Oxford Brookes University

Location *

Post Code *

Student(s) Name(s) *

Organisation Name *

Industry *

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Your Name *

Your Position *

Your Phone *

Your Email *

Read Letter *

I have read and agree to the employer responsibilities

I am aware of the learning outcomes of the placement/ work-based learning module the student is undertaking (see attached guide) and I agree to support these alongside the work they are doing for my organisation.*

Who is your nominated contact for compliance with these requirements of health and safety legislation?

Position

Does your organisation have a written Health and Safety Policy? *

Do you have a policy regarding health and safety training for people working in your undertaking, including use of vehicles, machinery and equipment, and will you provide all necessary health and safety training along with supervision and free personal protective equipment for our placement student(s)? *

Have you implemented adequate measures and procedures to ensure compliance with all pandemic-related measures? *

What health and safety instruction/ training will the work placement be given? (including induction and training relating to pandemic measures)? *

Do you have any legal proceedings against you with regards to any Health and Safety issues? *

Do you carry out risk assessments of your work practices, including manual handling and display screen equipment to identify possible risks, to employees (including students) within your undertaking? *

Are risk assessments kept under regular review and are the results implemented? *

Will the student be undertaking any higher risk activities? *

Is Employer Liability Insurance and Public Liability Insurance held? *

Is the student deemed to be an employee for the purposes of these insurance policies? *

Does your insurance cover liability for injuries or sickness suffered by placement/work experience students attributable to their duties within your organisation and do you have first aiders available in the student’s workplace? *

Is there a formal procedure for reporting and recording accidents and incidents (in accordance with RIDDOR in the UK or other country legislation if an international placement)? *

Have you procedures to be followed in the event of serious and imminent danger to people at work in your undertaking? *

Will you report to the University all recorded accidents involving our students? *

Will you report to the University any sickness involving our students which may be attributable to the work? *

Insurance Provider

Policy Number

Limit Of Indemnity

Will the placement require extensive travel to other countries? *

Will the placement/experience be required to travel regularly as part of their work?

If the answer to the above question was YES, please give details below

* I have read and agree to the Privacy Policy and I give consent for Oxford Brookes University to store my data

Form Completed By

Nominated Contact

Health and Safety Policy

Risk Assessment

Insurance

Accidents and Incidents

International