Title Page
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Conducted on
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Location
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Home Team
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Away Team
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Are the weather conditions OK for play to start?
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Has all visible debris been removed from the field ?
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Are the sprinkler covers intact and level with the field?
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Are the perimeter fences and/ or signs in a safe state?
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Are all boundary markers ( lines ropes cones etc) at least 3 metres from any possible source of harm such as fencing concrete trees buildings etc ?
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Are the game format and ground markings aligned with the competition guidelines?
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Are the playing surfaces OK to start play?
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Are the public areas (eg seating and walkways ) in a safe state ?
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Is medical assistance ( eg first aid kit, qualified people and ice ) at the ground and accessible?
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Are shaded areas sunscreen and clean drinking water available?
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Details of any action taken to address safety concerns
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Add any relevant photos
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Any other matters to note ?
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I / we declare that I / we are authorised to complete this form
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I /we declare that the following statements are correct A) The above check was completed as per the date and time noted above B) All hazards risks and safety concerns have been addressed to an acceptable level and recorded on this form C) Both teams and umpires are satisfied that the playing conditions surfaces and facilities are acceptable for play to start
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Home team Record name of authorised representative and position
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Away team Record name of authorised representative and position
