Primary Information

Client Information

  • Client Name

  • Student Date of Birth

  • Education Provider

  • Date of Work related learning

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

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?

  • Policy Number

  • Expiry Date

Opportunity Offered

Opportunity

  • Job Title

  • Risk Banding

  • Working hours

  • Activities Involved

  • How will they get to work?

  • Meals and breaks

  • Will the student need to arrange an interview?

  • 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

Workplace Health and Safety

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?

  • Is a Health and Safety law poster displayed?

  • Formal Management

  • 5+
  • Does a Health and Safety policy exist?

  • Does the employer record work related risk assessments?

  • Will the employer recorded a young persons risk assessment?

  • Does the employer have a Fire Risk Assessment?

  • 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?

Welfare

  • Welfare

  • Provision
  • Toilets

  • Drinking water

  • Hand washing & drying

  • Other

Fire

  • General Fire Precautions

  • Buildings
  • Are fire safety signs displayed?

  • Is there a Fire Alarm on site?

  • Is there any Emergency Lighting?

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

  • Does the employer carry out fire drills?

  • Does the employer have a fire log book?

  • Notes

  • Additional fire precautions

  • Type
  • Water

  • CO2

  • Powder

  • Foam

  • Wet Chemical

  • Blanket

  • Extinguishers last service date

Health and Safety cont..

First Aid

  • What type of first aid cover is available?

  • Are first aid notices displayed?

  • First Aid

  • Provisions
  • First Aid Kit

  • Eye wash

  • First Aid Room

  • Accident Book

Work Equipment and Processes

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

  • Equipment Safeguarding

  • Guarding
  • Fixed

  • Interlocked

  • Adjustable

  • Trip

  • Other

  • Last PATest Date

  • Vehicle Ramp Test Date

  • Compressor Test Date

  • PROHIBITED

  • Equipment
  • PROHIBITED

  • Tasks
  • PROHIBITED

  • Areas

Identified Significant Risks

  • IDENTIFIED SIGNIFICANT RISKS:

  • Risk Banding

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

  • Signed on behalf of B&E

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. Any ratings or scores displayed in our Public Library have not been verified by SafetyCulture for accuracy. Users of our platform may provide a rating or score that is incorrect or misleading. You should independently determine whether the template is suitable for your circumstances. You can use our Public Library to search based on criteria such as industry and subject matter. Search results are based on their relevance to your search and other criteria. We may feature checklists based on subject matters we think may be of interest to our customers.