Field Research Safety Plan	
The PI or Field Supervisor may use this form to assist with the development of a Safety Plan. The completed Safety Plan should be shared with all the members of the field research team and kept on file. Multiple trips to the same location can be covered by a single Safety Plan. The Safety Plan should be revised whenever a significant change to the location or scope of fieldwork occurs. EHS is available to assist in completion or review of the Safety Plan (292-1284).	
Principal Investigator:

Department:

Phone Number:

E-mail Address:

Dates of Travel: (list multiple dates if more than one trip is planned)

*If traveling outside the U.S. please contact office if International Affairs (292-6101) Location of Field Research:
Country:	Geographical Site:

Nearest City:	Nearest Hospital:

Directions to hospital from site:

Field Research: (Please include a brief description of the field work.)

University Contact:		Local (Field) Contact: Name:	Name:
Phone:	Phone:

Emergency Procedures: (Please include detailed plans for field location, including evacuation and emergency communication).
First Aid Training: (Please list any team members who are trained in first aid and the type of training received.)
Physical Demands: (Please list any physical demands required for this field research; e.g., diving, climbing, high altitude)	

Risk Assessment: Please list identified risks associated with the activity or the physical environment (e.g. extreme heat or cold, wild animals, endemic diseases, firearms, explosives, violence). List appropriate measures to be taken to reduce the risks.

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Travel Immunizations: (Please list required immunizations/prophylaxis.) Contact Employee Health (293-8146) or the OSU Rardin Family Practice Center (293-2700)
Field Team Membership: (Please list the names of all members of the field research team, and identify the Field Team Leader).