Student Placement Health and Safety Declaration

This form is to be completed by the placement provider. Its purpose is to confirm what health and safety and insurance arrangements will be in place for the duration of the placement.

During the placement period, the health and safety of students is vested with the placement provider.

As part of our placement approval process, we ask you to please complete the form below so that we can verify the arrangements.

To assist, the University will:

Prepare the student to ensure they are aware of general health and safety aspects. Such preparation is of a general nature and does not include specific information required for particular activities or workplaces.
Encourage the student and placement provider to report any problems experienced in regard to health and safety to the University.
Retain an active interest in any health and safety issues and related communications that arise during the placement

Declaration

Yes

We confirm we have a written Health and Safety Policy

We confirm we have a Health and Safety Advisor / similar position within the company

We confirm we have at least £5 million of Employers’ Liability insurance and that the student is deemed to be an employee for the purposes of this insurance policy

We confirm we have Public Liability insurance covering at least £5 million

We will provide the student with an induction in workplace health and safety arrangements including fire precautions specific hazards and safety precautions

We will include the student in a risk assessment process in relation to activities undertaken by them

We will provide appropriate instruction and training in safe working practices and in any control measures identified by the risk assessment

We confirm we will advise the University of any injury damage or serious near misses involving the student

We will facilitate any virtual or on-site visits to the student undertaken by University staff throughout the duration of the placement in a safe and confidential environment

We will provide ongoing supervision and training for the student in the performance of their duties

We will ensure necessary support measures are in place to enable the student to work remotely should that be a part of the placement or necessary at any point in the placement year

Name

Organisation

Position

Email Address

Student Name

Privacy notice

The data on this form will be used to record what health and safety and insurance arrangements will be in place for the duration of the placement you are providing. We will store this information along with your contact details to support the provision of the placement. We will not use the data for any other purpose.

The University of Warwick is the Data Controller of any information you have entered on this form and is committed to protecting the rights of individuals in line with Data Protection Legislation. The University's Data Protection webpages provide further information on your rights and how the University processes personal data. If you wish to submit a data subjects rights request, make a complaint or report a suspected personal data breach, please contact the University’s Data Protection Officer by email at infocompliance@warwick.ac.uk.

Spam prevention

Let us know you agree to cookies

Essential cookies

Functional cookies

Advertising cookies

Performance cookies

School of Engineering

Student Placement Health and Safety Declaration

Failure to load reCAPTCHA