Safety Officer Agreement
Primary Rec Club:
*
Please Select
Aikido
Archery
Badminton
Baseball
Boxing
Brazilian Jiu Jitsu
Climbing Team
Cycling
Equestrian
Ice Hockey, Men's
Ice Hockey, Women's
Judo
Karate (Shotokan)
Kendo
Kung Fu/Tai Chi
Lacrosse, Men's
Lacrosse, Women's
Roundnet
Rowing (UBRC)
Rugby, Men's
Rugby, Women's
Running
Sailing
Ski
Soccer, Men's
Soccer, Women's
Table Tennis
Tae Kwon Do
Tennis
Triathlon
Ultimate, Men's
Ultimate, Women's
Volleyball, Men's
Volleyball, Women's
Water Polo, Men's
Water Polo, Women's
Wrestling
Wushu
Secondary Rec Club:
Please Select
Aikido
Archery
Badminton
Baseball
Boxing
Brazilian Jiu Jitsu
Climbing Team
Cycling
Equestrian
Futsal
Ice Hockey
Judo
Karate (Shotokan)
Kayak
Kendo
Kung Fu/Tai Chi
Lacrosse, Men's
Lacrosse, Women's
Roundnet
Rowing (UBRC)
Rugby, Men's
Rugby, Women's
Running
Sailing
Ski
Soccer, Men's
Soccer, Women's
Table Tennis
Tae Kwon Do
Tennis
Triathlon
Ultimate, Men's
Ultimate, Women's
Volleyball, Men's
Volleyball, Women's
Water Polo, Men's
Water Polo, Women's
Wrestling
Wushu
(if applicable)
Name:
*
First Name
Last Name
E-mail:
*
A. SAFETY OFFICER RESPONSIBILITIES
Each club must designate AT LEAST one Safety Officer, but is encouraged to have more. In order to be a safety officer for your club, you must read and agree to the conditions below. Place a check mark in each box below to indicate you have read and understood each condition.
Read conditions and check each box
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I will ensure that our Club's first aid kit (if applicable) is stocked at all times during club activity. I am also aware that the first aid office is located on the first floor of the IMA Building.
I will complete and submit to the Rec Clubs Office within 24 hours an Accident/Injury form, anytime an injury occurs during club activity.
I will ensure that the IMA/Rec Clubs Office is contacted ANY TIME an ambulance/EMT is summoned to care for or check on an injured club member, or if a club member is taken to the hospital as a result of an injury sustained during club activity (whether Home or Away)
I will ensure that the Emergency Protocols (pdf) is on hand for quick reference at club activities/events.
I will ensure that any outdoor activity stops and club members seek shelter indoors if a thunder/lightning storm is approaching. I will then allow 30 minutes after the last sound of thunder or flash of lightning before resuming club activity.
I will ensure covid-19 safety policies and procedures are implemented and followed.
B. Additional Safety Protocols
The Department of Recreation provides general Accident/Injury guidelines and Emergency Protocols for clubs. Given that each club operates within varying parameters (i.e. Sailing/Kayak Club on water, Climbing Club in back-country), it may be necessary for your club to provide additional safety protocols.
If your primary club has any additional safety protocols, please list them:
If your secondary club has any additional safety protocols, please list them:
C. Certification Information
Attach current First Aid/CPR certification
List any additional certifications or training here (i.e. EMT, WFA, WFR, etc.):
D. Statement of Understanding
As a safety officer for my Rec Club (listed above), I have read and understand my responsibilities. With my electronic signature below, I agree to follow all policies and procedures set forth by the Department of Recreation.
Name:
*
Student ID Number:
Signature
*
Submit
Should be Empty: