Forms and Checklists

Waivers and Authorization Forms

SIA recommends that districts use the following forms available in English, Spanish, Russian, Ukrainian, Hmong, Hindi, Punjabi, Tagalog and Vietnamese.  These forms have been formatted with space at the top to allow for printing on district letterhead. The purpose and use guideline is provided for each of the available forms.
 
Use of Facilities Forms  

• Use of Facilities, Indemnity and Insurance Agreement (Education Code)
• Use of Facilities, Indemnity and Insurance Agreement (Non-Education Code)
• Use of Facilities Agreement Between Public Agencies

• Agreement for Activity Participation
• Contract for Adult Activity Participation
• Agreement for Team Participation
• Sports Physical Examination Form
• Student Field Trip Authorization
• Student Field Trip (Outside California) Authorization

• Volunteer Personal Automobile Use Form
• Student Personal Automobile Use Form
• Student Alternate Transportation Form

Purpose and use guidelines for Waivers and Authorization Forms - descriptions
   Download Waivers and Authorization Forms "Cheat Sheet" 

Americans with Disabilities Act (ADA)

• ADA Public Notice for District Website
    Download Template 
  
  
• ADA Public Notice for Parent/Student Handbook
    Download Template  

  ---

Compliance

Injury and lllness Prevention Program

• Appendix C – Sample Safety and Health Policy Statement
   Download Sample Statement 
  
  
• Appendix D – Monthly Property Checklist
   Download Checklist 
  
  
• Appendix E – Hazard Alert Form
   Download Form 
  
  
• Appendix H – Safety Meetings
   Download Form 
  
  
• Appendix J – Accident Investigation Report
   Download Form  

• Quarterly Non-Storm Water Discharge Inspection Report Form
   Download Form 
  
  
• Monthly Storm Water Inspection Report Form
   Download Form 
  
  
• Individual Annual Comprehensive Site Compliance Evaluation Form
   Download Form  

Driving Safety

SPAB Checklist
 Download Form  

Fire Safety and Arson Prevention

Arson Prevention Tips Checklist
 Download Checklist  

Health and Wellness

Golden Carrot Fund

• Golden Carrot Fund Request Form
   Download Form 
  
  
• Golden Carrot Fund Prevention Project/ Activity Evaluation
   Download Form 

Playground Safety

School, Employee and Workplace Safety

= MS Word/.doc format	= MS PowerPoint format	= PDF document
= MS Excel/.xls format	= Rich Text/.rtf format