Playground Safety Audit Form – Fill Out and Use This PDF

Playground Safety

Compliance Audit Form

Playground Name/ID Number ______________________________________________

Injuries to children may occur from many types of playground equipment and environmental con-

ditions. The checklist on the following pages will help you to assess and correct safety concerns

that may be present on or near your playground. While it does not cover every potential safety con-

cern in a children’s environment, it is an overview of most known playground safety concerns. The

checklist does not apply to home playground equipment, amusement park equipment, or to equip-

ment normally intended for sports use. The checklist also does not address the many important is-

sues of child development that pertain to play.

The playground safety compliance audit form is not a regulatory standard, but a compilation

of suggested guidelines based upon the Public Playground Safety Handbook written by the U.S.

Consumer Product Safety Commission (CPSC)1 Revised April 2008, American Society for Testing

and Materials (ASTM)2 F1487-07ae¹ Standard, ADA/ABA Accessibility Guidelines July 20043 and

expert opinions from individuals with a vast amount of experience in the field of playground safety.

Acknowledgments:

•Created from the “Statewide Comprehensive Injury Prevention Program” (SCIPP), Department of Public Health, 150 Trecost Street, Boston, MA 02111

•Adapted as Wheaton Park District’s “Initial Playground Safety Audit” September, 1989, Revised December 20, 1990 and November, 1991, Ken Kutska, CPRP

•Edited and updated June, 1992, by Ken Kutska, CPRP, and Kevin Hoffman, ARM, Park District Risk Management Agency

•Edited and updated March, 1998, by Ken Kutska, CPRP, CPSI; Kevin Hoffman, ARM, CPSI, and Tony Malkusak, CPRP, CPSI

•Edited and updated March, 1998, by Ken Kutska, CPRP, CPSI; Kevin Hoffman, ARM, CPSI, and Tony Malkusak, CPRP, CPSI

•Edited and updated March, 2003, by Ken Kutska, CPRP, CPSI; Kevin Hoffman, ARM, CPSI, and Tony Malkusak, CPRP, CPSI

•Excel™ formatted 2004, revised citations to 2008 CPSC Handbook and ASTM F1487-07ae¹ Standard, August, 2008, by Steve Plumb, CPRP, CPSI

•Revised September 2008 by IPSI, LLC, Ken Kutska, CPRP, CPSI, Executive Director

1.U.S. Consumer Product Safety Commission, (CPSC), 4330 East West Highway, Bethesda, MD 20814

2.American Society for Testing and Materials (ASTM), 100 Barr Harbor Drive West Conshohocken, Pennsylvania 19428

3.U.S. Access Board, 1331 F Street, NW, Suite 1000, Washington, DC, 20004

Revised 09/08 ©2009 IPSI, LLC

©

1	©2009 International Playground Safety Institute, LLC

Five Level Safety Concern

Priority Rating System

Rating	Description
Safety Concern Priority	Condition Likely to Cause
Priority 1 Safety Concern	Non-compliant safety concern that may result in
	permanent disability, loss of life or body part.
	Condition should be corrected immediately.
Priority 2 Safety Concern	Non-compliant safety concern that may result in
	temporary disability.
	Condition should be corrected as soon as possible.
Priority 3 Safety Concern	Non-compliant safety concern that is likely to
	cause a minor (non-disabling) injury.
	Condition should be corrected when time permits.
Priority 4 Safety Concern	Non-compliant safety concern whose potential
	to cause an injury is very minimal.
	Condition should be corrected if it worsens.
Priority 5	The item has been determined to be compliant
	with the owner/operator’s operating policy and
	standard of care.
	Continued ongoing preventive maintenance is
	recommended.

2	©2009 International Playground Safety Institute, LLC

Playground Safety Audit Forms

Background Information

Page 1

IMPORTANT: This information has been prepared to assist the agency’s attorney in defending potential litigation. Do not release to any person except an agency official, insurance representative, or an investigating police officer.

Play Area: __________________________________________________________	Date: __________________________
Eqpt Type: __________________________________________________________	Surface: _______________________
Audited By: _________________________________________________________	Intended User Age: _____________

General Environment

1. Category of Playground: (circle all that apply)

Community Park	Public School	Daycare Center
Neighborhood Park/Tot Lot	Private School	Other: ______________________

2.Equipment Inventory: (indicate the number of equipment pieces that exist)

A. Composite Structures		B. Freestanding Eqpt		C. Site Amenities
stairways/step ladders	_______	swings (to-fro)	_______	benches	_______
stairways/step ladders	_______	rotating swings	_______	tables	_______
rigid climbers	_______	seesaws	_______	fountains	_______
flexible climbers	_______	slides	_______	bike racks	_______
decks/platforms	_______	rigid climbers	_______	wheelchair parking	_______
play panels	_______	flexible climbers	_______	signs	_______
slides	_______	upper body eqpt	_______	litter barrels	_______
sliding poles	_______	rocking eqpt	_______	fencing	_______
horizontal ladders	_______	merry-go-round	_______	other	_______
horizontal rings	_______	spinner (< 20" D)	_______	other	_______
track rides	_______	sand play area	_______
crawl tunnels	_______	backhoe digger	_______
clatter/other bridges	_______	play panels	_______
ramps	_______	stepping pods	_______
transfer stations	_______	net climber	_______
roofs	_______	other	_______
other	_______	other	_______
other	_______	other	_______
					Revised 2008 IPSI©
		3		©2009 International Playground Safety Institute, LLC

General Environment (continued)

3. Playground Perimeter Concerns

Directions: Circle all potential concerns that exist, and indicate the actual distance item is from play area border. Evaluate each item with owner against KEY below. Items located within 100’ of playground should be evaluated for possible mitigationn.

Page 2			7/21/2008
	Distance	Priority
Playground Perimeter Concerns	from Border	Rating	Comments
1st public street
2nd public street
3rd public street
4th public street
streets with heavy traffic
water (ponds/streams/ditch)
soccer/football field
baseball/softball field (home plate)
basketball court
parking lot
railroad tracks
trees (not pruned up at least 7’)
golf course
quarry
contaminated area/landfill
other (specify)
other (specify)
other (specify)
		4	©2009 International Playground Safety Institute, LLC