Feedback/evaluation Form (Page 3 of 3) in pdf

Feedback/evaluation Form Page 3

Form 2

Queen's University Off-Campus Activity Safety Policy

Feedback/Evaluation Form

15. Were you the victim of an assault?

Yes

Please explain:

16. Did you experience or observe any obscene or annoying or harassing behaviour, not involving violence?

Please explain:

Yes

17. Were you caught up in any riots, public demonstrations or acts of civil unrest?

Yes

Please explain:

18. Did you experience any natural calamity (e.g., flood, fire, earthquake)?

Yes

Please explain:

19. Did you experience any form of danger not directed specifically at you?

Yes

Please explain:

20. Do you have first-hand knowledge of any crime affecting another participant in your activity?

Please explain:

Yes

21. Did you make use of the Queen's Emergency Support Protocol?

Yes

Please explain:

Very unsafe----------------------very safe

22. In general, how safe did you feel during your off-campus experience?

23. If your activity involved a host situation, how safe did you

feel at your host institution?

If you felt unsafe or very unsafe, please explain in what way the host situation was unsafe:

not at all resolved-----------------fully resolved

24. If you experienced any health or safety incident, please indicate

the degree of satisfaction that you feel regarding its resolution?

Please explain:

25. Please provide any other comments that you feel would be useful when planning and preparing for similar

activities in the future (attach additional sheets if necessary):

When completed, this form may be submitted to the Off-Campus Activity Leader, Principal Investigator/Activity

Coordinator, Department/Unit Head, Director of Environmental Health and Safety, or other University official.

Page 3 of 3

Feedback/evaluation Form Page 3