FROST letterhead

FROST Site Visit Risk Assumption Form


 

Program/Class Information

Participant Information

Acknowledgements

In consideration for participation in the program or class listed above, including the use of facilities, equipment, grounds, and/or personnel, the Participant understands, acknowledges, agrees, represents and warrants that

  • I am an adult over the age of 18 and have read and understand this entire form.
  • I am personally responsible for any loss injury or damage that I cause during the program/class.
  • I am responsible for my own medical expenses and insurance.
  • I agree to abide by all policies, ordinances, and guidelines of Northern Michigan University during the program/class. These are located at www.nmu.edu/policies.
  • I understand that participation may require me to travel in a personal vehicle or rented vehicle.
  • Participation may require special skills. I will reduce the risk of injury by limiting participation to reflect my own personal fitness or comfort level, and not ingesting or using any substance prior to or during the activity which could pose a hazard to myself or others.
  •  I understand that I have the right to discuss any concerns with my instructor and ultimately the instructor’s department-head. I have the choice to refrain from participation in any activity that makes me uncomfortable or which I consider an undue risk. Refer to the class syllabus for how participation is reflected in the class grading system.
  • This program/class is voluntary and I may choose to end my participation in the class at any time by contacting the Registrar’s office. Withdrawal may be indicated on my transcript and the standard NMU refund schedule applies. Withdrawal must occur before the 10th week of classes to be eligible for a “W” grade.
  •  I understand that even if this program/class is required for graduation, I have the right to request alternate procedures or activities. In most cases, alternate procedures or activities can be developed to meet graduation requirements.
  • Participation may require me to use specialized equipment, the misuse of which can cause serious injury or even loss of life. I agree to use the equipment only for the purpose intended. I understand that misuse of the equipment or failure to follow training instructions can result in my removal from the class, expulsion from the university, and/or criminal charges. Equipment: Required of all persons who visit the FROST facility: Personal protective equipment (PPE)--gloves, face mask, shoe covers
  • I attest that I have no health, medication, or physical restrictions that preclude me from using special equipment or participating in the program/class – or – I believe that I have health, medication, or physical restrictions that would preclude or limit the following activities:
  • Finally, I attest that I have read the Instructor’s Safety Expectations included at the bottom of this form and agree to adhere to these expectations.

Release of Liability

¶ 1. Knowing the risks and expectations, I want to participate in the program/class. I have the basic skills, physical ability, and training needed to safely participate in the program/class. I have honestly disclosed any known health or physical restrictions that could affect my safety or the safety of others in the program/class.  I accept the risks and I assume responsibility for my participation.

¶ 2. Knowing that this program/class participation entails various risks, and in consideration for being permitted to participate, I release NMU from any and all costs, claims, and liability which may arise in connection with my program/class participation, except insofar as such costs, claims, and losses are caused by intentional misconduct or gross negligence on NMU’s part. 

Signature

To sign this form, re-enter your full name, and enter today's date. After submission you will receive an email at the address entered on this form requesting confirmation. Your submission is not complete until we receive that confirmation. 

 

Re-enter your full name
Enter today's date

These are critical safety practices and expectations for this program/class: 

  • Always have 2 people out at FROST (no one is permitted in the field without a "buddy”)
  • Use universal precautions at all times. Assume everything in the FROST field is biohazardous and "dirty." Do not pick up anything that is dropped in the field without using a glove.
  • Wear long pants: shorts and skirts are not appropriate or permitted in the facility.
  • Long sleeves are recommended, but not required.
  • Wear closed-toe shoes without holes: sandals and other shoes that expose the feet are not permitted in the facility. A limited supply of field boots is available at FROST.
  • Wear recommended PPE: nitrile gloves (2 layers), face mask, shoe covers or field boots.
  • If PPE is dirty because you touch ANYTHING in the FROST field, ensure that dirty PPE is removed immediately and replaced with clean PPE. Dispose of soiled PPE in appropriate receptacle.
  • Dress appropriately for the weather: rain gear if raining; sunscreen if sunny; coat, gloves, hat if cold.
  • Be mindful of uneven terrain; no running in the FROST facility.
  • No food or drink, including gum, in the FROST facility.
  • If you need a drink of water or a snack to raise blood sugar, you must leave the field and enter the clean building to consume food and/or drink (unless the situation is an emergency and food/drink must be brought to someone in the field who is in immediate need of assistance).
  • Be mindful of metal hazards: potential sharps leftover from data collection, irrigation pipes, old barrels, old fencing, old barbed wire, metal cages.
  • There may be wildlife in the field; do not interact with wildlife. 
  • If a non-emergency incident occurs, call the Center for Forensic Science director at 906-458-5868; If an emergency incident occurs, call 9-1-1. Tell dispatcher that the closest address is 1990 US 41 S., Marquette, and instruct responders to drive up the hill and back toward the highway.
  • Mental Health safety: you cannot "un-ring" a bell, meaning once something is experienced it cannot be un-experienced. Be mindful of your mental status and excuse yourself from participation if you are adversely affected by the FROST experience. For counseling services, contact NMU Counseling and Consultation Services at (906) 227-2980 or CCS@nmu.edu. 

In addition to the above specific expectations, NMU also expects that you will act in a manner that will not put yourself or anyone else at risk of physical or emotional harm.