Writing A Trip Report

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Death of a Pupil on a School Trip - Lessons for Schools,
Employers and Teachers.

The Health and Safety Executive, the UK Regulator of Health and
Safety have published a report on the death of 10 year old Max
Palmer on an educational visit in 2002.

The HSE is analogous to the OSHA and has a remit to investigate
accidents and to prosecute under safety law.

Max was killed in a "plunge pooling" incident in the Lake
District in Cumbria in England's beautiful Lake District. The
Lake District is popular with schools for outdoor activities for
English schools and Max was killed during one such trip.

The weather was poor, the river was in spate and the water was
very cold and arrangements were unsatisfactory.

This report summarises the very detailed investigation into the
circumstances around the incident by the HSE and the Cumbrian
Police.

The investigation subsequent to the accident led to the
prosecution and jailing of the teacher in charge of the visit
for one year on a manslaughter charge.

HSE highlights in its report the fact that the report is
produced to: "Prevent further tragedies, not to blame."

The Legal Position

In the UK reponsibilities are apportioned as follows between
Schools, Employers(usually Local Councils) and Teachers as
follows:

*Employers are responsible for ensuring the effective management
of Health and Safety.

*Teachers, Heads and Managers are responsible for the Health and
Safety of pupils both when they are on school premises or when
they are offsite on authorised school activities elsewhere.

This responsibility is actually written into national teacher's
conditions of service and is also part of the Common Law "duty
of care" owed by one person (or body) to person not to act, or
fail to act, so as to avoid causing harm.

So what are the causes of this incident and what are the
lessons which can be learned from it?

Causes:

The Investigation identified two main causes for the tragedy:

1. The actions of the teacher in charge of the activity, before
and during the incident.

Amongst a range of shortcomings we can highlight the following:

The teacher who led the visit joined the school in 1998 as Head
of Geography and claimed to have "Mountain Leader Award", in
fact subsequent investigations showed he had not successfully
completed this award.He was also inadequately trained in First
Aid.

His actions contravened normally accepted good practice and
whilst teachers from another school staying at the centre
actually cancelled activities because of local conditions he
allowed water based activities to go ahead in water temperatures
of 47 degrees Fahrenheit.There was an inadequate and no ongoing
Risk Assessment.

The levels of supervision were inadequate. The apparent ratio
was 1 Adult to 5 Children but actually neither of the other
adults were experienced and so the level was actually 17:1.

The Emergency Response was inadequate when the emergency
actually occurred the teacher tried to save Max but quite
quickly succumbed to the cold and when he got out of the water
took no further part in the rescues.

The protective devices needed were not available, there was an
attempt at rescue with a "rope" made of knotted
towels.However,it was not until a pupil was sent to fetch a rope
from the activity centre being used by the trip that the alarm
was raised.Teachers from another school brought emergency rescue
equipment and were praised in their conduct by the report.

2.The weaknesses of the safety management system which allowed
the trip to go ahead and an unsuitable leader to be in charge of
children doing a high risk activity in difficult environmental
conditions, without adequate precautions.

A range of safety management shortcomings were identified but
whilst these may have contributed to allowing the incident to
happen they did not cause the incident.

The key point is that Health and Safety needs to be managed
effectively both by the employer and by the school.

Defects which allow The fact that a teacher could be appointed
as a leader when not adequately qualified or competent to lead,
is highlighted by the report.

What are the Lessons to be learned ?

The main lessons can be summarised as follows:

1. Leaders of outdoor activities in schools need to be competent
and diligent always putting the safety and wellbeing of the
children first.The Employer and the School need to determine who
will check qualifications and competence.

This means that ALL the adults who accompany a visit need some
form of training and any Leader needs to be competent for the
activity they are supervising.Competent when used by Regulators
generally relies on Lord Cullen's definition in the "Piper Alpha
Report" and means "sufficient knowledge skills, experience and
qualities" it also means "appointed in writing". A leader will
be a person who can carry out a meaningful and relevant risk
assessment on the spot and considering local conditions because
they "know" the activity planned.

This doesn't mean that every "leader" i.e adult going on a trip
has to be a mountaineer or an expert skier... people will have
different levels of competence but all adults on a trip should
have at least basic visit and safety training.

A suitable qualification for newer teachers and classroom
assistants which covers visits and the range of School Safety is
the College of Teachers Certificate of Educational Studies -
School Safety I.

This can be viewed at www.swaneducation.co.uk.

2.Visits should always take place under the aegis of "good
practice" and schools need to be sure that they either have "in
house" or have access to suitable personnel to deliver this.This
means that a list of approved visits is maintained and a
procedure is set up to accept/reject new "activities" proposed.

To see what "good practice" looks like in the UK for school
visits this is set out in the following free documents:

DfES - Guidance on Educational Visits (1998) and it's 2002
supplements available at
http://www.teachernet.gov.uk/wholeschool/healthandsafety/visits/

The Scottish Executive Education Department has also issued
relevant guidance - "Health and Safety on Educational
Excursions" which can be available at:

http://www.scotland.gov.uk/library5/education/hsee-00.asp

3. Schools need to have effective management systems in place
with suitable policies to ensure that proper planning and
preparation of visits goes ahead under clear policies and
procedures.

The Glenriddings Report highlights some important ones:

Approval,Parental Consents, Bringing External or Related
Children on Visits, Supervision on Visits,Medical Conditions,
Swimming, First Aid etc.

4. Favourable comments from Inspectors (in England and Wales
OFSTED) about educational visit programmes are no warranty that
the visits or practice are safe and are certainly no substitute
for thorough Risk Assessment.

5 Headteachers can delegate safety functions(NB not
responsibilities) but need to establish clear lines of
accountability. Every School should have a person responsible
for Health and Safety.For a way to distribute Safety Management
see http://www.swaneducation.co.uk - College of Teachers
Accredited Training Certificates of Educational Studies - School
Safety II). This includes an Option on Educational Visits, and
others on School Risk Assessment,School Safety Training and
School Safety Committee Operations.

6.All Educational Visits need to be operated through the
continuing assessment of risk. Risk Assessments need to be
relevant,have a clear regard to supervision levels and consider
how the party would respond in case of an emergency. The two key
words here are relevant and continuing. The report clearly
showed that the Leader was not competent to make a Risk
Assessment, so any Risk Assessment done by him was flawed.The
Risk Assessment did not take account of the local conditions so
it was not a continuing, ongoing or dynamic Risk Assessment.
Some other shortfalls identified included the levels of
supervision and the impact that this, and the lack of emergency
planning had on the outcome of theincident.

7.The Employer and the School need to clarify between them who
supplies "Generic" who "specific" safety training to avoid
confusion.There also needs to be clarity on who checks
qualifications and competence as this problem

8. Governors and School Boards are "informed friends" of the
school and Governors carry out a role analagous to non executive
directors in companies.The lesson to be learned from the report
is that Governors need to be trained as to what questions need
to be asked and Head teachers need to be sure that the Governors
are asked for approval well before any visit is planned. The
Governor's role is to probe the logic and value of the trip and
to act to check that all precautions are in place.

9.Monitoring and audit provide mechanisms whereby the compliance
with School and Employer Safety Systems can be checked. In
addition to normal in school monitoring by Govenors and the
Head, it is also recommended that field monitoring of visits
should be undertaken.

In conclusion, the report on this tragic incident gives all of
us in Education food for thought and in many cases one hopes a
timetable for action.

It is impossible to manage safety without a system to manage
within but I do welcome HSE's support for distributing some of
the safety management functions.

HSE in the report also drew attention to the delivery of major
and important documents to Head teachers without a support
infrastructure.

Pieces of paper are NOT a system. Any system of safety
management needs to be "owned" by the school.

Heads get hundreds of documents year all of them are important
but they need time and/or tools to manage effectively.

This is why I produced a Headteacher's Safety Management
Toolkit....

I hope that it and shortish briefing papers like this which I
provide free from time to time will help provide some focus and
some of that support.

About the Author

Dr. Paddy Swan is a qualified teacher with some 25 years safety
experience in industry and has produced 100 safety training and
management systems for international corporates. He is currently
the Principal Consultant of Swan Education which is an
Accredited Centre of the College of Teachers. Paddy is the
author of the Open Learning materials for the College's
Certificate of Educational Studies (COES I &II School Safety)
www.swaneducation.co.uk

My Hollywood Casino Joliet Trip Report


writing a trip report
writing a trip report
writing a trip report