ࡱ>  bjbjyy 0Z 6)6)6)6)6)J)J)J)8)D)J)7$*****+++&7(7(7(7(7(7(7$9}<fL76)+++++L76)6)**Ha7,,,+R6)*6)*&7,+&7,,623*0D,R~37w7073@<,.<833<6)v4,+++L7L7,+++7++++<+++++++++ ': HS009Fieldwork Participant FormRefer to HS917 Fieldwork Procedure for further information. This form is intended for use in capturing participant details for emergency contacts, medical conditions which may affect participation and relevant qualifications which are needed for particular activities. This form should be forwarded to a nominated UNSW person (Fieldwork Leader) and taken by the participant into the field. *Participant details*denotes mandatory fieldName:Relationship with UNSWZID:Email Address:Address:Phone H/M: *Next of kin or preferred emergency contactName:Relationship to ParticipantAddress:Email Address:Phone 91˰涶:Phone Mobile: Supervisor (if known)Name:Phone:WorkAfter Hours List Your Relevant Licences, Qualifications, Training  *MedicalDo you have any preexisting medical conditions, are taking any medication or have allergies that will require the establishment of a first aid response plan?YesNoAre you suitably fit to undertake the tasks required during the fieldwork?YesNoPlease list here or at least indicate a need to discuss any conditions which might affect your ability to undertake the tasks or the need for a first aid response plan with the fieldwork leader. *Participant DeclarationI acknowledge that I have a duty to: (a) take reasonable care for my own health and safety, and (b) take reasonable care that my acts or omissions do not adversely affect the health and safety of other persons, and (c) comply, so far as I am reasonably able, with any reasonable instruction that is given by the fieldwork staff, and (d) co-operate with any reasonable policy or procedure of the University that has been notified to me. The information provided on this form is correct to the best of my knowledge. I have provided the fieldwork leader with any relevant medical information and where necessary completed a first aid response plan. I acknowledge that UNSW is within its right to terminate my participation in a fieldwork activity and may institute academic misconduct proceedings in circumstances where I wilfully fail to work in a safe manner or fail in my above duties. 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