AMUSEMENT RIDE SAFETY INSPECTION REPORT

AMUSEMENT RIDE SAFETY INSPECTION REPORT
Missouri Division of Fire Safety Amusement Ride Safety Unit P.O. Box 844 Jefferson City, MO 65102 (573) 526-3660
OWNER INFORMATION
OWNER NAME
DATE OF INSPECTION

MonthDayYear
Date
BUSINESS NAME
STATE
Address

ADDRESS

Street Address Line 2

CITYSTATE

ZIP
RIDE INFORMATION
RIDE NAME
RIDE DESCRIPTION (EX: METAL ROLLER COASTER, CAROUSEL, ETC)
MANUFACTURER
MANUFACTURE DATE

MonthDayYear
Date
SERIAL NO.
CAPACITY
RPM
DATE OF LAST NDT TEST(S)

MonthDayYear
Date
UnSatisfactory - XX Explain orders below under REMARKS
FUNDAMENTAL
ENTRANCE & EGRESS
Upholstery / Seat Conditions Safety Restraints - Lap Bar, Seat Belts, Harness Tub / Seat Numbering Tubs / Hazardous Projections / Conditions Fiber Glass Conditions Fire Extinguisher - NFPA 101 Ride Clearance of Obstructions Manufacturer's Manual Daily Inspection Log Maintenance Log Operator Training Program Proper Operating Procedures when Observed Dark Rides - per NFPA 101
ELECTRICAL
Steps Ramps Platforms Fencing Warning Signs / Rider Restrictions
MECHANICAL
Portable Generator Grounded per NFPA Midway Electrical Boxes - Guarding Electrical Wiring Protected Electrical Disconnect for Ride Lighting Equipment Wiring & Secured Emergency Stop Switches
STRUCTURAL
Bracing Sweeps Blocking Gears Correct Grade of Bolts Fasteners, Safety Clips, R-Keys, Pins. Etc Wire Rope Inspection
OTHER
Drive Sheaves Single Point Suspension Guarding Moving Parts & Chains & Belts Hydraulic System Lubrication Anti-Rollback Devices Brakes Air Tank - requires Missouri Inspection Certificate if >5 cu. ft. or 38 gal.
IN THE ABSENCE OF ASTM STANDARDS FOLLOW MANUFACTURER'S INSPECTION GUIDELINES
REMARKS
NOTE: This is a general check list and is not intended to be"all inclusive". It is the responsibility of the inspector to perform the annual safety inspection per ASTM National Standards, Manufacturer's Inspections Guidelines and all Missouri laws, rules and regulations. | state that the above described amusement ride was inspected in accordance with required safety standards / guidelines and met these requirements/guidelines on the date of this inspection.
SIGNATURE OF INSPECTOR

Clear
DATE

MonthDayYear
Date
PRINTED NAME AND TITLE OF INSPECTOR AND COMPANY
AmRdInspectionRpt,p65 (1/2007)
Should be Empty:

AMUSEMENT RIDE SAFETY INSPECTION REPORT

OWNER INFORMATION

RIDE INFORMATION

FUNDAMENTAL

ENTRANCE & EGRESS

ELECTRICAL

MECHANICAL

STRUCTURAL

OTHER

IN THE ABSENCE OF ASTM STANDARDS FOLLOW MANUFACTURER'S INSPECTION GUIDELINES