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Playplace Cleaning Completion Form
What location is being cleaned?
*
Please Select
3756 - Odana - 6910 Odana Road
5612 - Allen - 2626 Allen Blvd
17850 - Waunakee - 651 W. Main Street
19974 - Janesville - 2610 W. Court Street
General Hazard Inspection
Equipment is secure, stable, and in good repair. Ensure equipment is free of any damaged or missing components and hardware.
*
Yes
No
What concerns need to be addressed?
*
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*
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Equipment is free of any sharp edges or hazards.
*
Yes
No
What concerns need to be addressed?
*
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*
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All nets are free of holes, tears, or cuts
*
Yes
No
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*
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*
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Steps or platforms are free of any obstacles and loose treads.
*
Yes
No
What concerns need to be addressed?
*
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*
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Foam-covered pipe work or plastic sleeve is free of damage showing exposed pipe.
*
Yes
No
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*
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*
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All structural clamps, brackets, and cables are in place, tight, and in good repair.
*
Yes
No
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*
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*
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All bolt thread ends have smooth finished caps in areas below 7ft.
*
Yes
No
What concerns need to be addressed?
*
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*
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Plastic surfaces are free of damage and connections have no gaps larger than 5/8".
*
Yes
No
What concerns need to be addressed?
*
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*
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Pads are free of tears and damage.
*
Yes
No
What concerns need to be addressed?
*
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*
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Windows and domes are securely in place and free of missing parts.
*
Yes
No
What concerns need to be addressed?
*
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*
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Safety surface flooring is in good condition with no worn or cracked surfaces.
*
Yes
No
What concerns need to be addressed?
*
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*
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Cleaning Process
Have all of the mats been taken out of the structure and floors underneath have been vaccumed to remove any debris?
*
Yes
No
N/A
The following surfaces have been sprayed with KAY Rapid Multi-Surface Disinfectant Cleaner, left to sit for 30 seconds, and then wiped down with a sanitized towel.
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All handles and steps
All tubes and slides
All mats inside of the structure
All tables and chairs
All floors within the structure
Please provide a picture of all mats having been removed and cleaned outside of the structure.
*
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Please provide multiple pictures of the cleaned unit once completed. Both inside and outside of the structure to show completeness.
*
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Verification
I certify that the playplace has been cleaned properly and verified for safety for the month.
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Name
*
First Name
Last Name
Date
*
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Month
-
Day
Year
Date
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