SIMPLY GYM PLATE LOADED (LOWERBODY) - BLANK

• Site conducted

  Select

• Conducted on

  Date

• Prepared by

• Location
  Address

LEG PRESS

• 1       Hinges move smoothly and do not squeak (oil if needed)

  Yes

  No

  N/A

• 2        Can all adjustments be moved safely

  Yes

  No

  N/A

• 3        Are any bolts missing

  Compliant

  Non-Compliant

  N/A

• 4        Are all nuts and bolts tightened

  Yes

  No

  N/A

• 5 Condition of seats and pads

  Good

  Fair

  Poor

  N/A

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

INCLINE LEG PRESS

• 1       Hinges move smoothly and do not squeak (oil if needed)

  Yes

  No

  N/A

• 2        Can all adjustments be moved safely

  Yes

  No

  N/A

• 3        Are any bolts missing

  Compliant

  Non-Compliant

  N/A

• 4        Are all nuts and bolts tightened

  Yes

  No

  N/A

• 5 Condition of seats and pads

  Good

  Fair

  Poor

  N/A

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

PENDULUM SQUAT

• 1       Hinges move smoothly and do not squeak (oil if needed)

  Yes

  No

  N/A

• 2        Can all adjustments be moved safely

  Yes

  No

  N/A

• 3        Are any bolts missing

  Compliant

  Non-Compliant

  N/A

• 4        Are all nuts and bolts tightened

  Yes

  No

  N/A

• 5 Condition of seats and pads

  Good

  Fair

  Poor

  N/A

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

HACK SQUAT

• 1       Hinges move smoothly and do not squeak (oil if needed)

  Yes

  No

  N/A

• 2        Can all adjustments be moved safely

  Yes

  No

  N/A

• 3        Are any bolts missing

  Compliant

  Non-Compliant

  N/A

• 4        Are all nuts and bolts tightened

  Yes

  No

  N/A

• 5 Condition of seats and pads

  Good

  Fair

  Poor

  N/A

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

CURVED HACK SQUAT

• 1       Hinges move smoothly and do not squeak (oil if needed)

  Yes

  No

  N/A

• 2        Can all adjustments be moved safely

  Yes

  No

  N/A

• 3        Are any bolts missing

  Compliant

  Non-Compliant

  N/A

• 4        Are all nuts and bolts tightened

  Yes

  No

  N/A

• 5 Condition of seats and pads

  Good

  Fair

  Poor

  N/A

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

KNEELING LEG CURL

• 1       Hinges move smoothly and do not squeak (oil if needed)

  Yes

  No

  N/A

• 2        Can all adjustments be moved safely

  Yes

  No

  N/A

• 3        Are any bolts missing

  Compliant

  Non-Compliant

  N/A

• 4        Are all nuts and bolts tightened

  Yes

  No

  N/A

• 5 Condition of seats and pads

  Good

  Fair

  Poor

  N/A

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

GLUTE KICKBACK

• 1       Hinges move smoothly and do not squeak (oil if needed)

  Yes

  No

  N/A

• 2        Can all adjustments be moved safely

  Yes

  No

  N/A

• 3        Are any bolts missing

  Compliant

  Non-Compliant

  N/A

• 4        Are all nuts and bolts tightened

  Yes

  No

  N/A

• 5 Condition of seats and pads

  Good

  Fair

  Poor

  N/A

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

GLUTE DRIVE

• 1       Hinges move smoothly and do not squeak (oil if needed)

  Yes

  No

  N/A

• 2        Can all adjustments be moved safely

  Yes

  No

  N/A

• 3        Are any bolts missing

  Compliant

  Non-Compliant

  N/A

• 4        Are all nuts and bolts tightened

  Yes

  No

  N/A

• 5 Condition of seats and pads

  Good

  Fair

  Poor

  N/A

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

STANDING CALF

• 1       Hinges move smoothly and do not squeak (oil if needed)

  Yes

  No

  N/A

• 2        Can all adjustments be moved safely

  Yes

  No

  N/A

• 3        Are any bolts missing

  Compliant

  Non-Compliant

  N/A

• 4        Are all nuts and bolts tightened

  Yes

  No

  N/A

• 5 Condition of seats and pads

  Good

  Fair

  Poor

  N/A

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

SEATED CALF

• 1       Hinges move smoothly and do not squeak (oil if needed)

  Yes

  No

  N/A

• 2        Can all adjustments be moved safely

  Yes

  No

  N/A

• 3        Are any bolts missing

  Compliant

  Non-Compliant

  N/A

• 4        Are all nuts and bolts tightened

  Yes

  No

  N/A

• 5 Condition of seats and pads

  Good

  Fair

  Poor

  N/A

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

SMITH MACHINE 1 (LEFT)

• 1       Hinges move smoothly and do not squeak (oil if needed)

  Yes

  No

  N/A

• 2        Can all adjustments be moved safely

  Yes

  No

  N/A

• 3 Cables are in good condition

  Yes

  No

  N/A

• 4        Are any bolts missing

  Compliant

  Non-Compliant

  N/A

• 5        Are all nuts and bolts tightened

  Yes

  No

  N/A

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

SMITH MACHINE 2 (RIGHT)

• 1       Hinges move smoothly and do not squeak (oil if needed)

  Yes

  No

  N/A

• 2        Can all adjustments be moved safely

  Yes

  No

  N/A

• 3 Cables are in good condition

  Yes

  No

  N/A

• 4        Are any bolts missing

  Compliant

  Non-Compliant

  N/A

• 5        Are all nuts and bolts tightened

  Yes

  No

  N/A

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