• Company Name

  • Address

  • Is the placement at more than one location?

  • Telephone No.

  • Email

  • No. of employees

  • Contact Name

  • Nature of Learner's Employment

  • Placement Type

  • Age of Learner

  • Induction scheme

  • Supervisors Name


  • Is Employers' Liability Insurance in place?

  • Policy Seen?

  • Insurance Company

  • Policy No.

  • Expiry Date

  • Has the provider made their insurance company aware of the learner?

  • Has the company been made aware of its responsibility to maintain suitable insurance during the period of the placement?


  • H&S Policy Applicable?

  • Available to Staff?

  • H&S Policy Seen?

  • Name of Competent Person

  • H&S Law Poster Displayed?


  • Is the company aware of their responsibilities under the Management of H&S at Work Regs?

  • Has the company got appropriate written risk assessments?

  • Has the company been made aware of the requirement to report accidents involving learners?

  • Is the placement provider aware of their obligation to safeguard the learner and the need to report any concerns?

  • Is the placement provider aware of their obligation to report any concerns relating to radicalisation?

  • Are COVID measures in place?

  • We agree to our company details being held for a period of 4 years.

  • We agree to our data being used solely for the purpose of supporting work experience and work based learning programmes.

  • We agree to our data being shared only with college staff, relevant students and college appointed partners for that purpose.

Overall Risk Rating confirmed as LOW


  • Appraisal Completed By

Checked and entered by PLACEMENT CO-ORDINATOR

  • Additional Comments:-

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