Work Related Learning - duplicate - duplicate

• Company Name

• Requesting Company

• Conducted on

  Date

• Prepared by

• Location
  Address

• Risk Banding

  High

  Medium

  Low

Client Information

• Client Name

• Student Date of Birth

• Education Provider

• Date of Work related learning

  Date

• Are there any reported health conditions, which may affect the training?

  YES

  NO

Employer Information

• Employer contact Name

• Number of employees

• Telephone

• Mobile

• E-mail

Insurance

• Details of Cover

Type

• Not available at time of visit.

• Insurance Company Name

• What type of cover is provided?

  ELI

  PLI

  N/A

• Policy Number

• Expiry Date

  Date

Opportunity

• Job Title

• Risk Banding

  High

  Medium

  Low

• Working hours

• Activities Involved

• How will they get to work?

• Meals and breaks

• Will the student need to arrange an interview?

  No

  Yes

• Personal Protective Equipment

PPE

• Smart Office

• Smart casual

• Casual

• Closed toe, flat shoes

• Safety boots - school to provide

• Hard hat

• Gloves

• Eye protection

• Ear protection

• Dust mask

• High visibility clothing

• Face protection

• Welding mask

• Respirator

• Other

• General health and safety hazards

Health and Safety Management

• Employer external contacts

Type

• HSE

• Local Authority

• OFSTED

• Care Quality Commision

• CHAS

• Other

• Are five or more people employed by the company?

  No

  Yes

• Is a Health and Safety law poster displayed?

  Yes

  No

  Leaflet Issued

• Formal Management

5+

• Does a Health and Safety policy exist?

  Yes

  No

  N/A

• Does the employer record work related risk assessments?

  Yes

  No

  N/A

• Will the employer recorded a young persons risk assessment?

  Yes

  No

  N/A

• Does the employer have a Fire Risk Assessment?

  Yes

  No

  N/A

• How will the information be made available to the learner?

Induction and Supervision

• Who will supervise the student?

• What will the induction cover?

• Will the induction be recorded?

  Yes

  No

  N/A

Welfare

• Welfare

Provision

• Toilets

• Drinking water

• Hand washing & drying

• Other

Fire

• General Fire Precautions

Buildings

• Are fire safety signs displayed?

  Yes

  No

  N/A

• Is there a Fire Alarm on site?

  Yes

  No

  N/A

• Is there any Emergency Lighting?

  Yes

  No

  N/A

• Are fire doors and walkways clear and unobstructed at the time of visit?

  Yes

  No

  N/A

• Does the employer carry out fire drills?

  Yes

  No

  N/A

• Does the employer have a fire log book?

  Yes

  No

  N/A

• Notes

• Additional fire precautions

Type

• Water

• CO2

• Powder

• Foam

• Wet Chemical

• Blanket

• Extinguishers last service date

  Date

First Aid

• What type of first aid cover is available?

  First Aider

  App Person

• Are first aid notices displayed?

  Yes

  No

  N/A

• First Aid

Provisions

• First Aid Kit

  Yes

  No

  N/A

• Eye wash

  Yes

  No

  N/A

• First Aid Room

  Yes

  No

  N/A

• Accident Book

  Yes

  No

  N/A

Work Equipment and Processes

• What equipment and processes will the student be involved with?

• Equipment Safeguarding

Guarding

• Fixed

  Yes

  No

  N/A

• Interlocked

  Yes

  No

  N/A

• Adjustable

  Yes

  No

  N/A

• Trip

  Yes

  No

  N/A

• Other

  Yes

  No

  N/A

• Last PATest Date

  Date

• Vehicle Ramp Test Date

  Date

• Compressor Test Date

  Date

• PROHIBITED

Equipment

• PROHIBITED

Tasks

• PROHIBITED

Areas

Identified Significant Risks

• IDENTIFIED SIGNIFICANT RISKS:

• Risk Banding

  High

  Medium

  Low

• I have read and understood the Letter of Understanding and agree with the terms - Signature on behalf of employer

  Sign

• Signed on behalf of B&E

  Sign