ADHOC Excursion Plan and Authorisation

Parent/Guardian(Required)

First Name Last Name

Email(Required)

Educator(Required)

First Name Last Name

Email(Required)

Submitted By(Required)

THIS FORM IS TO BE SUBMITTED FOR EACH ADHOC EXCURSION

Excursions promote opportunities for each child to build connections with the local community and world around them. All excursions are to complement the session of care and contribute to the outcomes of the learning, development and wellbeing program and must not be the sole purpose for the session of care. It is the responsibility of the Service, Educator, and Family to ensure the health, safety, and wellbeing of children when outside of the approved location of care.

Date of Excursion(Required)

Address:(Required)

Street Suburb State / Territory

Means of Transport(Required)

Describe Proposed Route that you intend to take:(Required)

Please upload any screenshots of maps, etc that may be relevant

Drop files here or

Accepted file types: jpg, png, pdf, docx, Max. file size: 5 MB.

Proposed Activities/Purpose of Excursion:(Required)

Children to Attend the Excursion:(Required)

I will take the following items and have access to the below:(Required)

YES

• First Aid Kit

• House keys

• Medication (if required)

• Medical Information for each child

• List of Emergency Contact Numbers

• Charged Mobile Phone

• Fluids and healthy snacks

• Sun protection cream and clothing

• Weather protection clothing

List Additional Items here:(Required)

E.g. flash light, pram, scooter

Transport and Vehicles Agreement has been signed?(Required)

Yes

IDENTIFYING HAZARDS

Have you identified any potential Hazards?(Required)

Yes

No

Examples of Potential Hazards

• The older child is prone to running away from the Educator, perhaps take the skateboard attachment for the child to ride on and discuss the importance of staying safe when out on an adventure. For more extreme cases, ask the family to install a toddler leash on the side of the pram.

• The day is hot, you will be travelling on foot, dehydration and heat stroke is possible. Some additional things to take could be hydrolyte, ice neck scarfs and check online to see if the local library is open just in case you need to seek respite.

• There is a local dog that has charged at you and the children before, plan a different route to avoid the dog.

Hazard Category(Required)

Hazard Description:(Required)

Describe how you may be able to turn this hazard into an Educational Learning opportunity?(Required)

To download a PDF with some examples Click here

Describe actions taken to make it safe for active engagement:(Required)

Describe any communications that you have had with the family:(Required)

Please upload any supporting evidence or documentation here:

Drop files here or

Accepted file types: jpg, png, pdf, docx, Max. file size: 5 MB.

THIS FORM IS TO BE SUBMITTED FOR EACH ADHOC EXCURSION

IDENTIFYING HAZARDS

Examples of Potential Hazards

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