SIMPLY GYM TREADMILL - BLANK

• Site conducted

  Select

• Conducted on

  Date

• Prepared by

• Location
  Address

Treadmill 1

• 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

• 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 5

• 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 6

• 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 7

• 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 8

• 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 9

• 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 10

• 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 11

• 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 12

• 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 13

• 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 14

• 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 15

• 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 16

• Yes

  No

  N/A

• Yes

  No

  N/A

• Yes

  No

  N/A