Author: Mads Frimann Madsen

Declaration - before fieldwork commences / To be filled in by responsible DTU field leader (or DTU leader/DTU supervisor if field leader is not from DTU)
Name of DTU field leader (or DTU leader/DTU supervisor)* as well as university unit:	Place for field work (country):
Name of representative in local working environment organisation:	Period for field work:
Working environment and risks
Where does the work take place (laboratory, forest, inland ice, ...):
What type of work? / Describe in brief the job function
In case of risky work, there are completed a risk assessment and emergency procedure, that has been approved by the local working environment organisation.	[Yes] Risk assessment □ / [Yes] Emergency procedure □ [Yes] □ : Approved by:
What are the risks and how are they prevented? Describe which safety equipment, technical and personal protective equipment that will be available during the field work
field attendee are instructed in the work, risk assessment, emergency procedure and safety equipment. It is verified that the field attendee complies with all security procedures.	[Yes] Work □ / [Yes] Risk assessment □ / [Yes] Emergency procedure □ / [Yes] Safety equipment □ / [Yes] Check □
Are there thought of any other essential circumstances (specify which) e.g. Known risk areas, vaccinations, etc. **	[Yes] □ : what:
The guidelines for field leader responsibility for stationed employee under field work are complied with (described at DTU-Inside)	[Yes] □ / [No] □ : What deviations:
Where is this declaration maintained?
This declaration is signed by	Date and signature
DTU field leader (or DTU leader/DTU supervisor if field leader is not from DTU) (under responsibility)
It is approved by the nearest DTU leader that the DTU field leader is competent in relation to his responsibility / Name:
Local working environment representative
The statement is regularly reviewed and updated as needed
* If the field leader is not from DTU, the field leader's responsibility goes to the DTU leader or DTU supervisor - The declaration of DTU field leader is also filled in. / ** A consent declaration must be signed if field work involves a trip to a possible risk area - contact HR