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Date of Accident Workshop Ticket #<br />
Skier Name Skier Phone<br />
Address Witness Name<br />
City, State Zip Witness Phone<br />
Skier’s Description of Accident and Injury<br />
82 / RISK MANAGEMENT<br />
(Use Back For Additional Comments)<br />
Description of System Rented Purchased<br />
Ski Brand Model Size<br />
Serial # Inv. #<br />
Boot Brand Model Size<br />
Binding Brand Model Size<br />
Condition of System<br />
Are the boot soles within industry standards? Yes No<br />
Are all buckles, boot adjustments functioning correctly? Yes No<br />
Are the A.F.D.’s Intact ? Yes No<br />
What are the Visual Indicator Settings? Toe Heel<br />
Is the Forward Pressure set correctly? Yes No<br />
Is the Toe Height set correctly? Yes No NA<br />
Do the brakes function smoothly? Yes No<br />
Is the ski bent delaminated or damaged? Yes No<br />
Describe:<br />
Was the equipment returned to service post-accident? Yes No<br />
Mechanical System Testing<br />
Testing Device Last Calibration date / /<br />
Clockwise Ctr Clockwise Clockwise Ctr Clockwise<br />
Toe L R<br />
Heel L R<br />
Background<br />
Shop Name<br />
POST ACCIDENT INSPECTION REPORT<br />
Inspected By Inspector Signature<br />
Checked By Checker Signature