FIELD
TRIP SAFETY POLICY AND PROGRAM -SAMPLE FORMS
APPENDIX 1
HAZARD
IDENTIFICATION SAMPLE FORM
(to
be filled out by trip leader and filed with LOC Safety Officer or Appropriate
Section/Division Head or designate prior to trip departure )
Field
Trip Name _____Ore Deposits of Moosepasture County____________
Date
_____May 20-22, 2000________________________________
Field
Trip Leader ___Jim Geo_______________________________________
Responsible
Safety officer ____Joe Desksitter, (LOC Safety Officer)___________
General
Hazards
| Nature of Hazard | Location of Hazard | Mitigation |
| Chips from rock hammers | All outcrops | Safety glasses |
| Possible cold rain/wet snow | Warn participants, ask for wet weather gear to be brought | |
| Vehicle safety - especially getting in and out of vans | In and around vans | Emphasize in safety presentation to participants |
Stop
_1___
| Nature of Hazard | Location of Hazard | Instructions to participants |
| Road cut (traffic hazard) | Roadway between cuts | Keep to shoulder, stay off pavement, obey instructions of leaders |
| Outcrop cliff (loose boulders) | North roadcut, east end where the cut is highest | Keep away from this area; wear hardhats |
Stop
_2___
| Nature of Hazard | Location of Hazard | Mitigation |
| Industrial hazards in an operating quarry | On quarry grounds | Obey company safety officer, use hard hats, safety boots as directed |
Stop
_3___
| Nature of Hazard | Location of Hazard | Mitigation |
| Rough, steep trail to outcrop with loose rocks | Upper part of trail | Avoid loosening stones on trail, warn those below |
Stop
__4__
| Nature of Hazard | Location of Hazard | Mitigation |
| Abandoned mine site - open holes | Immediately behind main trench | Avoid this area, Have ropes on hand in case of accident |
| Abandoned mine site - trenches, loose rock on trench walls | Do not climb on the trench walls, wear hard hats, when on top, take care not to knock loose rocks on those below |
Stop
____
| Nature of Hazard | Location of Hazard | Mitigation |
Stop
____
| Nature of Hazard | Location of Hazard | Mitigation |
Stop
____
| Nature of Hazard | Location of Hazard | Mitigation |
Stop
____
| Nature of Hazard | Location of Hazard | Mitigation |
APPENDIX 2 - SAMPLE FORM
COMMUNICATION
PLAN
(to
be filled out by trip leader and filed with LOC Safety Officer or Appropriate
Section/Division Head or designate prior to trip departure
Field
Trip Name _____Ore Deposits of Moosepasture County__________
Date
_____May 20-22, 2000_____________________
Field
Trip Leader ___________ Jim Geo__________________________________
Responsible
Safety officer Name____Joe Desksitter, (LOC Safety Officer)______ Phone
______456-6565____________________
Location
and phone numbers of accommodations during the trip:
| Date | Accommodation Name | Accommodation Phone |
| May 20 | Nitefite Hotel, Mooseville | 567-5454 |
| May 21 | Sparklyrock Inn, Oretown | 465-8745 |
Cell
Phone Information (trip leaders):
Mobile Radio Information
Other Communication
Location of public telephones
Location
and phone of Emergency facilities (police, emergency, medical, fire)
Other
Communications options
NB - no 911 service in this
area (to be filled out by trip leader and filed
with LOC Safety Officer or Appropriate Section/Division Head or designate
prior to trip departure)
Field Trip Name _____Ore Deposits of Moosepasture County__________
Date _____May 20-22, 2000_____________________
Field Trip Leader ___________ Jim Geo__________________________________
Responsible Safety officer Name____Joe Desksitter, (LOC Safety Officer)___________
Phone ________456-6565____________________
General Information
APPENDIX 4 - SAMPLE FORM
FIELD TRIP SAFETY REPORT
(to be filled out by trip leader and filed
with LOC Safety Officer or Appropriate Section/Division Head or designate
within 2 weeks of the end of the trip)
Field Trip Name _____Ore Deposits of Moosepasture County__________
Date _____May 20-22, 2000_____________________
Field Trip Leader ___________ Jim Geo__________________________________
Describe any safety-related incidents that occurred on the trip:
Describe any safety-related issues that arose during or as a result
of the trip:
Are there any measures you can recommend to avoid similar issues
on other GAC®/MAC field trips?
How can GAC®/MAC improve its safety program?
Cell
Phone Number
Cell Phone owner
766-4345
Jim Geo
766-2347
Jane Rockhammer (alt. Leader)
Radio model
Radio location
Area of operation
Emergency contact
Hours of availability
Lobby of Nitefite Hotel Mooseville (most of Day 1)
Outside Post office, Oretown
In Gastro Diner, Hwy 6 east of Mooseville
Facility
Location
Phone
Mooseville Police
Mooseville
567-6535
Moosepasture County Hospital
South Mooseville
765-4556
Oretown Medical Clinic (8AM-5PM
weekdays)
Oretown
564-7634
Mooseville and Area Volunteer
Fire Department
Upper Mooseville
456-3452
RCMP
Sulphide City
445-7985
Gas
Stations at west end of Mooseville and on Hwy 6 west of Oretown have phones
Stop #
Evacuation Challenge
Evacuation procedures
Nearest emergency medical facility
Hours of operation
3
Rough trail to outcrop at top of steep hill. Injury in this area
would be difficult to evacuate
Injured person could be carried down by 3 people without stretcher
Moosepasture County Hospital
24 hr Emergency
4
Someone may fall into abandoned mine opening
Let down ropes if conscious; call fire department for help
Oretown Medical Clinic
8-5 weekdays
Nature of the incident
Nature of the response
Injury response if any
Participant cut by rock chip from a rock hammer
Band aid from first aid kit
Twisted ankle at stop 4
Participant carried out to vehicle by 3 leaders
Ankle bound with elastic bandage, participant taken to Oreville
clinic for examination