STATE OF CALIFORNIA

DEPARTMENT OF INDUSTRIAL RELATIONS

DIVISION OF OCCUPATIONAL SAFETY AND HEALTH
AMUSEMENT RIDE SECTION
2424 Arden Way, Suite 340, Sacramento, CA 95825
(916) 263-3511 FAX (916) 263-3576

AMUSEMENT RIDE FIELD REPORT

OFFICE INSPECTOR INSPECTOR I.D. DATE INSPECTED STATE I.D. NUMBER
11 Bryan Eckman E6414 March 7, 2010 C-05717
PERMIT EXPIRES INSPECTION TIME INSPECTION FEE SURVEY TYPE SPECIAL CALL
PERMIT
NUMBER A T- 1 Hour $125.00 N/A 13
AMUSEMENT RIDE NAME MANUFACTURER TRADE NAME
Motor Cycle Jump Hampton Motor Cycle Jump
LOCATION / EVENT OWNER
Main Street, Hesperia, CA Butler Amusements
MAILING ADDRESS
3003 SW 153rd Drive, Suite 205
CITY STATE ZIP
Beaverton OR 97006
SERIAL NUMBER MODEL NUMBER DATE MANUFACTURED NO. OF CARRIERS NO. OF PERSONS
Portable 8 16
RIDE SPEED MAX DIRECTION OF TRAVEL RIDE DURATION HEIGHT REQUIREMENT AGE REQUIREMENT
5 CCW 2 Minutes

REQUIREMENTS SECTION

The Division conducted an inspection on the attraction named Motor Cycle Jump in the city of
Hesperia, CA.

At the time of the Divisions inspection, the following items were reviewed:

Operating Guidelines
First Aid Report
Inspection of Motorcycles
Maintenance Documentation
Operation Documentation
Training Documentation

During the Divisions inspection, the Division noticed that motorcycle #5 had a broken roll pin at the
spindle end of the sweep where the motorcycle slides onto the spindles. The Division also noticed
that the front stop bar was not completely there. The portion that was missing went under the
motorcycle to prevent it from tilting forward to the point of rolling over. (At the time of the incident, the
motorcycle rolled forward and the injured party fell off the motorcycle.) This front stop bar has been
partially missing for some time.

The Division called the patrons mother on March 9, 2010 to obtain an account of this incident and
received a response on March 9, 2010.
This was the first ride her daughter rode on for the day. Another boy rode on the same bike she was
on before her. On the first round, the ride experienced no problems. On the second round, the back of
the bike lifted up. When the bike flipped up, she hit her head and her arm became caught. She was
dragged approximately 1-2 feet. She was transported to the Desert Valley Medical Center in
Victorville, CA. Upon evaluation, a one inch bump on the left side on the top of her head was
discovered on the hairline. There were no x-rays taken at the time and she was released from the
hospital. Her mother also reported that her daughters arm is sore with no bruising and is otherwise
doing well.

At the conclusion of the Divisions inspection, the following requirements were given to the
Owner/Operator:

R1) The Owner/Operator shall install a new roll pin and replace the missing front stop bar on
motorcycle #5. 3911(b)(3)
NOTE: This requirement has been complied with prior to the Division leaving the location.

R2) The Owner/Operator shall update the daily inspection and training to include the connection
points from the motorcycle to spindle / sweep. 7916
NOTE: This requirement has been complied with prior to the Division leaving the location.

R3) The Owner/Operator shall retrain the maintenance personnel on the updated daily inspection
checklist. 7916
NOTE: This requirement has been complied with prior to the Division leaving the location.

R4) The Owner/Operator shall inspect all motorcycle roll pins at the spindle end of the sweep.
3911(b)(3)
NOTE: This requirement has been complied with prior to the Division leaving the location.

AMOUNT RECEIVED money collected $125 ck#1586___SIGNATURE________________________________________________

COMMENTS/NOTES