Mechanical Bull

1

Email

example@example.com

2

Does device have an emergency shut-off?

Yes

No

3

Is the unit equipped with variable speed controls?

Yes

No

4

Are employees trained in proper operation and safety?

Yes

No

5

Is there a minimum ceiling clearance of 12 feet or more?

Yes

No

6

Is there a minimum area fence clearance of two feet or more?

Yes

No

7

Is there minimum floor padding of 18 inches or more?

Yes

No

8

Covering consists of high-density foam (canvas or other material to provide smooth surface)

Yes

No

9

Covering consists of canvas air mattress

Yes

No

10

Is the base of the unit completely covered with padding?

Yes

No

11

Other:

12

Do you check Photo ID to verify the rider’s identity and age?

Yes

No

13

Are waivers signed in the presence of an employee?

Yes

No

14

Does employee verbally ask the individual about pre-existing injuries?

Yes

No

15

Do you require riders under 18 years to wear a helmet?

Yes

No

16

Please provide a complete list of venues in which you operate the ride. Bars or Taverns

Yes

17

Venue Type - Special Events

Yes

18

Venue Type - Private Parties

Yes

19

Venue Type - Rodeo Circuit

Yes

20

Venue Type - Fairgrounds

Yes

21

Venue Type - Other

22

Are signs clearly posted in a conspicuous location

Yes

No

23

Participants are required to sign a waiver of liability before participating in any event or activity

True

False

24

No one under the age of 18 rides without the presence of a parent or legal guardian

True

False

25

Waiver of liability must be signed in order to participate

True

False

26

Rider is participating at his/her own risk, and the operator is not liable for any accident or injury to any person regardless of how caused.

True

False

27

Individuals with pre-existing conditions, back, leg, neck or arm injuries, and those who are pregnant, are not permitted to ride.

True

False

28

Employees are not responsible for determining the physical ability of the participant. Riders do so at their own risk

True

False

29

Participants may request that the ride be stopped at any time

True

False

30

Are all attendants, supervisors or monitors at least 19 years of age?

Yes

No

31

If NO, please explain:

32

Number of attendants supervising the unit at any one time:

33

Are all rules and regulations strictly enforced?

Yes

No

34

Are employees instructed to enforce all rules and regulations, even if it means ejection of a participant from the ride or refusal of services?

Yes

No

35

Please provide a breakdown in your gross receipts for the following. If separate records are not kept, please include all sales in the ride receipts. (Ride receipts) $

36

Photo or videotape: $

37

Souvenirs: $

38

Clothing or similar items: $

39

Any other amusement rides or devices operated on the premises?

Yes

No

40

If YES, please explain:

41

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