ࡱ> NPMS ebjbj>> *>\ti\tie lllllLT! }}}A!C!C!C!C!C!C!$#b&\g!l}}}}}g!ll|!}.llA!}A!BS.-!!0!&`&6&l X}}}g!g!9f}}}!}}}}&}}}}}}}}} X 2: UNIVERSITY OF ALASKA DIVE PLAN Please submit form to  HYPERLINK "mailto:bhkonar@alaska.edu" bhkonar@alaska.edu Project or Mission: Dates: Divers Qualifications: Please include -if the diver is a student, staff, faculty or volunteer and if UAF, UAS, or UAA -please put star next to lead diver -current depth certification -expiration dates of physical, CPR, First Aid, and O2 -regulator and drysuit (type and date of last service) Please add rows as needed. EXPIRATION DATESDiverAffiliationStudent, staff, faculty, volunteerDepth CertMedical CPR First Aid O2 Regulator service dateDrysuit fit and functionality Please note that covid and other communicative diseases may be present in communities where scientific diving may be occurring. Please check and adhere to CDC guidelines and UA guidelines for local levels of risk and personal protection. https://covid.cdc.gov/covid-data-tracker/#datatracker-home Emergency Plan: Emergency Contacts List divers, telephone number, and relationship of person to be contacted for each diver in the event of an emergency. Please add rows as needed. DiverEmergency Contact Name and RelationshipEmergency Contact Phone NumberDAN Insurance # (Contacts for southcentral ֱֻ and Juneau are listed below; Acquire other contacts, see Appendix 7 of UA Dive Manual for other areas of ֱֻ;  HYPERLINK "http://www.sfos.uaf.edu/dive/" http://www.sfos.uaf.edu/dive/) PLEASE NOTE THAT THERE IS NO HYPERBARIC CHAMBER IN ALASKA Recompression Chamber Seattle Virginia Mason Center for Hyperbaric Medicine 925 Seneca St Seattle Washington 98101 206-583-6543 Air Ambulance: Lifemed ֱֻ 800-478-5433 LifeFlight 800-478-9111 Hospitals in Anchorage Providence Hospital Emergency 907-212-3111 Outside Anchorage 800-478-5433 ֱֻ Regional Hospital 907-264-1222 800-478-9111 Anchorage USCG 907-271-6700 907-229-8203 Juneau USCG Coordination Center 907-463-2000 907-463-2001 800-478-5555 Bartlett Memorial Hospital 907-796-8900 Bartlett Memorial Hospital Emergency 907-796-8427 Kodiak USGC Air Station 800-833-3489 Seldovia Fire/Ambulance/Clinic 907-234-7812 Police 907-234-7640 Homer Fire 907-235-3155 Police 907-235-3150 Hospital 907-235-8101 DIVERS ALERT NETWORK 919-684-4326 IF THERE IS AN ACCIDENT THAT REQUIRES HOSPITALIZATION OR RESULTS IN DEATH, PLEASE IMMEDIATELY CONTACT THE APPROPRIATE UNIVERSITY SAFETY MANAGER: UAF: Kim Davis UAF EHSRM (907) 474-5476; cell : (907) 590-6768  HYPERLINK "mailto:klamb1@alaska.edu" klamb1@alaska.edu UAS: Ryan Sand UAS Health & Safety Manager (HYPERLINK "tel:+1907-796-6015" \t "_blank"907) 796-6015 HYPERLINK "mailto:rgsand@alaska.edu"rgsand@alaska.edu Contacting the Campus Safety Officers immediately is imperative, as they are on a strict time line for notifying OSHA. Failure to notify OSHA within 8 hours of a fatality or within 24 hours of a hospitalization or amputation can result in fines to the University. To report accidents that require medical care (but not hospitalization) or minor injuries and incidents that do not require medical care, use the Origami Risk system located here (Note, you will need your UA login credentials):  HYPERLINK "/safety/occupational-safety/accident-reporting.php" /safety/occupational-safety/accident-reporting.php or here:  HYPERLINK "http://www.uas.alaska.edu/policies/reporting-portal.html" \t "_blank" http://www.uas.alaska.edu/policies/reporting-portal.html Approximate Number of Total Proposed Dives: Approximate Number of Proposed Dives Per Day: Location of Proposed Dives: Estimated depth(s) and bottom time(s) anticipated: Decompression status and repetitive dive plans: Proposed work, equipment, and boats to be employed: Any hazardous conditions anticipated:  67^_qrstȰȰȃo]oL;;L h|E&hrCJOJQJ^JaJ h|E&h/CJOJQJ^JaJ#h|E&h 6CJOJQJ^JaJ&h|E&h 56CJOJQJ^JaJ&h|E&hr 56CJOJQJ^JaJ0h|E&hr 0J5B*CJOJQJ^JaJph/jh|E&hr 5>*CJOJQJU^JaJ&h|E&hr 5>*CJOJQJ^JaJ h|E&h CJOJQJ^JaJ#h|E&h 5CJOJQJ^JaJ st 1 N $Ifgd|E&l gd|E&`gdrgd/$a$gd gd $a$ 1 N  $ / 8 = H K L c k ﮮ͠hmeCJOJQJ^JaJ h|E&hmeCJOJQJ^JaJhkWCJOJQJ^JaJ h|E&h|E&CJOJQJ^JaJ h|E&h/CJOJQJ^JaJ h|E&hrCJOJQJ^JaJ7  $ / 8 = H K L c FfwFf$Ifgdmel $Ifgd|E&l $$Ifa$gdmel   -DM gd Gu`gdrFfW Ffg$Ifgd|E&l  ] i l y z { ~~m_m~mNNN@NNNNNNNNh-CJOJQJ^JaJ h|E&h-CJOJQJ^JaJhkWCJOJQJ^JaJ h|E&h|E&CJOJQJ^JaJ h|E&h CJOJQJ^JaJ#h|E&h 5CJOJQJ^JaJh Gu5CJOJQJ^JaJh Guh Gu5OJPJQJaJ;h Gu5B*CJOJPJQJ^JaJfHph<@Cq Ah Guh Gu5B*CJOJPJQJ^JaJfHph<@Cq  z { $Ifgd|E&l $Ifgd l ^gd  K8888$Ifgd l kd$$Ifl\d ,"y t0644 lapyt- K8888$Ifgd l kd$$Ifl\d ,"y t0644 lapyt- w x N]wɸɥޓraaOaaaaOaa#h|E&hhX5CJOJQJ^JaJ h|E&hhXCJOJQJ^JaJ#h|E&hSm5CJOJQJ^JaJhSm5CJOJQJ^JaJ#h|E&h|E&5CJOJQJ^JaJ$h|E&h|E&0JCJOJQJ^JaJ h|E&h|E&CJOJQJ^JaJ)jh|E&h|E&CJOJQJU^JaJ h|E&h CJOJQJ^JaJ h|E&h-CJOJQJ^JaJ KID;;6gdhX^gd gd|E&kd|$$Ifl\d ,"y t0644 lapyt-N]=fz&Y ^`gd `gd gdhX`gdhX0]0gdhX Z0]0^gdhX=XYfz&Y_t$%9IJKﺩm#h|E&h|E&5CJOJQJ^JaJ)h|E&h|E&B*CJOJQJ^JaJph)h|E&h B*CJOJQJ^JaJph h|E&h CJOJQJ^JaJ#h|E&h 5CJOJQJ^JaJ h|E&h|E&CJOJQJ^JaJ#h|E&hhX5CJOJQJ^JaJ h|E&hhXCJOJQJ^JaJ*Y$JKZ[gdws(&$d%d&d'dNOPQgd|E&[$\$^`gd [$\$`gd `gd  FGXYZϽެxxggUGU7UGhd}60JCJOJQJ^JaJhd}6CJOJQJ^JaJ#jhd}6CJOJQJU^JaJ hd}6hfCJOJQJ^JaJ hfhfCJOJQJ^JaJ hfh|E&CJOJQJ^JaJ#hfh|E&5CJOJQJ^JaJ h|E&h|E&CJOJQJ^JaJ#h|E&hSm5CJOJQJ^JaJhSm5CJOJQJ^JaJ#h|E&h|E&5CJOJQJ^JaJhkW5CJOJQJ^JaJZ[_`ij#ձ՜ձձvdO)hkWhkWB*CJOJQJ^JaJph#hws(B*CJOJQJ^JaJphhws(0JCJOJQJ^JaJ*hws(0J>**䴳ϴ!%')ɲ(䴳ϴ#ɲ(䴳ϴ#󴥷&*䴳ϴɲ(䴳ϴ󴥷&5Cϴ󴥷&䴳ϴ%;<cdegd ^gd|E&[$gdZ[$gdws(#.>?$%Կ}l}}[J8#hd}6h 6CJOJQJ^JaJ hd}6h CJOJQJ^JaJ hSmh CJOJQJ^JaJ hSmhZCJOJQJ^JaJ)jhSmhZCJOJQJU^JaJ$hSmhZ0JCJOJQJ^JaJ2jhSmhZB*CJOJQJU^JaJph)hSmhZB*CJOJQJ^JaJph)hkWhkWB*CJOJQJ^JaJph,hkWhkW>**䴳ϴ%;9;<abcde쵡~~~o`O h|E&h GuCJOJQJ^JaJh Gu5CJOJQJ^JaJh 5CJOJQJ^JaJ h|E&h CJOJQJ^JaJ#h|E&h 5CJOJQJ^JaJ&h|E&h 56CJOJQJ^JaJ hfh CJOJQJ^JaJ#hd}6h 6CJOJQJ^JaJ&hd}6h|E&56CJOJQJ^JaJ&hd}6h 56CJOJQJ^JaJ(/ =!"#$% $$If!vh#v#vC#v;#v#v #v?#v:V l t0#655C5;55 5?5pFytmekd$$Ifl֞D L(#C; ? t0#644 lapFytme]$$If!v h#v#vC#v;#v#v#vu#v#vu#v ?#v :V l t0#655C5;555u55u5 ?5 pdytmekd$$Ifl D L(#C;uu? t0#6((((44 lapdytme]$$If!v h#v#vC#v;#v#v#vu#v#vu#v ?#v :V l t0#655C5;555u55u5 ?5 pdytmekd$$Ifl D L(#C;uu? t0#6((((44 lapdytme]$$If!v h#v#vC#v;#v#v#vu#v#vu#v ?#v :V l t0#655C5;555u55u5 ?5 pdytmekd $$Ifl D L(#C;uu? t0#6((((44 lapdytme$$If!vh#v#v#vy#v:V l t06555y5apyt-$$If!vh#v#v#vy#v:V l t06555y5apyt-$$If!vh#v#v#vy#v:V l t06555y5apyt-DDx02 0@P`p2( 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p8XV~ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@66666 OJPJQJ_HmH nH sH tH <`< NormalCJ_HmH sH tH 8@8  Heading 1$@&6TT  Heading 2$0@&]0`5CJOJQJL@L  Heading 3$@&`5CJOJQJL L  Heading 9 $0@&]05OJPJQJDA`D Default Paragraph FontZi@Z  Table Normal :V 4 l4a _H(k (No List 0U`0 Hyperlink>*B*R^@R IA0 Normal (Web)dd[$\$OJPJQJ_H.X . hXEmphasis6]j#j |E& Table Grid7:V0Rv1R ws(0Unresolved MentionB*ph`^\q PK![Content_Types].xmlN0EH-J@%ǎǢ|ș$زULTB l,3;rØJB+$G]7O٭Vj\{cp/IDg6wZ0s=Dĵw %;r,qlEآyDQ"Q,=c8B,!gxMD&铁M./SAe^QשF½|SˌDإbj|E7C<bʼNpr8fnߧFrI.{1fVԅ$21(t}kJV1/ ÚQL×07#]fVIhcMZ6/Hߏ bW`Gv Ts'BCt!LQ#JxݴyJ] C:= ċ(tRQ;^e1/-/A_Y)^6(p[_&N}njzb\->;nVb*.7p]M|MMM# ud9c47=iV7̪~㦓ødfÕ 5j z'^9J{rJЃ3Ax| FU9…i3Q/B)LʾRPx)04N O'> agYeHj*kblC=hPW!alfpX OAXl:XVZbr Zy4Sw3?WӊhPxzSq]y ew> Z#%e  Ye 6^qw F X > eXXXXXXX8@0(  B S  ?gV _ g33377<<GGKKk]y{{wwYYttI ;AQbdg77<<GGKKk]y{{wwYYtt I ;AQbdgJE|ek8pax9%6/Q"kB(k 6s0wL ax9 pB("1ax9z?8ZbBB(]iwC bB(65B(h\/?@ABCDFGHIJKLORoot Entry FBSQData  1Table)&WordDocument*>SummaryInformation(=DocumentSummaryInformation8ECompObjr  F Microsoft Word 97-2003 Document MSWordDocWord.Document.89q