Student Event Risk Management (SERM) – Events Step 1 of 6 16% This form has to be completed in full and submitted to the Society Coordinator on the 5th Floor of the Student Centre in order for SMUSA to approve any society to have an authorized event anywhere and at anytime. If the (S.E.R.M) “Student Event Risk Management Form” is not submitted for consideration or has been submitted and was “Denied” then the society event is not sanctioned.If your event includes any of the following: Alcohol, Transportation, or Activity you must complete the entire "S.E.R.M" form.If your event does not include alcohol, transportation or any activity you are only required to complete "Part A" of the "S.E.R.M" form.The Primary Event Organizer (PEO) must complete and submit this form for approval a minimum of ten (10) business days prior to the event for determination of risk and conformation of risk assessment. Society Events should not be publicized unless they are approved. If you don’t receive an approval notice you cannot assume that your event it is approved. Please refer to the Society Handbook for detailed guidelines.Society Name* Society Email* Primary Event Organizer* First Last Contact Number During Event*Email* Have you or your executive attended the Society Summit?*YesNoTitle of the Event*Event Date* Date Format: MM slash DD slash YYYY Event Date*TentativeConfirmedExpected number of participants*Location of event*Location*On - CampusOff - CampusStart time of event* : HH MM AM PM End time of event* : HH MM AM PM Capacity of the Venue*Event Description/Purpose*Please be very detailed so that we can best assist you in organizing the event.If your event is at the Gorsebrook:*Do you need:- Catering?- DJ?- Audio?- Stage?- Mics, projectors, or other equipement?- Assistance from SMUSA in organizing your event?If no, please just say so. Risk AssessmentThe purpose of this part is to: Identify hazards and associated risks Examine risk management techniques – either to prevent losses from happening or if unavoidable to reduce thefrequency or severity Select and implement techniques such as exposure avoidance, monitoring, and improving the event as needed Protect both the participant and the organizersALCOHOL INVOLVED?*YesNoSection 1 : AlcoholServed by bartenders/venue?*YesNoName of venue*Bartender/Venue management are “SmartServe” trained and are aware of their responsibility not to over serve or serve to minors?*YesNoWill the entrance/ticket cost include alcohol*YesNoIf so, how much alcohol is included in the ticket price?*Non-drinking volunteers (trained in either SmartServe, CPR and/or First Aid) designated to monitor attendees?:*YesNoNumber of expected participants?*Number of non-drinking volunteers present at the event?*Will attendees bring their Health card (MSI, AIG Student Health Plan, etc)?*YesNoWill attendees bring government issued photo I.D. (drivers license, passport, etc.)?*YesNoWill All-age events have a wristband policy in effect? (Persons under 19 not permitted alcohol)*YesNoWill security be informed of this event? (Security must be informed of any event on campus involving alcohol)*YesNoOther Information TRAVEL INVOLVED?*YesNoSection 2 : TRAVELAre you arranging group transportation?*YesNoRent cars/vans (insurance included in rental fee)?*YesNoName of company*Rent bus (insurance included in rental fee)?*YesNoName of company*Driving personal vehicle? (Minimum $1 million insurance)*YesNoTravel arrangements are made for attendees with special needs (if necessary):YesNoArrival/Departures times known by all attendees?*YesNoDo you have a contingency plan for persons missing return transportation?*YesNoWill alcoholic beverages be permitted on the bus and/or rental van?*YesNoWill intoxicated individuals be permitted to board the bus upon departure from Saint Mary's University?*YesNoWill attendees bring health card, identification and passport (as required)?*YesNoOut of province/country?*YesNoOut-of-Province events: Does each student have adequate out-of-province health coverage?*YesNoOut-of-Country events: International students will pick up requisite forms from the International Centre (e.g. “Status letter”*YesNoWill there be a designated Bus/Van/Car Monitor on/in each bus/van/car who will not consume alcohol during the event/trip?*YesNoName of Bus Monitor*Other Information PHYSICAL ACTIVITY/PERSONAL SAFETY RISK INVOLVED?*YesNoSection 3 PHYSICAL ACTIVITY/PERSONAL SAFETYModerate Physical Activity (e.g. dancing, skating, running, etc)*YesNoPlease Explain*High Physical Activity (e.g. ice hockey, skiing, paintball, rock climbing, etc*YesNoPlease Explain*Equipment involving degree of risk (e.g., hot tubs, trampolines, major audio, etc)*YesNoPlease Explain*Personal Safety Issues (e.g., walking after dark, soliciting, working with “at risk” persons etc)*YesNoPlease Explain*Will the Primary Event Organizer bring St. Johns Ambulance approved first –aid kit (s)*YesNoWill there be volunteers (trained in either CPR or First Aid) designated to monitor attendees?*YesNoHow many volunteers will there be?*Will attendees bring health card (MSI, AIG Student Health Plan, etc)?*YesNoWill crowd control measures be put in place*YesNoIn case of an emergency, has arrangements been made for evacuation of students with disabilities?*YesNoWill security be aware of your event and any special circumstances (including minors’ attendance)?*YesNoOrganizers aware of pertinent information regarding nearest hospital and means for transport (location/phone)?*YesNoOther Information COMMUNITY RELATIONS (ON & OFF CAMPUS) RISK INVOLVED?*YesNoSection 4:COMMUNITY RELATIONSWill there be amplified music/speeches?*YesNoAdherence to noise by-laws*YesNoAre you hosting the activity in a residential neighborhood?*YesNoLetter of notice sent to neighbors and surrounding businesses?*YesNoClean up crew has been designated*YesNoVenue staff will clean up*YesNoOther Information: PRIMARY EVENT ORGANIZER CONTRACTI,* First Last Print Namehereby Agree to act as the Primary Event Organizer on* Date Format: MM slash DD slash YYYY For The:*(Name of Organization)Event*(Name of Event)I am fully aware that:1. I will be responsible for organizing the event.2. I will ensure that the planning of the event complies with risk management procedures and alcoholpolicy.3. I will ensure that the rules/procedures for the event are posted for all participants.4. I will ensure that every event monitor is aware of their responsibilities.5. I will complete a detailed Student Event Incident Report and submit a copy to the Societies Committeewithin one working day of the incident.6. I will ensure the event will not compromise the dignity or general well being of participants.7. I am responsible to ensure that all advertising will be consistent with the information I submit on theStudent Event Risk Management form.8. I will return the event venue to the original state that I received it in.9. I am accountable to the President of my society and/or the Saint Mary’s University Students’Association, the Societies Committee, and ultimately Saint Mary’s University.10. If I break the Alcohol Policy or the Risk Management procedures I will be in violation of the SaintMary’s University Students’ Association Constitution and Bylaws and will jeopardize the ratificationof my society.I AGREE TO UPHOLD ALL THE REQUIREMENTS OF THE PRIMARY EVENT ORGANIZER AND AGREENOT TO CONSUME ANY ALCOHOL ON THE DAY OF THE EVENT UNTIL THE EVENT ENDS AND ALL THEPARTICIPANTS HAVE SAFELY DISPERSED.Position in Organization*Student #*(A Number)Local Phone*Date Date Format: MM slash DD slash YYYY For any questions or concerns please contact the SMUSA Society Coordinator via email at [email protected] or via phone at (902) 496-8732.