New York New Jersey Education and Research Center
Historical Perspectives on Occupational Safety and Health Tour
May 17-21, 2015
Our ERC’s 10thHistorical Perspectives tour is planned for May 17-21, 2015. The tour will depart on May 17 from Hunter College at 7:00 AM and Rutgers SPH (Piscataway, NJ) at 7:45 AM. We expect the bus to drop off at Rutgers SPH and Hunter College by 9:30 PM on May 21.
May 17Lackawana Coal Mine (B on map below) (overnight in Geneseo, NY)
May 18Noblehurst Farms, (C on map below) (overnight in Detroit, MI)
May 19River Rouge Tour (D on map below) (overnight in Perrysburg, OH)
May 20Materion Brush Beryllium (E on map below) (Pittsburgh, PA)
May 21Steel Mill Tour - Carrie Hard Hat Tour/Homestead Furnaces (F on map below)
NIOSH PPPT Lab (itinerary subject to change)
Please inform your program director andsend this completed form to Mitchel Rosenby March 1, 2015. Should you have any questions, please contact Mitchel Rosen (, PH 732-235-9452, FAX 732-235-5469).
Name:______
Address: ______
City: ______State: ______Zip:______
Phone #: ______Cell #: ______
Email: ______
Are you a US Citizen Yes No If no, what country are you a citizen______
Academic program/school: ______
Room with: ______
Leave from: (check one)Rutgers SPH (7:45 AM) 683 Hoes Lane West, Piscataway NJ
Hunter College(7:00 AM)2180 Third Avenue, NY
If you plan to leave your car at Rutgers, please provide the following information
Make ______Model ______State _____License Plate # ______
In Case of Emergency Contact: Please provide the name and contact information of someone for us to contact in case of emergency.
Name:______
Emergency contact phone #:______
Relation of emergency contact:______
My signature below indicates I have read/understand/agree to the financial issues, health and safety advisory, and photo release listed on the 2nd page of this document.
Signature:______Date:______
TRAVEL ARRANGEMENTS/FINANCIAL ISSUES
Arrangements have been made to travel on a luxury bus. It is expected that all participants will share a room. The NYNJERC will pay for the cost of the bus, hotel room charges, and admission charges to each site we visit. Any extra expenses (i.e., room service, in-room movies, gifts, tips, etc.) will be your responsibility. You will purchase your meals. Discuss with you program chair how/if these charges will be reimbursed. Please be sure to complete any travel forms that are required by your host institution.
International students must submit an I-20 form for our visit to NIOSH.
HEALTH AND SAFETY ADVISORY
The Historical Perspectives Tour is a 5-day, 4-night bus tour consisting of diverse occupational and environmental site visits requiring different levels of health and fitness for full participation. Some activities are comparable to visiting a museum while other activities may be more strenuous or not advisable depending on your personal health issues. You may decline to participate in certain of the activities or portions of the activities without revealing a personal health matter. There are knowledgeable faculty with whom you may discuss your concerns but this should not take the place of a visit or conversation with your private medical doctor prior to the trip.
Although some activities consist of light walking on level ground, other activities involve moderate walking on inclines, or for prolonged periods of time, possibly on uneven or slippery surfaces. Since we are visiting industrial and environmental sites of interest, conditions may include exposure to dusts, temperature extremes, tight spaces, darkness, low level chemicals used in industrial processes, or even unpredictable events. Personal protective equipment such as hard hats, respirators, and Tyvek suites may be required in certain areas. These increase the physical and even mental demands of the activity.
If you have concerns about your fitness or health concerns regarding any aspect of the trip please bring this to the attention of your group leader before the trip. Should concerns arise during the trip, or if there is any activity that you do not feel comfortable engaging in, please let the group leader know.
Anyone who has medical problems which are not well-controlled is advised to delay participation in the trip until their medical problems are stabilized.
We want you to have a safe and enjoyable educational experience.
PHOTO RELEASE
During the tour, photographs and videos make be taken of the experiences. By signing page 1 of this form, you grant permission to the NY/NJ ERC to use your photograph or video in print or electronic format for any publicity purpose. You will make no monetary or other claim against the NY/NJ ERC or it’s collaborating organizations for the use of the photograph or video. You acknowledge the NY/NJ ERCs right to crop or treat the photograph at its discretion. You also acknowledge that the NY/NJ ERC may choose not to use your photo at this time, but may do so at its discretion at a later date.
Page 1 of 2