Cossio Insurance Agency Family Entertainment Centers
Activity 4
NOTE: Remember not to hit your back button or your refresh button so that you do not
accidentally erase or wipe out any type of information that you have typed in.
Please click on an operation type from the list. Then answer the questions inside each operations. After
completely answering the questions, you may click on a new type of operation to begin completing new sets of questions.
Paintball / Laser Tag
Annual sales:
$
Laser Tag sales:
$
Minimum age:
Minimum height:
Max. players per game:
Judges to players ratio:
Written instructions, procedures and training provided for players?
Yes
No
Does equipment meet ASTM standards?
Yes
No
Specify types of air fills used:
Safety plugs required?
Yes
No
Repair or modify equipment sold?
Yes
No
Is there a scheduled maintenance plan for equipment?
Yes
No
If yes, please provide details of the maintenance plan:
Do manufacturers provide certificates of insurance adding you as additional insured?
Yes
No
Are participants separated by level of experience?
Yes
No
Are spectators property protected from paintball area/field?
Yes
No
Are participants in violation of the safety rules ejected?
Yes
No
Please list the protective gear supplied to participants:
Please indicate feet pers second used at your location:
How often is equipment inspected:
How often is equipment changed:
Facility endorsed or fenced?
Yes
No
Any barriers/obstacles?
Yes
No
If there are barriers/obstacles, please describe:
Hand to hand fighting allowed?
Yes
No
Eye protection required?
Yes
No
Are customers allowed to bring their own equipment?
Yes
No
If customers bring their own equipment, is the velocity and it checked?
Yes
No
Are the employees trained in first aid?
Yes
No
Do you have special events such as Tournaments, Big Games etc.?
Yes
No
Are products sold US made or purchased through US manufacturer?
Yes
No
Average age of rental equipment:
Annual no. of waivers signed:
Total sq. ft. area of playing field:
Total sq. ft. area of laser tag field:
Annual repair receipts:
Annual equipment sales:
Hours of operation:
Rock Climbing Wall
Annual sales:
$
Height of Wall:
Does rock wall meet all CWIG (Climbing wall Industry Group) standards and local codes?
Yes
No
Bouldering wall = 6 ft or less:
Yes
No
Are participants allowed to climb on their own:
Yes
No
What is the check in procedure?
What kinds of verbal contacts or warnings given?
When is safety testing done:
Certification system used:
Are spotters required?
Yes
No
If spotters are required, at what height?
Type of equipment is used? (describe belay system)
Type of landing system? (describe)
Who is responsible for daily maintenance:
Do you have a portable wall?
Yes
No
If you do have a portable wall, what is the frequency of use off premises?
Room Rentals
Annual sales:
$
Room Type:
No. of participants:
Roller Skating
Annual sales:
$
Sq. ft. area of surface:
Surface composition:
Date last resurfaced:
Rink Type:
Indoor
Outdoor
Waivers/disclaimers on ticket?
Yes
No
max rink capacity at any one time:
Water Slides
Annual sales:
$
How many different types of water slides do you currently own:
Name:
Manufacturer:
Receipts:
Describe
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Please make sure that you have completed everything to the best of your knowledge before going to the next page.