new zealand alpine club - australia section inc. procedure for … · 2018-01-24 · new zealand...

NZAC – Australia Section – Activity Safety Plan – Version Dec 2017 Review Date: Dec 2018

New Zealand Alpine Club - Australia Section Inc.

Procedure for Convening NZAC Activities The procedure for convening an official NZAC Activity involves the following process:

Activity Safety Plan (ASP) – to be completed by the Activity Convenor (AC)

• AC completes sections 1 to 4 of the ASP except participant details, which will not be available at this

time) and forward it to the Events Coordinator at least 4 weeks prior to the commencement of the

Activity for endorsement. This represents the trip outline.

• The Events Coordinator will review the ASP, seek further clarification or additional information or

suggest changes to the Plan and then formally endorse the Plan. The Activity will then be posted on the

NZAC Events Calendar and members are invited to apply to join the activity.

• AC will select applicants on the basis of demonstrated knowledge/skill for the intended activity (see

application to participate form below) and complete the remainder of the ASP. The ASP should then be

distributed to approved participants as the detailed activity guide no later than 7 days prior to the

commencement of the activity. This is the opportunity for the approved participants to review and

comment on the ASP, which then should be amended in line with comments received, if deemed

appropriate. This is then becomes the finalised ASP.

• A copy of the completed ASP and all relevant attachments must be carried on the activity by the AC for

reference for the duration of the activity.

• The AC must conduct a pre-activity briefing and involving all participants, either at the beginning of

the activity or remotely (i.e. online) before the start of the activity. This is the opportunity for all

participants to raise questions and/or concerns about the logistics and hazards identified within the ASP.

Waiver – to be completed by all participants

• All participants must sign the waiver at the start of the activity. Anyone who has not signed the waiver

prior to commencement of the activity must not be permitted to participate in the activity.

Application to Participate in Activity Form (Attachment 1) – to be completed by each prospective

participant (including Section guests)

• A member (or guest) cannot take part in any Section activity unless this application is completed

• The completed form must be provided to the AC at least 7 days, but preferably much earlier, prior to the

commencement of the activity.

• The AC must use the information provided in this form to either accept or reject each application on the

basis of required skills/experience for the activity.

Minor Indemnity Form (Attachment 2) - must be completed by the parent/guardian for participants

under the age of 18.

The completed form must be provided to the AC no later than 7 days prior to the activity date.

Incident Report Form (Attachment 3)- to be completed by the AC.

• This form should be completed for incidents where an injury was sustained or there was a potential for

an injury to be sustained (near miss).

• The form must be provided to the Events Coordinator within 5 days of the activity concluding.

• The Events Coordinator, in collaboration with the AC, must analyse the incident for possible future

learning for members as well as enter the details on the Section Incident register.

NOTE: All documents must be securely handled during the activity to protect member privacy and

archived on approved NZAC electronic file servers. An annual review of the above documents will be

undertaken to maintain currency & relevance.


New Zealand Alpine Club - Australia Section Inc.

Activity Safety Plan

1. Activity Summary Plan Version: Date:

Activity Name:

Activity Date(s):

Plan Prepared By:

Activity Location:

Activity Convenor(s) incl alternate:

Date Plan Submitted:

Maximum No. of Participants:

Activity Duration:

Activity Grade (Rating and System):

Fitness Level

Required:

Endorsement by Events Coordinator:

Name: Date of Endorsement:

1.1 Prerequisite skills/knowledge: (what skills/nowledge is required for this trip? (formal training or

experience). What actions are you expected to be able to perform?

1.2 Weather Forecast: (what is the predicted weather & how will it affect the activity. Update just before the

activity?)

1.3 Summary of Participants (please refer to Participant Application Forms for additional detail)

Name Contact No. Emergency Contact Contact No.

2. Pre-Activity Planning

2.1 Activity notification provided to ...(eg. landowner, leasee, Government agency)


Name(s) and Organisation(s) (where applicable)

Contact No(s).

2.2 Approval to enter lands obtained from ...

Name(s) and Organisation(s) (where applicable)

Contact No(s).

2.3 Activity intention left with ... (who will respond if party fails to return on the nominated date/time)

Nominated person:

Contact No:

2.4 Communications (eg. mobile phone(s), satellite phone(s), satellite personal messenger(s), VHF or UHF

radio(s) etc.)

Device Carried By Number/Channel/Frequency

3. Activity Details

3.1 General Information (location, map sheet, intended daily program, proposed route, critical points, altitude

gain/loss, camp/bivouac sites, contingency etc. Attach a route map, if possible)


3.2 Contingency plan (what might happen that will change the trip objective or route and what are the options?)

3.3 Travel Arrangements and Meeting Points (how will people travel and where will they meet up? List

vehicle details and location)

3.4 Equipment/Clothing List (specify required individual (I) and group (G) items – see Appendix A – Equipment

List for a comprehensive checklist)

The Ten Essentials

1. Navigation

2. Sun protection

3. Insulation (extra clothing)

4. Illumination

5. First-aid supplies

6. Fire

7. Repair kit and tools (including knife)

8. Nutrition (extra food)

Group Items


9. Hydration (extra water)

10. Emergency shelter

Individual Items

4. Safety Safety of Participants is our top priority.

Hazards MUST be proactively managed.

All participants MUST be involved in the completion of this section of the Plan prior to the

commencement of the Activity.

4.1. First Aid

First Aid Kit(s)/Items

Carried By Type/Contents

Medical or First Aid

Qualification(s)

Name Qualification(s)

Participant Medical

Condition(s)

(If confidentiality is required

provide information verbally

to Activity Convenor)

Name Condition(s) and Treatment(s)

4.2. Assessment of Hazards (describe the most serious hazards - i.e. Extreme & Very High categories - that

could result in catastrophic or very serious consequences)

Hazard Risk Level Proposed Action to Avoid Injury


4.3 Emergency Equipment and Procedure

Item Model Carried By

Personal locator beacon(s)

(PLBs)

Satellite phone

Avalanche transceiver(s)

Avalanche probe(s)

Snow shovel(s)

GPS

Other -

Emergency procedure

(remember the process)

Remove all from danger (if possible)

Assess impact

Search for/treat victims

Contact emergency services – call 000 or in NZ, 112

Record details – take notes & photos at the time of incident for future reference - complete

separate form (& report to NZAC)

Help contacts

(Who may assist you if you

need help?)

Name (agency or person) Contact No.

Overdue contact 1200hrs

on the day after the

nominated finish

date/time)

5. Activity Sign-off

I declare that the information provided in this Plan is based on the information available to me at the time and is to the

best of my knowledge true and accurate.

Activity Convenor:

Signature: Date:


6. Activity Waiver, Release and Indemnity

YOU MUST READ, ACCEPT AND SIGN THIS BEFORE TAKING PART IN AN ACTIVITY

ORGANISED BY THE AUSTRALIAN SECTION NEW ZEALAND ALPINE CLUB INC

I _________________________________ agree to take part in the

(your name)

___________________________________ on _____________________.

(activity name) (date)

The activity convenor is ______________________________________.

(Name of activity convenor).

I understand and accept:

1. This activity is organized by the Australian Section New Zealand Alpine Club Inc (‘the Club’).

2. The New Zealand Alpine Club Inc. is incorporated in New Zealand. The Australian Section New

Zealand Alpine Club Inc. is incorporated in Victoria, Australia. To the greatest extent possible, this waiver,

and the conduct of this activity, is governed by the laws of Victoria including but not limited to the

Associations Incorporation Reform Act 2012 and the Wrongs Act 1958.

3. I understand that the activity convenor is a volunteer and is coordinating this activity on behalf of the

Club and is the agent of the Club.

4. Mountain climbing, hiking and other outdoor activities coordinated by the Club carry inherent and

obvious risks. We will be climbing and walking through natural areas. There are risks I may be exposed to

cuts, abrasions, falls, slips and trips, impacted by falling debris and may contact wildlife including snakes.

I may suffer injuries ranging from minor cuts and abrasions through to fractures and serious, life

threatening injuries possibly leading to permanent and catastrophic disability and death. I acknowledge

and agree that the Activity has inherent and obvious dangers and risks, including risks of serious injury

and death.

5. I agree that due to the nature of the Activity, it is unreasonable for the Club to be responsible for my

safety. I acknowledge that I have participated in the pre-Activity briefing about the Plan for, and the risks

associated with, this Activity. I understand that I will not be under any sort of instruction or guided by any

member of the Club whilst undertaking this Activity. I am responsible for my own safety and for my own

assessment as to whether I am fit and capable to undertake the activity or any part of it.

6. Club activities are only available to club members. I warrant that I am a member of the New Zealand

Alpine Club. I further warrant that I have relevant prior experience, knowledge and skills to undertake this

activity.

7. I understand that there are no warranties or expectation that anyone will be able to assist me to leave an

activity should I wish to do so, or if I am unable to continue. Should I be injured or for any reason unable

to continue with the activity I agree to meet, or indemnify the Club for, any costs associated with my

leaving the activity which, I understand, may include the use of ambulances, helicopters, boats and other

assets as determined by local ambulance, police and search and rescue services.

8. I understand that the Club does not provide any medication for use on the activity. To the extent

required I will carry any medication that I require for my personal use. This includes but is not limited to


asthma medication and medication for allergy relief such as an epi-pen. I have, or will, advise the activity

convenor if I am carrying medication for my personal use.

9. To the full extent permitted by law, I waive all legal rights against, and fully release and agree to

indemnify, the Club and the activity convenor, for any losses or claims for damages or other compensation

however arising out of, or in relation to, my participation in this activity, This waiver, release and

indemnity applies regardless of any negligent or tortuous act or omission, breach of duty, breach of

contract, breach of statutory duty or breach of any consumer law implied warranties on the part of the

Club, its office bearers, directors, employees, agents or volunteers.

10. This waiver, release and indemnity binds me as well as anyone acting on my behalf including any

guardian, executor, beneficiaries or dependents.

11. I am over the age of 18 years old.

Signature: ______________________________________ Date: ______________

Sign here when you have read and accepted the form.

If you have any questions, ask them before signing the form.

You do not have to sign this form but if you are not willing to do so, you cannot take part in this activity.

The participant signed this form in my presence.

_____________________________________

Activity Convenor to sign.

If a parent, guardian or other responsible adult allows or encourages a person under the age of 18 years to participate in

the Activity, then that adult must be warned that the Club cannot accept any liability for injury or loss caused to the

other person. A separate liability indemnity form must be submitted for each participant under the age of 18 years &

signed by the responsible person. This form must be in possession of the Activity Convenor prior to the Activity

commencing.

7. Incident Reporting (include significant near misses - complete separate form for serious injuries)

Date Persons Involved Details of incident


8. Activity Diary/Activity Debrief (include issues that may require follow-up action)


Attachment 1: APPLICATION to PARTICIPATE in NZAC ACTIVITY

(complete for all activities) Email to: [email protected]

Section

Activity

MY CONTACT DETAILS

Full Name:

Date of Birth: Gender:

Mailing Address:

Contact Nº.s Home: Mobile:

Work: Email:

MY EMERGENCY CONTACT PERSON (Yes I have told them when & where I’m going)

Full Name:

Relationship:

Contact Nº.s Home: Mobile:

Work: Email:

(ADD or DELETE EXPERIENCE CATEGORIES as REQUIRED)

MOUNTAINEERING EXPERIENCE Please list any ascents or high alpine trips you have done recently.

ROCK CLIMBING EXPERIENCE

Please detail type of climbing e.g. sport, traditional, multi-pitch etc. and locations and frequency in last 12 months.

SKI TOURING EXPERIENCE

Please detail any winter ski touring, and any relevant avalanche awareness experience.

mailto:[email protected]


BUSHWALKING EXPERIENCE

Please detail any bushwalking or any relevant experience

INSTRUCTIONAL EXPERIENCE

Please list any mountaineering/snowcraft courses you have completed.

MEDICAL/FIRST AID QUALIFICATIONS

Please list any current medical or first aid qualifications that you may hold

ARE THERE ANY MEDICAL CONDITIONS WE SHOULD KNOW ABOUT?

(e.g. Allergies, Medications, Medical conditions, Physical difficulties). For the safety of the group and yourself, it is important that you declare any issues that may be of relevance, and discuss these with the trip leaders.

MY FOOD PREFERENCES

INDIVIDUAL CLOTHING AND GEAR LISTS: Please tick one option: Yes No

I have read the Individual Gear & Clothing Lists in the Course Information and I am able to assemble this equipment. I recognise that if any essential gear is missing at gear check on the first day the Activity Convenor may refuse my participation for safety reasons and no refund will be given.

GROUP EQUIPMENT LIST: (modify list to suit activity) Which of the items on the group equipment list do you have? (please tick):

HOW DO YOU RATE YOUR LEVEL OF FITNESS? (Tick one, 1 low, 10 high)

1 2 3 4 5 6 7 8 9 10

Low Average Very Fit!


HOW WOULD YOU RATE YOUR ENTHUSIASM FOR OUTDOOR ACTIVITY? (Tick one, 1 low, 10 high)

1 2 3 4 5 6 7 8 9 10

Like to take it easy Keen to be pushed a bit Full On!

MY ALPINE CLIMBING EXPERIENCE IS JUDGED AT: (Tick one, 1 low, 10 high)

1 2 3 4 5 6 7 8 9 10

Very Limited Frequent Alpine Climbing

DO YOU HAVE A PREFERENCE FOR A CLIMBING PARTNER?

(For example, male or female, or you could name a particular person you want to be paired with)

Male/Female: Name:

Optional Personal Profile info to give us some background about you:

ACTIVITY COSTS:

Accept Decline

NZAC MEMBERSHIP

NZAC Membership number: Please send me info on how to join

DECLARATION and CONSENTS

NZAC endorsed activities are essentially an opportunity for like-minded people to meet and enjoy an activity together. Participants are not ‘guided’ or ‘instructed’ and are responsible for their own actions and safety.

You will be asked to sign a liability indemnity/waiver at the pre-activity briefing.

The Activity is not available to anyone under 18 years unless a parent’s/ guardian’s permission is given (separate form)

I certify that the information provided by me above is complete, truthful, and accurate.

Name: Date:


Attachment 2: ACTIVITY LIABILITY WAIVER for PARTICIPANTS < 18 years

(complete only when relevant)

If a parent, guardian or other responsible adult allows or encourages a person under the age of 18 years to

participate in the Activity, then that adult must be warned that the Club cannot accept any liability for

injury or loss caused to the other person.

This form is to be completed by a responsible adult where the Participant is under 18 years of age.

If more than one responsible adult signing please photocopy & submit separate forms

Name(s) of junior Participant:

I acknowledge the risks of the Activity as described in the relevant Activity Safety Plan and agree to

indemnify the Club for any injury or loss arising from the above named minor(s) participating, and agree

that by signing this indemnity or by permitting the minor to participate, I will accept complete

responsibility for any injury or loss caused.

Print Name:

Relationship to Participant: Parent / Guardian / Other (specify) please delete whichever does not apply

Signed: Dated: / /

If a parent, guardian or other responsible adult allows or encourages a person under the age of 18 years to

participate in the Activity, then that adult must be warned that the Club cannot accept any liability for

injury or loss caused to the other person.

This form is to be completed by a responsible adult where the Participant is under 18 years of age.

If more than one responsible adult signing please photocopy & submit separate forms

Name(s) of junior Participant:

I acknowledge the risks of the Activity as described above and agree to indemnify the Club for any injury

or loss arising from the above named minor(s) participating, and agree that by signing this indemnity or

by permitting the minor to participate, I will accept complete responsibility for any injury or loss caused.

Print Name:

Relationship to Participant: Parent / Guardian / Other (specify) please delete whichever does not apply

Signed: Dated: / /


Attachment 3: INCIDENT REPORT FORM

(complete only for serious incidents/near misses)

Report on ________________________________________

Accurate and complete reporting of program incidents is essential to the continuing evaluation and improvement of NZAC activities. Thank you for your assistance. All information on this form is strictly confidential. To ensure this confidentiality, please deliver this form only to the Events Coordinator, Australia Section. 1 - SOURCE OF REPORT: Date of Report: ______________________

Your Name

Phone: day ________________ evening ______

Your role: leader assist party member rescuer

other________ _________ 2 – WHEN & WHERE DID IT HAPPEN? Date of Incident: Time of Day: am/pm

Mountain/Location: ____

Route: _______________

Weather _______________

Party size: Convenor________________________

3 – ACTIVITY ___NZAC Non-NZAC (check one or more)

___Hiking: __Backpacking __ Snowshoe __ Skiing: __ Nordic ___ Alpine ___Caving

Climbing: __Snow __Rock __ Ice Belaying ___ Rappelling

Canoeing: ____Kayaking __ Rafting __ Swimming _Vehicle travel __Other

4 – WHAT HAPPENED? TYPE OF INCIDENT (check or note by name# listed in 7 below)

___Injury ___Lost ___Property damage

___Illness ___Behavioural (disruptive) ___Other

___Death ___Near Miss (serious injury narrowly avoided) 5 – IF INJURY or ILLNESS, WHAT TYPE? (Check all that apply)

WOUND BONE/JOINT INJURY SUDDEN ILLNESS ___Abrasion ___Dislocation ___Allergic reaction

___Laceration ___Fracture ___Heart attack

___Puncture ___Sprain/Strain ___Other:

___Bruise ___Contusion


COLD/HEAT INJURY ALTITUDE OTHER ___Frostbite ___Acute mountain sickness ___Bite or Sting

___Hypothermia ___HACE ___Burn

___Heat exhaustion/stroke ___HAPE ___Other

6 – WHO WAS INJURED OR INVOLVED ? (Use separate sheet for additional names)

Name Age Sex Experience 1 M/F none, moderate, experienced, unknown

2 M/F none, moderate, experienced, unknown

3 M/F none, moderate, experienced, unknown

7 – OUTCOMES / EVACUATION

___Subject left activity ___walk unassisted, ___litter, ___vehicle, ___helicopter, ___other:

___Subject entered medical facility ___Returned to activity after treatment 8 – WHAT HAPPENED? – DESCRIPTION Please describe the incident. Attach additional paper, if needed.

9 – WHY DID IT HAPPEN? – INCIDENT CAUSES Contributory Causes – check all that apply UNSAFE CONDITIONS UNSAFE ACTS ERRORS IN JUDGMENT ___Avalanche ___Ascending too fast ___Distraction ___Lightning ___Descending too fast ___Misperception ___Darkness ___Moving too slow ___Miscommunication ___Exposure ___Climbing unroped ___Weather ___Inadequate belay ___Failed to follow directions ___Swift/cold water ___Loss of control/glissade ___Failure to follow rout ___Hazardous animal/plant __Rappel failure/error ___Failure to test holds ___Fall or slip on rock ___Placed no/inadequate pro


___Slip on snow or ice ___Climbing alone ___Exceeded abilities ___Fall into crevasse/moat ___Skiing ___Fatigue ___Falling rock, ice, or object ___Improper procedure ___Inadequate equip/clothing ___Faulty use of crampons ___No hard hat ___Poor position ___Equipment failure ___Ineffective Instruction ___Nut/chock pulled out ___Poor supervision ___Piton pulled out ___Dehydration ___Illness ___Drugs/alcohol ___Unfit ___Schedule ___Psychological ___Party separated ___Stranded ___Other: 10 – IMMEDIATE CAUSE

Circle the one item you checked above that you feel was the immediate cause. 11 – WHAT HAVE WE LEARNT?

Please list key points from this incident.

12 – RECOMMENDATIONS?

How can we prevent a recurrence?

Further investigation to be carried out? Yes/No


Appendix A – Sample Equipment Checklist

The following Sample Equipment Checklist is taken from p. 39 of Mountaineering: Freedom of the Hills,

Eight Edition.

Items in brackets [ ] are optional, depending on personal preference and the nature of the trip. Items with an asterisk (*) can be shared by the

group. See various other chapters for details on some of the gear on this list.

The Ten Essentials

1. Navigation

2. Sun protection

3. Insulation (extra clothing)

4. Illumination

5. First-aid supplies

6. Fire

7. Repair kit and tools (including knife)

8. Nutrition (extra food)

9. Hydration (extra water)

10. Emergency shelter

Clothing

Boots

Socks (inner and outer)

[T-shirt or tank top]

[Shorts]

Long underwear (top and bottom)

Insulating shirts, sweaters, or jackets (synthetic or wool)

Insulating pants (synthetic or wool) Rain parka

[Wind-resistant jacket]

Rain pants

[Wind pants]

Insulating hats (synthetic or wool) [Rain hat]

[Sun-protection hat]

[Balaclava]

Mittens

Gloves

[Glove liners]

[Overmitts]

[Gaiters]

[Stream-crossing footwear] [Waterproof-breathable socks]

Other

Day pack

Toilet paper

[Signaling device: whistle, cell phone, etc.]

[Insect repellent] [Spare eyeglasses] [Cup]

[Moleskin]

[Nylon cord] [Altimeter]

[GPS]

[Camera and batteries] [Binoculars] [Bandannas]

[Ice ax]

[Helmet]

[Toiletries]

[Alarm clock or alarm watch]

[Camp clothing]

[Camp footwear]

[Pack cover]

[Candle lantern]

[Rock climbing shoes]

[Chalk]

[Daisy chain]

[Athletic tape]

[Supergaiters]

[Snowshoes or skis]


[Avalanche transceiver]

*[Avalanche probe]

*[Flukes, pickets, ice screws]

*[Wands]

*[Snow saw]

[Handwarmer]

[Thermos bottle]

Additional Items for Overnight Trips

Internal- or external-frame pack

Sleeping bag and stuff sack

Sleeping pad

*Tent, tarp, or bivy sack

*Ground cloth

*Food

*Water container

*Repair kit

*Stove, fuel, and accessories *Pots (and cleaning pad) Spoon

[Fork]

[Bowl]

Additional gear for rock climbs

Helmet

Seat harness

Carabiners

Runners Belay-rappel device

Leather belay gloves

Prusik slings

*Climbing rope

*Rack: chocks, cams, etc.

*Chock pick

Additional gear for snow, glacier or winter climbs

Ice ax

Crampons

Carabiners

Seat harness

Chest sling or harness

Prusik slings

Rescue pulley

[Belay-rappel device]

*Climbing rope

*Spare sunglasses

Additional warm clothing, such as mittens, mitten shells, socks, balaclava, insulated parka, insulated bib pants, long underwear

*Snow shovel

*Group rst-aid kit

[Plastic boots]

[Runners]

new zealand alpine club - australia section inc. procedure for … · 2018-01-24 · new zealand...

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