Outdoor Safety Assessment

Outdoor Safety Assessment
Please complete this form to assess outdoor safety conditions.
Date of Assessment
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Location of Assessment
Street Address
Street Address Line 2
CityState / ProvincePostal / Zip Code
Identify potential hazards in the area
Safety equipment available (check all that apply)
Are there clear emergency exit routes?
Emergency Contact Name
First NameLast Name
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Additional Comments
Should be Empty: