ram forms kauri syndicate camp 2011

8/6/2019 RAM Forms Kauri Syndicate Camp 2011

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Risk AnalysisManagement Forms

TravelDaily Operation of Camp

Risk Management Document

Finlay Park

Waiau Pa Crisis Management Plans

Code of conduct for Parents

Useful Contact NumbersParentsMedical

Skills Log Declaration

Accident / Incident Register

Risk Management Evaluation Form

EOTC Event Report and Evaluation

Sign Off Sheet.


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Risk AnalysisManagement System

Waiau Pa Primary School

Kauri Syndicate

Date : Tuesday March29th Friday 1st April

Pupils : 98

Ratio : 1:6

Site : Cambridge

Base : Finlay Park

Theme : Outdoor Experience

Activities : Adventure and confidence basedactivities

Teacher in charge : Bevan Clark 027 273 4641Staff : Vicky Eden 027 313 7982

Bryer Lea 021 109 0140Rosemary Davis 027 688 5650


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RAM FORMS

TravelDaily Operation of Camp


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Waiau Pa School Risk identification and management form.

Kauri Syndicate Camp 2011 March29st

April1st

Activity / Situation: TRAVEL TO / FROM CAMP

This form covers All vehicle use, including but not restricted to:

y Transporting pupils- to / from camp

y Adults traveling to get extra supplies at store

Possible consequences of identified hazard.

1. Fatality2. Permanent Disability3. Medical Treatment Injury4. First Aid Injury5. Psychological Damage

EMERGENCIES.

Follow Crisis Management Plan.

Contact Emergency services (Phone 111)

Ensure where possible you have phone coverage.

Ensure Emergency Transport is available

Factors influenced

by:

Identified Hazard. Possible

Consequence

Mitigating Steps.

People y Poor driving skills- speed

- poor decisions

1,2,3,4 y Leave early to avoid rush

y Planned stops on way covered in drivers briefing.

y Check Drivers Licenses at school prior to departure.

y Students behaviour on Bus/Car 1,2,3,4,5 y How we group kids on the bus.

y Brief parents about expectations of students rebehaviour on trip

y Exceeding the 100km speed limit

y

1,2,3,4 y No Car/Bus to exceed the 100km speed limit orspeed restrictions in built up areas

y Teacher Injury unable to fill full duties. 2,3,4,5 y Students/Staff fully briefed on expected behaviourand days programme.

y Rubber necking 2,3,4,5 y Brief parents about transport expectations.

y Exceeding speed limit in built up areas 1,2,3,4 y No Car/Bus to exceed speed restrictions in built up

areasy Driver Fatigue 1,2,3,4 y Planned Stop ( Gordonton)

Equipment y Safety belts

y

1,2,3,4 y All drivers in cars to check all passengers are

wearing a seatbelt. All students on the bus to be

seated.

y Parents provided with map and a detaileddescription of directions.

y WOF not current cars and trailers 1,2,3,4, y Check WOF on car / trailers

y Check Registration

y Overcrowded Vechicles 1,2,3,4,5 y Distribute students per diagonal seat belt or 2 perseat on Bus.

y Overweight Vechicles 1,2,3,4 y Distribute equipment evenly among cars

y Incorrect loading of trailers 2,3,4 y Trailers checked before leaving.


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Environment y Poor road surface 1,2,3,4,5 y Driver briefing prior to leaving for camp

y Written notes on driving.

y Drivers have the final call as to whether they travel intheir vehicles.

y Heavy unexpected rain 1,2,3,4,5 y Driver briefing prior to leaving for camp

y Written notes on driving.

y Drivers have the final call as to whether they travel in

their vehicles.

y Wet/slippery roads 1,2,3,4 y Weather check on day

y Review with parents to allow for conditions prior

to trip

y Discuss with parents road conditions on route

and reinforce driving to the conditions.

y Sun strike 1,2,3,4 y Review with parents to allow for conditions priorto trip

y Discuss with parents road conditions on routeand reinforce driving to the conditions.

y Logging Trucks / Buses 1,2,3,4 y Caution around be aware of moving hazards

in front of and behind your vehicle.

y Fog 1,2,3,4 y Review with parents to allow for conditions prior

to trip



y Wind 1,2,3,4 y Review with parents to allow for conditions prior

to trip


y Floods and fiords 2,3,4 y Review with parents to allow for conditions prior

to trip


y Slips 2,3,4 y Review with parents to allow for conditions prior

to trip


y Metal road 1,2,3,4 y Review with parents to allow for conditions priorto trip


y Narrow roads 1,2,3,4 y Review with parents to allow for conditions priorto trip



Signed Principal :.. Date:.

Signed CampLeader :.. Date:.


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Waiau Pa Primary School Risk identification and management form.

Kauri Syndicate Camp 2011 March29th

April1st

Activity / Situation: DAILY OPERATION OF CAMP

This form covers All vehicle use, including but not restricted to:

y All activities in and around Finlay Park

y All movement in and around Finlay Park

y All inter-personal contact in and around Finlay Park.

y

Possible consequences of identified hazard.1. Fatality2. Permanent Disability

3. Medical Treatment Injury4. First Aid Injury5. Psychological Damage

EMERGENCIES.Follow Crisis Management Plan.

Contact Emergency services (Phone 111)

Ensure where possible you have phone coverage.

Ensure Emergency Transport is available

Factors influenced by: Identified Hazard. PossibleConsequence

Mitigating Steps.

People Disobedience 2,3,4,5 y Supervise leisure activities

y Clear guidelines of expectations andinstructions

y Boundaries defined

Failing to follow instructions 2,3,4,5 y Clear guidelines of expectations andinstructions


Pupil infighting / pranks 2,3,4,5 y Clear guidelines of expectations andinstructions


Poisoning 1,2,3,4,5 y Only adults in kitchen areas.

y First aid packavailable, awareness offirst aid officers and safety procedures

in accommodation and recreation areas.

Burns in food areas 1,2,3,4,5 y Only adults in kitchen, if students arerequired they must be supervised.

y When washing dishes an adult mustcheck the temperature of the water.

y Cold water / fire extinguisher and ice

packs readily on hand

y First aid pack is available, awareness offirst aid officers and safety procedures

in accommodation and recreation areas.

y Knowledge of contacts doctor ortrained first aider.

Food poisoning 1,2,3,4,5 y Washing hands, utensils and hygiene,storage of food

Personal safety: for adults / pupils /

amongst each other, other possible

outsiders

1,2,3,4,5 y Clear guidelines of expectations andinstructions

y Make sure no adult in alone with onechild

Inadequate supervision of leisure

activities

2,3,4,5 y Clear guidelines of expectations andinstructions

Teacher Injury Unable to fill full

leadership role.

1,2,3,4,5 y Four teachers to attend camp. Shared

Leadership.


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Equipment Broken furniture 3,4,5 y Inspect equipment-Check for ill repair

-Repair or remove

y Awareness of decks, pathways andrailings

Splinters / inadequate furniture 3,4,5 y Inspect equipment-Check for ill repair

-Repair or remove

Faulty equipment camp or school 2,3,4,5 y Inspect equipment

-Check for ill repair-Repair or remove

Broken crockery and cutlery. 3,4,5 y Inspect equipment-Check for ill repair

-Remove

Environment Weather wet slippery decks 1,2,3,4 y Daily weather checks

y Awareness of slippery spots

Cold / sun / wind effects 2,3,4,5 y Daily weather checks

y Awareness of slippery spots

Uneven surfaces for walking 3,4,5 y Taking care around buildings- Walk

-Supervision

Signed Principal :.. Date:.

Signed CampLeader :.. Date:.


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Risk Management Document

Finlay Park

Activities

Emergency Procedure Policyfor Accidents and Emergencies


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Near-Miss Register and Accident/ IncidentReporting.

1. PURPOSE

1.1 Waiau Pa Primary School aims to promote reporting and investigating of all incidents insupport of a safety culture where learning from errors is used to prevent a recurrence and tocomply with legislation. These guidelines are to ensure staff are aware of their responsibilityin relation to reporting incidents, that all incidents are properly investigated, to ensurecorrective action is taken to prevent recurrence and to reduce the risk potential at school.

2. DEFINITIONS

2.1 In relation to OHS Management Systems the terms accident and incident have the samemeaning, although many believe that an event such as a near -miss without injury, damage orloss is an incident and not an accident. To ensure that all nea r-miss events are reported,Waiau PaSchool has used the term accident/ incident on our report forms. Except for usingthe full name of report forms, the term incident will be used throughout this document and issynonymous with the term accident. The following definitions apply fo r the purpose of thisguideline:(a) Incident - An unplanned event resulting in, or having the potential for injury, ill -health,

damage or other loss.(b) Serious Incident - Where a staff member, student or visitor is fatally injured or sustains a

serious injury or illness, where no injury or illness occurs but the situation is immediatelylife threatening.

3. RESPONSIBILITIES

3.1 Employees and students must:(a) Report all incidents to their direct supervisor and/or manager.(b) Ensure the completion of the Accident / Incident Report Form.(c) Forward completed forms direct to the Principal or Health and Safety

Co-ordinator.

3.2 First-aid officers and duty teachers must:(a) Report all incidents requiring first -aid or near-miss incidents that theyattend, including those to visitors (including contractors).(b) Ensure the completion of the Accident / Incident Report Form. (c) Forward completed forms direct to Principal or Health and SafetyCo-ordinator.


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. e r nc pa or ea an a e y o -or na or, mus :(a) Review all Accident/Incident Report Forms.(b) Ensure timely completion of Accident/Incident Report Forms.(c) Provide feedback, advice, guidance and assistance to direct supervisors.(d) Monitor the investigation process and strategies implemented.

4. REPORTING

4.1 In the first instance staff shall, where it is safe to do so, take appropriate immediate action tominimise the risk of further injury or damage (for example, provide first aid, fight any fire,

contain spills, contact emergency services) before reporting incidents.(a) Reporting of incidents is essential for the identification of hazards in the workplace.(b) All near-miss incidents should be reported.(c) The person directly involved in the incident or, if unable, another person (staff member,

first aid officer) shall complete the Accident/Incident Report Form. This form should becompleted and forwarded to the Principal or Health and Safety Co -ordinator within 48hours of the incident occurring.

(d) For incidents which constitute an emergency, refer also to the Site Eme rgency Plans.(e) Serious incidents and hazards must be immediately reported to the Principal.

4.2 The Waiau Pa Primary School Accidents/Incidents Register in the SM Database is used torecord details from the Accident/Incident Report Form. Please note:

(a) Incidents that occur, are not considered serious and do not result in injury are still to berecorded in this register.

4.3 All workplace incidents that result in a staff member sustaining injury must be reported to thePrincipal within 24 hours of occurrence.

5. ACCIDENT/INCIDENT ACTION SHEET [Health & Safety Coordinator TO COMPLETE]

5.1 After an Accident/Incident Report Form has been registered in the SM Database, anAccident/Incident Action Sheet is completed and attached to the report form. The ActionSheet is to advise of further action to be taken. Further action includes, but is not limited to:(a) An investigation by Principal, B.O.T .

(b) Alternative action which could include completing an ergonomic assessment, riskassessment or submitting a maintenance request.

5.2 The Accident/Incident Report Form and Action Sheet will be distributed to other parties asrequired.

Generally, staff Accident/Incident Forms will be distributed to:(a) Principal, Deputy Principal and Senior Staff Members.(b) Health & Safety Committee Meeting for review at the next B.O.T meeting.

Student Accident/Incident Forms are sent to:(a) Principal.(b) Health & Safety Committee for review at the next B.O.T meeting.(c) Parent(s) of student involved.


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.

6.1 Where an Accident/Incident Action Sheet requests alternative action is required, it is usuallythe responsibility of the Principal to complete.

6.2 Alternative action includes, but is not limited to:(a) Completion of an ergonomic assessment.(b) Documenting a risk assessment.(c) Providing training to staff.(d) Developing and implementing a standard operating procedure.

(e) Consultation with staff about procedures.

6.3 Once the alternative action has been completed, the Principal is required to tick the ActionSheet off as completed, make comment on the action taken and return the sheet to theHealth & Safety Co-ordinator.

7. INCIDENT INVESTIGATION

7.1 The objective of the investigation is to establish the direct and contributing cause/s of theincident, so that corrective action can be adopted to prevent a future recurrence.

Where requested, incidents should be promptly investigated by Senior Staff, or by the person

in charge of the area where the incident occurred. The investigation should identify thecausal factors related to the incident and assess any hazards that need to be controlled.

The Principal should discuss the incident with relevant staff and decide on suitable riskcontrols to be implemented. The investigation and corrective actions are to be recorde d onthe Accident/Incident Investigation Form.

7.2 The Principal or Health & Safety Co -ordinator will sign off on all completed investigations andmonitor trends of incidents and initiate further investigation where:

(a) A number of incidents are noted for similar situations.(b) The Principal or Senior Staff have requested assistance to investigate an incident.

(c) A serious or major incident has occurred.(d) Any situation that is deemed to require further investigation.

8. INVESTIGATIONS COORDINATED BY B.O.T

8.1 The B.O.T will coordinate investigations into incidents that are considered to be of a seriousnature (see Definitions: serious incident). This investigation will be lead by a suitably trainedrepresentative of the B.O.T and will include assistance from person/s injured or ill, witnesses,duty staff and any other persons that may be required.

Following the investigation, a comprehensive report will be completed and distributed to

those parties as required.

8.2 Where a critical incident has occurred, it will be the responsibility of the B.O.T to ensureappropriate steps are taken to investigate and identify preventative action. Where such anincident occurs, an Accident/Incident Report Form is usually completed as soo n as possibleafter the incident has occurred.


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9.1 Records of all incident notifications, reporting, investigation and corrective actions shall bekept by the Principal & Health and Safety Co -ordinator. Where applicable, records shall bekept for the duration required by legislation.

9.2 The Deputy Principal and Senior Managers should also retain copies of these documents forauditing purposes. Training and competency records should also be kept, identifying thedescription of any training session, the date and location of the session, details of theprovider and details of the participants.


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Waiau Pa School Crisis Management Plans


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Crisis Management Plan

INJUR /ILLNESS

STOP! THINK! ACCESS!1-Safet of Self 2-Safet of Grou 3-Safet of Person s involved

DELEGATE1. Remember a leader must remain free to manage t

e situation. This role can be

delegated if circumstances deem it necessary.

2. A first-aiderto attend to any injuries/illnesses. Access injury/illness SRABCSdone (safety, response, airway, breathing, circulation, severe bleeding/shock)

3. A supervisorto manage the group warmth/shelter, fluids, food, reassurance4. Caller for Emergency Services5. Go-fer appointed , two people to run messages.

GATHERINFORMATRION1. Follow SRABCS2. Establish circumstances ofinjury/illness3. Gatherinformation aboutthe patients condition4. First aidertreat as appropriate.5. Gatherinformation on o tions; ie CONTINUE or EVACUATE

DECISION

1. Continue ifinjury/illness successfully treated and no residual effect 2. Evacuate ifin doubt orif serious3. Wait for emer enc services

COMMUNICATION1. Call emergency services; TIC calls whanau orif serious, call principal (who

contacts whanau as appropriate)

2. Keep group informed and reassured3. Keep principalinformed4. DO NOT SPEAK TO THE MEDIA

EVACUATION/RESOLUTION1. Continue with activity

2. Evacuate person & or group shortest route, if patient can walk. Assistedevacuation, call for help, keep patient and group comfortable, warm, dry, and

reassured.

DEBRIEFDiscuss event and its impact with the group if appropriate.


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EMOTIONAL DISTRESS

STOP! THINK! ACCESS!1-Safety of Self 2-Safety of Group 3-Safety of Person(s) involved

DELEGATE1. A supervisorto manage the group warmth/shelter, fluids, food,

reassurance

2. Teacher with counselling skills or whom affected studenttrusts tomanage the student. Reassure and support

3. T.I.Cliaises with teacher and school

GATHERINFORMATRION1. Establish circumstances ofthe distress listen, let studenttalk, check

physical evidence, be honest with the student.

2. Let student search for own solutions. Teacher facilitate this process3. Direct students thought/activity (keep occupied)

4. Consider options for resolution

DECISION

With the student, decide on a course of action.

COMMUNICATION1. If risk of serious harm, call emergency services, teacherin charge &

Principal, (May occur earlierin the process)

2. Someone stay with victim & reassure them.3. Keep group and Principalinformed; Principaltalks to Whanau and

media.

EVACUATION/RESOLUTION

Will depend on the nature ofthe distress.



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SERIOUS MISCONDUCTe. . lt, / l l e, exual acti it , latant efiance, t eft

STOP! THINK! ACCESS!

1-Safety of Self 2-Safety of Group 3-Safety of Person(s) involved

DELEGATE1. Most seniorteacherimmediately available to manage the student(s). Furtherteachers

to assistif required

2. Other adult supervisors to manage the group or factions, supported by seniorleaders warmth/shelter, fluids, food, reassurance, anger/anxiety management

3. If required; provide 1st Aid (go to incident plan)

GATHERINFORMATRION1. Establish circumstances ofincident/problem question person(s), check physical

evidence, interview witnesses, record responses

2. Consider options for resolution3. Are a large number of students at fault

DECISION1. Decide on a course of action. Loss of privileges / extra duties / Sent Home2. Contact Princi al

COMMUNICATION1. If appropriate; Call emergency services. Contact TIC/principal early2. Keep principalinformed; principaltalks to whanau and media

3. Keep group informed and reassured4. DO NOT SPEAK TO THE MEDIA


Consequences imposed / sent home (nextday iflarge number of students)

DEBRIEFDiscuss event and its impact with the group if appropriate. Contact appropriate

crisis managementteams if needed.


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FATALITY PLAN


DELEGATE1. A supervisorto manage the group warmth/shelter, fluids, food, reassurance2. Someone to manage the person(s) involved cover body, create a no-go zone

3. Two people minimum to be messengers as needed

GATHERINFORMATRION

1. Establish circumstances of death BUT DO NOT DISTURB THE BODY ORSCENE2. Question person(s), check physical evidence

DECISION

Body removed by Police, Principalinformed early

Do notleave body alone if possible, and treat with sensitivity.

COMMUNICATION1. Call police, teacherin charge and/or principal2. Keep group informed and reassured3. Keep TIC and/or principalinformed4. DO NOT SPEAK TO THE MEDIA


1. Police arrange removal ofthe body2. Allow for grieving3. Evacuate the group.

DEBRIEFManage needs ofthe group, Contact and liase with appropriate crisis

managementteams.


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MISSING / LOST PERSON


DELEGATE1. A supervisorto manage the group warmth/shelter, fluids, food, reassurance, check

all group accounted for

2. Someone to manage the person(s) involved, once found provide3. 1st Aid, resolve crisis4. Two people minimum to be messengers as needed

GATHERINFORMATRION1. Establish pointlast seen/contacted2. Circumstances of separation from group - question person(s), check physical

evidence; hiding? Lost?

3. Consider options to resolve search area, continue iflocated, SAR?

DECISION

Determine search area, activate own search plan?

Continue or evacuate when found or callin and wait for SAR.

Management and evacuation of group.

COMMUNICATION1. Call police SAR; call principal (who contacts whanau as appropriate)2. Keep group informed and reassured3. Keep principalinformed4. DO NOT SPEAK TO THE MEDIA


Person located, administer 1st aid, reassure, warmth, nourishment

Inform search team, Principal, rest of group.Evacuate person and or group.



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INCIDENT / PROBLEM (GENERIC)


DELEGATE1. A supervisorto manage the group warmth/shelter, fluids, food, reassurance2. Someone to manage the person(s) involved provide 1st Aid, resolve crisis

3. Others allocated roles Gofers, TLC giver, messenger

GATHERINFORMATRION

1. Establish circumstances ofincident/problem question person(s), check physicalevidence

2. Consider options for resolution

DECISION

Decide on a course of action.

COMMUNICATION1. Call emergency services, teacherin charge, principal(May occur earlierin the

process)

2. Keep group informed and reassured3. Keep principalinformed; principaltalks to whanau and media

4. DO NOT SPEAK TO THE MEDIA


Will depend on the nature ofthe distress.



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Code of conduct for ParentsStudent Behaviour Contract


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Parental Supervisor Code of Conduct.The following Code of Conduct applies to all parents attending a Waiau Pa Primary School E.O.T.C Event.

Parent Supervisor Safety Support the teaching staff in every aspect of the E.O.T.C experience Never be alone with any students, for example: camp bunk rooms, around corners out of sight of the group. Be aware of appropriate touching. For example shaking hands, a high five or a pat on the back is acceptable in a

group environment. Respect the rights, dignity and worth of others. Be fair, considerate and honest in all dealings with others. Treat everyone equally regardless of gender, disability, ethnic origin or religion.

Supervisors Duty of Care Immediately report any breaches of the code of conduct to the staff member in charge. Refrain from any form of physical or verbal abuse towards others

Provide a safe environment for the conduct of the activity in accordance with relevant school policy. Show concern and caution toward others who may be sick or injured.

Parents are Role Models

Be a positive role model. Remember that children learn best by example Ensure the students time spent with you is a positive experience Encourage and promote a healthy lifestyle refrain from smoking and drinking alcohol on all school camps and

E.O.T.C experiences. Encourage children to participate, do not force them. Challenge by Choice is one of our principles If you observe student behaviour that fails to meet the standards of behaviour and camp rules that we have set for

our students; please verbally reinforce those expectations to the student and or students concerned. Following thatdiscussion please inform the teaching staff of your conversation at your earliest convenience. If a student'sbehaviour is compromising the physical or emotional safety of other students/attendants in the absence of teachingstaff, decide upon an appropriate course of action (in conjunction with another adult, if present). Your first priority is

the physical and emotional safety of our students. Please involve the supervising staff member as soon as possible. As a parent supervisor attached to a student group, please remember you are there to support all of the students in

your group, not just your own child. Experiences are for the students, not the parents, please refrain from participating unless it is appropriate

Waiau Pa Primary School expects all parent helpers to abide by a Code of Conduct that upholds the principles and values ofthis organisation.

Parents have a responsibility to provide a duty of care consistent with school expectations and within their capability towardall students involved in the E.O.T.C experience.

Waiau Pa Primary School expects any parent volunteering to assist with supervision of an EOTC event to have no previousrecord of actions detrimental to the physical and emotional safety of students.

The school also reserves the right to select the parent supervision team they believe best meets the needs of the studentsand the EOTC activity.


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FINLAY PARK 2011

STUDENT CONTRACT

On arrival at camp, boundaries and safety rules will be explained. All students will be expected to

follow these rules absolutely, without fail.

CHILD

For my own safety and the safety of others at camp I agree to:

j Keep within the boundaries outlined on arrival at camp.

j Follow ALL camp rules as explained by the CampDirector or Teacher in charge

j Demonstrate respect and courtesy towards all Parent Helpers, Teachers an d CampStaff

j Co-operate with my Team in all activities

j Do my share of allocated duties

j Stay with my group making sure that my Parent Helper or Teacher always knows where I am

j I will not bring with me any cell phones, electronic games or any items which coul d be dangerous to

others.

Signed: . Child Name: .

PARENT

j I have read and discussed this contract with my child.

j I understand that this contract is in the best interest of safety for all.

j I understand that if my child breaks the contract I agree to collect him / her from camp.

j I understand that if my child is asked to leave camp there will be no refund of camp fees.

Signed: Parent Name: ..

Current cellphone no: .. Home no: .

Alternative contact: .. Phone no:


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Useful Contact Numbers


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Adults Attending CampPhone List

Cell Phone Number

Bevan 027 273 4641Vicky 027 313 7982Rosemary 027 688 5650Bryer 021 109 0140 Alex MacKinven 027 566 3376Dave Walker 027 246 6902Jeff Kerwin 021 664 718Chris Parsons 021 956 001Colin Crispe

Stephen Winterbottom 027 478 7175Toni Dolan 021 168 8908Michelle Butcher 027 486 3738Jo Grigg 021 0242 3884Carmen Robertson 021 0232 3026Jacquie Blake 021 279 7819Michelle Crofskey 021 255 3058

Principal

Simon Williams 027 431 3910

B.O.T ChairmanStephen Winterbottom 027 478 7175

School 09 2321 753


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Medical Emergency Contact Numbers

For all EMERGENCIESCALL 111

HOSPITAL

Waikato Hospital

All patients requiring emergency care need to present to the new department, located at Level 1 Acute Services

Building - just outside the old department, off Pembroke Street.

The Emergency Department is for emergency cases only.

For free confidential health advice 24-hours a day, seven days a week, phone Healthline: 0800 611 116

The new Emergency Department entrance is hard to miss off Pembroke Street, with Reception located near the

front door.

Security are permanently located at this entrance, allowing them to have greater oversight of who enters thedepartment whilst monitoring the drop off parking area.


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Consultation

For treating patients with less serious conditions.

Adult Acute AssessmentFor adults requiring emergency care. This area occupies a

third of the department and many rooms/cubicles haveensuite facilities.

The area also has a short stay unit for adult patientsrequiring a short period of observation or treatment but not

admittance to a ward.

Childrens EmergencyFor children and youth aged up to 17 years. This area also

has its own waiting area.

This area also has a dedicated short stay unit for children

who require a short period of treatment and/or observation

before discharge with their parent or caregiver.

ResuscitationFor seriously or critically ill patients.

Leamington Medical CentreCambridge

127 Shakespeare StLeamingtonCambridge

Phone: 07-827 5959Fax: 07-823 1925


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Maps

Waikato Hospital

Leamington Medical Centre

Cambridge


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Skills Log Declaration

I, ___________________ on behalf of the Waiau Pa Primary School Board of Trustees, have asked forand sighted the Risk Management information pertaining to our E.O.T.C activity from the IndependentE.O.T.C provider.

Signed : ______________________

Position : _____________________

I, ___________________ on behalf of the Waiau PaPrimary School Board of Trustees, have asked forand sighted the Skills Register and or Skill Logs of the independent E.O.T.C instructors involved in ourE.O.T.C activity.

Signed : ______________________

Position : _____________________


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Accident / Incident Register.

Accident Type Key:A = Serious Harm Injury, B1 = Medical Treatment, B2 = First Aid Return to normal activity,

C = Near-miss incident potential injury.

Date Type(ABC)

Person

Involved

Brief Description of Accident/Near Miss


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Incident Evaluation and Recommendation Form

E.O.T.C Event : Location:Date: Teacher In Charge:

Number of students /adults involved.

Number of near missor incidents recorded.

Types of Injury or Near Miss occurrences.

Abrasion Fatigue Cold Injury Asthma Urinary

Burn Puncture Hypothermia Infection Fever / Flu

Concussion Sprain Hyperthermia Allergy Dermatitis

Bruising Strain Gastrointestinal Cardiac Menstrual Laceration / Cuts Fatigue Respiratory Other

Activities being undertaken at the time.

Camping Abseiling Rafting Caving Canoeing

Cooking Skiing Ropes Course Kayaking Cycling

Initiatives Running Rock Climbing Tramping Swimming

Vehicle Sailing Tree Planting

Were correctprocedures followed?

If Not, what went wrong?

What can be done to reduce or eliminate these occurrences?


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Future Recommendations:

Action taken to implement future recommendations.


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E.O.T.C Event Report and Evaluation.

E.O.T.C Event : Teacher in Charge :

E.O.T.C Dates : E.O.T.C Location: Attendance Numbers: Boys: Girls: Adults:

Staffing : Transportation Used : Distance Traveled:E.O.T.C Goals and Curriculum Outcomes Set:

Evaluation of E.O.T.C Goals and Listed Curriculum Outcomes:

Cost / Benefit ? Adult Supervisors Where our needs met?

Item Rating out of 101= Low 10 = High

Comment

Pre-event organisation

Objectives MetTravel Arrangements

InstructionEquipment

Suitability of VenueAccommodationFood

Evening ActivitiesOther

Name : Date: Signed:


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Sign off Sheet

ALL PARENT AND TEACHING PERSONNEL ATTENDING THIS WAIAU PA SCHOOL E.O.T.C EVENT MUST SIGN BELOW

I fully understand the requirements of this HEALTH AND SAFETY PLAN

Person conducting the planTraining:______________________________________________________________________________________

Name: (print) Signature: Date: / /



















Name: (print) Date: / /

ram forms kauri syndicate camp 2011

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