Professional Documents
Culture Documents
SUMMARY
School or local Work Area to record details on the Field Trip database
FIELD TRIP TITLE:
DESTINATION TYPE:
(eg. Metro, Regional, Remote, Interstate,
REGIONAL
WALTER OLENICH
MOBILE NUMBER:
EMAIL ADDRESS:
Walter.Olenich@flinders.edu.au or
olenich@aapt.net.au
LEADERS SUPERVISOR:
TOTAL NUMBER OF PARTICIPANTS: 23
FLINDERS STAFF: 2
FLINDERS STUDENTS: 21
VOLUNTEERS: -
Date:
07/08/2014
John Macfarlane
Walter Olenich
Date:
21/07/2014
Date:
Date:
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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 :
EHLT Field Trip forms
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WALTER OLENICH
Sign:
Date: 17/06/14
If you are under 18 years old, your care-giver also needs to sign the form, below.
Sign:
Date:
In the event of any emergency please contact the following person: (Next of kin)
Name: CHRISTINE OLENICH
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: N/A
To: 25/11/14
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PLEASE ENSURE ALL PARTICIPANTS SIGN FORMS AND RETURN TO FIELD TRIP LEADER BEFORE
FIELD TRIP COMMENCES.
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5
.
6
.
WALTER OLENICH
Topic No.
HLPE 3532
Contact Phone:
Departure:
Date: 22 SEPTEMBER
Time: 8.00AM
Return:
Date: 24 SEPTEMBER
Time: 4.00PM
Destination
Contact No.
DEEP CREEK
C.P.
08 8598 0263
Transport arrangements:
Emergency contacts:
6.1 Nominated Contact Person at the University
Name: JOHN MACFARLANE
Contact No.
8201 3389, 0421 140 905
6.2 Security after hours (to initiate late return procedures * below)
Contact (08) 8201 2880
6.3 Emergency Services locations and contacts nearest to destination:
Hospital:
Country Fire Service:
Royal Flying Doctor
Service:
RAH, FLINDERS
N/A
Police:
Contact No.
Contact No.000, 131 444, 08 8558 2014
Other:
AMBULANCE
Contact No.000
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
John Macfarlane
Date: 21/07/2014
Walter Olenich
Signed: (Field Trip Leaders Supervisor)
Date:
Date:
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Item
Checked
Transport/Equipment/Itineraries/Maps
Yes
No
N/A
Yes
Vehicles, trailers, tow bars compatible and Road Traffic Act compliant?
Yes
Yes
No
N/A
No
N/A
No
N/A
No
Motor vehicle safety & recovery equipment ie. Bull bar, winch, tow rope, jumper leads,
shackles etc.
Yes
Yes
Yes
Yes
No
Equipment has been inspected to ensure its integrity and is of an approved design and
meets minimal legal requirements?
Briefings/Consultation/Accommodation/Catering
Yes
No
N/A
Yes
No
The participants have been consulted regarding arrangements, potential hazards etc?
Yes
No
Yes
No
Yes
Yes
If working alone, participant is advised that regular contact must be made with
Nominated Contact Person?
Yes
N/A
No
No
N/A
N/A
N/A
N/A
N/A
N/A
No
N/A
No
No
N/A
N/A
No
The hazards associated with the field trip have been identified/controls developed?
Yes
Yes
Yes
Yes
No
Yes
No
N/A
No
N/A
No
N/A
N/A
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N/A
Yes
First aid kits have been checked for contents and refilled?
No
N/A
No
Yes
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
N/A
N/A
N/A
N/A
N/A
N/A
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Yes
No
N/A
Department of Environment and Heritage advised of the dates for planned field trip and
associated trips?
Local Council advised of trip (where relevant)?
Yes
No
N/A
Yes
No
N/A
Yes
No
N/A
Scuba diving?
Snorkeling?
If yes, you must contact the Maritime Archeology Diving Officer on ext. 15533
Cliff walking or climbing?
Yes
No
N/A
Bush walking?
Yes
No
N/A
Yes
No
N/A
Yes
No
N/A
Firearms, spring or gas powered spears, explosives and other weapons will be taken on
Field Trip.
Involving geological and mining trips?
Yes
No
N/A
Yes
No
N/A
Other trips that may expose people to medium to high risk? Eg. Mountain bike riding,
canoeing, kayaking, swimming.
Flying in any form, ie. Planes. Air balloon, Helicopter
Yes
No
N/A
No
Yes
Are you going Overseas?
Relevant vaccinations identified/field party advised?
Visas, Passports, Embassies, Government travel warnings have been considered.
Dangerous/Hazardous substances (eg. Petrol, LP Gas)
Containers and labeling is compliant
N/A
No
Yes
Yes
N/A
No
N/A
IMPORTANT:
I have READ and UNDERSTOOD the EHLT 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 & Planning form
Field Trip Health & Safety Checklist form
Private Vehicle form (if applicable) one for each vehicle
Field Trip Summary
Risk Assessment
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
EHLT Field Trip forms
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School/Local Work Area Office retains full copy of signed documentation for archiving for 7 years
Date: 21/07/2014
Walter Olenich
Date:
EMERGENCY PLAN
DEEP CREEKJ C.P.BUSHWALK
22 to 24 Sept 2014
Contact Phone on Expedition: Walter Olenich
Dave Rawson
8201 3392
0421 140 905
8201 2880
000
131444
Victor Harbor
8558 2014
Fire CFS
8552 0500
Flinders
8204 5511
Royal Adelaide
8222 4000
8598 0263
Phone Coverage
Telstra reasonable (excellent on high ground)
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Department
Outdoor Education HLPE3532
Assessed by:
Walter Olenich & John Naumann
Refer EHLT
Location
DEEP CREEK CONS. PARK
Date
22/09/14 TO 24/09/2014
Booking Ref.
No
Area Supervisor
Russell Brown, Terry Magias
Review Date
04/12/2014
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 Trip Health & Safety Checklist and the Hazard Identification
Guidelines can 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
Field Trip: General
Hazard
R
A
Control
Exposure to elements
Medical emergency
Manual handling
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Action by
Field Trip Leader
W Olenich and all
Participants
Field Trip Leader
W Olenich and all
Participants
Field Trip Leader
W Olenich and all
Participants
Field Trip Leader
W Olenich and all
Participants
Field Trip Leader
W Olenich and all
Participants
Field Trip Leader
W Olenich and all
Participants
Field Trip Leader
W Olenich and all
Participants
Date of Trip
22/09/2014
To
24/09/2014
22/09/2014
To
24/09/2014
22/09/2014
To
24/09/2014
22/09/2014
To
24/09/2014
22/09/2014
To
24/09/2014
22/09/2014
To
24/09/2014
22/09/2014
To
24/09/2014
25/10/2015
Item
Hazard
R
A
Control
Emergency Evacuation
Lack of communication
NO
Action by
Date of Trip
22/09/2014
To
24/09/2014
22/09/2014
To
24/09/2014
22/09/2014
To
24/09/2014
22/09/2014
To
24/09/2014
Adequately controlled. No further action required, proceed to Summary of Risk and Signature block.
Further hazards identified. Proceed further with Risk Assessment
YES
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
Matrix enter 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
Field Trips: General/
Bushwalking
Hazard
Transport to site
Motor vehicle, Bus
P
HU
C
M
R
A
M
Fatigue
Exposure to elements
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Control
Licensed drivers, Restricted speed on program
Vehicles serviced and roadworthy, university
vehicles, commercial licensed operators
Safety brief by group leader
State appropriate/acceptable behaviours
Supervision by leader/ staff
All to apply common sense and traffic awareness
Follow road rules, Monitor group numbers
Monitoring of group/ individual progress by
leader, rest of group
Ensure adequate rest breaks
Amend program if considered necessary
Monitor local conditions, sunscreen, appropriate
shelter
Equipment/ clothing checks pre departure
Appropriate site
Action by
Field Trip Leader
W Olenich and all
Participants
Date
22/09/2014
To
24/09/2014
22/09/2014
To
24/09/2014
22/09/2014
To
24/09/2014
22/09/2014
To
24/09/2014
25/10/2015
Item
Hazard
R
A
Control
Action by
Date
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22/09/2014
To
24/09/2014
22/09/2014
To
24/09/2014
22/09/2014
To
24/09/2014
22/09/2014
To
24/09/2014
22/09/2014
To
24/09/2014
25/10/2015
Item
Hazard
R
A
Manual handling
Electrical storms
Control
Appropriate footwear, team lifting, limit size of
loads
Demonstration of correct techniques by leader
22/09/2014
To
24/09/2014
22/09/2014
To
24/09/2014
22/09/2014
To
24/09/2014
22/09/2014
To
24/09/2014
22/09/2014
To
24/09/2014
22/09/2014
To
24/09/2014
22/09/2014
To
24/09/2014
22/09/2014
To
24/09/2014
Prior training
Establish trip intentions
Constant monitoring of group position
GPS carried by all groups while in the field
22/09/2014
To
24/09/2014
22/09/2014
To
24/09/2014
M
Identified in advance
Review route plans/ identify safe route
Lost
HU
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Date
Identified in advance
Review route plans/ identify safe route
Hazardous locations (Generic)
Action by
25/10/2015
Item
Hazard
R
A
Control
Action by
Date
22/09/2014
To
24/09/2014
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
C
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
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.
Date: 17/07/2014
Date:
Date:
Emergency Response Plan: ALL SERIOUS INCIDENTS (A critical or life threatening injury)
Accident Management and Planning:
The effective management of any incident in the field will, for the most part rely on sound judgement and decision making from the group leaders on the scene.
First priority tasks: Immediate management of a serious incident, self, group, seek assistance of other leaders and or competent students to help stabilise the casualty.
Medical summary sheets consulted to gain relevant medical information, record treatment and prepare a report for emergency services.
When ringing 000 give: Group name, grid reference, casualties symptoms, treatment given, existing medical condition or allergy.
Debrief group to what is happening. Group members positioned to help identify casualty site for emergency services.
Second priority tasks: Make contact with the university emergency contact. Group leader should accompany casualty to hospital if possible.
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Very Likely
VL
Fatality
F
Likely
L
Major
M
Possible
Minor
m
Minor (usually reversible) injury or illness resulting in days off work or minor property
damage
P
Unlikely
First Aid
FA
Negligible
N
U
Highly
Unlikely
hU
No medical treatment
Forms of Hazard
Physical
Chemical
Ergonomic
Radiation
Psychological
Biological
Sources
Risk
Matri
x
Mechanical action, impact, electrical exposure, heat/cold, noise, vibration, explosion etc.
Corrosive liquid, toxic gases, noxious fumes etc.
Height of workbench, design of chair, set-up of a work station etc.
x-ray machine, infrared beams etc.
Stress from using equipment without proper training or instruction, interpersonal conflict
Sharps, specimen containers carrying infected material, viruses from A/C system
Environment Substances
Equipment/plant
Work systems
Probability
Control Hierarchy
Consequence
Very
likely
Likely
Possible
Unlikely
Highly
unlikely
Elimination
Is it necessary
Fatality F
Extreme
High
High
High
Medium
Substitution
Major injury M
High
High
High
Medium
Medium
Isolation
Minor injury m
High
Medium
Medium
Medium
Medium
Engineering
First aid FA
Medium
Medium
Medium
Low
Low
Administration
Negligible N
Medium
Medium
Low
Low
Low
PPE - Personal
Protective Equipment
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