To be completed, in advance of the activity trip, by teacher responsible for the activity.


___  Is the location of the activity trip indoors or outdoors? (I or O)


___  Are special clothing needs such as shoes, jackets, or gloves required?


___  Does the trip location include exposure to insect or animal bites, falling rocks, puncture wounds from plants, or eye irritation from dust or other airborne particles?


___  Does the trip require climbing above or below the ground floor?  If so, are walkways well marked, do they include hand or guardrails, and are they maintained in good condition?


___  Have extraordinary exposures been included on the activity Trip Permission Form to provide for an informed consent from parent or guardian?


___  Are first aid services available at the trip location in the event of an injury or illness?


___  Are food and water available at the trip location?  If not, will students bring their own food and water?  Are facilities available to safely store food and water?


___   Has the travel route been planned in advance?


___  Will transportation make stops traveling to or from the trip location?  If so, have stops been planned to maintain student control and safety?


___   Is adequate parking available for safe vehicle loading, unloading, parking, and turn around?


___  Does the learning experience involve direct contact with plants or animals?  If so, have students been questioned about potential allergic reaction?


___   Is prior evidence of liability insurance protection required by the trip location owner to allow use of the facility or property?


___   If trip includes residence at a camp facility, does the camp owner require proof of student accident insurance?


___  If the trip includes a wilderness program, have special arrangements been made for emergency or medical evacuation?