Risk Assessment Form – for Standard Risk Travel

Risk Assessment No

for office use

Contact details

Name *

Email address *

crsid *

Telephone number *

College

(if applicable)

Contact number whilst away *

Email address whilst away *

Pharmacology contact whilst you are away *

(person aware of your itinerary/contact details)

Emergency contact details *

(Next of Kin) Please note that your emergency contact may be called or emailed if you stop responding to contact or fail to respond in an overseas emergency.

Local contact *

Name and position, Contact number (include local area code), Email address, and Language spoken

Travel itinerary

Travel start date *

Day

Month

Year

Travel end date *

Day

Month

Year

Location of working away *

(town and country)

Address *

(whilst working away)

Type of working away *

Please describe, e.g. lab work

Detailed description of proposed activities including sites you will work across *

(if there are multiple)

Lone working *

Supervised *

Foreign and Commonwealth Office Travel advice rating

Please indicate below the FCO rating for the area that you will be staying and working in.

If FCO advice in place then give details *

No specific rating given *

Date checked *

Day

Month

Year

You can sign up to FCO travel alerts by following the link below; select your destination and subscribe to the email alerts for the country you propose to visit: https://www.gov.uk/foreign-travel-advice

By signing here *

Please sign and date...

I agree that I will subscribe to and monitor Foreign and Commonwealth Office travel alerts for my proposed destination. If these change I will arrange a review of the assessment with my UK Supervisor and/or return to the UK as soon as possible if advised to do so.

Personal vulnerabilities, Local Laws and Customs

Please sign here *

Insurance

In order to ensure that your work away is fully authorised you MUST purchase travel insurance if leaving the UK (and not visiting your home country). Please agree that you will buy insurance if applicable and include details of policy.

Policy details *

Check-in details/Emergency contact points

Arrange a suitable frequency and method check-in with your Supervisor or other designated person within the University for the duration of the trip.

Check-in Person *

(primary and alternative)

Check-in frequency *

Contact details *

Means of communication *

Hazard Table

The table below has been pre-filled with examples of hazards that may be present during your proposed working away – you MUST amend, remove or add hazards as appropriate. Control measures should be specific to you and the work you are proposing to carry out.

Guidance document for section 7 of the standard risk travel form can be obtain here

Hazards details:Hazard: Specific factors in the environment which may cause you harm - Hazard Description and Personal Vulnerabilities: If known: include frequency of when the threat may occur, for example when travelling, visiting a remote region, during religious festival, in a crowded space, etc. - Control Measures/actions to reduce risk levels: Include action that may be taken to reduce risks as far as possible/practical.

Crime *

Accident – Travel and Personal *

Authorities *

Environment *

Health *

The above are only examples to assist you. You must continue to add hazards to the fields as necessary.
The above are only examples to assist you. You must continue to add hazards to the above fiels as necessary.

Person working away:

I am signing to indicate that I have read and will abide by the statements above and will carry out additional risk assessments where necessary

Completed by *

Please enter your name, sign, and date

I am signing to indicate that this constitutes a suitable and sufficient assessment of the level of risk identified.

Departmental Safety Officer *

Please Include the Host Questionnaire

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Risk Assessment Form – for Standard Risk Travel

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School of Biological Sciences

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