RISK ASSESSMENT FORM Date: ______________ This Risk Assessment Form is a and should be used in conjunction with other references such as: Note: guide only The Risk Assessment for National Work Experience Programme for Disability Employment Services Guidelines; Disability Employment Services Deed; and The Australian Standard for Risk Management AS 4360:2004. Disability Employment Services provider Name: Employment Service Area: Disability Employment Services provider Contract ID: National Work Experience Programme Host Organisation: Disability Employment Services provider Contact Person: National Work Experience Programme Host contact for this activity: Position in organisation: Telephone:_________________ Fax:_____________________ Is this activity permitted under the Departments personal Accident and Telephone:___________________ Fax: _________________________ General and Products liability insurance? YES / NO Type of Activity: Has this Risk Assessment been conducted as part of the initial site monitoring visit for this activity? YES / NO Name of Activity: Have you confirmed there is a safe and healthy work environment? YES / NO Location of Activity: Does this activity comply with the relevant National Work Experience Programme for Disability Employment Services Guidelines and Reference Material? YES / NO
RISK ASSESSMENT FORM Date: ______________ Disability Employment Services provider Name: Employment Service Area: Disability Employment Services provider Contract ID: National Work Experience Programme Host Organisation: Disability Employment Services provider Contact Person: National Work Experience Programme Host contact for this activity: Position in organisation: Telephone:_________________ Fax:_____________________ Telephone:___________________ Fax: _________________________ Is this activity permitted under the Departments personal Accident and General and Products liability insurance? YES / NO Type of Activity: Has this Risk Assessment been conducted as part of the initial site monitoring visit for this activity? YES / NO Name of Activity: Have you confirmed there is a safe and healthy work environment? YES / NO Location of Activity: Does this activity comply with the relevant National Work Experience Programme for Disability Employment Services Guidelines and Reference Material? YES / NO Note: This Risk Assessment Form is a guide only and should be used in conjunction with other references such as: The Risk Assessment for National Work Experience Programme for Disability Employment Services Guidelines; Disability Employment Services Deed; and The Australian Standard for Risk Management AS 4360:2004.
risk_assessment_for_disability_employment_services_nwep_placements_v_1.0.docx