Template for Recording and Monitoring Remedial Actions for Lead in School Drinking Water Outlets

Remedial Action Plan Template

This template is intended to help schools track remedial actions for both applicable and non-applicable water outlets. It is essential to update this template regularly to ensure accurate monitoring and compliance with PHL §1110, and subsequent Title 10NYCRR Subpart 67-4.

Please follow the instructions below to effectively utilize the template.

Data Entry Instructions

  1. School Name: Replace the placeholder text with your school’s name in the designated area of the template.
  2. Date Last Updated: Ensure that you are updating the date on this sheet each time you make an edit to document the most current information you have.
  3. School Outlet ID: This is the unique ID that your school gave the water outlet when creating your sampling plan. The ‘School Outlet ID’ should match the ‘School Outlet ID’ from your sampling plan document. All outlets found on the remedial action plan should be able to be found on your sampling plan.
  4. Laboratory Sample ID: This is the unique ID that the testing laboratory gave the sample.
  5. Outlet Location: Note the location of every outlet both inside and outside the building as it was documented in your sampling plan.
  6. Outlet Description: Document the type of outlet, including but not limited to: drinking fountain, kitchen sink, bottle filler, bathroom sink, exterior hose, etc.
  7. Outlet Applicability: Document each outlet as ‘Applicable’ or ‘Non-Applicable’. If ‘Applicable’ you must follow instructions 8-10. If ‘Non-Applicable’ you can skip to number 10.
  8. Sample Results: Document the initial exceedance as reported from the results. If you perform remediation that requires post-remediation sampling, you must also document the post-remediation results for the outlet.
  9. Remedial Actions: You must update the applicable sections for every outlet that exceeds the action level of 5 ppb. This includes both the type of remediation and the date the remedial action was taken. You must also note actions taken to ensure non-applicable outlets will not be used for consumption.
  10. Notes/Comments: For Non-Applicable outlets, note exclusion criteria, such as signage/supervision/education or engineering controls. For Applicable outlets you can use this area for further documentation.
  11. Updating the Sheet: Regularly update the sheet whenever new information becomes available to maintain accurate records.

Important

Non-Applicable Outlets:

  1. Non-applicable outlets will not be tested at a laboratory and will therefore not have a ‘Laboratory Sample ID’ or ‘Sample Results’ and both columns should reflect ‘N/A’ for these types of outlets.
  2. The Notes/Comments column should clearly state the exclusion criteria for why an outlet was deemed non-applicable.
  3. If there are actions requiring maintenance for non-applicable outlets, such as signage/supervision/education or engineering controls, you should note those actions in the appropriate columns.

Signage and Education:

  1. Using signage alone at an outlet is not an acceptable method of remediation. If signage is placed at any outlet, it must be accompanied by appropriate education and/or supervision to ensure safety and compliance. This should be documented in the maintenance and monitoring schedule and documentation sections of your remedial action plan.