FACILITIES CHECKLIST

INSPECTION OF PREMISES FOR CONDITIONS OF SAFE USE

Facilities Checklist: This is a suggested facilities checklist. It is recommended that before each dance, the facility should be checked and items that are not in proper working order should be noted and brought to the attention of the custodian before taking possession of the facility (dirty, sticky floors; loose tile or floor boards; parking area lighting and condition, etc.) The form should be made in duplicate (original to custodian, and have him sign and date your copy). If this is not done, the club or organization could later be billed for repairs or cleaning; or worse, held liable if condition of facility is inadequate for dancing and an accidental injury is sustained by a dancer as a result of faulty conditions.

If you are filling this form out on the computer, use your tab key to move from field to field. Use your F1 key for information about each field.

Name of Square Dance Club

Dance Location:

Parking Lot Area

Entrance Area & Floor

Dance Floor

Caller’s Area on Stage

Kitchen

Dining Room Area

Restrooms

Lighting Facilities

Furniture

Windows & Drapes

We have inspected the square dance facilities provided for our use, both before and after the conclusion of our dance. We find all conditions to be normal and acceptable for safe use, except as noted above.

Signed	Date

Signed	Date

Complete duplicate copies: One for Club & One for Custodian.

NCSDA Insurance Fill in Form	August 2008

FACILITIES CHECKLIST

Peggy Rose

2008-08-27