Type into grey boxes and Tab between inputs

Unit of study / Research project / Other title: Start date: Finish date:
Fieldwork Description (this can be a brief outline if a comprehensive description of the proposed fieldwork has been attached):
A comprehensive description of the proposed fieldwork has been attached. / A risk assessment is attached.
Participants briefed on details of proposed fieldwork; relevant safety policies, procedures and expected conduct whilst on the field work. / Field work information sheet provided to all participants + all participants signed onto this safety plan.
All equipment, vehicles and tools will be checked for safety compliance prior to field work commencing. / Participants have disclosed any relevant medical conditions.
Required licenses, permits and agreements with land owners and other involved parties are up-to-date for the use of specialised equipment and/or plant.

Copies of this fully endorsed plan have been distributed to: School/Unit DBSO (if applicable) Fieldwork Supervisor

Volunteer insurance details are to be retained by the School/Unit office. If the Head of School/Administrative Unit deems that proposed fieldwork involves complex hazards or a higher than normal risk then a copy must also be sent to the Dean/Senior Manager.

UWA CONTACT AND CALL- HOME ARRANGEMENTS

UWA Contact Name(s): / Phone Number(s): / Call-Home Arrangement:
Emergency response plan if call-home arrangements fail:
Collaborators obligation (non UWA persons/organization) when leading a fieldtrip: In the event of an incident, injury or near miss a member of the coordinating field team will phone the UWA as soon as practicable. Via (details on this form) prioritized either : A) Fieldwork Supervisor B) Head of School (or Delegate)
or C) UWA Security and Parking on +61 (0)8 6488 2222. UWA must be involved in incident investigations and outcomes.
Name: / Organisation: / Position: / Signature:
FIRST AID: / (1) Provide first aid to the injured person. / (2) Ensure Status of all other persons. / (3) Call 000. Mobile phones can call 112 for ambulance (on any network and outside normal coverage area). / (4) Emergency Service will request location (including GPS co-ordinates), contact number, clinical details and will offer advice. / (5) Transfer to Medical Unit as directed by Medical Specialist(s) / (6) Contact POC, School Manager,

TRANSPORT ARRANGEMENTS TO FIELDWORK SITE(S) (details of any off-road driving must be included)

ITINERARY DETAILS

Date / Time / Location / Accommodation / Phone / E-mail (of accommodation)

PARTICIPANTS DECLARATION

I have read and fully understand the requirements of this Fieldwork Safety Plan and associated documents. I have completed and submitted Form 01 [REGISTRATION] FIELDWORK PARTICIPATION DECLARATION or hold active RiskTeq account which is renewed annually.

Name / Phone Number / NON UWA Volunteer or / Driver Competence / Signature / Date
(during fieldtrip) / Collaborator? / Approved driver / 4WD trained? / Off-road trained?
1 / V C
2 / V C
3 / V C
4 / V C
5 / V C
6 / V C
7 / V C
8 / V C
9 / V C

PERMISSION TO PROCEED

Print Name / Mobile (or fwd’d) phone / Signature / Date
Fieldwork Leader
Fieldwork Supervisor
DBSO (if applicable)
Head of School or Delegate
Fieldwork Safety Plan / Published: / October 2017 / Version 1.7
Authorised by UWA Safety, Health and Wellbeing / Review: / January 2021 / Page 1 of 2
This document is uncontrolled when printed (down loaded). The current version is available on the Safety, Health and Wellbeing website