[ { "page": 1, "items": [ { "page": 1, "type": "TEXT", "location": { "l": 83.9797, "t": 958.7433, "r": 215.9477, "b": 946.2641 }, "text": "XAVIER UNIVERSITY", "reading_order": 0 }, { "page": 1, "type": "TEXT", "location": { "l": 319.3627, "t": 957.7834, "r": 542.2687, "b": 945.7841 }, "text": "Risk Management & Insurance (513) 745-2090", "reading_order": 1 }, { "page": 1, "type": "TEXT", "location": { "l": 82.78, "t": 943.6242, "r": 713.1073, "b": 902.6848 }, "text": "TYPE OF PARTICIPANT TYPE OF EXPERIENCE AOR and Release Health History Form Required", "reading_order": 2 }, { "page": 1, "type": "TEXT", "location": { "l": 650.2425, "t": 955.8635, "r": 712.3875, "b": 946.5041 }, "text": "Rev. 06/23/2020", "reading_order": 3 }, { "page": 1, "type": "TEXT", "location": { "l": 82.78, "t": 902.6848, "r": 713.1073, "b": 820.806 }, "text": "XU STUDENTS XU FACULTY AND EMPLOYEES", "reading_order": 4 }, { "page": 1, "type": "TEXT", "location": { "l": 82.78, "t": 820.806, "r": 713.1073, "b": 779.8666 }, "text": "Ongoing Experience on- and off-campus Clubs, Club Sports Teams, Intramural Sports, Fitness Classes, Academic Classes AOR 101 includes full health history section in form", "reading_order": 5 }, { "page": 1, "type": "TEXT", "location": { "l": 82.78, "t": 779.8666, "r": 713.1073, "b": 738.9272 }, "text": "Overnight Experience Domestic and international travel --- Does not apply to destinations under a U.S. Dept of State Travel Warning --- Required if trip includes 5 or more overnight off-campus stays --- Otherwise only required for risky activity --- See Instructions AOR 102 HHF 201 or 203 and HHF 202 (for international travel only)", "reading_order": 6 }, { "page": 1, "type": "TEXT", "location": { "l": 82.78, "t": 738.9272, "r": 713.1073, "b": 697.9878 }, "text": "Overnight Experience Travel Warning Applies to destinations under a U.S. Dept of State Travel Warning AOR 102 TW prior approval required HHF 201 or 203 and HHF 202 (for international travel only)", "reading_order": 7 }, { "page": 1, "type": "TEXT", "location": { "l": 82.78, "t": 697.9878, "r": 713.1073, "b": 657.0484 }, "text": "Day Trip Experience Defined as less than 24 hours --Only required for risky activity --- See Instructions AOR 103 includes short health history section in form", "reading_order": 8 }, { "page": 1, "type": "TEXT", "location": { "l": 82.78, "t": 657.0484, "r": 713.1073, "b": 616.109 }, "text": "On-Campus Experience Only required for risky activity --- See Instructions AOR 104 includes short health history section in form", "reading_order": 9 }, { "page": 1, "type": "TEXT", "location": { "l": 82.78, "t": 616.109, "r": 713.1073, "b": 575.1696 }, "text": "XU STUDENTS", "reading_order": 10 }, { "page": 1, "type": "TEXT", "location": { "l": 82.78, "t": 575.1696, "r": 713.1073, "b": 534.2302 }, "text": "Student Internship Experience Required for all student internship experiences AOR 105 includes short health history section in form", "reading_order": 11 }, { "page": 1, "type": "TEXT", "location": { "l": 82.78, "t": 534.2302, "r": 713.1073, "b": 493.2908 }, "text": "Student Professional Field Experience Required for all student professional field experiences AOR 106 includes short health history section in form", "reading_order": 12 }, { "page": 1, "type": "TEXT", "location": { "l": 82.78, "t": 493.2908, "r": 713.1073, "b": 452.3515 }, "text": "NON-XU INDIVIDUALS", "reading_order": 13 }, { "page": 1, "type": "TEXT", "location": { "l": 82.78, "t": 452.3515, "r": 713.1073, "b": 411.4121 }, "text": "Non-XU 18 Years and Older Experience AOR 107 includes short health history section in form", "reading_order": 14 }, { "page": 1, "type": "TEXT", "location": { "l": 82.78, "t": 411.4121, "r": 713.1073, "b": 370.4727 }, "text": "Non-XU Under 18 Years Experience AOR 108 includes full health history section in form", "reading_order": 15 }, { "page": 1, "type": "TEXT", "location": { "l": 82.78, "t": 370.4727, "r": 713.1073, "b": 329.5333 }, "text": "XU STUDENTS", "reading_order": 16 }, { "page": 1, "type": "TEXT", "location": { "l": 82.78, "t": 329.5333, "r": 713.1073, "b": 288.5939 }, "text": "Travel To/From Xavier University To be signed by individuals when boarding transportation provided by Xavier University AOR 109", "reading_order": 17 }, { "page": 1, "type": "TEXT", "location": { "l": 82.78, "t": 288.5939, "r": 713.1073, "b": 247.6545 }, "text": "Separation From Group Travel See specific instructions for AOR 110 AOR 110 with specific instructions", "reading_order": 18 }, { "page": 1, "type": "TEXT", "location": { "l": 82.78, "t": 247.6545, "r": 713.1073, "b": 206.7151 }, "text": "HEALTH HISTORY FORMS", "reading_order": 19 }, { "page": 1, "type": "TEXT", "location": { "l": 82.78, "t": 206.7151, "r": 713.1073, "b": 165.7757 }, "text": "Student Health History Form Applies to ALL overnight travel domestic and international HHF 201", "reading_order": 20 }, { "page": 1, "type": "TEXT", "location": { "l": 82.78, "t": 165.7757, "r": 713.1073, "b": 124.8363 }, "text": "Student Health Screening Exam Form Applies to ONLY international travel HHF 202", "reading_order": 21 }, { "page": 1, "type": "TEXT", "location": { "l": 82.78, "t": 124.8363, "r": 713.1073, "b": 83.8969 }, "text": "Faculty/Employee Health History Form Applies to ALL overnight travel domestic and international HHF 203", "reading_order": 22 }, { "page": 1, "type": "TEXT", "location": { "l": 82.78, "t": 83.8969, "r": 713.1073, "b": 42.9575 }, "text": "• If an outside organization has supplied an alternate form for your activity or group, you must contact RM&I. • Original signed forms should be carried by event organizer or group leader, or by the student if traveling alone. • The sponsoring office or department must keep one paper or electronic copy of completed signed forms on hand during the experience, and at conclusion of the experience must retain a copy of signed forms for two years. • Campus Police should keep one paper or electronic copy of completed signed forms during the experience. • RE-TYPING OF FORMS IS PROHIBITED WITHOUT PRIOR APPROVAL FROM RM&I OR GENERAL COUNSEL. • THESE FORMS ARE THE ONLY FORMS APPROVED BY XAVIER UNIVERSITY", "reading_order": 23 }, { "page": 1, "type": "TEXT", "location": { "l": 84.9394, "t": 50.637, "r": 509.8765, "b": 38.1577 }, "text": "THESE FORMS ARE THE ONLY FORMS APPROVED BY XAVIER UNIVERSITY.", "reading_order": 24 } ] } ]