Derby District High School

10 Anderson Street
PMB 958 ~ Derby WA 6728
Derby.DHS@education.wa.edu.au
Ph.: 9193 3000

2021 Excursion Application Administration Cover Page

This page is to be used to assist the Organiser with the management of approvals and flow of the
documents through the school administration relating to their excursion
Excursion Date/s: Staff member in charge: Other Staff members attending:
24/5/2021 – 26/5/2021 Hayden Harris Allee Proud & Derek Ringrose

Excursion Title: Outdoor Education

Expedition Unit 1/3 (Manning Gorge)
INITIAL Approval
Approval Timeframes FINAL Approval (not less than)
(not less than)
One day excursion (no overnight stay) 2 Weeks 1 Week
Overnight excursion 3 Weeks 1 Week
Interstate or international 1 Term 1 Month
INITIAL APPROVAL
Step 1 Deputy Initial Approval granted.
Principal
(Line Manager) ☐ YES ☐ NO ___________________ ___________________
Signature Date
Step 2 Principal Initial Approval granted.

☐ YES ☐ NO ___________________ ___________________

Signature Date
Step 3 Deputy Excursion has been put on the Term Planner.
Principal
(Line Manager) ☐ YES ☐ NO ___________________ ___________________
Signature Date
PERMISSION LETTER APPROVAL
Step 4 Deputy Principal Parent/Caregiver Consent Forms checked by relevant Deputy Principal ☐ YES ☐ NO
(Line Manager) Parent/Caregiver Consent Forms can now be distributed ☐ YES ☐ NO

___________________ ___________________
Signature Date
FINAL APPROVAL
A finalised list of students and signed Parent/Caregiver Consent Forms need to accompany this package for final approval.
Please return to the Deputy Principal no later than _____/_____/_____ (see above timeframes).

Step 5 Deputy A finalised list of students and associated permission forms have been checked and are included.
Principal

☐ YES ☐ NO ___________________ ___________________

Signature Date
Step 6 Principal Final approval is granted. Declaration By Principal completed.

☐ YES ☐ NO ___________________ ___________________

Signature Date
Step 7 Front Office Final approval and ALL permission slips scanned. Document titled to match ‘Excursion title and
Reception Date shown above’. SIS updated with health information amendments. Stamp SCANNED
beneath Step 7 (left) of this page and return original documents to the Staff Member in Charge.

☐ YES ☐ NO ___________________ ___________________

Signature Date
 DECLARATION BY THE PRINCIPAL

PROPOSED EXCURSION TO – Manning Gorge

As the Principal of Derby District High School, I declare that I have sighted all relevant
documentation and confirm that all sections of the Proposal for Excursion have been completed and
it meets the requirements of the Excursions in Public Schools policy.
(tick relevant boxes below)

 (1) the proposed excursion has a clear educational purpose;

 all approvals as required under the Official Air Travel policy and from principals of any other
school attended by participating students have been obtained;

 (2&5) participating students have the capacity to undertake the excursion as evidenced by the
student health care plans and information and as attested to by principals of any other
participating school;

 (3&4) a suitable supervisory team, supervision strategies and system for identifying excursion
participants have been established;

 (6&7) an appropriate communication strategy and information about respective responsibilities

and obligations has been established and communicated to all those attending the excursion;

 (8) arrangements have been made for the safe transport and accommodation of excursions
participants;

 (9&10&11) where external providers are engaged, they have proper and current insurance cover
and staff responsibilities have been established;

 (13) an emergency response plan has been developed and a copy has been provided to the
relevant Regional Education Office or retained by the principal of the independent public
school;

 (14) the excursion has been properly costed; and

 as appropriate, travel insurance has been arranged by parents for all students;

 (15) Parents have been provided with full details of the excursion and have provided signed
consent.

Excursion approved by

Principal Name: ____________________________________

Principal Signature: ____________________________________

Date: ____________________________________
PROPOSAL FOR EXCURSION (intra and interstate)
NOTE:
1. Please print single sided.
2. Remove ‘Guidelines’ and other Appendices not needed for the excursion.
3. Attach all required documents in the order listed below.
4. Tick boxes as required.

School Derby District High School

Excursion to: Manning Gorge
Date of excursion: From: 24/5/21 to: 26/5/21
Staff member in charge: Hayden Harris -
• Allee Proud –
Other staff members • Derek Ringrose -
attending:

Documents attached: List of Staff members attending and their mobile numbers ❑
List of (proposed) students (include year level) ❑
Details of students not attending and alternative activities ❑
Student Health Care Summaries printed from SIS with parent /
guardian contact details (telephone numbers) ❑
Copies of WWC from external providers (as required) ❑
Copies of supervisor qualifications/DL (as required) ❑
Map of journey/destination/venue(s) ❑
Attach the relevant Evacuation Plans for venues (numbered) ❑
documents at the Map of venues to closest hospital (route/s) ❑
back of the Excursion Certificates of currency (numbered) ❑
package. Details of student travel insurance (if relevant) ❑
Emergency Response Plan APPENDIX A ❑
In This ORDER Costing spread sheet (if relevant) APPENDIX C ❑
Staff relief request advice APPENDIX B ❑
Letter to parent: ❑
a) Table/ Letter with information about the excursion
b) Details of accommodation (if overnight)
c) Travel insurance details (if required)
d) DDHS electronic payment details
e) Itinerary
f) Blank Health Care Summary (or room to add updated info)
g) Water based activities (if required)
h) Travel insurance details (if required)
 1. EDUCATIONAL PURPOSE OF EXCURSION (Refer to guidelines 1-2)
• To assess students’ practical and performance skills in an outdoor setting. This excursion
is linked to assessment Task 4, 5 & 6 of Unit 1 (year 11), Task 1, 4 & 5 of Unit 3 (year 12)
and Outcome 1, 2, 3 & 4 of the Outdoor Education course.
• The excursion has a clear educational purpose  

2. STUDENTS’ CAPACITY (Refer to guidelines 3-9)

NOTE: On the ‘Health Care Summaries’ highlight any student with an allergy / medical / or special needs.
List here the names of students highlighted and the provisions you will make for them.

General: Students are required to have attended at least 50% Outdoor Education lessons this
year to be appropriately informed and prepared for the trip. Hikes are of up to 5km will be
conducted throughout term 2 to prepare and build student fitness for expedition. Students will be
required to know how to swim at an appropriate level.
Students not attending will have expedition planner assessment tasks to complete at school.

• All participants have the capacity to undertake the excursion 


• Parents / Guardians complete signed documentation to confirm health information
held by the school remains current / up to date information regarding student medical

conditions has been obtained. 

• Alternative activities arranged for students NOT attending. 

3. SUPERVISORY TEAM (Refer to guidelines 10-17)

i.e.: Non-staff must complete Appendix D or sit an interview with the Principal before being accepted.
• Hayden Harris -
• Allee Proud -
• Derek Ringrose –
• Peter Brooking (RSAS)
• Bayden Lee (RSAS)

Staff-Student ratio is: 3:16

• A suitable supervisory team has been established with appropriate Staff-Student
ratio (list the ratio in the box above)  
• Working With Children checks (WWC) / Or exempt from WWCC to complete
Confidential Declaration  

4. SUPERVISION STRATEGIES (Refer to guidelines 18-24)

• Hayden will have a list of the names of participating students, contact details and up to date
medical information.
• Attendance and regular head counts (particularly at transitions) will be recorded throughout
the excursion. A number system will be utilized.
• Students to remain in allocated groups at all times.
• 1 school staff member will be inside each RSAS vehicle to monitor behavior etc.
• Appropriate first aid bag carried by teacher in charge.
• Teacher in charge to have student medical and contact details.
• Onsite supervision strategies have been established.
• All staff to be vigilant with student’s whereabouts and movements throughout.
• Hayden, Derek and Allee all have Bronze Medallion. One of them will be on the side
supervising water based activities.

Supervision strategies
• have been established with the supervisory team  
• address the circumstance where students are not in clear view of the supervisor/s  
 5. IDENTIFYING EXCURSION PARTICIPANTS (Refer to guideline 25)
- Tia-Rae Charles-Skinner
- Kyle Egan
- Mathew Joseph
- Cornelius Lennard
- Ryland Martin
- Jalen Sampi
- Alfie Sebastian
- Keil-Jamarl Taylor
- Nikoda Thomas
- Tyzeal Williams-Wilson
- Morgan Hammond
- Tuqiri Niki
- Aleerah Ozies
- Mundulla Rose
- Odin Thomas
- Robert Williams-Wilson
- Farren Wilson

- All students will be in school uniform.

- When swimming, students will be wearing bathers but will be sectioned off from the public and only
swim in designated areas.
- At night, students must always have a head torch on.
- Students will be briefed about informing teachers of any movements outside of the whole group
movements
- Students will be briefed on the safest route to and from locations, stop-and-wait points, and the use
of a leader and a tail person to stay as a group

• Systems for identifying excursion participants have been established  

6. COMMUNICATION STRATEGY (Refer to guideline 26 & 27)

Teacher in Charge will have copies of SIS student information print outs for all students and copies of permission forms on-hand
at all times
School Contacts:
School Number – 9193 3000
Eliot Money – 0427 429 334
Hilary Carruthers – 0427 931 203
Mohamed Youssef – 0409 130 976
Derek Ringrose - 0401 299 011
Fiona Hunter – 0431 975 569

Staff Attending:
Hayden Harris - 0478980590
Allee Proud - 0432 275 300
Derek Ringrose – 0401 299 011
Peter Brooking (RSAS) -
Bayden Lee (RSAS) -

Mt Barnett Roadhouse: 9191 7007

Staff and supervisory team to be kept in communication via email and face to face contact in weeks
leading up to the expedition and week of

- Students will be informed in contact hours occurring in Outdoor education and outdoor Recreation
classes of logistics, pick up time, etc.

• An appropriate communication strategy has been established and will be conveyed

to all those attending the excursion prior to commencing  
• An emergency signal and alternative mode of communication is in place.  

7. BRIEFING STUDENTS AND SUPERVISORS (Refer to guideline 28-30)

Staff Briefing:
20th May 2021, 2:15pm, Staff Room

Student Briefing:
17th May 2021, Period 4/5, VET room (27)

• Students and supervisors have been/will be fully briefed on responsibilities and

obligations.  

8. TRANSPORT ARRANGEMENTS (Refer to guidelines 31-41)

Derek Ringrose – School Pajero
Peter Brooking – RSAS Troop Carrier (Hayden Harris supervising)
Bayden Lee – RSAS Troop Carrier (Allee Proud supervising)

On the hike at Galvan’s and Manning Gorge, there will be one teacher at the front of the group
and one teacher at the back. The 3rd supervisor will be in the middle.

• Arrangements have been made for the safe transport of excursion participants  

9. VENUE/SITE FOR THE EXCURSION (Refer to guidelines 42-43)

List the names of the venues and write corresponding number on Evacuation Plans attached at
the back of this excursion package.

1. Galvan’s Gorge – Mt Barnett Roadhouse 9191 7007

2. Manning Gorge - Mt Barnett Roadhouse 9191 7007
3. Mt Barnett Roadhouse 9191 7007

• The venue or site for the excursion is suitable for the student group  
• An evacuation plan and who manages an evacuation is identified (map included)  

10. EXTERNAL PROVIDERS (Refer to guidelines 44-46)

Peter Brooking and Bayden Lee from Remote Schools Attendance Strategy (RSAS)
Jodie Newman Manager of Mt Barnett Roadhouse

• A suitable external provider has been engaged and staff responsibilities established 
 11. INSURANCE COVER FOR EXCURSIONS (Refer to guidelines 47-52)
List the names of the venues and write corresponding number on Certificate of Currency attached
at the back of this excursion package.

1. .
2. .
3. .
• External providers have sufficient and current public liability insurance to cover their
legal liability. (valid proof is required and is attached – min to be $20 million)  
• Where necessary external providers have sufficient and current professional
indemnity insurance to cover their legal liability. (valid proof is required and attached- min to be $5
million)  
• Students travelling interstate have been asked to source travel insurance.  

12. STUDENTS WHO ARE BILLETED (Refer to guidelines 53)

N/A (unless billeting students)

• Suitable arrangements have been made for billeted students.  

• Host family to complete an Undertaking to Provide a Billet (Appendix G)  

13. EMERGENCY RESPONSE PLANNING (Refer to guidelines 54-64)

See attached ‘Emergency Action Plan’ attached

• An emergency response plan has been developed  

• A copy has been provided to the relevant Regional Education Office.  

14. DETAILED COST OF EXCURSION (Refer to guidelines 65-66)

Provide details of how the excursion will be costed. (Provide D code if required)

• Outdoor Education budget D5625

• Items to be purchased:
Camping fees $500, fuel $120, food/water/ice $200, camping gear $200.
• The excursion has been properly costed (costing sheet attached if required)  

15. INFORMATION PROVIDED TO PARENTS FOR THEIR CONSENT (Refer to guidelines 67-69)

Refer to letter home section.

• Parents have / will be provided with full details of the excursion and signed consent
forms.  

16. ONLINE EXCURSION TRAINING (access via DOE WA Portal)

• DOE Online excursion training has been completed by the staff member in charge 


Staff member name: ________________________ Signature: _________________

 17. APPROVAL (SIGNATURES)

Staff member in Charge: Hayden Harris Signature ________________

(Authorised Department Employee) Date: ________________

Deputy Principal: ___________________________ Signature ________________

(Line Manager) Date: ________________

I confirm that all sections of the Proposal for Excursion have been completed and it
meets the requirements of the Excursion policy.

Principal signature __________________________________ Date___________

(If the Proposal for Excursion is endorsed, the principal must complete and endorse an
Application for Approval of Excursion and submit for approval as outlined in Appendix A of the
Excursion Procedures)
GUIDELINES RELATED TO INTRA AND INTER STATE EXCURSIONS

(1) EDUCATIONAL PURPOSE OF EXCURSION

1. School excursions should be planned in the context of the total educational program of the
school and link to related curriculum activities. The rationale for any excursion should
reference the school’s curriculum objectives and be relevant to their achievement.
2. Examples of high risk activities for school excursions include, but are not limited to, bungee
jumping, jet boating, para/hang gliding, white water rafting, tobogganing or skydiving.

(2) STUDENTS’ CAPACITY

3. Refer to the Student Health Care in Public Schools policy for advice on managing student
health care needs.
4. Parents are required to complete signed documentation to confirm that the health information
held by the school remains current (see the Student Health Care Summary and associated
templates available on the Department’s Student Health Care website). A Student Update
Form is available on SIS to facilitate the updating of health care information.
5. Any additional information provided by the parent regarding their child’s health care should be
attached to the Student Health Care Summary and associated health care plans.
6. Students’ capacity should be reassessed if any circumstances surrounding the excursion
activity change. This includes any change in the condition of the environment, or in the medical
fitness (e.g. conditions such as asthma or epilepsy) or capacity of the students to undertake the
activity.
7. There should be alternative activities or extra support for those students who wish to take part
in the excursion but do not have the prerequisite skills for the planned activity.
8. There should be alternative arrangements for any student who does not participate in an
excursion.
9. All excursions should take into consideration students’ cultural requirements, intellectual or
mental capacity and/or the degree of disability.

(3) SUPERVISORY TEAM

10. Adults, who are not teachers, but who possess the appropriate experience, competencies
and/or qualifications, can be supervisors.
11. The suitability of external providers or volunteers who are part of the supervisory team to
personally care for students in the absence of a suitable Department staff member should be
considered taking into account their health status, skills and experience and the characteristics
of the student group.
12. Principals and managers must confirm that all Department employees, volunteers, visitors and
external providers in child-related work have applied for or hold a valid Working with Children
Check in accordance with the Department’s Working with Children Checks in Public Schools
policy.
13. Volunteers who are exempt from having a Working with Children Check should be requested to
complete a Confidential Declaration (see Appendix H) indicating whether or not they have any
convictions or whether there are any circumstances or reasons that might preclude them from
working with or near children.
14. The supervisory team needs to have appropriate experience, knowledge and skills to identify
and manage potential risks at any stage during an excursion, taking into consideration the
characteristics of the student group including:
• number of students involved;
• age, experience and capabilities of the students;
• activities to be undertaken; and
• characteristics of the venue.
15. Collectively, the supervisory team should have the skills to:
• identify and establish a safe environment for the activity;
• monitor and respond to weather and environmental conditions before and during excursion
activities;
• monitor and assess the physical wellbeing of the students; and
• effect a rescue and render emergency care.
16. For outdoor education and recreation activities, including general water-based activities, the
supervisory team must hold the qualification(s) specified in the relevant section of the Outdoor
Education and Recreation Activities for Public Schools policy.
17. Supervisors need to be made aware that they are required to be on duty for the duration of an
excursion.

(4) SUPERVISION STRATEGIES

18. Supervision strategies should maintain the safety and wellbeing of students at all times.
19. It is recommended that supervisors not be permitted to take their own children on an excursion,
unless the children are members of the student group for whom the excursion is intended.
20. For outdoor education and recreation activities, including general water-based activities, the
level of supervision must comply with the relevant section of the Outdoor Education and
Recreation Activities for Public Schools policy.
21. Supervisory requirements such as the number of supervisors and the supervisory strategies
should take into account the:
• age of the students;
• experience and ability of the students;
• student medical conditions or disabilities;
• supervisor(s) competence and experience;
• type of activities to be undertaken;
• nature of the environment;
• location of the activity; and
• weather.
22. Supervision strategies should address the circumstance where students are not in clear view of
the supervisor(s).
23. Non-teaching staff, volunteers and external providers have a right to refuse a request to
personally care for students and to have their decision respected by members of the teaching
staff. However, a member of the non-teaching staff may have limited scope to refuse a request
from a member of the teaching staff to personally care for students if, by reason of their Job
Description Form, the request relates to a task that they are required to perform as part of their
normal duties.
24. For excursions involving an overnight stay(s) the following needs to be considered:
• single gender student groups have at least one supervisor of the same gender;
• mixed gender student groups have a mixed gender supervisory team unless all parents
have approved of alternatives during the consent seeking process;
• supervisory and accommodation arrangements, especially for sleeping and ablutions, are
such that supervisors are not placed in a position where there is potential for allegations of
improper conduct or where the propriety of their behaviour could be questioned; and
• supervisors understand they remain on call at all times, even when sleeping and having time
off to relax and that in the event of an emergency, all supervisors may be required to take
responsibility for students at short notice.

(5) IDENTIFICATION OF EXCURSION PARTICIPANTS

25. A suitable system of identification for excursion participants based on the assessment of the
environment, students’ skills, the type of activities to be undertaken and the number of students
needs to be established.

(6) COMMUNICATION STRATEGIES

26. A communication strategy that enables regular communication among all members of the
group may include public address systems, megaphones, air horns, whistles or, if necessary,
scheduling regular group meetings.
27. The communication strategy needs to clearly identify:
• a signal for gaining the full group’s attention;
• an emergency signal which is explained to all participants, and responses to it which have
been rehearsed prior to the commencement of the excursion; and
• an alternative mode of communication in case of the failure of the primary communication
method.
(7) BRIEFING STUDENTS AND SUPERVISORS

28. All relevant information about respective responsibilities and obligations needs to be clearly
communicated to students and supervisors including:
• emergency procedures and signals;
• methods of communication;
• appropriate use of any equipment;
• roles of supervisors;
• the system for identifying students and supervisors;
• areas demarcated specifically for identified student groups; and
• standards of acceptable behaviour;
29. Special information sessions need to be arranged for students who were absent from
preparatory excursion briefings.
30. Drugs that impair judgment and alcohol are both prohibited from consumption by supervisors
during an excursion.

(8) TRANSPORT ARRANGEMENTS

31. New laws for the restraint of children under the age of seven in vehicles introduced on
1 October 2010 apply to vehicles used to transport students on school excursions. For more
information, visit the Office of Road Safety website.
32. There is no law requiring children under seven years to use a child restraint or booster seat on
buses with more than 12 seats. However, schools should encourage children to wear any seat
belts that are available. If anchor points (for child restraints) or lap sash seat belts (for booster
seats) are available in the bus, the use of a restraint that is appropriate to the age and size of
the child should be encouraged, if it is feasible that they be used in the circumstances.
33. Licensed school bus drivers employed by the school are required to be Federal Police
screened every two years by the Department of Planning and Infrastructure.
34. School staff who drive vehicles with a seating capacity in excess of 12 persons need to have an
‘F’ extension on their licence.
35. All Department vehicles, including buses, shall only be driven by Department employees or
other authorised people engaged in school education programs. Parents or other people
licensed to drive a bus are not permitted to drive Department vehicles.
36. The use of private vehicles can only be authorised by the principal where there is no other
option. Vehicles used to transport students are required to have comprehensive motor vehicle
insurance cover and to be suitable for such use.
37. Transport by air is to be confined to recognised commercial operators.
38. Where parents/guardians have given approval for their child to make their own transport
arrangements to and/or from a venue, a member of the supervisory team needs to
acknowledge the arrival and approve the departure of the student from the venue.
39. If a student is required to leave an excursion prior to the scheduled time, a member of the
supervisory team needs to be satisfied that appropriate arrangements are in place for the
student to safely reach their destination.
40. If an accident occurs, the principal is required to submit a claim to RiskCover.
41. Further information on insurance is available by contacting the Department’s Head of Security
on (08) 9264 4825.

(9) VENUE/SITE FOR EXCURSION

42. Information on the suitability of the venue relative to the students’ skills and experience, the
planned activities and the supervision required may be sought from:
• personally visiting the venue or site;
• the local government authority environmental health or building services department;
• Department of Fire and Emergency Services or the local Police;
• the Department of Environment and Conservation or the local land manager (for natural
sites such as beaches or forests);
• the Regional Education Office closest to the venue(s);
• other schools that have visited the venue or site within the last six months;
• the external provider or tour organiser; or
• the Outdoor Education and Recreation Activities for Public Schools policy.

43. An evacuation plan and who manages an evacuation should be identified.

(10) EXTERNAL PROVIDERS

44. Where excursions involve the use of the services of external providers (including individuals,
government agencies or private companies), Department staff cannot sign indemnities,
disclaimers or other documents which absolve the external provider from liability for their own
negligent acts or omissions.
45. The suitability of an external provider may be determined from the verbal or written information
they provide related to:
• recent experience (including maintained log books);
• current qualifications, accreditation and any other relevant training; and
• public liability insurance (see below).
46. Where an external provider is engaged:
• the respective responsibilities of staff need to be clearly established with the manager of the
venue/external provider;
• any staff involved in activities with students need to have a current Working with Children
Check in accordance with the Department’s Working with Children Checks in Public Schools
policy;
• Volunteers assisting an external provider who are exempt from having a Working with
Children Check should be requested to complete a Confidential Declaration (see Appendix
H) indicating whether or not they have any convictions or whether there are circumstances
or reasons that might preclude them from working with or near children.

(11) INSURANCE COVER FOR EXCURSIONS

47. Refer to the Department’s Insurance and Claims Management Guide (Guide) that is accessible
from the Finance for Schools intranet site. It is recommended that you access it from the
intranet site to view the most up-to-date version of the guide. The Guide is intended for internal
Department use only.
48. The Department and schools are not permitted to obtain or broker travel insurance for students
or any other person. Schools should not provide guidance about suppliers or the types of
insurance products that could be sought.
49. For interstate excursions, parents/guardians are required to obtain travel insurance for their
child and complete the travel insurance section in the parent information and consent form
(Appendix F). Students who do not have insurance cover are not able to participate in the
excursion.
50. External providers should have sufficient and current public liability insurance to cover their
legal liability. The external provider should be requested to provide proof of their valid
insurance cover. The principal and authorised Department employee in charge of the
excursion should give consideration to the number of students going on excursion and whether
the insurance cover is enough to cover an incident that may occur resulting in multiple claims
by excursion attendees. The minimum level of public liability insurance requirement for cover
by external providers is $20 million.
51. Where necessary, external providers should also have sufficient and current professional
indemnity insurance to cover their legal liability. The external provider should be requested to
provide proof of their valid insurance cover. The principal and authorised Department
employee in charge of the excursion should give consideration to the number of students going
on excursion and whether the insurance cover is enough to cover an incident that may occur
resulting in multiple claims by excursions attendees. The minimum level of professional liability
insurance requirement for cover by external providers is $5 million.
52. If principals still have enquiries after reading the Insurance and Claims Management Guide,
they should contact Legal Services.

(12) STUDENTS WHO ARE BILLETED

53. When planning an excursion that involves students being billeted:

• Advise the parent in the host family of their responsibilities.
• Request the parent in the host family to complete an Undertaking to Provide a Billet (see
Appendix G), giving an assurance to provide a safe and secure home environment for each
billeted student.
 • Where students are billeted in a host family with adults, all adults in the household who have
a duty of care for the billeted student(s) need to have a valid Working with Children Check or
equivalent.
• Where students are billeted in a host family with adults who are not required to have a
Working with Children Check, those adults should be requested to complete a Confidential
Declaration (see Appendix H) indicating whether or not they have any convictions or
whether there are any circumstances or reasons that might preclude them from working with
or near children.
• The accommodation needs to include:
• a private bedroom or one shared with a student of the same gender;
• private bathing and toilet facilities; and
• any special requirements (e.g. avoidance of asthma triggers).
• The student should not be exposed to passive smoking.
• Confirm that a nominated member of the supervisory team:
- is contactable for the duration of the billet;
- contacts the student(s) regularly during the period of the billet; and
- has access to transport in order to visit the student(s) at short notice.
• It is recommended that the authorising principal make contact with the principal of a school
in the locality where the billeting is to occur and seek information regarding the suitability of
host families and the billeting arrangements.

(13) EMERGENCY RESPONSE PLANNING

54. During an excursion, a nominated supervisor should have ready access to:
• a list of the names of participating students and their parent contact telephone numbers;
• the Student Health Care Plans and Health Care Authorisations of those students who are
known to have health conditions that require support while in the care of the school; and
• relevant health information of supervisors;
55. For excursions involving an overnight stay(s), a copy of the planning documents, including all
Student Health Care Forms and Health Care Authorisations, need to be taken on the excursion,
with a further copy being provided to the principal.
56. For excursions undertaken during school vacations, students’ names, addresses (home and
away), contact telephone numbers and the itinerary for the excursion need to be provided to
the relevant Regional Education Office or principal of the independent public school.
57. The use of local first aid and emergency services should be investigated as part of an
emergency response plan.
58. First aid equipment needs to be available for the immediate treatment or care of a student or
supervisor who is injured or becomes ill during an excursion.
59. Many outdoor education and recreation activities require that a member of the supervisory
team hold a current first aid certificate, including a current cardiopulmonary resuscitation (CPR)
qualification (see the Outdoor Education and Recreation Activities for Public Schools policy).
60. Mobile telephones should not be relied on as the sole method of communication. In remote
locations, consideration should be given to other means of emergency communication such as
an Emergency Position Indicating Radio Beacon (EPIRB) or a satellite telephone.
61. A response plan needs to be developed that includes access to emergency support without
compromising the safety and welfare of the group or casualty.
62. Emergency procedures, including emergency signals, need to be clearly understood by all
students and supervisors.
63. All supervisors need to be familiar with evacuation procedures and, where appropriate, the
location of emergency equipment.
64. For excursions to rural locations, the emergency response plan needs to include:
• a map of the area(s) to be used, showing the location of the nearest telephone, ranger’s
residence, hospital, State Emergency Services office, nursing station or other similar
relevant information;
• access details (i.e. on-foot, 2WD and 4WD) including barriers;
• a list of the resources the group has with it (i.e. first aid kits, number of staff and external
providers with first aid qualifications, stretchers, number and type of vehicles and other
camping equipment);
• an estimate of the time it might take to raise an alarm and the amount of time that might
elapse before appropriate support could be provided; and/or
• the communication medium used (i.e. fixed telephone, mobile telephone, satellite telephone,
radio, EPIRB).
(14) DETAILED COST OF EXCURSION

65. Excursions should be properly costed so that participants are appropriately charged.
66. Refer to the Pricing worksheets for Excursions and Camps available from the Finance website
at www.det.wa.edu.au/education/finance/ (see the alphabetical listing under ‘Tools’).

(15) INFORMATION TO PARENTS FOR THEIR CONSENT

67. Parents need to be provided with full details of the excursion well in advance of the date to
enable them to make an informed decision about their child’s participation (see Appendix E).
This information should include full details of:
• the purpose of the excursion;
• date(s);
• activities to be undertaken;
• duration of activity(ies);
• location of activity(ies) (including alternative venues);
• student contact arrangements during the excursion;
• transport arrangements;
• cost;
• supervision to be provided (number of supervisors and number of students);
• staff action in case of student accident or illness on the excursion;
• liability for loss or damage to student property and medical costs incurred in case of
accident or illness; and
• special clothing or other items required.
68. The use of interpreter and translator services may be required to provide parents of culturally
and linguistically diverse students necessary information regarding the excursion.
69. Students participating in an excursion should only engage in activities for which parental
approval has been gained.
 List of Students attending the excursion.
(Note – The Deputy ‘signing off’ on this excursion needs to photocopy this list and give it
to the Front office ladies when giving the excursion package to the Principal.)

Excursion Title: Manning Gorge Outdoor Education Expedition

Excursion date/dates/times: 24/5/21 – 26/5/21 6am-2pm

Staff coordinating excursion: Hayden Harris and Allee Proud

Other staff attending: Derek Ringrose

11 - Tia-Rae Charles-Skinner Maybe (attendance and assessments)

11 - Kyle Egan Might be leaving DDHS
11 - Mathew Joseph
11 - Cornelius Lennard
11 - Ryland Martin Maybe (attendance and assessments)
11 - Jalen Sampi Maybe (attendance and assessments)
11 - Alfie Sebastian Maybe (attendance and assessments)
11 - Keil-Jamarl Taylor
11 - Nikoda Thomas
11 - Tyzeal Williams-Wilson
12 - Morgan Hammond
12 - Tuqiri Niki Maybe (attendance and assessments)
12 - Aleerah Ozies
12 - Mundulla Rose Maybe (attendance and assessments)
12 - Odin Thomas
12 - Robert Williams-Wilson
12 - Farren Wilson Maybe (attendance and assessments)
12 - David Rennardson Maybe (attendance and assessments)
 Student specific information
Students Requiring Medications during the Excursion
Please itemise all medication requirements during the camp / excursion in the table below
Student Medication Name & Dosage Time Staff Responsible
Taken
Ventolin Only Hayden Harris
Ventolin when
necessary
ADHD – 10mg Ritlin
Hayden Harris

Student Allergies / Health Conditions / Dietary Requirements

Please outline any conditions applicable
Student Details of Action Plan
condition
GENERIC ASTHMA PLAN
Asthma When experiencing symptoms like wheezing,
coughing or shortness of breath:
Asthma • Use Ventolin – 6 puffs via spacer

Asthma emergency (severe breathing problems,

symptoms get worse very quickly, reliever has
little or no effect):
• Call an ambulance immediately
• Say that this is an asthma emergency
• Keep taking reliever as often as needed
 PARENT INFORMATION AND CONSENT
FOR SCHOOL EXCURSION
This letter is to be retained by the parent/guardian providing consent

Dear Parent/Guardian,

I am pleased to provide you with the following information regarding an off-site excursion.
This information is provided to assist you in giving consent for your child’s involvement.

Excursion title Manning Gorge Outdoor Education Expedition

Purpose of the excursion To assess students’ practical and performance skills in an outdoor
setting. This excursion is linked to assessment Task 4, 5 & 6 of Unit 1
(year 11), Task 1, 4 & 5 of Unit 3 (year 12) and Outcome 1, 2, 3 & 4 of
the Outdoor Education course
Date(s) 24/05/2021 – 26/05/2021

Activities to be undertaken Hiking, orienteering, fishing, swimming, journals and campsite activities
such as cooking on trangias, setting up tents, etc.
Departure day/time Monday 7:00am

Return day/time Wednesday 12:30pm

Location/Venue Galvan’s Gorge, Mt Barnet Roadhouse, Manning Falls, Manning Gorge

Camping at Manning Gorge Campsite
Student contact arrangements Call DDHS on 9193 3000 where they will be able to transfer to you to one
during the excursion of the teachers with the satellite phone.

Transport arrangements 2x RSAS Troop Carriers and 1x School Pajero

Cost to student NA

Expected numbers of students Approximately 14

participating
Staff member in charge of the Hayden Harris
excursion
Supervisory staff Allee Proud, Hayden Harris, Derek Ringrose

Additional supervisors Bayden Lee and Peter Brooking (RSAS)

Relevant qualifications held by one
or more of the supervisory team
In case of student accident/illness
Liability for loss or damage to
student property and medical costs
incurred in case of accident or
illness
Special clothing or other items
required
Bronze Medallion – Hayden Harris, Derek Ringrose & Allee Proud
Signing the consent form gives permission for son/daughter to receive
medical treatment in case of emergency.
The school and its employees are not responsible for personal injuries or
property damage which may occur on an excursion. (Students bring
personal property at their own risk)
In cases of excursions, costs incurred as a result of accident or illness is
the responsibility of the parent/guardian.
Hat, swimwear, sunglasses, school uniform, walking/hiking shoes,
toiletries, water bottle, jumper

Additional Information
To be eligible for this expedition, students are required to have attended
at least 50% of Outdoor Education lessons this year to be appropriately
informed and prepared for the trip. Students must also be up to date with
all assessments and must have completed their expedition planners at a
satisfactory level.

Staff Member in Charge: Hayden Harris ___ Principal: Mr Eliot Money

 Overnight excursions advice

Student accommodation:

Venue:
Manning Gorge Campsite
Phone number: 9191 7007 (Mount Barnett Roadhouse)

Students will be accommodated as detailed below.

• 3 students per tent
• Boys and girls split up into different tents and opposite sides of camp.
• All tent are located on the same campsite at Manning Gorge.
• Supervisors will be centrally in their own tents (in the middle of the boys / girls).

Excursion Title: Manning Gorge Outdoor Education Expedition

Day/Date: Monday 24th May 2021 – Wednesday 26th May 2021

EXCURSION ITINERARY
This itinerary is to be retained by the parent/guardian providing consent
Excursion Structure & Itinerary
ITINERARY
Day / Date / Activity Notes
Time
Monday 24/5/21 Highlighted = to be
6:00am Students to arrive at Derby District High School assessed on
(DDHS) at the Follow the Dream gate.
Students will prepare for camp and assist in packing
the vehicles.

7:00am Depart DDHS.

11:00am Arrive at Galvan’s Gorge. Students will hike 1km to Outdoor Education
the waterfall and on arrive will sit down as a group Activities include:
for recess. While students eat, staff will provide a - Orienteering
briefing prior to entering the water. Student will now /mapping
have approximately 3 hours to swim and enjoy the - Swimming
gorge. Staff will locate the ancient rock art and will - Bushwalking
inform students of any flora and fauna to look out - Environmental
for. awareness
- Environmental
2:00pm Travel from Galvan’s Gorge to Mount Barnett management
Roadhouse. At the roadhouse students will have an
opportunity to go to the toilet and buy anything they
may need.
 3:00pm The group will arrive at Manning Gorge Campsite. - Setting up a
Student will now set up their tents (in designated tent.
areas) and unpack any gear they will need while here. - Picking an
Once tents are set up and approved by a teacher appropriate
students can have free time to kick a footy, explore
the campsite or to relax.

4.30pm Journal writing. Students will have 30 minutes to fill - Expedition

out their expedition journal for day 1. This is an Journal
opportunity for students to reflect on the day and to
ask any questions.

5:00pm Students to prepare / cook dinner on trangias. - Camp cooking

7:00pm Night games / activities. - Leadership

Students will have the opportunity to prepare and run
any games of activities they know.

8:00pm Showers / prepare for bed.

8:30pm Debrief and information for tomorrow. The entire

group to be sitting around the fire debriefing the
day’s activities and discussing tomorrow’s activities.

9:00pm Bed time.

Tuesday 24/5/21
6:30am Wake up. Cook / prepare breakfast. Pack day bag in - Bushwalking
preparation for the day’s activities (hiking to (prep)
Manning Falls). Leave camp by 9am.

9:00am Start the hike to Manning Falls. Arrive by 10:30am. - Bushwalking

- Orienteering
10:30am On arrival to Manning Falls, staff will provide a
briefing while students eat their recess.

11:00am Students can now swim in their designated area. Staff

will organise games.

12:30pm Lunch at Manning Falls.

2:00pm Depart Manning Falls. Hike back to camp to drop

bags and equipment off.

3:30pm Students have an hour to swim at Manning Creek. - Optional

Fishing
4.30pm Students to depart Manning Creek and when back at
camp are to complete day 2 of their journals. - Journals

5:00pm Students to prepare / cook dinner on trangias.

 7:00pm Night games / activities.
Students will have the opportunity to prepare and run
any games of activities they know.

8:00pm Showers / prepare for bed.

8:30pm Debrief and information for tomorrow. The entire

group to be sitting around the fire debriefing the
day’s activities and discussing tomorrow’s activities.

9:00pm Bed time.

Wednesday
26/5/21
6:30am Wake up. Cook / prepare breakfast. Pack up all
school and personal gear. Leave tents out do dry in
the sun.

8.30am Staff to inspect campsites.

9:00am Tents should be dry. Students to pack up tents.

Finalise packing vehicles.

9:30am Depart Manning Gorge Campgrounds to DDHS.

1:00pm Arrive at DDHS. Eat lunch if have not already. Pack

up Outdoor Education gear and clean vehicles.

2:00pm Home time.

PARENT CONSENT FOR SCHOOL EXCURSION

This consent form is to be returned to the school

I have read and understood the information regarding the excursion.

I consent to my child ________________________________ participating in the excursion

titled below.

Return this signed

Hayden Harris or Allee Proud
consent to

Excursion title Manning Gorge Outdoor Education Expedition

Date(s) 24th-26th May 2021

Student Health Care

Please review, amend and sign the Summary Medical Details attached to this consent
form. Please return it with this consent form by the date stated above.

Supervisors will refer to the Student Health Care Summary held at the school prior to the
excursion. If your son/daughter has any special health needs that are not included in the
health care information that you have previously provided to the school, please outline these
additional health risks below (details provided will be used to update student health
records). If you are unsure about the Health records currently held by the school, please
provide all medical information below or contact the School’s Administration for a copy of
the record held at the school.

Parent/Guardian Name ______________________________________________________

Parent/Guardian Signature__________________________ Date: / / 2021

 Water based or swimming activities advice
The excursion will involve the following water based or swimming activities:
- Galvan’s Gorge Waterfall (swimming)
- Manning Creek (swimming)
- Manning Falls (swimming)

Water based or swimming activities response

Please indicate your child’s swimming ability:

Department of Education swimming stage achieved: □

Date achieved: ______________

I am unsure - please assess my child: □

Swimming ability:
Stage 1 Beginner Stage 7 Intermediate
Stage 2 Water Discovery Stage 8 Water Wise
Stage 3 Preliminary Stage 9 Senior
Stage 4 Water Awareness Stage 10 Junior Swim and Survive*
Stage 5 Water Sense Stage 11 Swim and Survive*
Stage 6 Junior Stage 12 Senior Swim and Survive*

*Stages 10 to 12 are Royal Life Saving Society of Australia awards. Stage 10 focuses on safety and survival abilities including
clothed survival and personal fitness for survival and extends the student’s range of swimming skills. Stages 11 and 12 involve
further development of survival and swimming skills and endurance. Stage 12 provides a foundation for rescue awards.

I give permission for my son/daughter to participate in the water based or swimming activities.

___________________________ ___________________________
Parent/guardian name Parent/guardian signature

I give permission for my son/daughter to receive medical treatment in case of emergency.

I am aware that the school and its employees are not responsible for personal injuries or
property damage which may occur on an excursion, unless the school or its employees are
proven to be negligent.

In cases of excursions, costs incurred as a result of accident or illness is the responsibility of

the parent/guardian.

___________________________ ___________________________

Parent/guardian name Parent/guardian signature

_________________
Date

Form to be returned to Hayden Harris or Allee Proud by 17th May

 Appendices

Please print only those pages relevant or required by your

excursion.
APPENDIX A:

EMERGENCY ACTION PLAN

The Principal must be advised immediately on 0427 429 334 should any incidences occur on this excursion.
Protocols to
minimise risk Student medical information and parent contact details are carried with the teacher in charge/group leaders at all
times and accessible by other supervisors.

At the excursion venue/s, students will be given clear boundaries and expectations that will not exceed their ability.

Emergency signal – three short whistle blasts – all to leave the venue and proceed to the meeting place.

Fire exits, evacuation procedures, emergency signal and a meeting place will be identified at each venue.

Important contact numbers

Principal – Eliot Money – 0427 429 334

Associate Principal – Hilary Carruthers – 0427 931 203

Location of excursion Galvan’s Gorge, Mt Barnett Roadhouse, Manning Gorge

Camp, Manning Falls
Location / Map
Information
Detailed map of the activity area To be attached

Accessibility to vehicles e.g. Emergency, bus, cars, Pajero = emergency vehicle

etc.

Primary location if an emergency arises Evacuation area of Manning Gorge Campsite

Nearest first aid point e.g. Hospital (distance) KUPUNGARRI CLINIC Distance: 7km
Derby Hospital 313km

Teacher in Charge Hayden Harris 0478980590

Telephone
Contact Other supervisors contact details Allee Proud 0432 275 300

Details Derek Ringrose 0401 299 011

School Front Office 9193 3000

Principal (Eliot)
A/H school contact (Mohamed) 0409 130 976

Emergency contacts 000 for fire or life threatening emergencies

132 500 for SES emergency assistance

Nearest Hospital(s) (telephone and distance) Derby Hospital - 9193 3333 - 313km

Continued on the next page

 Location of vehicle first aid kit, e.g. behind driver
First Aid
Equipment
Location of portable first aid kit (this pack to be
carried at all times along with student medical
details).
Additional medical items being taken to cater for
students health needs i.e.: Ventolin
Location of toilets
Other supplies being taken on the excursion/camp
i.e.: water, sunscreen
Depending upon the nature of the emergency the following actions will take place:
Course of Examples of risk mitigation:
Action in
• All students to be in school uniform
Emergency
• Students to remain in groups with a staff member
• All staff to carry a mobile phone
• All staff to carry medical information and contact details of all students
Severe – possible spinal injury, severe concussion or
head trauma
Moderate – snake bite, mild concussion, fracture,
heat stroke, major asthma attack
Minor – heat exhaustion, strained ankle, minor
asthma
Vehicle accident
First Aid Kit always with Hayden, Allee or Derek. Behind
driver seats in vehicles.
First Aid Kit always with Hayden, Allee or Derek. Hayden to
carry student medical information.
Ventolin
Manning Gorge Campsite Toilet Block
Water bottles, sunscreen, hats
Ambulance (000) / SES (132500) and DDHS (9193 3000)
contacted.
Contact Principal
Any venue staff to be notified.
Unaffected students to be grouped together and moved to
a safe area or returned to transport.
All students will congregate back to the bus and will travel
to the nearest Hospital if required. NMSHS and parents
contacted.
Contact Principal (
First aid to be administered dependent upon the injury.
Student rests in bus/shelter area and returns with rest of
class as normal
First aid administered as required.
DDHS principal and parents contacted if required.
Severity will dictate what action is needed
Students to be removed to a safe location away from the
accident.
Vehicle owner, DDHS Principal () and relevant emergency
services to be contacted.
If required, the next location on the itinerary to be
contacted and informed of the delay. Excursion may be
cancelled if the delay will risk students returning to school
by advertised return time.
 Vehicle breakdown 1. Students to remain in the vehicle if safe to do so.
2. If unsafe, vehicle to be secured and students to be
removed to a safe location away from the vehicle
and are to remain together as a group.
3. DDHS and relevant emergency services (if required)
to be notified of the incident details.
a) DDHS 9193 3000
b) Principal
4. Winun Ngari to supply another bus or mechanic to
fix the problem.
5. Next location on the itinerary to be contacted (if
required) and informed of the delay. Excursion may
be cancelled if the delay will risk students returning
to school by advertised return time.

STUDENT BREACHING RULES If a student breaches major rules, or puts someone in

danger – including using substances (drugs, cigarettes),
leaving the group, acting in an unsafe manner etc. Mr
Ringrose will be informed, he will phone admin to discuss
the issue. One staff member will take the student back to
school/town as soon as possible. Parents/guardians will be
contacted on return to Derby and a meeting will be
arranged.

MISSING STUDENTS: If a student is found to be missing from the group, one to

two staff members will search for the missing student/s in
the immediate area whilst staying in phone contact with
Mr Ringrose, who will stay with the rest of the group. The
appropriate emergency group such as police, school, or
parent/caregiver will then be contacted if the student is
not found within a 30 minute timeframe. The remaining
students will be supervised at all times. If a student
becomes ill appropriate action will be determined by the
teacher in charge. Parent/Caregiver will be contacted
depending on the seriousness. If a student requires the
toilet they will always notify the teacher in charge when
they go and when they have returned. The remaining
students will stay in the immediate area until they have
returned with a staff member

Emergency Response Plan

In the case of an emergency staff will;
1. Call the relevant Emergency Provider
2. Contact the relevant Deputy
3. Notify Parents / Caregivers
4. Have an appropriate staff member remain with the student (if applicable)
5. Ensure remaining staff stay with rest of group and return to school (if applicable)

Telephone numbers and addresses of nearest facilities.

Hospital: Telephone: 9191 4747 (Kupungarri Clinic) / 9193 3333 (Derby Hospital)
Ambulance: Telephone: 000
Police Station: Telephone: 9115 2500 (Note: 131444 will connect to the nearest Police Station.)

Emergency assembly points in case of evacuation or separation have been identified. Please see attached map(s).
Student(s) Absconding;
In the event that student(s) abscond from the excursion activity:
1. The teacher in Charge (TIC) must be notified immediately

2. The TIC is to ensure an appropriate staff member is shadowing / actively trying to locate the
missing student(s)

3. If the student(s) cannot be located / successfully returned to the group within 30 minutes or
there is concern for student safety / welfare, the TIC and School Admin are to be informed
immediately. The TIC is also to inform the parents / caregivers

4. All available staff to visit places the student may be located and their peers interviewed as to
their likely whereabouts

5. If the student cannot be located by School staff within 1 hour: Police are to be notified.

Route DDHS to all locations:

1. Route of hike for Galvan’s Gorge:

2. Route of hike Manning Campground to Manning Falls:
Designated Areas:

2. Manning Falls:

Swim
Equipment here
and meeting
spot
Exit

2. Manning Gorge Campground:

Camp
here

Toilet /
shower Camp
site
Owner
Exit

1. Galvan’s Gorge:

Equipment
and meeting Exit
spot

Swim
here
APPENDIX C:
EMERGENCY ACTION PLAN
3. Mount Barnett Roadhouse: 1. Galvan’s Gorge:

All emergencies (front of roadhouse) 1 = Fire – enter water at the gorge

2 = All other emergencies – make way back
to vehicles

2. Manning Gorge Campground: 2. Manning Gorge Falls:

1. Fire
Evacuation

1. Fire
2. Evacuation
Evacuation
assembly
point

2.
Evacuation
Point

2.
Evacuation 1. Fire
1. Fire Evacuation
Point
Evacuation

1. Fire – go to evacuation point 2. If

1. Fire evacuation (in the water)
2. All other evacuations – evacuation
Muster point near camp showers
too dangerous enter water
immediately.
2. All other evacuations – evacuation
point 2 (rocks next to the water fall).
Designated Areas:

2. Manning Falls:

Swim
Equipment here
and meeting
spot
Exit

2. Manning Gorge Campground:

Camp
here

Toilet /
shower Camp
site
Owner
Exit

2. Galvan’s Gorge:

Equipment
and meeting Exit
spot

Swim
here
APPENDIX B:

First Aid / Water Qualification of Staff attending.

APPENDIX B:

Staff Relief Request Advice for Excursion

The Approved form must be given to the Deputy no later than 5 days prior to the Event
If the relief is required for more than one day, a separate form must be provided for each day

Day DATE Salary Cost Code for TR

Mon- Wed 24/ 05 / 21 –
❑ Professional
26/05/21 ❑ ½ Day ❑ Full Day ❑ Excursion Learning
❑ Other

Description of Event or Reason why Relief is Required (if not Excursion or PL)

Name of Participating Staff Member Additional Information (e.g., you have an Upper School Withdrawal)
Periods and Duty requiring coverage, please  the cells
F 1 2 R 3 4 L 5 B
Hayden Harris Monday X x x x x x
Tuesday X x x x
Wednesday x x x x x x x x
Allee Proud Monday x x x x x x
Tuesday x x x x
Wednesday x x x x x x
APPENDIX C:

Costing your Excursion

You need to complete a current the Department’s Pricing Worksheet. The image on this page is an example only
so you know what to expect. The Pricing Worksheet should be accessed via the Portal to ensure that you are
using the appropriate costs for 2016. Here is a link

http://det.wa.edu.au/finance/detcms/finance-and-administration/finance-for-schools/binary-files/p---s/pricing-
worksheet-camps-and-excursions-v51-july--2013.en
APPENDIX D:

Parents/Guardians/Staff from other school attending camps and excursions

Expectations of persons attending camps and/or excursions
If persons are required for an overnight camp it is expected that they sit an interview with
the Principal and/or Deputy and the staff member in charge of the camp.

If these persons are on a day excursion it is expected that they return the following list of camp
expectations signed.

As a camp supervisor I understand that:

✓ To the best of my knowledge, I am fit and healthy.

✓ I have provided a Working With Children (overnight camp) or completed a confidential declaration for
day camps/excursions (except if I am a parent of a child at the school for a day excursion).

✓ I may need to manage a potential risk on camp.

✓ My role includes that I monitor the physical well-being of students and notify the staff member in
charge of any concerns.

✓ I may be required to render emergency care until a supervising staff member is in attendance.

✓ As a supervisor I am required to be on duty for the whole duration of the excursion 24hrs/7.

✓ I cannot take my children on the excursion unless my children are in the class on the excursion.

✓ I cannot smoke or drink (alcohol) while on school based excursions.

✓ Drugs that impair judgement (including prescription medication) cannot be used while I am on the
camp/excursion.

✓ I may be required to take responsibility for students at short notice.

✓ I must use the common communication system – set up by the staff member in charge.

✓ If driving a bus or vehicle I must have an F class license and that permission to drive students in any
vehicle must have prior approval by the Principal.

Signed:

_____________________ ______________________ ___________________________

Parent/Guardian Teacher in Charge Principal

Date: ________________ Date: _________________ Date: ______________________