Weekly Playground Inspection Checklist at a glance
What it is: The Weekly Playground Inspection Checklist is a form for a School/Facility and the Date Inspected.
Who signs: Fill in Inspected by.
A filled-in Weekly Playground Inspection Checklist example: a weekly hardware check

How to fill out Weekly Playground Inspection Checklist, box by box
Playground Surfaces

Under Playground Surfaces, mark Yes, No or N/A and add Comments.
Surface materials appropriate?
Surface thickness 12 inches within 6 foot of playground equipment Does it extend 6 feet in all directions from the playground equipment? For swings, does it extend twice the height of the suspending bar in back and front?
Any holes or gaps that need filling in?
Other?
Hardware
Grounds
Equipment

Under Equipment, mark Yes, No or N/A and add Comments.
Do elevated surfaces (platforms, ramps) have guardrails?
Is equipment properly anchored?
Is there at least 9 ft. between play structures > 30" high?
Are spaces that could trap children (i.e., in guardrails/ladder rungs), < 3.5" or > 9"?
Any splintering on wood?
Mark Yes, No or N/A for Surface thickness correct? (12"), and add Comments.
Any sharp points or edges on equipment?
Is equipment in good overall condition?
Other (missing, broken, etc.) ?
Notes and Inspected by
More rules for Weekly Playground Inspection Checklist
This PDF report can be printed and filled in by hand, or completed on a computer and printed. It cannot be saved electronically with ADOBE Reader.
Sources
[1] Weekly Playground Inspection Checklist (Form 18, Revised 12/09) (the Official source link on this page).




