Trip-Specific International Travel Emergency Plan (Individual)

Traveler Information

Please enter your personal details below.

Traveler Name(Required)

First Last

Traveler Phone

Traveler Email(Required)

Please provide an email address so that the completed form can be sent to you.

Resources

Individuals who are traveling alone are encouraged t o review and complete the following information prior to departure:

Review and sign an International Travel Acknowledgement of Risk and Medical Consent form here
Review U.S. Department of State information on destination country(ies).
Register travel with the U.S. Department of State Safe Traveler Enrollment Program (STEP).
Complete the U.S. Department of State Traveler’s Checklist here.

Communications Plan

Travelers who are traveling to a hazardous area as defined by University Policy 1134: University Travel to International and/or Hazardous Locations must develop a communications plan. All travelers are encouraged to maintain routine contact with their respective college, school, or unit for the duration of travel.

George Mason Department Contact

Name

First Last

Phone

Contact Frequency

Contact Frequency (Other)

Please describe the planned frequency of communication with the above contact.

Planned Time of Contact

Record the time in your contact’s local time (e.g., EST).

Emergency Preparedness Considerations

Building Evacuation: Whenever an emergency warrants a building evacuation or local officials order a building evacuation, exiting the building using the nearest exit and proceed to the assembly area identified by the building. Travelers should identify two or more exit routes from their accommodations and primary work locations.

Shelter Locations: Shelter locations may be used in the event of severe weather, earthquakes, and manmade threats (e.g., violence or civil unrest) to provide temporary respite from natural and manmade hazards. Travelers are encouraged to monitor local news and radio for weather and social conditions to remain aware of potential threats. Identify a potential shelter location(s) in or near your accommodations or place of work.

Site-Specific Information (Site One)

Address of Accommodations (Site One)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Site One Phone

In-Country Emergency Contact (Site One)

Not Applicable

Not Applicable (N/A)

Name

First Last

Phone

Site One – Local Emergency Contacts

Local Law Enforcement Phone

Local Fire / Rescue Phone

Local Emergency Medical Services Phone

Site One – U.S. Consulate or Embassy Information

Nearest U.S. Consulate or Embassy (Site One)

U.S. Consulate or Embassy Address (Site One)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

U.S. Consulate or Embassy Phone (Site One)

Site-Specific Information (Site Two)

Site Two

Address of Accommodations (Site Two)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Site Two Phone

In-Country Emergency Contact

Not Applicable (Site Two)

Not Applicable (N/A)

Name

First Last

Phone

Site Two – Local Emergency Contacts

Local Law Enforcement Phone (Site Two)

Local Fire / Rescue Phone (Site Two)

Local Emergency Medical Services Phone (Site Two)

Site Two – U.S. Consulate or Embassy Information

Nearest U.S. Consulate or Embassy (Site Two)

U.S. Consulate or Embassy Address (Site Two)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

U.S. Consulate or Embassy Phone (Site Two)

Site-Specific Information (Site Three)

Address of Accommodations (Site Three)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Site Three Phone

In-Country Emergency Contact (Site Three)

Not Applicable (Site Three)

Not Applicable (N/A)

Name

First Last

Phone

Site Three – Local Emergency Contacts

Site Three – Local Law Enforcement Phone

Site Three – Local Fire / Rescue Phone

Site Three – Local Emergency Medical Services Phone

Site Three – U.S. Consulate or Embassy Information

Nearest U.S. Consulate or Embassy (Site Three)

U.S. Consulate or Embassy Address (Site Three)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

U.S. Consulate or Embassy Phone (Site Three)

Notification Procedures

At any point during an international educational travel experience it may be necessary to contact the university, services retained by the university, or personal contacts to respond to emergency situations.

Personal Medical Insurance Provider

Provider Name

Primary Phone

Alternate Phone

Personal Travel Insurance Provider

Provider Name

Primary Phone

Alternate Phone

Auto Insurance Provider

Provider Name

Primary Phone

Alternate Phone

Personal Physician

Provider Name

Primary Phone

Alternate Phone

Emergency Contact

Name

Primary Phone

Alternate Phone

Contact	Phone	Alternate Phone
Global Education Office	+01-703-993-2154	+01-703-993-7500 (After Hours)
International Travel Insurance Provider (Mercer)	+01-888-287-4741 (Toll Free)	+01-515-365-3990
University Police	+01-703-993-2810	N/A

U.S. Department of State Overseas Citizens Emergency Center

Provides assistance to U.S. citizens traveling abroad. The center should be contacted by phone (+01-202-501-4444) whenever any of the following occur abroad:

Death of an American citizen abroad;
Arrest / detention of an American citizen;
Robbery of an American citizen;
American citizens missing;
Crisis abroad involving American citizens.

Global Education Office (GEO) (George Mason University)

GEO should be notified whenever the following occur to facilitate services or support to student travelers as necessary:

Serious injury, illness, psychiatric situations, death, or hospitalization;
Reports or occurrence of infectious disease;
Natural disasters;
Political unrest or turmoil;
Missing employee or student; or,
Any other situation deemed an emergency by travelers.

George Mason University Police

University Police must be notified of crimes that involve employees or students or occur on property or locations under the control of the university in accordance with the Clery Act. Report crimes by phone +01-703-993-2810 or complete a report online at https://police.gmu.edu/clery-act-reporting/csa-form/. Report the following crimes:

Murder/non-negligent manslaughter;
Negligent manslaughter;
Sexual assault (i.e., rape, fondling, or incest
Robbery;
Aggravated assault;
Motor vehicle theft;
Arson;
Domestic violence;
Stalking;
Larceny/theft;
Vandalism, destruction of property, or damage to property;
Intimidation; or,
Simple Assault.

International Travel Insurance Provider

Should be contacted whenever the following services are needed:

Security evacuation services;
Emergency medical services;
Emergency travel services; or,
Information services.