Kent Placement Portfolio – Health and safety statement

This form should be completed by the placement mentor and given to the student during their induction.

Name of placement organisation
Nominated contact for compliance with the requirements of health and safety legislation
Name and position
Address
Telephone/Fax Email
Do you 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, plant and equipment, and will you provide all necessary health and safety training for the placement student?
Is the organisation registered with a) the Health and Safety Executive or b) the Local Authority Environmental Health Department?
Insurance
A) Do you hold Employer and Public Liability Insurance?
B) Will your insurances cover any liability incurred by a placement student as a result of his/her duties as an employee?
Risk Assessment
a) Have you carried out risk assessment of your work practices to identify possible risks, whether to your own employees or to others within your undertaking?
b) Are risk assessments kept under regular review?
c) Are the results of risk assessment implemented?
Accidents and incidents
a) Is there a formal procedure for reporting and recording accidents and incidents in accordance with RIDDOR (Reporting of Injuries, Deaths and Dangerous Occurrences)?
b) Have you procedures to be followed in the event of serious and imminent danger to people at work in your undertaking?
c) Will you report to the university all recorded accidents involving placement students?
d) Will you report to the university any sickness involving placement students which may be attributable to the work?

Please read the following and sign below:

1. In connection with any students undertaking work placement with the Placement Organisation, it is hereby agreed that the Placement Organisation will indemnify the College/University against all damages, loss claims, costs and expenses for which they may become legally liable as a result of death or bodily injury to such student or any other person and/or damage to material property arising out of any negligent act or omission of the Placement Organisation, its servants or agents.

2. The Placement Organisation shall maintain such insurances as are necessary to cover the aforementioned liability and shall, if requested by the College or University, produce documentary evidence that such insurances are properly maintained.

3. The Placement Organisation acknowledges its responsibilities under the Health and Safety at Work etc Act 1974 and all related legislation, and will ensure, as far as is reasonably practicable, the health, safety and welfare of students for the duration of the placement.

4. It is confirmed that where, following a risk assessment, a significant risk remains within the workplace, the student will not be asked to undertake any activity associated with that risk.

5. We understand that the College is insured against its legal liability for accidental deaths, injury, illness or property damage arising out of any negligent act or omission by the College and/or its students.

The above statements are true to the best of my knowledge and belief.

SignedPrint

Date

Thank you for completing the form. The student will keep a copy for their own records, and return a copy to you within one week of the start of the work placement.

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