SECTION 4. HOST EMPLOYER DETAILS Name of Organisation (Trading Name) Address Postal Address (if different) Contact Person Position Phone Fax Mobile Email Website Location of placement (if different to above address) OVERVIEW Type of industry Main activity Approximate no. of employees at proposed worksite Approx. no. of years in current operation Government enterprise Private enterprise Self-employed Other ☐ ☐ ☐ (please specify) Has your business hosted school students for work experience or work placement in the last 12 months? YES NO ☐ ☐ SUPERVISION AND STUDENT HOURS Name of experienced employee who will provide on-going supervision of the student. NB. The supervisor would not be a trainee or apprentice. Supervisor Name Position Supervisor contact details (if different from Phone Mobile Start date above) Finish date Total number of days Start Time Finish Time Lunch Break Student’s Total Hours DESCRIPTION OF ACTIVITIES Please note there are a number of hazardous activities which are prohibited for students undertaking workplace learning. These are listed in the and Exclusions” section of the Catholic Schools NSW insurance covers document that has been provided to you. “Conditions For each of the following, please provide full details regarding the student will undertake. For further advice on this section, see Employer to Workplace Learning Appendix 1. Activities/duties to be undertaken by the student Any activities or tasks the student is NOT to undertake e.g. no-go areas, machinery/equipment that is too dangerous for new/young workers to operate Indicate any risks to the student in the planned activities e.g. manual handling, repetitive activities; exposure to sun, chemicals, fumes, use of particular tools or equipment, proposed horse riding or use of farm vehicles. How will those risks be eliminated or controlled? special conditions (clothing, footwear, equipment, pre-training, vaccinations, transport, multiple sites, routine car travel, individual student needs, first day arrangements)
SECTION 4. HOST EMPLOYER DETAILS Name of Organisation (Trading Name) Address Postal Address (if different) Contact Person Position Phone Fax Mobile Email Website Location of placement (if different to above address) OVERVIEW Type of industry Main activity Approximate no. of employees at proposed worksite Approx. no. of years in current operation Government enterprise ☐ Private enterprise ☐ Self-employed ☐ Other (please specify) Has your business hosted school students for work experience or work placement in the last 12 months? ☐ YES ☐ NO SUPERVISION AND STUDENT HOURS Name of experienced employee who will provide on-going supervision of the student. NB. The supervisor would not be a trainee or apprentice. Supervisor Name Position Supervisor contact details (if different from above) Phone Mobile Start date Finish date Total number of days Start Time Finish Time Lunch Break Student’s Total Hours DESCRIPTION OF ACTIVITIES Please note there are a number of hazardous activities which are prohibited for students undertaking workplace learning. These are listed in the “Conditions and Exclusions” section of the Catholic Schools NSW insurance covers document that has been provided to you. For each of the following, please provide full details regarding the student will undertake. For further advice on this section, see Employer to Workplace Learning Appendix 1. Activities/duties to be undertaken by the student Any activities or tasks the student is NOT to undertake e.g. no-go areas, machinery/equipment that is too dangerous for new/young workers to operate Indicate any risks to the student in the planned activities e.g. manual handling, repetitive activities; exposure to sun, chemicals, fumes, use of particular tools or equipment, proposed horse riding or use of farm vehicles. How will those risks be eliminated or controlled? special conditions (clothing, footwear, equipment, pre-training, vaccinations, transport, multiple sites, routine car travel, individual student needs, first day arrangements)
2018-CSNSW-WPL-Student-Workplace-Learning-Record.docx