CCC - Playground Safety Inspection Audit

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

A. Combination Units

• Stairways/Step ladders

  Safe

  At Risk

  N/A

• Rigid Climbers

  Safe

  At Risk

  N/A

• Flexible Climbers (rope)

  Safe

  At Risk

  N/A

• Decks/Platforms

  Safe

  At Risk

  N/A

• Play Platforms

  Safe

  At Risk

  N/A

• Slides

  Safe

  At Risk

  N/A

• Sliding Poles

  Safe

  At Risk

  N/A

• Horizontal Ladders

  Safe

  At Risk

  N/A

• Crawl Tunnels

  Safe

  At Risk

  N/A

• Clatter/Other Bridges

  Safe

  At Risk

  N/A

• Ramps

  Safe

  At Risk

  N/A

• Roofs

  Safe

  At Risk

  N/A

• Other non specified equipment -<br>( Write item inspected in comments).

  Safe

  At Risk

  N/A

• Other non specified equipment-<br>(Write item inspected in comments).

  Safe

  At Risk

  N/A

B. Free Standing Equipment

• Seesaws

  Safe

  At Risk

  N/A

• Slides

  Safe

  At Risk

  N/A

• Rigid Climbers

  Safe

  At Risk

  N/A

• Flexible Climbers

  Safe

  At Risk

  N/A

• Upper Body Equipment

  Safe

  At Risk

  N/A

• Rocking Equipment

  Safe

  At Risk

  N/A

• Merry-Go-Round

  Safe

  At Risk

  N/A

• Spinner (<20"D)

  Safe

  At Risk

  N/A

• Sand Play Area

  Safe

  At Risk

  N/A

• Play Panels

  Safe

  At Risk

  N/A

• Stepping Pods

  Safe

  At Risk

  N/A

• Net Climber

  Safe

  At Risk

  N/A

• Swings (To & Fro)

  Safe

  At Risk

  N/A

• Trampoline

  Safe

  At Risk

  N/A

• Exercise Equipment

  Safe

  At Risk

  N/A

• Other non specified equipment-<br>(Write item inspected in comments)

  Safe

  At Risk

  N/A

C. Site Amenities

• Tables

  Safe

  At Risk

  N/A

• Drinking Fountains

  Safe

  At Risk

  N/A

• Bike Racks

  Safe

  At Risk

  N/A

• Disable Parking

  Safe

  At Risk

  N/A

• Signs

  Safe

  At Risk

  N/A

• Rubbish Bins

  Safe

  At Risk

  N/A

• Fencing/Gates

  Safe

  At Risk

  N/A

• Basketball Ring/s

  Safe

  At Risk

  N/A

• Skate Ramps

  Safe

  At Risk

  N/A

• Footpaths

  Safe

  At Risk

  N/A

• BBQ's

  Safe

  At Risk

  N/A

• Broken Glass

  Yes

  No

  N/A

• Benches

  Safe

  At Risk

  N/A

• Water Taps

  Safe

  At Risk

  N/A

• Other non specified equipment-<br>( Write item inspected in comments).

  Yes

  No

  N/A

General Comments

• Comments/Action Required/action Taken

  Yes

  No

  N/A

• Work order raised by -<br>( Name)

  Yes

  No

  N/A

• Auditors name and signature

  Sign