TRIP/TRAVEL

RISK ASSESSMENT FORM

Please complete all sections of this form in advance of each trip (e.g. fieldtrip to sample water, complete survey, excursion to visit sites, trip abroad, conference, expedition) and submit a copy for review to the Safety, Health and Welfare Office at least 10 working days in advance of the trip. If you require any guidance or assistance with completion of this form then please contact the Safety, Health and Welfare Office shw@tudublin.ie

SECTION 1	INFORMATION
1	Course Code / Details
2	School / Function
3	Trip Leader / Coordinator
4	Contact Details
SECTION 2	TRIP INFORMATION
5	Date(s) of Trip
6	Duration of Trip (days)
7	Location(s) and Address(es) of Trip
8	Participants	TYPE	NUMBER
Undergraduate students
Postgraduate students
Staff members
Members of the Public
Other (please specify)
9	Description of trip activities and itinerary

SECTION 3	ARRANGEMENTS & PROCEDURES Please outline what you have in place for the trip
10	Travel & Transportation Examples: Type Company Who will be meeting/greeting Designated meeting point(s)
11	Accommodation Examples: Location Facilities
12	Supervision of Students Examples: Security Staff numbers Accountability Log of contact numbers for attendees
13	Emergency Plans Examples: Fire Safety General personal safety Accidents/Incidents Reporting
SECTION 4	YES	NO	N/A
14	Is adequate insurance in place for the trip? Please email insurance@TUDublin.ie for confirmation	☐	☐	☐
15	Has all essential health and safety information been made available to all concerned parties?	☐	☐	☐
16	Have participants been instructed in the use of any special equipment?	☐	☐	☐
17	Have all participants completed the health questionnaire in Appendix A (only required for overnight stays or if medical information should be made known to organisers)	☐	☐	☐
YES	NO	N/A
18	Is there a qualified first-aider attending the trip? (Recommended in remote locations or where there is none in host organisation)	☐	☐	☐
19	Is a suitably stocked travel first-aid kit available? (Recommended in remote locations or where there is none in host organisation)	☐	☐	☐
20	Is appropriate safety clothing and equipment available (if required?)	☐	☐	☐

SECTION 5: RISK ASSESSMENT

The risk assessment table below sets out the hazards that may affect your trip. Please use them as a guide when completing your risk assessment specific to your trip activities. If a section is not applicable please mark it N/A.

An example has been highlighted.

This list is not exhaustive and can be modified to suit your needs.

SECTION 5	RISK ASSESSMENT
HAZARD	ASSOCIATED RISK(S)	CONTROL MEASURE(S)
Physical Hazards	Associated Risk(s)	Control Measure(s)
Weather Conditions: Inclement Weather EXAMPLE	Hypothermia Frostbite Sunburn Heat stroke Poor visibility Slips, trips and falls	Note weather forecast and cancel or modify activity accordingly Appropriate protective clothing Provision for shelter Restrict duration of exposure Monitoring and supervision Safety equipment and emergency supplies (torches, whistles, high visibility clothing, food) First-aid training and supplies
Travel & Transport
Vehicles and machinery
Travel and Transport
Electricity
Tools & Machinery
Buildings
Site location, terrain and conditions
Waste Management
Child protection

Chemical Hazards	Associated Risk(s)	Control Measure(s)
Exposure to Chemicals
Human Factor Hazards	Associated Risk(s)	Control Measure(s)
Examples: Lone working Assault Theft Personal injury / medical emergency Health/hygiene Local issues e.g. dress code, behaviour, customs etc.
Biological Hazards	Associated Risk(s)	Control Measure(s)
Exposure to Biological Agents
COVID-19	Transmission and spread of COVID-19	Follow current public health guidelines Do not attend if symptomatic or on advice of HSE Examples: Face coverings advisory Hand hygiene Ventilation Respiratory etiquette Response procedures for dealing with symptomatic individuals Cleaning and disinfection Follow infection control procedures for first-aid treatment

*This risk assessment has been undertaken to the best of the organiser’s knowledge and ability.

SECTION 6

Approved by the Head of School/Function:

Name:	Click or tap here to enter text.

School/Function:	Click or tap here to enter text.

Date:	Click or tap to enter a date._

APPENDIX A

Completed forms should be held by the School/Function for use on the trip and securely destroyed after the trip.

HEALTH QUESTIONNAIRE FOR TRIPS/TRAVEL (for Overnight Trips)

Please note that we require only information that may assist you in the event of an emergency situation. There is no requirement to complete below unless there is something important and relevant that should be brought to the organiser’s attention.

NOTE: The information below is requested to ensure your safety, health and welfare on trips and to ensure that appropriate assistance can be provided to reasonably accommodate personal safety on trips. All information provided will be treated as strictly confidential and used only to ensure your safety on a trip. You may be approached in confidence by the staff member organising the trip to clarify any assistance required to undertake the trip safely or to clarify details on this form.

We encourage anyone with a relevant medical condition to communicate details on the day to the trained first-aider/organiser accompanying you. If you have any concerns we can put you in contact with our occupational health service to speak with a nurse or doctor in confidence.

PLEASE USE BLOCK CAPITAL LETTERS

Name:	Click or tap here to enter text.

Mobile No.:	Click or tap here to enter text.

Date of Birth:	Click or tap here to enter text.Male/Female/Other: Click or tap here to enter text.

Next of Kin Name:	Click or tap here to enter text.

Next of Kin Contact Number:	Click or tap here to enter text.

Do you have, or have you ever had in the past, any of the following?

MEDICAL CONDITION	YES	NO	If YES, Please Give Details
Do you have any significant allergies (e.g. pollen/dusts/insects/food/medication/other) that could trigger a severe reaction?	☐	☐
Do you have any medical condition or take any medication that might cause you to become unexpectedly drowsy/ unsteady on your feet or cause a sudden loss of consciousness?	☐	☐
Do you have any history of a significant hearing impairment that might make it difficult to hear a warning alarm (e.g. fire/ evacuation alarm) or to follow instructions?	☐	☐
Do you have any significant visual impairment (not corrected by glasses)?	☐	☐
MEDICAL CONDITION	YES	NO	If YES, Please Give Details
Do you have any mobility difficulties or require use of any mobility aids to safely engage in a trip?	☐	☐
Do you need any assistance to safely undertake a trip?	☐	☐
Participant Signature	Click or tap here to enter text.
Date	Click or tap to enter a date.

*If any changes occur regarding the information provided please inform the organiser.