Facility Self-Assessment

For a Safe and Healthy Child Care Environment

You work hard every day to ensure that children can grow, learn and play in a safe and healthy environment. This self-assessment will support your awareness of environmental exposures and provide resources to address your concerns.

How to Use This Assessment

There are three possible responses to each question:

  • Yes = All is well, no action required at this time. Please reassess next time you perform the self-assessment.
  • No = There is an opportunity to make improvements. Resources provided can help you determine what next steps you take.
  • N/A = Not applicable to your facility. Continue to the next question.

It is recommended that the assessment be completed quarterly (unless indicated as annual), and more frequently when warranted (chronic symptoms, seasonal changes, etc.).

Outdoor Air Quality
3. Are windows facing areas of high vehicular activity closed during peak traffic hours?
4. Are you following your local regulations pertaining to idling of vehicles?
Indoor Air Quality
5. Is the interior free of substances (ex. deodorizers, air fresheners, perfume, etc.) that might trigger asthma, respiratory or scent sensitivity concerns?
6. Is there a written policy that prohibits smoking and tobacco use on the premises and is it enforced? (Conduct Annually)
8. For floor drains and plumbing traps, have infrequently used drains been observed and filled with water regularly to help prevent sewer gas smell?
9. Are gas-powered and open flame heating systems properly vented (to the outside or combustion air)?
10. Are Carbon Monoxide detectors or monitoring systems in use as recommended (where there is gas-powered appliance, equipment, or combustible fuel)?
11. Has carbon monoxide detector or monitoring system been checked at minimum monthly for working condition and as recommended by NFPA 72?
12. Have the air filters been changed as recommended (minimum every 3 months but more frequently based on occupancy and outdoor air quality)?
13. Have you tested for the following contaminants? (If children or staff experience chronic symptoms such as: dryness/irritation of the eyes, nose, throat and skin, headache, fatigue, shortness of breath, hypersensitivity and allergies, sinus congestion, coughing, sneezing, dizziness and nausea)
a. Biological: mold, dander, pollen, dust mites, bacteria
b. Chemical: Volatile Organic Compounds (VOCs), (ex. formaldehyde), lead, radon and carbon dioxide
c. Combustion: carbon monoxide, tobacco smoke
14. If testing was conducted, were recommendations implemented and documented?
15. Have you tested for VOCs after renovation, remodeling, new building construction or installation of new equipment, furniture, carpet or paint?
16. Has an Heating, Ventilation, and Air Conditioning (HVAC) professional tested your exhaust ventilation for adequate performance in limiting odors and moisture (i.e. rest rooms, janitor closets, kitchens and equipment rooms)?
17. Is the interior free of physical signs of mold or moisture damage (i.e. odors, leaks, condensation, wet drywall, wood, stained ceiling tiles, or other affected building material; in dark areas such as closets, etc.)?
18. Is the program free of excessive absenteeism as a result of sinus infections, asthma, allergies or other respiratory concerns?
Pest Management
32. Is the environment free of evidence identifying vermin infestation (i.e. droppings, chewed areas, holes, etc.)?
34. When facility is being treated for pests is the building empty of occupants?
35. Is the procedure for re-entry following pest management services known and implemented?
36. Is the facility free of commercially available pesticides (ex. bug spray)?
37. Are exterior areas accessible to children free of large growths of undesirable or toxic plants?
Chemical Safety
42. Are safety data sheets on all approved products (ex. window cleaners, toilet cleaners, etc.) updated based on product use and readily accessible in case of emergency?
Assessment Progress
25% Complete 5/20 Questions
Summary
Yes 3
No 1
N/A 1
Quick Links
Asthma Care Quick Reference

  • Check for recurrent symptoms: cough, wheezing, chest tightness
  • Perform spirometry for patients ≥5 years
  • Consider environmental triggers and medical history

Reduce Impairment
  • Prevent chronic symptoms
  • Maintain normal activity levels
  • Minimize SABA use
Reduce Risk
  • Prevent exacerbations
  • Preserve lung function
  • Minimize medication side effects

Key Medications:
  • ICS (Preferred long-term control)
  • SABA (Quick relief)
  • LABA (Combination therapy)
Dosage Guidelines

Follow stepwise approach based on severity:
View Stepwise Chart

Safety Notes
  • Monitor growth in children
  • Check inhaler technique
  • Watch for oral thrush
Asthma Care Quick Reference

Key Indicators
  • • Recurrent cough/wheezing
  • • Nighttime symptoms
  • • Exercise-induced symptoms
Testing
  • • Spirometry for ≥5 years
  • • Symptom frequency assessment
  • • Environmental trigger evaluation

Control Goals
Reduce Impairment
  • Minimize daily symptoms
  • Maintain normal activity
Reduce Risk
  • Prevent exacerbations
  • Preserve lung function
Medication Approach
Quick Relief
SABA
Albuterol
Maintenance
ICS
Inhaled Corticosteroids
Combination
LABA + ICS
Long-term control

Key Components
  • Daily management steps
  • Exacerbation recognition
  • Medication adjustments
  • Emergency contacts
Important

Review plan at every visit
Update with seasonal changes

Download Template

Asthma Prevention Video Series

Part 1: Outdoor Air Quality

Understanding outdoor asthma triggers and prevention strategies

Part 2: Indoor Environments

Managing indoor air quality and common household triggers

Part 3: Pest Management

Reducing asthma risks from pests and pesticides

Part 4: Cleaning Practices

Safe cleaning methods to minimize respiratory irritation

Part 5: HVAC Maintenance

Proper ventilation system care for asthma prevention

Part 6: Emergency Preparedness

Creating an asthma action plan for childcare facilities

Part 7: Staff Training

Educating caregivers on asthma management best practices