UCPS Playground Inspection

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

General Information

• Is the playground area free of litter and debris?

  Pass

  Fail

• Is there visible damage or vandalism to playground equipment?

  Pass

  Fail

Surfacing

• Is there adequate depth of surface under and around playground equipment?

  Pass

  Fail

• Is surfacing material compacted or deteriorating?

  Pass

  Fail

General Hazards

• Is playground equipment free from sharp points, corners or edges?

  Pass

  Fail

• Are there any missing or damaged caps or plugs?

  Pass

  Fail

• Is equipment free of potential clothing entanglement hazards?

  Pass

  Fail

• Is equipment free of pinching and crushing hazards, shearing points, or exposed morning parts?

  Pass

  Fail

• Is playground free of tripping hazards?

  Pass

  Fail

Equipment Condition

• Is equipment and playground area free of rot, rust, cracks and splinters?

  Pass

  Fail

• Is equipment safely anchored?

  Pass

  Fail

Hardware Security

• Are any equipment connection, covering, or fastening hardware devices loose or worn?

  Pass

  Fail

Equipment Zones

• Are equipment use zones free of obstacles?

  Pass

  Fail

Drainage Systems

• Is playground free of drainage problems?

  Pass

  Fail

• Signature

  Sign