LIMA PLAYGROUND SAFETY CHECKLIST

• Conducted on

  Date

• Prepared by

• Location
  Address

• Required checklist is to be completed by the school principal, playground aide, day care teacher or the custodian

• School: Checked by: Date:

  Date

• Check:

  Yes

  No

  N/A

• 1. Does the equipment have adequate protective surfacing under and around it (12-14“sand, crushed (if no, explain. Use note portion or the back of this sheet)

  Yes

  No

  N/A

• SURFACING: wood or equivalent protection)?

  Yes

  No

  N/A

• 2. Is the loose-fill surfacing material free of foreign objects or debris?

  Yes

  No

  N/A

• 3. Is the loose-fill surfacing material loose and un-compacted and of sufficient depth in heavy use areas such as under swings or at slide exits?

  Yes

  No

  N/A

GENERAL HAZARDS

• 4. Is all equipment free of sharp points, or dangerous corners or edges?

  Yes

  No

  N/A

• 5. Are all pipe ends covered with undamaged protective caps or plugs?

  Yes

  No

  N/A

• 6. Are all hazardous protrusions and projections, such as bars or bolts, removed?

  Yes

  No

  N/A

• 7. Are all potential clothing entanglement hazards removed or repaired (e.g. open S-hooks or protruding bolts)?

  Yes

  No

  N/A

• 8. Have you insured that there are no pinch, crush, or shearing points or any exposed moving parts?

  Yes

  No

  N/A

• 9. Is the playground area free of any trip hazards, such as exposed footings and anchoring devices, and rocks, roots, or any other environmental obstacles?

  Yes

  No

  N/A

DETERIORATION OF THE EQUIPMENT

• 10. Is all equipment free of rust, rot, cracks or splinters, especially where it comes in contact with the

  Yes

  No

  N/A

• 11. Are all components on the playground equipment unbroken and in good condition (e.g. handrails, guardrails, protective barriers, steps or rungs on ladders)?

  Yes

  No

  N/A

• 12. Are all fences, benches, and signs on the playground in an undamaged condition?

  Yes

  No

  N/A

• 13. Is all equipment securely anchored?

  Yes

  No

  N/A

SECURITY OF HARDWARE

• 14. Are all fastening devices and connections, such as S-hooks and chains, secure and in good condition?

  Yes

  No

  N/A

• 15. Are moving components, such as swing hangers, swing rings or nets, unworn and safe?

  Yes

  No

  N/A

• 16. Does the entire play area have satisfactory drainage, especially in heavy use areas such as under swings

  Yes

  No

  N/A

DRAINAGE and slide areas?

• 17. Is the entire playground free from miscellaneous debris or litter such as branches, cans, glass, animal

  Yes

  No

  N/A

• GENERAL UPKEEP OF PLAYGROUNDS none: no hazardous conditions found

  Yes

  No

  N/A

ACTIONS TAKEN ON HAZARDS APPARENT FROM THIS INSPECTION:

• NOTES: