YMCA of the Pikes Peak Region - Safety & Infrastructure Audit

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by Jason Pearce

• Location
  Address

• Personnel

Building Communication System(s)

• Functioning Paging and or radio communication system.

  Select Safe Questionable At Risk N/A

  • Safe
  • Questionable
  • At Risk
  • N/A

• Notes:

  Safe

  At Risk

  N/A

• Add media

  Media

Electrical -Overall

• Electrical - Panels are Free of Obstructions (36")

  Select Safe Questionable At Risk N/A

  • Safe
  • Questionable
  • At Risk
  • N/A

• Electrical - Major Infrastructure Issues

  Select Safe Questionable At Risk N/A

  • Safe
  • Questionable
  • At Risk
  • N/A

• GFCI Outlets Test and Perform Correctly

  Select Safe Questionable At Risk N/A

  • Safe
  • Questionable
  • At Risk
  • N/A

• Lighting Functions as Designed

  Select Safe Questionable At Risk N/A

  • Safe
  • Questionable
  • At Risk
  • N/A

• Lock-Out Tag-Out Kit On-Site

  Select Safe Questionable At Risk N/A

  • Safe
  • Questionable
  • At Risk
  • N/A

• Notes:

  Safe

  At Risk

  N/A

• Add media

  Media

Fire/Emergency System

• 4 Fire Drills Completed Annually

  Select Safe Questionable At Risk N/A

  • Safe
  • Questionable
  • At Risk
  • N/A

• AED Daily Checks

  Select Safe Questionable At Risk N/A

  • Safe
  • Questionable
  • At Risk
  • N/A

• AED Equipment is complete and rescue ready

  Select Safe Questionable At Risk N/A

  • Safe
  • Questionable
  • At Risk
  • N/A

• Alarm Panel Functions - based upon up to date test and inspection on-file

  Select Safe Questionable At Risk N/A

  • Safe
  • Questionable
  • At Risk
  • N/A

• Audible Alarm Alerts Function

  Select Safe Questionable At Risk N/A

  • Safe
  • Questionable
  • At Risk
  • N/A

• Back flow Testing - Current Inspection On-File

  Select Safe Questionable At Risk N/A

  • Safe
  • Questionable
  • At Risk
  • N/A

• Emergency Lighting Stations Function

  Select Safe Questionable At Risk N/A

  • Safe
  • Questionable
  • At Risk
  • N/A

• Exit Signs Illuminate/Function

  Select Safe Questionable At Risk N/A

  • Safe
  • Questionable
  • At Risk
  • N/A

• Evacuation Routes Are Posted & Current.

  Select Safe Questionable At Risk N/A

  • Safe
  • Questionable
  • At Risk
  • N/A

• Fire Doors are Functional

  Select Safe Questionable At Risk N/A

  • Safe
  • Questionable
  • At Risk
  • N/A

• Fire Department Inspection (current) On-File

  Select Safe Questionable At Risk N/A

  • Safe
  • Questionable
  • At Risk
  • N/A

• Fire Extinguisher checks monthly.

  Select Safe Questionable At Risk N/A

  • Safe
  • Questionable
  • At Risk
  • N/A

• Pull Stations Function

  Select Safe Questionable At Risk N/A

  • Safe
  • Questionable
  • At Risk
  • N/A

• Strobe Light Stations Function

  Select Safe Questionable At Risk N/A

  • Safe
  • Questionable
  • At Risk
  • N/A

• Notes:

  Safe

  At Risk

  N/A

• Add media

  Media

Mechanical/Pumps/HVAC - Overall

• Exhaust Fans - Visible Age/Condition

  Select Safe Questionable At Risk N/A

  • Safe
  • Questionable
  • At Risk
  • N/A

• Current Boiler Inspection Posted

  Select Safe Questionable At Risk N/A

  • Safe
  • Questionable
  • At Risk
  • N/A

• HVAC - appears to be balanced/positive air movement

  Select Safe Questionable At Risk N/A

  • Safe
  • Questionable
  • At Risk
  • N/A

• HVAC - Visible Age/Condition

  Select Safe Questionable At Risk N/A

  • Safe
  • Questionable
  • At Risk
  • N/A

• Pumps/Motors - Visible Age/Condition

  Select Safe Questionable At Risk N/A

  • Safe
  • Questionable
  • At Risk
  • N/A

• Notes:

  Safe

  At Risk

  N/A

• Add media

  Media

Aquatics - Pools/Hot Tub(s)

• Adequate Lighting.

  Safe

  Questionable

  At Risk

  N/A

• ADA Lifts are Functional

  Safe

  Questionable

  At Risk

  N/A

• Play Structure Condition

  Select Safe Questionable At Risk N/A

  • Safe
  • Questionable
  • At Risk
  • N/A

• Pool Drains are Secured in Place

  Select Safe Questionable At Risk N/A

  • Safe
  • Questionable
  • At Risk
  • N/A

• Pool Chemical Logs

  Select Safe Questionable At Risk N/A

  • Safe
  • Questionable
  • At Risk
  • N/A

• Pool Rules Posted

  Select Safe Questionable At Risk N/A

  • Safe
  • Questionable
  • At Risk
  • N/A

• Portable Stairs Condition

  Select Safe Questionable At Risk N/A

  • Safe
  • Questionable
  • At Risk
  • N/A

• Slide Condition

  Select Safe Questionable At Risk N/A

  • Safe
  • Questionable
  • At Risk
  • N/A

• Tile & Floor Condition

  Select Safe Questionable At Risk N/A

  • Safe
  • Questionable
  • At Risk
  • N/A

• Notes:

  Safe

  At Risk

  N/A

• Add media

  Media

Chemicals/PPE

• Applicable/Correct NFPA Placards

  Select Safe Questionable At Risk N/A

  • Safe
  • Questionable
  • At Risk
  • N/A

• Chemical Containers are Properly Labeled

  Select Safe Questionable At Risk N/A

  • Safe
  • Questionable
  • At Risk
  • N/A

• Chemical Eye Wash/Shower Tested/Current Inspections On-File

  Select Safe Questionable At Risk N/A

  • Safe
  • Questionable
  • At Risk
  • N/A

• Hazardous Chemicals Stored Correctly/Secondary Containment

  Select Safe Questionable At Risk N/A

  • Safe
  • Questionable
  • At Risk
  • N/A

• PPE Available and Stored Correctly

  Select Safe Questionable At Risk N/A

  • Safe
  • Questionable
  • At Risk
  • N/A

• SDS Up-To-Date in Chemical Area or Electronic

  Select Safe Questionable At Risk N/A

  • Safe
  • Questionable
  • At Risk
  • N/A

• SDS Up-To-Date at Main Desk or Electronic

  Select Safe Questionable At Risk N/A

  • Safe
  • Questionable
  • At Risk
  • N/A

• SDS Poster in Chemical Area(s).

  Select Safe Questionable At Risk N/A

  • Safe
  • Questionable
  • At Risk
  • N/A

• Chemical list at the front of each SDS binder.

  Select Safe Questionable At Risk N/A

  • Safe
  • Questionable
  • At Risk
  • N/A

• Notes:

  Safe

  At Risk

  N/A

• Add media

  Media

Plumbing -Overall

• Plumbing - Major Infrastructure Issues

  Select Safe Questionable At Risk N/A

  • Safe
  • Questionable
  • At Risk
  • N/A

• Plumbing - Visible Age/Condition

  Select Safe Questionable At Risk N/A

  • Safe
  • Questionable
  • At Risk
  • N/A

• Plumbing - Visible Leaks

  Select Safe Questionable At Risk N/A

  • Safe
  • Questionable
  • At Risk
  • N/A

• Plumbing - Safety Concerns

  Select Safe Questionable At Risk N/A

  • Safe
  • Questionable
  • At Risk
  • N/A

• Notes:

  Safe

  At Risk

  N/A

• Add media

  Media

Exterior and Parking

• Curbs/Islands

  Select Safe Questionable At Risk N/A

  • Safe
  • Questionable
  • At Risk
  • N/A

• Drain Downspouts

  Select Safe Questionable At Risk N/A

  • Safe
  • Questionable
  • At Risk
  • N/A

• Drive/Entry Way(s)/Drainage

  Select Safe Questionable At Risk N/A

  • Safe
  • Questionable
  • At Risk
  • N/A

• Exterior Doors are Secure

  Select Safe Questionable At Risk N/A

  • Safe
  • Questionable
  • At Risk
  • N/A

• Handicap parking signage.

  Select Safe Questionable At Risk N/A

  • Safe
  • Questionable
  • At Risk
  • N/A

• Landscaping

  Select Safe Questionable At Risk N/A

  • Safe
  • Questionable
  • At Risk
  • N/A

• Lighting is functional and adequate.

  Select Safe Questionable At Risk N/A

  • Safe
  • Questionable
  • At Risk
  • N/A

• Pavement Condition

  Select Safe Questionable At Risk N/A

  • Safe
  • Questionable
  • At Risk
  • N/A

• Pavement Stripe/Markings

  Select Safe Questionable At Risk N/A

  • Safe
  • Questionable
  • At Risk
  • N/A

• Signage

  Select Safe Questionable At Risk N/A

  • Safe
  • Questionable
  • At Risk
  • N/A

• Walkway Condition

  Select Safe Questionable At Risk N/A

  • Safe
  • Questionable
  • At Risk
  • N/A

• Walls/Paint

  Select Safe Questionable At Risk N/A

  • Safe
  • Questionable
  • At Risk
  • N/A

• Notes:

  Safe

  At Risk

  N/A

• Add media

  Media

Roof Structure(s)

• Roof Drainage Functions as Designed

  Select Safe Questionable At Risk N/A

  • Safe
  • Questionable
  • At Risk
  • N/A

• Roof HVAC Unit(s) Visual

  Select Safe Questionable At Risk N/A

  • Safe
  • Questionable
  • At Risk
  • N/A

• Roof Structure and/or Visible Damage

  Select Safe Questionable At Risk N/A

  • Safe
  • Questionable
  • At Risk
  • N/A

• Notes:

  Safe

  At Risk

  N/A

• Add media

  Media

Childwatch

• Chemical Containers are Properly Labeled

  Select Safe Questionable At Risk N/A

  • Safe
  • Questionable
  • At Risk
  • N/A

• Floors

  Select Safe Questionable At Risk N/A

  • Safe
  • Questionable
  • At Risk
  • N/A

• Signage

  Select Safe Questionable At Risk N/A

  • Safe
  • Questionable
  • At Risk
  • N/A

• Kitchen

  Select Safe Questionable At Risk N/A

  • Safe
  • Questionable
  • At Risk
  • N/A

• Equipment/Toys

  Select Safe Questionable At Risk N/A

  • Safe
  • Questionable
  • At Risk
  • N/A

• Storage/Shelving Safe and Anchored

  Select Safe Questionable At Risk N/A

  • Safe
  • Questionable
  • At Risk
  • N/A

• Vents

  Select Safe Questionable At Risk N/A

  • Safe
  • Questionable
  • At Risk
  • N/A

• Playground

  Select Safe Questionable At Risk N/A

  • Safe
  • Questionable
  • At Risk
  • N/A

• Desk

  Select Safe Questionable At Risk N/A

  • Safe
  • Questionable
  • At Risk
  • N/A

• Walls/Paint

  Select Safe Questionable At Risk N/A

  • Safe
  • Questionable
  • At Risk
  • N/A

• Restrooms

  Select Safe Questionable At Risk N/A

  • Safe
  • Questionable
  • At Risk
  • N/A

• Notes:

  Safe

  At Risk

  N/A

• Add media

  Media

Climbing Wall/Ropes

• Annual Inspection on file

  Select Safe Questionable At Risk N/A

  • Safe
  • Questionable
  • At Risk
  • N/A

• Notes:

  Safe

  At Risk

  N/A

• Add media

  Media

Gyms

• Cable system(s) annual inspection on-file

  Select Safe Questionable At Risk N/A

  • Safe
  • Questionable
  • At Risk
  • N/A

• Cable system(s) condition

  Select Safe Questionable At Risk N/A

  • Safe
  • Questionable
  • At Risk
  • N/A

• Ceiling Condition

  Select Safe Questionable At Risk N/A

  • Safe
  • Questionable
  • At Risk
  • N/A

• Floor Condition

  Select Safe Questionable At Risk N/A

  • Safe
  • Questionable
  • At Risk
  • N/A

• Mat Condition

  Select Safe Questionable At Risk N/A

  • Safe
  • Questionable
  • At Risk
  • N/A

• Notes:

  Safe

  At Risk

  N/A

• Add media

  Media

Elevator(s)

• Current inspection on-file/posted in elevator

  Select Safe Questionable At Risk N/A

  • Safe
  • Questionable
  • At Risk
  • N/A

• Notes:

  Safe

  At Risk

  N/A

• Add media

  Media

Flooring Overall

• Excessive Wear

  Select Safe Questionable At Risk N/A

  • Safe
  • Questionable
  • At Risk
  • N/A

• Trip Hazards

  Select Safe Questionable At Risk N/A

  • Safe
  • Questionable
  • At Risk
  • N/A

• Notes:

  Safe

  At Risk

  N/A

• Add media

  Media

Office Areas

• Cabinets/Shelving Safe and Anchored

  Select Safe Questionable At Risk N/A

  • Safe
  • Questionable
  • At Risk
  • N/A

• Electrical & Wiring

  Select Safe Questionable At Risk N/A

  • Safe
  • Questionable
  • At Risk
  • N/A

• Trip Hazards

  Select Safe Questionable At Risk N/A

  • Safe
  • Questionable
  • At Risk
  • N/A

• Notes:

  Safe

  At Risk

  N/A

• Add media

  Media

Slip Hazard or Frequently Wet Areas

• Mitigation measures in place

  Select Safe Questionable At Risk N/A

  • Safe
  • Questionable
  • At Risk
  • N/A

• Notes:

  Safe

  At Risk

  N/A

• Add media

  Media

Additional Items

• Area of Rescue Assistance Signage Posted at elevator entrance or stairway if N/A elevator.

  Select Safe Questionable At Risk N/A

  • Safe
  • Questionable
  • At Risk
  • N/A

• Confined Space Signage is posted

  Select Safe Questionable At Risk N/A

  • Safe
  • Questionable
  • At Risk
  • N/A

• No Photography Signage in Place

  Select Safe Questionable At Risk N/A

  • Safe
  • Questionable
  • At Risk
  • N/A

• Soccer Goal Anchor System in Place

  Select Safe Questionable At Risk N/A

  • Safe
  • Questionable
  • At Risk
  • N/A

• Storage or Unused Areas Free of Clutter

  Select Safe Questionable At Risk N/A

  • Safe
  • Questionable
  • At Risk
  • N/A

• Video Recording is operational

  Select Safe Questionable At Risk N/A

  • Safe
  • Questionable
  • At Risk
  • N/A

• Notes:

  Safe

  At Risk

  N/A

• Add media

  Media