2 Year Renewal / Certification Renewal Form

Name *

First Name Last Name

E-mail *

Best E-mail to Reach You

Best Phone Number to Reach You *

Area Code Phone Number

Home Mailing Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

(C2.3) Demonstrate skill, experience, and training to be considered a COMPETENT PERSON with regard to worker safety and fall protection. *

Agree Disagree

Current Challenge Course Employer *

Company Mailing Address *

Street Address or PO Box

Street Address Line 2

City State / Province

Postal / Zip Code Country

Job Title *

Job Responsibilities *

(C2.4) Have a demonstrated ability to inspect course ELEMENTS in accordance with ACCT Challenge Course Standards. *

Agree Disagree

(C2.9) Have a full understanding of the various course ELEMENTS he/she inspects including the operational procedures. *

Agree Disagree

(C2.10) Demonstrate his/her ability to consult with course designers and other professionals. *

Agree Disagree

Supervisor Name *

Supervisor Phone *

Area Code Phone Number

Certification Level *

In-House Level 1: (Introductory certification level for applicants who perform internal inspections at the site of the course currently insured) In-House Level 2: (Advanced level of certification for applicants who perform internal inspections at the site of the course currently insured) Professional Level 1: Introductory level of certification for applicants who perform professional inspections of traditional style challenge courses that are not typically open to the public and do not utilize complex or engineered life safety systems. Professional Level 2: Advanced level of certification for applicants who perform professional inspections of commercially operated challenge courses that utilize specialty engineered life safety products or more complex mechanical systems including electrical, pneumatic and hydraulic systems. Supervisor Endorsement: (For those who supervise other inspectors in your company.) The Endorsement includes an understanding of quality assurance practices for companies that offer inspections and allow a Level 1 or Level 2 Inspector to supervise an inspector Trainee: And / or the Level 2 Certification Applicant must also provide documented proof of employment as an Inspector, including documentation signed by the supervisor that the applicant meets the requirements for both the Level and Endorsement of the Supervisor sought

Certification # *

Please attach the following forms before submitting your application. Click this Link for the required forms

Please attach the following Forms to complete applicaition

Eye Exam- Must be official ACCT Form.

This form must be submitted together with your Affidavit from the Supervisor, Proof of Insurance, and Portfolio of the inspector at the time of submitting your Inspector Certification Request. Eye exams should be administered by an ophthalmologist, an optometrist, a doctor, a registered nurse, or a certified medical assistant. Exams must be completed within six (6) months prior to the exam. All applicants must pass an eye exam, with or without corrective lenses, to provide an acuity of 20/30 or more, both for near and far acute. All applicants must take a color perception test. If an applicant is colorblind, this does NOT disqualify the applicant, however, if the applicant is colorblind, a letter from the employee's supervisor must be sent stating that an acknowledgment must be submitted before the test.

Eye Exam *

Insurance Certificate- In-House applicants must provide a certificate of insurance showing a General Liability policy of $1,000,000.00 minimum coverage.

The Third-Party Professional applicant must provide an insurance certificate that demonstrates professional responsibility for minimum coverage of $1,000,000.00. Professional services covered by the professional liability policy must be included in the description of the operations of the insurance certificate. Professional services must include inspections. The certificate must be dated within 30 days of application. View Sample Insurance Certificate.

The certificate should list as the certificate holder:

Association for Challenge Course Technology

PO Box 19797

Boulder, CO 80308

Insurance Certificate *

Inspector Portfolio Requirements - please submit the official ACCT Inspector Portfolio

Complete each tab of the Inspector Portfolio to represent lifetime challenge course history. Please note: a minimum of at least 40 hours of training from a qualified third party covering challenge course operations, maintenance, and inspection is required for Level 1 and Level 2 Inspector In-House Certification.

For Level 1 and Level 2 Inspector Professional Certification, a minimum of 150 lifetime builder days (or equivalent) and a minimum of 12 third-party inspections conducted under the supervision of a qualified inspector.

Inspector portfolio *

Supervisor Affidavit - Each applicant is required to submit a notarized Supervisor Affidavit. Select the appropriate form below:

Supervisor Affidavit - for employees
Self Supervisor Affidavit - for owners/self-supervised

Supervisor affidavit *

*** Please review all your information before continuing to the payment section. The ICE In-House and Professional application fee of $125 are non-refundable; so please refer to the eligibility page to confirm you have the correct experience before you submit the application. Exam fees are also non-refundable. Please contact the Program Manager (heather@acctinfo.org) if you have additional questions. ***

ACCT Certified Inspectors must comply with ACCT Code of Ethics during their certification as set forth below:

Be free of bias with regards to religion, ethnicity, gender, age, national origin, and disability
Place the safety and well-being of users and workers associated with challenge course operations above all other considerations
Protect nearby general public property and the environment
Alert management of any safety concerns relating to the inspection being performed
Will not knowingly violate safety-related regulations, warnings, or instructions set forth by OSHA or other relevant Government Safety Standards
Will not misrepresent or knowingly deceive others concerning their experience or capabilities in conducting challenge course inspections
Will not misrepresent or misuse their certification card or the ACCT logo, both of which are the property of ACCT; the inspector must return the card to ACCT immediately if required to do so
Follow all other aspects of the ACCT Code of Ethics

I agree to comply with the ACCT Code of Ethics in my role as an applicant *

I Agree

Terms and Conditions: BY SUBMITTING THIS FORM YOU AGREE TO THE FOLLOWING TERMS AND CONDITIONS: I have reviewed and understand the renewal eligibility requirements for the Inspector Level of Certification I am requesting. All statements and supporting documents (including updates) are true and correct. I understand that any misrepresentation will subject me to disciplinary action by ACCT including but not limited to revocation of my Inspector Certification. Should I terminate my employment with the company named on my ACCT Inspector Certification card, I agree to provide ACCT with an updated Certificate of Insurance within 30 days naming my new employer.

*

I agree to the terms and conditions.

Please sign to agree to the terms and conditions. *

Clear

Renewal Fees *

Application fee $ 125.00

Level 1 in-house renewal $ 185.00

Level 2 in-house renewal $ 185.00

Level 1 Professional renewal $ 260.00

Level 2 Professional renewal $ 260.00

Supervisor Endorsement $ 55.00

Total $ 0.00

Please review all your information. After you hit submit, you will be redirected to Paypal for payment. Application and test fee are both due at time of application. This will complete your application.