ࡱ> E l bjbj .hj ihj il&&&&&I8\. 7777777$:[=t7772%%%:7%7%%5|6ϔw57 8<I85==$6=6Z9@%y477A!I8=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 (x23705; SSB8151; divesafe@sfu.ca). 1. Project director (= Principal investigator): Department/office number: Telephone: Email: Project start date: End date (maximum 1 year): 2. 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 all options that apply and provide requested information. Expand spaces as needed Mission(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): 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 Dive team Name each crew member, 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. NameAffiliationRoleQualification/ experienceEmergency contact and number Special environmental conditions (list all applicable conditions from Appendix 1 attached) 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 work day 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 routine days across the study period. 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 A. Fill out risk assessment, mitigation and contingency grid below. List hazards in the second column in each general category, indicate the likely level of risk for each hazard (low, medium, high), and explain how risk will be mitigated and contingency plans if needed. This risk assessment should cover all fieldwork risks, and thus include but not be limited to diving risks. Add as many rows as needed for full assessment. HazardRiskMitigation & ContingencyPhysicalBiologicalHuman-made B. 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) Emergency equipment on board Incident reporting protocol Key emergency contact information (DAN, DSO, PI) Medical and insurance information of team members (use table below; add rows as needed) NameDate of last diving medicalKnown allergies and relevant medical issuesDAN 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 ԰AVs 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 an 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 ./56IKTY^cd  H O V r y ˷˭ˋ}r}rhhOJQJ^Jh 5OJQJ^JhB haGg5OJQJ^JhB h*ij5OJQJ^JhYOJQJ^JhdXOJQJ^Jh OJQJ^Jh{pOJQJ^Jhp3OJQJ^JhJh*ijOJQJ^JhJhd5OJQJ^Jhd5OJQJ^JhJh 5OJQJ^J(./cd ! y z { < ? @  h"0]0gd  h"0]0gd*ij "0]0gd*ij  4 !0]0gd*ij$  4 !0]0a$gd    ! $ + 4 5 9 \ ] e v w x y z { ߼߲鲼󚌚~p^I)hWh 56CJOJQJ\^JaJ#hWh 6CJOJQJ^JaJhB hC5OJQJ^JhB hJ5OJQJ^JhB h$}5OJQJ^JhB h*ij5OJQJ^JhdXOJQJ^JhaGgOJQJ^JhaGghaGgOJQJ^JhaGg>*OJQJ^Jh*ij>*OJQJ^Jh OJQJ^Jhp3OJQJ^JhJh*ijOJQJ^J   4 < > ? @ A B C D E F G H I J K L M N X Y [ b e k o x { ƻh OJQJ^JhJh OJQJ^Jhth 5OJQJ^JhJhC>*OJQJ^JhC>*OJQJ^JhJ>*OJQJ^JhJhJ>*OJQJ^JhChC6OJQJ^J#hWh 6CJOJQJ^JaJ5@ A B C D E F G H I J K L M N +  h"0]0gd  h"0]0gd*ij     * + 5 j      # ǹvllll__llll_hJh*ijOJQJ^JhCOJQJ^Jhth*ij5OJQJ^JhaGgOJQJ^J#hWht6CJOJQJ^JaJhaGg5OJQJ^JhB haGg5OJQJ^JhB hk5OJQJ^JhJOJQJ^JhJhJ>*OJQJ^JhdXOJQJ^Jh OJQJ^JhJh OJQJ^J% 2 3 /0EFfop 0$If]0 h"0]0gdkgdaGg h"0]0gdp3 h"0]0gd*ij# $ ' 1 2 3 5 7 > ? 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