Office use only - TRIM NO. Date rec’d: / / Date entered: / /

Adelaide and Mount Lofty Ranges Natural Resources Management Board

Volunteer community group

application for insurance cover 2013-14

The Adelaide and Mount Lofty Ranges Natural Resources Management Board (the board) offers insurance cover to volunteer community groups working toward sustainable natural resource management in its region.

Acceptance of this application by the Board will enable the group to be covered by the board’s insurers SAICORP

For the insurance cover eligibility conditions please see the fact sheet below: Requirements of volunteer insurance cover.

Once accepted the group’s volunteers will also be eligible for assistance with safety training.

Date form completed: __/__/__

  1. Contact details for group

Name of group:
Contact person:
Position in group:
Address:
Work phone: / Fax:
Home phone: / Mobile:
Email: / Group web address:

Preferred form of contactEmail Post FaxTelephone

  1. Additional contact information

Position / Chairperson / Secretary / Public Officer/other
Name:
Address:
Bus. hrs.phone:
Mobile ph:
Email:

3. Group details:

Year the group commenced:

Total number of members involved with the group:

Please include any other details considered relevant

  1. Group legal status

Is the group incorporated under the Association Incorporations Act 1985? Yes No

If not, is the group a sub-committee or branch of another body? Yes No

If yes, what is the name of the body?

5. Main aims of group

______

______

______

6. Activities planned for this financial year

  1. Please provide some details on normal group activities:

General meeting days
Regular working bee days
(if applicable)
Meeting / work venues:
(if applicable)
Work site location/s and council area:
e.g. X council, reserve name, plus nearest street/road or access point)
Types of physical work performed:
e.g. growing, planting,weed removal.Use of chemicals, slasher, whipper-snipper
  1. Please provide a brief outline of the group’s activities and any major projects planned for next year.

Please indicate whetherthe group has land owner approval for group activities taking place on their properties

Project or activity description / Site of activities
(if applicable) / Landowner approval (if applicable)

7. Safety and skills training

A. Does the group undertake hazardous physical work or work requiring specific training

(e.g. use of brush cutters, chainsaws, and motorised augers)? Yes No

B. If so, have members of the group received safety training for this work through the board or other sources in the past 3 years? Yes No

Please fill in the table below.

Training type / Date / Training provider / venue / Names of members trained
First aid
Brushcutters
Chainsaws
Hazard ID and safety planning
Other
(e.g. chemical handling)

C. Do members of the group require any safety training? Yes No

If so, please fill in the table below.

Training type requested / Training level and other relevant information / Preferred provider, if any / Number requiring training
e.g. First Aid / e.g. Senior First Aid / eg.St John’s or Red Cross / 4
  1. Board program or staff contacts:

A. Please specify which board program or staff member the group works with, if any:

Program / Yes / no / Staff member/s name
Community Group Action (e.g. Our Patch, Catchment Care)
Land Management Program
Coast and Marine
Water Management Services
Manager, Volunteer Support

B. Does the group receive support from project officers from other organisations (e.g. council)?

Please specify:

Agreement

I have read the Adelaide and Mount Lofty Ranges Natural Resources Management Board’s Requirements of volunteer insurance coverbelow Yes No

The (Name of group) agrees to follow the minimum processes outlined in the Adelaide and Mount Lofty Ranges Natural Resources Management Board’s Requirements of volunteer insurance cover (Attachment 1) to ensure the safety of its volunteers and to ensure that the group’s volunteers are covered by the board’s insurance.

Signature: / Name: / Date

Insurance management process

We will notify you by letter of the outcome of the group’s application for insurance cover through the board.

If the group is offered insurance cover for the current financial year the board will send you an insurance renewal form annually for subsequent years.

Please note: the board’s insurance cover for volunteer groups does not cover paid employees of the group.

The board will keep the group informed of any changes to safety requirements, and any training and support services it makes available.

The name and contact details of the group will be supplied to the government insurer, SAICORP. Information supplied by you on this insurance renewal form will be kept by the board confidentially.

For further information re volunteer group insurance please read Nature of volunteer insurance cover on the region’s website or contact Liz Millington, Manager, Volunteer Support, on
08 8273 9126,0417 770 747 or

Attachment 1 - Requirements of volunteer insurance cover

The Adelaide and Mount Lofty Ranges Natural Resources Management Board (the board) offers insurance cover to volunteers and volunteer community groups who are working to improve and sustain the natural assets of the region.

Volunteer insurance is provided through regional NRM boards and the Government’s insurer SAICORP.

The Work Health and Safety Act 2012 requires that all volunteers must be adequately protected from unsafe situations to ensure, as far as is reasonably practical, the safety and well-being of volunteers.

Specifically the Act requires that:

  • Workplaces for volunteers must be maintained in a condition which ensures, so far as is reasonably practicable, that the volunteers are safe from injury and risk to health and volunteers must be provided with a safe working environment, safe systems of work, plant and substances in a safe condition and adequate facilities as prescribed for their welfare.
  • Volunteers must be provided with adequate information, instruction, training and supervision, as far as is reasonably necessary, to ensure that they are safe from injury and risks to health.

Where insurance is offered to volunteer community groups by the Adelaide and Mount Lofty Ranges NRM Board, the boardrequires that groups meet the above standards.

To ensure the safety of volunteers and to ensure that volunteer community groups are covered by the insurance, the following minimum processes must be followed:

  1. Landholder permission must be obtained for any volunteer community groups’activity not on the group’s own premises/property
  1. Volunteers must be registered members of the group or registered as volunteers at events organised by the group

Volunteers must either be listed in the group membership records or, if participating at specific group events, recorded on an attendance record.

These records should provide emergency contact details for each volunteer and any medical informationrelevant to the safety of individual volunteers and those working with them.

Sample templates of registration forms are available through the Manager Volunteer Support.

.

  1. An attendance record must be kept for the group’s volunteering activities

The group is asked to keep copies of their attendance sheet / records safely for future reference.

Should an insurance claim be made by a volunteer or member of the public, these records provide proof for the insurer that either was involved with a group activity at the time of injury or damage to property.

Sample templates of attendance sheets are available through the Manager Volunteer Support

  1. A suitable risk assessment is conducted on site for volunteer activities to identify and avoid any reasonably foreseeable accident or injury

Volunteer community groups registered for insurance by the board will be offered training in Hazard Identification & Safety Planning and are encouraged to identify, mitigate and record risks.

A sample Hazard ID and Safety Plan is available through the Manager Volunteer Support.

For further information on insurance, safety training or safety management for volunteerscontact the board’s Manager, Volunteer Support(Tel: 8273 9126; Mob: 0417 770 747; email: liz.millington@ sa.gov.au)

AMLR NRMBoard Volunteer Community Group Insurance Application Form – June 2013 1