Procedure for Convening NZAC Activities - New Zealand Alpine Club - Australia Section Inc - NZ Alpine Club
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New Zealand Alpine Club - Australia Section Inc.
Procedure for Convening NZAC Activities
The procedure for convening an official NZAC Activity involves the following process:
Activity Safety Plan (ASP) – to be completed by the Activity Convenor (AC)
• AC completes sections 1 to 4 of the ASP except participant details, which will not be available at this
time) and forward it to the Events Coordinator at least 4 weeks prior to the commencement of the
Activity for endorsement. This represents the trip outline.
• The Events Coordinator will review the ASP, seek further clarification or additional information or
suggest changes to the Plan and then formally endorse the Plan. The Activity will then be posted on the
NZAC Events Calendar and members are invited to apply to join the activity.
• AC will select applicants on the basis of demonstrated knowledge/skill for the intended activity (see
application to participate form below) and complete the remainder of the ASP. The ASP should then be
distributed to approved participants as the detailed activity guide no later than 7 days prior to the
commencement of the activity. This is the opportunity for the approved participants to review and
comment on the ASP, which then should be amended in line with comments received, if deemed
appropriate. This is then becomes the finalised ASP.
• A copy of the completed ASP and all relevant attachments must be carried on the activity by the AC for
reference for the duration of the activity.
• The AC must conduct a pre-activity briefing and involving all participants, either at the beginning of
the activity or remotely (i.e. online) before the start of the activity. This is the opportunity for all
participants to raise questions and/or concerns about the logistics and hazards identified within the ASP.
Waiver – to be completed by all participants
• All participants must sign the waiver at the start of the activity. Anyone who has not signed the waiver
prior to commencement of the activity must not be permitted to participate in the activity.
Application to Participate in Activity Form (Attachment 1) – to be completed by each prospective
participant (including Section guests)
• A member (or guest) cannot take part in any Section activity unless this application is completed
• The completed form must be provided to the AC at least 7 days, but preferably much earlier, prior to the
commencement of the activity.
• The AC must use the information provided in this form to either accept or reject each application on the
basis of required skills/experience for the activity.
Minor Indemnity Form (Attachment 2) - must be completed by the parent/guardian for participants
under the age of 18.
The completed form must be provided to the AC no later than 7 days prior to the activity date.
Incident Report Form (Attachment 3)- to be completed by the AC.
• This form should be completed for incidents where an injury was sustained or there was a potential for
an injury to be sustained (near miss).
• The form must be provided to the Events Coordinator within 5 days of the activity concluding.
• The Events Coordinator, in collaboration with the AC, must analyse the incident for possible future
learning for members as well as enter the details on the Section Incident register.
NOTE: All documents must be securely handled during the activity to protect member privacy and
archived on approved NZAC electronic file servers. An annual review of the above documents will be
undertaken to maintain currency & relevance.
NZAC – Australia Section – Activity Safety Plan – Version Dec 2017 Review Date: Dec 2018New Zealand Alpine Club - Australia Section Inc.
Activity Safety Plan
Date:
1. Activity Summary Plan Version:
Activity Name: Activity Date(s): Plan Prepared By:
Activity Location: Activity Convenor(s) incl alternate: Date Plan Submitted:
Maximum No. of Participants: Activity Duration: Activity Grade (Rating and System): Fitness Level
Required:
Endorsement by Events Coordinator: Name: Date of Endorsement:
1.1 Prerequisite skills/knowledge: (what skills/nowledge is required for this trip? (formal training or
experience). What actions are you expected to be able to perform?
1.2 Weather Forecast: (what is the predicted weather & how will it affect the activity. Update just before the
activity?)
1.3 Summary of Participants (please refer to Participant Application Forms for additional detail)
Name Contact No. Emergency Contact Contact No.
2. Pre-Activity Planning
2.1 Activity notification provided to ...(eg. landowner, leasee, Government agency)
NZAC – Australia Section – Activity Safety Plan – Version Dec 2017 Review Date: Dec 2018Name(s) and Organisation(s) (where applicable) Contact No(s).
2.2 Approval to enter lands obtained from ...
Name(s) and Organisation(s) (where applicable) Contact No(s).
2.3 Activity intention left with ... (who will respond if party fails to return on the nominated date/time)
Nominated person: Contact No:
2.4 Communications (eg. mobile phone(s), satellite phone(s), satellite personal messenger(s), VHF or UHF
radio(s) etc.)
Device Carried By Number/Channel/Frequency
3. Activity Details
3.1 General Information (location, map sheet, intended daily program, proposed route, critical points, altitude
gain/loss, camp/bivouac sites, contingency etc. Attach a route map, if possible)
NZAC – Australia Section – Activity Safety Plan – Version Dec 2017 Review Date: Dec 20183.2 Contingency plan (what might happen that will change the trip objective or route and what are the options?)
3.3 Travel Arrangements and Meeting Points (how will people travel and where will they meet up? List
vehicle details and location)
3.4 Equipment/Clothing List (specify required individual (I) and group (G) items – see Appendix A – Equipment
List for a comprehensive checklist)
Group Items
The Ten Essentials
1. Navigation
2. Sun protection
3. Insulation (extra clothing)
4. Illumination
5. First-aid supplies
6. Fire
7. Repair kit and tools (including knife)
8. Nutrition (extra food)
NZAC – Australia Section – Activity Safety Plan – Version Dec 2017 Review Date: Dec 20189. Hydration (extra water) Individual Items
10. Emergency shelter
4. Safety Safety of Participants is our top priority.
Hazards MUST be proactively managed.
All participants MUST be involved in the completion of this section of the Plan prior to the
commencement of the Activity.
4.1. First Aid
First Aid Kit(s)/Items Carried By Type/Contents
Medical or First Aid Name Qualification(s)
Qualification(s)
Participant Medical Name Condition(s) and Treatment(s)
Condition(s)
(If confidentiality is required
provide information verbally
to Activity Convenor)
4.2. Assessment of Hazards (describe the most serious hazards - i.e. Extreme & Very High categories - that
could result in catastrophic or very serious consequences)
Hazard Risk Level Proposed Action to Avoid Injury
NZAC – Australia Section – Activity Safety Plan – Version Dec 2017 Review Date: Dec 20184.3 Emergency Equipment and Procedure
Item Model Carried By
Personal locator beacon(s)
(PLBs)
Satellite phone
Avalanche transceiver(s)
Avalanche probe(s)
Snow shovel(s)
GPS
Other -
Emergency procedure Remove all from danger (if possible)
(remember the process) Assess impact
Search for/treat victims
Contact emergency services – call 000 or in NZ, 112
Record details – take notes & photos at the time of incident for future reference - complete
separate form (& report to NZAC)
Help contacts Name (agency or person) Contact No.
(Who may assist you if you
need help?)
Overdue contact 1200hrs
on the day after the
nominated finish
date/time)
5. Activity Sign-off
I declare that the information provided in this Plan is based on the information available to me at the time and is to the
best of my knowledge true and accurate.
Activity Convenor:
Signature: Date:
NZAC – Australia Section – Activity Safety Plan – Version Dec 2017 Review Date: Dec 20186. Activity Waiver, Release and Indemnity
YOU MUST READ, ACCEPT AND SIGN THIS BEFORE TAKING PART IN AN ACTIVITY
ORGANISED BY THE AUSTRALIAN SECTION NEW ZEALAND ALPINE CLUB INC
I _________________________________ agree to take part in the
(your name)
___________________________________ on _____________________.
(activity name) (date)
The activity convenor is ______________________________________.
(Name of activity convenor).
I understand and accept:
1. This activity is organized by the Australian Section New Zealand Alpine Club Inc (‘the Club’).
2. The New Zealand Alpine Club Inc. is incorporated in New Zealand. The Australian Section New
Zealand Alpine Club Inc. is incorporated in Victoria, Australia. To the greatest extent possible, this waiver,
and the conduct of this activity, is governed by the laws of Victoria including but not limited to the
Associations Incorporation Reform Act 2012 and the Wrongs Act 1958.
3. I understand that the activity convenor is a volunteer and is coordinating this activity on behalf of the
Club and is the agent of the Club.
4. Mountain climbing, hiking and other outdoor activities coordinated by the Club carry inherent and
obvious risks. We will be climbing and walking through natural areas. There are risks I may be exposed to
cuts, abrasions, falls, slips and trips, impacted by falling debris and may contact wildlife including snakes.
I may suffer injuries ranging from minor cuts and abrasions through to fractures and serious, life
threatening injuries possibly leading to permanent and catastrophic disability and death. I acknowledge
and agree that the Activity has inherent and obvious dangers and risks, including risks of serious injury
and death.
5. I agree that due to the nature of the Activity, it is unreasonable for the Club to be responsible for my
safety. I acknowledge that I have participated in the pre-Activity briefing about the Plan for, and the risks
associated with, this Activity. I understand that I will not be under any sort of instruction or guided by any
member of the Club whilst undertaking this Activity. I am responsible for my own safety and for my own
assessment as to whether I am fit and capable to undertake the activity or any part of it.
6. Club activities are only available to club members. I warrant that I am a member of the New Zealand
Alpine Club. I further warrant that I have relevant prior experience, knowledge and skills to undertake this
activity.
7. I understand that there are no warranties or expectation that anyone will be able to assist me to leave an
activity should I wish to do so, or if I am unable to continue. Should I be injured or for any reason unable
to continue with the activity I agree to meet, or indemnify the Club for, any costs associated with my
leaving the activity which, I understand, may include the use of ambulances, helicopters, boats and other
assets as determined by local ambulance, police and search and rescue services.
8. I understand that the Club does not provide any medication for use on the activity. To the extent
required I will carry any medication that I require for my personal use. This includes but is not limited to
NZAC – Australia Section – Activity Safety Plan – Version Dec 2017 Review Date: Dec 2018asthma medication and medication for allergy relief such as an epi-pen. I have, or will, advise the activity
convenor if I am carrying medication for my personal use.
9. To the full extent permitted by law, I waive all legal rights against, and fully release and agree to
indemnify, the Club and the activity convenor, for any losses or claims for damages or other compensation
however arising out of, or in relation to, my participation in this activity, This waiver, release and
indemnity applies regardless of any negligent or tortuous act or omission, breach of duty, breach of
contract, breach of statutory duty or breach of any consumer law implied warranties on the part of the
Club, its office bearers, directors, employees, agents or volunteers.
10. This waiver, release and indemnity binds me as well as anyone acting on my behalf including any
guardian, executor, beneficiaries or dependents.
11. I am over the age of 18 years old.
Signature: ______________________________________ Date: ______________
Sign here when you have read and accepted the form.
If you have any questions, ask them before signing the form.
You do not have to sign this form but if you are not willing to do so, you cannot take part in this activity.
The participant signed this form in my presence.
_____________________________________
Activity Convenor to sign.
If a parent, guardian or other responsible adult allows or encourages a person under the age of 18 years to participate in
the Activity, then that adult must be warned that the Club cannot accept any liability for injury or loss caused to the
other person. A separate liability indemnity form must be submitted for each participant under the age of 18 years &
signed by the responsible person. This form must be in possession of the Activity Convenor prior to the Activity
commencing.
7. Incident Reporting (include significant near misses - complete separate form for serious injuries)
Date Persons Involved Details of incident
NZAC – Australia Section – Activity Safety Plan – Version Dec 2017 Review Date: Dec 20188. Activity Diary/Activity Debrief (include issues that may require follow-up action) NZAC – Australia Section – Activity Safety Plan – Version Dec 2017 Review Date: Dec 2018
Attachment 1: APPLICATION to PARTICIPATE in NZAC ACTIVITY
(complete for all activities)
Email to: australia.events@alpineclub.org.nz
Section
Activity
MY CONTACT DETAILS
Full Name:
Date of Birth: Gender:
Mailing Address:
Contact Nº.s Home: Mobile:
Work: Email:
MY EMERGENCY CONTACT PERSON (Yes I have told them when & where I’m going)
Full Name:
Relationship:
Contact Nº.s Home: Mobile:
Work: Email:
(ADD or DELETE EXPERIENCE CATEGORIES as REQUIRED)
MOUNTAINEERING EXPERIENCE
Please list any ascents or high alpine trips you have done recently.
ROCK CLIMBING EXPERIENCE
Please detail type of climbing e.g. sport, traditional, multi-pitch etc. and locations and frequency in last 12 months.
SKI TOURING EXPERIENCE
Please detail any winter ski touring, and any relevant avalanche awareness experience.
NZAC – Australia Section – Activity Safety Plan – Version Dec 2017 Review Date: Dec 2018BUSHWALKING EXPERIENCE
Please detail any bushwalking or any relevant experience
INSTRUCTIONAL EXPERIENCE
Please list any mountaineering/snowcraft courses you have completed.
MEDICAL/FIRST AID QUALIFICATIONS
Please list any current medical or first aid qualifications that you may hold
ARE THERE ANY MEDICAL CONDITIONS WE SHOULD KNOW ABOUT?
(e.g. Allergies, Medications, Medical conditions, Physical difficulties). For the safety of the group and yourself, it is important that you declare any issues
that may be of relevance, and discuss these with the trip leaders.
MY FOOD PREFERENCES
INDIVIDUAL CLOTHING AND GEAR LISTS: Please tick one option: Yes No
I have read the Individual Gear & Clothing Lists in the Course Information and I am able to assemble
this equipment. I recognise that if any essential gear is missing at gear check on the first day the Activity
Convenor may refuse my participation for safety reasons and no refund will be given.
GROUP EQUIPMENT LIST: (modify list to suit activity)
Which of the items on the group equipment list do you have? (please tick) :
HOW DO YOU RATE YOUR LEVEL OF FITNESS? (Tick one, 1 low, 10 high)
1 2 3 4 5 6 7 8 9 10
Low Average Very Fit!
NZAC – Australia Section – Activity Safety Plan – Version Dec 2017 Review Date: Dec 2018HOW WOULD YOU RATE YOUR ENTHUSIASM FOR OUTDOOR ACTIVITY? (Tick one, 1 low, 10 high)
1 2 3 4 5 6 7 8 9 10
Like to take it easy Keen to be pushed a bit Full On!
MY ALPINE CLIMBING EXPERIENCE IS JUDGED AT: (Tick one, 1 low, 10 high)
1 2 3 4 5 6 7 8 9 10
Very Limited Frequent Alpine Climbing
DO YOU HAVE A PREFERENCE FOR A CLIMBING PARTNER?
(For example, male or female, or you could name a particular person you want to be paired with)
Male/Female: Name:
Optional Personal Profile info to give us some background about you:
ACTIVITY COSTS:
Accept Decline
NZAC MEMBERSHIP
NZAC Membership number: Please send me info on how to join
DECLARATION and CONSENTS
NZAC endorsed activities are essentially an opportunity for like-minded people to meet and enjoy an activity together.
Participants are not ‘guided’ or ‘instructed’ and are responsible for their own actions and safety.
You will be asked to sign a liability indemnity/waiver at the pre-activity briefing.
The Activity is not available to anyone under 18 years unless a parent’s/ guardian’s permission is given (separate form)
I certify that the information provided by me above is complete, truthful, and accurate.
Name: Date:
NZAC – Australia Section – Activity Safety Plan – Version Dec 2017 Review Date: Dec 2018Attachment 2: ACTIVITY LIABILITY WAIVER for PARTICIPANTS < 18 years
(complete only when relevant)
If a parent, guardian or other responsible adult allows or encourages a person under the age of 18 years to
participate in the Activity, then that adult must be warned that the Club cannot accept any liability for
injury or loss caused to the other person.
This form is to be completed by a responsible adult where the Participant is under 18 years of age.
If more than one responsible adult signing please photocopy & submit separate forms
Name(s) of junior Participant:
I acknowledge the risks of the Activity as described in the relevant Activity Safety Plan and agree to
indemnify the Club for any injury or loss arising from the above named minor(s) participating, and agree
that by signing this indemnity or by permitting the minor to participate, I will accept complete
responsibility for any injury or loss caused.
Print Name:
Relationship to Participant: Parent / Guardian / Other (specify)
please delete whichever does not apply
Signed: Dated: / /
If a parent, guardian or other responsible adult allows or encourages a person under the age of 18 years to
participate in the Activity, then that adult must be warned that the Club cannot accept any liability for
injury or loss caused to the other person.
This form is to be completed by a responsible adult where the Participant is under 18 years of age.
If more than one responsible adult signing please photocopy & submit separate forms
Name(s) of junior Participant:
I acknowledge the risks of the Activity as described above and agree to indemnify the Club for any injury
or loss arising from the above named minor(s) participating, and agree that by signing this indemnity or
by permitting the minor to participate, I will accept complete responsibility for any injury or loss caused.
Print Name:
Relationship to Participant: Parent / Guardian / Other (specify)
please delete whichever does not apply
Signed: Dated: / /
NZAC – Australia Section – Activity Safety Plan – Version Dec 2017 Review Date: Dec 2018Attachment 3: INCIDENT REPORT FORM
(complete only for serious incidents/near misses)
Report on ________________________________________
Accurate and complete reporting of program incidents is essential to the continuing evaluation and
improvement of NZAC activities. Thank you for your assistance. All information on this form is
strictly confidential. To ensure this confidentiality, please deliver this form only to the Events
Coordinator, Australia Section.
1 - SOURCE OF REPORT: Date of Report: ______________________
Your Name
Phone: day ________________ evening ______
Your role: leader assist party member rescuer
other________ _________
2 – WHEN & WHERE DID IT HAPPEN?
Date of Incident: Time of Day: am/pm
Mountain/Location: ____
Route: _______________
Weather _______________
Party size: Convenor________________________
3 – ACTIVITY ___NZAC Non-NZAC (check one or more)
___Hiking: __Backpacking __ Snowshoe __ Skiing: __ Nordic ___ Alpine ___Caving
Climbing: __Snow __Rock __ Ice Belaying ___ Rappelling
Canoeing: ____Kayaking __ Rafting __ Swimming _Vehicle travel __Other
4 – WHAT HAPPENED? TYPE OF INCIDENT (check or note by name# listed in 7 below)
___Injury ___Lost ___Property damage
___Illness ___Behavioural (disruptive) ___Other
___Death ___Near Miss (serious injury narrowly avoided)
5 – IF INJURY or ILLNESS, WHAT TYPE? (Check all that apply)
WOUND BONE/JOINT INJURY SUDDEN ILLNESS
___Abrasion ___Dislocation ___Allergic reaction
___Laceration ___Fracture ___Heart attack
___Puncture ___Sprain/Strain ___Other:
___Bruise ___Contusion
NZAC – Australia Section – Activity Safety Plan – Version Dec 2017 Review Date: Dec 2018COLD/HEAT INJURY ALTITUDE OTHER ___Frostbite ___Acute mountain sickness ___Bite or Sting ___Hypothermia ___HACE ___Burn ___Heat exhaustion/stroke ___HAPE ___Other 6 – WHO WAS INJURED OR INVOLVED ? (Use separate sheet for additional names) Name Age Sex Experience 1 M/F none, moderate, experienced, unknown 2 M/F none, moderate, experienced, unknown 3 M/F none, moderate, experienced, unknown 7 – OUTCOMES / EVACUATION ___Subject left activity ___walk unassisted, ___litter, ___vehicle, ___helicopter, ___other: ___Subject entered medical facility ___Returned to activity after treatment 8 – WHAT HAPPENED? – DESCRIPTION Please describe the incident. Attach additional paper, if needed. 9 – WHY DID IT HAPPEN? – INCIDENT CAUSES Contributory Causes – check all that apply UNSAFE CONDITIONS UNSAFE ACTS ERRORS IN JUDGMENT ___Avalanche ___Ascending too fast ___Distraction ___Lightning ___Descending too fast ___Misperception ___Darkness ___Moving too slow ___Miscommunication ___Exposure ___Climbing unroped ___Weather ___Inadequate belay ___Failed to follow directions ___Swift/cold water ___Loss of control/glissade ___Failure to follow rout ___Hazardous animal/plant __Rappel failure/error ___Failure to test holds ___Fall or slip on rock ___Placed no/inadequate pro NZAC – Australia Section – Activity Safety Plan – Version Dec 2017 Review Date: Dec 2018
___Slip on snow or ice ___Climbing alone ___Exceeded abilities
___Fall into crevasse/moat
___Skiing ___Fatigue
___Falling rock, ice, or object ___Improper procedure
___Inadequate equip/clothing ___Faulty use of crampons
___No hard hat ___Poor position
___Equipment failure ___Ineffective Instruction
___Nut/chock pulled out ___Poor supervision
___Piton pulled out ___Dehydration
___Illness ___Drugs/alcohol
___Unfit ___Schedule
___Psychological ___Party separated
___Stranded
___Other:
10 – IMMEDIATE CAUSE
Circle the one item you checked above that you feel was the immediate cause.
11 – WHAT HAVE WE LEARNT?
Please list key points from this incident.
12 – RECOMMENDATIONS?
How can we prevent a recurrence?
Further investigation to be carried out? Yes/No
NZAC – Australia Section – Activity Safety Plan – Version Dec 2017 Review Date: Dec 2018NZAC – Australia Section – Activity Safety Plan – Version Dec 2017 Review Date: Dec 2018
Appendix A – Sample Equipment Checklist The following Sample Equipment Checklist is taken from p. 39 of Mountaineering: Freedom of the Hills, Eight Edition. Items in brackets [ ] are optional, depending on personal preference and the nature of the trip. Items with an asterisk (*) can be shared by the group. See various other chapters for details on some of the gear on this list. The Ten Essentials 1. Navigation 2. Sun protection 3. Insulation (extra clothing) 4. Illumination 5. First-aid supplies 6. Fire 7. Repair kit and tools (including knife) 8. Nutrition (extra food) 9. Hydration (extra water) 10. Emergency shelter Clothing Boots Socks (inner and outer) [T-shirt or tank top] [Shorts] Long underwear (top and bottom) Insulating shirts, sweaters, or jackets (synthetic or wool) Insulating pants (synthetic or wool) Rain parka [Wind-resistant jacket] Rain pants [Wind pants] Insulating hats (synthetic or wool) [Rain hat] [Sun-protection hat] [Balaclava] Mittens Gloves [Glove liners] [Overmitts] [Gaiters] [Stream-crossing footwear] [Waterproof-breathable socks] Other Day pack Toilet paper [Signaling device: whistle, cell phone, etc.] [Insect repellent] [Spare eyeglasses] [Cup] [Moleskin] [Nylon cord] [Altimeter] [GPS] [Camera and batteries] [Binoculars] [Bandannas] [Ice ax] [Helmet] [Toiletries] [Alarm clock or alarm watch] [Camp clothing] [Camp footwear] [Pack cover] [Candle lantern] [Rock climbing shoes] [Chalk] [Daisy chain] [Athletic tape] [Supergaiters] [Snowshoes or skis] NZAC – Australia Section – Activity Safety Plan – Version Dec 2017 Review Date: Dec 2018
[Avalanche transceiver] *[Avalanche probe] *[Flukes, pickets, ice screws] *[Wands] *[Snow saw] [Handwarmer] [Thermos bottle] Additional Items for Overnight Trips Internal- or external-frame pack Sleeping bag and stuff sack Sleeping pad *Tent, tarp, or bivy sack *Ground cloth *Food *Water container *Repair kit *Stove, fuel, and accessories *Pots (and cleaning pad) Spoon [Fork] [Bowl] Additional gear for rock climbs Helmet Seat harness Carabiners Runners Belay-rappel device Leather belay gloves Prusik slings *Climbing rope *Rack: chocks, cams, etc. *Chock pick Additional gear for snow, glacier or winter climbs Ice ax Crampons Carabiners Seat harness Chest sling or harness Prusik slings Rescue pulley [Belay-rappel device] *Climbing rope *Spare sunglasses Additional warm clothing, such as mittens, mitten shells, socks, balaclava, insulated parka, insulated bib pants, long underwear *Snow shovel *Group rst-aid kit [Plastic boots] [Runners] NZAC – Australia Section – Activity Safety Plan – Version Dec 2017 Review Date: Dec 2018
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