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					DURHAM UNIVERSITY Academic Office SECTION 3 APPENDIX (A3.11) INDIVIDUAL FIELDWORK / MISCELLANEOUS TRAVEL AUTHORISATION FOR STUDENTS

UNIVERSITY OF DURHAM INDIVIDUAL FIELDWORK / MISCELLANEOUS TRAVEL AUTHORISATION FOR STUDENTS This form should be used to authorise travel for any purposes relevant to a student’s programme of study other than placements. It therefore includes fieldwork and conference travel. It should be used for students at all levels (undergraduate, taught postgraduate and research). University insurance cover cannot be provided unless authorisation has been given using this form. Department, Degree Programme and Module as applicable: Locations to be Visited (country and region etc): Dates of Travel: If you are starting travel to your placement from outside the UK please give details below as this requires special insurance clearance: (a) country from which the trip will start …………… (b) details of any manual work involved ………………………………………………………………………………………………… …………………………………………………………………………………. Purpose of Journey: Name of Student travelling: Level of Risk as per Control Risks Website (www.crg-online.com) Low/Medium/High/Extreme (If Medium Risk or above please print off the information from the Website and attach to this form) Have the Foreign Office advised against travel? (www.fco.gov.uk) Risk Assessment: You need to complete a Fieldwork Risk Assessment which you can find at http://www.dur.ac.uk/healthandsafety/F1-Fieldwork3.htm Please attach a copy of the completed Fieldwork Risk Assessment form. Where travel is to a country where the risk of travel is showing as Medium or above please also attach details of the measures taken to identify and reduce the risks in this particular area: Fieldwork Risk Assessment Attached Area Risk Assessment Attached YES/NO YES/NO YES/NO

Active Monitoring: If you are travelling to a high risk area and do not feel able to rely upon local support to protect your safety, Active Monitoring can be set up which will involve you phoning Control Risks on a daily basis at a pre-agreed time. If you fail to make contact Control Risks will escalate the situation to locate you. Would you be interested in setting up Active Monitoring? YES/NO Personal Activities: The University travel insurance cover can be extended to include 7 days cover for personal leisure time subject to the dates being specified below along with the details of the activities to be undertaken in these 7 days: Date from ………………. to ………………………(inclusive) Activities to be undertaken: .................................................................................................................................................... .................................................................................................... Please note that the University travel insurance cover will only cover personal leisure time for the dates mentioned above and the activities mentioned above and only where cover is confirmed by the Insurance Officer. Please note that any dangerous or hazardous activities* are excluded. For any other personal leisure time or activities, you will need to arrange separate travel insurance which must also include your personal effects for the extra period. *Hazardous activities and sports are defined as deliberate exposure to needless danger (except in an attempt to save human life), parasailing, parascending, white water rafting, abseiling, skiing off-piste, tobogganing, gliding, hot air ballooning, parachuting, rock climbing, hang gliding, potholing and caving and scuba diving. Please note that students must take all reasonable care to avoid and prevent Bodily Injury and Sickness which includes the use of all safety equipment and protective head wear when undertaking any sports. Furthermore, any claim for Bodily Injury and Sickness which arises directly or indirectly from or in connection with the use of intoxicating liquor or drugs, solvent abuse or alcoholism is not covered. Student Declaration: I understand and accept the risks associated with this trip. I understand the insurance situation and the need to take out separate insurance for personal leisure time and activities not specified above or for which cover has not been confirmed by the Insurance Officer. I further understand that it is my responsibility to take reasonable care of my own health and safety and of the health and safety of others for the duration of this trip. Student’s Signature Date Signature Position Signature Position …………………………………………………………… ………………………………… …………………………………………. ………………………………………… Date…………………… ………………………………………….. …………………………………………. Date…………………….

Authorisation by Supervisor (PhD students only)

Authorisation by Head of Department

Authorisation by Insurance Officer, Procurement Office, University Office Personal Leisure Activities cover: ………………………………………………………………………………………………… …………………………………………………………………………………………………. Cover for trip: ………………………………………………………………………………………………… ………………………………………………………………………………………………… Signature ………………………………………….. Date…………………… IMPORTANT NOTES Please note that travel which has not been fully authorised as above is NOT covered by the University travel insurance arrangements. This form must be submitted to the Insurance Officer in the Procurement Office at least 3 weeks before travel to enable insurance cover to be confirmed. Where travel is intended to a Medium Risk area or above or where the Foreign Office have advised against travel, please contact the Insurance Officer before booking travel as the insurers may not cover this. Any student who fails his/her exams and is asked to withdraw from the University is no longer a registered student and all university insurance cover ceases. If you are in this position you must not travel to a placement or other activity which was planned in the expectation of passing your exams. If you are waiting for the result of a resit exam or an appeal you must not travel to a placement or similar activity until and unless you have the result of that resit or appeal and the outcome allows you to continue as a registered student.


				
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