Application for Exemption Haunted Houses - Illinois

This Illinois-specific "Application for Exemption Haunted Houses" is a document released by the Illinois Department of Labor.

Download the fillable PDF by clicking the link below and use it according to the applicable legal guidelines.

ADVERTISEMENT
APPLICATION FOR EXEMPTION
HAUNTED HOUSES
Haunted Houses are “amusement attractions” within the meaning of the Amusement Ride and Attraction Safety Act, 430
ILCS 85/2-1 (“Act”). As such, Haunted Houses are subject to the inspection and permitting requirements of the Act. However,
pursuant to Section 2-16 of the Act an operator of a Haunted House may qualify for an exemption by certifying that it meets all of
the criteria set forth below and by submitting this form fully completed along with the certifications of the state fire marshal and/or a
political subdivision of the State to the Department prior to the commencement of operations of the Haunted House. All required
records are subject to the Department’s inspection. If you do not qualify for an exemption, you must apply for a permit to operate a
Haunted House by returning the enclosed application with appropriate fees and documentation at least 30 days prior to
commencement of Haunted House operations.
Operator Certification
The undersigned hereby certifies to the Department of Labor (“Department”) that the below listed person/organization
intends to operate a Haunted House located at ________________________________________________________________, and
that ALL of the below listed criteria have been met:
(Street Address, City and State and Zip Code)
1.
The Haunted House is owned or operated by _________________________
______________________________ which is a non-profit religious, educational or charitable institution or
association. (Provide documentation of your non-profit or charitable status (e.g. Secretary of State filing.)
2.
The Haunted House is located within a building.
3.
The building within which the Haunted House is located is subject to inspection and has been approved to operate by
the State Fire Marshal or by any political subdivision of the State of Illinois under its building, fire electrical, and
related public safety ordinance. (Certification by Fire Marshal or political subdivision must be included – See
below)
4.
The Haunted House itself is and has been subject to inspection in accordance with Section 2-17 of the Act by the
political subdivision whose attestation is set forth below, whose regulations are as stringent or more stringent than the
Departments. (Certification by Fire Marshal or political subdivision must be included – See below)
5.
All Haunted House operators/assistants/attendants, including volunteers, are at least 16 years of age. (The operator
must have and maintain documentation to substantiate this certification).
6.
All operators/assistants/attendants have been trained in the safe operation of the Haunted House. (The operator must
have and maintain documentation to substantiate this certification).
7.
All persons who act as operators/assistants/attendants have undergone the required criminal history records checks,
national sex offender public registry check and are subject to a substance abuse policy, which includes random drug
testing, unless such operators, assistants, attendants are volunteers. (The operator must have and maintain
appropriate records of this requirement, such as, the volunteer roster form included in the application for
permit to operate).
_____________________________
_______________________________
Print Name
Street Address
____________________________________
_______________________________________
Signature
City and State and Zip Code
____________________________________
_______________________________________
Telephone Number
e-mail address
_________________________________________________________________________________
Building: State Fire Marshal and/or Political Subdivision Certification
The undersigned, the _____________________________ hereby certifies on behalf of the
Title
__________________________________________________________ that the above referenced building containing the
Name of Fire Marshal or political subdivision of the state
(Continued Next Page)
1of 2
APPLICATION FOR EXEMPTION
HAUNTED HOUSES
Haunted Houses are “amusement attractions” within the meaning of the Amusement Ride and Attraction Safety Act, 430
ILCS 85/2-1 (“Act”). As such, Haunted Houses are subject to the inspection and permitting requirements of the Act. However,
pursuant to Section 2-16 of the Act an operator of a Haunted House may qualify for an exemption by certifying that it meets all of
the criteria set forth below and by submitting this form fully completed along with the certifications of the state fire marshal and/or a
political subdivision of the State to the Department prior to the commencement of operations of the Haunted House. All required
records are subject to the Department’s inspection. If you do not qualify for an exemption, you must apply for a permit to operate a
Haunted House by returning the enclosed application with appropriate fees and documentation at least 30 days prior to
commencement of Haunted House operations.
Operator Certification
The undersigned hereby certifies to the Department of Labor (“Department”) that the below listed person/organization
intends to operate a Haunted House located at ________________________________________________________________, and
that ALL of the below listed criteria have been met:
(Street Address, City and State and Zip Code)
1.
The Haunted House is owned or operated by _________________________
______________________________ which is a non-profit religious, educational or charitable institution or
association. (Provide documentation of your non-profit or charitable status (e.g. Secretary of State filing.)
2.
The Haunted House is located within a building.
3.
The building within which the Haunted House is located is subject to inspection and has been approved to operate by
the State Fire Marshal or by any political subdivision of the State of Illinois under its building, fire electrical, and
related public safety ordinance. (Certification by Fire Marshal or political subdivision must be included – See
below)
4.
The Haunted House itself is and has been subject to inspection in accordance with Section 2-17 of the Act by the
political subdivision whose attestation is set forth below, whose regulations are as stringent or more stringent than the
Departments. (Certification by Fire Marshal or political subdivision must be included – See below)
5.
All Haunted House operators/assistants/attendants, including volunteers, are at least 16 years of age. (The operator
must have and maintain documentation to substantiate this certification).
6.
All operators/assistants/attendants have been trained in the safe operation of the Haunted House. (The operator must
have and maintain documentation to substantiate this certification).
7.
All persons who act as operators/assistants/attendants have undergone the required criminal history records checks,
national sex offender public registry check and are subject to a substance abuse policy, which includes random drug
testing, unless such operators, assistants, attendants are volunteers. (The operator must have and maintain
appropriate records of this requirement, such as, the volunteer roster form included in the application for
permit to operate).
_____________________________
_______________________________
Print Name
Street Address
____________________________________
_______________________________________
Signature
City and State and Zip Code
____________________________________
_______________________________________
Telephone Number
e-mail address
_________________________________________________________________________________
Building: State Fire Marshal and/or Political Subdivision Certification
The undersigned, the _____________________________ hereby certifies on behalf of the
Title
__________________________________________________________ that the above referenced building containing the
Name of Fire Marshal or political subdivision of the state
(Continued Next Page)
1of 2
Haunted House is and has been subject to inspection in accordance with Section 2-16 of the Act.
_____________________________________
______________________________________________
Print Name
Street Address
_____________________________________
______________________________________________
Signature
City and State and Zip
_____________________________________
______________________________________________
Telephone Number
e-mail address
Haunted House: Political Subdivision Certification
The undersigned, the _____________________________ hereby certifies on behalf of the
Title
__________________________________________________________ that the above referenced
Name of political subdivision of the state
Haunted House is and has been subject to inspection in accordance with Section 2-17 of the Act and whose regulations are
as stringent or more stringent than those of the Department’s regulations.
_____________________________________
______________________________________________
Print Name
Street Address
_____________________________________
______________________________________________
Signature
City and State and Zip
_____________________________________
______________________________________________
Telephone Number
e-mail address
2of 2

Download Application for Exemption Haunted Houses - Illinois

1403 times
Rate
4.7(4.7 / 5) 84 votes
ADVERTISEMENT
Page of 2