Attachment C Drinking Water Outlet Inventory – (Complete for each school) Name of School: _______________________________________ Address: ____________________________________ Grade Levels: _____ Year School Constructed: ______ Renovated/Additions: __________________________________ Individual school project officer Name/Signature: _____________________________ Date Completed: ______________ # Type Location Code Operational of Filter Brass Aerator/ Motion Chiller Water Cooler Comments (Y/N) Corrosion (Y/N) Fittings, Screen Activated (Y/N) Make Model (Y/N) Faucets (Y/N) (Y/N) or valves? (Y/N)
Attachment C – Drinking Water Outlet Inventory (Complete for each school) Name of School: _______________________________________ Address: ____________________________________ Grade Levels: _____ Year School Constructed: ______ Renovated/Additions: __________________________________ Individual school project officer Name/Signature: _____________________________ Date Completed: ______________ # Type Location Code Operational (Y/N) of Corrosion (Y/N) Filter (Y/N) Brass Fittings, Faucets or valves? (Y/N) Aerator/ Screen (Y/N) Motion Activated (Y/N) Chiller (Y/N) Water Cooler Comments Make Model