TRIP PARTICIPANT LIST

Transcription

1 TRIP LEADER FORMS TRIP PARTICIPANT LIST Complete this form for all advertised club trips with copies to the club Trip Coordinator prior to the trip. Trip Name Location(s) Date(s) Trip Leader Ground Charlie ALL PARTICIPANTS: Driver s Name Forum Vehicle Name Make Model Rego No. Of Passengers Personal Details Form Y/N Passenger s Names WERE THERE ANY REPORTABLE INCIDENTS? Yes / No (If Yes, fill in the Incident Report Form) OVERLANDER 4WD CLUB Page 1 of 6

2 TRIP LEADER FORMS VISITOR -TRIP PARTICIPANT FORM This form should be completed for all club trips when a visitor driving his / her own vehicle attends a Club trip. Submit the completed and signed form to the Trip Leader. TRIP: DATE(S): DESTINATION: TRIP LEADER: VISITOR INFORMATION NAME: FORUM NAME POSTCODE: PHONE NUMBERS: PASSENGERS: VEHICLE MAKE: MODEL: REGISTRATION: PERSONAL DETAILS: Complete and sign separate Personal Details Form hand over to Trip Leader 1) As a visitor you are representing the OVERLANDER 4WD Club and are expected to abide by our Rules and By-laws. If you are not familiar with our Rules or By-laws please ask the Trip Leader to explain them or give you a copy to read. 2) If you are not confident or do not wish to attempt any part of an event, it is your responsibility to inform the Trip Leader. 3) In the event of vehicle recovery, it is the vehicle owner s responsibility to approve recovery attachment points, and where safe, to perform the attachment. 4) Safe driving practices must be adhered to at all times. 5) Please check your vehicle insurance to ensure it has the appropriate level of cover. 6) Whilst on a Club trip you are not covered by the club s public liability insurance. 7) Visitors may attend no more than 2 (two) trips / events as a Visitor prior to joining the Club. Acknowledgement I agree to abide by the OVERLANDER 4WD Club s Rules & By-laws and the directions of the Trip Leader. Signature: Date: OVERLANDER 4WD CLUB Page 2 of 6

3 PERSONAL DETAILS FORM TRIP LEADER FORMS The details below are very important in the event of an accident or personal injury. Please fill in correctly and completely. All attendees of a club trip must fill out this form. NAME: PHONE NUMBERS: POSTCODE: D.O.B.: NEXT OF KIN NAME: Not on this trip. PHONE NUMBERS: POSTCODE: Relationship: DOCTOR NAME: PHONE: MEDICARE NO: AMBULANCE NO: BLOOD TYPE: PRIVATE HEALTH INSURANCE: INSURER: MEMBER NO: Do you want to be treated as a Private Patient? Y / N Please Circle If NO, Private Health insurance details should not be passed to the authorities MEDICATION: KNOWN ALLERGIES: OTHER: This personal information form should be placed in a sealed envelope with your name on the front. The envelope should be carried in the vehicle along with envelopes for each person travelling in the vehicle. Please keep in the glove box or centre console. One (1) sealed copy should also be handed over to the Trip Leader. Envelopes should be returned to the participants after the trip for re-use on a subsequent trip. Signature: Date: OVERLANDER 4WD CLUB Page 3 of 6

4 TRIP LEADER FORMS TRIP INCIDENT REPORT This form is required to record any reportable incident occurring during the trip. An incident can involve the Club group or the general public. Examples of reportable incidents are: bodily injury, sexual harassment, any personal grievance, racial discrimination or property damage to vehicles or private property. DATE & TIME OF REPORT: SUBMITTED BY: CONTACT DETAILS: FORUM NAME: (If not a Club member) DATE OF INCIDENT: LOCATION: DESCRIPTION OF INCIDENT: WITNESS NAMES & ADDRESSES: 1) 2) 3) WITNESS STATEMENTS: Signature: Date: OVERLANDER 4WD CLUB Page 4 of 6

5 EMERGENCY PLANS -CHECK LIST TRIP LEADER FORMS In planning a trip it is important to recognise that you are expected to return home on an appropriate date or time or to arrive at a particular destination when you say you will. There are always other external parties that are affected by where we go and to this end it is important for all participants to know whom to contact for information when things go wrong or emergency contact is required to a trip participant. NAME AND CONTACT DETAILS OF EXTERNAL PERSON (Ground Charlie) NAME: TELEPHONE: (BH) (AH) TRIP ROUTE: What tracks will the trip use? Where appropriate provide marked-up maps. REFUGE EVACUATION POINTS: List helipads and other areas such as football grounds or open areas. CONTACT DETAILS POLICE List major town Police Station number: PARK RANGER / LAND MANAGER PRIVATE LAND OWNER NAME & PHONE NO. COMMUNICATION DETAILS: MOBILE PHONE: UHF CB: YES (GSM) / YES (CDMA) / NO / PARTIAL / UNSURE Channels being monitored/used: SAT PHONE: YES / NO / NOT REQUIRED / UNSURE HF RADIO: YES / NO / NOT REQUIRED / UNSURE OTHER: In remote areas, what time do I contact Ground Charlie? How can an external contact get urgent messages to me? Strategy if unsuccessful in contacting Ground Charlie? Number: Frequencies used: Local repeaters: OVERLANDER 4WD CLUB Page 5 of 6

6 TRACK SURVEY FORM TRIP LEADER FORMS Location: Map Name: Map Scale: Track Name: Track Length: Km Track Status: Open Year Round Seasonal Closure Permanent Closure Other: Track Runs Between: (eg. X Road & Y Track) Track Co-ordinates: (GPS/Map refs or similar) (Start) (Finish) Track Function: (Tick all applicable) Forestry Road Scenic route 4WD Touring Route Access to camping/fishing etc destination Access to scenic destination Through track or link Weather During Assessment: Fine Rain (light) Rain (Heavy) Snow Mist Fog Track Condition During Assessment: Wet Damp Dry Track Surface: (Tick all applicable) Rocky Stepped Dusty Graded Sandy Cross Drains Side Drains Gravel (packed) Gravel (loose) Firm Clay Icy Track Characteristics: (Tick all applicable) Steep (> 1in4) Undulating Boggy Rutted Fallen Trees Intruding Foliage Overgrown Narrow Side-slopes Wash-outs Corrugations Drainage Humps Diversions Impassable Other (Describe) Water Crossings: Record the number and types of crossings of each depth encountered Axle Wheel Bonnet Not Clay or muddy Water Depth Dry Shallow Deep Deep Deep Navigable entry Rock, Sand or Gravel Entry Rocky Bed Sandy Bed Muddy Bed Vehicle Suitability: (Tick all applicable) GREEN High Range, Road Tyres BLUE Dual Range, Road Tyres BLACK Dual Range, High Clearance RED Dual Range, High Clearance, Recovery Gear OL4WDC Track Classification: (Tick all applicable) GRADE 1 GRADE 2 GRADE 3 GRADE 4 GRADE 5 Surveyed By: Day & Date of Assessment: Time: Forum Name: Telephone: ADD ANY FURTHER COMMENTS YOU FEEL APPROPRIATE ON THE REVERSE OF THIS FORM PLEASE RETURN THIS FORM TO THE CLUB TRIP COORDINATOR. OVERLANDER 4WD CLUB Page 6 of 6