Feedback/evaluation Form Page 2
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Queen's University Off-Campus Activity Safety Policy
Feedback/Evaluation Form
C. Living Accommodations
1. Do you have any comments about the living accommodations that were provided?
D. Health and Safety
(please circle the appropriate response, and add comments/explanations where appropriate)
1. In the case of an international activity, did you register at the Canadian Embassy/High Commission?
Yes
No
n/a
2. Did you acquire supplemental travel health insurance before you departed?
Yes
No
n/a
3. Did you have special needs that you identified prior to departure?
Yes
No
n/a
4. Were these special needs addressed during your off-campus experience?
Yes
No
n/a
5. Did your special needs become an issue during your off-campus experience
Yes
No
n/a
Please explain:
6. Did you have any incidents affecting your health and/or safety that resulted in medical,
legal or police support?
Yes
No
n/a
Please explain:
7. Did you have any incidents affecting your health and/or safety that you did not take
medical, legal or police action to address?
Yes
No
Please explain:
8. Did you become ill during your off-campus activity?
Yes
No
9. Did you seek medical treatment?
Yes
No
10. Did you have to abandon the activity prematurely due to illness or injury?
Yes
No
11. Was illegal or disturbing drug-related activity evident in the area in which you were living/working?
Yes
No
12. Did anyone intentionally damage any of your property?
Yes
No
13. Did anyone steal anything from you? (e.g., from your room, car or luggage,
even if it was something minor. Include the theft of books.)
Yes
No
14. Did anyone take anything from you using force or the threat of force?
Yes
No
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