VP Risk Assessment Form — EcoSwell

EcoSwell Risk Assessment Form

HEALTH & SAFETY

Overseas Travel Safety Security Risk Assessment (TSS)

DISCLAIMER: PLEASE READ THIS BEFORE BEGINNING TO FILL IN THE FORM

This form requires International/Travel Insurance information to be completed. Please secure this before starting the form.
This form cannot be saved and may take up to 1 hour to complete. Please account for this to avoid any issues.
Please skim through the form and be aware of its content before starting to fill it in.

PART ONE

If you follow our advice to you, all of our volunteers/research interns will be safe. This Risk Assessment has been designed to helps us and our volunteer/research interns to be even safer. Please follow the requirements listed below to complete this Risk Assessment:

ALL overseas Volunteers/Research Interns MUST complete this Travel Safety & Security Risk Assessment BEFORE travelling to Peru
If you are in need of any further advice contact any member of the EcoSwell team or email us at info@ecoswell.org
If you choose to ignore the current recommended security and travel health advice for Peru, you will be travelling at your own risk

PART TWO

ALL participants must fill in the sections below and MUST read the typical risks and mitigations shown at Appendix A.

PART ONE

List of cities & locations to be visited

Date of Travel

MM

DD

YYYY

Date of Return

MM

DD

YYYY

Purpose of Travel

Briefly state project details/activities you will be doing

Have you travelled to Peru before? If Yes, provide details.

Where will you be staying in the cities you will be visiting?

List the address and a link to Google Maps if possible

Provide details of overland/marine travel that you will undertake during this trip

Who will be your point of contact during your travel?

Important Contacts

Emergency Contact

List the name and contact details of the person EcoSwell should contact in the event of an emergency:

Emergency Contact Phone

Country

(###)

###

####

Emergency Contact Email

Emergency Contact Relationship

EcoSwell Contact

Enter the name and contact details for your EcoSwell contact

EcoSwell Contact Position

EcoSwell Contact Phone

Country

(###)

###

####

Embassy Nationality

Enter details of your Embassy in Peru (search using google)

Embassy Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Embassy Phone

Country

(###)

###

####

Insurance Company

Add the name, website and telephone number of your insurance company (paid by you or your institution for this trip):

Insurance Company Phone

Country

(###)

###

####

Insurance Company Website

http://

PART TWO

Foreign & Commonwealth Office: What are the current risks identified by FCO for Peru?

Go to www.fco.gov.uk Click on ‘Travel Advice’ Select Peru

Travel Advice

Copy and paste the travel summary from the FCO webpage for Peru:

Threats Identified

Crime

Street crime, local scams, theft, hotel room security

Crime Risk Probability

Crime Risk Mitigations

Describe what you will do to reduce the likelihood of these threats from occurring

Conflict

Localized tensions, demonstrations or fighting that could result in outbreak of hostilities

Conflict Risk Probability

Conflict Risk Mitigations

Describe what you will do to reduce the likelihood of these threats from occurring

Political

Civil unrest, strikes, riots, political demonstrations, upcoming elections or other significant events

Political Risk Probability

Political Risk Mitigations

Describe what you will do to reduce the likelihood of these threats from occurring

Kidnap

Abduction, kidnapping

Kidnap Risk Probability

Kidnap Risk Mitigations

Describe what you will do to reduce the likelihood of these threats from occurring

Transportation

Airport collection, local driving standards, hazardous terrain, vehicle roadworthiness, safety belts available

Transportation Risk Probability

Transportation Risk Mitigations

Describe what you will do to reduce the likelihood of these threats from occurring

Medical capabilities

Hospital proximity and standards, methods of payment for treatment, access to local doctor

Medical Capabilities Risk Probability

Medical Capabilities Risk Mitigations

Describe what you will do to reduce the likelihood of these threats from occurring

Food contamination

Allergies, Hepatitis A, dysentery/diarrhea, severe stomach upset

Food Contamination Risk Probability

Food Contamination Risk Mitigations

Describe what you will do to reduce the likelihood of these threats from occurring

Water & drinking water contamination

Dysentery/diarrhea, legionella, leptospirosis, polio, cholera, typhoid

Water Contamination Risk Probability

Water Contamination Risk Mitigations

Describe what you will do to reduce the likelihood of these threats from occurring

Utilities

Compatibility of equipment, voltage, safety standards, power cuts

Utilities Risk Probability

Utilities Risk Mitigations

Describe what you will do to reduce the likelihood of these threats from occurring

Climate conditions

Extreme heat or cold, high humidity, monsoon/storms, altitude

Climate Conditions Risk Probability

Climate Conditions Risk Mitigations

Describe what you will do to reduce the likelihood of these threats from occurring

Natural disasters

Typhoon, tornado, tsunami, avalanche, earthquake, floods

Natural Disasters Risk Probability

Natural Disasters Risk Mitigations

Describe what you will do to reduce the likelihood of these threats from occurring

Contact - with insects

Bites/stings, Lyme’s disease, malaria, yellow fever

Contact with Insects Risk Probability

Contact with Insects Risk Mitigations

Describe what you will do to reduce the likelihood of these threats from occurring

Contact - with animals

Allergies, asthma, bird flu, bites, dermatitis, rabies, stings

Contact with Animals Risk Probability

Contact with Animals Risk Mitigations

Describe what you will do to reduce the likelihood of these threats from occurring

Local Culture

Customs, dress, religion, behaviour

Local Culture Risk Probability

Local Culture Risk Mitigations

Describe what you will do to reduce the likelihood of these threats from occurring

Legal differences

Local codes/guidance, local statute

Legal Differences Risk Probability

Legal Differences Risk Mitigations

Describe what you will do to reduce the likelihood of these threats from occurring

Activities

Working at height, over or near water, adjacent highways, railways

Activities Risk Probability

Activities Risk Mitigations

Describe what you will do to reduce the likelihood of these threats from occurring

Hazardous substances/chemicals

Material Safety Data Sheets not available, available antidotes, transport requirements, spillage controls

Hazardous Substances/Chemicals Risk Probability

Hazardous Substances/Chemicals Risk Mitigations

Describe what you will do to reduce the likelihood of these threats from occurring

Field work/research

Permits to work, safe systems of work, tides/water conditions, medical back-up, remoteness of work site

Field Work/Research Risk Probability

Field Work/Research Risk Mitigations

Describe what you will do to reduce the likelihood of these threats from occurring

Please sign by entering your name and email address as they appear below.

Name

Email

        Name:
        
        Email:
          
        Date:

Appendix A