Challenge Course Inspection Request Form

Contact Name:

Title:

Email:

Organization Name:

Organization Website:

Type of
Organization:

School/School District	Private/Independent	Public
Camp/Recreation Center	Non profit	Profit
Therapeutic	Non profit	Profit
Corporate	Non profit	Profit

Mailing Address:

City:

State:

Zip:

Phone:

Fax:

Physical Location Address for the Course (if different than mailing addresss)

City:

State:

Zip:

Phone:

Challenge Course History:

What company built your course?:

What year was it built?:

What company did your last Course Inspection?:

What is the date of your last Course Inspection?:

Were repairs recommended on you last Course Inspection Report?:

Explain:

Challenge Course Description:

Indoor Outdoor Both

Highs Lows

on poles in trees mixed poles & trees

Does your agency have an operating lift on-site so that the inspector can use to access indoor elements? Yes No

Number of Elements

Low: High: Total:

Equipment: (helmets, harnesses, belay gear, ropes etc.)
My gear will outfit:
1-15 participants
16-30
30+

Date you need your Challenge Course inspected by:

Any other services we can help you with at this time:
Program Development and Consultation
Challenge Course Installation, Design or Repairs
Training and Staff Development
Credentialing, Accreditation and Program Safety Audits
Programs for Youth
Publications and Books
Props, Packs, Challenge Course equipment
Other: