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SAMPLE FORM <br /> ARK <br /> INSPECTOR DATE <br /> L <br /> Look for: Loose fasteners/footings, sharp surfaces, ,sodmetCing parts, surface <br /> problems, vandalism, litter, splitting/decaying <br /> SPLAY COMPONENT OK PROBLEM - DESCRIBE CORRECTIVE ACTION TAKEN DATE <br /> Mainstructure <br /> Regular slide <br /> Spiral slide <br /> (Tube slide <br /> Tire swing <br /> Belt swing <br /> Chain Ladder <br /> "Monkey" bars <br /> Rinq bridge <br /> wood bridge <br /> Metal Arch Climber <br /> Wood Arch Climber <br /> • Tire Climber <br /> Trawl Tube <br /> Arch tunnel <br /> Log roll <br /> Chinning bar <br /> Trolley ride <br /> Firepole <br /> Balance Beam <br /> Rope net <br /> Rope walk <br /> Chain walk <br /> Merry go Round <br /> Swin set slide <br /> Climber - free Stan <br /> "Dish" ride <br /> Diggers <br /> Header <br /> Surface material <br /> Rcfuse/Hazards <br /> Inc <br /> ✓VJ <br />