Permission to Proceed Department * Date of event MM DD YYYY Time of event Hour Minute Second AM PM Name person in charge First Name Last Name Name second person in charge First Name Last Name Event Location Address 1 Address 2 City State/Province Zip/Postal Code Country Safety Checklist Safety Check First Aid Kit Emergency Phone First Aid Trained Person Ratio 1:5 (under 5 years) Ration 1:5 (Swimming) Ration 1:10 (5-18 years old) Event Details Low Risk Evaluation Medium Risk Evaluation High Risk Evaluation Assessed up Risk assessment officer Yes No Full name of person completing form * First Name Last Name Thank you!