basic education

Department:
Basic Education
REPUBLIC OF SOUTH AFRICA

NEIMS_Assessor

Assessor
Contact details
National EMIS number

ABERDE

School Name

Assessment date

Time Started

Time Ended

Checklist, If YES; colour in black in the block Yes, if No; colour in black
Total number of pages of the assessment
Yes

No

Photos school

Yes

No

Photos accommoda

Yes

No

Form B1

Yes

No

Form B2

Yes

No

All assessment forms scanned & available in electronic format

Principal /Circuit manager/ district manager / regional mana

Name

SIGNED OFF BY
Name

SIGNED OFF BY

Signature

Designation

District office / Region office

Signature

Provincial Head Office

Data capturer (if captured by provincial department)

Designation

Name

Signature

Designation

Data verified (if captured by provincial department)

Name

Signature

Designation

Provincial NEIMS ADMINISTRATOR (approve that DBE can capture or load s

Name

SIGNED OFF BY

Signature

Designation

Department of Basic Education

Data capturer (if data is not captured by provincial department)

Name

Signature

Designation

Data verified (if data is not captured by provincial department)

Name

Signature

Designation

Data approved and loaded on the system (NEIMS administrator)

Name

Signature

Designation

Page

of

__________

Checklist Sign

Signature of assessor
E-mail

MAY 2013 V13

ERDEEN SECONDARY SCHOOL

(dd-mm-ccyy)

black in the block No, left of the description.

modation

Yes

No

Are all the pages submitted

Yes

No

Form A

Yes

No

Form A2

Yes

No

Form A

Yes

No

Form B3

Yes

No

Form B

ormat

manager verification that assessment has been done

nation

Date

Telephone

Cell

E-mail

nation

Date

Telephone

Cell

E-mail

nation

Date

Telephone

Cell

E-mail

nation

Date

Telephone

Cell

E-mail

oad school on central system)

nation

Date

Telephone

Cell

E-mail

nation

Date

Telephone

Cell

E-mail

nation

Date

Telephone

Cell

E-mail

nation

Date

Telephone

Cell

E-mail

tion

Checklist Sign off

MAY 2013 V13

Form A1
Form A3
Form B4

E-mail

E-mail

E-mail

E-mail

E-mail

E-mail

E-mail

E-mail

basic education
Department:
Basic Education
REPUBLIC OF SOUTH AFRICA

National EMIS number

1. Total number of photos taken

Yes No Are all the photos in PDF format and available

PHOTOS: ALL PHOTOS MUST BE NUMBERED, SEE GUIDELINES FOR PHO

1 - Entrance gate with national EMIS number
20 - Front outside view of the school site
2 - Front view of the administration building
18 - View of parking bays
19 - View of assembly area
21 Four views of the school taken from the four fence lines
22 Four views of the school taken from the four fence lines
23 Four views of the school taken from the four fence lines
24 Four views of the school taken from the four fence lines
13 - Availability of electricity
28 - View of water supply (water tanks etc)
27 - View of the fence
29 - View of water taps on site
30 - Outside view of Guard house
3 - Inside view of the office principal
31 - Inside view of admin block
32 - Outside view of school hall
33 - Inside view of school hall
4 - Outside view of a classroom (best condition)
5 - Inside view of a classroom (best condition)

6 - Outside view of a classroom (worst condition)

7 - Inside view of a classroom (worst condition)
8 - Outside view of ablution facilities (best condition)
9 - Inside view of ablution facilities (best condition)
10 - Outside view of ablution facility (worst condition)
11 - Inside view of ablution facilities (worst condition)
12 - Availability of mobile water
34 - Outside view of computer room
35 - Inside view of computer room
36 - Outside view of library or/and multimedia centre
37 - Inside view of library or/and multimedia centre
38 - Outside view of laboratory
39 - Inside view of laboratory
40 - Outside view of (consumer studies/dance/arts etc)
41 - Inside view of (consumer studies/dance/arts etc)
42 - Outside view of each type workshop (Name the workshop)
43 - Inside view of each type of workshop (Name the workshop)
17 - Outside view of facilities nutrition scheme + storage area
44 - Inside view of facilities nutrition scheme+ storage area
45 - Outside view of Gr R facilities
46 - Inside view of Gr R facilities
15 - Sport facility (worst condition)
14 - Sport facility (best condition)
16 - Vegetable garden available

Page

of

__________

PHOTOS

MAY 2013 V13

and available in electronic format

NES FOR PHOTOS

25 - View of outdoor facilities for Gr R

26

47 - Views of any defects, collapsed structures, danger

48
49- Outside view of sport facility (name building)
50

51
52- Inside view of sport facility (name buildings)
53

54
55 - Sanitation facilities at sport facilities
56

the workshop)

e the workshop)
storage area

57
58 - Change rooms with showers at sport facilities
59
60 - Any other photos of interest
61

basic education
Department:

Page

Basic Education
REPUBLIC OF SOUTH
AFRICA

of

NEIMS Site Identification

NATIONAL EMIS NUMB

Date of Assessment
Date school was completed, handed over to education

0 1

School type

_______

Public/Independent

(DD-MM

(DD-MM

School status:

Official Name of School

Other Name of School
Site Size

Yes No Formal boundaries for the school site.

2 . 6 7

ha

(dimensions indi

Mark or complete each relevant information block as required, apply to a

Province

Western Cape

Eastern Cape

Northern Cape

North West

Gauteng

Mpumalanga

Education District
Metropolitan
Metropolitan Municipality

OR
District Municipality
Local Municipality
Latitude South

Longitude East

Principals Initials:

Principals surname

Principals Cell Number

School Tel Number

School Fax Number

E-mail
Website
Street Number
Suburb / Village

Street name

Postal Code
Postal Address
City/Town/Suburb
Postal Code
Grades Offered
Land Ownership

Lowest Grade Offered

National

Yes No

Highest Grade Offered

Provincial

Local Government

Has the agreement been signed between the MEC and owner of pro

Private Owner (Surname & initials)

Contact d
TOTAL Grade R learners only

Number of Learners & Educators

Hospitality/Consumer studies

ML

TOTAL Grade 1 to Grade 12 learners on

FL

Boarding facilities

ML

Technical centre

FL

Full service schoo

Other Details

1
2
3

Host school

National EMIS

Tenant school (school using the site of the host school-during normal school hours)

National EMIS

Platoon school (using facilities of host school after normal school hours)

National EMIS

Catchment Areas

MAY 2013 V13

FORM A1

NATIONAL EMIS NUMBER

(DD-MM-CCYY)
(DD-MM-CCYY)
Yes No Double shift site

(dimensions indicated on the sketch plan)

as required, apply to all pages.

Free State

Limpopo

KwaZulu-Natal

Private/Commercial

ween the MEC and owner of property. (Section 14)

Contact details

Grade 1 to Grade 12 learners only

Total number of educators (Gr R inc)

ME

Full service school

National EMIS No
National EMIS No.
National EMIS No.

FE

Declared as a rural school

basic education
Department:
Basic

Page

Education
REPUBLIC OF SOUTH AFRICA

NEIMS Site Development

Mark or complete each relevant information block as required, apply t

Water Supply
1

None

Rainwater Harvesting

Borehole/Well on site

0
2

Level of service

No distribution pipe from the source

For watering of sport fields and gardens

Mobile Tankers

Municip

Number of

Reliability (1=N

For drinking purpose

For veg

Site storm water drainage

1

None

Storm water drainage on

site

Storm water drainage

from buildings

Storm w

Generator

Solar

Grid co

Electricity Supply
1

None

Level of service

No distribution cabling from the source

Reliability (1=N

To some of the
buildings

To som
to sport

Municipal

Remov

Waste disposal
1

None

Private

Removed weekly

Removed monthly

Reliability (1=N

Sanitation Disposal (This refers to the type of service, a bucke

1

None

Bucket

Vacuum

Site pu

Reliability (1=N

Site Security Provided

1

No security

Gate

Concrete Palisade

10 Access Control

Wire Fence
Security room (Guard

11 house)

Razor w
fence

12 Alarm s

Level of service. The minimum height of fencing must be 1.8m

No fence

Less than 25% of fence is

of required minimum height

Less than 50% fence is

of required minimum
height

Less th
of fence
require
minimu

Foot path

Gravel

Access availability to site

Type of access

No Vehicle Access

Maintenance needed

Communication System Available

1

None

Intercom and/or public address system

Yes

Cell network

Landline

No Internet connectivity for teaching and learning

4
Yes

Fax Ma

No

Grade R playground
1

None

Sport fields
1

None

Maintenance needed

Sand pit

Swings

Indicate number of fields

0

Athletics

0
Maintenance needed

Jungle gym

Tennis

1
Soccer

0
1

Cricket

0
1

General
1

None

Nutrition centre

Infestation

Vandalism

14 Risk of Flooding

15 Dongas

Food Garden

Flagpol

10 Hydrants

11 Rocks

16 Marshy Land

17 Any situ

Description of danger

CODES
Maintenance

Not needed

Less than 25%

needed

Less t
50% n

ge

of

_______

FORM A2

MAY 2013 V13

NATIONAL EMIS NUMBER

y to all blocks for the rest of the page.

cipal/Communal

Municipal Yard Supply

of taps for drinking purposes (taps on site - not in buildings)

=No water at all; 2<25%; 3<50%; 4<75%; 5<100%; 6=Always available)

vegetable garden

For sewerage system (flush toilets)

m water drainage from sport fields

Maintenance needed

Maintenance needed

connection

=Not at all; 2<25%; 3<50%; 4<75%; 5<100%; 6=Always available)

ome or all building as well as

ort facilities

Maintenance needed

oved daily

Maintenance needed

=Not at all; 2<25%; 3<50%; 4<75%; 5<100%; 6=Always available)

ket collection, vacuum tankers or sewer connection)

purification

Municipal Sewage

=Not at all; 2<25%; 3<50%; 4<75%; 5<100%; 6=Always available)

Maintenance needed

or wire
e

m system

than 75%
nce is of
ired
mum height

Pre cast

Brick Wall

Steel
Palisade

Electric Fence

Maintenance needed

13 Security lights 14 Surveillance

cameras
5

Less than 100%

of fence is of
required
minimum height

el Road

Surfaced Road

Vehicle Track

Wheel chairs access

Machine

2 Way Radio

Internet

Public Call Box

Internet connectivity for administrative purpose

gs

Combi
court

Ride on

Hockey

1
Rugby

pole

ks

Climbing
equipment

Netball

Other

Maintenance needed

Maintenance needed

Swimming pool

Squash court

Lightning
Protector

12 Sinkholes

Steep Slope

Power Lines crossing the site

13 Cell Phone Tower on site

situation that poses danger to learners or educators

s than
% needed

Less than
75% needed

Less than
6 Need to be
100% needed
replaced

basic education
Department:
Basic
Education
REPUBLIC OF SOUTH AFRICA

NEIMS PARKING/WALKWAYS/ASSEMBLE AREA

Mark or complete each relevant information block as required and use codes where applicable
Yes

No

Is there parking facilities on the site

Parking facilities

Yes

No

Is there walkways b

Number of parking bays

0

Outer walls

Maintenance

Roof

Open parking

None

Face Brick

Face & plastered brick

None

Wood

Thatch

Maintenance

Rainwater fittings

Maintaince

Ceilings

Maintenance

Floor

Maintenance

None

Roof without
gutters & facia
board

Roof with facia

board

None

Concrete

Metal

None

Mud/Clay

Concrete finish

Walkways

Number of walkways
0

Outer walls

Maintenance

Roof

Open

None

Face Brick

Face & plastered brick

None

Wood

Thatch

Maintenance

Rainwater fittings

Maintenance

Ceilings

Maintenance

Floor

Maintenance

None

Roof without
gutters & facia
board

Roof with facia board

None

Concrete

Metal

None

Mud/Clay

Concrete finish

Assembly area

Number of assembly areas

0

Outer walls

Maintenance

Roof

Maintenance

Open

None

Face Brick

Face & plastered brick

None

Wood

Thatch

Rainwater fittings

Maintaince

Ceilings

Maintenance

Floor

Maintenance

None

Roof without
gutters & facia
board

Roof with facia

board

None

Concrete

Metal

None

Mud/Clay

Concrete finish

CODES
Maintenance

1 Not needed

2 Less than
25% needed

3 Less than 50%

needed

Page

7 of

s where applicable. See codes on bottom of page for maintenance.

there walkways between buildings

Yes

No

Is there an assemble area

Covered parking

Lockup garage

Plaster brick

Block Brick

Prefab on permanent
slab

Wood

Flat Metal

Pitch Metal

Fibre cement

Fibreglass

Roof with gutters

Roof, gutters & facia

board

Roof, gutters, down pipes &

facia board

Gutters, down pipes and rainwa

drainage

Wood

Cypsum

Fibre Cement

Suspended
Ceiling

Metal

Wood

Vinyl

Ceramic

Under cover

Plaster brick

Block Brick

Prefab on permanent slab

Wood

Flat Metal

Pitch Metal

Fibre cement

Fibreglass

Roof with
gutters

Roof, gutters &

facia board

Roof, gutters, down

pipes & facia board

Gutters, down pipes and rainwa

drainage

Wood

Cypsum

Fibre Cement

Suspended
Ceiling

Metal

Wood

Vinyl

Ceramic

y areas
0

Under cover

Plaster brick

Block Brick

Prefab on permanent
slab

Wood

Flat Metal

Pitch Metal

Fibre cement

Fibreglass

Roof with gutters

Roof, gutters &

facia board

Roof, gutters, down

pipes & facia board

Gutters, down pipes and rainwa

drainage

Wood

Cypsum

Fibre Cement

Suspended
Ceiling

Metal

Wood

Vinyl

Ceramic

4 Less than
75% needed

5 Less than
100%
needed

6 Need to be replaced

FOR

MAY 2013 V13

NATIONAL EMIS NUMBER

If no ignore the rest of the page where applicable

Metal

Mud/Clay

10

Concrete

11

Stone

Tile / Slate

Concrete

10

Mobile

11

Alternative
technology

12

Glass

13

12

Alternative
technology

down pipes and rainwater

Mobile

Alternative
technology

Carpets

Paving bricks

10

Bitumen
surface

11

Mobile

12

Alternative
technology

Metal

Mud/Clay

10

Concrete

11

Stone

12

Glass

Tile / Slate

Concrete

10

Mobile

11

Alternative
technology

13

12

Alternative
technology

down pipes and rainwater

Mobile

Alternative
technology

Carpets

Paving bricks

10

Bitumen
surface

11

Mobile

12

Alternative
technology

Metal

Mud/Clay

10

Concrete

11

Stone

12

Glass

Tile / Slate

Concrete

10

Mobile

11

Alternative
technology

13

12

down pipes and rainwater

Mobile

Alternative
technology

Carpets

Paving bricks

10

Bitumen
surface

11

Mobile

12

Alternative
technology

FORM B1
2

Mobile

14

Tiles

15

Alternative technology
Storm damage

Asbestos

Storm damage

Storm damage

Storm damage

Storm damage

Mobile

14

Tiles

15

Alternative technology
Storm damage

Asbestos

Storm damage

Storm damage

Storm damage

Storm damage

Mobile

14

Tiles

15

Alternative technology
Storm damage

Asbestos
Storm damage

Storm damage

Storm damage

Storm damage

basic education
Department:

Page

Basic Education
REPUBLIC OF SOUTH
AFRICA

NEIMS BUILDING ASSESSMENT

Mark or complete each relevant information block as required and use codes where aplicable. See co

Building identification
Building Number

Number of floors 1

Outer walls

Maintenance

Roof

Maintenance

Rainwater fittings

Type of material

Building ty

None

Face Brick

Face &
plastered brick

Plastered Brick

None

Wood

Thatch

Flat Metal

None

Roof without gutters

& facia board

Roof with facia

board

Roof with gutters

Maintenance

Windows

Assess all windows of the whole building

Window frames

Maintenance

Doors

None

Wood

Metal

Aluminium

Aluminium

Assess all doors of the whole building

Door frames

Maintenance

None

Wood

Metal

311

Length
(m)

Width
(m)

Ceiling

Burglar bars

314

Number of broken windows

Number of broken doors

Maintenance

Type

314

Maintenance

315

Type

Maintenance

Walls

Type

Room belongs to

Room
type
(room
code)

Floor

Ramp

Room (door)
number

Room Utilisation

312

311

313

311

CODES
Walls

None

Face Brick

Face & plastered brick

Plastered Brick

Block

Floor

None

Mud/Clay

Concrete finish

Metal

Wood

Toilet type

None

Pit

Bucket

Enviro Loo

VIP

Ceiling

None

Concrete

Metal

Wood

Cypsu

Maintenance

Not needed

Less than 25%

needed

Less than 50%

needed

Less than 75%

needed

Less t
100%

None

Wash basin with mirror

Wash basin without mirror

Wash basin type

basic education
Department:
Basic Education
REPUBLIC OF SOUTH
AFRICA

Burglar bars

Number of broken windows

Number of broken doors

Maintenance

Ceiling

Type

Maintenance

Walls

Type

Width
(m)

Maintenance

Length
(m)

Type

Floor

Ramp

Room belongs to

Room
type
(room
code)

Room (door)
number

NEIMS BUILDING ASSESSMENT

Room
type
(room
code)
Room belongs to

Room (door)
number

Length
(m)

.
.
.
.
.
.
.
.
.

Width
(m)

.
.
.
.
.
.
.
.
.

Ceiling

Burglar bars

Number of broken windows

Number of broken doors

Maintenance

Walls

Type

Maintenance

Floor

Type

Maintenance

Type

Ramp

NEIMS BUILDING ASSESSMENT

.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.

.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.

.
.
.
.

.
.
.
.

ge

8 of

MAY 2013 V13

NATIO

codes at bottom of this page.

type E

D U

Number of fire hoses 0

Fire hose maintenance

Block Brick

Prefab on
permanent slab

Wood

Metal

Mud/Clay

10

Concrete

11

Stone

Pitch Metal

Fibre cement

Fibreglass

Tile /
Slate

Concrete

10

Mobile

11

Alternative t

Roof with
gutters & facia
board

Roof, gutters,
down pipes &
facia board

Gutters, down
pipes and
rainwater
drainage

Number of stoves
Number of fridges
Number of beds

1
0
0
0
0
1
1
3

2
0
0
0
0
2
1
2

2
0
0
0
0
2
1
2

None

2
Wood

3
Metal

Equipment

Glass

Electricity

Fan

Alternative
technology

Aircon

Heater

Glass

Maintenance

Plug point

Maintenance

None

Lights

Maintenance

Doors

Sprinkler system

Fire detectors

Maintenance

Fire extinguishers

Maintenance

Window panes

Number of computers

Security

Fully Technical
Consumer/Hospitality

Writing board

Pin board

Chalk board

Alternative
technology

Maintenance

Alternative
technology

Safe door

Alarm

Camera

Security gate

drainage

Safe door

Part of in

Pre Fabricated

Wood

Metal

Mud/Clay

10

Vinyl

Ceramic

Carpets

Paving bricks

10 Bitumen surface

Flush toilet
(septic tank)

Flush toilet
(municipal)

Mobile
toilets

9 Chemical toilet

sum

Fibre cement

Suspended
ceiling

Mobile

s than
% needed

6 Need to be

k Brick

od

replaced

Alternative technology

Concrete

10 Alternative sanitation

11
11

Fan

Electricity

Aircon

Heater

Maintenance

_______

Plug point

Equipment

Lights

Maintenance

Sprinkler system

Fire detectors

Fire extinguishers

Maintenance

Number of computers

Number of beds

Number of fridges

Number of stoves

Security

Fully Technical
Consumer/Hospitality

_______ of

Writing board

Pin board

Chalk board

Maintenance

Safe door

Alarm

Camera

Security gate

Page

MAY 2013 V13

NATIONA
Part of in

Fan

Electricity

Aircon

Heater

Maintenance

_______

Plug point

Equipment

Lights

Maintenance

Sprinkler system

Fire detectors

Fire extinguishers

Maintenance

Number of computers

Number of beds

Number of fridges

Number of stoves

Security

Fully Technical
Consumer/Hospitality

_______ of

Writing board

Pin board

Chalk board

Maintenance

Safe door

Alarm

Camera

Security gate

Page

MAY 2013 V13

NATIONA
Part of in

FORM B2
NATIONAL EMIS NUMBER 2

Page 1 of B2

Length
Building Size 2
12

Glass

13

Mobile

14

Width

8
Tiles

9
15

Alternative
technology
Storm damage

Alternative technology

12

Asbestos
Storm damage

Type of material

None

Aluminium

PVC

Fibre cement

Maintenance

0
1
0
0
0
1 0
1
0
0
1

0
2
0
0
0
1 0
1
0
0
1

0
2
0
0
0
1 0
1
0
0
1

Maintenance

Number of urinals

Asbestos

Number of wash basin

Type of wash basin

Number of toilets

Type of toilet

Part of infrastructure

Number of other wash

facilities

Number of showers

Steel

Number of baths

Number of water taps

Cupboard

Shelves

3
Storm damage

Storm damage

Alternative
technology
Storm damage

Ablution and wash facilities

native sanitation

1 0

1 0

Stone

12 Glass

13 Mobile

Mobile

12 Alternative technology

14 Tiles

15 Alter

nativ
e
tech
nolo
gy

Maintenance

Number of urinals

Number of wash basin

Type of wash basin

Part of infrastructure

Number of toilets

Type of toilet

Number of other wash

facilities

NATIONAL EMIS NUMBER 2

Number of showers

Number of baths

Maintenance

Number of water taps

Cupboard

Shelves

FORM B2
5

Page 2 of B2

Ablution and wash facilities

Maintenance

Number of urinals

Number of wash basin

Type of wash basin

Part of infrastructure

Number of toilets

Type of toilet

Number of other wash

facilities

NATIONAL EMIS NUMBER 2

Number of showers

Number of baths

Maintenance

Number of water taps

Cupboard

Shelves

FORM B2
5

Page 3 of B2
Ablution and wash facilities

basic education
Department:
Basic Education
REPUBLIC OF SOUTH AFRICA

Page __________of ________

NEIMS SITE LAYOUT

MAY 2013 V13

NATIONAL EMIS NUMBER

Page 1 of site layout Total number of site layout pages

Checklist

Fence

Gate

Water

Electricity

Sewer

Nutrition Vegetable
Sport Borehole
centre
Garden

Taps

North

Land Dimensions:

Length

Width

Date

basic education
Department:
Basic
Education
REPUBLIC OF SOUTH AFRICA

MAY 2013 V1

NEIMS SITE LAYOUT

NATIONAL EMIS NUMBER

Page 2 of site layout

Checklist

Fence

Gate

Water

Electricity

Sewer

Nutrition Vegetable
Sport Borehole
centre
Garden

Taps

North

Land Dimensions:

Length

Width

Date

basic education
Department:
Basic

MAY 2013 V1

Education
REPUBLIC OF SOUTH AFRICA

NEIMS SITE LAYOUT

NATIONAL EMIS NUMBER

Page 3 of site layout

Checklist

Fence

Gate

Water

Electricity

Sewer

Nutrition Vegetable
Sport Borehole
centre
Garden

Taps

North

Land Dimensions:

Length

Width

Date

B4

MAY 2013 V13

Walkways

Assembly area

Paving

MAY 2013 V13

B4

2 0 0 1 0 0 0 0 5
Walkways

Assembly area

Paving

MAY 2013 V13

B4

2 0 0 1 0 0 0 0 5
Walkways

Assembly area

Paving