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    Fieldwork Acknowledgement Form

    Uploaded by

    Tom Matthews
    This form collects medical and emergency contact information from participants to ensure their safety during a field trip. It requires authorization for participation, acknowledges risks, and confirms the participant is fit to participate. Any medical conditions or special needs are disclosed and will remain confidential with the field trip supervisor. Contact details for two emergency contacts are also required in case of any incidents during the field trip.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Fieldwork Acknowledgement Form

    Uploaded by

    Tom Matthews
    30 views1 page
    This form collects medical and emergency contact information from participants to ensure their safety during a field trip. It requires authorization for participation, acknowledges risks, and confirms the participant is fit to participate. Any medical conditions or special needs are disclosed and will remain confidential with the field trip supervisor. Contact details for two emergency contacts are also required in case of any incidents during the field trip.

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    This form collects medical and emergency contact information from participants to ensure their safety during a field trip. It requires authorization for participation, acknowledges risks, and confirms the participant is fit to participate. Any medical conditions or special needs are disclosed and will remain confidential with the field trip supervisor. Contact details for two emergency contacts are also required in case of any incidents during the field trip.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    30 views1 page

    Fieldwork Acknowledgement Form

    Uploaded by

    Tom Matthews
    This form collects medical and emergency contact information from participants to ensure their safety during a field trip. It requires authorization for participation, acknowledges risks, and confirms the participant is fit to participate. Any medical conditions or special needs are disclosed and will remain confidential with the field trip supervisor. Contact details for two emergency contacts are also required in case of any incidents during the field trip.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

    Fieldwork Acknowledgement Form

    The purpose of this form is to have your (or if under 18 years old, your parent’s/guardian’s) authorisation to attend the field trip
    and to abide by all relevant University of Sydney rules and regulations. This is compulsory. The medical questionnaire is to
    indicate to the person in charge of your fieldtrip if you have any medical condition which may be aggravated by the fieldtrip
    activity, affect your ability to participate in any fieldtrip activity and inform him/her of any special needs if applicable.

    This information is confidential and will be held by the person in charge of the fieldtrip only.

    PARTICIPANT DETAILS
    Name: Fieldtrip Name:

     Staff  Student  Volunteer Student/Staff number: Phone number:

    EMERGENCY CONTACT(s) Provide at least one


    Name Relation to You Contact no

    Name Relation to You Contact no

    MEDICAL QUESTIONNAIRE
    Are you required to take any medication that might impair your ability to undertake duties on the fieldtrip, e.g. medication which induces drowsiness and
    may impact on ability to operate machinery or vehicles?  YES (If yes, provide details below)  NO

    Do you have any preexisting condition or allergies that might impact on your ability to undertake fieldwork duties, e.g. hernia, back pain, recent injury,
    heart condition, asthma, diabetes, epilepsy, food allergies, bee stings, pollen sensitivity, etc?  YES (If yes, provide details below)  NO

    Doctor’s name: Practice: Phone number:

    ACKNOWLEDGEMENT
     I acknowledge that I have received information from the pre-trip briefing about the fieldwork, including risks and hazards.
     I acknowledge I am adequately fit to undertake the proposed activities required during the fieldwork.
     I have advised the Fieldwork Supervisor of any medical condition, injury or allergy
     I have raised any safety issues that concern me prior to departure, and will do so as they arise during fieldwork.
     I will not wilfully endanger any of my co-participants.
     I have made the fieldwork leader aware of any special dietary/medical needs.
     I acknowledge that the University may terminate my participation in a fieldwork activity, and/or institute academic misconduct
    proceedings in instances where I wilfully or maliciously fail to work in a safe manner. I accept full responsibility for my own
    behaviour and actions whilst on the fieldwork, and agree to conform to reasonable requests made by those in charge.

    The information provided by me on this form is correct, to the best of my knowledge.

    Full Name (Print – if under 18, then print parent or guardian’s name): _________________________________________

    Signed (if under 18, then parent or guardian must sign): ____________________________________________

    Date: _________________________

    Privacy Statement
    The personal information that you provide on this form is protected by the Privacy and Personal Information Act (1998) and the Information Privacy Act
    (2002). Access to the information that you provide is only available to persons authorised access in the course of their duties at The University of Sydney.
    The University of Sydney will not disclose your personal information without your consent unless the University is under a legal obligation to do so.

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