Title Page
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Document No.
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School Name
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Conducted on
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Prepared by
General Inspection
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Playground area free of litter and debris
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Equipment not damaged or vandalized
Surfacing
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Adequate depth of surface under and around equipment
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Surfacing material free of glass, debris, or other foreign objects
General Hazards
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Equipment free of sharp points, corners or edges
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Protective caps or plugs not missing or damaged
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Equipment free of potential clothing entanglement hazards
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Playground area free of tripping hazards
Deterioration of Equipment
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Equipment and playground area free from presence of rot, rust, cracks, and splinters
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Equipment safely anchored
Security of Hardware
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Equipment connection, covering or fastening hardware devices not loose or worn
Equipment Use Zones
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Equipment use zones free of obstacles
Drainage Systems
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Playground area free from drainage problems
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Signature
