Climbing Wall Orientation and Risk Management Checklist for New Climbers Participant Name: As a new climber, I understand that I require orientation and/or training before participating in climbing activities in this facility. I understand the facility may require me to pass an assessment or assessments prior to allowing me to participate in certain activities. I understand that if I need additional assistance, orientation, instruction, training or assessment during my participation at the climbing facility at any future time that it is my responsibility to seek such assistance, orientation, instruction, training or assessment for the climbing gym staff prior to participating in any activity for which I am not trained or qualified. My signature indicates that I understand the information above and that the climbing gym staff and orientation video have presented this information to me. Participant Signature: Please answer the following questions: Top-rope climbing and belay experience: Lead climb and belay experience: List any limiting physical conditions (consult physician if unsure): ------------------------------------------------------------------FOR STAFF USE ONLY-------------------------------------------------------------------- Facility Orientation Auto Belay Qualification Bouldering Orientation ú Asses climbing experience Climber Understands or Demonstrates: ú Fitness to participate Climber understands or ú Liability waiver signed demonstrates: ú Inherent risks of Auto Belays ú Safety policies & rules form Not clipping in; signed ú Inherent risks of bouldering Mechanical failure; Holds can spin or break; ú Orientation video watched User error, etc. All falls are ground falls; ú Qualification process overviewed ú Proper use and functioning of the You will fall bouldering; ú Check-In/check-out procedure Auto Belay Falls may result in injury; ú Policy for minors reviewed Weight limitations for device; Injuries can be severe, etc. ú Correct use of personal protective For use by one person; ú Facility rules for bouldering equipment Avoid other climbers; Appropriate equipment in good Grading system; Avoid pendulum falls; repair; Where allowed; Avoid entanglement; Follow manufacturer’s instructions Maximum height; Do no redirect lifeline; for use, care, inspection, Topping out; Never climb into slack; retirement; Age restrictions. Report unusual functioning. Get qualified instruction for new ú Awareness of surroundings ú Fitting and securing of harness or unfamiliar equipment. Clear landing area; ú Auto Belay attachment to harness Location of other climbers. Correct location; Facility and Bouldering Orientation ú Purpose and limitations of Gate orientation; Locked. padded flooring ú Gets checked my another climber Employee: No guaranteed safety; before climbing Purpose of spotting; ú Tests retraction of lifeline before Signature: Spotting technique; climbing Position of spotter; Date: ú Climbs on route When to spot; Climbs in line with device; Hazards to spotters; Never climbs above device; Limitations; Auto Belay Qualification Does not use hangers, quickdraws, Demonstration. or carabiners as holds. Employee: ú Spotting review ú Checks landing zone ú Down climbing Signature: ú Lowers correctly ú Falling technique ú Re-attaches lifeline to floor Date: .