SKETCH LOCATION OF NEEDED REPAIRS
Ground Surfacing
| Circle One
| Comments
|
| There is at least 12 inches deep resilient ground surface (wood chips) under and at least 6 feet around all play equipment | Y / N / NA
| |
| The area around the fixed equipment and the fall zone is free from foreign objects and obstructions (protruding roots, rocks, drain pipes, etc.) | Y / N / NA
| |
| Concrete supports are covered with at least 12 inches of ground cover | Y / N / NA
| |
| The play chip area is free from collections of standing water | Y / N / NA
| |
| The field is free of holes and uneven surfacing | Y / N / NA
| |
| The blacktop and sidewalks are free of holes, cracks and raised surface over ¼ inch | Y / N / NA
| |
| The grounds are free from litter and glass | Y / N / NA
|
Play Structures
| Circle One
| Comments
|
| There are no sharp edges, broken parts, pinching actions or loose bolts | Y / N / NA
| |
| All openings are either less than 3 ½ inches or greater than 9 inches to prevent trapping a child’s head | Y / N / NA
| |
| Wood surfaces are in good repair; no splitting, rot, or excessively worn or warped areas | Y / N / NA
| |
| There are no protrusions longer than 1/8” that can catch clothing | Y / N / NA
| |
| All cables, hooks, chains and links are in good repair (no frayed cables, worn hooks, chains and links, etc) | Y / N / NA
| |
| Painted surfaces are smooth and free from chips or peeling paint | Y / N / NA
| |
| Surfacing Type: | Surfacing Depth: | |
| Moveable backboards (basketball) | Y / N / NA
| |
| Bleachers: Broken or missing boards, fasteners. Bent, broken or cracked support structures, proper tracking of bleachers when extended. | Y / N / NA
|
Other Fixed Equipment
| Circle One
| Comments
|
| Soccer goals, ball walls and backstops are securely anchored in the ground and free of protursions and sharp points | Y / N / NA
| |
| Bike racks, picnic tables and benches are securely anchored and in good repair | Y / N / NA
| |
| Basketball nets are nylon and in good repair | Y / N / NA
| |
| Fence is secure and free from protrusions | Y / N / NA
|
SKETCH LOCATION OF NEEDED REPAIRS
| Maintenance Department |
| Date received ____________________ |
| WO#s assigned | __________ |
| __________ | ||
| __________ | ||
| __________ |