ࡱ>  bjbj gg_)6 D\\\L\5 "888.AU 4444444$#8:x4]48852"""884"4""1|N38ki5R2z4C5<5d2Q;2Q;$N3Q;N3,a>,"$aaa44%"vaaa5Q;aaaaaaaaa X : SIMON FRASER UNIVERSITY DIVING SAFETY PROGRAM DIVING PROJECT DESCRIPTION, APPROVAL & RENEWAL FORM Please fill out the information requested below as completely as possible. Circle relevant categories and add details where necessary. Questions concerning diving operations and project approval should be directed to the Diving Safety Officer, Dr Isabelle Ct (SSB8151; 51tel: x23705; cell: 778-836-6222). IMPORTANT! In case of serious incidents (e.g., diving incident that causes death, injury or decompression sickness requiring treatment), please contact the DSO and notify Campus Security by calling the 51emergency line 778.782.4500 immediately. EHS will notify WorkSafeBCand assist with the university's response. In addition, all incidents also need to be reported to 51within 24 hours using this link: HYPERLINK "/srs/contact/report/report-incident.html" \o "/srs/contact/report/report-incident.html" \t "_blank"/srs/contact/report/report-incident.html 1A. Project director (= Principal investigator) Department/office number: Position: Email: Telephone: Cell: Office: In the field: 1B. Diver-in-charge (if different from 1A) Department/office number: Position: Email: Telephone: Cell: Office: In the field: Diver-in-charge experience: A diver in charge is required to have >50 logged dives in the specific task/environment and is approved to act as a Diver-In-Charge by the DSO. & CAUS 1 or & CAUS 2 Recreational certificate: Number of scientific dives: Number of recreational dives: Please describe why the diver-in-charge is qualified for this project: 2. Project information 2A. Project title 2B. Project duration Start date: End date (maximum 1 year): 2C. Project description Please include a short introduction, hypotheses/questions addressed, and detailed methods to be used, particularly as they relate to diving. Use as much space as needed. Discipline: Zoology Botany Chemistry Geology Oceanography Other Funding: Unfunded University Grant Donation Other If funded, specify funding source : 3. General diving information Circle or bold all options that apply and provide requested information. Expand spaces as needed Objective(s): Observation and Recording Surveying Coring Photography Collection and Sampling Installation and Maintenance Training Other (specify): Mode: SCUBA (air) SCUBA (other) Snorkel Special modes & equipment (specify; see Appendix): Will the project involve: & Dives deeper than 60ft/18m? How many? & Repetitive dives? How many? & Will the Repetitive Factor return to 1.0 before the start of the next diving day? & Dives in confined spaces? How many? & Dives in overhead environments? How many? & Dives at altitude? How many? & Altitude corrections: & Diving equipment and scientific tools? Specify: & Thermal protection/exposure suit? Specify: Dive sites Give country, site names and coordinates; indicate access (i.e. shore or boat) for each site Anticipated total number of dives: Maximum depth (m): Anticipated number of dives at: 0 10 m11 20 m21 30 m31 40 m Special environmental conditions (list all applicable conditions from Appendix 1 attached) Dive team Provide the name of each diver, his/her home institution, role in the project and level of qualification (e.g. CAUS Level 1) and (for non-CAUS/AAUS divers) experience (e.g. PADI Rescue diver + 60 research dives); identify the diver-in-charge with an asterisk. Add rows as needed. Divers DiverAffiliationRoleQualification/experience Surface support Provide the name of each additional supporting crew member, his/her home institution, role in the project and any applicable certifications. Add rows as needed. Crew memberAffiliationRoleCertifications/experience 4. Dive plan A. Provide a general description of the diving schedule (e.g., number of dives per day, days per week, number of weeks/months of study, dry day frequency, maximum workday length) and other dive details (e.g., maximum depth, training provided/needed, bounce diving, use of equipment such as lift bags). B. Give anticipated dive profiles and residual nitrogen status for days across the study period using the DCIEM tables. Propose the most aggressive potential dive plan. Follow the example below; please expand the table as needed Example dive profiles Dive detailsDive #1Dive #2Max depth30m30mLeave surface9:3015:50Reach bottom9:3215:52Leave bottom9:4516:03Reach surface9:5016:08Actual bottom time15(min)13(min)Total decompression5(min)5(min)Total dive time20(min)18(min)Repetitive factor (in)1.01.1Effective bottom time15(min)14.3(min)Dive schedule30m/15(min)30m/15(min)Repetitive group (out)DESurface interval6:00>18:00 5. Risk assessment and safety protocols 5A. Risk assessment, mitigation and contingency grid List hazards in the first column under the relevant category, then use the risk matrix to determine the risk rating of the identified hazard based on its probability of occurrence and impact if it were to occur. Explain how risk will be mitigated and contingency plans if needed.Using the risk matrix once more, show how the risk rating is impacted by the mitigation measures implemented. Colour code the Risk Ratings in the Mitigation table as applicable. Risk rating post-mitigation should be below HIGH depending on the nature of the hazard and the implemented mitigation measures. This risk assessment should cover all fieldwork risks and not be limited to diving risks. Examples of include: weather, oceanographic conditions, uneven or moving surfaces, and physical injuries such as hypothermia (physical); viruses, contact with hazardous wildlife (biological); the presence of chemicals or allergens on board (chemical); traffic, diver errors, improper gear storage (human-made). Be specific and inclusive. Expand the table as needed. HazardPre-mitigationMitigation and contingency (How will you be mitigating the identified risks)Post mitigationRisk impactRisk Probability Risk RatingRisk impactRisk Probability Risk RatingPhysical       ChemicalBiological      Human-made Risk impactRisk probabilityHighly unlikelyUnlikelyPossibleLikelyHighly likelyNegligibleLOWLOWLOWMEDIUMMEDIUMMinorLOWLOWMEDIUMMEDIUMMEDIUMModerateMEDIUMMEDIUMMEDIUMMEDIUMHIGHMajorMEDIUMMEDIUMMEDIUMHIGHHIGHSevereMEDIUMHIGHHIGHHIGHHIGHRisk matrix: Use the following Risk Matrix to determine the Risk Rating (Low, Medium, High) for each hazard pre- and post-mitigation. 5B. Safety protocols Provide details for: Diver recall method Step-by-step diving accident procedure Communication chain in case of accident (with tel/channel numbers) Evacuation protocol, with details of accessible/hyperbaric facilities (with tel numbers, evacuation modes, activation and travel times) Boat information and emergency equipment on board Incident reporting protocol Key emergency contact information (DAN, DSO, PI) Emergency contact and insurance information of team members (use table below; add rows as needed) Diver/crew memberEmergency contact name and numberRelationshipDAN insurance # 6. I understand that all diving conducted under University auspices must comply with the University Diving Regulations. I understand further that all personnel involved in the diving operations described herein must be registered with SFUs Diving & EMPU Safety Committee. PI Signature: Date: For DSO use Initial submission date: Approved Not approved Comments: Signed: Date: (Diving Safety Officer; on behalf of Chair of Diving & EMPU Safety Committee) ________________________________________________________________ Renewal An approved diving project may be renewed for one additional year without review when the diving activities undertaken to not deviate from those described in the original submission. Changes in personnel and other minor changes that do not increase risk can be made by completing the Amendment to a Diving Project form in Appendix 2. I confirm that the current diving project complies with the conditions for renewal. PI Signature: Date: Appendix 1 - Special diving modes and equipment Umbilical diving Rebreathing apparatus (closed and semi-closed circuit) Mixed gas diving (includes use of oxygen) Bells (open and closed) Saturation diving Habitats Chamber diving Submersible vehicles (includes atmospheric diving systems) Diver lock-out vehicles Compressors Power tools Explosives Electrical equipment Special environmental conditions Diving under ice Altitude diving Deep diving (deeper than 40 m/130 feet) Decompression diving Diving in zero visibility Diving in contaminated water Night diving Diving in caves, shipwrecks, pipes, tunnels or other enclosed spaces Blue-water diving (no bottom) Diving in strong currents Appendix 2 Amendment to an approved diving protocol Please use this form for minor amendments to approved diving protocols. Minor amendments do not alter in a detrimental way the diving profiles, residual nitrogen status of divers or anticipated hazards and risks of the project. Examples include changes in personnel, methods or dive location, etc. Please submit electronically completed amendment forms, signed and dated, to the dso. 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8#6OJQJ]^Jh1\6OJQJ]^J-----..0.C.M.]........../////$/5/^/t////000 090:0;0<0=0>0t0u0v0w000ƶƨ&hJ=hJ=5CJOJQJ\^JaJ)hJ=hJ=5:CJOJQJ\^JaJhJ=5:OJQJ\aJhJ=hJ=5OJQJ\^JhJ=OJQJ^Jh}hh 5OJQJ^Jh 5OJQJ^Jh OJQJ^Jh}hh OJQJ^J/....///$/5/^/t////0 0:0;0<0=0t0u0v011 $dNgdkgdJ= & Fgd gd  & Fgd 011111 -4>GJfijksFSnop͹mm\m hk6CJOJQJ]^JaJ&hkhJ=6CJOJQJ]^JaJ&hkhk5CJOJQJ\^JaJ hk5CJOJQJ\^JaJ hkhJ=CJOJQJ^JaJU&hkhJ=5CJOJQJ\^JaJhTlhJ=:OJQJ^JaJ#hJ=hJ=:CJOJQJ^JaJ hJ=hJ=CJOJQJ^JaJ$: PROTOCOL NO.: PROTOCOL TITLE: AMENDMENT(S) REQUESTED AND JUSTIFICATION(S) SECTION(S) OF PROTOCOL AFFECTED Please give amended wording for each section affected. For new personnel, please give affiliation, role in dive team, qualification and experience, emergency contact and number, relationship, and DAN insurance number. DO THE AMENDMENTS CHANGE: THE PROFILES OF THE DIVES? RESIDUAL NITROGEN STATUS OF DIVERS? HAZARDS AND RISKS? For any Yes answer, please explain how safe diving will be maintained. PI name: PI signature: Date: DSO name: DSO signature: Date:      PAGE \* MERGEFORMAT 2 v. 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