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Off-campus Field Research Safety Form

 
INSTRUCTIONS
Complete all items below.
If you are traveling to more than one location chose emergency information marked as #1 and #2.
After you click on the "submit" button you will receive an email with this information.
PRINT the email and TAKE it with you on your trip so you will have the emergency phone numbers if needed.
This information will be kept on file in the Plant Sciences Human Resources office in case of emergency.

   

TRAVEL WITHIN CALIFORNIA
select counties in which you will travel for emergency phone numbers and location of closest hospital

TRAVEL OUTSIDE CALIFORNIA
THE FOLLOWING QUESTIONS ARE FOR TRAVEL ANYWHERE