Information

  • Document No.

  • Audit Title

  • Site

  • Location
  • Conducted on

  • Prepared by

General

  • Visibility for Supervision (min 2m)

  • Comment

  • Outcome (inc CRM no, if needed)

  • CRM Required

  • Add to Winter List

  • Date completed

  • Photo

  • Softfall (Synthetic Material)

  • Comment (Check for degradation of surface or chewing gum, foreign objects, rocks, burns, Joints, wear layer, impact attenuation layer or sub- base failure)

  • Outcome (inc CRM no, if needed)

  • CRM Required

  • Add to Winter List

  • Date completed

  • Photo

  • Edging

  • Comment

  • Outcome (inc CRM no, if needed)

  • CRM Required

  • Add to Winter List

  • Date completed

  • Photo

  • Loose-fill Material<br>1. Check depth min 300-400 mm, top up or rack as required<br>2. Material deterioration or contamination

  • Comment

  • Outcome (inc CRM no, if needed)

  • CRM Required

  • Add to Winter List

  • Date completed

  • Photo

  • Accessibility<br>1. Check Access ramps, pathways entrances free of slipping and tripping hazards<br>2. Paths around playground clear of hazards, cracks, trips, vegetation<br>3. Gates, closing & locking devices operational, no finger entrapment (>12)<br>4. Access, entrance & ancillary items free of protrusions/ sharp edges

  • Comment

  • Outcome (inc CRM no, if needed)

  • CRM Required

  • Add to Winter List

  • Date completed

  • Photo

  • Vegetation<br>Check litter, glass, syringes, eye hazards etc

  • Comment

  • Outcome (inc CRM no, if needed)

  • CRM Required

  • Add to Winter List

  • Date completed

  • Photo

  • Sandpits<br>1. No ponding water, drainage issues or health hazards.<br>2. Sandpit edges and supports intact & secure.<br>3. Sand raked to remove foreign objects, fouling, glass.

  • Comment

  • Outcome (inc CRM no, if needed)

  • CRM Required

  • Add to Winter List

  • Date completed

  • Photo

  • Playground Surface<br>1. Pay particular attention to surfacing subject to high use, beneath high equipment, forced movement devices and exposed footings<br>2. Rubbish that may be hygiene issue, broken glass, rocks, foreign objects likely to cause injury removed<br>3. Drainage operational, no contamination from run off

  • Comment

  • Outcome (inc CRM no, if needed)

  • CRM Required

  • Add to Winter List

  • Date completed

  • Photo

  • Equipment - Platforms, Structures and Frames<br>1. Foundation, corrosion and free of movement<br>2. Water penetration, physical damage<br>3. Guards, rails, screws and bolts are present and secure<br>4. No loose items, and equipment is free from moss, mould, unhygienic material

  • Comment

  • Outcome (inc CRM no, if needed)

  • CRM Required

  • Add to Winter List

  • Date completed

  • Photo

  • Chains, Ropes, Cables, Net and Tires<br>1. No damage, frays, worn or cut wire strands.<br>2. No entrapment hazards, no corrosion or sharp edges.

  • Comment

  • Outcome (inc CRM no, if needed)

  • CRM Required

  • Add to Winter List

  • Date completed

  • Photo

  • Bubbles and water features (Clean and operationational)

  • Comment

  • Outcome (inc CRM no, if needed)

  • CRM Required

  • Add to Winter List

  • Date completed

  • Photo

  • Is graffiti present?

  • Comment

  • Outcome (inc CRM no, if needed)

  • CRM Required

  • Add to Winter List

  • Date completed

  • Photo

Play Equipment

  • Basketball Ring

  • Comment

  • Outcome (inc CRM no, if needed)

  • CRM Required

  • Add to Winter List

  • Date completed

  • Photo

  • Rockers

  • Comment

  • Outcome (inc CRM no, if needed)

  • CRM Required

  • Add to Winter List

  • Date completed

  • Photo

  • Sea Saws

  • Comment

  • Outcome (inc CRM no, if needed)

  • CRM Required

  • Add to Winter List

  • Date completed

  • Photo

  • Swings<br>1. Check for squeaks, swing action, quietness.<br>2. Wear and tear of seat, chains and connectors. <br>3. Seat clearance from ground >350mm (tire swing > 400mm)

  • Swing type (Select all that apply)

  • Comment

  • Outcome (inc CRM no, if needed)

  • CRM Required

  • Add to Winter List

  • Date completed

  • Photo

  • Carousel (Rotating Equipment)

  • Speed limited to 5 meters per second?

  • Bearing functionality confirmed?

  • Comment (Check for covers, seats, pedals, rope secure, no entrapment , protrusions or sharps including underside)

  • Outcome (inc CRM no, if needed)

  • CRM Required

  • Add to Winter List

  • Date completed

  • Photo

Climbing equipment

  • Fortress / tower

  • Comment

  • Outcome (inc CRM no, if needed)

  • CRM Required

  • Add to Winter List

  • Date completed

  • Photo

  • Slide<br>1. No damage or foreign objects on slide bed/sides, wear and tear, entrapment or protrusions<br>2. Structure, slides & supports-stability, looseness, corrosion, splinters.<br>3. Runout section fall height <350mm(or <200mm small slides)

  • Comment

  • Outcome (inc CRM no, if needed)

  • CRM Required

  • Add to Winter List

  • Date completed

  • Photo

  • Net / spiderweb

  • Comment

  • Outcome (inc CRM no, if needed)

  • CRM Required

  • Add to Winter List

  • Date completed

  • Photo

  • Flying fox<br>1. Check trolley operation and cable is secure<br>2. No missing parts, and are free from rot and corrosions

  • Speed limited to 7 meters per second

  • Comment

  • Outcome (inc CRM no, if needed)

  • CRM Required

  • Add to Winter List

  • Date completed

  • Photo

Exercise equipment

  • Sit up bench

  • Comment

  • Outcome (inc CRM no, if needed)

  • CRM Required

  • Add to Winter List

  • Date completed

  • Photo

  • Chin dip lift

  • Comment

  • Outcome (inc CRM no, if needed)

  • CRM Required

  • Add to Winter List

  • Date completed

  • Photo

  • Hip twist

  • Comment

  • Outcome (inc CRM no, if needed)

  • CRM Required

  • Add to Winter List

  • Date completed

  • Photo

  • Air walk

  • Comment

  • Outcome (inc CRM no, if needed)

  • CRM Required

  • Add to Winter List

  • Date completed

  • Photo

  • Hip swing

  • Comment

  • Outcome (inc CRM no, if needed)

  • CRM Required

  • Add to Winter List

  • Date completed

  • Photo

  • Sit up (laying) or push up

  • Comment

  • Outcome (inc CRM no, if needed)

  • CRM Required

  • Add to Winter List

  • Date completed

  • Photo

  • Leg up

  • Comment

  • Outcome (inc CRM no, if needed)

  • CRM Required

  • Add to Winter List

  • Date completed

  • Photo

  • Aerobic step ups

  • Comment

  • Outcome (inc CRM no, if needed)

  • CRM Required

  • Add to Winter List

  • Date completed

  • Photo

Additional Items

  • Additional Items

  • Comment

  • Outcome (inc CRM no, if needed)

  • CRM Required

  • Add to Winter List

  • Date completed

  • Photo

Office Use

  • Signature required

  • COORDINATOR COMMENTS

  • Coordinator signature required

  • Date required

  • Data entry completed - CRM created or job added to Winter list Docs #3111629

  • CRM No. and Date completed

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