Rest Area Safety Assessment
Evaluate the safety, cleanliness, and condition of rest areas to ensure public well-being and compliance.
Rest Area Name or Location
*
Date and Time of Assessment
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Assessor's Full Name
*
First Name
Last Name
Contact Email
*
example@example.com
General Safety and Condition Assessment
*
Rows
Excellent
Good
Fair
Poor
Cleanliness of area
1
2
3
4
Lighting (day/night)
5
6
7
8
Signage visibility and clarity
9
10
11
12
Emergency equipment availability
13
14
15
16
Restroom condition
17
18
19
20
Accessibility for disabled
21
22
23
24
Security presence or surveillance
25
26
27
28
Are all emergency exits and routes clearly marked and unobstructed?
*
Yes
No
Not Applicable
Presence of Safety Hazards (check all that apply)
*
Wet/slippery floors
Broken equipment/furniture
Obstructed pathways
Poor lighting
No visible hazards
Other (please specify)
Rate the overall safety of the rest area
*
1
2
3
4
5
Upload photos to support your assessment (optional)
Upload a File
Drag and drop files here
Choose a file
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Additional Comments or Observations
Would you recommend this rest area for public use?
*
Yes
No
With reservations (please explain)
Submit Assessment
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