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Risk Management Questionnaire

Thank you in advance for completing this important Risk Management Questionnaire for your student organization. It is important that your organization complete this form for the safety of both your organization and your organization’s members. If you need any assistance completing this form, please do not hesitate to contact Student Activities at activities@lclark.edu.

1) Student organizations with a high probability of exposure to risk are requested to report to Student Activities what training they have organized for themselves and how they manage exposure to risk as an organization. These training sessions are to be facilitated by external coaches, faculty/staff advisors, or on peer basis. Some organizations only conduct off-campus activities with third parties who are bonded, insured, and licensed (these organizations must provide Student Activities with the contact information for these third parties).

2) Student organization with the high probability of exposure to risk are required to have all members complete and sign L&C’s Acknowledgement and Assumption of Risks and Agreements of Release and Indemnity Form (aka the Liability Waiver Form). All completed forms are to be submitted to Student Activities in Templeton 258.
a) Please have all of your organization’s members complete and sign this form.
b) Forms only need to be completed and signed for participation in an organization, not
for each activity.
c) If your organizations’ members are members of multiple organizations, they must
complete a form for each organization.
d) Please collect all of the forms from your members and submit them all at once.
e) All forms must be submitted to Student Activities in Templeton 258.

3) In the following form, please respond as thoroughly as possible. If there is an item that does not pertain to your organization, please put N/A as a response.

All fields marked with asterisk (*) are required.

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Student Organization name*

Please enter the name of your student organization.

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Risk Management training sessions*

Please enter the risk management training sessions that your organization has, who facilitates them, and how often they occur. If your organization works with a third party, please list their name and contact information.

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Location(s) of your organization's practices, competitions, activities, etc.*

Please list where your organization holds its activities both on-campus and off-campus.

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Qualifications for someone to serve as advisor or coach*

List the qualifications that your organization requires for somene to serve as your organization's advisor or coach and what training they've had.

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Steps taken to ensure a safe environment for your organization*

List the steps taken by your organization prior to any of its activities to enure that everything takes place in a safe environment.

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List any potential unique risk exposures*

Please list any potential unique risks assocated with you organization (e.g. bee stings, burns, etc.) and how your organization manages them.

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List type of medical supervision*

List the type of medical supervision organization plans to maintaion for practices, competitions, activities, etc.

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First Aid Kit*

Please list an inventory of everything in your organization's first aid kit (including any specialized items); name of who is responsible for maintaining the first aid kit, and who is responsible ensuring that the kit is present at all practices, competions, activities, etc.

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Emergency Action Plan*

Please explain how your organization will address a participant's injury, who your organization will address and travel emergencies, and how your organization will address any severe weather emergencies.

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Name of person submitting this form*

Please indicate the name of who is submitting this information.

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Electronic Signature*

Please check this box to certify your responses.

I certify that I am submitting this information to the best of my knowledge and understand that I will be contacted by Student Activities to review this submission.

Link (required)