Register Company Name Contact Name Building / Street Town City Postcode Phone Email Employer Liability Insurance Policy Number Employer Liability Insurer Employer Liability Insurance Expiry Date Public Liability Insurance Policy Number Public Liability Insurer Public Liability Insurance Expiry Date No. Employees on this site No. Employees in Company Department/areas where students will work/have access What facilities exist for rest/breaks? Hours of attendance Placements tasks – Job Description Main Work Tasks Main Work Hazards Control Measures Prohibitions Are there areas/machinery/processes prohibited to the student? Yes No If yes – What are they? How will the student be made aware of the prohibitions etc.? Training and Supervision of student How and by whom will the initial basic health and safety induction and emergency evacuation procedures be explained? How and by whom will the student be supervised and trained? Will the student be on a one to one basis/left alone with an employee? Does that employee have an up to date DBS check? DBS number Are you aware if any employee has been prohibited from working with young people? Yes No Do you have a written health and safety policy document in place? Do you have a written Covid risk assessment in place? Are there arrangements for in-house Health and Safety Audits/Inspections? Have suitable and sufficient company Risk assessment been undertaken? Have results been recorded? Have risk assessments for a young person (under 18 years old) been completed in accordance with the current Management of Health and Safety Work Regulations? Will outcomes of Risk Assessments be communicated to parents/guardians? Yes No If so, how? Who is the Competent Person responsible for health and safety at this company? Name and Job Title Are emergency evacuation procedures in place? Is emergency information signage displayed? Is there an incident/accident reporting system in place? Is there a qualified first aider available? Where is the first aid kit kept? Is the statutory information displayed appropriately? Will the student travel in a vehicle during their placement? (Please ensure that student sits in the back of the vehicle if possible with a mobile phone to hand and that the vehicle insurance is made aware of student travelling in vehicle) Dress Code for the student Is PPE required? Yes No Who will be expected to provide PPE? Expiry date of Inspection Type of Business Communication Recreational, Sporting, Tourism and Leisure Activities Agriculture, Horticulture and Forestry Animal Husbandry, Kennels etc Associated Building Trades Automotive Products Banking, Finance and Insurance Builders Merchants Business Services etc Chemicals and Chemical Product Manufacture Labouring Property Maintenance Clothing/Textile Manufacture Computer Hardware and Software Construction/Civil Engineering Electrical, Optical and Medical Equipment Manufacture Electricity, Gas and Water Environment and Effluent Disposal Fishing Food Processing/Manufacture Hair and Beauty Handling, and Lifting Equipment Manufacture Health and Social Work Hotels, Restaurants and Catering Installation, Contracting and Repairs Legal/ Solicitors/ Courts Machinery, Plant and Equipment Manufacture Manufacturing - Radio, TV and Communication Equipment Manufacturing - Unspecified Metal Treatment/Processing/Stockist/Supplier Metals and Metal Product Manufacture Mining and Quarrying Non Metallic Mineral Product Manufacture Other Business Activities Other Community Activities Paper and Paper Product Manufacture Precision Engineers Public Administration, Defence Etc. Publishing and Printing Rubber and Plastic Product Manufacture Transport, Storage, Warehousing and Steel Stockholding Vehicle Sales, Repairs and Maintenance Wholesale Wood and Wooden Products Manufacture Accountant Administration Arts/Crafts/Design Construction/Building Trades Education/Training Engineering/Scientific/Technical Health/Medical/Care Manufacturing/Assembly/Processing Retail Service Sector Sports and Leisure Uniformed Services Working With Animals Florist Architects Heating Systems Facilities Management Health & Safety Child Care / Nursery Chartered Surveyors Landscaping / Horticulture / Arboriculture Media Risk N/A Low Medium High None I confirm to the best of my knowledge that the details in this report are correct. I agree that this information may be placed on the Mainframe database system under password protection in accordance with the data Protection Act. Yes No I understand that this information may be shared amongst schools/colleges/universities with a view to contacting me for further placement opportunities. I agree to allow the Department for Children, Schools and Families the LSC and college staff or their agencies, reasonable access to any student as required. I also agree to endorse the principles of working with young people. Officer's Signature Officer's Name Forget your private link? Click here to have it emailed to you.