Available Equipment

The following equipment is available for request. Please download and read the appropriate file to confirm you understand your responsibilities for each type of equipment you have requested. Place a check mark in the box next to that equipment to select it.

You must be able to arrange pick-up and return of equipment based on availability. In order to request the Bike/Pedestrian trailer or Safe Kids van, a representative from a municipality, state government agency, or public safety agency must be available to transport or tow the trailer/van.


		Bike and Pedestrian Safety Trailer
		Hot Cars Display
		Safe Kids Van
		Spot the Tot Rug

Request Information

Name of Event* *Event Name is Required

Date Event Begins*

November 2024

Date Event Ends*

November 2024

Time Event Starts

Hours*

Minutes*

am / pm*

*Event Time is not valid
First Name* *First Name is Required
Last Name* *Last Name Is Required
Phone* xxx-xxx-xxxx *Phone is Required *Valid phone is in the form of xxx-xxx-xxxx
Cell Phone* xxx-xxx-xxxx *Phone is Required *Valid phone is in the form of xxx-xxx-xxxx
Email* *Email is Required *Must be an Email address
Name of Safe Kids Affiliation:* *Affiliation Is Required
Address* *Address is Required
City* *City is Required
State*

Zip* *Zip is Required *Invalid Zip Code
Location of Event:* *Location Is Required
County of Event*

Address of Event* *Location Address is Required
Event City* *City is Required
State*

Zip* *Zip is Required *Invalid Zip Code

Responsible Party Transporting Van/Trailer - First, Last and Agency Names are required when requesting Van/Trailer, otherwise may leave blank.

First Name *Pickup First Name is Required for Trailer/Van equipment
Last Name *Pickup Last Name is Required for Trailer/Van equipment
Agency *Pickup Agency Name is Required for Trailer/Van equipment

Comments

I agree: You must Agree to continue

to coordinate with NC DOI-OSFM Injury Prevention staff member on picking up or having equipment delivered.
that the equipment will be used for its intended purpose in a safe and proper manner.
that I have read and printed instructions and requirements for requested equipment.
to inspect all equipment in the presence of an NC DOI-OSFM staff member at the time of check-out and check-in, to determine that the equipment is in working order and that nothing is missing or damaged.
to return all equipment in the condition it was received.
to either ship item or make arrangements with NC DOI-OSFM Injury Prevention staff member to have item returned within 4 business days.
to pay the cost of any piece or part of equipment that is lost, stolen or damaged while the equipment is in my care.
to report any damages, defects or problems with the equipment that is checked out under my name, when it's returned.