SB Workplace Pre- Placement & Learning Form
To meet MPA Skill’s Duty of Care requirements and to ensure that all parties are aware of their responsibilities in being part of this Program, the following checklist has been prepared as a record of visit and discussions to the Host Employer prior to the student commencing their work placement. A signed copy of this checklist can be provided. MPA Skills will provide insurance cover for personal injury sustained by the student during work experience when the work experience has been organised by MPA Skills. If the work experience has not been organised by MPA Skills then the student will not be covered for personal injury.
Given Names: *
Surname: *
Course Name:
Placement Dates *
Host Employer Name *
Host Employer address *
Host Contact Person Name *
Host Contact Person Mobile *
Host Employer Email *
Host Employer Position *
1. Outline of the student’s program has been discussed focusing on how Workplace Learning fits into the program *
2. The Workplace Supervisor has had their role explained in relation to the student’s training *
3. The assessment procedures and arrangements have been discussed with the Workplace Supervisor in relation to visits to be made by the MPA Skills representative *
4. Skills have been identified in which the Workplace Supervisor believes they will be able to address in the placement *
5. The following Occupational Health and Safety issues have been discussed with the Workplace Supervisor: • A site and OH&S induction must be completed prior to the student commencing any work tasks. • Is there a qualified first aid person on site? • Are safety notices visible? (e.g. – safety equipment required, exits, fire extinguishers etc.) • Are there any particular safety issues which the supervisor would like reinforced with the student by MPA Skills or school staff? *
6. The following Housekeeping rules have been discussed with the Workplace Supervisor: • All work areas are to be tidy and free of any tripping hazards. • There must be an adequate supply of water. • There must be sufficient bins on site *
7. Insurance details have been discussed with the Workplace Supervisor and the necessary documentation has been signed and copies have been made for the workplace, MPA Skills and the school representative *
8. Student emergency details have been provided and medical conditions as applicable discussed *
9. The MPA Skills representative has identified whether the student will be leaving the place of employment and travelling in a car or other vehicle and travel arrangements have been discussed (student’s responsibility in most cases) *
10. Workplace Supervisor have been made aware that any damage to business equipment is not covered under MPA Skills insurance policy. An appropriate level of Public Liability insurance for their business or industry risk profile is required *
11. All parties have determined working hours for the student *
12. The Workplace Supervisor has signed a Workplace Learning declaration *
13. The host understands that the Pre Apprentice is to make use of real work projects and tasks to provide pre-apprentices the opportunity to engage in meaningful work *
14. The host understands that the work practice exposes the pre-apprentice to real work place conditions. Real work place conditions include but are not limited to the physical environment, stress and noise levels, degree of safety or danger, customers and clients and commercial outputs *
H High level of risk - the student cannot commence work placement with this Host Employer. M Medium level of risk - planned corrective action required to reduce risk to a lower level prior to the student commencing work placement. L Low level of risk - risk controlled to as low as ‘reasonably practicable’, therefore there is no corrective action required and the student may commence their work placement.
Please rate Risk Assessment *
Work Place Supervisor Name *
MPA Skills Representative Name *
I am aware of the general information on ADWPL (Workplace Learning) including employer responsibilities, occupational health & safety, working hours and assessment *
I acknowledge that any vehicle used to transport the student will have a current vehicle license, be insured & the driver will have a current driver’s license *
I acknowledge that I have received a copy of MPA Skills Certificate of Currency. *
I confirm that the company listed above has consulted with their insurance broker to determine that they hold the appropriate level of Public Liability insurance for their business and have provided MPA Skills with a copy of their Certificate of Currency *
If you have said No to any of the Important Information Questions, please write in them comments as to why
Please draw your signature in the box below...