Risk Management and Activity Waiver Form

It is important that everyone work to manage the risks associated with conducting these programs. Given the different administrations in these community based programs, it is challenging to provide a specific set of practices for all involved.

For programs with non-Extension certifying authorities, please contact your appropriate administration for risk management guidance.

For those programs in which the Division of Extension is the certifying authority, the following recommendations are from discussion with UW-Madison Risk Management.

  • Have a good student to instructor ratio. UW-Madison requirement is 1:10 instructor to student ratio for youth of this age. This program is for students who are minors. Talk with 4-H Youth Development educator in your county about safety with minor considerations.
  • Required use of the activity-waiver-2019 Please download the Activity Waiver and modify contact information for your county information. The Activity Waiver was developed by UW System Legal Department and should not be changed other than for local information.
  • Have parents/guardians watch “Parent and Caregiver Video – For Tractor and Machinery Operation Certification Program” and indicate they have reviewed on registration form or provide an introductory meeting and watch during that program.  If you wish to adapt the presentation, the PowerPoint and transcript is available https://uwmadison.app.box.com/s/si0rtgciljgn9gjjmy2gj7x6ly1wathf
  • Use tractors and machinery in good operating conditions. Tractors must have ROPs and a functional seatbelt. Operators must be required to wear the seatbelt during operation of the tractor. Tractors should have manual transmissions and an open-platform operator’s station. If a tractor has an instructional seat, the seat maybe used by an instructor. Remember to teach youth that these are instructional seats, not an extra seat for a friend to ride along.
  • Keep value of borrowed equipment under $100,000.
  • Establish safe use guidelines for your practice driving and driving exam operating areas. Keep students that may be observing operation out of the driving course area. Identify course with boundary markers.
  • Check who is insuring equipment used in the classes. If using equipment loaned to the program, ask if their insurance will cover property damage. If owner’s insurance does not cover property damage, please contact Risk Management.
  • Program may be listed on county approved programs for coverage by mutual insurance. It may be possible to get American Income Life coverage from 4-H program. We are checking into Camps and Clinic Insurance with UW Madison Risk Management.
  • If a program participant is injured, seek appropriate care and complete UW Madison Non- Employee Accident Report form  Return form to: UW-Madison Office of Risk Management, 21 N. Park Street, Suite 5301, fax 608-262-9082 or email to riskmgmt@bussvc.wisc.edu within 48 hours of incident. If individuals asked for Risk Management follow-up refer them to 608-262-0379.