DET NSW School Sports Unit

Guidelines for the Safe Conduct of Sport and Physical Activity in Schools

Last updated: 2003

Appendix E

Bicycle Report

For students to fill in:

Name of owner

Type of bicycle -- BMX/10 speed/family/terrain/mountain/other

Colour

Frame or identification number

Engraved/Stamped on (bottom bracket/rear fork/seat)	Bicycle helmet (suitably fitted)
Bicycle lock	Warning device (bell)

Circle faulty parts

	Repair or Adjust	Pass	Comment	Repair made
1. Frame fit
2. Seat
3. Handlebars
4. Headset
5. Front brake
6. Back brake
7. Wheels
8. Pedals
9. Chain
10. Suitable for cycling at night	Yes/No

Please have any repairs or adjustments completed by (date)
Signature of person making report

Teacher Police Bicycle Mechanic

Date of Report
Date of Recheck
Repairs completed / not completed

Signed

Repairs and adjustments identified on this report are the responsibility of the parent/caregiver.
* Reference: Bicycle Education Activity Manual published DET Curriculum Support Directorate.