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Playground Inspection Form
North Livingston Elementary
Inspector
First
Last
Date
MM
/
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YYYY
Playground
preschool
main
General Playground Environment
Signage
In place and in good condition
Needs improvement
Trash receptacles
In place
emptied
not emptied
needs improvement
General Surfacing Material
Impact absorbing material
in play areas under equipment
depth is appropriate
resilient and non-compacted
needs improvement
Surfaces
free of tripping hazards
needs improvement
Drainage
efficient and acceptable in play areas
needs improvement
All Equipment
Free of:
warping
bending
cracking
rust
breakage
protruding bolt ends
splinters
sharp edges
protrusions or points
deterioration
no exposed ends or tubing on ends present
chipped paint
area needs improvement
Use zone
free of obstacles
no sharp object in fall zone
needs improvement
Moving Equipment
Fastening or connection
tight and free of wear
needs improvement
Swing hooks
free of wear
less than dime spacing in s hooks
chains secure in hooks
needs improvement
Chains
Free of rust
secure, not breaking apart
needs improvement
Lubrication
swings not squeeky
moving parts appear lubricated
needs improvement
Crunch points
area is free of crunch points
needs improvement
Any area marked "needs improvement" above requires explanation here:
Explanation of follow-up repairs/action:
Personnel following-up
First
Last
Date of follow-up
MM
/
DD
/
YYYY
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