Guidelines for the Safe Conduct of Sport and Physical Activity in Schools

Last updated: 2003

Appendix C

Risk Management Planning Form

To be completed by the teacher-in-charge of an outdoor recreation activity prior to the commencement of the activity. The
principal will consider the information in this assessment when determining approval for the walk.

Type of activity: _______________________________________________________

Location: ____________________________________________________________
(details of route and map attached)

Commencement date and time of activity: ___________________________________________________________________

Date and approximate time due out: ___________________________________________________________________

Teachers/parents/instructors: ___________________________________________________________________

Total number of people on activity: ______________ (list of participants attached)

Aims of the activity: ___________________________________________________________________

___________________________________________________________________

Necessary skills of accompanying adults: ___________________________________________________________________

___________________________________________________________________

Experience of participants: ___________________________________________________________________

___________________________________________________________________

Medical conditions of participants: ___________________________________________________________________

___________________________________________________________________

Medications: _________________________________________________________

Method of communication between the activity group and outside contact: ___________________________________________________________________

Risks (List the undesired events when an accident, injury or loss could occur).

1. ___________________________________________________________________

2. ___________________________________________________________________

3. ___________________________________________________________________

4. ___________________________________________________________________

Having identified potential risks/dangers associated with this extended activity (an example is provided on the
following page), complete the form page 285 to indicate the factors that might lead to problems and the precautions
that will be taken to minimise the likelihood of accidents and misadventure (an example is provided page 286).

Risk Management Planning Sample Form

To be completed by the teacher-in-charge of an extended walk prior to the commencement of the activity. The principal will
consider the information in this assessment when determining approval for the walk.

Type of activity: Extended bushwalk

Location: Waterfall to Heathcote (details of route and map attached)

Commencement date and time of activity: 25/9/97 9:00am

Date and approximate time due out: 26/9/97 2:00pm

Teachers/Parents/Instructors: B. Smith (T); T. Green (T); Mrs S. Jones (P)

Total number of people on activity: 16 (list of participants attached)

Aims of the activity: To provide initial experience in lightweight camping and carrying a laden pack in a training exercise.

Necessary skills of accompanying adults: St John Senior First Aid Course (Smith); cardio-pulmonary resuscitation (Smith and Green).

Experience of participants: 11 students have been on overnight hikes with scouts or guides; all have been on one day bushwalk with teachers last term.

Medical conditions of participants: Rachel Brownlee is an asthmatic. Not on regular medication. Carries a spray in case of an attack.

Medications: Ventolin inhaler

Method of communication between walking party and outside contact: Teacher-in-charge will phone twice a day at 8am and 6pm.

Risks (List the undesired events where an accident, injury or loss could occur)

Participants suffer exhaustion.
Walker falls and is injured.
Tree branch hits walker in the eye.
Walker separated from group and cannot be located.
Participant suffers asthma attack.
Participant’s belongings become wet.

The above six undesired events are all generic type examples. Where teachers know the proposed route well the examples
might be more specific. (eg. at grid reference 134600 the fork in the track is overgrown. Take care to note landmark; at grid
reference 214255 proceed no further along the path by creek if heavy rain occurs).

Having identified potential risks/dangers associated with this extended bushwalk, complete the form overleaf to indicate the factors that might lead to problems and the precautions that will be taken to minimise the likelihood of accidents and misadventure.

Note: This sample form has been completed as a guide to the type of detail that is helpful and appropriate.

	Dangers For each inherent risk (identified above) list the factors which could lead to the risk eventuating.	Risk Management Strategies Indicate actions and precautions that will be taken to reduce risks.
People Attributes people bring to an activity: skills, attitudes, physical fitness, health, age, fears, numbers, etc.
Equipment Resources that impact on the activity: clothing, tents, lights, vehicles, etc.
Environment Factors that impact on the activity: weather, terrain, water, snow/ice, etc.

	Dangers For each inherent risk (identified above) list the factors which could lead to the risk eventuating.	Risk Management Strategies Indicate actions and precautions that will be taken to reduce risks.
People Attributes people bring to an activity: skills, attitudes, physical fitness, health, age, fears, numbers, etc.	Poor organisation of program. Poor group control. Walkers following too closely person ahead. Poor supervision. Poor supervision and group control. Poor supervision. Lack of or cursory pre-walk check of equipment.	Good program organisation to ensure walkers not stressed. Close supervision of participants at all times. Clear and concise instructions to participants. Ensure instructions are followed. Advise participants to allow personal space. Close supervision of activity, briefing of participants, awareness of others. Good group control and supervision. Each adult responsible for small group of students. Recognition of triggers, signs and symptoms, close supervision. Check all participants' belongings prior to walk including waterproof lining of pack and spare clothes.
Equipment Resources that impact on the activity: clothing, tents, lights, vehicles, etc.	Inappropriate clothing. Participant is carrying too great a load. Inappropriate/worn shoes. No medication. Lack of spare clothes. Pack not waterproofed.	Clothing lists to participants prior to walk (including hat, sunscreen, water). Teachers to check pack doesn't exceed 1/4 of body weight. In pre-walk talks advise of necessity for suitable footwear. Equipment check (including shoes) prior to departure. Check medication is being carried prior to departure. Check clothing/plastic bag liner prior to departure.
Environment Factors that impact on the activity: weather, terrain, water, snow/ice, etc.	Hot / icy conditions. Exposed location. Muddy conditions / steep slope. Obstacles. Low branches across track. Poor visibility. Rain / check crossing.	Check weather forecast. Choose sheltered site to rest. Be prepared to change program. Find alternate way around difficult section of track. Assist participants as required. Warn walkers of danger. Check numbers regularly. Have all participants keep spare clothing in plastic bag inside rucksack.

Walking Party Intentions Form

This form provides information about a walking party from ______________________________________ School.

Copies of this form are being provided to:

__________________________________________________________________

Leader’s name: ______________________________________________________

Phone number(s): ____________________________________________________

Other adults on the trip and phone numbers:

__________________________________________________________________

Planned trip route:

Day 1: ____________________________________________________________

Day 2: ____________________________________________________________

Day 3: ____________________________________________________________

Starting day, date and time: ____________________________________________

Expected finishing day, date and time ____________________________________

Possible changes to route plans (for bad weather, etc):

________________________________________________________________

Location at which vehicles have been left:

_________________________________________________________________

Vehicle registration numbers:

_________________________________________________________________

The group carries: Waterproof jackets (colours)
Spare dry clothes
Food for ______________ days
Whistles
Mirror / Cyalume light sticks/strobe/flares/other* ____________________________
Tents or emergency shelter (colours)
Sleeping bags
First aid kit
Matches
Map and compass
* Cross out anything not applicable

The contact person for the group is ________________. He/she can be contacted at phone number _____________.
If the walking party has not returned by __________________ (day, date, time) and we have not communicated with
the Contact Person, he/she will report our situation to the police at ______________________________________.

Note: Attached to this form is a list of all the students participating in this walk. Details include their names,
sex, age and class. Also attached is a map showing the route of the walk.

Sample Information

Name of School ____________________________________________________

Date _______________________________________

Dear Parent/Caregiver,

This note is to inform you of important details relating to a forthcoming bushwalk and to seek your permission for your child to attend.

Details of locations to be visited: ________________________________________________________________

________________________________________________________________

Purpose of the trip: _________________________________________________

________________________________________________________________

Activities that are part of the program:

________________________________________________________________

Supervision will be provided by:

________________________________________________________________

Degree of difficulty: [Indication to be given of minimum level of fitness recommended and major challenges of the walk, such as distance to be covered, terrain description, height to ascend or descend].

________________________________________________________________

Contact System: [Inform parents of arrangements the school has made for the walking group to make contact with the school and for the school/parents to make contact with the group in case of emergency]. [Inform parents of

________________________________________________________________

Cost: _______________________

Departure: ____________________________ ___________________________
[time and place]

Return: __________________________________________________________
[time and place]

Please complete and return the information to

____________________________________ by ______________ (date required).

Permission Note

I hereby consent to my child ___________________________
participating in the ___________________________________
expedition to _______________________________________ (indicate general location)
on _______________________________________________ (dates).

If required, I consent to the supervising teacher seeking any medical aid that he/she feels is necessary.

Signature of Parent/Caregiver: ________________________________________

Date: _______________________

Parent/Caregiver’s contact phone nos:

___________________________ (day)

___________________________ (night)

___________________________ (mobile)

Note: Health details and signed parental permission notes should be taken on extended walks and carried by the teacher-in-charge in a waterproof packet.

HEALTH DETAILS

Does your child suffer from any medical condition? (asthma, diabetes, epilepsy, etc.) Please note any details of the medical management program that the leader may need to be aware.

________________________________________________________________

Give details of any medication your child is currently taking together with the dispensing routine:

________________________________________________________________

Give details of any allergy your child has to common foods, plants, insect bites, medications (eg. penicillin), etc:

________________________________________________________________

In what year was your child last immunised against tetanus?

____________________________

How far can your child swim? (circle) less than 25m 25-50m 50-100m more than 100m

(* include only if swimming is part of activities) Is there any other information we may need to be aware of, that may impact on any of the activities undertaken during the activity? ________________________________________________________________

________________________________________________________________

Medicare Number: _________________________________________



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