Playground Safety Audit Form – Fill Out and Use This PDF

Playground Safety Audit Form is an essential tool for assessing the safety of playground areas and recreational facilities. It allows professionals to effectively risk-assess playgrounds, ensuring they are meeting applicable standards and up to date in terms of danger prevention policies. Careful consideration must be taken when conducting audits and performing inspections of such areas, as the safety of children must always be the utmost priority. The Checklist provides a comprehensive list that offers a thorough review of critical standards with regards to survey components, allowing inspection teams to reports risk factors and take corrective actions as needed. The Playground Safety Audit Form offers detailed assessment parameters on different aspects like surfacing, access and use, erosion potentials alongside issues related to design among other items. This ensures compliance with guidelines set out by the relevant associations or organizations around the world.

Playground Safety Audit Form PDF Details

Playgrounds provide an important recreational opportunity for children and families, but it’s essential to ensure that they are safe and well-maintained. A playground safety audit is a critical tool used to verify the condition of any given play area, ensuring that anything from falls and slips to electrical shocks can be avoided. In this article, we will go through the importance of a playground safety audit as well as how you can create your own customized form. We will also discuss what questions should be asked when doing inspections and some best practices for following up on any corrective action items needed to maintain proper playground safety standards. Read on to get started!

Question	Answer
Form Name	Playground Safety Audit Form
Form Length	61 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	15 min 15 sec
Other names	PSINA CD_61pgs_51 playground audit form

Form Preview Example

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, 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

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

GENERAL ENVIRONMENT(continued)

Page 3

7/21/2008

		Compliant	Non-comp	Priority
GENERAL ENVIRONMENT CONDITIONS		(YES)	(NO)	Rating	COMMENTS

4.	If needed, fence is provided for perimeter
	concerns w/in 100' of border. See Pg 2 for
	list of concerns. (CPSC 2.1)

5.	Shaded area is provided. (CPSC 2.1.1)

6.	Play area is visible to deter inappropriate
	behavior. (CPSC 2.2.4)

7.	Equipment not recommended on public
	playgrounds include… climbing ropes
	not secured at both ends, trampolines,
	swinging gates, giant strides, heavy metal
	swings (animal swings), multiple occupancy
	swings (except tire swings), rope swings,
	swinging dual exercise rings and trapeze
	bars. (CPSC 2.3.1)

8.	Playground is accessed safely by a
	sidewalk that is free of standing water,
	pea gravel, and low branches.

9.	Seating (benches, tables) is in good
	condition (free of splinters, missing
	hardware/slats, protruding bolts, etc).

10.	Signs on all bordering streets advise
	motorists that a playground is nearby.

11.	Trash receptacles are provided and
	located outside of play area.

5	©2009 International Playground Safety Institute, LLC

MATERIALS AND MANUFACTURE

Page 4

7/21/2008

		Compliant	Non-comp	Priority
GENERAL CONDITIONS		(YES)	(NO)	Rating	COMMENTS

1.	Playground equipment is manufactured
	and constructed only of materials that
	have a demonstrated durability.
	(ASTM 4.1; CPSC 2.5.1)

2.	Metals subject to structural degradation
	such as rust or corrosion are painted,
	galvanized or otherwise treated.
	(ASTM 4.1.1; CPSC 2.5.1)

3.	Wood materials are naturally rot-resistant
	or treated to avoid deterioration.
	(ASTM 4.1.3; CPSC 2.5.5)

4.	Plastics and other materials that
	experience ultraviolet (UV) degradation
	are UV protected. (ASTM 4.1.1)

5.	Users cannot ingest, inhale, or absorb
	any potentially hazardous amounts of
	substances through body surfaces as
	a result of contact with the equipment.
	(ASTM 4.1.2; CPSC 2.5.4)

6.	Moving suspended elements are connected
	to the fixed support w/ bearings or bearing
	surfaces that serve to reduce friction and
	wear. (ASTM 4.2.3; CPSC 2.5.2)

7.	Steel cable permanently affixed to a hanger
	assembly performs as a bearing surface.
	Cable ends are inaccessible or capped.
	Cables or steel-cored ropes are protected
	to prevent fraying, loosening, unraveling,
	or excessive shifting. (ASTM 4.2.3.1)

8.	Creosote-treated wood and coatings
	that contain pesticides are not used.
	(CPSC 2.5.5)

9.	CCA-treated wood is not used, or is
	regularly coated (min. once/year) w/ a
	penetrating sealant or stain. (CPSC 2.5.5.1)

10.	Play structures are anchored to the
	ground and not intended to be relocated.
	(ASTM 5.3)

6	©2009 International Playground Safety Institute, LLC

		USE		ZONES
Page 5						7/21/2008

		Compliant	Non-comp		Priority
General Conditions		(YES)		(NO)	Rating	Comments

A. Stationary Equipment

1.	Use zone extends min. 72" on all sides of
	structure. Equipment intended for user to
	maintain contact w/ the ground during play
	(i.e. talk tubes, activity panels) is exempt
	from use zone requirements. (ASTM 9.2.1,
	Fig. A1-32; CPSC 5.3.9)

2.	Use zones for 2 or more stationary
	structures that are play-functionally linked
	are treatd as if separate components are
	part of a composite unit. (ASTM 9.2.2,
	Fig. A1-44; CPSC 5.3.9)

3.	Use zones of stationary equipment and
	other equipment may overlap. If adjacent
	designated play surfaces of each structure
	are < 30", the min. distance between
	equipment is 72". If adjacent designated
	play surfaces of either structure are > 30",
	the min. distance between equipment is
	108". (ASTM 9.2.3, Fig. A1-32; CPSC 5.3.9)

B. Rotating Equipment

1. Minimum use zone for rotating eqpt is 72"
	from perimeter. No other structure may
	overlap this use zone. Rotating eqpt < 20"
	diameter are exempt and may be 72" apart
	when each have designated play surfaces <
	30" high, or 108" apart when one or both
	have designated play surfaces > 30" high.
	(ASTM 9.3.2, Fig. A1-33; CPSC 5.3.4.1)

2. Single user equipment (i.e. sand diggers)
	where user maintains contact w/ the
	ground are exempt from use zone
	requirements. (ASTM 9.2.3)

3. No other structure overlaps the use zone
	of eqpt that rotates around a horizontal
	axis w/ a designated play surface > 30".
	(ASTM 9.3.5; CPSC 5.3.4.1)

7	©2009 International Playground Safety Institute, LLC

USE ZONES(continued)

Page 6

7/21/2008

		Compliant	Non-comp	Priority
General Conditions		(YES)	(NO)	Rating	Comments

C. To-Fro Swings

1.	Use zone to front and rear of to-fro swing
	is 2X where X = distance between pivot
	point and surfacing. (ASTM 9.4.1.1, Fig.
	A1-34 and A1-35; CPSC 5.3.8.3.3)

2.	For swings w/ fully enclosed seats, use
	zone is 2W where W = distance between
	pivot point and top of occupied sitting
	surface. (ASTM 9.4.1.2, Fig. A1-36 and
	A1-37; CPSC 5.3.8.3.3)

3.	No other play structure overlaps the
	front-to-rear use zone of a to-fro swing.
	(ASTM 9.4.1.3, Fig. A1-34-A1-37;
	CPSC 5.3.8.3.3)

4.	Use zone width is at least as wide as
	distance measured from 30" on either
	side of outer suspending rope, chain,
	or cable measured 60" above surfacing.
	(ASTM 9.4.1.4, Figs. A1-34-A1-37)

5.	Use zone around support structure is
	min. 72" in all directions from the structure.
	Support structure use zones for adjacent
	to-fro swings may overlap (6' apart).
	Support structure use zones may
	overlap w/ other equipment w/ min.
	108" between structures. (ASTM 9.4.1.5,
	Figs A1-34-A137; CPSC 5.3.8.3.3)

D. Rotating Swings

1. Use zone is min. horizontal distance of
	Y+30", where Y = vertical distance between
	pivot point and top of swing seat. (ASTM
	9.4.2.1, Fig. A1-38; CPSC 5.3.8.4.1)

2. No other play structure use zone overlaps
	rotating swing use zone. (ASTM 9.4.2.2;
	CPSC 5.3.8.4.1)

3. Use zone around support structure is
	min.72" in all directions from the structure.
	(ASTM 9.4.2.3; CPSC 5.3.8.4.1)

4. Support structures of adjacent rotating
	swings may overlap (6' apart), however,
	swing bay clearances (Y+30") are not
	overlapped. (ASTM 9.4.2.4, Fig A1-38;
	CPSC 5.3.8.4.1)

5. Support structure use zone may overlap
	use zone of other equipment w/ min.
	108" between structures. (ASTM 9.4.2.5;
	CPSC 5.3.9)

			8		©2009 International Playground Safety Institute, LLC

USE ZONES(continued)

Page 7

7/21/2008

			Compliant	Non-comp	Priority
	General Conditions		(YES)	(NO)	Rating	Comments

	E. Rocking/Springing Equipment

1.		Use zone for equipment intended for
		sitting is min. 72" in all directions from
		at-rest perimeter. (ASTM 9.5.1.1,
		Fig A1-39; CPSC 5.3.7)

2.		Use zone of adjacent eqpt may overlap
		when each structure has max. seat height
		of 30". (ASTM 9.5.1.2; CPSC 5.3.7)

3.		Use zone of rocking/springing eqpt may
		overlap to 72" apart when each structure
		has max. designated play surface height <
		30"; and to 108" apart when either has a
		designated play surface higher than 30".
		(ASTM 9.5.1.3; CPSC 5.3.7)

4.		Use zone for rocking/springing eqpt
		intended for standing is min. 84" in all
		directions from the at-rest perimeter.
		(ASTM 9.5.2.1, Fig A1-39)

5.		No other play structure use zone overlaps
		the standing rocking/springing structure
		use zone. (ASTM 9.5.2.2)

6.		Equipment w/ limited movement or eqpt
		on which user cannot develop enough
		force to launch or propel themselves
		away from the eqpt is exempt from
		these requirements. (ASTM 9.5.2.3)

	F. Slides

	1. Use zone around steps or ladder, chute,
		platform or slide bed of straight, wavy,
		or spiral slides is min. 72" from perimeter.
		(ASTM 9.6.1, Fig A1-40; CPSC 5.3.6.5)

	2. Use zone at exit is min. X where X =
		vertical distance from highest point of
		sliding surface to surfacing. Use zone at
		slide exit is min. 72" and need not be > 96".
		(ASTM 9.6.2, 9.6.2.1; CPSC 5.3.6.5)

	3. A clear zone, free of equipment, extends
		min. 21" from inside of each side wall
		from the end of the slide to the perimeter
		of the slide use zone. Clearance zones
		for two or more parallel slide beds may
		overlap. Clearance zones for converging
		slides may not overlap. (ASTM 9.6.3,
		Figs A1-41-43; CPSC Appendix B.2.3)

9	©2009 International Playground Safety Institute, LLC

USE ZONES(continued)

Page 8

7/21/2008

		Compliant	Non-comp	Priority
General Conditions		(YES)	(NO)	Rating	Comments

G. Track Rides

1.	Track ride use zones are min. 72" in all
	directions from equipment. (ASTM 9.9.1;
	CPSC 5.3.9)

H. Composite Structures

1.	Use zone is min. 72" from structure
	perimeter, and complies w/ use zones
	established for individual types of eqpt.
	(ASTM 9.7.1.2; CPSC 5.3.9)

2.	Professional judgment may be used to
	eliminate hazards created by circulation
	conflicts or adjacent structures that are
	in close proximity. (ASTM 9.7.2)

I.	Placement of Equipment

1.	Sufficient space is provided between
	all adjacent structures and individual
	play eqpt for the purposes of play and
	circulation. (ASTM 9.8; CPSC 2.2.3)

2.	In settings where periodic overcrowding
	is likely, a supplemental circulation area
	beyond the use zone is provided, using
	professional judgement of owner/operator.
	(ASTM 9.8.2)

3.	Moving equipment such as swings and
	rotating equipment are located near the
	periphery away from circulation routes.
	(ASTM 9.8.3; CPSC 2.2.3)

4.	Overhead obstructions within play
	structure usezones are min. 84" from
	each designated play surface, the use
	zone, or the pivot point of swings.
	(ASTM 9.8.4.1)

5.	Overhead utility line clearances comply
	w/ all local, state, and national codes
	such as National Electrical Safety Code.
	(ASTM 9.8.4.2)

10	©2009 International Playground Safety Institute, LLC

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