NCDOL Elevator & Amusement Device Bureau Incident Investigation Data [Date of Incident 01/07/2022 Time 17:26 [Date Reported 01/08/2022 Time 12:00 [Date of Investigation: 01/08/2022 Investigator: Randall Rabon CEE RL acs, | cation of Incident: Beech Mt Ski Resort [Location Address 1: PO Box 1118 [Location Address 2: [Gity/St/Zip: Banner Elk, NC 28604 Ace. occurred in: WATAUGA county _ perator of Equipment; Beech Mi Ski Resort mer of Equipment: Beech Mt Ski Resort [Adar of Owner 1: PO Box 1118 [Addr of Owner 2: [City/SwZip: Banner Elk, NC 28604 [Address. [Address 2 LJ [City/SuZip] [Telephone: [Equipment Type: TRAM [Device Name: Lift 1 [State ID Number: 1992 janufacturer: Doppelmayr (Serial Number: Date Device last Certified: 11/08/2021 lleged Injuries: [Head fracture, Broken Right Arm|[the safe operation of the device [Description of Incident: [Person involved was riding Chairlift 1 going up when she jumped off so she wouldn't be exposed| Ito water shower. [Cause of Incident: [Snow boarder ran into the snow making hydrant causing the water line break spraying water on [Chairlift at tower 8 [Corrective Action: Had to replace damage lap bar on chair 61 and 2 sheaves on the downhill side of tower 8 they ifrozen up replaced liners |Additional Information: lone [Violations Issued: IONE |Penalties: IONE. Reportable: Y Cause of Accident: RIDER jote: A Reportable Accident i lother than first aid, by a phy one that results in death or injury requiring medical treatment, jan and/or Occurrence results in damage to the device or affectingNCDOL Elevator & Amusement Device Bureau Incident Investigation Data [Date of Incident 01/07/2022 Time 05:26 [Date Reported 01/08/2022 ‘Time 12:00 _| [Date of Investigation: 01/08/2022 Investigator: Randall Raborn ea eS, [Location of Incident: Beech Mt SkiResort [Location Address 1: PO Box 1118 [Location Address 2: [City/St/Zip: Banner Bik, NC 28604 Ace. occurred in; WATAUGA county __ [Operator of Equipment: Beech Mt Ski Resort aa [Owner of Equipment: Beech Mt Ski Resort [Addr of Owner 1: PO Box 1118 [Addr of Owner 2: [Equipment Type: TRAM, [Device Name: Lift 1 [State 1D Number: 1992 [Manufacturer: Doppelmayr |Serial Number: ate Device last Certified: 11/08/2021 [Alleged Injuries: [Unknown refused toDescription of Incident: (Rider riding chairlift 1 jumped off of chairlift, ‘ause of Incident: now boarder ran into water hydrant causing water line to break, [Corrective Action: Replaced damage lap bar on chair 61 and replace 2 sheaves on downhill side of tower 8 they had lirozen up liners had to be replaced |Additional Information: [ONE ‘iolations Issued: (ONE enalties: ONE. Reportable: Y_ Cause of Accident: RIDER jote: A Reportable Accident is one that results in death or injury requiring medical treatment, ther than first aid, by a physician and/or Occurrence results in damage to the device or affecting he safe operation of the deviceNCDOL Elevator & Amusement Device Bureau Incident Investigation Data [Date of Incident 01/07/2022 Time 17:26 Date Reported 01/08/2022 Time 12:00 [Date of Investigation: 01/08/2022 Investigator: Randall Rab [Location of Incident: Beech Mt Ski Resort [Location Address 1: PO Box 1118 [Location Address 2: EE [City/St/Zip: Banner Elk, NC 28604 Ace. occurred in: WATAUGA count [Operator of Equipment: Beech Mt Ski Resort [Owner of Equipment: Beech Mt Ski Resort [Addr of Owner I: PO Box 1118 Z ] [Addr of Owner 2: [City/SvZip: Banner Elk, NC Name of person involved in incident: First [Address 1: PY [Address 2: [City/suZi [Telephone in Sex: 5 Age [Equipment Type: TRAM [Device Name: Lift 1 [State ID Number: 1992 [Manufacturer: Doppelmayr [Serial Number: [Date Device last Certified: 11/08/2021 eged Injuries: [Unknown refused to talk[Description of Incide Rider riding Chairlift 1 jumped off Chairlift Sause of Incident: ‘Snow boarder ran into water hydrant causing waterline to break at tower 8 (Corrective Action: [Replaced damaged lap bar on chair 61 and replaced 2 sheaves on downhill side of tower 8 they lhad frozen up liners had to be replaced. |Additional Information: INONE. [Violations Issued: IONE Penalties: [ONE Mreuaencud Reportable: Y Cause of Accident: RIDER. jote: A Reportable Accident is one that results in death or injury requiring medical treatment, lother than first aid, by a physician and/or Occurrence results in damage to the device or affecting line safe operation of the device