Please give the completed form to your Placement Manager
Placement Information
Student’s Name / CID
Department at Imperial / UG or PG
Placement Provider / Location
Dates of Attendance (mm/yyyy) / to / Did you require a visa? / YES NO
Name of Placement Manager at Imperial
Name of Supervisor at the Placement Provider
Name of additional placement “tutor” at Imperial.
Brief Title of Placement/Project
Preparation for the Placement
Did you understand who had responsibility for what in terms of planning your placement? / YES NO
Did you receive sufficient support from your Placement Manager and the Dept/College in general while planning your placement? / YES NO
Did you receive sufficient support from the Placement Provider while planning your placement / YES NO
Thinking back to before your departed, did you consider the arrangements which the placement provider or you made for your accommodation sufficient? See also next section. / YES NO N/A
Space for Comments about Preparation (optional)
Arrival
Did you receive a Day 1 induction (building safety arrangements) at your Placement Provider, and a more detailed area induction on the local health and safety arrangements (specifically any hazards, risks, controls and emergency procedures)? / YES NO
Was the accommodation (arranged for you or which you arranged for yourself) adequate? / YES NO N/A
Did you move accommodation during your placement? / YES NO N/A
Please comment on your accommodation (location, accessibility, facilities etc). Would you recommend it to other students?
Space for other Comments: arrival in the host town/city and at the Placement Provider (optional)
During the Placement
Was the contact between you, your Placement Manager and the supervisor at the Placement Provider adequate? / YES NO
Please comment specifically on the supervision provided by the Placement Provider
In the context of your specific placement, did you consider that you had access to relevant training opportunities (and general health and safety awareness) in order that you could fulfil the objectives of your placement? / YES NO
Did you experience any accidents, either to yourself or others (in the workplace, while travelling to and from the placement location and whilst living there)? / YES NO
If you yourself experienced an accident did you report it to College? / YES NO N/A
Please provide any specific feedback on health and safety training/awareness which would be useful to any future student undertaking a placement.
Did you have cause to utilise the College’s Overseas Travel Insurance? / YES NO N/A
Please comment about the access to facilities you enjoyed at the placement provider (e.g. computer access; email; information resources/library)
Were you happy overall with how you integrated yourself into local life (making friends, participating in activities etc) / YES NO
Space for other Comments (optional).
Assessment of academic work
If your placement involved producing a project report were you satisfied with the system employed to mark it? / YES NO N/A
If your placement was at an institution of higher education (HEI) and involved you undertaking examinations/assessments which were the responsibility of the host HEI, were you satisfied with the guidance received by both your home dept and the host HEI in order to be able to navigate the system at the host HEI? / YES NO N/A
Were you satisfied with the system employed by your home department in transferring your exam results and other assessments? / YES NO N/A
Please comment (optional).
Reflecting on your placement (optional)
What were the benefits of doing a placement for you? What elements of the experience were most beneficial?
How do you feel you can use your placement experience during the remainder of your studies
How do you feel the placement experience will help you in the long-term?
Were there any negative aspects to your experience, about which you have not referred to already?
With regard to your particular placement provider and placement location is there anything you would have preferred to have known more information about before undertaking the placement
Space for any final comments (especially any information which would be helpful to future students going to this particular location or placement provider)