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20: Appendix E- Example Playground Inspection Form

  • Page ID
    69649
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    Appendix E: Example Playground Inspection Form764

    Inspected By: _________________________________________

    Time ________________

    Date ________________

    Surfacing

    OK

    IF NOT OK, COMMENTS OR ACTIONS TO BE TAKEN

    1. Safety surface depth sufficient (12”)?

    _______________________________________________________

    1. Inadequate safety surface material (other than ASTM surfacing material)?

    _______________________________________________________

    1. Does safety surface comply with ADA?

    _____ Yes ______ No ______ Don’t Know

    1. Poor drainage area (standing water) or potential problems?

    _______________________________________________________

    1. Areas of compaction, kick-out, or wear have been leveled or repaired?

    _______________________________________________________

    1. Sidewalks, paved surfaces, steps, and platforms have been swept or cleaned of loose surface materials and debris?

    _______________________________________________________

    General Hazards

    1. There are no sharp points, corners, or edges?

    ________________________________________________________

    1. There are no protrusions or projections?

    ________________________________________________________

    1. There are no pinch points, crush points, or exposed moving parts?

    ________________________________________________________

    1. Potential clothing entanglement hazards have been eliminated?

    ________________________________________________________

    1. There are no missing or damaged protective caps or plugs?

    ________________________________________________________

    1. Hanging tree branches have been trimmed (6’ clearance)?

    ________________________________________________________

    1. Fall zones not per CPSC (6’ perimeter all directions)?

    ________________________________________________________

    1. Openings < 3 ½” or > 9” to prevent head entrapment?

    ________________________________________________________

    1. Footings exposed, cracked or loose in ground?

    ________________________________________________________

    1. Trip hazards, broken glass, trash, ropes, tree roots or foreign objects in play area have been removed?

    ________________________________________________________

    Play Structures

    1. Broken supports or anchors?

    ________________________________________________________

    1. Pipe ends missing plugs or caps?

    ________________________________________________________

    1. Broken or missing rails/rungs/steps?

    ________________________________________________________

    1. Protruding bolt heads or threads?

    ________________________________________________________

    1. Loose, missing, worn or rusted bolts/nuts/or other fasteners?

    ________________________________________________________

    1. Broken clamps?

    ________________________________________________________

    1. Peeling or chipped paint?

    ________________________________________________________

    1. Entrapment/pinch or crush points?

    ________________________________________________________

    1. Vinyl coated decks/platforms/steps have visible cracks or peeling?

    ________________________________________________________

    1. Excessive wear of any component/slide part?

    ________________________________________________________

    1. Wooden equipment is free of splinters, checking, large cracks, warping, and rot?

    ________________________________________________________

    1. General condition/appearance?

    ___________Good _________ Fair __________Poor

    Swings

    1. Broken, twisted, worn, rusted chain?

    ________________________________________________________

    1. Inadequate (non-commercial) chain?

    ________________________________________________________

    1. Worn, rusted or broken swing hangers?

    ________________________________________________________

    1. Open, worn or rusted “S” hooks (dime will not pass through)?

    ________________________________________________________

    1. Grommets show wear or rust?

    ________________________________________________________

    1. Missing, worn or cracked swing seats?

    ________________________________________________________

    1. Inadequate fall zone around swings?

    ________________________________________________________

    1. Swing frame damaged?

    ________________________________________________________

    1. Swing chain wrapped around top rail?

    ________________________________________________________

    1. Safety surface worn or scattered?

    ________________________________________________________

    1. Loose, missing or protruding bolts?

    ________________________________________________________

    1. General condition/appearance?

    ___________Good _________ Fair __________Poor

    Slides

    1. Slide bedways have imperfections?

    ________________________________________________________

    1. Handrails loose or missing?

    ________________________________________________________

    1. Steps broken or missing, or flaws/cracks?

    ________________________________________________________

    1. Sit down transition platform present?

    ________________________________________________________

    1. Safety rails or sit-down canopy at bedway entry present?

    ________________________________________________________

    1. Slide exit parallel to ground?

    ________________________________________________________

    1. Safety surface at slide exit has been leveled or repaired?

    ________________________________________________________

    1. Fall zone adequate on all sides?

    ________________________________________________________

    1. General condition/appearance?

    ___________Good _________ Fair __________Poor

    Freestanding Climbers/Monkey Bars

    1. Not free-fall design?

    ________________________________________________________

    1. Loose or broken rails or rungs?

    ________________________________________________________

    1. Need painting?

    ________________________________________________________

    1. Tire worn, cut or broken?

    ________________________________________________________

    1. Plastic structures are free of holes and cracks?

    ________________________________________________________

    1. General condition/appearance?

    ___________Good _________ Fair __________Poor


    This page titled 20: Appendix E- Example Playground Inspection Form is shared under a CC BY license and was authored, remixed, and/or curated by Jennifer Paris.