Title Page
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Conducted on
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Prepared for
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Prepared by
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Location
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Check play equipment for cracks, bending, warps, rusting, or breakage of any components
- Safe
- At Risk
- N/A
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Check wooden slides for splintering wood where legs and hands touch
- Safe
- At Risk
- N/A
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Check metal slides that they do not become too hot when the sun shines down on them
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Check for any cracked toys that may pose a pinching hazard
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Check for loose nuts, bolts, and caps or protruding bolts with sharp edges and no caps
- Safe
- At Risk
- N/A
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Check for splintering wood on play equipment, picnic tables, and wooden fences
- Safe
- At Risk
- N/A
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Check for protruding nails on play equipment, picnic tables, and wooden fences
- Safe
- At Risk
- N/A
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Check for rusty equipment and toys accessible to children
- Safe
- At Risk
- N/A
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Check the chains on swings to see that they are securely attached
- Safe
- At Risk
- N/A
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Check for vandalism (broken glass or trash)
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Monitor sand and play area for animal feces, poisonous plants, and mushrooms
- Safe
- At Risk
- N/A
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Check for tripping hazards such as exposed footings, roots, rocks, etc.
- Safe
- At Risk
- N/A
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Check for slipping hazards such as sand on walkways or pavement
- Safe
- At Risk
- N/A
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Check tired for pooling water, bee hives
- Safe
- At Risk
- N/A
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Check for broken supports/anchors
- Safe
- At Risk
- N/A
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Check for lack of lubrication on moving parts
- Safe
- At Risk
- N/A
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Check for poor drainage areas
- Safe
- At Risk
- N/A
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Check for chipping or peeling pain on all toys, equipment, and buildings
- Safe
- At Risk
- N/A
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Check for sharp edges and points on toys, fences, play equipment, etc
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Monitor fence for thorny plants or bushes that may be accessible to children's reach
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Check to see that all gates on pool fences are latched
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Check to see that all self latching devices on gates are functioning properly
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Check to see that there are no containers of standing water, which could pose a drowning hazard
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Inspector's full name and signature
