SIMPLY GYM ACCESSORIES - BLANK

• Site conducted

  Select

• Conducted on

  Date

• Prepared by

• Location
  Address

All Barbells (Including Hex Bar & EZ)

• 1       Is equipment to a good cleanly standard

  Yes

  No

  N/A

• 2 Any rough edges / sharp parts?

  Safe

  At Risk

  N/A

• 3 How safe do you feel using this piece of equipment? 1 = Not Safe - 5 = Safe

Preacher Curl (Unbranded)

• 1       Is equipment to a good cleanly standard

  Yes

  No

  N/A

• 2 Any rough edges / sharp parts?

  Safe

  At Risk

  N/A

• 3 How safe do you feel using this piece of equipment? 1 = Not Safe - 5 = Safe

Platforms

• 1       Is equipment to a good cleanly standard

  Yes

  No

  N/A

• 2 Any rough edges / sharp parts?

  Safe

  At Risk

  N/A

• 3 Platform frame is fixed and safe

  Yes

  No

  N/A

• 4 How safe do you feel using this piece of equipment? 1 = Not Safe - 5 = Safe

Bumper Plates

• 1       Is equipment to a good cleanly standard

  Yes

  No

  N/A

• 2 Any rough edges / sharp parts?

  Safe

  At Risk

  N/A

• 3 How safe do you feel using this piece of equipment? 1 = Not Safe - 5 = Safe

Urethene black plates

• 1       Is equipment to a good cleanly standard

  Yes

  No

  N/A

• 2 Any rough edges / sharp parts?

  Safe

  At Risk

  N/A

• 3 How safe do you feel using this piece of equipment? 1 = Not Safe - 5 = Safe

Adjustable bench 1

• 1       Is equipment to a good cleanly standard

  Yes

  No

  N/A

• 2        Can all adjustments be moved safely and pins stay in.

  Yes

  No

  N/A

• 3        Are any bolts missing or loose? (If so please tighten)

  Safe

  At Risk

  N/A

• 4 Any splits in seats and pads

  Pass

  Fail

  N/A

• 5 Any rough edges / sharp parts?

  Safe

  At Risk

  N/A

• 6 How safe do you feel using this piece of equipment? 1 = Not Safe - 5 = Safe

Adjustable bench 2

• 1       Is equipment to a good cleanly standard

  Yes

  No

  N/A

• 2        Can all adjustments be moved safely and pins stay in.

  Yes

  No

  N/A

• 3        Are any bolts missing or loose? (If so please tighten)

  Safe

  At Risk

  N/A

• 4 Any splits in seats and pads

  Pass

  Fail

  N/A

• 5 Any rough edges / sharp parts?

  Safe

  At Risk

  N/A

• 6 How safe do you feel using this piece of equipment? 1 = Not Safe - 5 = Safe

Adjustable bench 3

• 1       Is equipment to a good cleanly standard

  Yes

  No

  N/A

• 2        Can all adjustments be moved safely and pins stay in.

  Yes

  No

  N/A

• 3        Are any bolts missing or loose? (If so please tighten)

  Safe

  At Risk

  N/A

• 4 Any splits in seats and pads

  Pass

  Fail

  N/A

• 5 Any rough edges / sharp parts?

  Safe

  At Risk

  N/A

• 6 How safe do you feel using this piece of equipment? 1 = Not Safe - 5 = Safe

Adjustable bench 4

• 1       Is equipment to a good cleanly standard

  Yes

  No

  N/A

• 2        Can all adjustments be moved safely and pins stay in.

  Yes

  No

  N/A

• 3        Are any bolts missing or loose? (If so please tighten)

  Safe

  At Risk

  N/A

• 4 Any splits in seats and pads

  Pass

  Fail

  N/A

• 5 Any rough edges / sharp parts?

  Safe

  At Risk

  N/A

• 6 How safe do you feel using this piece of equipment? 1 = Not Safe - 5 = Safe

Adjustable bench 5

• 1       Is equipment to a good cleanly standard

  Yes

  No

  N/A

• 2        Can all adjustments be moved safely and pins stay in.

  Yes

  No

  N/A

• 3        Are any bolts missing or loose? (If so please tighten)

  Safe

  At Risk

  N/A

• 4 Any splits in seats and pads

  Pass

  Fail

  N/A

• 5 Any rough edges / sharp parts?

  Safe

  At Risk

  N/A

• 6 How safe do you feel using this piece of equipment? 1 = Not Safe - 5 = Safe

Adjustable bench 6

• 1       Is equipment to a good cleanly standard

  Yes

  No

  N/A

• 2        Can all adjustments be moved safely and pins stay in.

  Yes

  No

  N/A

• 3        Are any bolts missing or loose? (If so please tighten)

  Safe

  At Risk

  N/A

• 4 Any splits in seats and pads

  Pass

  Fail

  N/A

• 5 Any rough edges / sharp parts?

  Safe

  At Risk

  N/A

• 6 How safe do you feel using this piece of equipment? 1 = Not Safe - 5 = Safe

Adjustable bench 7

• 1       Is equipment to a good cleanly standard

  Yes

  No

  N/A

• 2        Can all adjustments be moved safely and pins stay in.

  Yes

  No

  N/A

• 3        Are any bolts missing or loose? (If so please tighten)

  Safe

  At Risk

  N/A

• 4 Any splits in seats and pads

  Pass

  Fail

  N/A

• 5 Any rough edges / sharp parts?

  Safe

  At Risk

  N/A

• 6 How safe do you feel using this piece of equipment? 1 = Not Safe - 5 = Safe

Adjustable bench 8

• 1       Is equipment to a good cleanly standard

  Yes

  No

  N/A

• 2        Can all adjustments be moved safely and pins stay in.

  Yes

  No

  N/A

• 3        Are any bolts missing or loose? (If so please tighten)

  Safe

  At Risk

  N/A

• 4 Any splits in seats and pads

  Pass

  Fail

  N/A

• 5 Any rough edges / sharp parts?

  Safe

  At Risk

  N/A

• 6 How safe do you feel using this piece of equipment? 1 = Not Safe - 5 = Safe

Adjustable bench 9

• 1       Is equipment to a good cleanly standard

  Yes

  No

  N/A

• 2        Can all adjustments be moved safely and pins stay in.

  Yes

  No

  N/A

• 3        Are any bolts missing or loose? (If so please tighten)

  Safe

  At Risk

  N/A

• 4 Any splits in seats and pads

  Pass

  Fail

  N/A

• 5 Any rough edges / sharp parts?

  Safe

  At Risk

  N/A

• 6 How safe do you feel using this piece of equipment? 1 = Not Safe - 5 = Safe

Adjustable bench 10

• 1       Is equipment to a good cleanly standard

  Yes

  No

  N/A

• 2        Can all adjustments be moved safely and pins stay in.

  Yes

  No

  N/A

• 3        Are any bolts missing or loose? (If so please tighten)

  Safe

  At Risk

  N/A

• 4 Any splits in seats and pads

  Pass

  Fail

  N/A

• 5 Any rough edges / sharp parts?

  Safe

  At Risk

  N/A

• 6 How safe do you feel using this piece of equipment? 1 = Not Safe - 5 = Safe

Adjustable bench 11

• 1       Is equipment to a good cleanly standard

  Yes

  No

  N/A

• 2        Can all adjustments be moved safely and pins stay in.

  Yes

  No

  N/A

• 3        Are any bolts missing or loose? (If so please tighten)

  Safe

  At Risk

  N/A

• 4 Any splits in seats and pads

  Pass

  Fail

  N/A

• 5 Any rough edges / sharp parts?

  Safe

  At Risk

  N/A

• 6 How safe do you feel using this piece of equipment? 1 = Not Safe - 5 = Safe

Adjustable bench 12

• 1       Is equipment to a good cleanly standard

  Yes

  No

  N/A

• 2        Can all adjustments be moved safely and pins stay in.

  Yes

  No

  N/A

• 3        Are any bolts missing or loose? (If so please tighten)

  Safe

  At Risk

  N/A

• 4 Any splits in seats and pads

  Pass

  Fail

  N/A

• 5 Any rough edges / sharp parts?

  Safe

  At Risk

  N/A

• 6 How safe do you feel using this piece of equipment? 1 = Not Safe - 5 = Safe

Adjustable bench 13

• 1       Is equipment to a good cleanly standard

  Yes

  No

  N/A

• 2        Can all adjustments be moved safely and pins stay in.

  Yes

  No

  N/A

• 3        Are any bolts missing or loose? (If so please tighten)

  Safe

  At Risk

  N/A

• 4 Any splits in seats and pads

  Pass

  Fail

  N/A

• 5 Any rough edges / sharp parts?

  Safe

  At Risk

  N/A

• 6 How safe do you feel using this piece of equipment? 1 = Not Safe - 5 = Safe

Adjustable bench 14

• 1       Is equipment to a good cleanly standard

  Yes

  No

  N/A

• 2        Can all adjustments be moved safely and pins stay in.

  Yes

  No

  N/A

• 3        Are any bolts missing or loose? (If so please tighten)

  Safe

  At Risk

  N/A

• 4 Any splits in seats and pads

  Pass

  Fail

  N/A

• 5 Any rough edges / sharp parts?

  Safe

  At Risk

  N/A

• 6 How safe do you feel using this piece of equipment? 1 = Not Safe - 5 = Safe

Adjustable bench 15

• 1       Is equipment to a good cleanly standard

  Yes

  No

  N/A

• 2        Can all adjustments be moved safely and pins stay in.

  Yes

  No

  N/A

• 3        Are any bolts missing or loose? (If so please tighten)

  Safe

  At Risk

  N/A

• 4 Any splits in seats and pads

  Pass

  Fail

  N/A

• 5 Any rough edges / sharp parts?

  Safe

  At Risk

  N/A

• 6 How safe do you feel using this piece of equipment? 1 = Not Safe - 5 = Safe

Adjustable bench 16

• 1       Is equipment to a good cleanly standard

  Yes

  No

  N/A

• 2        Can all adjustments be moved safely and pins stay in.

  Yes

  No

  N/A

• 3        Are any bolts missing or loose? (If so please tighten)

  Safe

  At Risk

  N/A

• 4 Any splits in seats and pads

  Pass

  Fail

  N/A

• 5 Any rough edges / sharp parts?

  Safe

  At Risk

  N/A

• 6 How safe do you feel using this piece of equipment? 1 = Not Safe - 5 = Safe

Adjustable bench 17

• 1       Is equipment to a good cleanly standard

  Yes

  No

  N/A

• 2        Can all adjustments be moved safely and pins stay in.

  Yes

  No

  N/A

• 3        Are any bolts missing or loose? (If so please tighten)

  Safe

  At Risk

  N/A

• 4 Any splits in seats and pads

  Pass

  Fail

  N/A

• 5 Any rough edges / sharp parts?

  Safe

  At Risk

  N/A

• 6 How safe do you feel using this piece of equipment? 1 = Not Safe - 5 = Safe

Adjustable bench 18

• 1       Is equipment to a good cleanly standard

  Yes

  No

  N/A

• 2        Can all adjustments be moved safely and pins stay in.

  Yes

  No

  N/A

• 3        Are any bolts missing or loose? (If so please tighten)

  Safe

  At Risk

  N/A

• 4 Any splits in seats and pads

  Pass

  Fail

  N/A

• 5 Any rough edges / sharp parts?

  Safe

  At Risk

  N/A

• 6 How safe do you feel using this piece of equipment? 1 = Not Safe - 5 = Safe

Adjustable bench 19

• 1       Is equipment to a good cleanly standard

  Yes

  No

  N/A

• 2        Can all adjustments be moved safely and pins stay in.

  Yes

  No

  N/A

• 3        Are any bolts missing or loose? (If so please tighten)

  Safe

  At Risk

  N/A

• 4 Any splits in seats and pads

  Pass

  Fail

  N/A

• 5 Any rough edges / sharp parts?

  Safe

  At Risk

  N/A

• 6 How safe do you feel using this piece of equipment? 1 = Not Safe - 5 = Safe

Adjustable bench 20

• 1       Is equipment to a good cleanly standard

  Yes

  No

  N/A

• 2        Can all adjustments be moved safely and pins stay in.

  Yes

  No

  N/A

• 3        Are any bolts missing or loose? (If so please tighten)

  Safe

  At Risk

  N/A

• 4 Any splits in seats and pads

  Pass

  Fail

  N/A

• 5 Any rough edges / sharp parts?

  Safe

  At Risk

  N/A

• 6 How safe do you feel using this piece of equipment? 1 = Not Safe - 5 = Safe

Adjustable bench 21

• 1       Is equipment to a good cleanly standard

  Yes

  No

  N/A

• 2        Can all adjustments be moved safely and pins stay in.

  Yes

  No

  N/A

• 3        Are any bolts missing or loose? (If so please tighten)

  Safe

  At Risk

  N/A

• 4 Any splits in seats and pads

  Pass

  Fail

  N/A

• 5 Any rough edges / sharp parts?

  Safe

  At Risk

  N/A

• 6 How safe do you feel using this piece of equipment? 1 = Not Safe - 5 = Safe

Adjustable bench 22

• 1       Is equipment to a good cleanly standard

  Yes

  No

  N/A

• 2        Can all adjustments be moved safely and pins stay in.

  Yes

  No

  N/A

• 3        Are any bolts missing or loose? (If so please tighten)

  Safe

  At Risk

  N/A

• 4 Any splits in seats and pads

  Pass

  Fail

  N/A

• 5 Any rough edges / sharp parts?

  Safe

  At Risk

  N/A

• 6 How safe do you feel using this piece of equipment? 1 = Not Safe - 5 = Safe

Adjustable bench 23

• 1       Is equipment to a good cleanly standard

  Yes

  No

  N/A

• 2        Can all adjustments be moved safely and pins stay in.

  Yes

  No

  N/A

• 3        Are any bolts missing or loose? (If so please tighten)

  Safe

  At Risk

  N/A

• 4 Any splits in seats and pads

  Pass

  Fail

  N/A

• 5 Any rough edges / sharp parts?

  Safe

  At Risk

  N/A

• 6 How safe do you feel using this piece of equipment? 1 = Not Safe - 5 = Safe

Adjustable bench 24

• 1       Is equipment to a good cleanly standard

  Yes

  No

  N/A

• 2        Can all adjustments be moved safely and pins stay in.

  Yes

  No

  N/A

• 3        Are any bolts missing or loose? (If so please tighten)

  Safe

  At Risk

  N/A

• 4 Any splits in seats and pads

  Pass

  Fail

  N/A

• 5 Any rough edges / sharp parts?

  Safe

  At Risk

  N/A

• 6 How safe do you feel using this piece of equipment? 1 = Not Safe - 5 = Safe

Ab Crunch Bench 1

• 1       Is equipment to a good cleanly standard

  Yes

  No

  N/A

• 2        Can all adjustments be moved safely and pins stay in.

  Yes

  No

  N/A

• 3        Are any bolts missing or loose? (If so please tighten)

  Safe

  At Risk

  N/A

• 4 Any splits in seats and pads

  Pass

  Fail

  N/A

• 5 Any rough edges / sharp parts?

  Safe

  At Risk

  N/A

• 6 How safe do you feel using this piece of equipment? 1 = Not Safe - 5 = Safe

Ab Crunch Bench 2

• 1       Is equipment to a good cleanly standard

  Yes

  No

  N/A

• 2        Can all adjustments be moved safely and pins stay in.

  Yes

  No

  N/A

• 3        Are any bolts missing or loose? (If so please tighten)

  Safe

  At Risk

  N/A

• 4 Any splits in seats and pads

  Pass

  Fail

  N/A

• 5 Any rough edges / sharp parts?

  Safe

  At Risk

  N/A

• 6 How safe do you feel using this piece of equipment? 1 = Not Safe - 5 = Safe

Dumbbells 2kg-60kg

• 1       Is equipment to a good cleanly standard

  Yes

  No

  N/A

• 2 Any rough edges / sharp parts?

  Safe

  At Risk

  N/A

• 3 How safe do you feel using this piece of equipment? 1 = Not Safe - 5 = Safe

Weights Trees

• 1       Is equipment to a good cleanly standard

  Yes

  No

  N/A

• 2 Any rough edges / sharp parts?

  Safe

  At Risk

  N/A

• 3 How safe do you feel using this piece of equipment? 1 = Not Safe - 5 = Safe

Tall Dumbbell Rack (2-20kg)

• 1       Is equipment to a good cleanly standard

  Yes

  No

  N/A

• 2 Any rough edges / sharp parts?

  Safe

  At Risk

  N/A

• 3 How safe do you feel using this piece of equipment? 1 = Not Safe - 5 = Safe

Kettlebells

• 1       Is equipment to a good cleanly standard

  Yes

  No

  N/A

• 2 Any rough edges / sharp parts?

  Safe

  At Risk

  N/A

• 3 How safe do you feel using this piece of equipment? 1 = Not Safe - 5 = Safe

Sleds

• 1       Is equipment to a good cleanly standard

  Yes

  No

  N/A

• 2 Any rough edges / sharp parts?

  Safe

  At Risk

  N/A

• 3 How safe do you feel using this piece of equipment? 1 = Not Safe - 5 = Safe

TRX's

• 1       Is equipment to a good cleanly standard

  Yes

  No

  N/A

• 2 Do the straps have an tears

  Safe

  At Risk

  N/A

• 3 How safe do you feel using this piece of equipment? 1 = Not Safe - 5 = Safe

• Yes

  No

  N/A