Content
Skip To Navigation
Skip to Content
1. Select a User Group
2. Select a Category
3. Select an Age Range
Individuals & Caregivers
Physical & Occupational Therapy
Public Health Professionals
Teachers
Individuals & Caregivers
Physical & Occupational Therapy
Public Health Professionals
Teachers
Individuals & Caregivers
Physical & Occupational Therapy
Public Health Professionals
Teachers
Individuals & Caregivers
Physical & Occupational Therapy
Public Health Professionals
Teachers
Individuals & Caregivers
Physical & Occupational Therapy
Public Health Professionals
Teachers
Individuals & Caregedivers
Physical & Occupational Therapy
Public Health Professionals
Teachers
Individuals & Caregivers
Physical & Occupational Therapy
Public Health Professionals
Teachers
Individuals & Caregivers
Physical & Occupational Therapy
Public Health Professionals
Teachers
Individuals & Caregivers
Physical & Occupational Therapy
Public Health Professionals
Teachers
Individuals & Caregivers
Physical & Occupational Therapy
Public Health Professionals
Teachers
Individuals & Caregafgivers
Physical & Occupational Therapy
Public Health Professionals
Teachers
Individuals & Caregivers
Physical & Occupational Therapy
Public Health Professionals
Teachers
Individuals & Caregivers
Physical & Occupational Therapy
Public Health Professionals
Teachers
Individuals & Caregivers
Physical & Occupational Therapy
Public Health Professionals
Teachers
Individuals & Caregivers
Physical & Occupational Therapy
Public Health Professionals
Teachers
Submit
Home
About
iChip
Articles
Directories
Videos
Resources
Contact
Home
About
iChip
Articles
Directories
Videos
Resources
Contact
Request form for Playground
Home
»
Request Forms
Font Size:
A
A
A
A
Name
Address 1
Address 2
City
State
Zip
Country
Phone Number
TTY
Toll-Free
Fax
Website of Playground, City or Town, or Site Owner
Build Date
Date of Last Inspection
If the Playground is located at a park, school, or other facility please fill in box with this information
What would a child, parent and/or a grandparent with a disability enjoy about this playspace? Is it fun for children with and without disabilities?
Is there a story you want to share about the development of this playground?
Contact Name
Contact Title
Contact Phone
Contact TTY
Contact Toll-Free
Contact Fax
Contact Email
Contact Website
Please select the description that best describes the location of this play space, playground or play facility
Municipal Park(City Town or Country)
State Park
National Park
Public Schools
Private Schools
Eating Place
Hotel Motel or Resort
Sporting and Recreational Camp
Recreational Vehicle Park Campground and Campsite
Miscellaneous Amusement and Recreation
Child Day Care Service
Civic Social and Fraternal Association
Water Playground/Splash Pad at Swimming Pool
Private Playground that you must pay a fee to use
Church
Airport
Highway Welcome Center
Other, please Specify
Play Area designed for 6-month to 23-month-olds?
Yes
No
Play Area designed for 2 to 5-year-olds?
Yes
No
Play Area designed for 5 to 12-year-olds
Yes
No
How much of this playground has shade from trees or shade structures
Please provide a genereal description of this play space, playground or play facility in the space provided
Is this play space, playground or play facility accessible via public transportation?
Yes
No
Please indicate which of the following play types this play space, playground or play facility provides on an accessible route:
Balancing
Yes
No
Climbing
Yes
No
Rocking
Yes
No
Sliding
Yes
No
Spinning
Yes
No
Swinging
Yes
No
Other
Please indicate which of the following features this play space, playground or play facility provides on an accesible route:
Balance Apparatus
Yes
No
Climbers
Yes
No
Dramatic Play Areas
Yes
No
Fine Motor Skill Activity
Yes
No
Gross Motor Skill Activity
Yes
No
Interactive Panels
Yes
No
Natural Play Areas
Yes
No
Overhead Climbers
Yes
No
Playhouses
Yes
No
Sand Play Areas
Yes
No
Slides
Yes
No
Social Seating Areas
Yes
No
Spinning Elements
Yes
No
Spinning Riders
Yes
No
Swings
Yes
No
Water Play Areas
Yes
No
Other
Does this play space have freestanding ground level components(i.e., sand diggers, sand tables, and musical elements, etc.) on accessible pathways or route of travel?
Yes
No
If yes, how many?
Please provide the total number of ground level play components available:
Does this play space have at least one spring toy and/ or bouncer has back support and seat belts to assist children in remaining in an upright position:
Yes
No
If yes, how many?
How many of these can be reached from an accessible pathway or route of travel?
Does this play space have at least one spinning/rotating component with back and foot support for better restraint:
Yes
No
If yes, how many?
Please provide the total number of elevated play components available:
Plesae indicate which of the following features your play space, playground or play facility provides on an accessible route:
Interactive Panels
Yes
No
Playhouses
Yes
No
Slides
Yes
No
Climbers
Yes
No
Fine Motor Skill Activities
Yes
No
Crawl Tubes
Yes
No
Sliding Poles
Yes
No
Bubble Windows
Yes
No
Swinging Bridges
Yes
No
Other
Please indicate which of the following accesible features your play space, playground or play facility provides:
Satisfactory elevated-to-ground-based play component ratios:
Yes
No
Accessible route that connects ground-level components to the transfer system or ramp system used to access elevated components
Yes
No
Ramps as the primary means connecting multiple elevated play components on a composite structure (structure with muliple activities/components for play)
Yes
No
What percentage of the play structure can be reached via ramp?
Maneuvering space for a wheelchair to make a 180-degree turn on the play decks on elevated play components:
Yes
No
Clear areas of floor or ground space to provide unobstructed room for a single wheelchair and its occupant at play components on accessible routes:
Yes
No
Panels are set within reach range for typical use (e.g., sufficient knee clearence) to allow all children to play with the component in a natural, straight-forward position:
Yes
No
Platform lifts to provide access to elevated play components:
Yes
No
Accessible play tables such as those for sand and water play or in gathering areas.
Yes
No
If so, what are the heights of sand tables in play space?
Accessible entry points and seats for individuals to transfer, sit or gain access (height of entry point or seat should be between 11 inches and 24 inches):
Yes
No
At least one swing has full body support with restraint feature (e.g., belt, etc.):
Yes
No
Number and description of support swings
A visual prompt is provided between adjacent play platforms with a difference in elevation (e.g. platforms with different colors or edge markers on elevated platform moving from higher to lower elevation)
Yes
No
Universally accessible bathroom(s) and/or porta-potty(ies):
Yes
No
Benches and seating areas are provided and have an adjacent accessible space(s) so people who use wheelchairs can sit next to family and friends:
Yes
No
Elevated or curbed-like borders are placed around non-accessible safety surfaces (e.g., sand, pea gravel) to prevent inadvertent entry/falling into that surface:
Yes
No
Quiet semi-enclosed areas where a child can regroup from over-stimulation and/or engage play quietly:
Yes
No
Gathering places - where children can socialize together:
Yes
No
Shade - natural, man-made (roofs, under platform centers):
Yes
No
Good line of sight for supervision of activities is designed into the play environment layout so adults can allow the children freedom to play independently:
Yes
No
The arrangement of play equipment supports participation by children of all abilities (please describe):
Yes
No
Horizontal surfaces for manipulative play are set at varying heights to facilitate use by children with different abilities:
Yes
No
Natural or man-made barriers (e.g., fencing, shrubs, berms) are provided around the pre-school area to safely contain the children within the play space:
Yes
No
Play components/activities offer rigor and challenge for varying abilities:
Yes
No
Focus is placed on the natural environment as an asset for play:
Yes
No
Each platform on an elevated composite structure offers play choices (at least one play panel/activity and one wheelchair accessible route) so there are no ramps to nowhere:
Yes
No
Do composite play structures provide a clear, barrier-free thruway on platform centers? Support posts do not protrude through the barrier-free portion of a platform center. This includes support posts for roof structures:
Yes
No
Does the elevated route have a 36 inch clear width:
Yes
No
Does the elevated route have handrail grips:
Yes
No
Are handrail grips 20-28 inches above the ramp surface:
Yes
No
Are handrails in place on both sides of ramps?
Yes
No
Does the elevated route connect the entry and exit points of at least 50% of the elevated play components provided in the play area:
Yes
No
Are ramps in place to provide access to elevated play components
Yes
No
How close to the highest play deck can a child who uses a wheelchair get?
How many elevated play components can be accessed using the ramp system?
Does the ramp have at least 36-inches of clear width?
Yes
No
Are ramp landings provided at the top and bottom of each ramp run?
Yes
No
Does the ramp change directions?
Yes
No
Is landing size at least 60 inches wide?
Yes
No
Is satisfactory maneuvering space provided on ramps routes on the same level as play components?
Yes
No
Are transfer systems in place to provide access to elevated play components?
Yes
No
If yes, how many?
How many elevated play components can be accessed using the transfer system?
Can slides be accessed using the transfer system?
Yes
No
Are transfer supports such as handrails, handgrips or other handholds provided on each level of the transfer system (each step and platform)?
Yes
No
Are transfer platforms at least 24 inches wide
Yes
No
Are transfer platforms between 11 inches and 18 inches tall?
Yes
No
Are transfer platforms at least 14 inches deep?
Yes
No
Do transfer platforms have unobstructed sides?
Yes
No
Is a clear 30" x 48" parking space at the transfer platform free & clear of an accessible route making it possible for an individual to park their mobility device?
Yes
No
Are transfer steps at least 24 inches wide?
Yes
No
Are transfer steps at least 14 inches deep?
Yes
No
Are transfer steps 8 inches high or less
Yes
No
Does the ground surface along accessible routes and clear floor spaces comply with the ASTM F 1951 Standard Specification for Determination of Accessibility of Surface Systems Under and Around Playground Equipment?
Yes
No
Is the ground surface made of poured in place rubber?
Yes
No
Is the ground surface made of shredded rubber?
Yes
No
Are there accessible hard surface pathways into, around, and within the play space?
Yes
No
Is the ground surface made of rubber tiles?
Yes
No
Is the ground made of engineering wood fiber?
Yes
No
Is the play table at least 24 inches high?
Yes
No
Is the play table at least 30 inches wide
Yes
No
Is the play table at least 17 inches deep?
Yes
No
Signage in Alternate Formats (Braille, Large Print, Audio, Etc.):
Yes
No
A Website that can be read by screen readers
Yes
No
A Website in which accesibility informatio is included:
Yes
No
Signage to indicate facility accomodates children of all abilities
Yes
No
Other
No accessible information and interpretation
Yes
No
Accessibility coordinator available at the play space, playground or play facility:
Yes
No
Staff training on topics such as disability awareness and/or accommodating visitors with disabilities:
Yes
No
In order to provide more information to potential visitors with disabilities, please provide a general description of the accessible features and services available at your play space, playground or play facility.
Reset
Submit
Request Forms
Programs
Organizations
Equipment
Parks
Personal Trainers
Calendar
Youth
Playground
twitter
facebook
google+
pinterest
tumblr
reddit
email
