Type of Trampoline: Wall to Wall
Bungee Stand Alone Tramp Track
Manufacturer/Brand of trampoline systems:
Are the trampoline systems fully compliant with ASTM and NFPA regulations:
a. ASTM F1159: Standard practice for design and manufacture of patron-directed amusement
devices:
Yes No
b. ASTM F2375: Standard practice for design, manufacture and installation of safety netting around
tops of trampolines and foam pits:
Yes No
c. NFPA 701: Minimum flame resistance for materials from which pads and trampolines are made:
Yes No
Are safety signs posted at your facility and at the points of entry?
Yes No
What is the average ration of participants to employee supervision?
What is the minimum ratio of participants to employee supervision?
Is every participant required to sign a waiver?
Yes No
Are parents of legal guardians required to sign waivers on behalf of all minors?
Yes No
What is the minimum participation age?
Are minors permitted to jump with parent/guardian?
Yes No
Are participants separated by age and experience?
Yes No
Are instructions given to jumpers prior to each session?
Yes No
How are they given?
Verbally Video
Written
How are employees trained?
Total number of employees/workers/volunteers
Are background checks performed on all employees?
Yes No
Is at least one supervisor who is trained and certified in first aid on duty at all times?
Yes No
Is all equipment inspected prior to each jump session?
Yes No
Do you repair trampoline equipment?
Yes No
Name of contractor performing repairs
Are they insured?
Yes No
Are certificates of general liability insurance required?
Yes No
Do the certificates list you as an additional insured?
Yes No
Do you execute written contracts with the contractor including indemnification clauses in your favor?
Yes No
Have you modified your trampoline system?
Yes No
If yes, how
Are competitive jumping lessons taught?
Yes No
Are there devices/activities other than trampolines in the facility
(Please list: ie. rings, bars, climbing walls, basketball courts, etc):
Yes No
Are jumpers separated from participants of other devices/activities listed above?
Yes No
Any apparatus hanging from ceiling in jumping area?
Yes No
Distance from jumping area to apparatus
Distance from jumping area to ceiling
Do entrances and platforms have impact-absorbing material on all surfaces within 48 inches of device frames (floor, patron barriers, banisters, rails, etc.
Yes No
Is barrier netting at top of all platform barriers?
Yes No
Is barrier or gate used to prevent unauthorized access to devices?
Yes No
Does a redundant fall-through protection device exist under all jump surfaces?
Yes No
Is impact-absorbing matting completely covering springs and device frames?
Yes No
Is impact-absorbing matting attached to jump surfaces and secured to device frames?
Yes No
Total square footage of trampolines
Do you own or lease the premises?
Own Lease
Square footage of building
Do you have fire alarms?
Yes No
Do you have an automatic sprinkler system?
Yes No
Are all building/facility exits in compliance with applicable building codes?
Yes No
Hours of operation: Weekdays to Weekends to
Will you remain open after normal business hours for overnight camps, lock-ins or similar activities?
Yes No
Total estimated sales for upcoming year and prior four years:
Projected Sales: Upcoming Year
Actual: Current Year
Actual: First Prior Year
Actual: Second Prior Year
Actual: Third Prior Year
What is your average annual attendance?
Do you sell food or non-alcoholic beverages?
Yes No
Total food or non-alcoholic beverages sales (if any):
Do you sell or serve alcoholic beverages, or allow consumption of alcoholic beverages on your
property?
Yes No
Submit