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Educational Field Trip Excursion Tour Checklist

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PALLISER REGIONAL SCHOOLS

Educational Field Trip,


Excursion/Tour Checklist
Nature and Location of Field Trip:
Teacher:

Orrin Hawke

Number of Students Participating:


YE
S

Alford Lake Outdoor Ed Trip

25

N
O

PRE-ACTIVITY
*
Does this field trip have educational value? Educational value is
*

Does this activity meet all of Palliser Regional Schools requirements for
field trips?

Does the activity meet the Safety Guidelines for Physical Activity in
Alberta Schools?

Have the students been given instruction in this activity?

Is there a sufficient number of staff/chaperones for the number of


students participating? How many staff/chaperones?
5

If the participants are co-ed, are the staff/chaperones co-ed?

Is the staff qualified in this activity? List qualifications:


Ed Course, CTS course, Non-restricted License

Is the staff First Aid certified?

Is the staff CPR certified?

Are any of the chaperones qualified in this activity? Number of qualified


chaperones: 4

Have the students been provided with the rules of the behaviour for this
activity? What are those rules? All school rules apply, no co-ed cabins, no
alcohol or drugs, safety

OFA, Outdoor

December 2015

YE
S

N
O

CONSENT FORMS
*
Has AP 260 Community-Based Activities, Field Trips, Excursions and
Tours been verbally reviewed with students and parents/guardians?
*
Has the Palliser Consent for Participation, Risk Acknowledgement, Waiver
and Indemnity for National and International Study Tours been completed
for every student?
*
Is the date, time and location of the activity noted on the consent form?
*

Has a complete itinerary of the trip been provided to the


parents/guardians?

Does the consent form list the hazards/risks involved with this activity?

Does the consent form indicate the mode of transportation to the activity?

Does the consent form include the cost of the activity?

Does the consent form disclose the danger of inadequate health and
medical insurance?

Have the parents given consent for emergency medical treatment?

Does the contractor offering this trip activity require a certificate of


insurance? If yes, make a request through the Corporate Treasurer,
providing
School name, activity name, address where the activity will occur and
grade level participating.
ON THE FIELD TRIP
*
Have alternate plans been made if this activity is cancelled because of
bad weather? List alternate activities:
*

Is there a contingency plan for dealing with emergencies? If so, what?


Listed on Itinerary

Attach a copy the detailed trip itinerary of day-by-day planned activities.

December 2015

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