3. 
6. Park Safety and Maintenance Checklist
8. Park Name*
9. Location*
11. Inspector*
12. Date
    Date
16. A. Parking
18. 1. Check here if no problems found with Parking
20. 1. Uneven concrete/asphalt surface
21. Deficiency Noted
22. Picture
25. Corrective Action
26. Date Corrected
    Date Corrected
28. 1. Inadequate lighting (if parks opens in the evenings)
29. Deficiency Noted
30. Picture
33. Corrective Action
34. Date Corrected
    Date Corrected
38. B. Signage
40. 1. Check here if no problems found with Signage
42. 1. Park name identification sign problems
43. Deficiency Noted
44. Picture
47. Corrective Action
48. Date Corrected
    Date Corrected
50. 1. Park hours of operation/rules not posted clearly
51. Deficiency Noted
52. Picture
55. Corrective Action
56. Date Corrected
    Date Corrected
60. C. Walkways
62. 1. Check here if no problems found with Walkways
64. 1. Uneven walking surface/debris present
65. Deficiency Noted
66. Picture
69. Corrective Action
70. Date Corrected
    Date Corrected
72. 1. Ground level not flush with walking surface
73. Deficiency Noted
74. Picture
77. Corrective Action
78. Date Corrected
    Date Corrected
82. D. Fencing
84. 1. Check here if no problems found with Fencing
86. 1. Poor Condition with gaps/openings
87. Deficiency Noted
88. Picture
91. Corrective Action
92. Date Corrected
    Date Corrected
94. 1. Top/Bottom of fence has protruding or sharp edges
95. Deficiency Noted
96. Picture
99. Corrective Action
100. Date Corrected
     Date Corrected
102. 1. Playground not separated from traffic lane by fencing
103. Deficiency Noted
104. Picture
107. Corrective Action
108. Date Corrected
     Date Corrected
112. E. Restrooms
114. 1. Check here if no problems found with Restrooms
116. 1. Faucets/Dispensers in poor condition
117. Deficiency Noted
118. Picture
121. Corrective Action
122. Date Corrected
     Date Corrected
124. 1. Floors wet/filled with debris
125. Deficiency Noted
126. Picture
129. Corrective Action
130. Date Corrected
     Date Corrected
132. 1. Door latch hardware in poor condition
133. Deficiency Noted
134. Picture
137. Corrective Action
138. Date Corrected
     Date Corrected
142. F. Playground
144. 1. Check here if no problems found with Playground
146. 1. Age-appropriate signage not present
147. Deficiency Noted
148. Picture
151. Corrective Action
152. Date Corrected
     Date Corrected
154. 1. Ground cover poorly maintained
155. Deficiency Noted
156. Picture
159. Corrective Action
160. Date Corrected
     Date Corrected
162. 1. Equipment in poor condition; not maintained
163. Deficiency Noted
164. Picture
167. Corrective Action
168. Date Corrected
     Date Corrected
170. 1. Entrapment hazards on equipment
171. Deficiency Noted
172. Picture
175. Corrective Action
176. Date Corrected
     Date Corrected
180. G. Other Park Features
182. 1. Check here if no problems found with other park features
184. 1. Picnic tables in poor condition; found splinters or broken hardware
185. Deficiency Noted
186. Picture
189. Corrective Action
190. Date Corrected
     Date Corrected
192. 1. Water fountains in poor condition; found broken hardware
193. Deficiency Noted
194. Picture
197. Corrective Action
198. Date Corrected
     Date Corrected
200. 1. Trash receptacles not placed throughout park
201. Deficiency Noted
202. Picture
205. Corrective Action
206. Date Corrected
     Date Corrected
208. 1. Barbecue grills in poor condition
209. Deficiency Noted
210. Picture
213. Corrective Action
214. Date Corrected
     Date Corrected
216. Landscaping

     1. Landscaping poorly maintained
217. Deficiency Noted
218. Picture
221. Corrective Action
222. Date Corrected
     Date Corrected
224. 1. Sprinkler system in poor condition
225. Deficiency Noted
226. Picture
229. Corrective Action
230. Date Corrected
     Date Corrected
234. H. Other concerns
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236. 1. Receive an email copy of this form.
237. Email address

     This field is not part of the form submission.

238. Submit

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