Details of the placementName of placement or businessThe full name of the business where the student will be basedStreet AddressCityState/ProvinceZIP / Postal CodeCountryAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChina, People's Republic ofChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrance, MetropolitanFrench GuianaFrench PolynesiaFrench South TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island And Mcdonald IslandHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJohnston IslandJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarReunion IslandRomaniaRussiaRwandaSaint HelenaSaint Kitts and NevisSaint LuciaSaint Pierre & MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and South SandwichSpainSri LankaStateless PersonsSudanSudan, SouthSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwan, Republic of ChinaTajikistanTanzaniaThailandTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks And Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited States of America (USA)UruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis And Futuna IslandsWestern SaharaYemenZambiaZimbabweMain SectorE.g. Childcare, Finance, Retail, Hospitality etc.Number of employeesThe number of employees working for the companyWill the student be based here for the entire placement?YesNoHave you hosted a work experience student previously?YesNoDetails of the lead contactFull NameThe full name of the lead contact for the placementJob TitleThe job title of the person who is the lead contact for the placementPhone NumberThe phone number of the lead contact for the placementEmail AddressThe email address of the lead contact for the placementNames of the student(s) who you are offering work experience to:Please add each student's name as a separate itemNameHealth & Safety DetailsWhat languages do students need to be able to speakIf more than one, please add each language as a separate itemLanguagePlease provide an overview of what the student will be involved in during the placementIs the student likely to be alone with only one adult for significant periods of time?YesNoIf so, can you ensure that the relevant adult is not barred from working with children?YesNoNot applicable applicable as the student will not be alone with an employeeDoes the student need a criminal records (e.g. a DBS) check?YesNoDoes the placement and its environment carry any risks additional to a typical low risk workplace?YesNoWhat is the dress code expected of the student?Is PPE or other special safety equipment required?YesNoWorking HoursE.g. Monday 2nd October 2023 to Friday 6th October 2023 full time or Every Thursday between Monday 2nd October 2023 and Friday 22nd December 2023Eating and refreshment arrangementsEmployer Liability InsuranceIn order for us to approve work experience placements, organisation must have up-to-date employer liability insurance in place. This is a compulsory requirement to ensure students safety. Please supply details of your employer liability insurance provider, policy number, expiry datePlease upload your Employers' Liability Insurance policy *Choose FileNo file chosenDelete uploaded fileRisk AssessmentThe second document required for the work experience approval process is a risk assessment that is up to date, written and appropriate. This is to show that the employer has consider potential hazards that may pose harm to students on work experience and that the employer has put appropriate measures in place to keep this risk to a minimum. If your organisation does not have a risk assessment for work experience placements, please use the template and the examples from the government website to complete one. Using the examples at the bottom of the webpage will make the process of creating a risk assessment really easy and quick. https://www.hse.gov.uk/simple-health-safety/risk/risk-assessment-template-and-examples.htm Please upload a copy of the risk assessment *Choose FileNo file chosenDelete uploaded filePlease confirm you have a Health & Safety policy that is written down, up to date and appropriate (including taking into account having a young person working at the organisation).YesNoUnsurePlease upload a copy of your health and safety policyChoose FileNo file chosenDelete uploaded filePlease confirm that your company will abide by data protection and privacy law:YesNoPlease read and confirm you will follow the safeguarding policy below:The Employer placement lead (and whoever else is directly interacting with the young person on the placement) should be mature in their attitudes and able to establish good professional relationships with young people; Physical contact should be avoided where possible, with the understanding that sometimes it is unavoidable, for example when it is necessary to show someone how to operate machinery;If a student doesn't show up to their placement, or they have an accident during the placement, or the student commits a significant act of indiscipline, you must let the School placement coordinator know right away;If a young person confides to an adult personal information that gives rise to concern for the young person's safety or the safety of others, the adult should: Be open to listening and be non-judgemental; Not promise to keep anything secret; Write down what the young person said in as much detail as they can, and as soon as possible pass on the information to the School placement coordinator. Yes, I confirm our organisation will abide by the safeguarding policyNo, our organisation will not be able to abide by the safeguarding policyTextTextSubmit the formSave as Draft
