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“A” Off-Site Activity Proposal

Single Activity

Please read and review the CBE Off-Site Activities Procedures Manual prior to completing the proposal
Once the Principal has approved this off-site activity:
  • The Principal should e-mail a copy of the proposal (do not send support documents) toA – Online @cbe.ab.caat least one (1) week prior to the trip.

School:
Principal: / Phone: / Fax: / Area:
Destination (venue):
Career and Technology Centre
2336 - 53rd Ave SW
Calgary, Alberta T3E 1L2 / Departure Date (dd-mth-yr): 14-Nov-13 / Return Date(dd-mth-yr):
14-Nov-13
Departure Time: 9:00 / Return Time:3:30
Area of Study (as defined in the program of studies):
ZoomText for Mac Users / Type of Trip:
One Day Short-term Program
Grade Level (Please check all that apply):
ECS 1 2 3 4 5 6
7 8 9 10 11 12 SP / # of Students : / Male:
Female:
Contact phone number of the teacher-in-charge during the field trip:Angela Leavens
Facility: Career and Technology CentreCell No. 403-801-5521
Supervision / Staff/ Volunteers / Gender / What curriculum areas are taught? / Date
of last visit to site: / Will you be present for the entire trip? If not, specify schedule. / List relevant Certifications
(e.g. level of first aid, etc.
and expiry date)
(appendix 2 and chapter 7)
Teacher-in-Charge / (1 TIC only)
Angela Leavens /
F /
Vision Strategist /
October 2013 / Yes /
M. Ed. TVI
Staff:
# / (list) of Staff
Cathy Bell /
F /
Orientation and Mobility Instructor /
First Aider - expires Jan 2015
Volunteers: #0 / (list)of Volunteers /
N/A /
N/A
Teacher in Charge has confirmed volunteers have completed the Volunteer Clearance process.YesNo
Supervision
Students must be supervised at all times by CBE Staff and/or Volunteers.
  1. List the training, skills, knowledge and experience related to the activities and supervision in general, that support the choice of each supervisor. List each individual separately, including the Teacher in Charge. If specific volunteers are not known, please provide the general criteria. E.g. knowledge of students, first aid, etc. TVI (teachers of students with visual impairments) and 1 Orientation and Mobility Instructor, EA-Braille
  1. List the specific responsibilities for each supervisor?
Staff will be assisting students travelling in an unfamiliar environment. Orientation and Mobility skills will be applied to this new environment under the supervision of the Orientation and Mobility Instructor.
  1. How has such information and responsibilities been communicated? (e.g. meetings, manual, written communication)
Meeting and written communication
  1. Will the larger group be split into smaller groups at any time during the off-site activity? YesNo
  1. How will you manage/split the group?
Students will be together in one group throughout the day.
Method of Transportation (chapter 4)
School-owned Van (name of employee , class of license of driver )
School-owned Bus (name of employee , class of license of driver )
Rental Van (name of company: )
Arranged by Service Provider (name of carrier: )
Charter Bus (name of company: )
No transportation provided by school
Other: taxi service arranged as needed thorugh CBE transportation
Staff driver (name of employee , class of license of driver )
Has the CBE employee completed the Driver Agreement for School Staff? Yes No
Has a Driver Abstract been provided? Yes No
Volunteer Driver (name of volunteer , class of license of driver )
Has the volunteer completed the Volunteer Driver Agreement Yes No
Has a Driver Abstract been provided? Yes No
Complete If using a Service Provider, Attending Conference or Athletics Tournament
Name: / Contact Person: / Phone Number:
address: / city/town: / e-mail:
  1. What role does the service provider have with regards to the preparation of the off-site activity?
  1. What is the role of the service provider during the off-site activity?

RESTRICTED ACTIVITIES
Please indicate any and all of the following activities that are planned for this Off-Site Activity. By checking the boxes below, I am verifying that I have read the information on this Restricted activity in the Offsite Manual.
Acitivity/ies
Canoeing-Flat Water Kayaking-Flat Water Skiing & Snowshoeing
Canoe Tripping-Flat Water Kayaking-Moving Water Skiing & Snowboarding-Downhill Facility
Canoeing-Moving Water Kayaking in Sheltered Water Snowshoeing
Cycling Mountain Biking Swimming
Ice Skating Sailing Urban Pathways
Fine and Performing Arts Skiing-Cross Country Wall Climbing
Hiking

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CBE Educational Review of Off- Site Activities
General Learner Outcomes: Students will have an opportunity to learn about accessibility features on the Macintosh Operating System and using the software program ZoomText.
Itinerary: / Specific Learner Outcomes:
(Reflect the Program of Studies, CBE 3 Year Education Plan and/or CBE Results) / Method of Assessment with Brief Description:
(Self-assessment checklists, performance assessments, written products etc. with specific student knowledge, skills and attitudes identified. Identify use of observations and products. Attach rubrics if used.)
Specific Activity/Brief Description: / Location:
Orientation to facility and Facility Tour / CT Centre
2336 - 53rd Ave SW
Calgary, Alberta T3E 1L2 / Expanded Core Curriculum as outlined by Alberta Education:Compensatory Skills, Social Interaction Skills, Orientation and Mobility) / Orientation and Mobility instructors are on site to help students understand the location of exits, washrooms, etc.
Lunch / CT Centre
2336 - 53rd Ave SW
Calgary, Alberta T3E 1L2 / Expanded Core Curriculum as outlined by Alberta Education / Observation: does the student need support to begin conversation with peers, does the student show independence during lunch, opportunity to train and/or observe competence regarding stairs and cane use.
Classroom Activities / CT Centre
2336 - 53rd Ave SW
Calgary, Alberta T3E 1L2 / Expanded Core Curriculum as outlined by Alberta Education: Compensatory Skills - specifically using ZoomText 10 on the Mac OS.
Closing Activities / CT Centre
2336 - 53rd Ave SW
Calgary, Alberta T3E 1L2 / Exploration of assistive technologies that are presented by Humanware and Aroga technologies. / Students will be supported in exploring a variety of magnification devices that are not provided by the CBE or SSVI.

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Complete the chart below to indicate the hazards and the risks of this trip. List all the activities including transportation that will occur during the trip. List all the risks and hazards (cause of accident) in relation to the identified activities. List the precautions that have been made to minimize the risk.
Note: Common Risks and Hazards have been identified for the specific programs. This is limited based on the possibility of different activities being selected. Not all risks have been identified. The T-I-C and the Principal must add in additional risks for the specific activities.
activity
/
Risk/Hazards (Cause of Injury)
/
Precautions Taken
Entire Trip
/
Slips, trips and falls
/
Low Ratio of 1:4 Staff:Student
Pre-existing medical conditions
/
check student medical information from the AofR
Allergies
/
check student medical information from the AofR
getting lost or seperated from the group
/
students will wear ID tags and be redirected to the group
Eating
/
choking
/
supervision of students at all times, on-site first aiders

Taxi

/

delay, mechanical, poor driving, accidents and collisions

/

Hire an approved method of transportation. Taxis are booked by CBE Transport. Parents are aware of this transportation method and it is identified on the AofR.

Inside site

/

fire and unfamiliar environment

/

evacuation procedure explained during introduction

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Requirements Checklist
Complete and attach the following forms to the template when submitting to the Principal for approval
Consent and Acknowledgement of Risk - Student
Consent and Acknowledgement of Risk – Volunteer
Parent letter
Swimming Ability Form (if applicable)
Detailed Itinerary: Provide detailed itinerary from sun up to sun down.
Teacher Summary: Use Teacher in Charge Summary form found in the Off-site document library on the website.
Attach the completed Service Request when using a Service Provider.

Trip Preparation

As the Teacher-in-Charge:
  • What preparation have you undertaken to gain familiarity and check the appropriateness of the site (terrain, equipment, buses, etc.)?
Teacher in charge has visited the site and completed an Orientation and Mobility Checklist
  • What effects will weather have on this off-site activity?
Weather may effect transportion (i.e. students in taxi's may be delayed by poor weather).
  • How have you prepared the students’ skills, and knowledge and readiness for the off-site activity?
Students have been identified by the CBE as benefitting from the program. Student Referral is required to be completed by a teacher of the visually impaired.
  • How have you ensured that parents and students have received all pertinent information regarding this trip, including hazards and emergency procedures?
Communication with parents includes Parent Information Letter, AofR
Emergency Procedures (Chapter 6) OFFSITE Activities Procedures Manual
General: Urban Environment
Identify the:
  • Emergency Contact phones numbers?Emergency: 911 Non- Emergency:
  • School Emergency Contact Info: OR
  • Communication devices used for emergency contact(includes cell phones, 2-Way Radios, etc)?cell phone 403-801-5521
  • Are you relying on a service provider to meet the first aid ratio? no
  • First Aid kit required (type): yes No. 2 kit & CBE INcident Report
  • Steps that will be followed if a student is ill or has a non-life threatening injury?
Provide the best possible care, contact school principal and contact parent regarding any incident

Name of Teacher-in-charge

Angela Leavens / Date (year/month/day)
2013/10/28 / Signature of teacher-in-charge

I have reviewed, discussed and I APPROVE this trip.

Name of Principal / Date (year/month/day)

//

Principal: Please note the proposal should be emailed to A – Online Activities without support documents and in “doc.” format. The system cannot upload a PDF file or support documents. No signatures are required on the proposal. The proposal must be sent to A – Online from the Principal’s email account, as proof this trip has been approved.

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