SIMPLY GYM LADIES ONLY GYM - BLANK

• Site conducted

  Select

• Conducted on

  Date

• Prepared by

• Location
  Address

TREADMILL 1 (LEFT)

• 1       Belt is properly alligned with the correct tension

  Yes

  No

  N/A

• 2        The belt is undamaged (cracks, etc)

  Yes

  No

  N/A

• 3         Both emergency stops work

  Yes

  No

  N/A

• 4         Tread can hold its speed above 16kpm for over 1 minute

  Yes

  No

  N/A

• 5 Heart rate monitor works

  Yes

  No

  N/A

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

TREADMILL 2

• 1       Belt is properly alligned with the correct tension

  Yes

  No

  N/A

• 2        The belt is undamaged (cracks, etc)

  Yes

  No

  N/A

• 3         Both emergency stops work

  Yes

  No

  N/A

• 4         Tread can hold its speed above 16kpm for over 1 minute

  Yes

  No

  N/A

• 5 Heart rate monitor works

  Yes

  No

  N/A

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

TREADMILL 3

• 1       Belt is properly alligned with the correct tension

  Yes

  No

  N/A

• 2        The belt is undamaged (cracks, etc)

  Yes

  No

  N/A

• 3         Both emergency stops work

  Yes

  No

  N/A

• 4         Tread can hold its speed above 16kpm for over 1 minute

  Yes

  No

  N/A

• 5 Heart rate monitor works

  Yes

  No

  N/A

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

TREADMILL 4 (RIGHT)

• 1       Belt is properly alligned with the correct tension

  Yes

  No

  N/A

• 2        The belt is undamaged (cracks, etc)

  Yes

  No

  N/A

• 3         Both emergency stops work

  Yes

  No

  N/A

• 4         Tread can hold its speed above 16kpm for over 1 minute

  Yes

  No

  N/A

• 5 Heart rate monitor works

  Yes

  No

  N/A

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

STAIR MASTER 1

• 1 Stairs run smoothly with no faults

  Yes

  No

  N/A

• 2 Stop button works

  Yes

  No

  N/A

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

STAIR MASTER 2

• 1 Stairs run smoothly with no faults

  Yes

  No

  N/A

• 2 Stop button works

  Yes

  No

  N/A

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

CROSS TRAINER 1 (LEFT)

• 1 Belt runs smoothly

  Yes

  No

  N/A

• 2 Frame running smoothly

  Yes

  No

  N/A

• 3 Handle bars are fixed (not rattling)

  Yes

  No

  N/A

• 4 Resistence increases/decreases appropriately

  Yes

  No

  N/A

• 5 Heart rate monitor works

  Yes

  No

  N/A

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

CROSS TRAINER 2

• 1 Belt runs smoothly

  Yes

  No

  N/A

• 2 Frame running smoothly

  Yes

  No

  N/A

• 3 Handle bars are fixed (not rattling)

  Yes

  No

  N/A

• 4 Resistence increases/decreases appropriately

  Yes

  No

  N/A

• 5 Heart rate monitor works

  Yes

  No

  N/A

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

CROSS TRAINER 3

• 1 Belt runs smoothly

  Yes

  No

  N/A

• 2 Frame running smoothly

  Yes

  No

  N/A

• 3 Handle bars are fixed (not rattling)

  Yes

  No

  N/A

• 4 Resistence increases/decreases appropriately

  Yes

  No

  N/A

• 5 Heart rate monitor works

  Yes

  No

  N/A

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

CROSS TRAINER 4

• 1 Belt runs smoothly

  Yes

  No

  N/A

• 2 Frame running smoothly

  Yes

  No

  N/A

• 3 Handle bars are fixed (not rattling)

  Yes

  No

  N/A

• 4 Resistence increases/decreases appropriately

  Yes

  No

  N/A

• 5 Heart rate monitor works

  Yes

  No

  N/A

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

UPRIGHT BIKE 1

• 1 Pedals run smoothly

  Yes

  No

  N/A

• 2 Bike straps are intact and in good condition

  Yes

  No

  N/A

• 3 Handle bars are fixed (not rattling)

  Yes

  No

  N/A

• 4 Seats can be adjusted

  Yes

  No

  N/A

• 5 Heart rate monitor works

  Yes

  No

  N/A

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

RECUMBENT BIKE 1

• 1 Pedals run smoothly

  Yes

  No

  N/A

• 2 Bike straps are intact and in good condition

  Yes

  No

  N/A

• 3 Handle bars are fixed (not rattling)

  Yes

  No

  N/A

• 4 Seats can be adjusted

  Yes

  No

  N/A

• 5 Heart rate monitor works

  Yes

  No

  N/A

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

RECUMBENT BIKE 2

• 1 Pedals run smoothly

  Yes

  No

  N/A

• 2 Bike straps are intact and in good condition

  Yes

  No

  N/A

• 3 Handle bars are fixed (not rattling)

  Yes

  No

  N/A

• 4 Seats can be adjusted

  Yes

  No

  N/A

• 5 Heart rate monitor works

  Yes

  No

  N/A

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

ROWER 1

• 1 Seats run smoothly, is tight and properly alligned

  Yes

  No

  N/A

• 2 Chain is well lubricated and runs smoothly

  Yes

  No

  N/A

• 3 Handle is attached and hand protectors are not worn

  Yes

  No

  N/A

• Battery level

• 5 How safe do you feel using this piece of equipment out of 5 1 = Not safe

POWERPLATE

• Turns on with no faults

  Yes

  No

  N/A

SEATED ROW

• 1       Runs smoothly and doesn’t squeak (oil if needed)

  Yes

  No

  N/A

• 2         Are all cables secure and not damaged/frayed

  Yes

  No

  N/A

• 3         Are all bolts and nuts tightened

  Yes

  No

  N/A

• 4 Condition of pads

  Good

  Fair

  Poor

  N/A

• 6 Rate equipment out of 5 1 = Out of order 3= OK 5 = Safe

CHEST PRESS

• 1       Runs smoothly and doesn’t squeak (oil if needed)

  Yes

  No

  N/A

• 2        Can seat be adjusted safely

  Safe

  At Risk

  N/A

• 3         Are all cables secure and not damaged/frayed

  Yes

  No

  N/A

• 4         Are all bolts and nuts tightened

  Yes

  No

  N/A

• 5 Condition of pads

  Good

  Fair

  Poor

  N/A

• 6 Rate equipment out of 5 1 = Out of order 3= OK 5 = Safe

LAT PULLDOWN

• 1       Runs smoothly and doesn’t squeak (oil if needed)

  Yes

  No

  N/A

• 2         Are all cables secure and not damaged/frayed

  Yes

  No

  N/A

• 3         Are all bolts and nuts tightened

  Yes

  No

  N/A

• 4 Condition of pads

  Good

  Fair

  Poor

  N/A

• 5 Rate equipment out of 5 1 = Out of order 3= OK 5 = Safe

LEG PRESS

• 1       Runs smoothly and doesn’t squeak (oil if needed)

  Yes

  No

  N/A

• 2        Can seat be adjusted safely

  Yes

  No

  N/A

• 3         Are all cables secure and not damaged/frayed

  Yes

  No

  N/A

• 4         Are all bolts and nuts tightened

  Yes

  No

  N/A

• 5 Condition of pads

  Good

  Fair

  Poor

  N/A

• 6 Rate equipment out of 5 1 = Out of order 3= OK 5 = Safe

LEG EXTENSION

• 1       Runs smoothly and doesn’t squeak (oil if needed)

  Yes

  No

  N/A

• 2        Can seat be adjusted safely

  Yes

  No

  N/A

• 3         Are all cables secure and not damaged/frayed

  Yes

  No

  N/A

• 4         Are all bolts and nuts tightened

  Yes

  No

  N/A

• 5 Condition of pads

  Good

  Fair

  Poor

  N/A

• 6 Rate equipment out of 5 1 = Out of order 3= OK 5 = Safe

LEG CURL

• 1       Runs smoothly and doesn’t squeak (oil if needed)

  Yes

  No

  N/A

• 2        Can seat be adjusted safely

  Yes

  No

  N/A

• 3         Are all cables secure and not damaged/frayed

  Yes

  No

  N/A

• 4         Are all bolts and nuts tightened

  Yes

  No

  N/A

• 5 Condition of pads

  Good

  Fair

  Poor

  N/A

• 6 Rate equipment out of 5 1 = Out of order 3= OK 5 = Safe

ADDUCTOR/ ABDUCTOR

• 1       Runs smoothly and doesn’t squeak (oil if needed)

  Yes

  No

  N/A

• 2         Are all cables secure and not damaged/frayed

  Yes

  No

  N/A

• 3         Are all bolts and nuts tightened

  Yes

  No

  N/A

• 4 Condition of pads

  Good

  Fair

  Poor

  N/A

• 5 Rate equipment out of 5 1 = Out of order 3= OK 5 = Safe

SQUAT RACK

• 1. Safe distance from mirrors

  Yes

  No

  N/A

• 2. No sharp edges

  Safe

  At Risk

  N/A

• 3. Are all nuts and bolts tightened

  Yes

  No

  N/A

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

HIP THRUST (NAUTILUS)

• 1       Runs smoothly and doesn’t squeak (oil if needed)

  Yes

  No

  N/A

• 2         Are all bolts and nuts tightened

  Yes

  No

  N/A

• 3 Condition of pads

  Good

  Fair

  Poor

  N/A

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

HIP THRUST BENCH

• 1         Are all bolts and nuts tightened

  Yes

  No

  N/A

• 2 Condition of pads

  Good

  Fair

  Poor

  N/A

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