INDEPENDENT SAFETY MONITOR (Selected by the LSC)

Name of Independent Safety Monitor                         

Phone:      (        )          -

E-mail:  

Qualifications (Check one):            Experienced Open Water Meet Director  

                                                  Please list experience: 

Experienced Open Water Referee 

                                                  Please list experience: _____________________________                                                   

                                                 (Position in Lifeguard/Water Safety Management (prefer open water experience) 

                                                  Please list experience:__________________________________________________

Selected by (Name & Title):     Chris Swensen

Phone:      ( )     -  (cell)

E-mail:  

LSC APPROVAL (To be completed prior to submitting to Open Water Zone Representative)

This application has been reviewed by the LSC and is in compliance with LSC rules and regulations.

Signed:   

Date:  

Name:  

Title: 

E-mail:  

Address:   

City:  

State:  

Zip:  

Basic Information

Name of Host Club:  

Name of Event:  

Event Location:  

Event Date:    

City:  

State:   

LSC:  

Zone: 

Length of Race(s:)  

Age Groups Participating: (circle all that apply)              10&U            11&12         13&14              15-18              Open 

Key PErsonnel

Meet Director(s):  

Cell Phone:      

Home Phone:  (          ) 

E-mail:  

Meet Referee:  

Phone: ( )    -

E-mail :

Meet Safety Officer:  

Phone: ( )

E-mail: 

WATER QUALITY:                        See Even Safety Plan

Step 1:  Attach certificate (or reference URL site) with necessary information showing the site meets local governing body requirements for bathing. 

Step 2:  One week prior to the event, check water quality again and submit certification (or reference URL site)  to the Independent Safety Monitor 

Step 3:  On race day, submit additional water sample for certification.  If results returned are inconsistent with the local governing body’s standards, notify swimmers who participated in the event of any known exposures post-race. 

If an exceptional event such as heavy rain or flooding affects the water quality, the Referee, the Meet Director, or the Independent Safety Monitor shall have the authority to postpone or cancel the race.

TECHNICAL MEETING (Recommended)             See Even Safety Plan

Tentative date/time of recommended Technical Meeting (within 24 hrs of race, athlete and/or coach/designated coach required to attend):

PRE-RACE MEETING (Required)                  See Even Safety Plan

Tentative date/time of MANDATORY Pre-Race Safety meeting (athletes must attend to participate in race): 

RACE PLAN

Race Day conditions                      See Even Safety Plan & Meet Notice

Expected air temperature:  

Expected water temperature:   

Minimum Allowed: 60.8°F         Maximum Allowed 5K+: 87.8°F

Combined air & water temperature: (Must be between 118°F and 177.4°F)  

Type of body of water: (circle one)       Ocean       Lake          River           Other: 

Water type: (circle one)     

Course: (circle one)    Closed course (not accessible  by boat)                                           Open course   

General water depth of course:   

If open course, please indicate the agency used to control the traffic while swimmers are on the course.. 

Agency:  

How to contact during event: 

Expected water conditions for the athletes: (marine life, tides, currents, underwater hazards)

How is the course marked?

Turn buoy height:                       Color  

Intermediate buoy height:    Color  

Starting Location:        

Finish Location:           

FEEDING STATIONS: None

Designated area that nourishment may be passed on to athletes. It is recommended that the feeding station be a boat, series of boats, or barge.

Will you have a feeding station?                

What type of structure(s) will serve as the feeding station? 

How many people can the structure(s) safely hold? 

MEDICAL Personnel

Name of lead medical personnel (emergency trained) on site : 

Circle One: 

Experience in extreme events (Marathon, Triathlon, etc)(Recommended):  

Will medical personnel be located on the course?                            

The required number of medical personnel will be dependent on the course layout, number of athletes in the water, expected conditions, etc.  How many medical personnel do you plan to have on site?  _____

FIRST RESPONDERS/LIFEGUARDS

Indicate the qualifications of the first responders (prefer open water experience).

ARC Lifeguards                  USLA                     YMCA                     Equivalent water certified first responder___

3_________

Number on course: _

Indicate their location on the Race Plan Map 

AMBULANCE/EMERGENCY TRANSPORTATION

MANDATORY  Number on site: ____

Have you spoken with the local emergency response agency regarding your event and potential emergencies?  Yes             No

ON SITE MEDICAL CARE                    

Describe the on site set up for medical care, such as medical treatment tent, heating or cooling tent or facility.  Indicate the location on the Race Plan Map.  

MEDICAL FACILITIES                            See Even Safety Plan

Name of closest medical facility: 

Type of medical facility: (eg. urgent care, hospital) 

Distance to closest medical facility: 

Approximate transport time: 

WATER CRAFT 

Sufficient coverage to cover the course: Number__ ___

List additional water craft for Officials (not counted as safety craft):    

List other water craft for race supervision: (Boats, Jet Skis, Kayaks, paddle boards, etc)   

List additional water craft for feeding stations (if over 5K): 

List additional water craft for escorted events: 

Emergency Signal Flag MANDATORY for all water craft (Boats, Jet Skis, Kayaks, paddle boards, etc):  Color _  

ATHLETE ACCOUNTABILITY                  See Even Safety Plan

Describe method of athlete body numbering (MANDATORY): 

Describe method  of electronic  identification of athletes (Recommended): 

Describe different cap colors for the various age groups/genders? (Recommended): 

Describe method of accounting for all competitors before, during and at conclusion of race(s):  

WARM-UP/WARM-DOWN PLAN                     See Even Safety Plan

Explain safety plan for warm-up/warm-down.

COMMUNICATIONS  

Primary method between Meet Officials:           Radio        Cell Phone     Megaphone      Other _______________

Secondary method:     

Primary method for communicating between medical personnel, first responders & safety craft:  

Radio(separate channel/method from above)      Cell Phone           Megaphone        Other _____ __________________________

Secondary method:  

SAFETY PLAN:                                  See Even Safety Plan

Maximum number of swimmers on course at a time: 

If more participants show up on race day, what is the procedure for adjusting the safety plan to accommodate the increased number of entries?

.

How are the lifeguard staff and safety crafts distributed to supervise this event to maximize the recognition, rescue and treatment of any athlete?

How is the safety staff deployed to maximize the rapid response to a troubled athlete 

How will the event be altered if insufficient safety personnel/craft are available race day? 

.

Missing athlete plan: 

SEVERE WEATHER                                         See Even Safety Plan

Is a lightning detector or weather radio available on site?   

What is the severe weather plan?  

What is the site evacuation plan?

TO BE COMPLETED BY OPEN WATER ZONE REPRESENTATIVE

Approved:  

Signed: 

Date:

Name: 

E-mail: