SAFETY PLAN TEMPLATE
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1 SAFETY PLAN TEMPLATE DATE Last Reviewed - February 2017 EVENT / LOCATION EVENT MANAGER CONTACT NUMBER PARTICPANTS Classification How many OFFICIALS Who How many HELPERS Who How many VENUE Manager Contact Number Copies of Evacuation and Emergency Procedures received and communicated to all participants. Pre-event venue check - signs, exits etc. Included in briefing of all participants. Building WOF FIRST AID Organisation Who How Many Contact Number/s Qualifications Vehicle Access for COMMUNICATIONS Radios Mobile Phones PA
2 FRESH WATER ON SITE? TOILET HYGIENE? BRIEFING Responsibility Time/s and Place/s Attendees Content (incl.) Emergency Evacuation Procedure) ROLES AND RESPONSIBILITIES Role Responsibilities 1. Event Controller Run through the conditions of play, run through the emergency evacuation procedure. Eliminate or isolate any hazards. Be the main contact person in case of emergency should the Executive Officer not be present. 2. Executive Officer Assist the Event Controller, as above; request the Health and Safety Procedures/Plan for the venue. Be the main contact person at the event in case of any emergency. 3. Executive Members All who are at the event in a non-playing capacity are to assist the Event Controller to ensure that the event is run safely. 4. District Committee/ Members Assist the Controller, Executive Officer and Executive Committee Members and help prepare a safe venue.
3 ON THE DAY CHECKLIST FIRST AID Personnel Ambulance First Aid Kit/s CONTACT NUMBERS (for on-site emergencies) Event Manager Coach Media Ambulance First Aid PARTICIPANT BRIEFING/S EQUIPMENT Mat Rollers Measures Scoreboards Mats Bowls
4 Consider risks that are related to: STEPS TO FOLLOW WHEN ASSESSING RISKS Your specific event The specific sport involved - see the NSO for advice, if required The specific venue/s you are using - see event managers/owners for details if required. Please refer to the Indoor Bowls Health and Safety Plan for an overview and clarification of shared responsibility: 1. Identify the risks (losses or damage) that could result from the activity - Physical injury (sprained ankles, broken bones,abrasions, bruising, medical events i.e. asthma, cuts, stabbed by callipers Social/psychological Material (gear or equipment) Programme interruption 2. List the factors that could lead to each risk/loss - People (slips, trips, falls from gear on the floor, wet floors, etc.) Equipment (i.e. bowls hitting people, unsecured scoreboards, mat rollers not stored away) Environment (enclosed areas, uneven floor, slippery surfaces) 3. Think of strategies that could reduce the chances of each factor leading to the risk/loss ( i.e. clear explanation of the games and rules, allow enough space to minimise collisions, suitable footwear, do not use stages, remove un-needed gear from the playing area, bowls measures are stored safely, any wet floor is dried immediately) - Eliminate If possible Minimise If can t isolate Cancel If can t minimise 2. Make an emergency plan to manage each identified risk/loss. Devise strategies for each risk and an associated emergency plan including responsibilities and equipment/resources required. 3. Continual monitoring of safety during the activity - Assess new risks Manage risks Adapt plans
5 RISK ASSESSMENT FACTORS TO CONSIDER People Resources and Equipment Environment Outside providers Instructors / Officials / Volunteers / Participants / Spectators Experience Medical ( i.e. pre-existing medical conditions) Sport specific risks (NSO) Special needs Language abilities, Cultural abilities, Behaviour, Physical disability, Social Information Parents / Whanau Plan Food and Drink Transport Toilet Facilities Special Equipment Safety Equipment Venue Specific Risks Emergency Services Security Human Created Environment Unsafe act(s) by participants (i.e. not looking where they are going)
6 RISK MANAGEMENT PLAN / SAFETY ACTION PLAN EVENT Manager Date Risk: What could go wrong? Cause Prevention: Eliminate/ Isolate/ Minimise Equipment Who is Responsible?
7 Record of Accident /Incident/ Serious Harm To be completed by the Event Controller (or deputy) and injured person and sent to Executive Officer or Health and Safety Representative within 48 hours of the event. Is it an - o Accident o Incident/Near Miss o Condition (e.g. OOS) Surname:... First name(s): Residential address: Telephone:.. Gender: o M o F Date of event:. Time: am/pm Date reported:.. Hours on site since arrival at venue:.. Location where event occurred:. Occupation:... o Disease nervous system o Disease musculo-skeletal system o Disease digestive system o Disease infectious or parasitic o Disease respiratory system o Tumour (malignant or benign) o Damage artificial aid o Fatal Injured part of body: o Trunk o Head o Upper limb(s) o Multiple locations o Neck o Internal organs o Lower limb(s) Mechanism of event: o Fall, trip or slip o Sound or pressure o Biological factors o Body stressing o Mental stress o Being hit by moving objects o Heat, radiation or energy o Chemicals or other substances o Hitting objects with part of the body Was a Significant Hazard involved? o Yes o No Type of engagement: o Official o Participant o Employee Nature of injury or disease: o No injury o Superficial o Sprain or strain o Open wound o Head injury o Poisoning/toxic effect o Fracture, spine o Other fractures o Multiple injuries o Foreign body o Puncture wound o Internal injury, trunk o Chemical reaction o Occupational hearing loss o Burns o Bruising/crushing o Mental disorder o Amputation, including eye loss o Nerves/spinal cord o Dislocation o Disease skin o Disease circulatory system Type of treatment given: o Nil o First aid o Doctor o Hospital Agency of injury: o Machinery or (mainly) fixed plant o Mobile plant or transport o Tools, appliances, equipment (powered) o Tools, appliances, equipment (nonpowered) o Chemical or chemical products o Material or substance o Environmental agency o Animal, human or biological agency (not bacterial/virus) o Bacterial or virus
8 THE INVESTIGATION: Describe what happened. ANALYSIS: What caused the event? PREVENTION: What action has or will be taken to prevent a recurrence? By whom?.. By when? Were ACC forms completed? o Yes o No Event Controller:. Full Name.. Signature.. Date Consent (in the case of an ACC claim): I authorise the {Executive Officer or Health and Safety Representative} to obtain medical and any other records that are, or may be, relevant to this claim. I authorise disclosure to any accident insurer of personal information and health information held by other parties relating to the claim. I authorise disclosure of my health and other information relating to this claim to: my employer, ACC, contracted health or rehabilitation providers, employee representatives. Injured Person:.. Signature.. Date
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