University of California, Davis
Research and Innovation Fellowship for Agriculture (RIFA)
2014-15
International Travel Emergency Preparedness & Planning
YOU MUST DO THE FOLLOWING BEFORE YOU TRAVEL:
1. Check with the U.S. Center for Disease Control (http://wwwnc.cdc.gov/travel/default.aspx),
for travel and health outbreak advisories, required vaccinations and suggested health
related suggestions for any country and region. Check well in advance of your travel. Be
sure you have the appropriate shots and recommended medications to take with you
before you go. DO THIS EARLY! Some vaccinations require a series of multiple doses to
be effective and can take up to several months before travel is recommended!
2. Review UC Davis travel policies and guidelines (http://travel.ucdavis.edu/foreign/index.cfm).
3. Review UC Davis international travel resources, emergency guidelines, and campus travel
advisories (https://uoip.ucdavis.edu/international/travel.html). Also note the international
travel “check list” and be sure you know your responsibilities and rights.
4. Register your trip with the local US Embassy through the Department of State, Bureau of
Consular Affairs (http://travel.state.gov/content/passports/english/go/step.html).
Below are the required forms you must complete and return before your departure. You will want
to keep copies of these documents while traveling.
5. Read, sign and submit UC Davis Waiver of Liability form (see Appendix A).
6. Complete and submit Emergency Contact form (see Appendix B).
7. Complete and submit the In-country Emergency Preparedness Plan (see Appendix C),
indicating relevant local hospitals, contacts, phone numbers, embassy location and any
additional medical information that might be useful should something happen while you are
abroad.
8. Review (free to students) UC Travel Insurance coverage, register online, and submit copy
of insurance card (see Appendix D). Keep insurance card on you while traveling!
(http://www.ucop.edu/risk-services/loss-prevention-control/travel-assistance/enrollingin-uc-trip-insurance.html).
9. Copy and submit passport photo page (either hard copy or scan and email).
10. Submit air travel itinerary to & from destination (either hard copy or scan and email).
Send all required documentation (above #5-10) at least 10 days before your trip to:
Scan & email:
Gwynn Benner (wlbenner@ucdavis.edu)
Or mail hard copy:
202 South Hall
One Shields Avenue
University of California, Davis
Davis, CA 95616
Questions about these forms and process? Call Gwynn at 530-752-8342
UC Davis Contact in Case of Emergency --24 hours per day, 7 days per week-- Campus Dispatch at 530752-1230, from where emergency reports will be channeled to the appropriate offices(s). For non-life
threatening health or safety concerns, please contact Gwynn Benner (cell phone: 530-574-7485 or
wlbenner@ucdavis.edu). For project concerns or program issues, contact Elana Peach-Fine
(elana.ipo@gmail.com).
Rev. 2/9/16
UC Davis Contact in Case of Emergency –24 hours per day, 7 days per week-- Campus Dispatch at 530-752-1230, from
where emergency reports will be channeled to the appropriate offices(s). For non-life threatening health or safety
concerns, please contact Gwynn Benner (cell phone: 530-574-7485 or wlbenner@ucdavis.edu). For project concerns or
program issues, contact Elana Peach-Fine (elana.ipo@gmail.com).
Rev. 2/9/16
UC Davis Contact in Case of Emergency –24 hours per day, 7 days per week-- Campus Dispatch at 530-752-1230, from
where emergency reports will be channeled to the appropriate offices(s). For non-life threatening health or safety
concerns, please contact Gwynn Benner (cell phone: 530-574-7485 or wlbenner@ucdavis.edu). For project concerns or
program issues, contact Elana Peach-Fine (elana.ipo@gmail.com).
Rev. 2/9/16
(Appendix B)
Emergency Contact Information
Your Full Name:
Student ID#:
Academic Department:
Permanent/Home Address:
Cell phone number:
In case of an Emergency, please contact on my behalf:
#1 Name:
Address:
Relationship:______________ Home Phone (_____)____________Work Phone (_____)_________________
#2 Name:
Address:
Relationship:______________ Home Phone (_____)_____________Work Phone (_____)________________
Your Age: _______
Birthdate: (mm/dd/yy) _____/_____/______
In case of Emergency, please be aware of my medical information:
Physician’s Name:
Physician Address:
Physician Phone:
Please describe any medical conditions that emergency staff might need to be aware:
I am taking the following medication(s):
I am allergic to:
Prescription Eyewear: Y ____ N ____
Do you have additional health insurance? Yes
No
If yes, please provide the following:
Name of Insurance Company:
Phone:
Address:
Policy Number:
Group Number:
UC Davis Contact in Case of Emergency –24 hours per day, 7 days per week-- Campus Dispatch at 530-752-1230, from
where emergency reports will be channeled to the appropriate offices(s). For non-life threatening health or safety
concerns, please contact Gwynn Benner (cell phone: 530-574-7485 or wlbenner@ucdavis.edu). For project concerns or
program issues, contact Elana Peach-Fine (elana.ipo@gmail.com).
Rev. 2/9/16
(Attachment C)
Travel Emergency Contingency Plan
In preparation for your travel abroad you will want to be sure you know where to go and what to
do in case of an emergency. You will want to determine that up front before you leave!
Your Full Name:
Cell phone:
Will your cell phone function and be accessible while abroad? Y / N
Be clear about roaming and international fees! If you anticipate purchasing a local cell phone, please
email Gwynn Benner (wlbenner@ucdavis.edu) with the phone number once you know it. WhatsApp
Messenger is a free online international texting app you might want to download before you go.
Itinerary:
Dates:
City/Country:
In-Country Contact info:
Emergency Service:
Where is the closest hospital/clinic:
What is the Emergency services number (i.e., the country’s 911) or equivalent:
Itinerary:
Dates:
City/Country:
In-Country Contact info:
Emergency Service:
Where is the closest hospital/clinic:
What is the Emergency services number (i.e., the country’s 911) or equivalent:
UC Davis Contact in Case of Emergency –24 hours per day, 7 days per week-- Campus Dispatch at 530-752-1230, from
where emergency reports will be channeled to the appropriate offices(s). For non-life threatening health or safety
concerns, please contact Gwynn Benner (cell phone: 530-574-7485 or wlbenner@ucdavis.edu). For project concerns or
program issues, contact Elana Peach-Fine (elana.ipo@gmail.com).
Rev. 2/9/16
(Attachment D)
Medical, Health, Travel Insurance
You will want to register your international trip with the University of California to be sure you are covered
by the free travel insurance with ACE. Coverage is limited. Review coverage carefully. Be knowledgeable
about what is and is not covered (http://www.ucop.edu/risk-services/_files/travel/soc-benefit-summary2013-2014.pdf). Student travel insurance FAQs (http://www.ucop.edu/risk-services/_files/travel/soc-faq10-31-13.pdf).
In a life-threatening emergency, first contact the in-country emergency response service. If you need further
assistance, use the number provided on your ACE insurance card. Europ Assistance (EA) USA has agents in
208 countries worldwide and thirty-four 24 hour alarm centers providing expertise and practical help with
travel assistance worldwide. iJet/Worldcue provides travel intelligence and security extraction services.
You may also want to purchase additional medical and/or travel insurance. If you are relying on a private
medical insurance plan, check the coverage for foreign travel. Or you may want to consider purchasing
insurance that is specifically designed for international (extended) travel. While not an endorsement, HTH
has individual international travel insurance policies for students. HTH
(https://www.hthtravelinsurance.com/students_plans.cfm) provides insurance for UC Davis Summer Abroad
and other programs across campus. Others also exist. Be sure they are a reputable provider.
To register for the (free) UC ACE Travel Insurance and for answers to frequently asked questions, see:
http://www.ucop.edu/risk-services/loss-prevention-control/travel-assistance/index.html. For questions
regarding UC travel coverage call (510) 987-9832, M-F 8:00-5:00 or leave a voicemail. For technical
support/issues regarding registering online, please call (415) 437-3980 or send an email to
info@ecompliance.net.
NOTES ON COVERAGE:
All registered students are covered when participating in any off-campus, University-related activity.
Coverage is FREE and there is no deductible, but you must maintain your own personal health insurance. The
policy covers your entire off-campus trip for UC related activities. In addition, the policy provides for a 7 day
personal “deviation” on Foreign travel (i.e., if you arrive early or take personal days before or after the trip).
This insurance program does not constitute comprehensive health insurance. It does not cover nonemergency medical services, routine treatment for a medical condition, physical exams, vaccinations, routine
checkups, other preventative care, and things of that nature. Further, in the event of a serious or catastrophic
accident or sickness, this insurance may not be sufficient to provide full coverage and you will need other
personal health insurance. Coverage includes “traveling companions” (e.g., spouse and children. The program
provides $15,000 per occurrence for domestic travel and $500,000 per occurrence for foreign travel and is
intended to provide some immediate treatment for medical emergencies arising from accidents sustained and
sudden illness contracted during the course of the travel while participating in University activities.
You must complete and submit a claim form if you are seeking reimbursement for: Student Accidental
Dismemberment Claim Form; Student Travel Accident and Sickness Claim Form DOC; Loss of Personal Effects
and Money Claim Form; Student Travel Accidental Death Claim Form.
UC Davis Contact in Case of Emergency –24 hours per day, 7 days per week-- Campus Dispatch at 530-752-1230, from
where emergency reports will be channeled to the appropriate offices(s). For non-life threatening health or safety
concerns, please contact Gwynn Benner (cell phone: 530-574-7485 or wlbenner@ucdavis.edu). For project concerns or
program issues, contact Elana Peach-Fine (elana.ipo@gmail.com).