Work Placement Health & Safety Monitoring Record Date: Monitoring Department vet is review due being conducted for Name of person undertaking assessment: Employer Details Employer’s name: Number of Less than 5 More than 5 employees: Workplace address: Main contact: Position: Health and safety contact: Telephone no. Postcode: E-mail address: Supervisor(s): Enforcement action (Prosecutions, Notices) Occupational Tasks/Activities Undertaken and Assessed Type of work carried out by student/learner Of the above which activities assessed on this visit Employers Liability Insurer Policy Number Expiry Date 1 2 Is the Health and Safety Policy still relevant and current? Yes/No Are risk assessments and control measures still relevant and up to date, taking into account the 3 Yes/No age, previous experience, maturity and lack of awareness of risks of the learner/young person? 4 Are accident, incidents and first aid measures still relevant and up to date? Yes/No Are adequate supervision, training, information and instruction arrangements still in place? 5 Yes/No Specifically: Is adequate competent supervision provided? Yes/No Is on-going instruction and training given? Yes/No/NA Was/is induction received? Yes/No 6 Are work equipment and machinery arrangements adequate and up to date? Yes/No 7 Are personal protective equipment and clothing arrangements still adequate and up to date? Yes/No 8 Are fire risk assessments and emergency arrangements still adequate and up to date? Yes/No 9 Is the working environment still safe and healthy? Yes/No 10 Ofsted or CQC report does not raise any H&S issues. Strike through if not applicable Yes/No – Learner assessment Are learner risk assessments in place for all learners in this work placement? Have they been reviewed where applicable? Is the student receiving any additional support as required
Work Placement Health & Safety Monitoring Record Date: Monitoring review due Department vet is being conducted for Name of person undertaking assessment: Employer Details Employer’s name: Number of employees: Less than 5 More than 5 Workplace address: Postcode: Main contact: Position: Health and safety contact: Telephone no. E-mail address: Supervisor(s): Enforcement action (Prosecutions, Notices) Occupational Tasks/Activities Undertaken and Assessed Type of work carried out by student/learner Of the above which activities assessed on this visit 1 Employers Liability Insurer Policy Number Expiry Date 2 Is the Health and Safety Policy still relevant and current? Yes/No 3 Are risk assessments and control measures still relevant and up to date, taking into account the age, previous experience, maturity and lack of awareness of risks of the learner/young person? Yes/No 4 Are accident, incidents and first aid measures still relevant and up to date? Yes/No 5 Are adequate supervision, training, information and instruction arrangements still in place? Yes/No Specifically: Is adequate competent supervision provided? Is on-going instruction and training given? Was/is induction received? Yes/No Yes/No/NA Yes/No 6 Are work equipment and machinery arrangements adequate and up to date? Yes/No 7 Are personal protective equipment and clothing arrangements still adequate and up to date? Yes/No 8 Are fire risk assessments and emergency arrangements still adequate and up to date? Yes/No 9 Is the working environment still safe and healthy? Yes/No 10 Ofsted or CQC report does not raise any H&S issues. – Strike through if not applicable Yes/No Learner assessment Are learner risk assessments in place for all learners in this work placement? Have they been reviewed where applicable? Is the student receiving any additional support as required
Employer-HS-Monitoring-Form-June-17.docx