Fillable Lamar University Off-Site Experiential Learning Safety Plan (Lamar University)

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Lamar University Off-Site Experiential Learning Safety Plan (Lamar University)

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File type: PDF

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Lamar University Off-Site
Experiential Learning Safety Plan
Principal Investigator:
Department:
Phone Number:
E-mail Address:
Dates of Travel: (List multiple dates if more than one trip is planned)
Location of Field Experience:
Country:__________________________ Geographical Site: ___________________________
Nearest City:_____________________________________________________
(Name, Distance from Site)
N
earest Hospital or Medical Clinic:
_______________________________________________
(Location, Distance from Site)
Field Experience: (Please include a brief description of the field work).
University Contact:
P
hone
Local (Field) Contact:
P
hone
Emergency Procedures: (Please include detailed plans for field location including evacuation
and emergency communication; Include a separate sheet if necessary).
First Aid Training: (Please list any team members who are first aid trained and the type of
training they have).
Physical Demands: (Please list any physical demands required for this field research, e.g.,
Diving, Climbing, Temperature Extremes, High Altitude).
Risk Assessment: Please list identified risks associated with the activity or the physical
environment (e.g., extreme heat or cold, wild animals, endemic diseases, firearms, explosives,
violence). List appropriate measures to be taken to reduce the risks; Include a separate sheet if
necessary.
Identified Risk Control of Risk
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Medical Considerations (Please list required immunizations or examinations for travel)
Field Team Membership (Please list the names of all members of the field research team, and
identify the Field Team Leader.)
Additional Comments
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Lamar University Off-Site Experiential Learning Safety Plan (Lamar University)

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Completed 22 August 2020

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