR/VERMIN CONTROL
√ -

5. Maintenance & Repair 6. Lighting/Foot-Candles 7. Heating, Ventilation, A/C

Maintained
- 19. Drinking Fountains - 20. Approved Source

OTHER - 28. 23. Infestation/Control - 29. 24. Brush/Trash 25. Water Collection/Drainage

ITEM NUMBERS

COMMENTS AND INSTRUCTIONS (continue on attached sheet)

HEALTH DEPARTMENT INSPECTOR: COPY OF REPORT RECEIVED BY:
DH 4030, 01/05 (Obsoletes Previous Editions)

Roy (Mike) McGinnis

PHONE: DATE:

CHD / HEADQUARTERS

SCHOOL INSPECTION
PURPOSE:
√ ROUTINE - CONSTRUCT COMPLAINT QA SURVEY PREOPENING

SCHOOL INSPECTION
TYPE:
12 √ 22 23 24 Private School Public School Charter School Vocational School College/University Other

-

REINSPECTION CHANGE OF OWNER CONSULTATION EMDEMIOLOGY OTHER

STATE OF FLORIDA DEPARTMENT OF HEALTH COUNTY HEALTH DEPARTMENT
PUBLIC/PRIVATE SCHOOL INSPECTION REPORT

NAME OF FACILITY ADDRESS OWNER

Roosevelt Elementary
CITY ZIP

CENSUS

RESULTS
√ -

1220 15th Street Palm Bch Co School Board

West Palm Beach 33401 () 832-1861

460 1000 2000 3000 100 10 1 2 3 ▬ 5 6 7 8 9 200 20 300 30

Satisfactory

PERSON IN CHARGE BEGIN END

PHONE

Incomplete Unsatisfactory Correct Violations by √ Next Inspection
-

8:00 AM on:

1
2 3 4 5 6 7 8 9

15

2 35
1 3 4 5 6 7 8 9 00 10 PM 15 20 25 30 ▬ 40

DATE
0 0 1 1 2 3 4 5 6 7 8 9 0 1 2 3 0 1 2 3 4 5 6 7 8 9 05 06 07 08 09 10 11 12 13 14

▬ 00 10 PM ▬ 20 25 30 35 40

DATE

POSITION #

PERMIT NUMBER
50-51-01164
0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 0 0 0 0 0 1 1 1 1 1 2 2 2 2 2 3 3 3 3 3 4 4 4 4 4 5 5 5 5 5 6 6 6 6 6 7 7 7 7 7 8 8 8 8 8 9 9 9 9 9

400 40 500 50 600 ▬ 700 70 800 80 900 90

05 AM ▬ 05 AM

0 8
▬0 1 1 2 3 4 5 6 7 ▬ 9

1 6
0 2 3 0 2 3 4 5 ▬ 7 8 9 ▬ 1

1

0
05 06 07 08 09

6 9 8
0 0 0 1 1 1 2 2 2 3 3 3 4 4 4 5 5 5 ▬ 6 6 7 7 7 9 ▬ 9

3 7
0 1 2 4 5 6 7 9 0 1 2 4 5 6 ▬ 8 9

▬ 3

▬ 10 11 12 13 14

FEMALES

10 45 11 50 12 55

10 45 11 50 12 55

8 8 ▬ 8

MALES

OUT OF BUSINESS

As per section 120.695 of the Florida Statutes (FS), this form will serve as a "Notice of Non-Compliance" for any violations noted. Items marked below violate the requirements of Chapters 64E-13 and 64E-11 of the Florida Administrative Code (FAC) and must be corrected within the time period indicated in the "Results " section above. Continued operation of this facility without making these corrections is a violation of Chpater 64E-13 and 64E-11, FAC, and Chapters 381, FS. Failure to correct violations may result in an administrative fine or other legal action being initiated or continued.

SCHOOL SANITATION - 1. School Site
-

- 8. Natural Ventilation - 9. Mechanical Ventilation

√ 15. Handwash Facilities - 16. Showers/Fixtures - 17. Shower Water Temp.

LIQUID/SOLID WASTE - 21. Sewage Disposal
-

MISC. - 26. First Aid Kit FOOD
- 27. Food Insp. Rpt.

2. Playground Equipment 3. Athletic Equipment

22. Solid Waste

BUILDINGS - 4. Construction
-

SANITARY FACILITIES - 10. Provided/Accessible
√ 11. Cleanliness & Repair √ 12. Toilet Facilities - 13. Separation of Sexes - 14. Fixture Ratio

WATER SUPPLY
- 18. Installed/Operated/

VECTOR/VERMIN CONTROL
√ -

5. Maintenance & Repair 6. Lighting/Foot-Candles 7. Heating, Ventilation, A/C

Maintained
√ 19. Drinking Fountains - 20. Approved Source

OTHER - 28. 23. Infestation/Control - 29. 24. Brush/Trash 25. Water Collection/Drainage

ITEM NUMBERS

COMMENTS AND INSTRUCTIONS (continue on attached sheet)

HEALTH DEPARTMENT INSPECTOR: COPY OF REPORT RECEIVED BY:
DH 4030, 01/05 (Obsoletes Previous Editions)

Kai Bonner Jones

PHONE: DATE:

() 274-5334

CHD / HEADQUARTERS

SCHOOL INSPECTION
PURPOSE:
√ ROUTINE - CONSTRUCT COMPLAINT QA SURVEY PREOPENING

SCHOOL INSPECTION
TYPE:
12 √ 22 23 24 Private School Public School Charter School Vocational School College/University Other

-

REINSPECTION CHANGE OF OWNER CONSULTATION EMDEMIOLOGY OTHER

STATE OF FLORIDA DEPARTMENT OF HEALTH COUNTY HEALTH DEPARTMENT
PUBLIC/PRIVATE SCHOOL INSPECTION REPORT

NAME OF FACILITY ADDRESS OWNER

Roosevelt Middle
CITY ZIP

CENSUS

RESULTS
√ -

1900 N Australian Avenue Palm Beach County School Board

West Palm Beach 33407 () 655-9660

1188 ▬ 2000 3000 10 1 2 3 4 5 6 7 8 9 200 20 300 30

Satisfactory

PERSON IN CHARGE BEGIN END

PHONE

Incomplete Unsatisfactory Correct Violations by √ Next Inspection
-

8:00 AM on:

9
1 2 3 4 5 6 7 8

30
00 05 AM 10 PM 15 20 25 ▬ 35

1210
1 2 3 4 5 6 7 8 9 00 05 AM ▬ PM 15 20 25 30 35 40

DATE
0 0 1 1 2 3 4 5 6 7 8 9 0 1 2 3 0 1 2 3 4 5 6 7 8 9 05 06 07 08 09 10 11 12 13 14

DATE

POSITION #

PERMIT NUMBER
50-51-01165
0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 0 0 0 0 0 1 1 1 1 1 2 2 2 2 2 3 3 3 3 3 4 4 4 4 4 5 5 5 5 5 6 6 6 6 6 7 7 7 7 7 8 8 8 8 8 9 9 9 9 9

400 40 500 50 600 60 700 70 800 80 900 90

0 8
▬0 1 1 2 3 4 5 6 7 ▬ 9

1 6
0 2 3 0 2 3 4 5 ▬ 7 8 9 ▬ 1

1

0
05 06 07 08 09

6 9 8
0 0 0 1 1 1 2 2 2 3 3 3 4 4 4 5 5 5 ▬ 6 6 7 7 7 9 ▬ 9

3 7
0 1 2 4 5 6 7 9 0 1 2 4 5 6 ▬ 8 9

▬ 3

▬ 10 11 12 13 14

FEMALES

▬ 40 10 45 11 50 12 55

10 45 11 50 ▬ 55

8 8 ▬ 8

MALES

OUT OF BUSINESS

As per section 120.695 of the Florida Statutes (FS), this form will serve as a "Notice of Non-Compliance" for any violations noted. Items marked below violate the requirements of Chapters 64E-13 and 64E-11 of the Florida Administrative Code (FAC) and must be corrected within the time period indicated in the "Results " section above. Continued operation of this facility without making these corrections is a violation of Chpater 64E-13 and 64E-11, FAC, and Chapters 381, FS. Failure to correct violations may result in an administrative fine or other legal action being initiated or continued.

SCHOOL SANITATION - 1. School Site
√ -

- 8. Natural Ventilation - 9. Mechanical Ventilation

- 15. Handwash Facilities - 16. Showers/Fixtures - 17. Shower Water Temp.

LIQUID/SOLID WASTE - 21. Sewage Disposal
-

MISC. √ 26. First Aid Kit FOOD
- 27. Food Insp. Rpt.

2. Playground Equipment 3. Athletic Equipment

22. Solid Waste

BUILDINGS - 4. Construction
√ √

SANITARY FACILITIES √ 10. Provided/Accessible
√ 11. Cleanliness & Repair - 12. Toilet Facilities - 13. Separation of Sexes - 14. Fixture Ratio

WATER SUPPLY
- 18. Installed/Operated/

VECTOR/VERMIN CONTROL
√ -

5. Maintenance & Repair 6. Lighting/Foot-Candles √ 7. Heating, Ventilation, A/C

Maintained
√ 19. Drinking Fountains - 20. Approved Source

OTHER - 28. 23. Infestation/Control - 29. 24. Brush/Trash 25. Water Collection/Drainage

ITEM NUMBERS

COMMENTS AND INSTRUCTIONS (continue on attached sheet)

HEALTH DEPARTMENT INSPECTOR: COPY OF REPORT RECEIVED BY:
DH 4030, 01/05 (Obsoletes Previous Editions)

Kai Bonner Jones

PHONE: DATE:

() 274-5334

CHD / HEADQUARTERS

SCHOOL INSPECTION
PURPOSE:
√ ROUTINE - CONSTRUCT COMPLAINT QA SURVEY PREOPENING

SCHOOL INSPECTION
TYPE:
12 √ 22 23 24 Private School Public School Charter School Vocational School College/University Other

-

REINSPECTION CHANGE OF OWNER CONSULTATION EMDEMIOLOGY OTHER

STATE OF FLORIDA DEPARTMENT OF HEALTH COUNTY HEALTH DEPARTMENT
PUBLIC/PRIVATE SCHOOL INSPECTION REPORT

NAME OF FACILITY ADDRESS OWNER

Rosenwald Elementary
CITY ZIP

CENSUS

RESULTS
√ -

1321 Palm Beach Road W Pbc School Board S. Dowers

South Bay 33493 () 996-4970

236 1000 2000 3000 100 10 1 ▬ 3 4 5 6 7 8 9 200 20 300 ▬

Satisfactory

PERSON IN CHARGE BEGIN END

PHONE

Incomplete Unsatisfactory Correct Violations by √ Next Inspection
-

8:00 AM on:

12 15
1 2 3 4 5 6 7 8 9 00 05 AM 10 PM ▬ 20 25 30 35 40

1 30
▬ 00 2 3 4 5 6 7 8 9 05 AM 10 PM 15 20 25 ▬ 35 40

DATE
0 0 1 1 2 3 4 5 6 7 8 9 0 1 2 3 0 1 2 3 4 5 6 7 8 9 05 06 07 08 09 10 11 12 13 14

DATE

POSITION #

PERMIT NUMBER
50-51-01171
0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 0 0 0 0 0 1 1 1 1 1 2 2 2 2 2 3 3 3 3 3 4 4 4 4 4 5 5 5 5 5 6 6 6 6 6 7 7 7 7 7 8 8 8 8 8 9 9 9 9 9

400 40 500 50 ▬ 60 700 70 800 80 900 90

0 5
▬0 1 1 2 3 4 ▬ 6 7 8 9

2 7
0 1 3 0 1 3 4 5 6 ▬ 8 9

1

0
05 06 07 08 09

2 8 9
0 0 0 1 1 1 ▬ 2 2 3 3 3 4 4 4 5 5 5 6 6 6 7 7 7 8 ▬ 8

5 0
0 1 2 3 4 6 7 8 ▬ 1 2 3 4 6 7 8 9

▬ 2

▬ 10 11 12 13 14

▬ 5

FEMALES

10 45 11 50 ▬ 55

10 45 11 50 12 55

MALES

9 9 ▬ 9

OUT OF BUSINESS

As per section 120.695 of the Florida Statutes (FS), this form will serve as a "Notice of Non-Compliance" for any violations noted. Items marked below violate the requirements of Chapters 64E-13 and 64E-11 of the Florida Administrative Code (FAC) and must be corrected within the time period indicated in the "Results " section above. Continued operation of this facility without making these corrections is a violation of Chpater 64E-13 and 64E-11, FAC, and Chapters 381, FS. Failure to correct violations may result in an administrative fine or other legal action being initiated or continued.

SCHOOL SANITATION √ 1. School Site
-

- 8. Natural Ventilation - 9. Mechanical Ventilation

- 15. Handwash Facilities - 16. Showers/Fixtures - 17. Shower Water Temp.

LIQUID/SOLID WASTE - 21. Sewage Disposal
-

MISC. - 26. First Aid Kit FOOD
- 27. Food Insp. Rpt.

2. Playground Equipment 3. Athletic Equipment

22. Solid Waste

BUILDINGS - 4. Construction
√ -

SANITARY FACILITIES - 10. Provided/Accessible
- 11. Cleanliness & Repair - 12. Toilet Facilities - 13. Separation of Sexes - 14. Fixture Ratio

WATER SUPPLY
- 18. Installed/Operated/

VECTOR/VERMIN CONTROL
√ -

5. Maintenance & Repair 6. Lighting/Foot-Candles 7. Heating, Ventilation, A/C

Maintained
- 19. Drinking Fountains - 20. Approved Source

OTHER - 28. 23. Infestation/Control - 29. 24. Brush/Trash 25. Water Collection/Drainage

ITEM NUMBERS

COMMENTS AND INSTRUCTIONS (continue on attached sheet)

HEALTH DEPARTMENT INSPECTOR: COPY OF REPORT RECEIVED BY:

James Threlkeld S. Dowers
CHD / HEADQUARTERS

PHONE: DATE:

05/27/2010

DH 4030, 01/05 (Obsoletes Previous Editions)

SCHOOL INSPECTION
PURPOSE:
√ ROUTINE - CONSTRUCT COMPLAINT QA SURVEY PREOPENING

SCHOOL INSPECTION
TYPE:
12 √ 22 23 24 Private School Public School Charter School Vocational School College/University Other

-

REINSPECTION CHANGE OF OWNER CONSULTATION EMDEMIOLOGY OTHER

STATE OF FLORIDA DEPARTMENT OF HEALTH COUNTY HEALTH DEPARTMENT
PUBLIC/PRIVATE SCHOOL INSPECTION REPORT

NAME OF FACILITY ADDRESS OWNER

Rosenwald Elementary
CITY ZIP

CENSUS

RESULTS
√ -

1321 Palm Beach Road W Pbc School Board S. Downers

South Bay 33493 () 996-4970

225 1000 2000 3000 100 10 1 ▬ 3 4 5 6 7 8 9 200 ▬ 300 30

Satisfactory

PERSON IN CHARGE BEGIN END

PHONE

Incomplete Unsatisfactory Correct Violations by √ Next Inspection
-

8:00 AM on:

12 30
1 2 3 4 5 6 7 8 9 00 05 AM 10 PM 15 20 25 ▬ 35 40

1 30
▬ 00 2 3 4 5 6 7 8 9 05 AM 10 PM 15 20 25 ▬ 35 40

DATE
0 0 1 1 2 3 4 5 6 7 8 9 0 1 2 3 0 1 2 3 4 5 6 7 8 9 05 06 07 08 09 10 11 12 13 14

DATE

POSITION #

PERMIT NUMBER
50-51-01171
0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 0 0 0 0 0 1 1 1 1 1 2 2 2 2 2 3 3 3 3 3 4 4 4 4 4 5 5 5 5 5 6 6 6 6 6 7 7 7 7 7 8 8 8 8 8 9 9 9 9 9

400 40 ▬ 50 600 60 700 70 800 80 900 90

1 1
0 0 2 3 4 5 6 7 8 9

2 9
0 0 1 3 4 5 6 7 8 ▬

1

0
05 06 07 08 09

2 8 9
0 0 0 1 1 1 ▬ 2 2 3 3 3 4 4 4 5 5 5 6 6 6 7 7 7 8 ▬ 8

5 0
0 1 2 3 4 6 7 8 ▬ 1 2 3 4 6 7 8 9

▬▬ 1 3

▬ 2

▬ 10 11 12 13 14

▬ 5

FEMALES

10 45 11 50 ▬ 55

10 45 11 50 12 55

MALES

9 9 ▬ 9

OUT OF BUSINESS

As per section 120.695 of the Florida Statutes (FS), this form will serve as a "Notice of Non-Compliance" for any violations noted. Items marked below violate the requirements of Chapters 64E-13 and 64E-11 of the Florida Administrative Code (FAC) and must be corrected within the time period indicated in the "Results " section above. Continued operation of this facility without making these corrections is a violation of Chpater 64E-13 and 64E-11, FAC, and Chapters 381, FS. Failure to correct violations may result in an administrative fine or other legal action being initiated or continued.

SCHOOL SANITATION √ 1. School Site
-

- 8. Natural Ventilation - 9. Mechanical Ventilation

- 15. Handwash Facilities - 16. Showers/Fixtures - 17. Shower Water Temp.

LIQUID/SOLID WASTE - 21. Sewage Disposal
-

MISC. - 26. First Aid Kit FOOD
- 27. Food Insp. Rpt.

2. Playground Equipment 3. Athletic Equipment

22. Solid Waste

BUILDINGS - 4. Construction
√ -

SANITARY FACILITIES - 10. Provided/Accessible
- 11. Cleanliness & Repair - 12. Toilet Facilities - 13. Separation of Sexes - 14. Fixture Ratio

WATER SUPPLY
- 18. Installed/Operated/

VECTOR/VERMIN CONTROL
√ -

5. Maintenance & Repair 6. Lighting/Foot-Candles 7. Heating, Ventilation, A/C

Maintained
- 19. Drinking Fountains - 20. Approved Source

OTHER - 28. 23. Infestation/Control - 29. 24. Brush/Trash 25. Water Collection/Drainage

ITEM NUMBERS

COMMENTS AND INSTRUCTIONS (continue on attached sheet)

HEALTH DEPARTMENT INSPECTOR: COPY OF REPORT RECEIVED BY:

James Threlkeld S. Downers
CHD / HEADQUARTERS

PHONE: DATE:

11/29/2010

DH 4030, 01/05 (Obsoletes Previous Editions)

SCHOOL INSPECTION
PURPOSE:
√ ROUTINE - CONSTRUCT COMPLAINT QA SURVEY PREOPENING

SCHOOL INSPECTION
TYPE:
12 √ 22 23 24 Private School Public School Charter School Vocational School College/University Other

-

REINSPECTION CHANGE OF OWNER CONSULTATION EMDEMIOLOGY OTHER

STATE OF FLORIDA DEPARTMENT OF HEALTH COUNTY HEALTH DEPARTMENT
PUBLIC/PRIVATE SCHOOL INSPECTION REPORT

NAME OF FACILITY ADDRESS OWNER

Royal Palm Beach High
CITY ZIP

CENSUS

RESULTS
√ -

10600 Okeechobee Boulevard Palm Beach County School Board x

Royal Palm Beach 33411 (555) 555-5555

2062 1000 ▬ 3000 100 10 1 2 3 4 5 6 7 8 9 200 20 300 30

Satisfactory

PERSON IN CHARGE BEGIN END

PHONE

Incomplete Unsatisfactory Correct Violations by √ Next Inspection
-

8:00 AM on:

9
1 2 3 4 5 6 7 8

30
00 05 AM 10 PM 15 20 25 ▬ 35

1230
1 2 3 4 5 6 7 8 9 00 05 AM 10 PM 15 20 25 ▬ 35 40

DATE
0 0 1 1 2 3 4 5 6 7 8 9 0 1 2 3 0 1 2 3 4 5 6 7 8 9 05 06 07 08 09 10 11 12 13 14

DATE

POSITION #

PERMIT NUMBER
50-51-01174
0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 0 0 0 0 0 1 1 1 1 1 2 2 2 2 2 3 3 3 3 3 4 4 4 4 4 5 5 5 5 5 6 6 6 6 6 7 7 7 7 7 8 8 8 8 8 9 9 9 9 9

400 40 500 50 600 60 700 70 800 80 900 90

1 0
▬1 2 3 4 5 6 7 8 9

1 2
0 ▬ 3 4 5 6 7 8 9 ▬ 1 2 3

1

0
05 06 07 08 09

6 9 3
0 0 0 1 1 1 2 2 2 4 4 4 5 5 5 ▬ 6 6 7 7 7 8 8 8 9 ▬ 9

7 0
0 1 2 4 5 6 8 9 ▬ 1 2 3 4 5 6 8 9

0 ▬ 0

3 3 ▬ 3

▬ 10 11 12 13 14

FEMALES

▬ 40 10 45 11 50 12 55

10 45 11 50 ▬ 55

▬ 7

MALES

OUT OF BUSINESS

As per section 120.695 of the Florida Statutes (FS), this form will serve as a "Notice of Non-Compliance" for any violations noted. Items marked below violate the requirements of Chapters 64E-13 and 64E-11 of the Florida Administrative Code (FAC) and must be corrected within the time period indicated in the "Results " section above. Continued operation of this facility without making these corrections is a violation of Chpater 64E-13 and 64E-11, FAC, and Chapters 381, FS. Failure to correct violations may result in an administrative fine or other legal action being initiated or continued.

SCHOOL SANITATION - 1. School Site

- 8. Natural Ventilation - 9. Mechanical Ventilation

√ 15. Handwash Facilities √ 16. Showers/Fixtures - 17. Shower Water Temp.

LIQUID/SOLID WASTE - 21. Sewage Disposal
-

MISC. - 26. First Aid Kit FOOD
- 27. Food Insp. Rpt.

2. Playground Equipment 3. Athletic Equipment

22. Solid Waste

BUILDINGS √ 4. Construction
√ √ -

SANITARY FACILITIES - 10. Provided/Accessible
√ 11. Cleanliness & Repair - 12. Toilet Facilities - 13. Separation of Sexes - 14. Fixture Ratio

WATER SUPPLY
- 18. Installed/Operated/

VECTOR/VERMIN CONTROL
√ √

5. Maintenance & Repair 6. Lighting/Foot-Candles 7. Heating, Ventilation, A/C

Maintained
√ 19. Drinking Fountains - 20. Approved Source

OTHER √ 28. 23. Infestation/Control √ 29. 24. Brush/Trash 25. Water Collection/Drainage

ITEM NUMBERS

COMMENTS AND INSTRUCTIONS (continue on attached sheet)

HEALTH DEPARTMENT INSPECTOR: COPY OF REPORT RECEIVED BY:

Jaime Morales x
CHD / HEADQUARTERS

PHONE: DATE:

10/12/2010

DH 4030, 01/05 (Obsoletes Previous Editions)

SCHOOL INSPECTION
PURPOSE:
√ ROUTINE - CONSTRUCT COMPLAINT QA SURVEY PREOPENING

SCHOOL INSPECTION
TYPE:
12 √ 22 23 24 Private School Public School Charter School Vocational School College/University Other

-

REINSPECTION CHANGE OF OWNER CONSULTATION EMDEMIOLOGY OTHER

STATE OF FLORIDA DEPARTMENT OF HEALTH COUNTY HEALTH DEPARTMENT
PUBLIC/PRIVATE SCHOOL INSPECTION REPORT

NAME OF FACILITY ADDRESS OWNER

Royal Palm School
CITY ZIP

CENSUS

RESULTS
√ -

6650 Lawrence Road P.B.C. School Board

Lantana 33462 () 641-1291

570 1000 2000 3000 100 10 1 2 3 4 ▬ 6 7 8 9 200 20 300 30

Satisfactory

PERSON IN CHARGE BEGIN END

PHONE

Incomplete Unsatisfactory Correct Violations by √ Next Inspection
-

8:00 AM on:

1
2 3 4 5 6 7 8 9

45
05 AM 15 20 25 30 35 40

3 30
1 2 4 5 6 7 8 9 00 05 AM 15 20 25 ▬ 35 40

DATE
0 0 1 1 2 3 4 5 6 7 8 9 0 1 2 3 0 1 2 3 4 5 6 7 8 9 05 06 07 08 09 10 11 12 13 14

▬ 00

DATE

POSITION #

PERMIT NUMBER
50-51-01176
0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 0 0 0 0 0 1 1 1 1 1 2 2 2 2 2 3 3 3 3 3 4 4 4 4 4 5 5 5 5 5 6 6 6 6 6 7 7 7 7 7 8 8 8 8 8 9 9 9 9 9

400 40 500 50 600 60 700 ▬ 800 80 900 90

0 5
▬0 1 1 2 3 4 ▬ 6 7 8 9

1 9
0 2 3 0 2 3 4 5 6 7 8 ▬ ▬ 1

1

0
05 06 07 08 09

4 3 5
0 0 0 1 1 1 2 2 2 3 ▬ 3 ▬ 4 4 6 6 6 7 7 7 8 8 8 9 9 9

8 1
0 1 2 3 4 6 7 9 0 ▬ 2 3 4 5 6 7 9

10 PM ▬ 10 PM

▬ 10 11 12 13 14

5 5 ▬ 5

FEMALES

10 ▬ 11 50 12 55

10 45 11 50 12 55

▬ 8

MALES

OUT OF BUSINESS

As per section 120.695 of the Florida Statutes (FS), this form will serve as a "Notice of Non-Compliance" for any violations noted. Items marked below violate the requirements of Chapters 64E-13 and 64E-11 of the Florida Administrative Code (FAC) and must be corrected within the time period indicated in the "Results " section above. Continued operation of this facility without making these corrections is a violation of Chpater 64E-13 and 64E-11, FAC, and Chapters 381, FS. Failure to correct violations may result in an administrative fine or other legal action being initiated or continued.

SCHOOL SANITATION - 1. School Site
-

- 8. Natural Ventilation - 9. Mechanical Ventilation

- 15. Handwash Facilities - 16. Showers/Fixtures - 17. Shower Water Temp.

LIQUID/SOLID WASTE - 21. Sewage Disposal
-

MISC. - 26. First Aid Kit FOOD
- 27. Food Insp. Rpt.

2. Playground Equipment 3. Athletic Equipment

22. Solid Waste

BUILDINGS - 4. Construction
√ -

SANITARY FACILITIES - 10. Provided/Accessible
- 11. Cleanliness & Repair - 12. Toilet Facilities - 13. Separation of Sexes - 14. Fixture Ratio

WATER SUPPLY
- 18. Installed/Operated/

VECTOR/VERMIN CONTROL
√ -

5. Maintenance & Repair 6. Lighting/Foot-Candles 7. Heating, Ventilation, A/C

Maintained
- 19. Drinking Fountains - 20. Approved Source

OTHER - 28. 23. Infestation/Control - 29. 24. Brush/Trash 25. Water Collection/Drainage

ITEM NUMBERS

COMMENTS AND INSTRUCTIONS (continue on attached sheet)

HEALTH DEPARTMENT INSPECTOR: COPY OF REPORT RECEIVED BY:
DH 4030, 01/05 (Obsoletes Previous Editions)

Rebekah Lejeune

PHONE: DATE:

CHD / HEADQUARTERS

SCHOOL INSPECTION
PURPOSE:
√ ROUTINE - CONSTRUCT COMPLAINT QA SURVEY PREOPENING

SCHOOL INSPECTION
TYPE:
12 √ 22 23 24 Private School Public School Charter School Vocational School College/University Other

-

REINSPECTION CHANGE OF OWNER CONSULTATION EMDEMIOLOGY OTHER

STATE OF FLORIDA DEPARTMENT OF HEALTH COUNTY HEALTH DEPARTMENT
PUBLIC/PRIVATE SCHOOL INSPECTION REPORT

NAME OF FACILITY ADDRESS OWNER

Royal Palm School
CITY ZIP

CENSUS

RESULTS
√ -

6650 Lawrence Road P.B.C. School Board

Lantana 33462 () 641-1291

570 1000 2000 3000 100 10 1 2 3 4 ▬ 6 7 8 9 200 20 300 30

Satisfactory

PERSON IN CHARGE BEGIN END

PHONE

Incomplete Unsatisfactory Correct Violations by √ Next Inspection
-

8:00 AM on:

1
2 3 4 5 6 7 8 9

30
05 AM 15 20 25 ▬ 35 40

3 30
1 2 4 5 6 7 8 9 00 05 AM 15 20 25 ▬ 35 40

DATE
0 0 1 1 2 3 4 5 6 7 8 9 0 1 2 3 0 1 2 3 4 5 6 7 8 9 05 06 07 08 09 10 11 12 13 14

▬ 00

DATE

POSITION #

PERMIT NUMBER
50-51-01176
0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 0 0 0 0 0 1 1 1 1 1 2 2 2 2 2 3 3 3 3 3 4 4 4 4 4 5 5 5 5 5 6 6 6 6 6 7 7 7 7 7 8 8 8 8 8 9 9 9 9 9

400 40 500 50 600 60 700 ▬ 800 80 900 90

0 8
▬0 1 1 2 3 4 5 6 7 ▬ 9

1 3
0 2 3 0 2 ▬ 4 5 6 7 8 9 ▬ 1

1

0
05 06 07 08 09

4 3 5
0 0 0 1 1 1 2 2 2 3 ▬ 3 ▬ 4 4 6 6 6 7 7 7 8 8 8 9 9 9

8 1
0 1 2 3 4 6 7 9 0 ▬ 2 3 4 5 6 7 9

10 PM ▬ 10 PM

▬ 10 11 12 13 14

5 5 ▬ 5

FEMALES

10 45 11 50 12 55

10 45 11 50 12 55

▬ 8

MALES

OUT OF BUSINESS

As per section 120.695 of the Florida Statutes (FS), this form will serve as a "Notice of Non-Compliance" for any violations noted. Items marked below violate the requirements of Chapters 64E-13 and 64E-11 of the Florida Administrative Code (FAC) and must be corrected within the time period indicated in the "Results " section above. Continued operation of this facility without making these corrections is a violation of Chpater 64E-13 and 64E-11, FAC, and Chapters 381, FS. Failure to correct violations may result in an administrative fine or other legal action being initiated or continued.

SCHOOL SANITATION - 1. School Site
-

- 8. Natural Ventilation - 9. Mechanical Ventilation

- 15. Handwash Facilities - 16. Showers/Fixtures - 17. Shower Water Temp.

LIQUID/SOLID WASTE - 21. Sewage Disposal
-

MISC. - 26. First Aid Kit FOOD
- 27. Food Insp. Rpt.

2. Playground Equipment 3. Athletic Equipment

22. Solid Waste

BUILDINGS - 4. Construction
-

SANITARY FACILITIES - 10. Provided/Accessible
- 11. Cleanliness & Repair - 12. Toilet Facilities - 13. Separation of Sexes - 14. Fixture Ratio

WATER SUPPLY
- 18. Installed/Operated/

VECTOR/VERMIN CONTROL
√ -

5. Maintenance & Repair 6. Lighting/Foot-Candles 7. Heating, Ventilation, A/C

Maintained
- 19. Drinking Fountains - 20. Approved Source

OTHER - 28. 23. Infestation/Control - 29. 24. Brush/Trash 25. Water Collection/Drainage

ITEM NUMBERS

COMMENTS AND INSTRUCTIONS (continue on attached sheet)

HEALTH DEPARTMENT INSPECTOR: COPY OF REPORT RECEIVED BY:
DH 4030, 01/05 (Obsoletes Previous Editions)

Rebekah Lejeune

PHONE: DATE:

CHD / HEADQUARTERS

SCHOOL INSPECTION
PURPOSE:
√ ROUTINE - CONSTRUCT COMPLAINT QA SURVEY PREOPENING

SCHOOL INSPECTION
TYPE:
12 √ 22 23 24 Private School Public School Charter School Vocational School College/University Other

-

REINSPECTION CHANGE OF OWNER CONSULTATION EMDEMIOLOGY OTHER

STATE OF FLORIDA DEPARTMENT OF HEALTH COUNTY HEALTH DEPARTMENT
PUBLIC/PRIVATE SCHOOL INSPECTION REPORT

NAME OF FACILITY ADDRESS OWNER

Royal Palm School
CITY ZIP

CENSUS

RESULTS

6650 Lawrence Road P.B.C. School Board

Lantana 33462 () 641-1291

570 1000 2000 3000 100 10 1 2 3 4 ▬ 6 7 8 9 200 20 300 30

Satisfactory

PERSON IN CHARGE BEGIN END

PHONE

Incomplete Unsatisfactory Correct Violations by Next Inspection

8:00 AM on:

12 15
1 2 3 4 5 6 7 8 9 00 05 AM ▬ 20 25 30 35 40

3 15
1 2 4 5 6 7 8 9 00 05 AM ▬ 20 25 30 35 40

DATE
1 1 0 9 1 0
0 0 2 3 4 5 6 7 8 9 ▬ 0 1 2 3 4 5 6 7 8 ▬ 2 3 05 06 07 08 09 ▬ 10 11 12 13 14 ▬▬ 1

DATE

POSITION #

PERMIT NUMBER
50-51-01176
0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 0 0 0 0 0 1 1 1 1 1 2 2 2 2 2 3 3 3 3 3 4 4 4 4 4 5 5 5 5 5 6 6 6 6 6 7 7 7 7 7 8 8 8 8 8 9 9 9 9 9

400 40 500 50 600 60 700 ▬ 800 80 900 90

1 1
0 0 2 3 4 5 6 7 8 9

0 2
▬ 0 1 ▬ 3 4 5 6 7 8 9 2 3

1

0
05 06 07 08 09

4 3 5
0 0 0 1 1 1 2 2 2 3 ▬ 3 ▬ 4 4 6 6 6 7 7 7 8 8 8 9 9 9

8 1
0 1 2 3 4 6 7 9 0 ▬ 2 3 4 5 6 7 9

10 PM ▬ 10 PM

▬▬ 1

▬ 10 11 12 13 14

5 5 ▬ 5

FEMALES

10 45 11 50 ▬ 55

10 45 11 50 12 55

▬ 8

MALES

OUT OF BUSINESS

As per section 120.695 of the Florida Statutes (FS), this form will serve as a "Notice of Non-Compliance" for any violations noted. Items marked below violate the requirements of Chapters 64E-13 and 64E-11 of the Florida Administrative Code (FAC) and must be corrected within the time period indicated in the "Results " section above. Continued operation of this facility without making these corrections is a violation of Chpater 64E-13 and 64E-11, FAC, and Chapters 381, FS. Failure to correct violations may result in an administrative fine or other legal action being initiated or continued.

SCHOOL SANITATION - 1. School Site
-

- 8. Natural Ventilation - 9. Mechanical Ventilation

√ 15. Handwash Facilities - 16. Showers/Fixtures - 17. Shower Water Temp.

LIQUID/SOLID WASTE - 21. Sewage Disposal
-

MISC. - 26. First Aid Kit FOOD
- 27. Food Insp. Rpt.

2. Playground Equipment 3. Athletic Equipment

22. Solid Waste

BUILDINGS - 4. Construction
√ -

SANITARY FACILITIES - 10. Provided/Accessible
√ 11. Cleanliness & Repair √ 12. Toilet Facilities - 13. Separation of Sexes - 14. Fixture Ratio

WATER SUPPLY
- 18. Installed/Operated/

VECTOR/VERMIN CONTROL
√ -

5. Maintenance & Repair 6. Lighting/Foot-Candles 7. Heating, Ventilation, A/C

Maintained
√ 19. Drinking Fountains - 20. Approved Source

OTHER - 28. 23. Infestation/Control - 29. 24. Brush/Trash 25. Water Collection/Drainage

ITEM NUMBERS

COMMENTS AND INSTRUCTIONS (continue on attached sheet)

HEALTH DEPARTMENT INSPECTOR: COPY OF REPORT RECEIVED BY:
DH 4030, 01/05 (Obsoletes Previous Editions)

Rebekah Lejeune

PHONE: DATE:

CHD / HEADQUARTERS

SCHOOL INSPECTION
PURPOSE:
ROUTINE CONSTRUCT COMPLAINT QA SURVEY PREOPENING

SCHOOL INSPECTION
TYPE:
12 √ 22 23 24 Private School Public School Charter School Vocational School College/University Other

√ REINSPECTION - CHANGE OF OWNER CONSULTATION EMDEMIOLOGY OTHER

STATE OF FLORIDA DEPARTMENT OF HEALTH COUNTY HEALTH DEPARTMENT
PUBLIC/PRIVATE SCHOOL INSPECTION REPORT

NAME OF FACILITY ADDRESS OWNER

Royal Palm School
CITY ZIP

CENSUS

RESULTS

6650 Lawrence Road P.B.C. School Board

Lantana 33462 () 641-1291

570 1000 2000 3000 100 10 1 2 3 4 ▬ 6 7 8 9 200 20 300 30

Satisfactory

PERSON IN CHARGE BEGIN END

PHONE

Incomplete Unsatisfactory Correct Violations by Next Inspection

8:00 AM on:

1
2 3 4 5 6 7 8 9

00

2 50
1 3 4 5 6 7 8 9 00 10 PM 15 20 25 30 35 40

DATE
1 1 2 3 1 0
0 0 2 3 4 5 6 7 8 9 0 0 1 ▬ 4 5 6 7 8 9 05 06 07 08 09 ▬ 10 11 12 13 14 ▬▬ 1 3

▬ ▬ 10 PM 15 20 25 30 35 40

DATE

POSITION #

PERMIT NUMBER
50-51-01176
0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 0 0 0 0 0 1 1 1 1 1 2 2 2 2 2 3 3 3 3 3 4 4 4 4 4 5 5 5 5 5 6 6 6 6 6 7 7 7 7 7 8 8 8 8 8 9 9 9 9 9

400 40 500 50 600 60 700 ▬ 800 80 900 90

05 AM ▬ 05 AM

1 1
0 0 2 3 4 5 6 7 8 9

0 9
▬ 0 1 2 3 4 5 6 7 8 ▬ 2 3

1

0
05 06 07 08 09

4 3 5
0 0 0 1 1 1 2 2 2 3 ▬ 3 ▬ 4 4 6 6 6 7 7 7 8 8 8 9 9 9

8 1
0 1 2 3 4 6 7 9 0 ▬ 2 3 4 5 6 7 9

▬▬ 1

▬ 2

▬ 10 11 12 13 14

5 5 ▬ 5

FEMALES

10 45 11 50 12 55

10 45 11 ▬ 12 55

▬ 8

MALES

OUT OF BUSINESS

As per section 120.695 of the Florida Statutes (FS), this form will serve as a "Notice of Non-Compliance" for any violations noted. Items marked below violate the requirements of Chapters 64E-13 and 64E-11 of the Florida Administrative Code (FAC) and must be corrected within the time period indicated in the "Results " section above. Continued operation of this facility without making these corrections is a violation of Chpater 64E-13 and 64E-11, FAC, and Chapters 381, FS. Failure to correct violations may result in an administrative fine or other legal action being initiated or continued.

SCHOOL SANITATION - 1. School Site
-

- 8. Natural Ventilation - 9. Mechanical Ventilation

- 15. Handwash Facilities - 16. Showers/Fixtures - 17. Shower Water Temp.

LIQUID/SOLID WASTE - 21. Sewage Disposal
-

MISC. - 26. First Aid Kit FOOD
- 27. Food Insp. Rpt.

2. Playground Equipment 3. Athletic Equipment

22. Solid Waste

BUILDINGS - 4. Construction
-

SANITARY FACILITIES - 10. Provided/Accessible
- 11. Cleanliness & Repair - 12. Toilet Facilities - 13. Separation of Sexes - 14. Fixture Ratio

WATER SUPPLY
- 18. Installed/Operated/

VECTOR/VERMIN CONTROL
√ -

5. Maintenance & Repair 6. Lighting/Foot-Candles 7. Heating, Ventilation, A/C

Maintained
- 19. Drinking Fountains - 20. Approved Source

OTHER - 28. 23. Infestation/Control - 29. 24. Brush/Trash 25. Water Collection/Drainage

ITEM NUMBERS

COMMENTS AND INSTRUCTIONS (continue on attached sheet)

HEALTH DEPARTMENT INSPECTOR: COPY OF REPORT RECEIVED BY:
DH 4030, 01/05 (Obsoletes Previous Editions)

Rebekah Lejeune

PHONE: DATE:

CHD / HEADQUARTERS

SCHOOL INSPECTION
PURPOSE:
ROUTINE CONSTRUCT COMPLAINT QA SURVEY PREOPENING

SCHOOL INSPECTION
TYPE:
12 √ 22 23 24 Private School Public School Charter School Vocational School College/University Other

√ REINSPECTION - CHANGE OF OWNER CONSULTATION EMDEMIOLOGY OTHER

STATE OF FLORIDA DEPARTMENT OF HEALTH COUNTY HEALTH DEPARTMENT
PUBLIC/PRIVATE SCHOOL INSPECTION REPORT

NAME OF FACILITY ADDRESS OWNER

Royal Palm School
CITY ZIP

CENSUS

RESULTS

6650 Lawrence Road P.B.C. School Board x

Lantana 33462 () 641-1291

570 1000 2000 3000 100 10 1 2 3 4 ▬ 6 7 8 9 200 20 300 30

Satisfactory

PERSON IN CHARGE BEGIN END

PHONE

Incomplete Unsatisfactory Correct Violations by Next Inspection

8:00 AM on:

9
1 2 3 4 5 6 7 8

40
00 05 AM 10 PM 15 20 25 30 35

1100
1 2 3 4 5 6 7 8 9 ▬ 05 AM 10 PM 15 20 25 30 35 40

DATE
1 2 0 9 1 0
0 0 ▬1 3 4 5 6 7 8 9 ▬ 0 1 3 1 2 3 4 5 6 7 8 ▬ 05 06 07 08 09 ▬ 10 11 12 13 14

DATE

POSITION #

PERMIT NUMBER
50-51-01176
0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 0 0 0 0 0 1 1 1 1 1 2 2 2 2 2 3 3 3 3 3 4 4 4 4 4 5 5 5 5 5 6 6 6 6 6 7 7 7 7 7 8 8 8 8 8 9 9 9 9 9

400 40 500 50 600 60 700 ▬ 800 80 900 90

1 1
0 0 2 3 4 5 6 7 8 9

2 3
0 0 1 ▬ 4 5 6 7 8 9

1

0
05 06 07 08 09

4 3 5
0 0 0 1 1 1 2 2 2 3 ▬ 3 ▬ 4 4 6 6 6 7 7 7 8 8 8 9 9 9

8 1
0 1 2 3 4 6 7 9 0 ▬ 2 3 4 5 6 7 9

▬▬ 1 3

▬ 2

▬ 2

▬ 10 11 12 13 14

5 5 ▬ 5

FEMALES

▬ ▬ 10 45 11 50 12 55

10 45 ▬ 50 12 55

▬ 8

MALES

OUT OF BUSINESS

As per section 120.695 of the Florida Statutes (FS), this form will serve as a "Notice of Non-Compliance" for any violations noted. Items marked below violate the requirements of Chapters 64E-13 and 64E-11 of the Florida Administrative Code (FAC) and must be corrected within the time period indicated in the "Results " section above. Continued operation of this facility without making these corrections is a violation of Chpater 64E-13 and 64E-11, FAC, and Chapters 381, FS. Failure to correct violations may result in an administrative fine or other legal action being initiated or continued.

SCHOOL SANITATION - 1. School Site
-

- 8. Natural Ventilation - 9. Mechanical Ventilation

- 15. Handwash Facilities - 16. Showers/Fixtures - 17. Shower Water Temp.

LIQUID/SOLID WASTE - 21. Sewage Disposal
-

MISC. - 26. First Aid Kit FOOD
- 27. Food Insp. Rpt.

2. Playground Equipment 3. Athletic Equipment

22. Solid Waste

BUILDINGS - 4. Construction
-

SANITARY FACILITIES - 10. Provided/Accessible
- 11. Cleanliness & Repair - 12. Toilet Facilities - 13. Separation of Sexes - 14. Fixture Ratio

WATER SUPPLY
- 18. Installed/Operated/

VECTOR/VERMIN CONTROL
√ -

5. Maintenance & Repair 6. Lighting/Foot-Candles 7. Heating, Ventilation, A/C

Maintained
- 19. Drinking Fountains - 20. Approved Source

OTHER - 28. 23. Infestation/Control - 29. 24. Brush/Trash 25. Water Collection/Drainage

ITEM NUMBERS

COMMENTS AND INSTRUCTIONS (continue on attached sheet)

HEALTH DEPARTMENT INSPECTOR: COPY OF REPORT RECEIVED BY:

Rebekah Lejeune x
CHD / HEADQUARTERS

PHONE: DATE:

11/23/2010

DH 4030, 01/05 (Obsoletes Previous Editions)

SCHOOL INSPECTION
PURPOSE:
ROUTINE CONSTRUCT COMPLAINT QA SURVEY PREOPENING

SCHOOL INSPECTION
TYPE:
12 √ 22 23 24 Private School Public School Charter School Vocational School College/University Other

√ REINSPECTION - CHANGE OF OWNER CONSULTATION EMDEMIOLOGY OTHER

STATE OF FLORIDA DEPARTMENT OF HEALTH COUNTY HEALTH DEPARTMENT
PUBLIC/PRIVATE SCHOOL INSPECTION REPORT

NAME OF FACILITY ADDRESS OWNER

Santaluces High School
CITY ZIP

CENSUS

RESULTS

6880 Lawrence Road Pbc School Board

Lantana 33462 () 439-4004

2217 1000 ▬ 3000 100 10 1 2 3 4 5 6 7 8 9 20

Satisfactory

PERSON IN CHARGE BEGIN END

PHONE

Incomplete Unsatisfactory Correct Violations by Next Inspection

8:00 AM on:

1
2 3 4 5 6 7 8 9

15
05 AM ▬ 20 25 30 35 40

3 30
1 2 4 5 6 7 8 9 00 05 AM 15 20 25 ▬ 35 40

300 30

DATE
0 5 2 6 1 0
▬0 1 1 2 3 4 ▬ 6 7 8 9 0 1 3 0 1 3 4 5 ▬ 7 8 9 05 06 07 08 09 ▬ 10 11 12 13 14

▬ 00

DATE

POSITION #

PERMIT NUMBER
50-51-01204
0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 0 0 0 0 0 1 1 1 1 1 2 2 2 2 2 3 3 3 3 3 4 4 4 4 4 5 5 5 5 5 6 6 6 6 6 7 7 7 7 7 8 8 8 8 8 9 9 9 9 9

400 40 500 50 600 60 700 70 800 80 900 90

0 5
▬0 1 1 2 3 4 ▬ 6 7 8 9

0 5
▬ 0 1 2 3 1 2 3 4 ▬ 6 7 8 9

1

0
05 06 07 08 09

4 3 5
0 0 0 1 1 1 2 2 2 3 ▬ 3 ▬ 4 4 6 6 6 7 7 7 8 8 8 9 9 9

8 1
0 1 2 3 4 6 7 9 0 ▬ 2 3 4 5 6 7 9

10 PM ▬ 10 PM

▬ 2

▬ 10 11 12 13 14

5 5 ▬ 5

FEMALES

10 45 11 50 12 55

10 45 11 50 12 55

▬ 8

MALES

OUT OF BUSINESS

As per section 120.695 of the Florida Statutes (FS), this form will serve as a "Notice of Non-Compliance" for any violations noted. Items marked below violate the requirements of Chapters 64E-13 and 64E-11 of the Florida Administrative Code (FAC) and must be corrected within the time period indicated in the "Results " section above. Continued operation of this facility without making these corrections is a violation of Chpater 64E-13 and 64E-11, FAC, and Chapters 381, FS. Failure to correct violations may result in an administrative fine or other legal action being initiated or continued.

SCHOOL SANITATION - 1. School Site
-

- 8. Natural Ventilation √ 9. Mechanical Ventilation

- 15. Handwash Facilities - 16. Showers/Fixtures - 17. Shower Water Temp.

LIQUID/SOLID WASTE - 21. Sewage Disposal
-

MISC. - 26. First Aid Kit FOOD
- 27. Food Insp. Rpt.

2. Playground Equipment 3. Athletic Equipment

22. Solid Waste

BUILDINGS - 4. Construction
√ -

SANITARY FACILITIES - 10. Provided/Accessible
√ 11. Cleanliness & Repair - 12. Toilet Facilities - 13. Separation of Sexes - 14. Fixture Ratio

WATER SUPPLY
- 18. Installed/Operated/

VECTOR/VERMIN CONTROL
√ -

5. Maintenance & Repair 6. Lighting/Foot-Candles 7. Heating, Ventilation, A/C

Maintained
√ 19. Drinking Fountains - 20. Approved Source

OTHER √ 28. 23. Infestation/Control - 29. 24. Brush/Trash 25. Water Collection/Drainage

ITEM NUMBERS

COMMENTS AND INSTRUCTIONS (continue on attached sheet)

HEALTH DEPARTMENT INSPECTOR: COPY OF REPORT RECEIVED BY:
DH 4030, 01/05 (Obsoletes Previous Editions)

Rebekah Lejeune

PHONE: DATE:

CHD / HEADQUARTERS

SCHOOL INSPECTION
PURPOSE:
√ ROUTINE - CONSTRUCT COMPLAINT QA SURVEY PREOPENING

SCHOOL INSPECTION
TYPE:
12 √ 22 23 24 Private School Public School Charter School Vocational School College/University Other

-

REINSPECTION CHANGE OF OWNER CONSULTATION EMDEMIOLOGY OTHER

STATE OF FLORIDA DEPARTMENT OF HEALTH COUNTY HEALTH DEPARTMENT
PUBLIC/PRIVATE SCHOOL INSPECTION REPORT

NAME OF FACILITY ADDRESS OWNER

Santaluces High School
CITY ZIP

CENSUS

RESULTS

6880 Lawrence Road Pbc School Board Gaddy, Asst. Principal

Lantana 33462 () 439-4004

2217 1000 ▬ 3000 100 10 1 2 3 4 5 6 7 8 9 20

Satisfactory

PERSON IN CHARGE BEGIN END

PHONE

Incomplete Unsatisfactory Correct Violations by Next Inspection

8:00 AM on:

2
1 3 4 5 6 7 8 9

00
▬ 10 PM 15 20 25 30 35 40

2 15
1 3 4 5 6 7 8 9 00 10 PM ▬ 20 25 30 35 40

300 30

DATE
0 8 3 0 1 0
▬0 1 1 2 3 4 5 6 7 ▬ 9 0 1 2 ▬ 1 2 4 5 6 7 8 9 05 06 07 08 09 ▬ 10 11 12 13 14

DATE

POSITION #

PERMIT NUMBER
50-51-01204
0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 0 0 0 0 0 1 1 1 1 1 2 2 2 2 2 3 3 3 3 3 4 4 4 4 4 5 5 5 5 5 6 6 6 6 6 7 7 7 7 7 8 8 8 8 8 9 9 9 9 9

400 40 500 50 600 60 700 70 800 80 900 90

▬ 05 AM ▬ 05 AM

0 8
▬0 1 1 2 3 4 5 6 7 ▬ 9

1 6
0 2 3 0 2 3 4 5 ▬ 7 8 9 ▬ 1

1

0
05 06 07 08 09

4 3 5
0 0 0 1 1 1 2 2 2 3 ▬ 3 ▬ 4 4 6 6 6 7 7 7 8 8 8 9 9 9

8 1
0 1 2 3 4 6 7 9 0 ▬ 2 3 4 5 6 7 9

▬ 3

▬ 10 11 12 13 14

5 5 ▬ 5

FEMALES

10 45 11 50 12 55

10 45 11 50 12 55

▬ 8

MALES

OUT OF BUSINESS

As per section 120.695 of the Florida Statutes (FS), this form will serve as a "Notice of Non-Compliance" for any violations noted. Items marked below violate the requirements of Chapters 64E-13 and 64E-11 of the Florida Administrative Code (FAC) and must be corrected within the time period indicated in the "Results " section above. Continued operation of this facility without making these corrections is a violation of Chpater 64E-13 and 64E-11, FAC, and Chapters 381, FS. Failure to correct violations may result in an administrative fine or other legal action being initiated or continued.

SCHOOL SANITATION - 1. School Site
-

- 8. Natural Ventilation - 9. Mechanical Ventilation

- 15. Handwash Facilities - 16. Showers/Fixtures - 17. Shower Water Temp.

LIQUID/SOLID WASTE - 21. Sewage Disposal
-

MISC. - 26. First Aid Kit FOOD
- 27. Food Insp. Rpt.

2. Playground Equipment 3. Athletic Equipment

22. Solid Waste

BUILDINGS - 4. Construction
-

SANITARY FACILITIES - 10. Provided/Accessible
- 11. Cleanliness & Repair - 12. Toilet Facilities - 13. Separation of Sexes - 14. Fixture Ratio

WATER SUPPLY
- 18. Installed/Operated/

VECTOR/VERMIN CONTROL
√ -

5. Maintenance & Repair 6. Lighting/Foot-Candles 7. Heating, Ventilation, A/C

Maintained
- 19. Drinking Fountains - 20. Approved Source

OTHER - 28. 23. Infestation/Control - 29. 24. Brush/Trash 25. Water Collection/Drainage

ITEM NUMBERS

COMMENTS AND INSTRUCTIONS (continue on attached sheet)

HEALTH DEPARTMENT INSPECTOR: COPY OF REPORT RECEIVED BY:

Rebekah Lejeune Gaddy, Asst. Principal
CHD / HEADQUARTERS

PHONE: DATE:

08/16/2010

DH 4030, 01/05 (Obsoletes Previous Editions)

SCHOOL INSPECTION
PURPOSE:
√ ROUTINE - CONSTRUCT COMPLAINT QA SURVEY PREOPENING

SCHOOL INSPECTION
TYPE:
12 √ 22 23 24 Private School Public School Charter School Vocational School College/University Other

-

REINSPECTION CHANGE OF OWNER CONSULTATION EMDEMIOLOGY OTHER

STATE OF FLORIDA DEPARTMENT OF HEALTH COUNTY HEALTH DEPARTMENT
PUBLIC/PRIVATE SCHOOL INSPECTION REPORT

NAME OF FACILITY ADDRESS OWNER

Seminole Trails Elementary
CITY ZIP

CENSUS

RESULTS

4075 Willow Pond Road Pbc School Board x

West Palm Beach 33417 () 640-5051

920 1000 2000 3000 100 10 1 2 3 4 5 6 7 8 ▬ 200 ▬ 300 30

Satisfactory

PERSON IN CHARGE BEGIN END

PHONE

Incomplete Unsatisfactory Correct Violations by Next Inspection

8:00 AM on:

9
1 2 3 4 5 6 7 8

30
00 05 AM 10 PM 15 20 25 ▬ 35

1215
1 2 3 4 5 6 7 8 9 00 05 AM 10 PM ▬ 20 25 30 35 40

DATE
0 3 2 3 1 0
▬0 1 1 2 4 5 6 7 8 9 0 1 0 1 ▬ 4 5 6 7 8 9 05 06 07 08 09 ▬ 10 11 12 13 14

DATE

POSITION #

PERMIT NUMBER
50-51-01220
0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 0 0 0 0 0 1 1 1 1 1 2 2 2 2 2 3 3 3 3 3 4 4 4 4 4 5 5 5 5 5 6 6 6 6 6 7 7 7 7 7 8 8 8 8 8 9 9 9 9 9

400 40 500 50 600 60 700 70 800 80 900 90

0 3
▬0 1 1 2 4 5 6 7 8 9

0 1
▬ 0 1 2 ▬ 2 3 4 5 6 7 8 9

1

0
05 06 07 08 09

6 9 3
0 0 0 1 1 1 2 2 2 4 4 4 5 5 5 ▬ 6 6 7 7 7 8 8 8 9 ▬ 9

7 0
0 1 2 4 5 6 8 9 ▬ 1 2 3 4 5 6 8 9

▬ 2

▬ 3

3 3 ▬ 3

▬ 3

▬ 10 11 12 13 14

FEMALES

▬ 40 10 45 11 50 12 55

10 45 11 50 ▬ 55

▬ 7

MALES

OUT OF BUSINESS

As per section 120.695 of the Florida Statutes (FS), this form will serve as a "Notice of Non-Compliance" for any violations noted. Items marked below violate the requirements of Chapters 64E-13 and 64E-11 of the Florida Administrative Code (FAC) and must be corrected within the time period indicated in the "Results " section above. Continued operation of this facility without making these corrections is a violation of Chpater 64E-13 and 64E-11, FAC, and Chapters 381, FS. Failure to correct violations may result in an administrative fine or other legal action being initiated or continued.

SCHOOL SANITATION - 1. School Site
-

- 8. Natural Ventilation - 9. Mechanical Ventilation

√ 15. Handwash Facilities - 16. Showers/Fixtures - 17. Shower Water Temp.

LIQUID/SOLID WASTE - 21. Sewage Disposal
-

MISC. - 26. First Aid Kit FOOD
- 27. Food Insp. Rpt.

2. Playground Equipment 3. Athletic Equipment

22. Solid Waste

BUILDINGS √ 4. Construction
√ √ -

SANITARY FACILITIES - 10. Provided/Accessible
√ 11. Cleanliness & Repair - 12. Toilet Facilities - 13. Separation of Sexes - 14. Fixture Ratio

WATER SUPPLY
- 18. Installed/Operated/

VECTOR/VERMIN CONTROL
√ -

5. Maintenance & Repair 6. Lighting/Foot-Candles 7. Heating, Ventilation, A/C

Maintained
√ 19. Drinking Fountains - 20. Approved Source

OTHER √ 28. 23. Infestation/Control √ 29. 24. Brush/Trash 25. Water Collection/Drainage

ITEM NUMBERS

COMMENTS AND INSTRUCTIONS (continue on attached sheet)

HEALTH DEPARTMENT INSPECTOR: COPY OF REPORT RECEIVED BY:

Jaime Morales x
CHD / HEADQUARTERS

PHONE: DATE:

03/01/2010

DH 4030, 01/05 (Obsoletes Previous Editions)

SCHOOL INSPECTION
PURPOSE:
√ ROUTINE - CONSTRUCT COMPLAINT QA SURVEY PREOPENING

SCHOOL INSPECTION
TYPE:
12 √ 22 23 24 Private School Public School Charter School Vocational School College/University Other

-

REINSPECTION CHANGE OF OWNER CONSULTATION EMDEMIOLOGY OTHER

STATE OF FLORIDA DEPARTMENT OF HEALTH COUNTY HEALTH DEPARTMENT
PUBLIC/PRIVATE SCHOOL INSPECTION REPORT

NAME OF FACILITY ADDRESS OWNER

South Olive Elementary
CITY ZIP

CENSUS

RESULTS
√ -

7101 S Olive Avenue Pbc School Board

West Palm Beach 33405 () 533-6359

612 1000 2000 3000 100 ▬ 1 2 3 4 5 ▬ 7 8 9 20

Satisfactory

PERSON IN CHARGE BEGIN END

PHONE

Incomplete Unsatisfactory Correct Violations by √ Next Inspection
-

8:00 AM on:

9
1 2 3 4 5 6 7 8

30
00 05 AM 10 PM 15 20 25 ▬ 35

1140
1 2 3 4 5 6 7 8 9 00 05 AM 10 PM 15 20 25 30 35 ▬

300 30

DATE
0 0 1 1 2 3 4 5 6 7 8 9 0 1 2 3 0 1 2 3 4 5 6 7 8 9 05 06 07 08 09 10 11 12 13 14

DATE

POSITION #

PERMIT NUMBER
50-51-01260
0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 0 0 0 0 0 1 1 1 1 1 2 2 2 2 2 3 3 3 3 3 4 4 4 4 4 5 5 5 5 5 6 6 6 6 6 7 7 7 7 7 8 8 8 8 8 9 9 9 9 9

400 40 500 50 600 60 700 70 800 80 900 90

0 6
▬0 1 1 2 3 4 5 ▬ 7 8 9

2 1
0 1 3 0 ▬ 3 4 5 6 7 8 9

1

0
05 06 07 08 09

6 9 8
0 0 0 1 1 1 2 2 2 3 3 3 4 4 4 5 5 5 ▬ 6 6 7 7 7 9 ▬ 9

3 7
0 1 2 4 5 6 7 9 0 1 2 4 5 6 ▬ 8 9

▬ 2

▬ 3

▬ 10 11 12 13 14

FEMALES

▬ 40 10 45 11 50 12 55

10 45 ▬ 50 12 55

8 8 ▬ 8

MALES

OUT OF BUSINESS

As per section 120.695 of the Florida Statutes (FS), this form will serve as a "Notice of Non-Compliance" for any violations noted. Items marked below violate the requirements of Chapters 64E-13 and 64E-11 of the Florida Administrative Code (FAC) and must be corrected within the time period indicated in the "Results " section above. Continued operation of this facility without making these corrections is a violation of Chpater 64E-13 and 64E-11, FAC, and Chapters 381, FS. Failure to correct violations may result in an administrative fine or other legal action being initiated or continued.

SCHOOL SANITATION - 1. School Site
-

- 8. Natural Ventilation - 9. Mechanical Ventilation

√ 15. Handwash Facilities - 16. Showers/Fixtures - 17. Shower Water Temp.

LIQUID/SOLID WASTE - 21. Sewage Disposal
-

MISC. - 26. First Aid Kit FOOD
- 27. Food Insp. Rpt.

2. Playground Equipment 3. Athletic Equipment

22. Solid Waste

BUILDINGS - 4. Construction
√ -

SANITARY FACILITIES - 10. Provided/Accessible
√ 11. Cleanliness & Repair √ 12. Toilet Facilities - 13. Separation of Sexes - 14. Fixture Ratio

WATER SUPPLY
- 18. Installed/Operated/

VECTOR/VERMIN CONTROL
√ -

5. Maintenance & Repair 6. Lighting/Foot-Candles 7. Heating, Ventilation, A/C

Maintained
√ 19. Drinking Fountains - 20. Approved Source

OTHER - 28. 23. Infestation/Control - 29. 24. Brush/Trash 25. Water Collection/Drainage

ITEM NUMBERS

COMMENTS AND INSTRUCTIONS (continue on attached sheet)

HEALTH DEPARTMENT INSPECTOR: COPY OF REPORT RECEIVED BY:
DH 4030, 01/05 (Obsoletes Previous Editions)

Kai Bonner Jones

PHONE: DATE:

() 274-5334

CHD / HEADQUARTERS

SCHOOL INSPECTION
PURPOSE:
ROUTINE CONSTRUCT COMPLAINT QA SURVEY PREOPENING

SCHOOL INSPECTION
TYPE:
12 13 √ 23 24 Private School Public School Charter School Vocational School College/University Other

√ REINSPECTION - CHANGE OF OWNER CONSULTATION EMDEMIOLOGY OTHER

STATE OF FLORIDA DEPARTMENT OF HEALTH COUNTY HEALTH DEPARTMENT
PUBLIC/PRIVATE SCHOOL INSPECTION REPORT

NAME OF FACILITY ADDRESS OWNER

South Technical Community High School
CITY ZIP

CENSUS
1221 ▬ 2000 3000 100 10 1 2 3 4 5 6 7 8 9 ▬ 20 √ -

RESULTS
Satisfactory Incomplete Unsatisfactory Correct Violations by √ Next Inspection
-

1300 S W 30th Avenue Pbc School Board

Boynton Beach 33426 () 533-6359

PERSON IN CHARGE BEGIN END

PHONE

8:00 AM on:

1
2 3 4 5 6 7 8 9

15
05 AM 10 PM ▬ 20 25 30 35 40

4 15
1 2 3 5 6 7 8 9 00 05 AM 10 PM 20 25 30 35 40

300 30

DATE
0 0 1 1 2 3 4 5 6 7 8 9 0 1 2 3 0 1 2 3 4 5 6 7 8 9 05 06 07 08 09 10 11 12 13 14

▬ 00

DATE

POSITION #

PERMIT NUMBER
50-51-01261
0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 0 0 0 0 0 1 1 1 1 1 2 2 2 2 2 3 3 3 3 3 4 4 4 4 4 5 5 5 5 5 6 6 6 6 6 7 7 7 7 7 8 8 8 8 8 9 9 9 9 9

400 40 500 50 600 60 700 70 800 80 900 90

0 5
▬0 1 1 2 3 4 ▬ 6 7 8 9

1 1
0 2 3 0 2 3 4 5 6 7 8 9 ▬ ▬

1

0
05 06 07 08 09

4 3 5
0 0 0 1 1 1 2 2 2 3 ▬ 3 ▬ 4 4 6 6 6 7 7 7 8 8 8 9 9 9

8 1
0 1 2 3 4 6 7 9 0 ▬ 2 3 4 5 6 7 9

▬ ▬

▬ 10 11 12 13 14

5 5 ▬ 5

FEMALES

10 45 11 50 12 55

10 45 11 50 12 55

▬ 8

MALES

OUT OF BUSINESS

As per section 120.695 of the Florida Statutes (FS), this form will serve as a "Notice of Non-Compliance" for any violations noted. Items marked below violate the requirements of Chapters 64E-13 and 64E-11 of the Florida Administrative Code (FAC) and must be corrected within the time period indicated in the "Results " section above. Continued operation of this facility without making these corrections is a violation of Chpater 64E-13 and 64E-11, FAC, and Chapters 381, FS. Failure to correct violations may result in an administrative fine or other legal action being initiated or continued.

SCHOOL SANITATION - 1. School Site
-

- 8. Natural Ventilation √ 9. Mechanical Ventilation

√ 15. Handwash Facilities - 16. Showers/Fixtures - 17. Shower Water Temp.

LIQUID/SOLID WASTE - 21. Sewage Disposal
-

MISC. - 26. First Aid Kit FOOD
- 27. Food Insp. Rpt.

2. Playground Equipment 3. Athletic Equipment

22. Solid Waste

BUILDINGS - 4. Construction
√ -

SANITARY FACILITIES - 10. Provided/Accessible
√ 11. Cleanliness & Repair - 12. Toilet Facilities - 13. Separation of Sexes - 14. Fixture Ratio

WATER SUPPLY
- 18. Installed/Operated/

VECTOR/VERMIN CONTROL
√ -

5. Maintenance & Repair 6. Lighting/Foot-Candles 7. Heating, Ventilation, A/C

Maintained
√ 19. Drinking Fountains - 20. Approved Source

OTHER - 28. 23. Infestation/Control - 29. 24. Brush/Trash 25. Water Collection/Drainage

ITEM NUMBERS

COMMENTS AND INSTRUCTIONS (continue on attached sheet)

HEALTH DEPARTMENT INSPECTOR: COPY OF REPORT RECEIVED BY:
DH 4030, 01/05 (Obsoletes Previous Editions)

Rebekah Lejeune

PHONE: DATE:

CHD / HEADQUARTERS

SCHOOL INSPECTION
PURPOSE:
√ ROUTINE - CONSTRUCT COMPLAINT QA SURVEY PREOPENING

SCHOOL INSPECTION
TYPE:
12 13 √ 23 24 Private School Public School Charter School Vocational School College/University Other

-

REINSPECTION CHANGE OF OWNER CONSULTATION EMDEMIOLOGY OTHER

STATE OF FLORIDA DEPARTMENT OF HEALTH COUNTY HEALTH DEPARTMENT
PUBLIC/PRIVATE SCHOOL INSPECTION REPORT

NAME OF FACILITY ADDRESS OWNER

South Technical Community High School
CITY ZIP

CENSUS
1221 ▬ 2000 3000 100 10 1 2 3 4 5 6 7 8 9 ▬ 20 √ -

RESULTS
Satisfactory Incomplete Unsatisfactory Correct Violations by √ Next Inspection
-

1300 S W 30th Avenue Pbc School Board Debbie Buchboltz

Boynton Beach 33426 () 533-6359

PERSON IN CHARGE BEGIN END

PHONE

8:00 AM on:

11 15
1 2 3 4 5 6 7 8 9 00 10 PM ▬ 20 25 30 35 40

2 00
1 3 4 5 6 7 8 9 ▬ 10 PM 15 20 25 30 35 40

300 30

DATE
0 0 1 1 2 3 4 5 6 7 8 9 0 1 2 3 0 1 2 3 4 5 6 7 8 9 05 06 07 08 09 10 11 12 13 14

DATE

POSITION #

PERMIT NUMBER
50-51-01261
0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 0 0 0 0 0 1 1 1 1 1 2 2 2 2 2 3 3 3 3 3 4 4 4 4 4 5 5 5 5 5 6 6 6 6 6 7 7 7 7 7 8 8 8 8 8 9 9 9 9 9

400 40 500 50 600 60 700 70 800 80 900 90

05 AM ▬ 05 AM

0 6
▬0 1 1 2 3 4 5 ▬ 7 8 9

1 0
0 2 3 ▬ 2 3 4 5 6 7 8 9 ▬ 1

1

0
05 06 07 08 09

4 3 5
0 0 0 1 1 1 2 2 2 3 ▬ 3 ▬ 4 4 6 6 6 7 7 7 8 8 8 9 9 9

8 1
0 1 2 3 4 6 7 9 0 ▬ 2 3 4 5 6 7 9

▬ 10 11 12 13 14

5 5 ▬ 5

FEMALES

10 45 ▬ 50 12 55

10 45 11 50 12 55

▬ 8

MALES

OUT OF BUSINESS

As per section 120.695 of the Florida Statutes (FS), this form will serve as a "Notice of Non-Compliance" for any violations noted. Items marked below violate the requirements of Chapters 64E-13 and 64E-11 of the Florida Administrative Code (FAC) and must be corrected within the time period indicated in the "Results " section above. Continued operation of this facility without making these corrections is a violation of Chpater 64E-13 and 64E-11, FAC, and Chapters 381, FS. Failure to correct violations may result in an administrative fine or other legal action being initiated or continued.

SCHOOL SANITATION - 1. School Site
-

- 8. Natural Ventilation √ 9. Mechanical Ventilation

√ 15. Handwash Facilities - 16. Showers/Fixtures - 17. Shower Water Temp.

LIQUID/SOLID WASTE - 21. Sewage Disposal
-

MISC. - 26. First Aid Kit FOOD
- 27. Food Insp. Rpt.

2. Playground Equipment 3. Athletic Equipment

22. Solid Waste

BUILDINGS - 4. Construction
√ -

SANITARY FACILITIES - 10. Provided/Accessible
√ 11. Cleanliness & Repair - 12. Toilet Facilities - 13. Separation of Sexes - 14. Fixture Ratio

WATER SUPPLY
- 18. Installed/Operated/

VECTOR/VERMIN CONTROL
√ -

5. Maintenance & Repair 6. Lighting/Foot-Candles 7. Heating, Ventilation, A/C

Maintained
- 19. Drinking Fountains - 20. Approved Source

OTHER - 28. 23. Infestation/Control - 29. 24. Brush/Trash 25. Water Collection/Drainage

ITEM NUMBERS

COMMENTS AND INSTRUCTIONS (continue on attached sheet)

HEALTH DEPARTMENT INSPECTOR: COPY OF REPORT RECEIVED BY:

Rebekah Lejeune Debbie Buchboltz
CHD / HEADQUARTERS

PHONE: DATE:

06/10/2010

DH 4030, 01/05 (Obsoletes Previous Editions)

SCHOOL INSPECTION
PURPOSE:
√ ROUTINE - CONSTRUCT COMPLAINT QA SURVEY PREOPENING

SCHOOL INSPECTION
TYPE:
12 13 √ 23 24 Private School Public School Charter School Vocational School College/University Other

-

REINSPECTION CHANGE OF OWNER CONSULTATION EMDEMIOLOGY OTHER

STATE OF FLORIDA DEPARTMENT OF HEALTH COUNTY HEALTH DEPARTMENT
PUBLIC/PRIVATE SCHOOL INSPECTION REPORT

NAME OF FACILITY ADDRESS OWNER

South Technical Community High School
CITY ZIP

CENSUS
1262 ▬ 2000 3000 100 10 1 2 3 4 5 6 7 8 9 ▬ 20 √ -

RESULTS
Satisfactory Incomplete Unsatisfactory Correct Violations by √ Next Inspection
-

1300 S W 30th Avenue Pbc School Board Mr. Cort

Boynton Beach 33426 () 533-6359

PERSON IN CHARGE BEGIN END

PHONE

8:00 AM on:

2
1 3 4 5 6 7 8 9

15
00

3 45
1 2 4 5 6 7 8 9 00 05 AM 15 20 25 30 35 40

300 30

DATE
0 0 1 1 2 3 4 5 6 7 8 9 0 1 2 3 0 1 2 3 4 5 6 7 8 9 05 06 07 08 09 10 11 12 13 14

DATE

POSITION #

PERMIT NUMBER
50-51-01261
0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 0 0 0 0 0 1 1 1 1 1 2 2 2 2 2 3 3 3 3 3 4 4 4 4 4 5 5 5 5 5 6 6 6 6 6 7 7 7 7 7 8 8 8 8 8 9 9 9 9 9

400 40 500 50 600 60 700 70 800 80 900 90

▬ 05 AM ▬ 20 25 30 35 40

0 8
▬0 1 1 2 3 4 5 6 7 ▬ 9

2 4
0 1 3 0 1 3 ▬ 5 6 7 8 9

1

0
05 06 07 08 09

4 3 5
0 0 0 1 1 1 2 2 2 3 ▬ 3 ▬ 4 4 6 6 6 7 7 7 8 8 8 9 9 9

8 1
0 1 2 3 4 6 7 9 0 ▬ 2 3 4 5 6 7 9

10 PM ▬ 10 PM

▬ 2

▬ 10 11 12 13 14

5 5 ▬ 5

FEMALES

10 45 11 50 12 55

10 ▬ 11 50 12 55

▬ 8

MALES

OUT OF BUSINESS

As per section 120.695 of the Florida Statutes (FS), this form will serve as a "Notice of Non-Compliance" for any violations noted. Items marked below violate the requirements of Chapters 64E-13 and 64E-11 of the Florida Administrative Code (FAC) and must be corrected within the time period indicated in the "Results " section above. Continued operation of this facility without making these corrections is a violation of Chpater 64E-13 and 64E-11, FAC, and Chapters 381, FS. Failure to correct violations may result in an administrative fine or other legal action being initiated or continued.

SCHOOL SANITATION - 1. School Site
-

- 8. Natural Ventilation - 9. Mechanical Ventilation

√ 15. Handwash Facilities √ 16. Showers/Fixtures - 17. Shower Water Temp.

LIQUID/SOLID WASTE - 21. Sewage Disposal
-

MISC. - 26. First Aid Kit FOOD
- 27. Food Insp. Rpt.

2. Playground Equipment 3. Athletic Equipment

22. Solid Waste

BUILDINGS - 4. Construction
√ -

SANITARY FACILITIES - 10. Provided/Accessible
√ 11. Cleanliness & Repair - 12. Toilet Facilities - 13. Separation of Sexes - 14. Fixture Ratio

WATER SUPPLY
- 18. Installed/Operated/

VECTOR/VERMIN CONTROL
√ -

5. Maintenance & Repair 6. Lighting/Foot-Candles 7. Heating, Ventilation, A/C

Maintained
- 19. Drinking Fountains - 20. Approved Source

OTHER - 28. 23. Infestation/Control - 29. 24. Brush/Trash 25. Water Collection/Drainage

ITEM NUMBERS

COMMENTS AND INSTRUCTIONS (continue on attached sheet)

HEALTH DEPARTMENT INSPECTOR: COPY OF REPORT RECEIVED BY:

Rebekah Lejeune Mr. Cort
CHD / HEADQUARTERS

PHONE: DATE:

08/24/2010

DH 4030, 01/05 (Obsoletes Previous Editions)

SCHOOL INSPECTION
PURPOSE:
√ ROUTINE - CONSTRUCT COMPLAINT QA SURVEY PREOPENING

SCHOOL INSPECTION
TYPE:
12 √ 22 23 24 Private School Public School Charter School Vocational School College/University Other

-

REINSPECTION CHANGE OF OWNER CONSULTATION EMDEMIOLOGY OTHER

STATE OF FLORIDA DEPARTMENT OF HEALTH COUNTY HEALTH DEPARTMENT
PUBLIC/PRIVATE SCHOOL INSPECTION REPORT

NAME OF FACILITY ADDRESS OWNER

Spady Elementary
CITY ZIP

CENSUS

RESULTS
√ -

321 NW 10th Avenue Pbc School Board

Delray Beach 33444 () 243-1558

630 1000 2000 3000 100 10 1 2 3 4 5 ▬ 7 8 9 200 20 300 ▬

Satisfactory

PERSON IN CHARGE BEGIN END

PHONE

Incomplete Unsatisfactory Correct Violations by √ Next Inspection
-

8:00 AM on:

10 15
1 2 3 4 5 6 7 8 9 00 05 AM 10 PM ▬ 20 25 30 35 40

1215
1 2 3 4 5 6 7 8 9 00 05 AM 10 PM ▬ 20 25 30 35 40

DATE
0 0 1 1 2 3 4 5 6 7 8 9 0 1 2 3 0 1 2 3 4 5 6 7 8 9 05 06 07 08 09 10 11 12 13 14

DATE

POSITION #

PERMIT NUMBER
50-51-01264
0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 0 0 0 0 0 1 1 1 1 1 2 2 2 2 2 3 3 3 3 3 4 4 4 4 4 5 5 5 5 5 6 6 6 6 6 7 7 7 7 7 8 8 8 8 8 9 9 9 9 9

400 40 500 50 600 60 700 70 800 80 900 90

0 9
▬0 1 1 2 3 4 5 6 7 8 ▬

3 0
0 1 2 ▬ 1 2 4 5 6 7 8 9

1

0
05 06 07 08 09

2 8 8
0 0 0 1 1 1 ▬ 2 2 3 3 3 4 4 4 5 5 5 6 6 6 7 7 7 9 9 9

5 5
0 1 2 3 4 6 7 9 0 1 2 3 4 6 7 8 9

▬ 3

▬ 10 11 12 13 14

▬ ▬

FEMALES

▬ 45 11 50 12 55

10 45 11 50 ▬ 55

8 ▬ ▬ 8

MALES

OUT OF BUSINESS

As per section 120.695 of the Florida Statutes (FS), this form will serve as a "Notice of Non-Compliance" for any violations noted. Items marked below violate the requirements of Chapters 64E-13 and 64E-11 of the Florida Administrative Code (FAC) and must be corrected within the time period indicated in the "Results " section above. Continued operation of this facility without making these corrections is a violation of Chpater 64E-13 and 64E-11, FAC, and Chapters 381, FS. Failure to correct violations may result in an administrative fine or other legal action being initiated or continued.

SCHOOL SANITATION - 1. School Site
√ -

- 8. Natural Ventilation - 9. Mechanical Ventilation

√ 15. Handwash Facilities - 16. Showers/Fixtures - 17. Shower Water Temp.

LIQUID/SOLID WASTE - 21. Sewage Disposal
-

MISC. - 26. First Aid Kit FOOD
- 27. Food Insp. Rpt.

2. Playground Equipment 3. Athletic Equipment

22. Solid Waste

BUILDINGS - 4. Construction
-

SANITARY FACILITIES - 10. Provided/Accessible
√ 11. Cleanliness & Repair √ 12. Toilet Facilities √ 13. Separation of Sexes - 14. Fixture Ratio

WATER SUPPLY
- 18. Installed/Operated/

VECTOR/VERMIN CONTROL
√ -

5. Maintenance & Repair 6. Lighting/Foot-Candles 7. Heating, Ventilation, A/C

Maintained
- 19. Drinking Fountains - 20. Approved Source

OTHER - 28. 23. Infestation/Control - 29. 24. Brush/Trash 25. Water Collection/Drainage

ITEM NUMBERS

COMMENTS AND INSTRUCTIONS (continue on attached sheet)

HEALTH DEPARTMENT INSPECTOR: COPY OF REPORT RECEIVED BY:
DH 4030, 01/05 (Obsoletes Previous Editions)

Herbert Al Wilson

PHONE: DATE:

CHD / HEADQUARTERS

SCHOOL INSPECTION
PURPOSE:
√ ROUTINE - CONSTRUCT COMPLAINT QA SURVEY PREOPENING

SCHOOL INSPECTION
TYPE:
12 √ 22 23 24 Private School Public School Charter School Vocational School College/University Other

-

REINSPECTION CHANGE OF OWNER CONSULTATION EMDEMIOLOGY OTHER

STATE OF FLORIDA DEPARTMENT OF HEALTH COUNTY HEALTH DEPARTMENT
PUBLIC/PRIVATE SCHOOL INSPECTION REPORT

NAME OF FACILITY ADDRESS OWNER

Suncoast High (Magnet)
CITY ZIP

CENSUS

RESULTS
√ -

600 W 28th Street Pbc School Board Linda Cartlidge

Riviera Beach 33404 () 881-4675

1376 ▬ 2000 3000 100 10 1 2 3 4 5 6 7 8 9 200 20 ▬ 30

Satisfactory

PERSON IN CHARGE BEGIN END

PHONE

Incomplete Unsatisfactory Correct Violations by √ Next Inspection
-

8:00 AM on:

10 50
1 2 3 4 5 6 7 8 9 00 10 PM 15 20 25 30 35 40

2 50
1 3 4 5 6 7 8 9 00 10 PM 15 20 25 30 35 40

DATE
0 0 1 1 2 3 4 5 6 7 8 9 0 1 2 3 0 1 2 3 4 5 6 7 8 9 05 06 07 08 09 10 11 12 13 14

DATE

POSITION #

PERMIT NUMBER
50-51-01333
0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 0 0 0 0 0 1 1 1 1 1 2 2 2 2 2 3 3 3 3 3 4 4 4 4 4 5 5 5 5 5 6 6 6 6 6 7 7 7 7 7 8 8 8 8 8 9 9 9 9 9

400 40 500 50 600 60 700 70 800 80 900 90

05 AM ▬ 05 AM

0 6
▬0 1 1 2 3 4 5 ▬ 7 8 9

0 1
▬ 0 1 2 3 ▬ 2 3 4 5 6 7 8 9

1

0
05 06 07 08 09

6 9 8
0 0 0 1 1 1 2 2 2 3 3 3 4 4 4 5 5 5 ▬ 6 6 7 7 7 9 ▬ 9

3 7
0 1 2 4 5 6 7 9 0 1 2 4 5 6 ▬ 8 9

▬ 3

▬ 10 11 12 13 14

FEMALES

▬ 45 11 ▬ 12 55

10 45 11 ▬ 12 55

8 8 ▬ 8

MALES

OUT OF BUSINESS

As per section 120.695 of the Florida Statutes (FS), this form will serve as a "Notice of Non-Compliance" for any violations noted. Items marked below violate the requirements of Chapters 64E-13 and 64E-11 of the Florida Administrative Code (FAC) and must be corrected within the time period indicated in the "Results " section above. Continued operation of this facility without making these corrections is a violation of Chpater 64E-13 and 64E-11, FAC, and Chapters 381, FS. Failure to correct violations may result in an administrative fine or other legal action being initiated or continued.

SCHOOL SANITATION - 1. School Site
-

- 8. Natural Ventilation - 9. Mechanical Ventilation

√ 15. Handwash Facilities √ 16. Showers/Fixtures - 17. Shower Water Temp.

LIQUID/SOLID WASTE - 21. Sewage Disposal
-

MISC. - 26. First Aid Kit FOOD
- 27. Food Insp. Rpt.

2. Playground Equipment 3. Athletic Equipment

22. Solid Waste

BUILDINGS - 4. Construction
√ √

SANITARY FACILITIES - 10. Provided/Accessible
√ 11. Cleanliness & Repair - 12. Toilet Facilities - 13. Separation of Sexes - 14. Fixture Ratio

WATER SUPPLY
- 18. Installed/Operated/

VECTOR/VERMIN CONTROL
√ -

5. Maintenance & Repair 6. Lighting/Foot-Candles √ 7. Heating, Ventilation, A/C

Maintained
√ 19. Drinking Fountains - 20. Approved Source

OTHER √ 28. 23. Infestation/Control - 29. 24. Brush/Trash 25. Water Collection/Drainage

ITEM NUMBERS

COMMENTS AND INSTRUCTIONS (continue on attached sheet)

HEALTH DEPARTMENT INSPECTOR: COPY OF REPORT RECEIVED BY:

Kai Bonner Jones Linda Cartlidge
CHD / HEADQUARTERS

PHONE: DATE:

() 274-5334 06/01/2010

DH 4030, 01/05 (Obsoletes Previous Editions)

SCHOOL INSPECTION
PURPOSE:
√ ROUTINE - CONSTRUCT COMPLAINT QA SURVEY PREOPENING

SCHOOL INSPECTION
TYPE:
12 √ 22 23 24 Private School Public School Charter School Vocational School College/University Other

-

REINSPECTION CHANGE OF OWNER CONSULTATION EMDEMIOLOGY OTHER

STATE OF FLORIDA DEPARTMENT OF HEALTH COUNTY HEALTH DEPARTMENT
PUBLIC/PRIVATE SCHOOL INSPECTION REPORT

NAME OF FACILITY ADDRESS OWNER

U. B. Kinsey/Palm View Elementary
CITY ZIP

CENSUS

RESULTS
√ -

800 11th Street Pbc School Board Adrienne Howard

West Palm Beach 33401 () 655-2891

497 1000 2000 3000 100 10 1 2 3 ▬ 5 6 7 8 9 200 20 300 30

Satisfactory

PERSON IN CHARGE BEGIN END

PHONE

Incomplete Unsatisfactory Correct Violations by √ Next Inspection
-

8:00 AM on:

10 20
1 2 3 4 5 6 7 8 9 00 05 AM 10 PM 15 ▬ 25 30 35 40

1210
1 2 3 4 5 6 7 8 9 00 05 AM ▬ PM 15 20 25 30 35 40

DATE
0 0 1 1 2 3 4 5 6 7 8 9 0 1 2 3 0 1 2 3 4 5 6 7 8 9 05 06 07 08 09 10 11 12 13 14

DATE

POSITION #

PERMIT NUMBER
50-51-01439
0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 0 0 0 0 0 1 1 1 1 1 2 2 2 2 2 3 3 3 3 3 4 4 4 4 4 5 5 5 5 5 6 6 6 6 6 7 7 7 7 7 8 8 8 8 8 9 9 9 9 9

400 40 500 50 600 60 ▬ 70 800 80 900 ▬

0 8
▬0 1 1 2 3 4 5 6 7 ▬ 9

1 0
0 2 3 ▬ 2 3 4 5 6 7 8 9 ▬ 1

1

0
05 06 07 08 09

6 9 8
0 0 0 1 1 1 2 2 2 3 3 3 4 4 4 5 5 5 ▬ 6 6 7 7 7 9 ▬ 9

3 7
0 1 2 4 5 6 7 9 0 1 2 4 5 6 ▬ 8 9

▬ 3

▬ 10 11 12 13 14

FEMALES

▬ 45 11 50 12 55

10 45 11 50 ▬ 55

8 8 ▬ 8

MALES

OUT OF BUSINESS

As per section 120.695 of the Florida Statutes (FS), this form will serve as a "Notice of Non-Compliance" for any violations noted. Items marked below violate the requirements of Chapters 64E-13 and 64E-11 of the Florida Administrative Code (FAC) and must be corrected within the time period indicated in the "Results " section above. Continued operation of this facility without making these corrections is a violation of Chpater 64E-13 and 64E-11, FAC, and Chapters 381, FS. Failure to correct violations may result in an administrative fine or other legal action being initiated or continued.

SCHOOL SANITATION - 1. School Site
-

- 8. Natural Ventilation - 9. Mechanical Ventilation

- 15. Handwash Facilities - 16. Showers/Fixtures - 17. Shower Water Temp.

LIQUID/SOLID WASTE - 21. Sewage Disposal
-

MISC. - 26. First Aid Kit FOOD
- 27. Food Insp. Rpt.

2. Playground Equipment 3. Athletic Equipment

22. Solid Waste

BUILDINGS - 4. Construction
√ √

SANITARY FACILITIES - 10. Provided/Accessible
- 11. Cleanliness & Repair - 12. Toilet Facilities - 13. Separation of Sexes - 14. Fixture Ratio

WATER SUPPLY
- 18. Installed/Operated/

VECTOR/VERMIN CONTROL
√ -

5. Maintenance & Repair 6. Lighting/Foot-Candles √ 7. Heating, Ventilation, A/C

Maintained
√ 19. Drinking Fountains - 20. Approved Source

OTHER - 28. 23. Infestation/Control - 29. 24. Brush/Trash 25. Water Collection/Drainage

ITEM NUMBERS

COMMENTS AND INSTRUCTIONS (continue on attached sheet)

HEALTH DEPARTMENT INSPECTOR: COPY OF REPORT RECEIVED BY:

Kai Bonner Jones Adrienne Howard
CHD / HEADQUARTERS

PHONE: DATE:

() 274-5334 08/10/2010

DH 4030, 01/05 (Obsoletes Previous Editions)

SCHOOL INSPECTION
PURPOSE:
√ ROUTINE - CONSTRUCT COMPLAINT QA SURVEY PREOPENING

SCHOOL INSPECTION
TYPE:
12 √ 22 23 24 Private School Public School Charter School Vocational School College/University Other

-

REINSPECTION CHANGE OF OWNER CONSULTATION EMDEMIOLOGY OTHER

STATE OF FLORIDA DEPARTMENT OF HEALTH COUNTY HEALTH DEPARTMENT
PUBLIC/PRIVATE SCHOOL INSPECTION REPORT

NAME OF FACILITY ADDRESS OWNER

Washington Elementary
CITY ZIP

CENSUS

RESULTS
√ -

1709 W 30 Street Pbc School Board

Riviera Beach 33404 () 881-4665

341 1000 2000 3000 10 1 2 ▬ 4 5 6 7 8 9 200 20 300 30

Satisfactory

PERSON IN CHARGE BEGIN END

PHONE

Incomplete Unsatisfactory Correct Violations by √ Next Inspection
-

8:00 AM on:

11
1 2 3 4 5 6 7 8 9 00 05 AM 10 PM 15 20 25 30 35 40

1 15
▬ 00 2 3 4 5 6 7 8 9 05 AM 10 PM ▬ 20 25 30 35 40

DATE
0 0 1 1 2 3 4 5 6 7 8 9 0 1 2 3 0 1 2 3 4 5 6 7 8 9 05 06 07 08 09 10 11 12 13 14

DATE

POSITION #

PERMIT NUMBER
50-51-01465
0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 0 0 0 0 0 1 1 1 1 1 2 2 2 2 2 3 3 3 3 3 4 4 4 4 4 5 5 5 5 5 6 6 6 6 6 7 7 7 7 7 8 8 8 8 8 9 9 9 9 9

400 ▬ 500 50 600 60 700 70 800 80 900 90

1 1
0 0 2 3 4 5 6 7 8 9

2 2
0 0 1 3 4 5 6 7 8 9

1

0
05 06 07 08 09

6 9 8
0 0 0 1 1 1 2 2 2 3 3 3 4 4 4 5 5 5 ▬ 6 6 7 7 7 9 ▬ 9

3 7
0 1 2 4 5 6 7 9 0 1 2 4 5 6 ▬ 8 9

▬▬ 1 3

▬ ▬

▬ 3

▬ 10 11 12 13 14

FEMALES

10 45 ▬ 50 12 55

10 45 11 50 12 55

8 8 ▬ 8

MALES

OUT OF BUSINESS

As per section 120.695 of the Florida Statutes (FS), this form will serve as a "Notice of Non-Compliance" for any violations noted. Items marked below violate the requirements of Chapters 64E-13 and 64E-11 of the Florida Administrative Code (FAC) and must be corrected within the time period indicated in the "Results " section above. Continued operation of this facility without making these corrections is a violation of Chpater 64E-13 and 64E-11, FAC, and Chapters 381, FS. Failure to correct violations may result in an administrative fine or other legal action being initiated or continued.

SCHOOL SANITATION - 1. School Site
-

- 8. Natural Ventilation - 9. Mechanical Ventilation

√ 15. Handwash Facilities - 16. Showers/Fixtures - 17. Shower Water Temp.

LIQUID/SOLID WASTE - 21. Sewage Disposal
-

MISC. - 26. First Aid Kit FOOD
- 27. Food Insp. Rpt.

2. Playground Equipment 3. Athletic Equipment

22. Solid Waste

BUILDINGS - 4. Construction
√ -

SANITARY FACILITIES - 10. Provided/Accessible
- 11. Cleanliness & Repair - 12. Toilet Facilities - 13. Separation of Sexes - 14. Fixture Ratio

WATER SUPPLY
- 18. Installed/Operated/

VECTOR/VERMIN CONTROL
√ -

5. Maintenance & Repair 6. Lighting/Foot-Candles 7. Heating, Ventilation, A/C

Maintained
- 19. Drinking Fountains - 20. Approved Source

OTHER √ 28. 23. Infestation/Control - 29. 24. Brush/Trash 25. Water Collection/Drainage

ITEM NUMBERS

COMMENTS AND INSTRUCTIONS (continue on attached sheet)

HEALTH DEPARTMENT INSPECTOR: COPY OF REPORT RECEIVED BY:
DH 4030, 01/05 (Obsoletes Previous Editions)

Kai Bonner Jones

PHONE: DATE:

() 274-5334

CHD / HEADQUARTERS

SCHOOL INSPECTION
PURPOSE:
√ ROUTINE - CONSTRUCT COMPLAINT QA SURVEY PREOPENING

SCHOOL INSPECTION
TYPE:
12 √ 22 23 24 Private School Public School Charter School Vocational School College/University Other

-

REINSPECTION CHANGE OF OWNER CONSULTATION EMDEMIOLOGY OTHER

STATE OF FLORIDA DEPARTMENT OF HEALTH COUNTY HEALTH DEPARTMENT
PUBLIC/PRIVATE SCHOOL INSPECTION REPORT

NAME OF FACILITY ADDRESS OWNER

Wellington Elementary
CITY ZIP

CENSUS

RESULTS
√ -

13000 Paddock Drive P.B.Co. School Board Mike Bonowski

Wellington 33414 () 793-7775

851 1000 2000 3000 10 1 2 3 4 5 6 7 ▬ 9 200 20 300 30

Satisfactory

PERSON IN CHARGE BEGIN END

PHONE

Incomplete Unsatisfactory Correct Violations by √ Next Inspection
-

8:00 AM on:

10 30
1 2 3 4 5 6 7 8 9 00 05 AM 10 PM 15 20 25 ▬ 35 40

1 00
▬ ▬ 2 3 4 5 6 7 8 9 05 AM 10 PM 15 20 25 30 35 40

DATE
0 0 1 1 2 3 4 5 6 7 8 9 0 1 2 3 0 1 2 3 4 5 6 7 8 9 05 06 07 08 09 10 11 12 13 14

DATE

POSITION #

PERMIT NUMBER
50-51-01481
0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 0 0 0 0 0 1 1 1 1 1 2 2 2 2 2 3 3 3 3 3 4 4 4 4 4 5 5 5 5 5 6 6 6 6 6 7 7 7 7 7 8 8 8 8 8 9 9 9 9 9

400 40 500 ▬ 600 60 700 70 800 80 900 90

0 2
▬0 1 1 3 4 5 6 7 8 9

0 1
▬ 0 1 3 ▬ 2 3 4 5 6 7 8 9

1

0
05 06 07 08 09

8 5 2
0 0 0 1 1 1 3 3 3 4 4 4 5 ▬ 5 6 6 6 7 7 7 ▬ 8 8 9 9 9

8 0
0 1 3 4 5 6 7 9 ▬ 1 2 3 4 5 6 7 9

▬ 2

2 2 ▬ 2

▬ 10 11 12 13 14

FEMALES

▬ 45 11 50 12 55

10 45 11 50 12 55

▬ 8

MALES

OUT OF BUSINESS

As per section 120.695 of the Florida Statutes (FS), this form will serve as a "Notice of Non-Compliance" for any violations noted. Items marked below violate the requirements of Chapters 64E-13 and 64E-11 of the Florida Administrative Code (FAC) and must be corrected within the time period indicated in the "Results " section above. Continued operation of this facility without making these corrections is a violation of Chpater 64E-13 and 64E-11, FAC, and Chapters 381, FS. Failure to correct violations may result in an administrative fine or other legal action being initiated or continued.

SCHOOL SANITATION - 1. School Site
-

- 8. Natural Ventilation - 9. Mechanical Ventilation

√ 15. Handwash Facilities - 16. Showers/Fixtures - 17. Shower Water Temp.

LIQUID/SOLID WASTE - 21. Sewage Disposal
-

MISC. - 26. First Aid Kit FOOD
- 27. Food Insp. Rpt.

2. Playground Equipment 3. Athletic Equipment

22. Solid Waste

BUILDINGS - 4. Construction
√ -

SANITARY FACILITIES - 10. Provided/Accessible
- 11. Cleanliness & Repair √ 12. Toilet Facilities - 13. Separation of Sexes - 14. Fixture Ratio

WATER SUPPLY
√ 18. Installed/Operated/

VECTOR/VERMIN CONTROL
√ -

5. Maintenance & Repair 6. Lighting/Foot-Candles √ 7. Heating, Ventilation, A/C

Maintained
√ 19. Drinking Fountains - 20. Approved Source

OTHER - 28. 23. Infestation/Control - 29. 24. Brush/Trash 25. Water Collection/Drainage

ITEM NUMBERS

COMMENTS AND INSTRUCTIONS (continue on attached sheet)

HEALTH DEPARTMENT INSPECTOR: COPY OF REPORT RECEIVED BY:

Daniel Ukpong Mike Bonowski
CHD / HEADQUARTERS

PHONE: DATE:

02/01/2010

DH 4030, 01/05 (Obsoletes Previous Editions)

SCHOOL INSPECTION
PURPOSE:
√ ROUTINE - CONSTRUCT COMPLAINT QA SURVEY PREOPENING

SCHOOL INSPECTION
TYPE:
12 √ 22 23 24 Private School Public School Charter School Vocational School College/University Other

-

REINSPECTION CHANGE OF OWNER CONSULTATION EMDEMIOLOGY OTHER

STATE OF FLORIDA DEPARTMENT OF HEALTH COUNTY HEALTH DEPARTMENT
PUBLIC/PRIVATE SCHOOL INSPECTION REPORT

NAME OF FACILITY ADDRESS OWNER

West Riviera Elementary
CITY ZIP

CENSUS

RESULTS
√ -

1057 W 6th Street P B C School Board Gayle Harper

Riviera Beach 33404 (561) 881-4769

552 1000 2000 3000 100 10 1 2 3 4 ▬ 6 7 8 9 20

Satisfactory

PERSON IN CHARGE BEGIN END

PHONE

Incomplete Unsatisfactory Correct Violations by √ Next Inspection
-

8:00 AM on:

9
1 2 3 4 5 6 7 8

35
00 05 AM 10 PM 15 20 25 30 ▬

1140
1 2 3 4 5 6 7 8 9 00 05 AM 10 PM 15 20 25 30 35 ▬

300 30

DATE
0 0 1 1 2 3 4 5 6 7 8 9 0 1 2 3 0 1 2 3 4 5 6 7 8 9 05 06 07 08 09 10 11 12 13 14

DATE

POSITION #

PERMIT NUMBER
50-51-01494
0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 0 0 0 0 0 1 1 1 1 1 2 2 2 2 2 3 3 3 3 3 4 4 4 4 4 5 5 5 5 5 6 6 6 6 6 7 7 7 7 7 8 8 8 8 8 9 9 9 9 9

400 40 500 ▬ 600 60 700 70 800 80 900 90

1 1
0 0 2 3 4 5 6 7 8 9

1 6
0 2 3 0 2 3 4 5 ▬ 7 8 9

1

0
05 06 07 08 09

6 9 8
0 0 0 1 1 1 2 2 2 3 3 3 4 4 4 5 5 5 ▬ 6 6 7 7 7 9 ▬ 9

3 7
0 1 2 4 5 6 7 9 0 1 2 4 5 6 ▬ 8 9

▬▬ ▬ 1

▬ 3

▬ 10 11 12 13 14

FEMALES

▬ 40 10 45 11 50 12 55

10 45 ▬ 50 12 55

8 8 ▬ 8

MALES

OUT OF BUSINESS

As per section 120.695 of the Florida Statutes (FS), this form will serve as a "Notice of Non-Compliance" for any violations noted. Items marked below violate the requirements of Chapters 64E-13 and 64E-11 of the Florida Administrative Code (FAC) and must be corrected within the time period indicated in the "Results " section above. Continued operation of this facility without making these corrections is a violation of Chpater 64E-13 and 64E-11, FAC, and Chapters 381, FS. Failure to correct violations may result in an administrative fine or other legal action being initiated or continued.

SCHOOL SANITATION √ 1. School Site
-

- 8. Natural Ventilation - 9. Mechanical Ventilation

√ 15. Handwash Facilities - 16. Showers/Fixtures - 17. Shower Water Temp.

LIQUID/SOLID WASTE - 21. Sewage Disposal
-

MISC. - 26. First Aid Kit FOOD
- 27. Food Insp. Rpt.

2. Playground Equipment 3. Athletic Equipment

22. Solid Waste

BUILDINGS - 4. Construction
√ √ -

SANITARY FACILITIES - 10. Provided/Accessible
- 11. Cleanliness & Repair √ 12. Toilet Facilities - 13. Separation of Sexes - 14. Fixture Ratio

WATER SUPPLY
- 18. Installed/Operated/

VECTOR/VERMIN CONTROL
√ -

5. Maintenance & Repair 6. Lighting/Foot-Candles 7. Heating, Ventilation, A/C

Maintained
- 19. Drinking Fountains - 20. Approved Source

OTHER √ 28. 23. Infestation/Control - 29. 24. Brush/Trash 25. Water Collection/Drainage

ITEM NUMBERS

COMMENTS AND INSTRUCTIONS (continue on attached sheet)

HEALTH DEPARTMENT INSPECTOR: COPY OF REPORT RECEIVED BY:

Kai Bonner Jones Gayle Harper
CHD / HEADQUARTERS

PHONE: DATE:

() 274-5334 11/16/2010

DH 4030, 01/05 (Obsoletes Previous Editions)

SCHOOL INSPECTION
PURPOSE:
√ ROUTINE - CONSTRUCT COMPLAINT QA SURVEY PREOPENING

SCHOOL INSPECTION
TYPE:
12 √ 22 23 24 Private School Public School Charter School Vocational School College/University Other

-

REINSPECTION CHANGE OF OWNER CONSULTATION EMDEMIOLOGY OTHER

STATE OF FLORIDA DEPARTMENT OF HEALTH COUNTY HEALTH DEPARTMENT
PUBLIC/PRIVATE SCHOOL INSPECTION REPORT

NAME OF FACILITY ADDRESS OWNER

William T. Dwyer High
CITY ZIP

CENSUS

RESULTS
√ -

13601 N Military Trail Pbc School Board

Palm Beach Gardens 33418 () 625-7800

2072 1000 ▬ 3000 100 10 1 2 3 4 5 6 7 8 9 200 20 300 30

Satisfactory

PERSON IN CHARGE BEGIN END

PHONE

Incomplete Unsatisfactory Correct Violations by √ Next Inspection
-

8:00 AM on:

9
1 2 3 4 5 6 7 8

20
00 05 AM 10 PM 15 ▬ 25 30 35

1 30
▬ 00 2 3 4 5 6 7 8 9 05 AM 10 PM 15 20 25 ▬ 35 40

DATE
0 0 1 1 2 3 4 5 6 7 8 9 0 1 2 3 0 1 2 3 4 5 6 7 8 9 05 06 07 08 09 10 11 12 13 14

DATE

POSITION #

PERMIT NUMBER
50-51-01516
0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 0 0 0 0 0 1 1 1 1 1 2 2 2 2 2 3 3 3 3 3 4 4 4 4 4 5 5 5 5 5 6 6 6 6 6 7 7 7 7 7 8 8 8 8 8 9 9 9 9 9

400 40 500 50 600 60 700 70 800 80 900 90

0 5
▬0 1 1 2 3 4 ▬ 6 7 8 9

1 0
0 2 3 ▬ 2 3 4 5 6 7 8 9 ▬ 1

1

0
05 06 07 08 09

4 5 8
0 0 0 1 1 1 2 2 2 3 3 3 ▬ 4 4 5 ▬ 5 6 6 6 7 7 7 9 9 9

0 5
▬ 0 1 2 3 4 5 6 7 9 1 2 3 4 ▬ 6 7 8 9

▬ 10 11 12 13 14

FEMALES

▬ 40 10 45 11 50 12 55

10 45 11 50 12 55

8 8 ▬ 8

MALES

OUT OF BUSINESS

As per section 120.695 of the Florida Statutes (FS), this form will serve as a "Notice of Non-Compliance" for any violations noted. Items marked below violate the requirements of Chapters 64E-13 and 64E-11 of the Florida Administrative Code (FAC) and must be corrected within the time period indicated in the "Results " section above. Continued operation of this facility without making these corrections is a violation of Chpater 64E-13 and 64E-11, FAC, and Chapters 381, FS. Failure to correct violations may result in an administrative fine or other legal action being initiated or continued.

SCHOOL SANITATION - 1. School Site
-

- 8. Natural Ventilation - 9. Mechanical Ventilation

√ 15. Handwash Facilities √ 16. Showers/Fixtures - 17. Shower Water Temp.

LIQUID/SOLID WASTE - 21. Sewage Disposal
-

MISC. - 26. First Aid Kit FOOD
- 27. Food Insp. Rpt.

2. Playground Equipment 3. Athletic Equipment

22. Solid Waste

BUILDINGS - 4. Construction
√ √

SANITARY FACILITIES √ 10. Provided/Accessible
√ 11. Cleanliness & Repair - 12. Toilet Facilities - 13. Separation of Sexes - 14. Fixture Ratio

WATER SUPPLY
- 18. Installed/Operated/

VECTOR/VERMIN CONTROL
√ √ -

5. Maintenance & Repair 6. Lighting/Foot-Candles √ 7. Heating, Ventilation, A/C

Maintained
√ 19. Drinking Fountains - 20. Approved Source

OTHER √ 28. 23. Infestation/Control - 29. 24. Brush/Trash 25. Water Collection/Drainage

ITEM NUMBERS

COMMENTS AND INSTRUCTIONS (continue on attached sheet)

HEALTH DEPARTMENT INSPECTOR: COPY OF REPORT RECEIVED BY:
DH 4030, 01/05 (Obsoletes Previous Editions)

Julia Holtzhausen

PHONE: DATE:

CHD / HEADQUARTERS

SCHOOL INSPECTION
PURPOSE:
√ ROUTINE - CONSTRUCT COMPLAINT QA SURVEY PREOPENING

SCHOOL INSPECTION
TYPE:
12 √ 22 23 24 Private School Public School Charter School Vocational School College/University Other

-

REINSPECTION CHANGE OF OWNER CONSULTATION EMDEMIOLOGY OTHER

STATE OF FLORIDA DEPARTMENT OF HEALTH COUNTY HEALTH DEPARTMENT
PUBLIC/PRIVATE SCHOOL INSPECTION REPORT

NAME OF FACILITY ADDRESS OWNER

William T. Dwyer High
CITY ZIP

CENSUS

RESULTS
√ -

13601 N Military Trail Pbc School Board

Palm Beach Gardens 33418 () 625-7800

2295 1000 ▬ 3000 100 10 1 2 3 4 5 6 7 8 9 20

Satisfactory

PERSON IN CHARGE BEGIN END

Mr. Geiger (Assistant Principal) PHONE

Incomplete Unsatisfactory Correct Violations by √ Next Inspection
-

8:00 AM on:

10 00
1 2 3 4 5 6 7 8 9 ▬ 05 AM 15 20 25 30 35 40

3 00
1 2 4 5 6 7 8 9 ▬ 05 AM 15 20 25 30 35 40

300 30

DATE
0 0 1 1 2 3 4 5 6 7 8 9 0 1 2 3 0 1 2 3 4 5 6 7 8 9 05 06 07 08 09 10 11 12 13 14

DATE

POSITION #

PERMIT NUMBER
50-51-01516
0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 0 0 0 0 0 1 1 1 1 1 2 2 2 2 2 3 3 3 3 3 4 4 4 4 4 5 5 5 5 5 6 6 6 6 6 7 7 7 7 7 8 8 8 8 8 9 9 9 9 9

400 40 500 50 600 60 700 70 800 80 900 90

0 9
▬0 1 1 2 3 4 5 6 7 8 ▬

2 4
0 1 3 0 1 3 ▬ 5 6 7 8 9

1

0
05 06 07 08 09

6 9 8
0 0 0 1 1 1 2 2 2 3 3 3 4 4 4 5 5 5 ▬ 6 6 7 7 7 9 ▬ 9

3 7
0 1 2 4 5 6 7 9 0 1 2 4 5 6 ▬ 8 9

10 PM ▬ 10 PM

▬ 2

▬ 3

▬ 10 11 12 13 14

FEMALES

▬ 45 11 50 12 55

10 45 11 50 12 55

8 8 ▬ 8

MALES

OUT OF BUSINESS

As per section 120.695 of the Florida Statutes (FS), this form will serve as a "Notice of Non-Compliance" for any violations noted. Items marked below violate the requirements of Chapters 64E-13 and 64E-11 of the Florida Administrative Code (FAC) and must be corrected within the time period indicated in the "Results " section above. Continued operation of this facility without making these corrections is a violation of Chpater 64E-13 and 64E-11, FAC, and Chapters 381, FS. Failure to correct violations may result in an administrative fine or other legal action being initiated or continued.

SCHOOL SANITATION - 1. School Site
-

- 8. Natural Ventilation - 9. Mechanical Ventilation

√ 15. Handwash Facilities √ 16. Showers/Fixtures - 17. Shower Water Temp.

LIQUID/SOLID WASTE - 21. Sewage Disposal
-

MISC. √ 26. First Aid Kit FOOD
- 27. Food Insp. Rpt.

2. Playground Equipment 3. Athletic Equipment

22. Solid Waste

BUILDINGS - 4. Construction
√ √ -

SANITARY FACILITIES - 10. Provided/Accessible
√ 11. Cleanliness & Repair - 12. Toilet Facilities - 13. Separation of Sexes - 14. Fixture Ratio

WATER SUPPLY
- 18. Installed/Operated/

VECTOR/VERMIN CONTROL
√ -

5. Maintenance & Repair 6. Lighting/Foot-Candles 7. Heating, Ventilation, A/C

Maintained
√ 19. Drinking Fountains - 20. Approved Source

OTHER √ 28. 23. Infestation/Control - 29. 24. Brush/Trash 25. Water Collection/Drainage

ITEM NUMBERS

COMMENTS AND INSTRUCTIONS (continue on attached sheet)

HEALTH DEPARTMENT INSPECTOR: COPY OF REPORT RECEIVED BY:

Kai Bonner Jones Mr. Geiger (Assistant Principal)
CHD / HEADQUARTERS

PHONE: DATE:

() 274-5334 09/24/2010

DH 4030, 01/05 (Obsoletes Previous Editions)

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