UNIVERSITY OF WASHINGTON

DIVE PLAN
DIVING SAFETY PROGRAM
ENVIRONMENTAL HEALTH AND SAFETY
Dive Team Leader Date

Department

Purpose

Special Equipment/Gas Mixture

Special Training Required

Number Average Average Deepest Location

of Dives Depth Times Dive

Potential Hazards

Diver's Name Depth

Certification

Department Phone
Number

Diver's Name Depth

Certification

Department Phone
Number

Diver's Name Depth

Certification

Department Phone
Number

Diver's Name Depth

Certification

Department Phone
Number

Diver's Name Depth

Certification

Department Phone
Number

Diver's Name Depth

Certification

Department Phone
Number

UoW 1687 ( 4/97)

Environmental Health and Safety, Box 354400
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