Health & Life Safety Manual - Electronic Resource Center

FIELD NOTICE OF VIOLATIONSDISTRICT NAME AND NUMBERFACILITY NAMEFACILITY LOCATIONCOUNTYPotential problems or violations of the Health Life/Safety Code for Public School (23 Illinois Administrative CodePart 180) as noted below were discovered in the course of the annual inspection of the above named facilityconducted on________________________by________________________________________________________________DateName and Title of Person who Conducted InspectionThe Board of Education will receive a formal report of the findings of this inspection within ten days of thecompletion of the last such inspection of district facilities.GLOSSARYNUMBERLOCATION(i.e. Fire Area, Floor, or Room Number)DESCRIPTION OF PROBLEMDistrict will respond to the above violations by ________________, stating their corrective actions.c LISTING CONTINUED ON NEXT PAGESigned this _________ day of _________________, _____________________________________________________________________________________________________Typed Name of Inspector Date Signature of InspectorForm 36-19 (3/04) (Prescribed by the Regional Superintendent for the Regional Superintendent)180.300 aPAGE ________ OF________ PAGES2-31