FIELD TRIP INFORMATION FORM
MONASH UNIVERSITY
SCHOOL OF GEOGRAPHY AND ENVIRONMENTAL SCIENCE
This form must be lodged with the Safety Officer prior to the trip.
Please lodge a copy on google docs, shared with darren.j.hocking@monash.edu
Supply completed forms, with the Check List, Risk Assessment, and required attachments
Take at least one hard copy per vehicle: A blank hazard & incident report form is included.
Current guidelines for travel in urban / rural & remote / international areas:
http://www.monash.edu.au/ohs/topics/travel.html
Field Activity:
Destination (attach map with Refs or Google Maps link for each specific area):
Participants (number)
For larger groups attach a list
Indicate status of participant (Trip Leader, Safety Officer (TL & SO 1 ea/trip), Staff, Postgrad., Honours, Undergrad., or Visitor)
Include the emergency contacts (Next of Kin) for each participant (for small groups add below) – for larger group attach list.
Name
Vehicles
Phone Number
Status
First Aider
Toyota Hilux 4x4, White Twin Cab Ute, ZBT317, Diesel
Y/N
Toyota Land Cruiser 4x4, White Troop Carrier, TSP883 Diesel
Y/N
Other Vehicle(s) Make: ________________________ Model: ______________________________
Colour: _____________________ Registration: _____________ Fuel: __________
Equipment Carried (tick box/number):
First Aid Kit
Tent
Food for (days)
Water (Litres)
Fuel (Litres)
Additional Communication- SPOT GPS messenger, Satellite or Field phones (Make, model, type, and Number):
Accommodation Booked (name, address, phone):
Departure:
Time:
Date:
Time:
Date
Proposed Route:
ETA Destination:
Proposed Return Route:
Return ETA:
Time:
Date:
Notification Deadline: Time:
Date:
Remember: Inform the Safety Officer or nominated person (who has a copy of all paperwork) upon your return
IMPORTANT NOTE: No enquiries will be commenced by the Police or the Search & Rescue organisation
unless your party is reported overdue by the Safety Officer, a relative or other responsible person, or a distress
call is received.
School of Geography and Environmental Science Trip Form, Risk Assessment, Contacts and Hazard and Incident Form
Version 4.2 26/2/14 For information and submission see SGES Safety Officer – darren.j.hocking@monash.edu
CHECKLIST FOR COUNTRY AND REMOTE FIELD ACTIVITIES
1. Field activity details
Itinerary attached
2. Transport
Arranged appropriate transport
Details of licensed and trained drivers for vehicles attached
3. First aid
Arranged for sufficient, appropriate first aid kits to be prepared
Checked that first aid kits are fully stocked
For Rural areas (check levels for remote areas):
Groups up to 15 people Up to two persons trained in Level 2 First Aid or higher
Groups of 16 to 30 people 2 people trained in Level 2 First Aid or higher
Groups of over 30 people 2 people trained in Level 2 First Aid or higher, plus an additional person trained in Level 2 First Aid or higher, for every
additional 10 people or part thereof
4. Access
Obtained permits and/or permission for access to the area of field activity
5. Communication
Provided appropriate means of daily communication and ensured its effectiveness in the proposed
area of the field activity.
Provided back up means of communication – sat phone, SPOT2 GPS messenger.
Developed communication protocols – attach a list of who to contact in order of priority:
Eg Police/Fire Ambulance 000 or 112 from a mobile (uses all networks).
Safety Officer Darren Hocking 03 99020882, 0417169790, AH 0359885313.
School Manager: Maliha Dhaliwal 03 99058127, 99020176, 0405406218
List all local emergency services and medical facilities.
List local contacts – rangers, land owners, etc
Details of personal contact(s) for everyone on the trip

6. Safety equipment:
Provided essential safety equipment (Attach list) eg 4x4 recovery equipment, hard hats, HiVis vests
Essential safety equipment has undergone checking and maintenance and is in good working order
Provided appropriate navigation aids
7. Information provided to participants
Provided all participants with information outlining safety issues (attached)
Given safety briefing to all participants (attendance records attached)
8. Emergency procedures
Details of appropriate emergency procedures attached
Participants provided with a list of general emergency procedures and contact numbers (attached)
9. Undergraduate activities
9a Attached lists of:
Student names
Student identification numbers
Personal contact details
9b Information
Developed and distributed 'Student guidelines for safety on undergraduate field activities (attached)
Provided all participants with an information notice outlining safety issues (attached)
Given safety briefing to all participants (attendance records attached)
Received acknowledgment forms & medical conditions from student participants (summary attached)
9c Supervision
Briefed all supervisors on their duties, responsibilities and obligations (Details of briefing and attendance
records attached)
School of Geography and Environmental Science Trip Form, Risk Assessment, Contacts and Hazard and Incident Form
Version 4.2 26/2/14 For information and submission see SGES Safety Officer – darren.j.hocking@monash.edu
Risk Assessment
School of Geography & Env. Sci., Arts Faculty, Building 11, Clayton Campus.
Area/Task Description:
Take time to go though each listed item, and add extra lines or additional Risk Assessments or Safe
Work Method Statements to target specific actions in special cases (eg tower climbing, excavation,
using hazardous materials or equipment)
I have read the below Risk Assessments and understand the documented risks and risk controls and agree to adhere to
the risk controls as stated.
Name:
Role:
Date:
Approved by School Safety Officer:
Date:
Approved by Supervisor:
Date:
Activity & Description:
Actioned by (participants
initials), on which dates.
Transportation: sealed roads, using
Description of
Hazard
Road accident
various vehicles.
Risk Level
Corrective Action
H3 (C1/L4)
Qualified drivers required for all vehicles (vehicle to be
High
checked, suitable, and roadworthy).
INSERT INITIALS OF THOSE
Travel during daytime, avoid dusk & dawn on rural roads.
CONCERNED AND THE DATE
Reduce speed in wet.
APPLICABLE. IN EVERY RELEVANT
Driver rest breaks – min. every 2 hrs, for a min. of 15 min
BOX, DELETE ANY BOXES NOT
Driving for a max. of 12 hrs per 24 hr period.
RELEVANT.
Inform U/grad & HDR students regarding procedures for
ADD TASK SPECIFIC RISK
pick-up and drop-off.
ASSESSEMENT DETAIL AS
Adequate level of supervision and clear instruction.
REQUIRED, ATTACH SEPARATE
No alcohol, illegal or legal drugs that impair driving.
DOCUMENT IF NECESSARY.
All buses or coaches must be fitted with seat belts.
Transportation: unsealed roads; using
Collision, rolling,
H7 (C2/L5)
As per ‘Transportation: Sealed Roads’.
various vehicles.
driving over students
Medium
Use 4x4 vehicles where appropriate.
Drivers to complete 4x4 training course.
Extra care in wet, on poor roads & tracks.
Even at remote field sites road laws to be followed
Work Environment (weather): Heat,
Hypo/hyperthermia,
H7 (C3/L4)
Wear appropriate clothing and footwear – include hats,
cold, sun & rain.
sunburn,
Medium
long sleeves, sunscreen, closed footwear, warm clothing,
dehydration.
Flora & fauna.
Walking: rural areas
waterproof clothing, appropriate hydration.
Poisonous & toxic
B4 (C3/L4)
Wear appropriate clothing.
plants & animals
Medium
Avoid contact.
Tripping or falling.
H2 (C2/L3)
Wear appropriate footwear, walking shoes/boots.
High
Be aware of & avoid gully edges. Walking with a
companion & have mobile phone available ( no use in car).
Camping
Camp sites.
H2/H7 (C1/L4)
Look for site 1 hour before sun set.
High
- protection from adverse weather conditions,
- protection from natural hazards; such as flash floods,
School of Geography and Environmental Science Trip Form, Risk Assessment, Contacts and Hazard and Incident Form
Version 4.2 26/2/14 For information and submission see SGES Safety Officer – darren.j.hocking@monash.edu
rock falls, tree falls, etc,
- insect pests.
At least 20 metres from any waterway.
‘The best campsites are found not made’.
Campfires.
Fire
H7 (C2/L4)
No fires on day of Total Fire Ban, includes gas appliances
High
such as: BBQ, stoves, fridges and lights.
Use a camp stove wherever possible.
Small fires where permitted for warmth & cooking.
Fires only in a proper fire place. Avoid lighting on a windy
day.
All flammable material within 3 metres must be cleared.
Fires must not be left unattended & must be completely
extinguished with water before leaving the camp site.
Hygiene, Food & water
Personal (& toilets).
B1 (C3/L4)
Medium
Use appropriate soaps &/or wipes,
- before handling food
- after field activities
- after using toilet facilities.
Hygiene, disease.
Malaria, etc.
B6? (C3/L4)
Take anti-malarial drugs. Vaccinations as indicated by
Medium
medical service. Avoid bites, use spray, use netting.
Observe safe hygiene practices.
Catering: for staff and students
Equipment: assembly, dismantling
Physical Injury.
and & using
E2 (M3/D4)
Restricted use to trained operators.
Medium
Inspection & Maintenance.
Follow instructions for correct use of equipment.
Wear appropriate Personal Protection Equipment.
Use correct manual handling techniques.
Waders
Boat; small inflatable (8’)
Water, still.
Water, still.
H2 (C1/L4)
Competent swimmers, work in water no deeper than hips.
High
Work with a min of two people.
H2 (C1/L4)
Competent swimmers. Use PFDs. Follow safe boating
High
practices.
Work with a min of two (2).
Natural Disasters
Fire, Flood, Storm
H7 High
Avoid conditions, check forecast.
Evacuation Plan.
Bushfire Awareness & survival training
Do not enter floodwaters.
School of Geography and Environmental Science Trip Form, Risk Assessment, Contacts and Hazard and Incident Form
Version 4.2 26/2/14 For information and submission see SGES Safety Officer – darren.j.hocking@monash.edu
Emergency Contact List
General contacts and ADD site/trip specific contacts
Police / Fire / Ambulance
also from a mobile phone using any available network
Monash Emergency Counselling 24hr Service
Lifeline (24 hours)
000
112
1800 350 359
13 11 14
Hospitals
See Victorian hospital list so you can list the hospital closest to the field activities
For interstate & overseas you should research and list suitable medical facilities
Eg. OSHC Worldcare medical clinics
Clayton campus Health Service (Bus. Hours)
9905 3175
Poisons Information 24hr
13 11 26
Police Search and Rescue Squad
Outside Metropolitan Areas Freecall
Police non-emergency
(03) 9399 7503
1800 135 729
131 444
Water Police Squad 24 hr
Freecall
(03) 9399 7500
1800 135 729
SES - State Emergency Service 24 hr
Storm and flood rescue
13 25 00
Victorian Roads Hazards
13 11 71
Monash Security
(03) 9905 3333
Geography and Environmental Science Contacts
School Manager: Maliha Dhaliwal
GES office (03) 9905 8127, PSI office (03) 9902 0176, Mobile 0405 406 218
Safety Officer: Darren Hocking
Office (03) 9902 0882, Home (AH) 5988 5313, Mobile 0417 169 790
Local Contacts: eg RFDS, Park Ranger, DEPI contact,
- local police
-
School of Geography and Environmental Science Trip Form, Risk Assessment, Contacts and Hazard and Incident Form
Version 4.2 26/2/14 For information and submission see SGES Safety Officer – darren.j.hocking@monash.edu
AS/NZS 4801
OHSAS 18001
OHS20309
SAI Global
OHS HAZARD AND INCIDENT REPORT
INCIDENT NUMBER (issued by OH&S)
TYPE OF REPORT
Hazard
Near miss
Injury/Illness
GMO Exposure/Release
Environment
Unacceptable Behaviour
DETAILS OF PERSON REPORTING INCIDENT (for persons not directly involved in incident)
Surname: ……………………………………… Given Name: ............................................... ID No: ……………………….
Telephone: ………………………………..….. Email: ………………………………………………………………………….……
Signature of person reporting hazard or incident: …………………………………………………………
DETAILS OF PERSON INVOLVED IN INCIDENT OR REPORTING A HAZARD
Date:
/
/
Surname: ……………………………………... Given Name: ……………………………………...
Telephone: ………………………………..….. Email: ………………………………………………………………………….……
Employee
Adjunct
ID No:
Faculty/Division:
Unit:
Contractor
Employer:
Engaged by:
Visitor
Reason for visiting:
Undergraduate
Course:
Student ID:
Honours
Postgraduate
Faculty of enrolment:
Student ID:
Signature of person involved in incident: ............................................................................................................. Date:
/
/
DETAILS OF WITNESS (if applicable)
Surname: ……………………………………... Given Name: ……………………………………...
Telephone: ………………………………..….. Email: ………………………………………………………………………….……
HAZARD OR INCIDENT DETAILS (attach additional details if required)
Date:
/
/
Time................. am/pm
Campus: ………………… Building: ………………….. Location: ...........................................................................................................
Off Campus
Location: ……………………………………………………………………………..
Do any of the following apply?
Travelling on duty
In class/lecture
Sport/exercise
After Hours
Conducting Research
Brief description of hazard or incident
.....................................................................................................................................................................................................................
.....................................................................................................................................................................................................................
.....................................................................................................................................................................................................................
INJURY/ILLNESS DETAILS (if applicable)
Describe injuries/illness
.....................................................................................................................................................................................................................
.....................................................................................................................................................................................................................
.....................................................................................................................................................................................................................
Treatment details:
None
First aider
On-campus medical service
Own doctor
Hospital: Out-patient
In-patient
Report is being sent directly to OH&S without further details or signatures as confidential issues are involved
SUPERVISOR (or nominated delegate)
Surname: ……………………………………... Given Name: ……………………………………... ID No: ……………………….
Signature: ……………………………………...………... Date:
/
/
DISTRIBUTION
Original
Supervisor/Safety Officer for investigation (Finally OHS Consultant or Advisor)
Copy
Person involved in incident
Copy
Local OHS Committee Chairperson
Copy
Health and Safety Representative
Copy
OHS Consultant or Advisor
School of Geography and Environmental Science Trip Form, Risk Assessment, Contacts and Hazard and Incident Form
Version 4.2 26/2/14 For information and submission see SGES Safety Officer – darren.j.hocking@monash.edu
PLEASE NOTE THIS IS NOT A WORKCOVER CLAIM FORM
For information regarding WorkCover please contact HR, Employee Assistance x29573
INSTRUCTIONS
This form is for reporting all hazards and incidents (including non-injury or near-miss incidents), exposure or
release of GMOs, environmental incidents and unacceptable behaviour.
PERSON INVOLVED IN INCIDENT, OR REPORTING HAZARD OR INCIDENT OR ENVIRONMENTAL EVENT





Copy form and retain copy as a receipt of injury notification
Staff member: Pass form on to your supervisor or safety officer and participate in investigation of the incident with
supervisor, safety officer and health & safety representative
Student: Pass form on to your supervisor, safety officer or Faculty office and participate in investigation of the
incident
Non-staff member: Pass form on to the supervisor or the safety officer of the area, OH&S or to Security & Traffic
Supervisor or person providing initial treatment should fill in the form if the injured person is unable to do so
Reports containing confidential issues can be forwarded directly to OH&S, bypassing any party as necessary
SUPERVISOR







Notify OH&S (990 51016) immediately of all serious incidents
Review and sign form
Inform safety officer and health & safety representative (if applicable)
Lead investigation of reported hazard or incident
Forward original to safety officer
Scan and email to OHS Consultant/Advisor
Scan and email to Return to Work unit if WorkCover claim is possible
SAFETY OFFICER



Notify OH&S (990 51016) immediately of all serious incidents
Inform health & safety representative (if applicable)
Support investigation of reported hazard or incident
HEALTH AND SAFETY REPRESENTATIVE



Notify OH&S (990 51016) immediately of all serious incidents
Participate in investigation of reported hazard or incident
Discuss the matter with staff involved and consult with management on resolution of incident
OCCUPATIONAL HEALTH & SAFETY (OH&S)


Report appropriate incidents to relevant regulatory authorities
Enter information into database and follow up on missing details
OHS COMMITTEE CHAIRPERSON

Receive copy of form for tabling at next local OHS committee meeting
ENVIRONMENTAL OFFICER

Review status of preventive and corrective actions
Privacy statement:
The information on the form is collected for the primary purpose of reporting, investigation and recording of hazards and incidents. The information may also be used
for a related secondary purpose, providing required information to relevant units within Monash University such as Employee Assistance & Rehabilitation and Risk &
Insurance; providing you with information about OHS matters; to comply with legislative reporting requirements; attending to day to day administrative matters; and
preparing statistical analyses. The information collected on this form may be disclosed to other organisations such as government departments e.g. WorkSafe Victoria;
external organisations where Monash University employees regularly work such as hospitals, Monash owned companies or other tertiary organisations; the university’s
legal advisers or other professional advisers and consultants engaged by the university. If all of the information requested is not provided, it may not be possible for the
university to meet its legal obligations. You have a right to access personal information that Monash University holds about you, subject to any exceptions in relevant
legislation.
School of Geography and Environmental Science Trip Form, Risk Assessment, Contacts and Hazard and Incident Form
Version 4.2 26/2/14 For information and submission see SGES Safety Officer – darren.j.hocking@monash.edu