The University of Winnipeg

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The University of Winnipeg

Field Research Safety Permit Permit Request

Introduction and Scope:

In line with the University of Winnipeg’s Health and Safety Mission, related University policies,

and the overarching principles of the applicable occupational health and safety regulations, the

University is dedicated to ensuring the health and safety of its employees and students through

every reasonable precaution.

The scope of academic activities conducted by the University is as diverse as the interests across

its various teaching and research disciplines. These activities may occur anywhere inside the

University, in other institutions, and in the field. Managing the risks associated with these activities

poses unique challenges, especially since safety and emergency response services available on

campus may not be accessible in all locations. Therefore, it is crucial for those supervising and

participating in such projects to be highly skilled and prepared to handle risks independently. This

is especially important for those working in remote areas where emergency support and medical

facilities may be limited or where environmental conditions and safety regulations might not meet

Canadian, provincial, or University standards.

This questionnaire/checklist must to be filled out by each participant-supervisor pair for every field

season or expedition involving field work conducted outside of the University of Winnipeg. Field

work is defined as research activities taking place away from the University. The completed and

signed checklist must be submitted to the Safety Office at least 30 business days before the

participant leaves for the field, and a copy should accompany the participant during their fieldwork.

Requester Info

Email Address* Required

Phone Number* Required

First Name* Required

Last Name* Required

Permit Date & Time

Start Date* Required

Start Time* Required

Expiration Date* Required

Expiration Time* Required

Location

Name* Required

Additional Location Details

Basic Information

Faculty* Required

Department* Required

Phone and Email* Required

Faculty Supervisor* Required

Location of Field Research (Region/Province)* Required

Date of Departure* Required

Date of Return* Required

Responsibility

Have you read and accepted the Responsibilities outlined above?* Required

Planning and Preparation: Fieldwork Information

List all geographical sites you will be visiting during this fieldwork. Include: Geographical Site / Permit / Duration of Stay / Activities Conducted.* Required

Is a map showing the approximate area of each site included?* Required

Fieldwork research protocol attached?* Required

Do you have any previous experience with the fieldwork location, if yes, in what capacity?* Required

What living arrangements have been made for individuals participating in the fieldwork activity?* Required

Is there anyone first aid trained in the group?* Required

What are the safety precautions that will be taken?* Required

Is the team exposed to wild animals, water, confined areas etc.?* Required

How will participants call for immediate assistance if they require medical care, security services, or are experiencing violence, harassment, etc.?* Required

Are participants aware of Health and Safety, Sexual Violence and Harassment policy?* Required

Are participants aware of the reporting procedure?* Required

Training record attached?* Required

Planning and Preparation: Fieldwork Participants

Participant #1* Required

Participant #2* Required

Participant #3* Required

Participant #4* Required

Participant #5* Required

Participant #6* Required

Additional Particpants* Required

Check In

Name of check-in person(s)* Required

Phone* Required

Relationship* Required

First Aid, Medical and Emergency Information

First aid trained individual* Required

Contact information* Required

Medical materials and safety devices brought to site* Required

Documents for medical services (e.g. insurance)* Required

Immunizations or prophylaxis required* Required

Training Required

List of Trainings Required* Required

Social Environment

Travel Itinerary

Include all dates and modes of transportation, including (where applicable) the carrier and flight number.* Required

Protocol

Please provide the protocol number associated with this work, if applicable (e.g., Animal Care, Biosafety, Radiation Safety, Laser Safety, or Human Research Ethics).* Required

Dangerous Situation Evacuation Procedure

List reasonably foreseeable situations in which an evacuation from the fieldwork site would be required.* Required

Hazard Identification and Risk Assessment

Hazards and Mitigation.* Required

Safety Checklist

Safety checklist attached?* Required

Acknowledgement

Principal Investigator Signature* Required

Participant #1 Signature* Required

Participant #2 Signature* Required

Participant #3 Signature* Required

Participant #4 Signature* Required

Participant #5 Signature* Required

Participant #6 Signature* Required

Safety and Health Manager Signature* Required

Department Chair Signature* Required

Add Supporting Documents

Add files to upload as supporting documentation along with your permit request.

Files

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