Off-Campus Events/Travel Please Fill This Form Out at least 10 Days Prior to Your Activity Email the Risk Manager Off-Campus Events/Travel Risk Assessment Name* First Last PhoneEmail* Date Activity Starts MM slash DD slash YYYY Date Activity Ends MM slash DD slash YYYY Detailed Description of All Activities*Is this a Course Trip? Yes No What is the Course Number?Number of Participants*EWU Faculty/StaffStudents (18 & Over)Student (Less than 18)Non EWU Affiliated If There are Minors, Have You Had Background Checks for all Trip Leaders? Yes No Where are you Going?* Travel is Within Spokane County Travel Within Washington State Travel to Other USA Locations Area Experiencing Natural Disaster, Civil or Political Unrest Traveling to a Private Property Check all that applyModes of Transportation University Vehicle Privately Owned Vehicle Rental Vehicle Commercial Carrier (ie., Planes, Train, or Bus) Privately Owned Aircraft or Boat Bicycle Check all that applyIdentify Possible Risks or Hazards* There will be exposure to animals There will be exposure to insects or poisonous plants Activities require strenuous exertion Field conditions or activities are challenging (i.e., rough terrain, high crime area, epidemic, hazardous materials, using heavy machinery?) Traffic conditions in this area present special problems Crowds Remote location Alcohol Other Check all that applyDescribe any Other Potential Risks or HazardsHas a Near-by Medical Facility or Medical Provider Been Identified? Yes No Will First Aid be Available on Site? Yes No Things you plan to provide to prepare participants for this trip: Travel Safety Briefing Medical Care Info (What to do / where to go for health care) Risks (travel, weather, terrain, crowds, crime, etc) Behavior expectations (Student Conduct Code) Check all that applyWhat Are Your Plans if There is a Disciplinary Issue?Will There be any Agreements or Contracts with Third Party Vendors? If so, Please Describe…Do you understand that any participants who are prescribed an epinephrine auto-injector must bring it along for this trip?* Yes No Δ
