OFFICE OF STUDENT LIFE

Safety & Emergency Preparedness

SAFETY QUESTIONNAIRE FOR PLANNING OF OVERSEAS TRIPS (EXPEDITIONS & RURAL AREAS)

FOR TEAM LEADER(S) TO COMPLETE AND SUBMIT TO THE OSL MANAGER-IN-CHARGE

Please kindly complete the following to the fullest of your knowledge. Please indicate the item as ‘N/A’ should the item be not applicable to you.

TRIP / PROJECT / EVENT INFORMATION
  • Trip /Project / Event Name

  • Period
/ From :To :
  • Team size

  • Name & Contact numbers of leader(s)

DETAILS OF OVERSEAS LOCATION
  1. Name of site (pls include country, suburb, village name etc.)

  1. Nature of activities to be carried out at site

  1. Location of site

  1. Name of nearest town

  1. Travelling distance from nearest town to site

  1. Any transport available at job site?
  • Can it fit a stretcher?
Length: 216 cm; Width 61 cm; Depth: 19 cm; Weight: 12 kg; Load Capacity: Max 270 kg)
  1. Any medical personnel on site?
  • If YES,
/ YES / NO
DOCTOR / PARAMEDIC / NURSE
  1. Any medical equipment on site?
  • If YES, extent and nature e.g. First Aid Clinic, Medications, Oxygen, Splints, etc
  • Stretcher (if YES, can it be winched?)

NEAREST SUITABLE HOSPITAL TO PROJECT SITE (If Known/Arranged)
  • Name of hospital

  • Does Endorsing Organisation have agreement for local treatment?
/ YES / NO
  • Address

  • Telephone number (to include country code)

  • Facsimile number

  • E-mail

  • Travelling distance from hospital to site

  • Travelling time from hospital to site

  • Does hospital have ambulance?
/ YES / NO
  • Does hospital have heli-evac facilities?
/ YES / NO
  • Does hospital have an Accident & Emergency facility capable of handling major trauma cases?
/ YES / NO
  • Does hospital have surgery facilities?
/ YES / NO
  • Does hospital have X-ray capabilities?
/ YES / NO
NEAREST AIRPORT
  • Name of nearest airport

  • Address

  • Telephone number (to include country code)

  • Facsimile number

  • Travelling distance from site

OVERSEAS TELECOMMUNICATIONS DETAILS
a)Overseas Representative Contact (if any)
  • Name and Designation

  • Telephone number (to include country code)

  • Facsimile number

  • E-mail

b)SMU Contingent (on site)
  • Name of leader(s)

  • Telephone number

  • Facsimile number

  • E-mail

PERSONNEL STATIONED IN SINGAPORE TO ASSIST THE TEAMS IN CASE OF EMERGENCY SITUATIONS
a)Name 1 & Designation
  • Tel/Fax/Mobile/E-mail

b)Name 2 & Designation
  • Tel/Fax/Mobile/E-mail

ADDITIONAL INFORMATION
Any additional information you think is important for inclusion in the Emergency Procedure?

Completion of the following is mandatory.

GROUP INSURANCE AND CONTACT ADMINISTRATION
1. Group insurance company/broker
2. Policy number
3. Emergency hotline number

SnEP Overseas Trip Safety Questionnaire (Expeditions & Rural Areas) (March 2014)

This document is intended for use by SMU only. No part of this material may be copied, reproduced, posted or transmitted

in any form or by any means without the prior written consent of the Safety & Emergency Preparedness (SnEP) Unit at SMU.