EHLFIELD TRIPFORM

EHL FIELD TRIP FORMS TO BE COMPLETED IN ACCORDANCE WITH

EHL FIELD TRIP GUIDELINES PROCEDURES

SUMMARY

School or local Work Area to recorddetails on the Field Trip database

FIELD TRIP TITLE:
FIELD TRIP PURPOSE:
(eg. Film Shoot, Diving, Bushwalking):
DATE: / FROM:TO:
FIELD TRIP DESTINATION:
(eg. Darwin, Canada, VictorHarbour)
DESTINATION TYPE:
(eg. Metro, Regional, Remote, Interstate,
Interstate remote etc.)
BRIEF DESCRIPTION OF FIELD TRIP:
NAME OF FIELD TRIP LEADER:
MOBILE NUMBER:
EMAIL ADDRESS:
NAME OF FIELD TRIP
LEADER’S SUPERVISOR:
TOTAL NUMBER OF PARTICIPANTS: / FLINDERS STAFF:
FLINDERS STUDENTS:
VOLUNTEERS:
Signed: (Nominated University Contact person) / Date:
Signed: (Field Trip Leader) / Date:
Signed: (Field Trip Leader’s Supervisor) / Date:
Signed: (School Dean or Nominee) / Date:

EHL Field Trip Vehicles

Booking a University Vehicle

Contact the Transport Officeon 8201 2015.

A booking form (available from School Offices) must be completed at the time of booking a vehicle.

Where possible, University or hired vehicles must be used for the transportation of staff and students on Field Trips.

Use of Private Vehicle

Private vehicles used on University business must be covered by comprehensive insurance,Use of Vehicles on University Business (Field Trips). Private vehicles must be roadworthy, registered, driven by a licensed driver and only used when there is no reasonable alternative.

Please Note:

Vehicle Insurance Cover

In most cases personal/private comprehensive vehicle insurance is valid on work related travel. However, it may be wise to confirm that this is included in your comprehensive cover, with your insurance provider.

Private vehicles are not covered by University insurance.

Workers’ Compensation insurance for staff covers personal injury but not vehicle damage.

  • Security in Car Parks

Vehicles should be locked and made secure when left in the University car parks. Do not leave any valuables in open view in vehicles. Advise the security office of the field trip and and length of time the vehicle will be left in carpark.

  • Alcohol and Drugs

In accordance with the University’s Use of Vehicles on UniversityBusiness policy, vehicles are not to be driven by any person whose blood alcohol level is 0.05% or more, or who has consumed other drugs which affect their ability to drive safely.

If you are using a private vehicle please provide the following details:

Name:
Contact Number:
Registration Number:
Make of vehicle:
Model of vehicle:
Colour of vehicle:
I agree and understand private vehicle use.
Signature :

EHL Participant Safety Acknowledgment

To be completed by all participants and returned to Field Trip Leader.

A copy to be retained by participant.

For repeated field trips to the same or similar locations, this form can be completed on a semester basis unless the participant’s personal circumstances change

As a participant on a field trip you are asked to READ, UNDERSTAND, SIGN and RETURN this form (in accordance with requirements of theOHS&W Act, 1986). Whilst participating in the field trip you must carry your personal ID and medications, together with food and drink provisions as required.

The following guidelines are for your personal safety. Failure to comply with reasonable instructions may result in younot being permitted to participate in the remainder of the field trip.

  1. Obey all reasonable directions from Field Trip Leader. All boating operations require that you heed instruction and direction of the boat operator, and all diving instructions from the dive leader.
  2. Wear appropriate clothing for prevailing weather conditions (sturdy, enclosed footwear and hat are required).
  3. Stay clear of hazardous areas or dangerous locations (eg cliff edges, mine shafts, quarry faces and open slopes).
  4. Behave in an orderly manner at all times.
  5. Respect the property of others at all times – such as that of landowners and places where you are accommodated.
  6. Do not leave your group without notifying the Field Trip Leader of your intended movements in time and place.
  7. Limit the consumption of alcohol or other drugs to ensure that you do not endanger your own safety or the safety

of any other person on the field trip.

  1. Firearms, spring or gas powered spears, unauthorised explosives and other weapons are not permitted on any field trip.
  2. All participants are expected to assist in housekeeping duties as directed by the Field Trip Leader.
  3. University insurance, see EHLField Trip Guidelines Procedures.

I have read, understood and agree to the conditions of this field trip. I agree that I will not intentionally cause any concern regarding my own health and safety or that of others on the field trip.

I hereby give permission for medical treatment to be administered to me in the event of an emergency.

Name: (BLOCK CAPITALS):
Sign: / Date: / Mobile
In the event of any emergency please contact the following person:
(Next of Kin, who is not on the Field Trip)
Name: / Contact No:

Medical condition: Please advise if you suffer from any known medical conditions, including allergies which may affect your health or safety on any field exercise, and if you will be taking any medications during any trips, as follows:

Medication:

This is a confidential form.

For the duration of the field trip/s this document will be held by the Field Trip Leader and the University Nominated Contact Person.

Valid from: / Valid to:
If you are under 18 years old, your parent/guardian/care-giver also needs to sign the form, below.
Sign: / Date:

PLEASE ENSURE ALL PARTICIPANTS SIGN FORMS AND RETURN TO FIELD TRIP LEADER

BEFORE FIELD TRIP COMMENCES.

EHLField Trip Itinerary and Planning

1. / Field Trip Leader: (Name) / Topic No.
Contact Phone: / Work: / Mobile:
2. / Departure: / Date: / Time: / Location:
3. / Return: / Date: / Time: / Location:
4. / Destination / Contact Details(if applicable) / Contact No.
5. / Transport arrangements:
6. / Emergency contacts:
6.1 Nominated Contact Person at the University
Name: / Contact No.
6.2Security after hours (to initiate late return procedures * below) / Contact (08) 8201 2880
6.3 Emergency Services locations and contacts nearest to destination:
Hospital: / Contact No.
Fire Services: / Contact No. 000 or 112 (mobile)
Ambulance: / Contact No. 000 or 112 (mobile)
Royal Flying Doctor Service: / Contact No.
Police: / Contact No. 131 444 or 000 or 112 (mobile)
Other: / Contact No.

If it is anticipated that the return time will be after hours or on a weekend, a copy of the completed documentation must be provided to Flinders University Security

7.Late return procedures:

*Procedure to be followed by Nominated Contact Person OR Security at the University if field tripgroup is not back on time:

  • Phone Field TripLeader.
  • Phone other participants if the leader is not contactable.
  • Phone Security on 82012880 (24 hours). Check for returned gear if other participantsnot contactable.
  • Check for return of University vehicle.
  • Call Emergency Services in field triparea (Police, Coastguard, Park Ranger, landowner etc).
  • Advise School Dean.
  • School Dean to advise Executive Dean.

Signed: (NominatedUniversity Contact person) / Date:
Signed: (Field TripLeader) / Date:

EHLFIELD TRIP HEALTH AND SAFETY CHECKLIST

Refer EHL GUIDE TO ASSESSING RISKS AND IDENTIFYING HAZARDS

ItemChecked
Transport/Equipment/Itineraries/Maps
Transport arrangement identified? / Yes / No / N/A
Vehicles & trailers are registered, roadworthy and covered by insurance? / Yes / No / N/A
Vehicles, trailers, tow bars compatible and Road Traffic Act compliant? / Yes / No / N/A
Motor vehicles spare parts (hoses, belts, tools) etc. identified/obtained? / Yes / No / N/A
Motor vehicle safety & recovery equipment ie. Bull bar, winch, tow rope, jumper leads, shackles etc. / Yes / No / N/A
Relevant licenses and permits obtained? / Yes / No /  N/A
Written itineraries have been prepared? / Yes / No / N/A
Relevant maps obtained? / Yes / No / N/A
Equipment has been inspected to ensure its integrity and is of an approved design and meets minimal legal requirements? / Yes / No /  N/A
Briefings/Consultation/Accommodation/Catering
Participant briefing sessions held in advance of the field trip? / Yes / No / N/A
The participants have been consulted regarding arrangements, potential hazards etc? / Yes / No / N/A
A personal needs list has been developed, implemented and communicated? / Yes / No / N/A
Catering arrangements organised? / Yes / No / N/A
Accommodation arrangements have been organised? / Yes / No /  N/A
If working alone, participant is advised that regular contact must be made with Nominated Contact Person? / Yes / No / N/A
Occupational Health and Safety
The hazards associated with the field trip have been identified/controls developed? / Yes / No / N/A
RelevantUniversity OHS&W Procedures brought to the attention of participants? / Yes / No / N/A
Student or volunteer responsibilities communicated to participants? / Yes / No / N/A
Policy on drugs and alcohol explained to participants? / Yes / No / N/A
Fire fighting equipment required for the trip identified/obtained? / Yes / No / N/A
First aid kits have been checked for contents and refilled? / Yes / No / N/A
Qualified First Aid Officer(s) identified/communicated to participants? Please note: A qualified First Aid Officer must be present on all field trips to remote locations or where the risk assessment identifies the need. / Yes / No / N/A
Emergency procedures relevant to the field trip identified and developed.
Eg. Medical, fire, evacuation) / Yes / No / N/A
Effective communication system identified/obtained? eg. Mobile phone coverage, satellite phone for remote areas. / Yes / No / N/A
Clothing relevant to conditions identified? / Yes / No / N/A
Personal Protective Equipment required identified? / Yes / No / N/A
Weather forecasts and field site conditions obtained? / Yes / No / N/A
Advising Authorities (where relevant)
LocalPark Ranger advised of proximity of field party? / Yes / No / N/A
Department of Environment and Natural Resources (DENR)and/or Department of Aboriginal Affairs and Reconciliation (ARD) (where relevant) advised of the dates for planned field trip and associated trips? / Yes / No / N/A
Local Council advised of trip (where relevant)? / Yes / No / N/A
Have permits and special permissions been obtained. / Yes / No / N/A
Special Safety Precautions are required.
NB. If you tick Yes to any of the following, your Field Trip is considered High Risk. All possible hazards must be identified on the Risk Assessment form.
Does your Field Trip include any of the following:
  • Boating trips?
  • Scuba diving?
  • Snorkeling?
If yes, you must contact the Maritime Archeology Diving Officer on ext. 15533. / Yes No N/A
Cliff walking, climbing, clambering over rocks? / Yes / No / N/A
Bush walking? / Yes / No / N/A
Tractor driving or other plant and equipment? / Yes / No / N/A
The use of high voltage equipment? / Yes / No / N/A
Firearms, spring or gas powered spears, explosives and other weapons will be taken on Field Trip. / Yes / No / N/A
Involving geological and mining trips? / Yes / No / N/A
Other trips that may expose people to medium to high risk? Eg. Mountain bike riding, canoeing, kayaking, swimming. / Yes / No / N/A
Flying in any form, ie. Planes. Air balloon, Helicopter / Yes / No / N/A
Are you going Overseas?
Relevant vaccinations identified/field party advised?
Visas, Passports, Embassies, Government travel warnings have been considered. / Yes / No / N/A
Dangerous/Hazardous substances (eg. Petrol, LP Gas)
  • Containers and labeling is compliant
  • Storage and use, hazards identified/controlled
  • Containers must be bunded whilst in transit
/ Yes / No / N/A

IMPORTANT:

I have READ and UNDERSTOOD the EHL Field Trip Guidelines & Procedures / Yes / No

The following Field Trip Forms have been completed:(Please tick)

Participant Health & Safety Acknowledgment forms – one for each participant

Field Trip Itinerary & Planningform

FieldTrip Health & Safety Checklist form

Private Vehicleform (if applicable) – one for each vehicle

Field Trip Summary

Risk Assessment

The Field Trip Leader to ensure: (Please tick)

A signed and full copy of the Field Trip documentation is provided to the University Nominated Contact Person or Security if it is anticipated that the return time will be after hours or on a weekend.

All participants are provided with a copy of the completed Field Trip Itinerary & Planning form

Field Trip Leader retains a full copy of signed documentation

School/Local Work Area Office retainsfull copy of signed documentation for archiving for 7 years

Signed: (Field Trip Leader) / Date:
Signed: (Field Trip Leader’s Supervisor) / Date:

EHL Field Trip Forms Last updated: 7/09/2011 Page 1 of 10


EHLFIELD TRIPRISK ASSESSMENT FORM
Cost Centre:
EHL Faculty / Department: / Location: / Area Supervisor:
Assessed by: / Date: / Review Date:

Refer EHL GUIDE TO ASSESSING RISKS AND IDENTIFYING HAZARDS

The following table includes most hazards that would be associated with a medium-low risk trip.

List identified hazards for your field trip and detail measures taken to address the hazards. The Field TripHealth Safety Checklist and theHazard Identification Guidelinescan provide indicators for possible hazards.

If necessary, this generic risk assessment must be modified to meet individual requirements of each Field Trip.The Action by and Date columns will need to be completed.

Item / Hazard / P / C / RA / Control / Action by / Date of Trip
Field Trip: General / Motor vehicle accident / U / M / M / Appropriate licences & training, appropriate vehicle. Driver has rest break every 2 hours
Exposure to elements / U / m / M / Monitor local conditions, sunscreen, appropriate shelter
Heat Stress/ Dehydration / U / M / M / Sufficient water, at least 1.5 litres per person per day, appropriate clothing
Medical emergency / U / M / M / Appropriate medication, mobile communication
Bites and Stings / U / M / M / Mobile communication, first aid kit
Slippery surface, footing / U / M / M / Appropriate footwear, team lifting, limit size of loads
Manual handling / U / m / M / Appropriate footwear, team lifting, limit size of loads
Natural disaster (e.g. bushfire) / U / M / M / Emergency planning, communication, street directory
Alcohol/recreational drug use / U / M / M / No alcohol/recreational drugs on field trips
Emergency Evacuation / U / M / M / On arrival emergency evacuation points to be identified and local procedures followed. To be communicated to participants
Lack of communication / P / M / M / Mobile coverage to be checked and phones charged and can be re-charged. Consider satellite phone
Tripping / U / m / M / Taping down or covering over trip hazards or cables, use of safety cones to designate hazard
Working in public places / U / m / M / Have Flinders ID readily available. Work in safe areas only, considering the public and traffic. Use of safety vests and cones to identify hazards and working area
Lighting / U / M / M / Use of RCD device, operators to have passed competency test, use of shot bags and safety mesh on lights, use of gloves and glasses when changing globes
Can you identify any further hazards? / NO
YES  / Adequately controlled. No further action required, proceed to Summary of Risk and Signature block.
Further hazards identified. Proceed further with Risk Assessment

ADDITIONAL HAZARDS

To evaluate other identified hazards associated with this trip; type each identified hazard on the form, complete the Probability (P) and Consequence (C), using the Risk Matrixenter the Risk Assessment rating (RA) refer page 10. Complete a detailed list of controls you will put in place to ultimately eliminate or significantly reduce the associated risk.

Item / Hazard / P / C / RA / Control / Action by / Date
Task-Specific Items
SUMMARY OF RISK Review the risk measured, and the controls, then please select the relevant risk summary statement:
A / The assessment reveals that the potential risk to health from the use of the plant/equipment/procedure is not currently significant
B / The assessment reveals that the potential risk to health from the use of the plant/equipment/procedure is significant, however controls are in place that reduce risk to acceptable levels / 
C / The assessment reveals that the potential risk to health from the use of the plant/equipment/procedure is significant. Interim controls are in place to reduce risk to acceptable levels.
Signed: (Field Trip Leader) / Date:
Signed: (Field Trip Leader’s Supervisor) / Date:
EHL GUIDE TO ASSESSING RISKS AND IDENTIFYING HAZARDS
Probability - Risk Factors → / Consequence - Risk Factors →
Very Likely
VL / Probably occur immediately or within a short period of time / Fatality
F / May cause death or loss of facility
Likely
L / Probably occur in time / Major
M / Severe injury or illness or major property damage
Possible
P / Could happen occasionally / Minor
m / Minor (usually reversible) injury or illness resulting in days off work or minor property damage
Unlikely
U / Could eventually happen / First Aid
FA / First aid level treatment
Highly Unlikely
hU / Has potential to occur, but probably never will / Negligible
N / No medical treatment
Forms of Hazard
Physical / Mechanical action, impact, electrical exposure, heat/cold, noise, vibration, explosion etc.
Chemical / Corrosive liquid, toxic gases, noxious fumes etc.
Ergonomic / Height of workbench, design of chair, set-up of a work station etc.
Radiation / x-ray machine, infrared beams etc.
Psychological / Stress from using equipment without proper training or instruction, interpersonal conflict
Biological / Sharps, specimen containers carrying infected material, viruses from A/C system
Sources / EnvironmentSubstancesEquipment/plantWork systems
Risk Matrix / Consequence / Probability / Control Hierarchy
Very likely / Likely / Possible / Unlikely / Highly unlikely / Elimination / Is it necessary
Fatality F / Extreme / High / High / High / Medium / Substitution / Is there a less hazardous alternative
Major injury M / High / High / High / Medium / Medium / Isolation / Eg Restrict access, use in a closed container, fume cabinet
Minor injury m / High / Medium / Medium / Medium / Medium / Engineering / Eg Trolleys to move loads, guards on machinery, Fume cupboard
First aid FA / Medium / Medium / Medium / Low / Low / Administration / Eg: Training, Safe Work Procedure, signage
Negligible N / Medium / Medium / Low / Low / Low / PPE - Personal
Protective Equipment / Eg: Gloves, respirator, safety glasses

EHL Field Trip Forms Last updated: 7/09/2011 Page 1 of 10