Wildcare - Health and Safety Form - Emergency Response Plan

Health and Safety Form - Emergency Response Plan

Group Name

Date Activity Commences

Date Activity Concludes

Group/Activity Leader

First Surname

Location/Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Directions to location

Trained First Aid Responders on-site

Name of Responder 1

First Surname

Name of Responder 2

First Surname

Name of Responder 3

First Surname

Location of on-site First Aid Kit

Accessing Emergency Medical Assistance

Is emergency medical assistance available on-site?

Yes

Landline Phone Number

On-site or nearby

Mobile Phone Number

Satellite Phone Number

2-way Radio

Frequency and Call Sign

E.P.I.R.B. Registration Number

Emergency Position Indicating Radio Beacon

EMERGENCY CONTACTS

Police, Fire, Ambulance: 000 or 112 (in limited reception)

Poisons Information Centre: 131 126

Name of Additional Contact 1

First Surname

Include any additional contacts specific for activity and/or site (eg. PWS on call ranger, land holder, closest medical facility)

Phone Number of Additional Contact 1

Name of Additional Contact 2

First Surname

Phone Number of Additional Contact 2

Name of Additional Contact 3

First Surname

Phone Number of Additional Contact 3

Describe the process that will be undertaken in the event of a medical emergency

Health and Safety Form – Emergency Response Plan

Health and Safety Form - Emergency Response Plan

Trained First Aid Responders on-site

Accessing Emergency Medical Assistance

EMERGENCY CONTACTS

Police, Fire, Ambulance: 000 or 112 (in limited reception)

Poisons Information Centre: 131 126