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Risk Management PlanDance Visions Academy

Sienna ThornburgSerena Grossman

Wednesday, June 5, 2013

Dance Visions Academy

Our desire is to inspire the dreams of movement, dance and performing style in both

boys and girls. Our academy offers a full curriculum in classical ballet, jazz, lyrical,

contemporary, modern, tap, musical theatre, acrobatics and hip hop with a special

emphasis designed to introduce these dance forms to young children. Our daily pre-

professional ballet program grooms the advanced dancer for a future career or an

exclusive university dance program. Dance Visions Academy offers a highly

credentialed staff with international ballet companies, Broadway credits, television and

film resumes.

Visit our website at www.dancevisionsacademy.com to view our 2012-2013 Schedule

and teacher bios.

OUR GOAL as teachers at DANCE VISIONS ACADEMY is to develop strong, properly

trained bodies, a joy in movement, and appreciation of music, a gentle discipline, a

pride in accomplishment and a love of fine arts.

Risk Management Plan

http://www.dancevisionsacademy.com/


Table of Contents

1. Philosophy & Policy………………………………………………………………………….2

2. Needs Assessment…………………………………………………………………………..3

3. Goals & Objectives…………………………………………………………………………..4

4. Site & Facility…………………………………………………………………………………5

5. Program Development……………………………………………………………………….6

6. Supervision……………………………………………………………………………………7

7. Rules, Regulations & Procedures…………………………………………………………..8

8. Safety Inspections……………………………………………………………………………9

9. Accidental Reporting……………………………………………………………………10-11

10. Emergency Procedures…………………………………………………………………..12

11. Releases & Waivers………………………………………………………………………13

12. Insuring Against Risk……………………………………………………………………..14

13. In-Service Training………………………………………………………………………..15

14. Public Relations……………………………………………………………………………16

15. Outside Specialists………………………………………………………………………..17

16. Periodic Review……………………………………………………………………………18

* Appendices…………………………………………………………………………………………..19

Risk Management Plan


Philosophy & Policy

PhilosophyIt is the basic purpose of Dance Visions Academy to teach various forms of dance to students of all ages in a manner that improves their knowledge, ability and appreciation of the dance form. We are committed to a philosophy of using only qualified and trained instructors, to provide dance instruction in a safe environment, with the best and most reasonable standard of care possible. We want to ensure the safety of all participants, spectators and employees.

To that end, we endorse the establishment and maintenance of an extensive program to manage risk safely within the organization. A risk management plan is written, reviewed, or updated annually by the Director and Manager of Dance Visions Academy. The review shall include the modification of work practice controls, the process of inspections, and risk reduction procedures for any new programs that are implemented.

The plan includes responsibilities for risk management, hazard recognition and inspections, accident/ incident reporting, equipment, facilities, emergency action plan, training, waivers and insurance.

PolicyIt is the policy of Dance Visions Academy to ensure:

Proper supervision : All instructors are required to have proper certification or experience in dance instruction and to supervise students at all times during class periods.

Safe facilities : Classrooms shall provide a safe environment for students to learn by being clean, using proper and safe equipment, a studio free from obstructions, with students’ and instructors’ gear and personal effects stored in a designated area away from the dance floor.

Effective Programs : All classes shall begin with an appropriate stretch and warm-up period to minimize risk of injury to participants. Teachers will instruct based on students abilities and practice safe methods to ensure that students do not get injured in the process.

Risk Management Plan Page 4


Needs Assessment

We need to keep our risk management plan updated throughout the year. To do this we have a task force made up of our instructors to insure these steps are assessed at the appropriate times. Our Head Instructor will be in charge of delegating all tasks to appropriate instructors. Each instructor will be put into a team and have a certain task they need to have completed in their time frame. The sections will be as follows:

1. Philosophy policy, emergency procedures, site, and facility will be assessed once a year

2. Goals, objectives supervision, insurance, legal specialists, public relations will be assessed bi-yearly

3. Rules, regulations, procedures, releases, waivers, agreements to participate, in-service training, and needs assessment will be assessed quarterly.

Accident Reporting will be done daily by all staff.

* Preliminary Sixteen-Step Checklist: See page 20 in Appendices



Goals & Objectives

GoalTo avoid injuries or accidents to all students and instructors that occur at Dance Visions Academy, during dance instruction and in all areas of the facility.ObjectivesIn order to prevent injury and accidents, Dance Visions Academy will strive:

1. To develop appropriate safety rules and procedures.2. Have students, parents and instructors acknowledge and agree to said safety

rules and procedures.3. Post safety rules and procedures in a prominent place at the dance facility so all

members can visibly see policies.4. Conduct a program of periodic monitoring and checks to ensure compliance with

the guidelines of the facility.

GoalStaff members will create a list of new or previous goals at their quarterly staff meeting and carry them out at the following quarterly meeting.Objectives

1. By creating their own goals, staff members are more likely to abide by them.2. They address goals that relate specifically to themselves or their specific area.3. Staff members can voice their opinions in a safe place where they will be heard.

GoalAll studio facilities will be checked six times annually.Objectives

1. This will ensure all facilities are properly maintained for the business to run successfully.

2. Ensure that facilities are safe for students and instructors.3. Check for any broken fixtures, mirrors, barres, etc. that directly affects the daily

running of the studio.

GoalAll staff members will be CPR, First Aid Certified, and trained in Emergency Procedures protocol.Objectives

1. This will ensure students will have immediate care if an accident occurs.2. If there is an emergency, all staff will be prepared to take action immediately.3. Forms trust between the families of the students and the academy by ensuring

them we are doing everything in our power to protect their children from all hazards and danger.



Site & Facility

SiteWe strive to ensure:

1. Elimination of all potential site and building hazards2. Conformance to all applicable building codes3. Conformance to federal, state, and local rules and regulations including size,

layout, health, fire, emergency and accessibility standards4. Functional, aesthetically pleasing facilities

* Site Floor Plan: See page 21 in Appendices

FacilityPossible Risks:

Personal Risk : Injuries to each dancer are common (sprains, bruises, cuts, blisters,...etc.). To reduce risk, make sure dancers are in a safe environment and are responsible for their activity. Dancers must assume their own risk while in the studio.

Lighting : There must be adequate lighting for dancers. Make sure all lights stay on while in studio, even during daytime hours.

Floors : Floors must be cleaned at the end of every week (Sundays) with a mop and water. Hazards due to dirty floors not being safe to dance on and to reduce infection spread via feet, sweat, dirt...etc. Instructors must make sure floor is cleared and free from any slick spots due to oils, water and sweat before and after class is over.

Equipment : Dance equipment such as but not limited to: barres, mats, mirrors, floors, music systems,...etc. must be inspected on a regular basis (daily) by instructors and other faculty. Any hazards must be reported in a timely manner and corrected.

Crime or unwanted intruders : Due to late classes, the studio must remained locked to any outside intruders after dark. Doors must be able to be locked so students can be safe inside facilities. Front desk must be manned at all times in the lobby area, especially during evening hours. This provides a sense of security for members.

* Grounds Inspection and Evaluation Checklist: See page 22 in Appendices



Program Development

Instructor Qualifications

* Job Description Form: See page 23 in Appendices

Progression PrinciplesClass levels shall be set by student age and experience.

* Class Progression: See pages 24-26 in Appendices

Class SizesClasses sizes are limited based on studio size. The maximum capacity of each studio is as follows (not including instructors or possible quests):

Studio A: 30 students Studio B: 50 students Studio C: 20 students Studio D: 25 students Studio E: 30 students

Releases, Waivers or AgreementsAll students shall sign a liability release prior to participating in any classes, with parents signing releases for students under the age of 18. All students must understand the rules and regulations of the studio before becoming a member.

* See page 13: Releases and Waivers for more information

Record KeepingRecords shall be maintained for the following:

Instructor certification and experience Evaluations of both students and instructors Safety instruction Class schedules and enrollment Liability release forms Emergency procedures Accident / Injury Reports Standard employment records Student enrollment contracts



Supervision

Supervision through staff meetings held every other week. Meetings review the following:

Changes in class schedule and enrollment Staff performance reviews and evaluations Review rules and procedures as well as changes to same Review facility and safety inspection results Discuss staff suggestions and recommendations

PLAN OF SUPERVISION

HEAD INSTRUCTOR’S RESPONSIBILITIES

INSTRUCTOR’S RESPONSIBILITIES

STUDENT’S RESPONSIBILITIES

Ensure all students under his/her jurisdiction are aware

of policy and procedure.

Advise all students of this policy and procedures.

Adhere to policy.

Ensure that instructors in his/her section enforce this

policy and procedures.

Ensure that students follow this policy and procedures.

Follow the procedures.

Issue warnings or initiate disciplinary action as needed to

ensure student compliance.

Ask for additional training if needed.

* Introduction to Safety for New Employees: See pages 27-28 in Appendices



Rules, Regulations and Procedures

Review all program areas for safety rules and regulations.

Safety RulesIn order to reduce risk, there is a general studio etiquette we ask all participants and teachers to abide by. In this way, everyone can understand how he or she should conduct themselves in order to abide by Dance Visions Academy’s rules of safety.

* Studio Etiquette: See page 29 in Appendices

RegulationsMost risk associated with the academy comes from personal injury or accidents. In order to reduce these risks we ask students to follow our strict dress code rules to decrease their chances of improper wear while participating.

* Dress Codes: See page 30 in Appendices

ProceduresWe keep a detailed documentation of all formal procedures between students and the studio. We set clear policies relating to behavior and tuition payments.

* Policies: See page 31 in Appendices

* Tuition Statement: See page 32 in Appendices



Safety Inspections

Here at Dance Visions Academy, we are dedicated to developing a routine, systematic method for safety inspections and investigations. We strive to:

Determine what is to be inspected and how frequently. Make it a regular practice. Establish a pattern of inspections and demand for need. Develop a series of checklists suitable for easy application throughout the

system. Establish a method of reporting faulty equipment and maintenance problems that

allows minimum downtime and maximum follow-up. Develop a reporting and monitoring system that will allow easy access to vital

statistics regarding breakdowns. (When, where, why and how often) Investigations will depend on the frequency and severity of damages and/or

breakdown.

* Safety Inspections Inventory: See page 33 in Appendices



Accidental Reporting

The accident reporting procedure is as follows:

Employee Accidents: ALL on the job injuries need to be immediately reported to a supervisor. Report

of Accident Forms (Employee Supervisor, Witness[when applicable]) need to be completed for every injury or accident. After supervisor review, copies of the reports shall be routed to the Director of Operations and Development and the Risk Management Division within 24 hours.

Forms are available in the office. Under Dance Visions Academy’s policy, employees injured on the job should go

to Med People. for treatment. For after hours injuries or emergencies, the employee should seek treatment at the Starling City Hospital Emergency Room. Any follow up Care should be done at Med People.

Any medical treatment performed by the employee’s personal physician will not be covered by workers compensation.

When the injured employee returns to work, they must have a doctor’s release stating what work they are physically capable of performing and restrictions to their work activity.

- The Supervisor’s Report of an Accident form is completed in the case of damage to city property.

- The Accident Report is for bodily injury.- Witness’ Report of Accident form is for any witness to the accident who

are not members of the Dance Visions Academy.

Visitor Participant Accidents: Inform supervisor immediately Inform Division Director/ Safety Director. Inform Risk Management. Fill out Accident Report form completely, and route to the Owner of Dance

Visions Academy within 24 hours. Take the time to gather information- names, addresses, witnesses, etc. that would be helpful in the follow-up accident investigation. Fill out the form completely and legibly.

Employee Safety: Make sure first aid kits are stocked. If any site is in need of employee safety equipment contact the head instructor

onsite.



* Accident Report: See page 34 in Appendices

* Report of Injury Instructions: See pages 35-37 in Appendices



Emergency Procedures

Emergencies must be taken seriously and could happen at any time. Emergency procedures go as follows:

1. All employees must be CPR certified and trained in First Aid.2. All employees and dancers must have medical forms on file.3. All employees must know where to locate first aid kits and fire distinguishers.4. There will be a daily schedule for checking the first aid kits in every employee’s

area.5. Each first aid kit will contain emergency procedure cards.6. All employees should know the emergency evacuation plan 7. Have all emergency phone numbers in every first aid kit.

* Emergency Procedures: See pages 38-40 in Appendices



Releases and Waivers

Dance Visions Academy has a strict philosophy toward the use of releases, waivers, and agreements to participate. We require that all students read and fill out the proper forms in order to participate at the academy. It is crucial that both the studio and the students/parents understand their roles within the agency. All forms are kept on file for every student in attendance. All forms are to benefit the students in case of injuries or accidents that occur at the facility.

* Liability Release Form: See pages 41-42 in Appendices

* Acknowledgement of Risk: See page 43 in Appendices

* Health Form: See pages 44-46 in Appendices

* Statement of Admission: See page 47 in Appendices

* Indemnification Agreement: See page 48 in Appendices



Insuring Against Risk

To insure against risk, Dance Visions Academy uses transference because it will help to protect us against potential risks. This means we will use an outside insurance policy to cover accidents and liabilities.

Dance Visions Academy holds: General Liability, Umbrella Liability, Travel and Tournament Coverage, Excess Accident medical, Property Coverage, and Crime insurances. These insurances are provided by Markel Insurance Company to protect our employees, dancers, and property.

General Liability: Protects against being sued for claims that caused someone physical injury or damage to their property. $1 million/occurrence; $3 million aggregate

Umbrella Liability: Umbrella liability provides extra protection for catastrophic events. Umbrella Liability goes into effect after general liability insurance is exceeded and up to $5 million.

Travel and Tournament Coverage (for dance competitions): Covers dance competitions that we sponsor for students and instructors participate in. We have the Broad Tournament Coverage that protects us when we are the sole or participating sponsor of a dance competition.

Excess Accident Medical: If students are injured at school or during sponsored activities, Excess Accident Medical insurance pays their covered medical expenses. There’s coverage up to $10,000 in medical expenses per student with a $25 per claim deductible.

Property Coverage Buildings: Protects your building whether you own or rent. Business income: If your school is temporarily closed due to a covered loss

(fire, lightning, windstorm), this insurance covers your lost income and continuing expenses.

Business personal property: Protects your office furniture and fixtures if they are damaged by a covered cause of loss.

Systems breakdown: Protects you when any mechanical, electrical, or pressure system breaks down. This includes heating and air conditioning systems, computers, boilers, refrigerators, hot water heaters, and telephone systems.

Other Coverage Crime: Covers employee dishonesty, theft of money and securities, and forgery.



In-Service Training

Procedure For New Instructors

Goal: For new instructors to learn the rules, regulations, guidelines, and procedures at Dance Visions Academy.

Objectives: Within the first month of hire, each new instructor will be guided through the daily operation of the Dance Visions Academy by the Head Instructor, which will include but not be limited to:

1. Rules in the studio2. Warm-up techniques3. Tuition Collection4. Choreography5. Cleaning6. Behavioral Issues7. Emergency Procedures8. Sickness or Injury9. Dance technique10.Critique of students

Academy’s training will be held every month for new employees. This will continue up to one year or as required. All employees that have been with Dance Visions Academy for one year or more will have a mandatory, paid, in-service training every four months.

Procedures for All Instructors

Goal: Know all procedures, rules, regulations, and guidelines of Dance Visions Academy.

Objectives: Have a quarterly meeting to go over all procedures, rules, regulations, and guidelines. Discuss any concerns, new objectives/ procedures, and upcoming events at these meetings.

In-service training or other department training shall be as described in the Dance Visions Academy Policy Manual. Training shall be provided at a frequency to be determined by the Head Instructor (not less than quarterly), and shall include instruction on building security and alarm systems, evacuation plans and procedures, child safety.

Guest instructors including the discussion of new trends, tips, movements, etc. shall provide topic specific training. All training is mandatory and employee will be compensated for their time at no less than 2 hours per session.

* Administrative Policy on Safety: See page 49 in Appendices

* New Employees Safety Orientation Checklist: See page 50 in Appendices Risk Management Plan Page 17


Public Relations

In an effort to maintain a suitable environment at Dance Visions Academy, we strive to incorporate the following:

Having informed, visible staff Being nice to people Consistency of rule enforcement Treating users like family Well-kept and maintained areas and facilities Using waivers, releases, and agreements to participate Employing only qualified personnel

Sample Statement to Injury:We would like to offer our condolences to the student and the parents who were affected by the injury. The student is a true asset to our team here at Dance Visions Academy and we hope to have them back as soon as they are in good health.

Here at Dance Visions Academy, we are accredited and licensed by the state to instruct dance. We keep detailed health records of all students and hope they will assume risk when participating at the academy.

We would like to say how saddened we are by the injury/accident. We hope nothing but health and a speedy recovery for the future.



Outside Specialists

Beal Business Law- Bruce Leonard Beal -

Business Attorney

34242 Pacific Coast HighwaySuite D Dana Point, CA 92629

TEL: 949.481.5555

Legal InsuranceWe will have a General Counsel Retainer for Dance Visions Academy. For a minimum monthly retainer fee we will have access to a package of business law services. These services are specifically tailored to meet our needs. It will provide us with sound advice of a business attorney. With an experienced business attorney on retainer, we will have quick and inexpensive advice from someone who already knows our business. The General Counsel Retainer allows us an agreed minimum amount of hours each month to respond to our immediate legal concerns by telephone, email, or meetings, including at in-house. Our legal fair will be managed and it will help to prevent legal problems. Other legal advice we will have access to includes:

risks and benefits of any business decision advice regarding general corporate and commercial legal matters advice regarding general professional legal matters contract negotiations, drafting, review, interpretation, claims and resolutions private procurement, proposals, and contracting assistance government procurement, proposals, and contracting assistance international transactions, projects, and businesses real estate matters corporate policy development, including personnel policies, including hiring and

firing environmental issues design, engineering and construction contracting matters



Periodic Review

Having risk management requires updating all the time. In order for validity to be established, certain elements need to be reviewed more frequently than others.

For example, safety inspections and accident reporting need to be done daily. They need to be done daily because we need to make sure all areas are clear of debris and any other dangerous objects that could affect our dancers’ wellbeing.

All agreements made between Dance Visions Academy and the students need to be reviewed monthly. We need to keep all their information up to date and make sure all legal aspects are still current. Insurance will also need to be reviewed monthly so that the policy can be updated if any new policies or regulations have been established. This is to keep our students, establishment, and instructors covered.

Emergency procedures will be reviewed at the quarterly staff meeting. The instructors and students will participate in an emergency drill once every quarter. The time of the drill will be decided upon by the head instructor. This will ensure the quality and accuracy of each instructor’s ability to abide by the emergency procedures and perform accordingly. When drill is over the instructors will be assessed and given a list of improvements to work on if needed.

Releases and waivers will be reviewed annually. Each student and their parent/guardian are required to sign these forms at the beginning of class each year. The forms will be updated and reviewed to verify all laws, grammar, and policies are current. All forms are kept on file for each student in attendance.

The philosophy policy, site and facility development, and public relations vary by circumstance. They will stay current unless an unforeseen circumstance occurs. They will need to be reviewed on a case-by-case basis decided by the head instructor.

Needs assessment, goals, objectives, program development, supervision, rules, regulations, procedures, supervision and periodic review will all happen during the quarterly in-service training. These topics will be discussed during training so that instructors may express their concern for tactics that are no longer working or methods that are working really well. They will get a chance to discuss new ideas for these various areas and work out goals and objectives to help them be successful.

It is very important to review each and every one of these steps and take them seriously. Each step provides a n opportunity to make Dance Visions Academy a safe and secure place where students can enjoy the art of dance.



Appendices

Preliminary Sixteen-Step Checklist………………………………………………………….20

Site Floor Plan………………………………………………………………………………….21

Grounds Inspection and Evaluation Checklist……………………………………………...22

Job Description Form………………………………………………………………………….23

Class Progression………………………………….………………………………………24-26

Introduction to Safety for New Employees………………………………………………27-28

Studio Etiquette………………………………………………………………………………..29

Dress Codes………………………………………………………………………………………………………………..30

Policies………………………………………………………………………………………………………………………..31

Tuition Statement………………………………………………………………………………………………………...32

Safety Inspections Inventory………………………………………………………………………………………..33

Accident Report…………………………………………………………………………………………………………...34

Report of Injury Instructions……………………………………………………………………………………35-37

Emergency Procedures………………………………………………………………………..…………………38-40

Liability Release Form…………………………………………………………………….41-42

Acknowledgement of Risk…………………………………………………………………….43

Health Form………………………………………………………………………………...44-46

Statement of Admission…………………………………………………………………………………………..47

Indemnification Agreement………………………………………………………………………………………….48

Administrative Policy on Safety……………………………………………………………………………………49

New Employees Safety Orientation Checklist……………………………………………………………...50



Preliminary Sixteen-Step Checklist



Site Floor Plan



Grounds Inspection and Evaluation Checklist

Date: Site Superintendent/ Supervisor: Facility:

It is the responsibility of the area supervisor to review the applicable items on this checklist on a monthly basis as required to insure that each facility is in an acceptable and safe condition. Areas must be checked daily for any signs of vandalism. If any vandalism or unusual condition is observed, inspection must also be completed at that time. All inspection checklists must be signed by the area supervisor.

Studios1. Mirrors are clean and free from cracks 2. Floors are clean and free from excess dirt or obstacles 3. Barres are bolted to wall and/or can stand on their own

* free from any broken or damaged areas 4. Benches are clean and unbroken 5. Other

General Sanitation1. Facility is free from trash 2. Restrooms and dressing rooms are clean and free of any left items 3. Other

Lighting1. Lights are functioning in all areas of facility, especially studios 2. Outside lights, surrounding academy are working during the evening 3. Other

RECOMMENDATIONS Checked by: Supervisor Approval: Indicate date when reported defects were rechecked and found corrected:



Job Description Form

Wage$15.00 per hour

OverviewClasses will range throughout the week and will range in age and proficiency.

QualificationsAll dance instructors must be proficient in the style that they are teaching. They must have proof of mastery classes and teaching aid experience. All instructors must be able to teach their skills in an age appropriate way.

All instructors must be at least eighteen years of age and not have not been convicted of a felony and must be a United States citizen. All instructors must also be first aid and CPR certified.

All instructors and other employees must abide by the Dance Visions Academy policies. All employees must have liability insurance. Instructors must be able to attend staff meetings, be willing to work overtime for recitals and be cognizant of suspected abuse or foul play.

DutiesAll instructors must have a lesson plan that may include stretching, muscle and proficiency strengthening, choreography, combinations, a number for the end of the year recital, and appropriate music and costumes for the class and age group.

SelectionAll desirable applicants will be called in to have a personal interview. A one minute dance solo and a one day lesson plan will need to be prepared in advance. Preference will be given to applicants with experience working at other dance studios.



Class Progression

YOUNG DANCER DepartmentBaby Ballet and Mommy Too! (2+)Creative Dance (3+)Primary A: Pre-Ballet/Tap or Jazz (4+)Primary A/B Pre-Ballet/Tap (4-5)Primary B Pre-Ballet/Tap/Jazz (5+)

BALLET DepartmentBallet 1A (6+) Minimum 1 class per week, 2nd class optionalBallet 1B (7+) Minimum 1 class per week, 2nd class optionalBallet 2A (8+) Minimum 2 classes per week, 3rd class optionalBallet 2A/2B (8+) Minimum 2 classes per week, 3rd class optionalBallet 2B (9+) Minimum 2 classes per week, 3rd class optionalBallet 3A (10+) Minimum 2 classes per week, 3rd class optionalBallet 3A/3B (10+) Minimum 3 classes per week, 4th class optionalBallet 3B (11+) Minimum 3 classes per week, 4th class optionalTweens Beg/Inter Ballet (10+) Minimum 2 classes per week, 3rd class optionalTweens Intermediate Ballet (11+) Minimum 2 classes per week, 3rd class optionalBallet 4A (12+) Minimum 4 classes per week, 5th class optionalBallet 4B (13+) Minimum 4 classes per week, 5th class optionalTeen 4A/4B (13+) Minimum 2 classes per week, 3rd class optionalBallet 5A (14+) Minimum 4 classes per week, 5th class optionalBallet 5A/B (14+) Minimum 4 classes per week, 5th class optionalBallet 5B/6 (15+) Minimum 4 classes per week, 5th class optionalBallet 5/6 (14+) Minimum 4 classes per week, 5th class optionalVaganova Academy (13+)ABT Academy 1ABT Academy 2ABT Academy 3ABT Academy 4

POINTE (Director recommendation required)Pointe Eligibility: (11+) 3-4 years of ballet technique required along with 2 ballet technique classes weekly.Pointe 3B (11+)Pointe 4A (12+)



Pointe 4B (13+)Teen Intermediate Pointe (13+)Pointe 5A (11+)Pointe 5B/6 (15+)

BALLET VARIATIONS Pilates based STRETCH & STRENGTH (13+)Variations 4A (12+) (Add $32 per month for 1/2 hour class)Variations 4B/5 (13+)Variations 5/6 (14+)

MUSICAL THEATRE Department MODERN DepartmentMusical Theatre 1B (7+) Teen Beg/Inter Modern (12+)Musical Theatre 2A/2B (8+) Modern 4A (12+)Musical Theatre 3A/3B (10+) Modern 4B (13+)Musical Theatre (12+) Advanced Modern (14+)

ACROBATICS Department TAP DepartmentBeginning Acro (8+) Tap 1 (6+)Intermediate Acro (10+) Tap 2 (8+)Advanced Acro (12+) Tap 3 (10+)

Tap 4 (11+)JAZZ Department Junior Advanced Tap (13+)Jazz 1A/1B (6+) Senior Advanced Tap (15+)Jazz 1B (7+)Jazz 2A/2B (8+)Jazz 2B (9+)Jazz 3A (10+)Jazz 3A/3B (10+)Jazz 3B (11+)Jazz 4A (12+)Teen Jazz 4A/4B (12+)Teen Beginning/ Intermediate Jazz (12+)Teen Intermediate/ Advanced Jazz (12+)Jazz 4B/5 (13+)Advanced Jazz (15+)

LYRICAL DepartmentLyrical Eligibility: Ballet 3A or higher, 10+, 2 ballet technique classes & 1 jazz class weeklyLyrical 3A (10+)Lyrical 3B (11+)Teen Lyrical 4/5 (12+)Lyrical 4A (12+)Lyrical 4B (13+)



CONTEMPORARY DepartmentContemporary Eligibility: Ballet 4B or higher, 13+,2 ballet technique classes & 1 jazz class weeklyContemporary 4B (13+)Contemporary/Lyrical 5A/5B (14+)Contemporary/Jazz 5A/5B (14+)Advanced Contemporary/Lyrical (15+)Advanced Contemporary/Jazz (15+)Advanced Contemporary Improv (15+)

HIP HOP DepartmentBoy’s Hip Hop A (6-9)Boy’s Hip Hop B (9-12)Hip Hop 1B (7+)Hip Hop 2A (8+)Hip Hop 2B (9+)Hip Hop 3A (10+)Hip Hop 3B (11+)Teen Intermediate Hip hop (12+)Teen Advanced Hip Hop (14+)

ADULT Morning ClassesAdult Intermediate TapAdult Intermediate/ Advanced TapAdult Gentle BalletAdult Intermediate BalletAdult Intermediate/Advanced Ballet



Introduction to Safety for New Employees

This written introduction to safety is to be given to new employees by their supervisors before they begin their work assignments. Its purpose is to stress from the beginning the importance of safety within the academy.

Each new employee is required to go through a general safety training covering a number of safety concerns, including blood borne pathogens. In addition, each employee must attend training on sexual harassment. This introduction does not take the place of such training. Rather, it places the employee on notice that such training is forthcoming and that the new employee must be aware of working safely.

As an employee of Dance Visions Academy, I will: Always ask the proper methods before performing any new task. Wear appropriate clothing and shoes, as required by my job. Lift properly, using my legs and not my back. Never operate any equipment such as stereos or speakers unless I have been

authorized and trained to do so. Immediately report unsafe work practices or safety hazards to my supervisor. Never be under the influence of drugs or alcohol while on duty or while on the

premises. Never take part in horseplay. Never perform any unsafe practice that will place myself or others in danger. Immediately report any accident or illness to my supervisor. Understand that Sierra Vista Regional Medical Center is the provider of medical

services for injuries or illness received on the job, and should be used if medical treatment is required.

Never touch blood or other human bodily fluids without first protecting myself with latex gloves and other protection as needed.

Immediately report any exposure to human blood to my supervisor. Know and obey the safety rules in my department, studio or any other area of the

facility. Understand that I am the most responsible for my own personal safety. Understand that the City of San Luis Obispo has zero tolerance toward sexual

harassment and that employees are encouraged to report incidents of sexual harassment to their superior, department head, or any city official.

Any infraction of the above rules will result in appropriate disciplinary action. Such action will take the form of verbal or written warnings, suspension, or dismissal, depending on the seriousness of the infraction.


Employee’s Statement

I have read the above safety rules with my supervisor. I understand them and will apply them at all times while I am employed by Dance Visions Academy.

Printed Name of Employee Signature of Employee

Witnessed by: Supervisor Date



Studio Etiquette

TardinessTo prevent injury and promote professional conduct, students are required to be punctual to class at all times, however, if you are more than 10 minutes late to class, please briefly explain “why” to the teacher and ask permission to take your position at the barre. If you are observing class because of injury, please speak to the teacher before class and then observe and take notes.

FocusIt is of the utmost importance to be prepared, to have physical energy, mental focus and retention of the work - in and out of the studio - in order to progress to a more complex level.

AttitudePlease bring a good team effort, a positive spirit, and be supportive of your fellow dancers. Professional level expectations for one another as dancers is expected from every member of the school. Dance Visions Academy reserves the right to suspend or dismiss any student whose attitude and behavior conflicts with the standards of the school or whose actions are deemed detrimental to other students or to the school as a whole.

Viewing PolicyPlease understand that your child learns much more without distractions at the viewing windows. Our suggestion is that you view your child’s progress the first lesson of each month. NO PARENTS, STROLLERS, SIBLINGS OR ANIMALS ARE ALLOWED IN ANY OF THE STUDIOS AT ANYTIME.



Dress Codes

Students’ appearance in class must be neat at all times.

Ballet ClassesGirls are required to have their hair in a bun and to wear a leotard in the color prescribed for your level (see leotard chart below). Pink tights, pink ballet shoes and pint pointe shoes are required. Knitted leg warmers - in conservative colors - may be worn but must be removed after the completion of barre.

Boys are required to wear black tights or dance pants, white T-shirts, white socks and black or white ballet shoes.

Jazz, Lyrical, Contemporary, Musical Theatre and Acro ClassesFitted dancewear must be worn. No street clothes allowed. Black or tan jazz shoes.

Modern ClassesBurgundy leotards (any style) and black ankle-length (footless tights).

Tap ClassesFitted dancewear must be worn. No street clothes allowed. Black tap shoes must be worn.

Hip Hop ClassesLoose fitting street clothes are acceptable as long as the instructor can see your feet. Clean tennis shoes or jazz shoes must be worn.



Policies

Tuition PolicyTuition payments are due by the first day of each month. No exceptions.Statements will only be mailed to delinquent accounts and a $15.00 late fee will be charged to your account after the 10th of each month. Students will NOT be allowed to take class or private lessons until delinquent accounts are paid in full.

A service charge of $20.00 will be due for any returned “NSF” checks. “NSF” checks must be replaced within 10 days of notification in the form of cash, money order, or bank check. We do not re-deposit “NSF” checks.

There are ABSOLUTELY NO REFUNDS OR CREDITS.

Tuition adjustments CANNOT be made. Missed classes must be made up within 4 weeks of absence.

Should you CHANGE CLASSES, ADD A CLASS or DROP A CLASS, a “Class Change Form” must be completed at the DVA front desk in order for bookkeeping to recognize the change. Otherwise, you are responsible for full tuition until the end of the month in which the form is received.

DVA reserves the right to refuse service and/or admission to our school and/or performances.

DVA’s Directors and Instructors are NOT liable for personal injuries, accidents, or loss of, or damage to, personal property. Each student may decline to participate in any activity. Please inform instructors of any physical limitation you may have.

NO FOOD, GUM, OR DRINKS (EXCEPT WATER) ALLOWED IN THE STUDIOS!

Lost and FoundDVA is NOT responsible for lost or stolen money, shoes, clothing, jewelry, etc. Please label ALL dance shoes, clothing and do not leave dance bags or purses in dressing room. Every 90 days, all unclaimed items will be donated to local charities.



Tuition Statement

MONTHLY TUITION PER STUDENTEffective September 4, 2012 - June 15, 2013

REGISTRATION FEE: $25.00 PER STUDENT

Classes average out by the end of the year to be 4 per month, even with holidays, therefore, tuition rates are the same for each month. Make up lessons are always available for any classes missed due to illness or holidays. Check with the front desk for suggested make up classes and times.

10% family discount if 3 or more from the same immediate family are enrolled.

JUNE tuition is due by MAY 15th! Due to this hectic time of year for all, it was necessary to enforce this rule many years ago.

NO REFUNDS, CREDITS OR TRANSFERS will be made for missed lessons.

MAKE UP LESSONS are always available and must be made up within four weeks of absence. Please check the front desk for the suggested make up classes and times. (Summer session excluded).



Safety Inspections Inventory

On File In Use Needs Updating or Needs to be developed

Title of inspection lists yes no yes no yes no

1. Studio equipment ___ ___ ___ ___ ___ ___ 2. Building inspection ___ ___ ___ ___ ___ ___ (interior 3. Building inspection ___ ___ ___ ___ ___ ___ (exterior)4. Dance Floors ___ ___ ___ ___ ___ ___5. Barres ___ ___ ___ ___ ___ ___6. Mirrors ___ ___ ___ ___ ___ ___7. Locker Rooms ___ ___ ___ ___ ___ ___8. Restrooms ___ ___ ___ ___ ___ ___

Schedule or dates for periodic inspection Frequency of Inspection1. Studio equipment _____________________2. Building inspection (interior) _____________________3. Building inspection (exterior) _____________________4. Dance Floors _____________________5. Barres _____________________6. Mirrors _____________________7. Locker Rooms _____________________8. Restrooms _____________________



Accident Report

Name of Injured Party: UFID: -

Person Filling Out Report:

Date: Time: Location:

Class or Production:

Supervisor or Stage Manager:

Witnesses:

Briefly Describe Injury:

Please Explain Accident in Full Detail (Use Additional Pages if Necessary)

Action Taken:



Report of Injury Instructions

General instructions To The Employer

Filling out this form is not an admission of liability. You must report a claim to your insurer whenever anyone believes that a work- related injury or illness that requires medical care or lost time from work has occurred. If the claimed injury wholly or partially incapacitates the employee for more than three calendar days, the claim must be made on this form and reported to your insurer within ten days. Your insurer may require you to file it sooner. Failure to file within the ten days may result in penalties. Self-insured employers have 14 days to file this form with the Department of Labor and Industry (Department). It is important to file this form quickly to allow your insurer time to investigate the claim. Your insurer will forward a copy of this form to the Department, if necessary.

If the claim involves death or serious injury (including injuries that later result in death), you must notify the Department and your insurer within 48 hours of the occurrence. The claim can be reported initially to the Department by telephone (805-625-3652), fax (805-625-6985), or personal notice. The initial notice must be followed by the filing of this form within seven days of the occurrence.

Employers are required to complete this form. Each piece of information is needed to determine liability and entitlement benefits. Failure to complete the form may result in delayed processing and possible penalties. You must file this form with your insurer, and give a copy to the employee and the employee’s local union office. You are required to provide the employee with a copy of the Employee Information Sheet, which is available on the Department’s web site at www.doli.state.ca.us. Employees are not responsible for completing this form.

SEND REPORT TO INSURER IMMEDIATELY- DO NOT WAIT FOR DOCTOR’S REPORT

SPECIFIC INSTRUCTIONS FOR COMPLETING THIS FORM

Item 2: OSHA Case #. Fill in the case number from the OSHA 300 log. This form contains all items required by the OSHA form 301.


http://www.doli.state.ca.us/


Items 15-21: Fill in all wage information. IF the employee does not work a regularly scheduled work week, attach a 26 week wage statement so your insurer can calculate the appropriate average weekly wage.

Items 22-24: Be as specific as possible in describing: the events causing the injury; the nature of the injury (cut sprain, burn, etc.), and the part(s) of body injured (back, arm, etc.); and the tools, equipment, machines, objects or substances involved.

Item 26: Fill in the first day the employee lost any time from work (including time lost for medical treatment), even if you paid the employee for the time lost.

Item 27: Check the appropriate box to indicate if there was lost time on the date of the injury and whether you paid for that lost time.

Item 28: Fill in the date you first became aware of the injury or illness. Item 29: Fill in the date you became aware that the lost time indicated in Item 26

was related to the claimed injury. Item 30: Leave the box blank if the employee has not returned to work by the

time you file this form. If the employee has returned to work, fill in the date and notify your insurer if the employee misses time due to this injury after that date.

Item 39: Fill in your Federal Employment IS number (FEIN). Items 40 and 44: Fill in your Unemployment ID number North American Industry

Classification System )NAICS) code which are both assigned by the California Unemployment Insurance Program (805-734-2865)

Items 46-54: Your insurer or claims administrator will complete this information.

INSTRUCTIONS TO THE INSURER/ CLAIMS ADMINISTRATOR/ SELF- INSURED EMPLOYER

The following data elements must be completed on this form prior to filing with the Department of Labor and Industry: employees name and social security number; date of injury; and the names of employer and insurer. If any of this information is missing, the First Report will be rejected and returned to you. Providing the name of the third party administrator does not meet the statutory requirement to provide the name of the insurer. NOTE: If the claim does not involve lost time beyond the waiting period or potential PPD, the form does NOT need to be filed by the Department.

Item 46: Fill in the name of the insurance company. If the employer is self-insured, indicate the name of the licensed or public self-insured company or group.



Items 46-47: Fill in the legal name of the employer who purchased the policy from the insurer (named in Item 46) and the policy number. If the employer is licensed to self-insure, fill in the certificate number.

Item 49: Fill in the insurer’s Federal Employment ID number (FEIN) number. Item 51: Fill in the name and address of the company administering the claim

(either the insurer or third party administrator). Be sure to mark either the “Insurer” or “TPA” box.

Item 53-54: Fill in the claims administrator’s FEIN and claim number.

This material can be made available in different forms, such as large print, Braille or on a tape. To request, call (805) 562-4546 or 1-800-654-9856 (DIAL-DU)/ Voice or TDD (805) 632-9586.

ANY PERSON WHO, WITH INTENT TO DEFRAUD, RECIEVES WOPRKERS’ COMPENSATION BENEFITS TO WHICH THE PERSON IS NOT ENTITLED BY KNOWINGLY MISREPRESENTING, MISSTATING, OR FAILING TO DISCLOSE ANY MATERIAL FACT IS GUILTY OR THEFT AND SHALL BE SENTENCED PURSUANT TO SECTION 609.52, SUBDIVISION 3.



Emergency Procedures

Procedure to call 9111. State your emergency.2. Stay Calm.3. Give your name and address.4. Listen. Allow 911 employee to direct conversation.5. Be Prepared to answer questions in a clear, calm manner.6. Remain on the telephone. DO NOT hang up until the dispatcher says to do so.

Emergency Fire Procedures



In the event that a fire, smoke from a fire, or a gas odor has been detected:___ Pull the fire alarm. ___ Evacuate students and instructors to a safe distance outside of the building. ___ Follow the normal fire drill routine. If normal route(s) are too dangerous, follow alternate route. ___ Instructors should take a class roster and account for all students. Roll must be taken after evacuation. ___ Head Instructor calls 911 and notifies authorities. Head Instructor must report incident to the fire marshal. ___ No one should re-enter the building(s) until declared safe by fire service personnel. ___ Head Instructor notifies students and staff of termination of emergency and


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resumption of normal operations.

Emergency Earthquake Procedures

DURING AN EARTHQUAKE:If indoors:• Stay inside, move away from windows, shelves, heavy objects or furniture which may fall over. Take cover under a table or desk. Instruct the students to "DUCK-COVER-HOLD".• In halls, stairways, or other areas where cover is not available, move to an interior wall.If outdoors:• Move to an open space, away from buildings and overhead power lines. Lie down or crouch low to the ground (legs will not be steady). Keep looking around to be aware of dangers, which may demand movement.• Doorways may become blocked if the door slams shut as the building shifts during an earthquake. If the door becomes jammed, it may be necessary to use the pry bar and gloves (in emergency backpack) to open the door or break windows to exit the classroom. If it is still not possible to exit the studio, blow the whistle (in emergency backpack) to alert rescuers.


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• Instructors should be organized in a "Buddy System". If one instructor is injured, the buddy instructor should evacuate both classes according to the earthquake evacuation procedure.

After An Earthquake:❑ Staff : Evacuate students from the building. Take class roster, emergency backpack and student kits. Check to be sure all students have left the school building. Tag the room with a green search and rescue tag if everyone is accounted for and is able to evacuate the room. If there are trapped or injured left in the room, tag the room with a red search and rescue tag to alert search and rescue teams.❑ Staff : Students are not to be left unattended at any time during evacuation process. Students are to remain quiet during evacuation.❑ Staff : Upon arrival at prearranged safe site, take roll and report attendance to Head instructor.❑Head Instructor: Notify police and fire (dial 911) if you have trapped or missing individuals. Organize Search and Rescue (SAR) teams, consisting of adults, to search for missing or trapped people.❑ Staff: Begin a search of the entire academy. Search rooms tagged with red Search and rescue tags for missing, trapped or injured people. When everyone has been removed from the room, change the red tag to a green tag. Check rooms with green Search and Rescue tags to be sure no one is left in the rooms. Report activities to Head Instructor. After each room is searched and no one is left in the room, close and lock the door if possible.❑Head Instructor: Organize the other Emergency Response Teams: the FirstAid Team, Security/Damage Assessment Team, Student Release Team and the Support Team.❑Head Instructor: Notify utility companies of any break or suspected break in utility lines as reported from Security/Damage Assessment Team.❑ Staff: Set up the treatment area. Categorize patient injuries. Care for the injured. Report casualties and injuries to the Head Instructor.❑ Staff: Provide for the welfare and positive morale of the student population. ❑ Staff: Students should be released only to authorized adults. Fill out student release forms for each student allowed to leave.

Liability Release Form

Waiver Liability Release

I hereby release, indemnify and hold harmless Dance Visions Academy, its owners, members, advisors, Board of Directors, and all employees and agents of these parties from all liabilities, suits, claims. and/or demands of any kind or nature, legal or financial, whether caused in any way by the negligence or not, arising from the participation in or observation of any Dance Visions Academy. activity for injuries to any person or property, whether on or off the premises. The student/participant named



below does voluntarily participate in any and all, Dance Visions Academy activities and that the student/participant and I understand that certain risks are inherent to and from participation and involvement with Dance Visions Academy and in its various formal and informal activities. These activities include but are not limited to Dance and Gymnastics. Dance Visions Academy is not responsible for any lost or stolen property, at any time. Anyone found to be violating any of the rules, codes of conduct, or found to be disruptive to either another individual or group may be asked to leave the premises or off-site location at any time and be refused re-entrance without any full or partial refund.

Medical Release

As the parent/legal guardian of the student/participant named below, I request and authorize that in my absence the student/participant named below be admitted to any hospital or medical facility for diagnosis and treatment. I request and authorize physicians, dentists, and staff, duly licensed as Doctors of Medicine/Osteopathy or Doctors of Dentistry or other such licensed technicians or nurses, to perform any diagnostic procedures, treatment procedures, operative procedures and x-ray treatment of the student/participant named below. I have not been given any guarantee as to the results of examination or treatment. I hereby authorize Dance Visions Academy, its owners, members, Board of Directors, and all employees and agents of these parties to act for the student/participant named below according to their best judgment in providing or arranging for emergency care in any emergency circumstance requiring medical attention. I authorize the hospital, medical or care facility to dispose of any specimen or tissue during the course of any diagnosis, treatment or other normal and customary procedures.

Photo Release

I hereby understand and am fully aware that the student/participant named below may be participating in Dance Visions Academy activities in which I and/or the student/participant named below may be photographed or videotaped (the Property) from time to time. I hereby irrevocably grant to Dance Visions Academy perpetually, exclusively, and for all media throughout the world (including print, non theatrical, home video, CD-ROM, internet and any other electronic medium presently in existence or invented in the future), the right to use and incorporate (alone or together with other materials), in whole or in part, photographs, sound bites or video footage taken as a result of participation in Dance Visions Academy activities. I hereby agree that I will not bring or consent to others bringing claim or action against Dance Visions Academy on the grounds that anything contained in the Property, or in the advertising



and publicity used in connection herewith, is defamatory, reflects adversely on me or the student/participant named below, violates any other right whatsoever, including, without limitation, rights of privacy and publicity. I hereby release Dance Visions Academy, its owners, members, Board of Directors, and all employees and agents of these parties from and against any and all claims, demands, actions, causes of actions, suits, costs, expenses, liabilities, and damages whatsoever that I may hereafter have against Dance Visions Academy. in connection with the Property. This agreement shall not obligate Dance Visions Academy to use the Property or to use any of the rights granted hereunder, or to prepare, produce, exhibit, distribute or exploit the Property. Dance Visions Academy shall have the right to assign its rights hereunder, without my consent, in whole or in part, to any person, firm, corporation or organization

Student/Participant: _________________________________

(if student is 18 or older) (signature)

_____ / ____ / ______ _________________________________

(mm) (dd) (yyyy) (print name)

Parent/Legal Guardian: _________________________________

(if student is under 18) (signature)

_____ / ____ / ______ _________________________________

(mm) (dd) (yyyy) (print name)

Acknowledgement of Risk

Dance Visions Academy Liability Waiver and Acknowledgment of Risk: READ AND SIGN BELOW

REGISTRATION IS INCOMPLETE WITHOUT SIGNATURE AND MUST BE

COMPLETED BEFORE CLASS

I understand and agree that in participating in any dance class, workshop, rehearsal or performance, there is a possibility of physical injury or death. I voluntarily agree, Risk Management Plan Page 45


therefore, to assume all risks and responsibility for any such injury or accident, which might occur to me or my child during any of Dance Visions Academy classes, rehearsals, performances, or activities. I also exempt, release, and indemnify Dance Visions Academy, its owners, agents, volunteers, assistants, employees, guest artists, faculty members, and/or students from any and all liability claims, demands, or causes of action whatsoever from any damage, loss, injury, or death to me, my children, or property which may arise out of or in connection with participation in any classes or activities conducted by Dance Visions Academy. I further hereby voluntarily agree to waive my rights and that of my heirs and assigns to hold Dance Visions Academy, its owners, agents, volunteers, assistants, employees, guest artists, faculty members, and/or students liable for such damage, loss, injury, or death. I understand that I should be aware of my physical limitations and agree not to exceed them. If I am signing this waiver for my children, I certify that I am the parent or legal guardian and have the right to waive these rights.

Permission is granted Dance Visions Academy to use photographs of students for publicity purposes. I have read, understood and agree to be bound by the above statement (please

print your name, sign & date): PRINTED:__________________________________________________

SIGNED:___________________________________________________If under 18, parents or legal guardian must sign FOR: ______________________________________________________Name of Student DATED: ____________________________________________________

Health Form

Today’s Date________________ Course start date_____________________

Length of course__________________ Gender___________________

Student’s Name_______________________ DOB_____________________

Parent’s Name ___________________________________________________



Phone Number ___________________________________________________

In Case of Emergency Notify ________________________________________

Phone Number and Email __________________________________________

Relationship to Student ____________________________________________

Medical History

Please list any medical conditions you have: may include asthma, allergies, diabetes, heart conditions, high or low blood pressure, etc.

__________________________________________________________________________________________________________________________________________________________________________________________________________________

List all medications that you take. Please include birth control pills, vitamins and minerals. We recommend that you bring what you may need or a written prescription from your physician.

Non-prescription________________________________________________________

Prescription____________________________________________________________

List any allergies or reactions you have to medications.

Medication Reaction Date

__________________ ___________________ ________________

__________________ ___________________ ________________

Do you smoke? Y / N

List any allergies or reactions you have to foods, molds, pollens, bees, insects, animals, etc.



__________________________________________________________________________________________________________________________________________________________________________________________________________________

List any physical or dance related problems you have including injuries, bone, joint, or muscular disorders, etc.__________________________________________________________________________________________________________________________________________________________________________________________________________________

Have you ever been hospitalized? Y / N (If yes, please specify below including dates)

Physical illness_______________________________________________________________________________________________________________________________________

Injury_______________________________________________________________________________________________________________________________________

Surgery_____________________________________________________________________________________________________________________________________

Psychiatric___________________________________________________________________________________________________________________________________

Have you been diagnosed with mental health issues, severe stress, mood change, or personality disorder DVA should be aware of?____________________________________________________________________________________________________________________________________________

Have you been vaccinated for the following: Chicken Pox: Y / N Measles: Y / N Mumps: Y / N

Please list all doctors’ information below, including primary care physician, chiropractors, physical therapists, etc.

Primary Physician ________________________ Telephone_________________

Other Health Care Providers _________________ Telephone_________________



Student Declaration

I, __________________, confirm that the information provided on this form is correct and true.

Student’s signature______________________________ Date__________________

Parent/ Guardian Signature _______________________ Date __________________(If under 18 years of age)

Doctor’s statement

I, _________________________ confirm that ____________________ is physically and mentally fit to participate in ______ hours of dance per week at Dance Visions Academy. I confirm that the above information listed in this health form is true and correct.

______________________ ______________ __________________Doctor’s signature (required) Date Doctor’s official stamp

______________________ ______________ __________________Doctor’s Address Phone number Email

Statement of Admission

DANCE VISIONS ACADEMY

When an accident occurs, no matter how insignificant it may seem to be, it is of the utmost importance never to admit to guilt or negligence of any kind until there is a formal investigation of the matter by your supervisors and the causes of the incident have been determined. You are required to contact your immediate supervisor and not to render speculation on the causes of the incident. Any and all questions relating to an Risk Management Plan Page 49


accident involving the property and/or personal must be directed to a department head or other designated manager.

Indemnification Agreement

Dance Visions Academy shall indemnify and hold harmless the ____(Agency)____, its officers, employees, volunteers, and agents against any claims, demands, cost and expenses, including reasonable attorney’s fees for the defense thereof, arising from or in connection with Dance Visions Academy’s use of ____(Agency)____ property provided that said claims, demands, costs and expenses have not been caused by the negligence of ____(Agency)____, its officers, employees, volunteers, and agents.

The ____(Agency)____,shall indemnify and hold harmless Dance Visions Academy, its Risk Management Plan Page 50


officers, employees, volunteers, and agents against any claims, demands, cost and expenses, including reasonable attorney’s fees for the defense thereof, arising from or in connection with the ____(Agency’s)____, use of Dance Visions Academy’s property provided that said claims, demands, costs and expenses have not been caused by the negligence of Dance Visions Academy, its officers, employees, volunteers, and agents.

Administrative Policy on Safety

The responsibility for a healthful work environment is a shared one, resting with all individuals at every level of the academy’s workforce. The common goal of eliminating all preventable workplace illnesses and injuries is attained through an uncompromising commitment to safety and to the recognizing and controlling hazards. To this end, workers and management must work in a nonadversarial, cooperative effort to promote safety and health for all employees. Furthermore, management demonstrates its commitment by providing leadership and necessary resources, while all employees utilize safe work practices and participate in the creation of policies that keep them from



harm’s way. Both recognize safety as so primary that it always takes precedence over workplace shortcuts. United efforts, as well as the individual role specified below, help ensure the protection of the academy’s valued public servants.

Head Instructors occupy a key role in the successful development and maintenance of safety programs and policies. As the highest level of management and with direct contact with instructors and students, they are expected to provide leadership and direction in the administration of all safety activities. They are also responsible for identifying and addressing safety issues, including implementing all applicable OSHA compliance programs, employee safety training, hazard assessments, accident reviews and corrective action procedures and other injury prevention policies.

Instructors, through their constant and cooperative efforts, account for the success of safety programs. They will make certain that students dance safely and observe all safety regulations. They are responsible for frequent studio and equipment checks and working through proper division channels to ensure the observance of safety policies.

Students, whether new or experienced, are the heart of all safety efforts. Instructors encourage student contributions on matters of safety. Students are expected to follow safe dance procedures and to take an active part in protecting themselves and their fellow peers. Having first- hand knowledge of dance studios and equipment, they can detect hazardous areas, conditions, practices, and behaviors in their areas and make corrective suggestions. Students must observe applicable safety regulations and practices.

New Employees Safety Orientation Checklist

Employee________________________________ Date Hired__________________Social Security No._________________________ Department_________________Position_________________________________ Physical Exam Y or N

Instructions: This form should be customized to include job and site specific safety issue. Please initial and date each section as the new employee completes it. If non-applicable, please use “NA”.

Person Initial Date



ResponsibleI. Safety Program Elements1. Safety Manual and Policy 2. Personnel Policies 3. Sexual Harassment Policy 4. Child Abuse Reporting Act 5. Statements of Admission* 6. Hazard Recognition 7. Accident Reporting/Investigation 8. Bloodborne Pathogens Protection 9. Emergency Response Plans 10. Right to Know Training 11. Security issues II Site Specific Instruction1. Location of First Aid Kit 2. Location of Fire Extinguishers 3. Location of MSDS 4. List of Specific Tools Used

*Defined as a response to public requests concerning agency liability or payment of bills following any injury, vehicle accident, or other loss.

I have completed an orientation and training for the above areas and feel I can perform my duties in a safe manner.

Employee Signature___________________________________ Date____________Instructor Signature____________________________________ Date____________Head instructor Signature_______________________________ Date____________


Documents

Risk Management Plan.docx - siennathornburg.weebly.comsiennathornburg.weebly.com/.../2/1/1/7/21172436/risk_management_pla… · Web viewBe sure to mark either the “Insurer”