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


  • 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


  • 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


  • 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

  • Provision
  • Toilets

  • Drinking water

  • Hand washing & drying

  • Other


  • 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


  • Equipment

  • Tasks

  • Areas

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

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