(1) PAID UC EMPLOYEE, ON DUTY
Note that at UCSD the decisive factor determining whether or not a person
is a paid employee is whether that person receives compensation via the
UCSD Payroll System. Students who also receive UCSD payroll compensation
(e.g. graduate students with research assistantships) ARE paid employees
in this sense. Non-payroll forms of compensation generally do NOT result
in a "paid employee" with the associated Worker's Compensation
coverage. It is the intent of this category to include only persons holding
Worker's Compensation coverage. Persons employed at other UC units should
verify that their employment status does in fact carry Worker's Compensation
coverage.
I hereby certify that I am a paid employee of the University
of California, thus covered by Worker's Compensation, and that my presence
aboard this ship for this cruise is in the course of my assigned duties.
(2) UC VOLUNTEER
These persons volunteer their services to UC in order to participate
in the work of the cruise. In the UCSD framework they may be from outside
UCSD or may be normally employed at another UCSD unit but volunteering for
purposes of this cruise. They must be appointed as Staff Volunteers by the
business office of the UCSD unit to the benefit of which they are volunteering,
because this status entitles them to Worker's Compensation coverage. Persons
in volunteer status at other UC units should verify that their status in
fact carries Worker's Compensation coverage.
I hereby certify that I am a Staff Volunteer of the
University of California, am covered by Worker's Compensation in that capacity,
have submitted the proper forms for appointment as such a Volunteer, and
that appointment has been approved.
(3) EMPLOYEE OF ORGANIZATION OTHER THAN UC, ON DUTY
I hereby certify that I am an employee (paid or volunteer)
of (employer) and am covered by Worker's Compensation or equivalent insurance
against injury while in that employment status, that my presence aboard
this ship for this cruise is in the course of my assigned duties to that
employer, and that that employer is responsible for all pay that may be
due me for work done aboard ship. I hereby release the Regents of the University
of California, its officers, agents and employees from any and all claims
or liabilities for injuries to my person, including death, or property,
in any way arising out of my presence on this ship, except such injuries
or damage caused solely by the gross negligence or willful misconduct of
The Regents of the University of California, its officers, agents, or employees.
I agree that I may be asked to perform work aboard ship that is a part of
the scientific program, and that I will not be compensated by the University
of California for such work.
(4) STUDENT, BUT NOT PAID UC EMPLOYEE AS IN #1 AND NOT
COVERED BY WORKER'S COMPENSATION THROUGH ANOTHER INSTITUTION AS IN #3
Students who neither receive UCSD Payroll System compensation
and thus UCSD Worker's Compensation coverage nor are covered by Worker's
Compensation or similar insurance through another UC unit or a non-UC institution
must sign in this category and complete a UC
Waiver of Liability.
I am a student not entitled to Worker's Compensation
coverage and have signed the required UC Waiver of Liability.
(5) OTHER
This category, which may involve uninsured persons, is
to be utilized ONLY when it is IMPOSSIBLE to register the person under any
of the other categories. All such persons must have been invited to participate
by or with the approval of the Chief Scientist or the Associate Director,
SIO, and they must sign a UC
Waiver of Liability.
I do not qualify to enroll in any other category and
have signed the required UC Waiver of Liability.
