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Work Smart, Play Well!

Duke Recreation and Physical Education

Crisis Management Manual

Risk Management Committee:

Mike Forbes, Jeremy Fritz, Janis Hampton, Matt Holdren,

Mike Howard, Nathan McKinnis, Meghan Weiseman, Steven McCune, Lisa Wright

Edited By Steven McCune

1

Contents Bylaws of Risk Management Committee ............................................................................................................... 3

Meeting Procedures ................................................................................................................................................ 4

Definitions............................................................................................................................................................... 5

Emergency Action Plans ......................................................................................................................................... 7

Upon Entering the Scene of an Emergency ............................................................................................................ 8

Crisis Scenarios ....................................................................................................................................................... 9

Allergic reaction.................................................................................................................................................. 9

Chemical Injury .................................................................................................................................................. 9

Cold-related emergency ...................................................................................................................................... 9

Electrocution ....................................................................................................................................................... 9

Fire ...................................................................................................................................................................... 9

Heart Attack and Stroke ...................................................................................................................................... 9

Heat-related emergency .................................................................................................................................... 10

Power Outage .................................................................................................................................................... 10

Seizure............................................................................................................................................................... 10

Tornado ............................................................................................................................................................. 10

Violent Crime.................................................................................................................................................... 10

First Aid Kit Protocol and Content ....................................................................................................................... 11

Emergency Evacuation Information ..................................................................................................................... 12

Emergency Exits for Wilson Recreation Center ............................................................................................... 12

Emergency Exits for Brodie Recreation Center................................................................................................ 13

Emergency Response Equipment Location by Facility ........................................................................................ 14

Wilson Recreational Center .............................................................................................................................. 14

Taishoff Aquatics Center .................................................................................................................................. 17

Card Gym .......................................................................................................................................................... 18

Card Gym Basketball Court/Team Store Area ................................................................................................. 18

IM Building ....................................................................................................................................................... 19

Brodie Recreation Center .................................................................................................................................. 19

Employee Information .......................................................................................................................................... 22

Workers’ Rights and Responsibilities ............................................................................................................... 22

Worker’s Compensation ................................................................................................................................... 22

Returning to Work from a Work-Related Injury/Illness ................................................................................... 23

........................................................................................................................................................................... 24

OSHA-Occupational Safety and Hazard Association ....................................................................................... 24

Waivers/Participation Agreements & Frequently Asked Questions ..................................................................... 25

Exercise Facility Guest Waiver and Release .................................................................................................... 26

2

Climbing Waiver and Participation Agreement ................................................................................................ 27

Climbing Wall Helmet Release ........................................................................................................................ 29

Aquatics Waiver and Participation Agreement ................................................................................................. 30

Recreation Photo/Video Consent Form ............................................................................................................ 31

Recreation & Physical Education ..................................................................................................................... 31

Photo/Video Consent ........................................................................................................................................ 31

Intramurals Waiver and Participation Agreement ............................................................................................ 32

Travel Request Form......................................................................................................................................... 33

Incident Report Form & Frequently Asked Questions ......................................................................................... 34

Duke Recreation and Physical Education - Incident Report Form ................................................................... 35

Draft Annex Posted for Future Committee Discussion ........................................................................................ 37

Budget Line, Annual Review ............................................................................................................................ 37

GL Code Creation ............................................................................................................................................. 37

Communication Logging .................................................................................................................................. 37

Projected Annual Expenses ............................................................................................................................... 37

Guest Speakers and Training ............................................................................................................................ 37

Safe Room ......................................................................................................................................................... 37

Appendix of Facility Maps ................................................................................................................................... 38

Index ..................................................................................................................................................................... 47

3

Bylaws of Risk Management Committee

Whereas, this manual provides logistical plans and resources to better help first responders deal with incidents

and emergencies as they may arise.

Whereas, the safety of patrons and employees is the absolute intent of this plan.

Whereas, the body of knowledge contained within is not complete, and this manual requires an ongoing update

based on new ideas and experiences of those who are charged to oversee it.

Therefore, be it resolved that the committee members appointed each term are responsible for the evolution and

innovation of this living document.

Be it further resolved, the following sections outline the expectations, action plans and appendices to guide the

department to a safer environment for those students and members who chose our programs and facilities for

recreation and education.

4

Meeting Procedures

The risk management committee shall be comprised of a representative from each program/facility area and

shall be headed by a risk management chair.

The risk management chair shall work with each committee member to equally delegate all tasks associated

with the responsibilities of the team.

A secretary/scribe should record all meeting minutes and share the minutes to each member following the

meeting.

The risk committee shall meet every month on a day and time that is most convenient for all team members.

The last meeting before each semester, the committee shall submit and update any changes to the risk manual.

Change is not mandatory but evolution is encouraged to demonstrate the living nature of this document.

Amendments to this document shall include the amendment date in parenthesis at the end of the paragraph

being amended. i.e. (Amended 9/12/12).

Any amendments to the manual shall then be disseminated to the entire staff at a time selected by the risk

management committee. General amendments will be delivered to the staff before all staff trainings which

typically take place at the beginning of the fall and spring academic semesters. Amendments deemed critical in

mitigating risk can be made effective immediately and at the discretion of the risk management committee.

It is the ethical responsibility of all risk managers, no matter the severity, to report and mitigate risk as soon as

the risk is discovered.

5

Definitions ABC’s of CPR- Airway, Breathing, Circulation

Automatic External Defibrillator (AED)- a portable defibrillator designed to be automated such that it can be

used by persons without substantial medical training who are responding to a cardiac emergency.

Cardio Pulmonary Resuscitation (CPR)- emergency procedure for reviving heart and lung function, involving

special physical techniques and often the use of electrical and mechanical equipment

Confidentiality- carried out or revealed in the expectation that anything done or revealed will be kept private

Crisis Management Manual- a systems approach written plan which is used to foresee and mitigate risk and

liability. This plan also provides detailed directions for action in emergencies and incidents which may take

place in the facility and surrounding space.

Duty to Act- each and every professional has the duty to act within the parameters of his/her own training.

Documentation- documents provided or collected together as evidence or as reference material. It is a record of

all aspects of injury/incident. “Who, what, when, where, why and how”. Proper documentation is important in

a court of law.

Emergency Action Plan (EAP)- The purpose of an EAP is to facilitate and organize employer and employee

actions during workplace emergencies

Emergency Medical Service (EMS)- a network of services coordinated to provide aid and medical assistance

from primary response to definitive care, involving personnel trained in the rescue, stabilization, transportation,

and advanced treatment of traumatic or medical emergencies.

Foreseeability- reasonable anticipation of the possible results of an action, such as what may happen if one is

negligent or consequential damages resulting a from breach of a contract

Incident- any event or occurrence both having to do with non-injury and injury and/or death or that is likely to

cause serious problems.

Liability- legal responsibility for something, especially costs or damages

Mitigate- to reduce the harmful effects of something

Occupational Safety and Hazard Association (OSHA)- an organization that provides standards for employers to

maintain a workplace free of hazards.

Personal Protective Equipment (PPE)- barriers used to protect against bloodborne pathogen transmission

Programmatic Hazard- those risks associated at the training level of staff development of improper training

that can lead to accident, injury or death due to negligence.

Negligence- a civil wrong tort causing injury or harm to another person or to property as the result of doing

something or failing to provide a proper or reasonable level of care

Risk- a probability that may cause accident, injury, death or financial damages to a person or facility.

6

Risk management- the reduction of those probabilities that may cause injury, death or financial damages

through an active search and mitigation of those foreseen hazards.

Standard of Care- industry and regulatory commissions provide specific guidelines which are to followed to

ensure a quality and safe environment for participants. Each recreation professional has an obligation to hold

the recreation department to these standards at all times.

7

Emergency Action Plans

Recreation Staff members ~Lay Responders~ are not required to provide care in emergency.

In the event of ANY emergency employees should:

1. Recognize if someone needs immediate help

2. Activate the EAP for the given emergency

a. Call EMS in the event of injury or life-threatening emergency

3. Follow general procedures for emergencies on land

Land Emergencies

Size up the scene, approach victim

Obtain consent from victim

Provide emergency care as needed

o Follow steps for initial assessment

o Summon EMS, if needed

o Perform secondary assessment

4. Red Cross Certified staff may assist members in the emergency throughout the facility

a. Assist with rescue

b. Provide secondary care

c. Clear the facility

d. Retrieve medical equipment

e. Call EMS

5. The chain of command is notified

a. Notify supervisor/facility manager

b. In the case of serious injury/death, notify appropriate managers

c. The supervisor will contact the victim’s family

6. Interview all witnesses

a. As soon as possible ask questions

b. Conduct interview privately and document them in writing

7. Document incidents by completing appropriate reports

a. Responding staff fills out incident report form.

b. All other staff involved must also document the form

8. Check all equipment for damage, restock medical supply kit

a. Clean up any potentially infectious fluids using bodily fluid cleanup kit

b. Use appropriate disinfectant such as bleach (found on pool deck).

c. Wash hands thoroughly before returning to work

9. Complete post-incident evaluation

a. Perform an after action review on what was good/bad

b. Plan better for next time

c. Repair or close any dangerous areas

d. Use experience to better the team

10. Follow-up staff discussion

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a. Crisis counseling opportunities should be communicated to staff responder to address Critical

Incident Stress

Upon Entering the Scene of an Emergency Size up the scene

A. Check for hazards that could present danger to you and victim

B. Determine what caused injury

C. Determine the number of victims- prioritize care

D. Determine if additional help is needed.

E. Put on personal protective equipment

Begin primary assessment

A. Obtain consent if victim is conscious

B. Summon Emergency Medical Service

Perform secondary assessment to determine any other life threating illness

A. Provide care for conditions found

B. Complete incident report form, advise victim and if possible, release the victim.

9

Crisis Scenarios

Allergic reaction

1. Activate the EAP

2. Help victim administer Epi pen if on hand

3. Make the victim comfortable in a seated position

4. Monitor the victims ABC’s

Chemical Injury

1. Determine if the scene is safe

2. Perform initial assessment & Summon EMS

3. Perform secondary assessment

4. BRUSH dry chemical off of skin

5. Flush skin and eyes with water for at least 20 minutes or until help arrives

6. If ingested call 911 and seek treatment steps.

Cold-related emergency

1. Gently move the victim to warm place

2. Monitor the ABC’s

3. Give rescue breathing if needed

4. Remove wet clothing

5. Warm victim with blankets, foil blanket.

6. NO CAFFEINE

7. Use hot-water bottles wrapped in cloth

Electrocution

1. Determine if the scene is safe

2. Perform initial assessment & Summon EMS

3. Perform secondary assessment

4. Treat any burns or injuries

5. Monitor ABC’s until help arrives

Fire

1. Direct patrons to exit through the appropriate exit points and report to sidewalk in front of Tennis

Courts (West) and other side of parking lot (East)

2. Wait for the all-clear.

Heart Attack and Stroke

1. Upon sizing up the scene call 911 and order the AED

2. Begin initial assessment

a. If victim is alert, have them relax

b. In case of stroke, Act FAST: Face, Arm, Speech, Time

c. If victim becomes unconscious begin the process of CPR.

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i. Attach AED when available

ii. Continue treatment until help arrives

Heat-related emergency

1. Move victim to cool place

2. Loosen tight clothing

3. Remove perspiration-soaked clothing

4. Apply cool, wet towels to skin

5. Fan the victim

6. Small amounts of cool water

7. If heat stroke is suspected, rapid cooling with cold water emersion

8. Treat for shock- never raise the legs

Power Outage

1. Emergency lights will activate

2. Wait for instruction from Building Supervisor

Seizure

1. Summon EMS if seizure is not typical of victim,

2. Last more than 5 minutes or in water, or multiple episodes

3. Do not attempt to touch the victim

4. Move objects which may hurt the victim

5. Treat for shock, monitor the victims ABC’s until help arrives

Tornado

1. Campus emergency siren will sound. Emergency system text message, sent.

2. Quickly direct all patrons to the nearest locker room.

3. Have patrons duck and cover with their head against the wall.

4. Ensure that a proper head count is done of all members and employees.

5. Treat any injuries as needed.

6. Wait for the all clear.

3.

Violent Crime

1. Summon Duke EMS/Police Immediately

2. If possible, move members away from the area.

3. Keep clear of the violence.

4. Allow EMS/Police to respond accordingly.

DO NOT ATTEMPT TO CONTROL THE ASSAILANT

11

First Aid Kit Protocol and Content

The following content will be provided in all medical kits throughout Duke Recreation and Physical

Education Facilities. Program specific medical supplies may also be supplemented in addition to the

supplies listed below. For refilling kits, contact Zee Medical.

Ice bags will be available at the front desk of the Wilson Center, front desk of the Brodie Center, and in the

First Aid Lockers located on the turf fields on East, West, and Central Campus.

Zee Medical- Soft Side Med Kit- $116.87

1-Tape, Plastic, 2" x 5 yd, 3-Cut spool - 1 ea

1- Eye Wash, Sterile, 4-oz. - 1 ea

1- Eye & Skin Buffered Flushing Sol., 8-oz.

1 box- Bndg, Non-Latex Sheer Strip, Xlg, 25

1 box- Bndg, Non-Latex Dura-Strip, 1", 100

1- Compress, Multi-Trauma Sterile, 10"x30"

2- Dressing, Sterile, 5" x 9"

1- Bandage, Elastic , 3" x 5 yds

1 box- Gauze Pads, 4" x 4". 10/bx

2- Elastic Roller Gauze NS, 3" x 4.5 yd

1- Emergency First Aid Guide

1- Ice Pack, Deluxe, Small

1- Bandage, Triangular 40" NS, 1/unit

1- 3-1 Antibiotic Ointment, 6/unit

1- Clean Wipes, Alcohol Swabs, 10/unit

1- Water-Jel, Burn-Jel, 6/unit

1- Eye Pads w/Adh. Strips, 2/unit

1- Nitrile Gloves, 2 pr/bg

1- PAM II (Protective Airway Mask)

1- Bndg, Kerlix, Sterile 4-1/2" x 4-1/2 yds

1- Scissors, Emergency

1- Soft-Side First Aid Kit Bag, Empty

1- QR Wound Seal, Single Pack

12

Emergency Evacuation Information

Emergency Exits for Wilson Recreation Center

There will be four primary exits used during a situation requiring emergency evacuation of the Wilson

Recreation center. (See Map in Appendix)

The front/main entrance (Exit 4)

The exit from the basketball courts towards the front of the building (Exit 3)

The exit next to the climbing wall (Exit 2)

The exit from the swimming offices (Exit 1)

Recreation and Physical Education employees will be our designated representatives for each exit point.

The life guards will sweep the pool and direct people to the exit by swimming offices (Exit 1).

Facility Monitor sweeps both locker rooms and lower floor, up one floor on the middle stair case,

and then out Exit 2 (by climbing wall)

Facility Monitor then performs a sweep of the climbing wall floor, including classrooms, and

sends patrons out Exit 2 (by climbing wall)

Weight room attendant sweeps weight room and restrooms down the hall to the right and up the

spiral stairs out Exit 3 (from basketball courts)

Weight Room attendant sweeps basketball court out Exit 3

Weight Room attendant directs patrons on the track to move down the spiral staircase and out

Exit 3 (from basketball courts)

Weight Room monitor will direct people in weight room up to Exit 3. This person will also

sweep basketball courts and track, directing patrons out Exit 3 (from basketball courts).

Guest Services Attendant sweeps offices and aerobics studios out Exit 4 (front entrance) and

waits to direct emergency services.

Rally point for all members, guests and staff is located at the bike rack by Tennis Court

Point person designee will be present at Rally Location with FCC radio

13

Emergency Exits for Brodie Recreation Center

There will be three primary exits used during a situation requiring emergency evacuation of the Brodie

Recreation Center. (See Map in Appendix)

The main building entrance/exit

The side exit off of the upper basketball court

The side exit directly across from the locker rooms in the pool area

Rally location is in front of Blackwell Residence Hall

Point person designee will be present at Rally Location with FCC radio

Recreation and Physical Education employees will be our designated representatives for each exit point.

The lifeguards will sweep the pool area directing patrons to the exit opposite of the locker rooms

in the pool area.

Lifeguards will bring the radio with them to Rally Location.

If pool is closed, no one is allowed in the natatorium.

Employees should bring radio to exit points.

The guest services staff member will sweep the following:

o weight room

o multipurpose room

o racquetball courts

o first floor restrooms

o first floor basketball courts

o hallway leading to the locker rooms

o the men’s and women’s locker room

o mind and body studio

o the office suite o Staff member will direct all patrons to the main exit and inform members of Rally Location

The facility monitor on duty will sweep the:

o upper level, consisting of:

stairway leading upstairs

cardio areas

classroom

upper basketball court consisting of the track above

Staff member will direct all patrons out the building’s side exit off of the

upper basketball court.

14

Emergency Response Equipment Location by Facility

Wilson Recreational Center

First Floor Alarm (1)

Fire Extinguisher (1)

Corridor Outside of Elevator

-Exit to outside (alarm exit) – exit leads to loading area at back of Wilson (“Bat Cave”)

- Fire Extinguisher

Second Floor Alarms (3)

Fire Extinguishers (3)

Emergency Exits (3)

Stair Exits (1)

Emergency Phone (3)

AEDs (1)

Spin Class Area -Alarm (1) in Spin Room area (wall closest to stairs where curtain is)

Corridor adjacent to Spin Class -Exit to Stairs (1) (non-alarm)

-Alarm (1) near elevator and stair exit

-Fire Extinguisher (1) on wall closest to Spin Room

Combative Room, Racquetball Courts, Pool Entrance Section, TRX Section, Back Corridor

-Emergency Phone (1) on wall between Combative Room and Racquetball Courts

-AED (1) in Combative Room (door locked)…*First Aid Kit?

-Fire Extinguishers (2)

*One at Pool Entrance – left wall

*One at Back Corridor where exit is

-Emergency Exit (1) (alarm exit) at Back Corridor – Exit leads to stairs outside at back of Wilson.

-Alarm (1) in Back Corridor at Exit

Men’s Locker Room -Emergency Phone (1) on wall upon entering

-Emergency Exit (1) (alarm exit) back corner – leads to above back corridor and outside stairs

*There is no sign stating that alarm will go off for this exit

-(2) Exits from Locker Room to Pool Area

Women’s Locker Room

-Emergency Phone (1) on wall upon entering

-Emergency Exit (1) (alarm exit) back corner – leads to above back corridor near spin room and elevator

-(2) Exits from Locker Room to Pool Area

15

Third Floor

Alarms (9)

Fire Extinguishers (5)

Emergency Exits (5)

Stair Exits (3)

Emergency Phone (1) *did not include monitors desk in weight room

AEDs (1)

First Aid Kits (2)

Back Corridor closest to Climbing Wall -Emergency Exits (2) (alarm exits) – exits lead to back of Wilson

-Alarms (2) at exits

-Fire Extinguisher (1)

Climbing Wall -First Aid Kit (1) at desk

Treadmill, Elliptical, Classrooms etc. Area -Emergency Phone (1) on wall nearest classroom 20

-Fire Extinguishers (2)

*One left wall near pool entrance

*One right wall in back treadmill area where TV is located

-Alarm (1) at left exit to stairwell

-Exit to Stairs (1) at left side in back treadmill area

-Emergency Exit (1) (alarmed exit) at right side back treadmill area – exit leads to Pool Lobby Room

Lobby area prior to Weight Room, Corridor where Bathrooms are adjacent to Weight Room and Wheelchair

Ramp Corridor -AED (1) on wall close to classroom 18

-Alarms (3)

*One on pillar when walking towards Weight Room

*One at Stairs Exit (nearest wheelchair ramp)

*One at Hallway Exit (bathroom corridor) leading to spiral stairwell

-Stair Exits (2)

*One near wheelchair ramp

*One down hallway adjacent to weight room (leads up to an emergency exit in Basketball Courts)

-Fire Extinguishers (2)

*One in hallway next to lockers and coat hangers (hallway adjacent to weight room)

*One in corridor where spiral stairs are (corridor connected to hallway adjacent to weight room)

Weight Room -Emergency Exits (2) (alarm exits) – lead to grass hill at back of Wilson

-Alarms (3)

*One at Emergency Exit right

*One at Emergency Exit left

*One at Main Entrance (right wall when facing stairs)

-First Aid Kit (1) at Monitors Desk

-Phone (1) at Monitors Desk

*No AED at Monitors Desk

16

Fourth Floor Alarms (8)

Fire Extinguishers (9)

Emergency Exits (5) *did not include main exit and behind monitors desk

Stair Exits (1) *did not include spiral stairs in basketball court area

Emergency Phone (1) *did not include monitors desk at main entrance

AEDs (1)

First Aid Kits (1)

Main Entrance -Main Exit

*Can exit behind monitor’s desk (not an entrance)

-Alarm (1) near exit doors in lobby

-AED (1) at monitor’s desk

-First Aid Kit (1) at monitor’s desk

-Phone (1) at monitor’s desk

Corridor/Hallway with Offices, Quenchers, etc. -Fire Extinguishers (2)

*One near Lisa Wright’s Office

*One at back exit where Offices are (room 104)

-Emergency Exit (1) (alarm exit) near Offices (room 104) – exit leads to front of Wilson where main entrance is located

-Alarm (1) at back emergency exit near Offices (room 104)

Multipurpose Room A – 110 -Fire Extinguisher (1)

Multipurpose Room B – 125B -Fire Extinguisher (1)

Hallway leading to Basketball Courts/Middle Stairs -Emergency Phone (1) next to TV and cork boards, close to Multipurpose Room B – 125B

-Fire Extinguisher (1) on wall next to Emergency Phone

Lobby Area outside of Basketball Courts -Stairs Exit (1) near elevator

-Alarm (1) on wall next to elevator and stairs exit

Basketball Courts -Fire Extinguishers (4)

*One at main entrance

*One at back wall on right court (outside court)

*One at back wall on left court (outside court)

*One at Emergency Exits near spiral stairs

-Alarms (5)

*One at main entrance

*One at Emergency Exit right side (back of courts)

*One at Emergency Exit left side (back of courts)

* Two at Emergency Exits near spiral stairs

-Emergency Exits (4)

*Two at back of courts left and right side – lead to side of Wilson, with stairs, where IM Building is located

*Two near spiral stairs – lead to front of Wilson, lawn area closest/near Tennis Center

-Automatic Closing Fire Door at Emergency Exit near spiral stairs.

17

Fifth Floor Alarms (2)

Fire Extinguishers (3)

Emergency Exits (0)

Stair Exits (2)

Emergency Phone (0) *Emergency Intercom?

AEDs (0)

First Aid Kits (0)

Indoor Track Area -Fire Extinguishers (3)

*One outside area from Track near spiral stairs (other side of door)

*One back wall right side

*One back wall left side

-Stair Exits (2): One on each side of track

-Alarms (2)

*One at Stairs Exit near elevator

*One at Stairs Exit spiral stairs side

-Emergency Intercom (wall on elevator side)

Stair Well Connector Fire Extinguishers (4)

-Fire Extinguisher in between each floor

Taishoff Aquatics Center

Alarms (3)

Fire Extinguishers (2)

Emergency Exits (2)

First Aid Kit (2)

AED (1)

-Alarm at Swim Coach Office Door

-Alarm at Exit in Swim Coach Corridor near exit door

-Emergency Exit in same area

-Alarm at Exit Door (Emergency Exit) near entrance to Women’s Locker Room

-First Aid Kit on wall near 1st Lifeguard stand (opposite Lifeguard office)

-AED on wall near 1st Lifeguard stand (opposite Lifeguard office)

-First Aid Kit in Lifeguard Office

-Fire Extinguisher on wall next to Lifeguard Office

-Fire Extinguisher on wall at pool check-in desk

Pool Lobby & Stairwell leading down to Coach’s Office

Alarms (4)

Fire Extinguishers (1)

Exits (2)

-Alarm (2) on near each exit door

-Alarm near stairs door

-Alarm in stairwell area outside of Coach’s Office Area

-Fire Extinguisher on wall in lobby near pool entrance

18

Card Gym

Ground Level Alarms (3)

Fire Extinguishers (3)

Exits (2)

-Alarm at Exit Doors (Fencing Room Side)

-Fire Extinguisher on wall near Equipment Room

-Fire Extinguisher on wall at bottom of stairs (Track & Field Locker Room Area)

-Alarm at Exit Doors (017 Office)

-Fire Extinguisher near Mechanical Room 019 (Mike Ryan Office Side)

-Alarm at bottom of stairs (Mike Ryan Office Side; stairs that come down from basketball court level)

_____________________________________________________________________________________________

Card Gym Basketball Court/Team Store Area

Alarms (3)

Fire Extinguishers (3)

Exits (4)

-Fire Extinguisher in hallway between basketball court and Wilson Center Monitors desk. Extinguisher is on corner wall

-Alarm at both exits in basketball court area on Wilson side – 1 alarm at exit into Wilson Area and 1 alarm at exit to outside

-Alarm at exit in corner opposite Duke Store

-Fire Extinguisher at Entrance to Duke Store

-Alarm at Door Exit in hallway entrance to Card Gym (Cameron Side)

-Fire Extinguisher on wall at Basketball Court Entrance (near stairwell leading down to basement area)

Card Gym 2

nd Floor Area (Coaches Offices) & Indoor Track Area

Alarms (3)

Fire Extinguishers (2)

-Fire Extinguisher at top of stairs (Cameron Side)

-Alarm at Door Entrance to Indoor Track

-Alarm at Exit of Indoor Track (Wilson Side)

-Alarm in lobby area outside of Indoor Track (Fencing Offices; Wilson Side)

-Fire Extinguisher near stairs

Card Gym 3

rd Floor (Track & Field/Cross Country Offices) and 4

th Floor

Alarms (2)

Fire Extinguishers (2)

-Alarm on wall

-Fire Extinguisher on wall

-Fire Extinguisher on wall on stairwell going up to 4th

Floor

-Alarm near 402 Door

19

IM Building

Alarms (7)

Fire Extinguishers (2)

Emergency Exits/Exits (4)

Main Lobby (Entrance Lobby)

-Alarm (1) on wall near entrance door

-Telephone *Does NOT work

Court Area

-Fire Extinguisher on wall near Monitor’s Room when you first walk in

-Alarm at Right Door Exit (front)

-Emergency Exit Door

-Alarm at mid-court (right) doors

-Doors here are locked, but posted with “non-exit” signs

-Alarm at back right door

-Emergency Exit Door

-Fire Extinguisher near back right door on wall

-Alarm at back left door

-Emergency Exit Door

-Alarm at mid-court (left) doors

-Doors here are locked, but posted with “non-exit” signs

-Alarm at Left Door Exit (front)

-Emergency Exit Door

Brodie Recreation Center

First Floor Alarms (5)

Fire Extinguishers (10)

Emergency Exits (12)

Emergency Phone (5)

AEDs (2)

First Aid Kits (2)

Front Desk

-AED (1) behind front desk, next to entrance

-First Aid Kit (1) behind front desk, next to entrance, on shelf

-Emergency Exits (4) located at main entry (Alarms #1-4 on front desk panel; will alarm when doors are propped)

Weight Room

-Emergency Phone (1) located on column towards front desk.

Hallway next to Room 149 (Multi-purpose Room) and Racquetball Courts

-Fire Extinguisher (2) next to room 149, outside of door; Second extinguisher is next to room 152, outside of storage closet

Main Stairwell Entrance

-Fire Extinguisher (1) at base of stairs, next to elevator

Restrooms

-Fire Extinguisher (1) adjacent to bathrooms on first floor, next to storage closet (room 157)

-Fire Alarm (1) adjacent to bathrooms on first floor, next to storage closet (room 157)

-Emergency Exit (1) located just past the restrooms, exits west (Alarm #5 on front desk panel)

20

First Floor Basketball Courts

-Fire Extinguisher (3) located at each fire exit

-Fire Alarm (3) located at each fire exit

-Emergency Phone (1) located near the main entrance of courts

-Emergency Exit (3) one exit located on the south side of the court (Alarm #6 on front desk panel). Two exits located on the

north side of the court (Alarm #7 and #8 on front desk panel)

Side Door Entry (Facing East)

-Fire Extinguisher (1) located at the entry/exit point

-Emergency Exit (1) located on the east side of the building, leads onto long walkway, near tennis courts (Alarm #9 on front

desk panel)

Men’s Locker Room

-Emergency Phone (1) located near main entrance

Women’s Locker Room

-Fire Extinguisher (1) located outside of the showers

-Emergency Phone (1) located near main entrance

-Emergency Exit (1) located where all lockers are located (Alarm #15 on front desk panel). This door puts you in the hallway

near housekeeping closet (Room115A). You must go up two steps to exit this way. Exit is alarmed, but does not register at

front desk. This exits to the east of the building, across from tennis courts.

Pool

-Fire Extinguisher (2) located near the filter room, and one near the fire exit

-Fire Alarm (1) located near the fire exit

-Emergency Phone (1) located in between men’s and women’s locker room doors

-AED (1) located in between the men’s and women’s locker room doors

-First Aid Kit (1) located in between the men’s and women’s locker room doors

- Emergency Exits (2) located nearest the basketball courts, exits to the east side of building, near side entry door (Alarm #10

on front desk panel); Second exit is nearest the filter room. Must exit this door, and through the filter room (Alarm #14 on

the front desk panel)

Second Floor

Alarms (3)

Fire Extinguishers (2)

Emergency Exits (1)

Stair Exits (3)

Emergency Phone (1)

AEDs (0)

First Aid Kits (0)

Main Stairwell -Fire Alarm (1) located at the top of the stairs, near the elevator

-Stair Exit (1) located next to elevator

Cardio Rooms

-Fire Extinguisher (1) located in the treadmill room

-Fire Alarm (1) located in the elliptical room, right next to room 208

-Emergency Phone (1) located in the treadmill room

-Stair Exits (1) located nearest room 208

Basketball Courts

-Fire Extinguisher (1) located on wall nearest room 208

-Fire Alarm (1) near stairway facing East (facing tennis courts)

-Stair Exits (1) facing the east side of building, near tennis courts)

21

Third Floor

Alarms (3)

Fire Extinguishers (3)

Emergency Exits (0)

Stair Exits (3)

Emergency Phone (0)

AEDs (0)

First Aid Kits (0)

Track Level

-Fire Extinguisher (3) located at each stairwell entry

-Fire Alarm (3) located at each stairwell entry

-Stair Exits (3) One stair exit is on the east side of building, facing tennis courts, Two stair exits are on the south side of

building. These stairs bring you to the second floor. Follow all exits outside from this area.

22

Employee Information

Workers’ Rights and Responsibilities

The lists and information contained herein are a mere summary of expectations and procedures to be

followed in case of an on-the-job injury/illness. This information should not be used as a sole resource

and we recommend that you consult the links provided below for the full information.

Work-Related Injury/Illness

All on-the-job injuries must be reported within 24 hours of the injury/illness. North Carolina Law requires the

Worker’s Compensation office to report injuries/illnesses to the North Carolina Industrial Commission within 5

days of knowledge of the injury. Staff must report incident to supervisor immediately or as soon as practical,

but no later than the conclusion of the staff member’s shift. The supervisor will refer the injured staff member

to seek medical treatment, if medical attention is needed. For urgent/life threatening injuries staff are to use the

Duke, Durham Regional or Duke Raleigh Hospital Emergency Department.

Within the first 24 hours of illness/injury the supervisor must complete a Report of Occupational Injury (Duke

Form A-016). This report is completed online. The supervisor will receive an email confirmation with the

attached A-016 and should retain a copy of the form as documentation. If a treatment physician sends the staff

member home, the staff member must notify and provide written documentation to the supervisor. Prior to the

staff member returning to work, the staff member must be cleared by entity employee health. Family Medical

Leave will run concurrently with any Workers’ Compensation leave.

For full review of this policy, please refer to the following link:

http://www.hr.duke.edu/policies/health_safety/injury_illness.php

Worker’s Compensation

The North Carolina Workers' Compensation Act covers staff who sustain an injury or become ill as a result of

on-the-job work. In accordance with this act, Duke staff will not be paid for the first seven calendar days of

disability following the injury or illness. However, if the injury or illness results in a disability lasting more than

21 days, staff will be paid from the date of the disability. Staff who are absent due to compensable injuries may

use accrued Paid Time Off, sick leave, vacation time, or earned discretionary holidays to cover the work-time

missed during the seven-day statutory waiting period.

For full review of this policy, please refer to the following link:

http://www.hr.duke.edu/policies/health_safety/workers_comp/index.php

For further information regarding compensation, cost allocation, and benefits, please refer to the following

links:

Compensation

o http://www.hr.duke.edu/policies/health_safety/workers_comp/compensation.php

Cost Allocation

o http://www.hr.duke.edu/policies/health_safety/workers_comp/cost_allocation.php

Benefits

o Duke will continue to make its contribution to health insurance, life insurance and the

retirement program, provided, in the case of the insurance programs, the staff member

23

continues his or her contribution to the plans. The staff member should contact the Benefits

Office for additional information and assistance.

http://www.hr.duke.edu/policies/health_safety/workers_comp/benefits.php

Returning to Work from a Work-Related Injury/Illness

A staff member who is out of the work place for a compensable workers' compensation illness or injury must

provide his or her supervisor with written medical authorization to return to work. If there is any question about

a staff member's ability to return to work, the situation must be reviewed with the entity Employee Health

department.

The staff member will normally assume his or her former position upon return to work.

A staff member with an occupational illness or injury who has been released to work but is unable to perform

all of the essential functions of their regular job, or needs a temporary accommodation to their hours or schedule

will be transitioned into the Return-to-Work Program.

For full review of this policy, please refer to the following link:

http://www.hr.duke.edu/policies/health_safety/return_to_work/index.php

For further information regarding procedure, limited work program, and alternate work program, please refer to

the following links:

Procedure

o http://www.hr.duke.edu/policies/health_safety/return_to_work/procedure.php

Limited Work Program

o http://www.hr.duke.edu/policies/health_safety/return_to_work/limited_work.php

Alternate Work Program

o http://www.hr.duke.edu/policies/health_safety/return_to_work/alternate.php

24

OSHA-Occupational Safety and Hazard Association

Worker Complaints

Filing a Complaint

o Filing options

o To file your discrimination complaint

o When can a complaint be filed?

o Who can complain?

o What information must the employee provide?

For full review of this policy, please refer to the following link:

http://www.osha.gov/as/opa/worker/complain.html

OSHA Compliant Handling Process

For full review of this policy, please refer to the following link:

http://www.osha.gov/as/opa/worker/handling.html

Whistleblower Complaints

For full review of this policy, please refer to the following link:

http://www.whistleblowers.gov/

Worker’s OSHA Information

Workers’ rights under OSHA Act

OSHA standards: Protection on the job

Workers can ask OSHA to inspect their workplace

Employer responsibilities

You cannot be punished or discriminated against for using your OSHA Rights

What to do if there is a dangerous situation at work

For full review of this information, please refer to the following link:

http://www.osha.gov/workers.html

25

Waivers/Participation Agreements & Frequently Asked Questions

What constitutes distributing a waiver?

Any Recreation and Physical Education sponsored event that involves potential hazards or risk.

Events include but are not limited to travel, special events, recreation facility use, rentals, program

participation, and Physical Education classes.

How are waivers stored and organized?

An original copy of all waivers should be stored on the T-drive in the “waivers” folder.

Program/Facility/Event Coordinators are responsible for distributing, collecting, and storing all signed

waivers.

Signed waivers for minors should be stored separately from adult waivers.

How long do we store completed waivers?

Waivers should be stored (paper and electronic) for no less than three years (this does not include

Minors, under the age of 18; see below)

Minors, under the age of 18, must be kept until they turn 18; thereafter, the form must be kept for no less

than three years.

o Waivers for minors must include a Date of Birth.

How often are waivers reviewed and revised?

The Risk Management Committee recommends that waivers are reviewed by program and facility

managers on a yearly basis or as needed.

When changes or additions to a program or facility are made, it is recommended that the waiver be

reviewed and updated by the Risk Management Committee. The Risk Management Committee may

consult Duke Corporate Risk Management depending on the extent of changes to be made to the waiver.

How often should waivers be distributed and collected for programming and facility use?

The Risk Management Committee recommends that program and facility users sign waivers on an

annual basis for each specific event. This can take place at the time of membership renewal,

program/event registration, and participation in various Physical Education classes.

Waivers are NOT required for the following situations:

Tours; which also includes other facility visitors

Any non-sponsored Recreation & Physical Education event where the host department or person(s) has

proof of insurance.

26

Form I

Exercise Facility Guest Waiver and Release

27

Form II

Climbing Waiver and Participation Agreement

RELEASE & INDEMNITY AGREEMENT &

CONSENT FOR MEDICAL TREATMENT

CLIMBING WALL INSTRUCTIONAL CLASS

.

I understand that, before I will be allowed to use the climbing wall at Duke University, I must successfully

complete an instructional class that includes an introduction to safety issues and procedures, instruction on the

care and use of equipment, knot tying, belaying techniques, climbing techniques, and proper climbing wall

etiquette.

As part of the consideration for participating in the climbing wall instructional class being offered by Duke

University, I hereby release. hold harmless, and forever discharge Duke University, its employees and agents

from any and all liability, claims, demands, actions, and causes of action whatsoever arising out of or related to

any loss, property damage, or personal injury, including death, that may be sustained by me or to any property

belonging to me while participating in the climbing wall instructional class.

I understand that the risks associated with climbing wall activities include, but are not limited to:

1. Injury, disability or death resulting from falling from the climbing wall and impacting against wall

surfaces or projections or the gymnasium floor;

2. Injury, disability or death resulting from rope abrasion, entanglement or other activities involving ropes

on or near the climbing wall such as climbing, belaying, rappelling, lowering on rope, rescue systems,

and other rope techniques;

3. Injury, disability or death resulting from contact with falling climbers or dropped objects;

4. Cuts and abrasions resulting from skin contact with the climbing wall;

5. Musculoskeletal injuries resulting from the physical stress of climbing and/or belaying; and

6. Injury, disability or death resulting from failure of ropes, slings, harnesses, climbing hardware, anchor

points, other climbing equipment or any part of the climbing wall.

I understand and acknowledge that the University does not permit any un-roped activities, such as traversing

and bouldering. I further understand and acknowledge that the University strongly recommends and encourages

all participants engaged in roped climbing activities to wear safety helmets.

I understand and acknowledge that it has been recommended that I have a physical examination and consult

with my physician about physical activity and exercise before participating in this activity, especially if I have

any physical conditions that may be affected by the activities involved, including, but not limited to, heart,

circulatory, respiratory, or musculoskeletal conditions or pregnancy. I acknowledge that I have either had a

physical examination or been given my physician's permission to participate or that I have decided to participate

in this activity without the approval of my physician.

28

I acknowledge that my participation in this class is elected by me because I wish to use the climbing wall and is

not required as part of my academic program or University employment. I voluntarily assume full responsibility

for any risk or loss, damage, or personal injury, including death, and for any property damage that may be

sustained by me as a result of participation in this activity except that caused by the negligence of the

University, its employees or agents.

In the event of illness or injury, I hereby authorize the program director or instructors or other agents to obtain

emergency or other medical treatment for me as deemed necessary, including administration of an anesthetic or

other medication and surgery, and I hereby assume the cost of such treatment. I Understand that this

authorization is given in advance of any specific diagnosis, or hospital care being required but is given to

provide authority and power on the part of the University to give specific consent to the diagnosis, treatment, or

hospital care which, in the best judgment of a licensed physician, is deemed advisable. I agree that a photocopy

of this signed release and consent form as effective as the original, and recognize that neither the University,

program director, instructors or other employees or agents assumes responsibility for, nor do they have any

liability for, the medical assistance and care which may be so selected and provided.

I further agree to indemnify and hold harmless the University, its employees and agents. from any loss, liability,

damage or cost, including court costs and attorney's fees that they may incur due to my participation in this

activity, except that caused by the negligence of the University, its employees or agents. .

This release and indemnity agreement is binding on myself, my heirs, assigns, and personal representatives. I

acknowledge that I am 18 years old or older. If I am not at least 18 years old, I have marked through he

preceding sentence, and I understand that my parent's or guardian's signature must appear below before I will be

permitted to participate in the activity.

_______________________ _________________________

Signature of Participant Signature of Parent or Guardian

(if participant is under 18)

Date: _____________ Date: _____________

29

FORM III

Climbing Wall Helmet Release

RELEASE AND HOLD HARMLESS AGREEMENT

CLIMBING WALL HELMET REFUSAL

I hereby acknowledge that I am aware of the dangers inherent with indoor sport climbing on the climbing wall

of Duke University located in Wilson Recreation Center. I realize that these activities pose a risk of injury,

disability and even death. I am aware that lead climbing and following of roped traverses present additional

hazards beyond top-roped climbing.

I am aware that Duke University strongly recommends and encourages use of a protective helmet for all roped

climbing and that the use of a protective helmet could prevent brain damage or death in the event of an accident.

I am aware that the University provides helmets to climbing wall participants free of charge. Against the

University's recommendation I am refusing to wear a protective helmet for all roped climbing situations. I take

full responsibility for my own personal decision in refusing this critical safety precaution, and I hereby release,

hold harmless, and forever discharge Duke University, its employees and agents from any and all liability,

claims, demands, actions, and causes of action whatsoever arising out of or related to any personal injury,

including death, that may be sustained by me while participating in climbing wall activities without a protective

helmet. This release and hold harmless agreement is binding on myself; my heirs, assigns, and personal

representatives.

I acknowledge that I am 18 years old or older. If I am not at least 18 years old, I have marked through the

preceding sentence, and I understand that my parent's or guardian's signature must appear below before I will be

permitted to participate in the program.

__________________________ _____________________________

Signature of Participant Signature of Parent or Guardian (if participant is

under 18)

Date: ______________________ Date: ________________________

30

FORM IV

Aquatics Waiver and Participation Agreement

DUKE UNIVERSITY

AQUATICS PARTICIPATION AGREEMENT

PLEASE READ THIS AGREEMENT CAREFULLY. IT IS A LEGAL CONTRACT AND AFFECTS

ANY RIGHTS YOU OR YOUR CHILD/WARD MAY HAVE IF HE/SHE IS INJURED OR

OTHERWISE SUFFERS DAMAGES WHILE PARTICIPATING IN Duke’s Aquatic Programs

(Activity). Be aware that by registering your child/ward (Participant) and having her/him participate in this Activity, you _______________________ and the Participant _____________________________ will be

waiving all claims for injuries the Participant might sustain arising out of his/her participation in this Activity.

In consideration of the Participant being permitted to take part in this Activity, we confirm by our signatures

below that we understand and agree to the following: 1. Assumption of Risks of Activity Participation: I/We understand that participation in the Activity is entirely voluntary and

that Duke University makes no representation about the safety or security of the location of the Activity or the modes of

travel in connection with the Activity, if any. I/We understand that risks are inherent in participating in this Activity and that

these risks could result in property damage and/or bodily injury to the Participant. I/We agree to accept and assume,

knowingly and voluntarily, all risks associated with the Activity whether present or future, known or unknown, arising from

or as a result of the Participant’s voluntary participation in the Activity. I/We have discussed the risks associated with the

Participant’s participation in the Activity as reflected by our signatures below. I/We hereby elect to participate in the

Activity.

2. Release and Waiver of Liability:

In return for Duke University permitting the Participant to register and participate in the Activity and having read

and understood this Participation Agreement, I/we hereby voluntarily agree to the following:

A. I/WE RELEASE, WAIVE, DISCHARGE AND COVENANT NOT TO SUE Duke University, its affiliates, trustees,

officers, employees or agents, (hereinafter referred to as RELEASEES) for any liability, claim, and/or cause of action

arising out of or related to any loss, damage, injury or harm of any sort, including death, that may be sustained by the

Participant, and for damage to any property belonging to him/her, that occurs as a result of traveling to or from any site

in connection with the Activity, or as a result of the Participant’s participation in the Activity. It is our intent and

agreement that the terms of this Section 2 shall bind any person asserting rights on our behalf, or otherwise asserting

claims by or through us, including my spouse, family members, heirs, assigns and personal representatives.

B. I/We further agree that this Participation Agreement, including this Section 2 shall be construed in accordance with the

laws of the state of North Carolina. Further, the release, waiver, discharge and covenant not to sue as expressed in this

Section 2 is given pursuant to the Uniform Contribution Among Tortfeasors Act, North Carolina General Statutes

Section 1B et seq. It is my/our intention not only to release any and all claims against RELEASEES, but also to relieve

RELEASEES from any liability to make contribution to other tortfeasors on account of any claims.

C. In signing this Waiver and Release, I/We acknowledge and represent that I/we have informed ourselves fully of the

contents of this Waiver and Release of liability and hold harmless agreement by reading it before we sign it, and that

I/we have reviewed it and Participant understands what it means and that I/We sign this document freely. I/We further

state that there are no health-related reasons or problems which preclude or restrict the Participant’s participation in this

Activity.

[NOTE: Participant and the Participant’s Parent/Guardian agree that this Participation Agreement may be executed in counterparts

(i.e., each required signature may appear on separate printed copies of the Participation Agreement), and that such counterpart

versions each shall be deemed an original and together shall constitute one and the same document for legal purposes.]

Participant: _______________________________________ Date: _________________________ I am the parent or guardian of the above-named Participant. I have reviewed this Participation Agreement and the description of the

Program, have discussed it with the Participant and concur with the Participant’s participation in the Program under the terms of this

Participation Agreement. Parent or Guardian: ________________________________ Date: _________________________

________________________________________________ ______________________________

Signature of Parent/Guardian Date

31

FORM V

Recreation Photo/Video Consent Form

Recreation & Physical Education

Photo/Video Consent

The Duke Rec & PE Department is continually looking for ways to showcase the experiences of students and

aid in the promotion of activities available to the student body. Members of the Duke Rec & PE Department

will be taking photographs, and video recording various activities and events for instructional use and/or for use

on the department’s web site, Facebook sites, and in its publications and other promotional materials.

Please indicate your willingness to have your photograph or video recording used by this department as

mentioned above.

CONSENT TO PHOTOGRAPHING AND VIDEO RECORDING:

Your Name _________________________________________________

(Please Print)

__ Yes, I give permission for Duke Rec & PE Department to use my photograph or video recording.

__ No, I do not give permission for Duke Rec & PE Department to use my picture or video recording.

I understand that all material obtained will be used by Duke Rec & PE department for educational and related

purposes, including program literature, presentations, displays, and departmental websites.

I understand that I will receive no compensation for my consent to participate.

I have read this information and have had the opportunity to ask questions. I agree to be bound by this consent

form, and hold harmless the Rec & PE Department and staff, Duke University and all other organizations

associated with Duke University.

Signature ____________________________________________________ Date ________________________

32

Form VI Intramurals Waiver and Participation Agreement

Duke University Intramurals Waiver

Agreement: I intend to participate in Intramurals sponsored by Duke University and the Duke Campus Recreation Department. I

certify that I am and will be medically sound when participating in any intramural competition, and hereby agree to and understand

that I voluntarily and of my own free will, elect to participate in Duke University Campus Recreation Intramurals. I will only

participate in those Intramural competitions and activities sponsored by Duke University Intramurals for which I believe I am

physically and psychologically prepared to compete in.

Consent: I hereby give my consent to any Duke University representative or employee to provide customary and basic medical

attention to myself in the event injury. I furthermore, understand and accept that this attention will only be provided upon my given

consent, and that it will be given by a non-professional student employee, a non-professional employee of Duke University, or a

professional employee of Duke University. I understand that transportation will not be provided by any Duke University student

employee or staff member, which includes officials, supervisors, or directors of Intramurals, and I hereby acknowledge that if I so

choose to transport myself following injury I assume all risks in doing so.

Release of Liability: I am aware of and voluntarily assume all risk to myself and property as I understand and accept the risks

associated with participation in Intramural events and competitions; including the risks of accidents, injuries, illnesses, damage or

destruction of property, paralysis, and even death, as well as, any other types of damages or loss. Furthermore, I agree Duke

University, the Duke Campus Recreation Department, Duke University Intramurals, along with the officials, supervisors, volunteers,

employees and directors of these organizations, shall not be held liable for any injury, loss or damage to property, or loss of life as a

result of my participation in any Duke University Intramural competition or event.

My signature below is my acknowledgement that I have read and understood every provision of this Waiver and Release of Liability,

and that I agree to abide by it.

In consideration of being allowed to participate in any way in Duke University Intramurals, related events and activities, the

undersigned acknowledges, appreciates, and agrees that:

1. The risk of injury from activities involved in this program is present, including the potential for permanent injury and death, and

while particular rules, equipment, and personal discipline may reduce this risk, the risk of serious injury does exist; and,

2. I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE

NEGLIGENCE OF THE RELEASEES or others, and, assume full responsibility for my participation; and,

3. I willingly agree to comply with the stated and customary terms and conditions for participation. If, however, I observe any unusual

significant hazard during my presence or participation or any threat to my health and safety, I will remove myself from participation

and bring such to the attention of the nearest official immediately; and,

4. I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE AND HOLD

HARMLESS Duke University Intramurals, Duke University,

Duke Campus Recreation, their officers, officials, supervisors and/or employees, directors, and other participants, WITH RESPECT

TO ANY AND ALL INJURY, DISABILITY, DEATH, or loss or damage to person or property, WHETHER ARISING FROM THE

NEGLIGENCE OF THE RELEASEES OR OTHERWISE. I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION

OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL

RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.

Signature ____________________________________________________ Date ________________________

33

Form VII Professional Staff Travel

Travel Request Form

For Professional Staff Only

Name of Individual______________________________________________________________

Group represented_______________________________________________________________

Name of event__________________________________________________________________

Type of activities________________________________________________________________

Date(s) of event_________________________________________________________________

Departure date____________________________ Departure time_________________________

Destination____________________________________________________________________

______________________________________________________________________________

Return departure date______________________ Return departure time____________________

Return arrival date_________________________ Return arrival time______________________

Type of transportation needed_____________________________________________________

Number of nights needed in hotel___________________________________________________

Location of Hotel needed_________________________________________________________

Supervisor’s signature____________________________________________________________

Emergency contact info

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

PLEASE ATTACH GROUP ROSTER (with phone numbers and insurance information)

34

Incident Report Form & Frequently Asked Questions

Who completes the form?

- For informal recreation incidents: guest service attendants, weight room assistants and facility monitors

- Sport Clubs: Safety officers

- Intramurals: Field supervisors

- PE: Course Instructors

- Group Fitness: Instructors

- Personal Training: Personal trainers

- Aquatics: Lifeguards

- Outdoor Adventures: Trip leaders or wall supervisor

Who receives completed form?

Initial completed forms should go to front desk personnel in Wilson and Brodie Center. The front desk

personnel will then put the forms in the mailbox of either the facility director or coordinator of the

corresponding building. After initial review by those parties, distribution of forms will be made to appropriate

program area directors or coordinators

Location of blank forms:

At all main service areas within Wilson and Brodie Recreation Centers (Wilson Center – front desk, weight

room, Taishoff Pool; Brodie Center – front desk and Brodie pool); will be located in all first aid kits for sport

clubs, intramurals, outdoor adventures. Each area director will ensure that copies are available in each area.

Where and how to file original completed forms:

Where: Wilson Center (all Central Campus and off-campus incident report forms to be returned to Wilson

Center Facility Director)

How: After receiving completed incident report form, Brodie Facility Coordinator and Wilson Facility Director

will review and discuss with appropriate program area directors/coordinators and provide copy if necessary.

Program area risk management committee representative will provide initial follow-up of incident if required,

then return completed follow-up document to Wilson or Brodie facility person according to location of incident.

What requires a follow-up communication: If EMS is called, a follow-up contact must be made to the injured

party/parties.

When is an injury related incident report form required to be completed?

Any time an incident results in care or assistance given to include but not be limited to ice, other first aid

supplies or a call to EMS. Distribution of band-aids/bandages does not require an incident report to be

completed. If further care is required, such as cleaning a wound and applying a bandage(s) greater than a band-

aid, an incident report form must be completed. If ice is given or used by Intramurals or Club Sports, an

incident report form is not necessary, but it must be documented in a log.

When is a non-injury related incident report form required to be completed?

When any circumstance arises that includes any or all categories listed in Section 1 of incident report form

Forms to be filed after completion of incident procedures:

Completed Incident Report Forms should be filed alphabetically regardless of program area, date, or location of

incident.

35

FORM VIII

Duke Recreation and Physical Education - Incident Report Form

INCIDENT DATA Date ____/____/____ Time ________ ☐AM ☐PM

Name: _____________________________________________________ Duke ID/ Personal ID Number: _____________________

Campus Address: ______________________________________ Date of Birth ___/___/_____ Sex: ☐ Male ☐ Female ☐ Other

Contact:______________________ Status: ☐Student ☐Faculty/Staff ☐Alumni ☐Guest ☐Employee on duty ☐Other_______

If under 18, name and phone number of parent/legal guardian: _________________________________________________________

EMS Notified ☐Yes ☐No Time Called________ Time of Arrival______ Technician Name ______________________________

Duke PD Notified ☐Yes ☐No Time Called______ Time of Arrival _______ Officer Name ___________________________

Supervisor Notified ☐Yes ☐No Supervisor On Site ☐Yes ☐No Supervisor(s) Name_________________________________

Refused Care/Assistance ☐ Yes ☐No (If Yes, Why?) ____________________________________________________

LOCATION:

WEST CAMPUS ☐Wilson Center ☐Taishoff Pool ☐Card Gym ☐IM Building ☐Cameron Indoor ☐Fields ☐Tennis Courts

☐K-Ville Lawn ☐Track ☐Pascal ☐Duke Trails ☐Jack Coombs Baseball Field ☐Other _____________________________

*** Specific location within building/area (court #, field #, machine #/description, etc.) ______________________________________________________

EAST CAMPUS ☐ Brodie Center ☐ Brodie Pool ☐ Fields ☐ Tennis Courts ☐ Trail ☐ Other _________________________

*** Specific location within building/area (court #, field #, machine #/description, etc.) ______________________________________________________

CENTRAL CAMPUS ☐Basketball Courts ☐Fields ☐Pool ☐Other ___________________________________________

*** Specific location within building/area (court #, field #, machine #/description, etc.) _______________________________________________________

OTHER _______________________________________________

*** Specific location within building/area (court #, field #, machine #/description, etc.) _____________________________________________________ PROGRAM area of participation: Check all that apply

☐Informal Recreation ☐Physical Education ☐Intramurals ☐Sport Clubs ☐Aquatics ☐Fitness ☐Outdoor Adventures ☐Special Events

☐Camp ☐Other______________________________

SECTION I: INCIDENT/NON-INJURY Check all that apply and write details of actions taken, on back of this form.

Refused Assistance from Recreation Staff: ☐Yes ☐No Involved Party Left Scene: ☐Yes ☐No

☐Theft ☐Altercation ☐Unauthorized Access ☐Misuse of Facility/Equipment ☐Other___________________________________

SECTION II: INJURY Check all that apply and write details of actions taken, on back of this form.

Part of Body Injured: (check all that apply) ☐Left Side ☐Right Side ☐Head ☐Neck ☐Spine ☐Face ☐Ear ☐Mouth ☐Teeth ☐Eye ☐Nose ☐Shoulder ☐Arm ☐Elbow

☐Wrist ☐Hand ☐Finger ☐Back ☐Chest ☐Abdomen ☐Rib ☐Hip ☐Groin ☐Leg ☐Knee

☐Ankle ☐Foot ☐Toe ☐Other: ____________________________________________________

Description of how injury occurred: (specify events leading to the accident/injury)

☐Collision with obstacle ☐Collision with person ☐Hit by projectile ☐Pre-existing ☐Equipment related ☐Non-contact

☐Sudden turn or stop ☐Fall ☐Sudden Illness ☐Other ____________________________________________

First Aid given: (check all that apply) Name of care giver: ________________________________ Position: __________________

☐Applied Ice ☐Stopped Bleeding ☐Immobilized ☐Washed Wound ☐Victim Self Care ☐CPR ☐Rescue Breathing ☐Bandage ☐None ☐AED ☐Other: ____________________________

Further Care: (check all that apply)

☐Ambulance to hospital ☐Went home on own ☐Returned to activity ☐Friend took home ☐Self/Friend ☐ Self/Friend to hospital ☐Left

area no info ☐Referred for treatment For Aquatics Use Only: ☐Assisted Rescue ☐Active Drowning Rescue ☐Passive Drowning Rescue ☐Submerged Rescue

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☐Spinal Management/Backboard ☐Emergency Oxygen

DETAILS OF INCIDENT Involved Party Account

Name ______________________________ Contact __________________________ Signature __________________________

___________________________________________________________________________________________________________

___________________________________________________________________________________________________________

___________________________________________________________________________________________________________

___________________________________________________________________________________________________________

___________________________________________________________________________________________________________

Additional Involved Party Account (supply accounts of all parties involved)

Name ______________________________ Contact ___________________________ Signature___________________________

___________________________________________________________________________________________________________

___________________________________________________________________________________________________________

___________________________________________________________________________________________________________

___________________________________________________________________________________________________________

Witness Account

Name ______________________________ Contact ____________________________ Signature __________________________

___________________________________________________________________________________________________________

___________________________________________________________________________________________________________

___________________________________________________________________________________________________________

Additional Witness Account (supply accounts of all witnesses involved)

Name ______________________________ Contact ____________________________ Signature ____________________________

___________________________________________________________________________________________________________

___________________________________________________________________________________________________________

___________________________________________________________________________________________________________

___________________________________________________________________________________________________________

___________________________________________________________________________________________________________

Staff Account

Name_______________________________ Contact ___________________________ Signature ____________________________

___________________________________________________________________________________________________________

___________________________________________________________________________________________________________

___________________________________________________________________________________________________________

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Signature of Parent/Legal Guardian (if victim is a minor) _______________________________________________ Date ___/___/___

Draft Annex Posted for Future Committee Discussion

This section shall be designated for all current and future discussions regarding the development of the

Crisis Manual for the Department of Recreation and Physical Education

Current Discussions:

Budget Line, Annual Review

GL Code Creation

Communication Logging

Projected Annual Expenses

Guest Speakers and Training

Safe Room

38

Appendix of Facility Maps

39

40

41

42

43

44

45

46

47

Index Allergic reaction, 10

Aquatics, 18, 32, 36, 37, 38

Aquatics Waiver and Participation Agreement, 32

Brodie, 12, 14, 21, 36, 37

Brodie Recreation Center, 14, 21

Budget Line, Annual Review, 39

Bylaws of Risk Management Committee, 4

Card Gym, 19, 20, 37

Card Gym Basketball Court/Team Store Area, 19

Chemical Injury, 10

Climbing Waiver and Participation Agreement, 29

Climbing Wall Helmet Release, 31

Cold-related emergency, 10

Consent, 34

Crisis Scenarios, 10

Definitions, 6

Draft Annex Posted for Future Committee

Discussion, 39

Electrocution, 10

Emergency, 6, 8, 9, 11, 12, 13, 14, 15, 16, 17, 18,

19, 20, 21, 22, 23, 35, 38

Emergency Action Plans, 8

Emergency Evacuation Information, 13

Emergency Exits for Brodie Recreation Center, 14

Emergency Exits for Wilson Recreation Center, 13

Emergency Response Equipment Location by

Facility, 15

Employee Information, 23

Equipment, 6, 15, 19, 38

Exercise Facility Guest Waiver and Release, 28

Expenses, 39

Fire, 10, 15, 16, 17, 18, 19, 20, 21, 22, 23

First Aid Kit Protocol and Content, 12

Frequently Asked Questions, 26, 36

Guest Speakers, 39

Heart Attack and Stroke, 10

Heat-related emergency, 11

IM Building, 18, 20, 37

Incident Report Form, 36, 37

Injury, 23, 24, 29

Intramurals Waiver and Participation Agreement,

34

Maps, 2, 41

Meeting Procedures, 5

Occupational Safety and Hazard Association

OSHA, 6, 25

Photo/Video Consent, 33

Power Outage, 11

Recreation, 8, 12, 13, 14, 26, 27, 31, 33, 34, 36, 37,

39

Recreation & Physical Education, 27, 33

Recreation Photo/Video Consent Form, 33

Returning to Work, 24

Seizure, 11

Tornado, 11

Travel Request Form, 35

Upon Entering the Scene of an Emergency, 9

Violent Crime, 11

Waivers/Participation Agreements, 26

Wilson, 12, 13, 15, 16, 17, 18, 19, 20, 31, 36, 37

Wilson Recreational Center, 15

Worker’s Compensation, 23, 24

Workers’ Rights and Responsibilities, 23

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