Appendix E: Sample Playground Inspection Form
Sample Playground Inspection Form[1]
| Playground Location: ______________________
Inspected By: ____________________________ |
Time: ________________
Date: ________________
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| General Hazards | OK | IF NOT OK, COMMENTS OR ACTIONS TO BE TAKEN | |
| 1. There are no sharp points, corners, or edges? | ☐ |
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| 2. There are no protrusions or projections? | ☐ |
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| 3. There are no pinch points, crush points, or exposed moving parts? | ☐ | ||
| 4. Potential clothing entanglement hazards have been eliminated? | ☐ |
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| 5. There are no missing or damaged protective caps or plugs? | ☐ | ||
| 6. Hanging tree branches have been trimmed (6’ clearance)? | ☐ | ||
| 7. Fall zones not per CPSC (6’ perimeter all directions)? | ☐ |
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| 8. Openings < 3 ½” or > 9” to prevent head entrapment? | ☐ |
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| 9. Footings exposed, cracked or loose in ground? | ☐ |
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| 10. Trip hazards, broken glass, trash, ropes, tree roots or foreign objects in play area have been removed? | ☐ | | |
| Play Structures | OK | IF NOT OK, COMMENTS OR ACTIONS TO BE TAKEN | |||
| 1. Broken supports or anchors? | ☐ | ||||
| 2. Pipe ends missing plugs or caps? | ☐ | ||||
| 3. Broken or missing rails/rungs/steps? | ☐ | | |||
| 4. Protruding bolt heads or threads? | ☐ | ||||
| 5. Loose, missing, worn or rusted bolts/nuts/or other fasteners? | ☐ | ||||
| 6. Broken clamps? | ☐ | ||||
| 7. Peeling or chipped paint? | ☐ | | |||
| 8. Entrapment/pinch or crush points? | ☐ | ||||
| 9. Vinyl coated decks/platforms/steps have visible cracks or peeling? | ☐ | ||||
| 10. Excessive wear of any component/slide part? | ☐ | ||||
| 11. Wooden equipment is free of splinters, checking, large cracks, warping, and rot? | ☐ | ||||
| 12. General condition/appearance? | ☐ | _____ Good _____ Fair _____ Poor | |||
| Slides | OK | IF NOT OK, COMMENTS OR ACTIONS TO BE TAKEN
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| 1. Slide bedways have imperfections? | ☐ | ||||
| 2. Handrails loose or missing? | ☐ | ||||
| 3. Steps broken or missing, or flaws/cracks? | ☐ | ||||
| 4. Sit down transition platform present? | ☐ | ||||
| 5. Safety rails or sit-down canopy at bedway entry present? | ☐ | ||||
| 6. Slide exit parallel to ground? | ☐ | ||||
| 7. Safety surface at slide exit has been leveled or repaired? | ☐ | ||||
| 8. Fall zone adequate on all sides? | ☐ | ||||
| 9. General condition/appearance? | ☐ | _____ Good _____ Fair _____ Poor | |||
| Swings | OK | IF NOT OK, COMMENTS OR ACTIONS TO BE TAKEN | |||
| 1. Broken, twisted, worn, rusted chain? | ☐ | ||||
| 2. Inadequate (non-commercial) chain? | ☐ | | |||
| 3. Worn, rusted or broken swing hangers? | ☐ | ||||
| 4. Open, worn or rusted “S” hooks (dime will not pass through)? | ☐ | ||||
| 5. Grommets show wear or rust? | ☐ | ||||
| 6. Missing, worn or cracked swing seats? | ☐ | ||||
| 7. Inadequate fall zone around swings? | ☐ | ||||
| 8. Swing frame damaged? | ☐ | ||||
| 9. Swing chain wrapped around top rail? | ☐ | ||||
| 10. Safety surface worn or scattered? | ☐ | ||||
| 11. Loose, missing or protruding bolts? | ☐ | ||||
| 12. General condition/appearance? | ☐ |
_____ Good _____ Fair _____ Poor |
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| Surfacing | OK | IF NOT OK, COMMENTS OR ACTIONS TO BE TAKEN | ||
| 1. Safety surface depth sufficient (12”)? | ☐ |
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| 2. Inadequate safety surface material (other than ASTM surfacing material)? | ☐ | |||
| 3. Does safety surface comply with ADA? | ☐ | _____ Yes _____ No _____ Don’t know | ||
| 4. Poor drainage area (standing water) or potential problems? | ☐ |
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| 5. Areas of compaction, kick-out, or wear have been leveled or repaired? | ☐ | | ||
| 6. Sidewalks, paved surfaces, steps, and platforms have been swept or cleaned of loose surface materials and debris? | ☐ |
| Freestanding Climbers/Monkey Bars | OK | IF NOT OK, COMMENTS OR ACTIONS TO BE TAKEN | |||
| 1. Not free-fall design? | ☐ | ||||
| 2. Loose or broken rails or rungs? | ☐ | ||||
| 3. Need painting? | ☐ | ||||
| 4. Tire worn, cut or broken? | ☐ | ||||
| 5. Plastic structures are free of holes and cracks? | ☐ | ||||
| 6. General condition/appearance? | ☐ | _____ Good _____ Fair _____ Poor | |||
NOTES/COMMENTS:
[1] Public Playground Safety Handbook by the U.S. Consumer Product Safety Commission is in the public domain
