NZSS Search & Rescue Caver Experience Questionnaire
A database is maintained by NZSS of cavers available for SAR operations.
Please send completed forms to: Sarah Brewer, Lodders Lane, RD3, Riwaka, Motueka.
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Version 2001 March
Corrections and updates to the webmaster please
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Name
Address
Age or optional date of birth
19 or less / 20-29 / 30-39 / 40-49 / 50-59 / 60-69 / 70+
| Contact | Home | Work |
| Phone | | |
| Mobile | | |
| Fax | | |
| Email | | |
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Next of Kin
Address
Relationship
| Contact | Home | Work |
| Phone | | |
| Mobile | | |
| fax | | |
| Email | | |
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Skills & Experience (where 0 = no experience, 5 = very experienced)
| Michie Phones | (0-5) | |
| Radios | (0-5) | |
| Rigging | (0-5) | |
| Rescue Digging | (0-5) | |
| Alpine Camping | (0-5) | |
| Helicopter Procedure | (0-5) | |
| Other (please specify) | (0-5) | |
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Previous SaR Experience
| Number of SaRExs attended: | | From (year) | |
| Years SaRExs attended: | | |
| Number of searches or rescues attended: | |
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Training Courses attended
| Track & Clue Awareness | Yes / No | Year Attended | |
| Search Methods | Yes / No | Year Attended | |
| Outdoor First Aid | Yes / No | Year Attended | |
| Other related courses (please specify) | | Year Attended | |
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Caving Experience
| Caving | | years |
| SRT | | years |
| Waitomo | | trips |
| Mt Arthur | | trips |
| Mt Owen | | trips |
| Takaka Hill | | trips |
| Other caving | | trips (please specify) |
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| Current Fitness Level |
1 (unfit) to 5 (very fit) |
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| North Island caves best known |
| South Island caves best known |
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Equipment
My personal equipment allows me to be completely self sufficient for 24 hours in the bush?
(minimum of four season sleeping bag, tent or fly, clothing for wet and cold conditions, stove, billy, pack, etc)
| Yes / No / Am intending to buy |
List items not owned at present:
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I own all personal caving gear required for
| Deep cave rescue | Yes / No | Except for: |
| Sub surface work | Yes / No | Except for: |
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I own rigging gear suitable for
| Regular rigging | Yes / No | Important items include: |
| Rescue rigging | Yes / No | Important items include: |
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Medical Conditions
(include injuries with long term effects, fear of heights, can't swim, etc)
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Preferred Level of Involvement
| Sharp end (Deep Rescue team) | |
| Subsurface group (Upper levels team) | |
| Base Camp support | |
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Signature |
Date: ____ / ____ / ____
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