Health and Safety Agreement

About the Health and Safety Agreement (HSA)

This form is to be completed by the placement provider. Its purpose is to confirm what health, 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, Warwick Business School and the University of Warwick 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

Complete and return the agreement

Complete the Health and Safety Agreement on Microsoft Forms.

The declarations included in this agreement are detailed below for your reference before completing.

If you are not authorised to complete this agreement for and on behalf of your organisation, please direct this to the relevant individual.

If your organisation is unable to access Microsoft Forms, please return a copy of the Health and Safety AgreementLink opens in a new window by email to Undergraduate@wbs.ac.uk.

If you are unable to complete and return the Health and Safety Agreement due to employer restrictions, please contact
Undergraduate@wbs.ac.uk Link opens in a new windowto discuss alternatives for verifying health, safety and insurance arrangements.

Questions? Get in touch.Link opens in a new window

Declarations for domestic placements (within the UK)

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 - Yes/No
We confirm we have Public Liability insurance covering at least £5 million - Yes/No
We confirm we have a written Health and Safety Policy - Yes/No
We will provide the student with an induction in workplace health and safety arrangements including fire precautions specific hazards and safety precautions - Yes/No
We will include the student in the risk assessment program in relation to activities undertaken by them - Yes/No
We will provide appropriate instruction and training in safe working practices and in any control measures identified by the risk assessment - Yes/No
We confirm we will advise the University of any injury damage or serious near misses involving the student - Yes/No
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 - Yes/No
We will provide ongoing supervision and training for the student in the performance of their duties - Yes/No
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 - Yes/No
We will make the department aware of any serious wellbeing and/or attendance and engagement concerns relating to the student that arise during the course of the placement (including prolonged periods of absence or absence without any notice) - Yes/No
I am authorised to sign this form for and on behalf of the organisation named above - Yes/No
Please let us know if there is anything further you wish to make us aware of in regards health and safety arrangements - Free text comments

Declarations for international placements (outside the UK)

We confirm we have insurance that covers liability for injuries or sickness suffered by the placement students or members of the public that are attributable to their duties within the organisation - Yes/No
We confirm we have a written Health and Safety Policy - Yes/No
We will provide the student with an induction in workplace health and safety arrangements including fire precautions specific hazards and safety precautions - Yes/No
We will include the student in the risk assessment program in relation to activities undertaken by them - Yes/No
We will provide appropriate instruction and training in safe working practices and in any control measures identified by the risk assessment - Yes/No
We confirm we will advise the University of any injury damage or serious near misses involving the student - Yes/No
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 - Yes/No
We will provide ongoing supervision and training for the student in the performance of their duties - Yes/No
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 - Yes/No
We will make the department aware of any serious wellbeing and/or attendance and engagement concerns relating to the student that arise during the course of the placement (including prolonged periods of absence or absence without any notice) - Yes/No
I am authorised to sign this form for and on behalf of the organisation named above - Yes/No
Please let us know if there is anything further you wish to make us aware of in regards health and safety arrangements - Free text comments