Host Business/Employer Address: ______

Form A2 / Work Place Learning involving Accommodation Away From Home
ON-SITE ACCOMMODATION PROVIDED BY THE HOST EMPLOYER / For use by schools/TAFE NSW in conjunction with the Student Placement Record and with Form A.
A copy must be provided to the parent/carer.
Also for use with interstate placements.
Student’s
names: / Year:
(e.g. 10) / School
/TAFE: / Host
business:

Host business/employer address: ______

______State: ______

Placement dates: ______

Acknowledgement of accommodation conditions by host employer

The school/TAFE NSW Institute appreciates you providing accommodation on site for the student(s) undertaking workplace learning away from home. The placement provides exceptional educational outcomes that the student(s) might otherwise have not been able to access.

The NSW Department of Education and Communities has policies and procedures related to child protection. The essential information about working with children and young people provided in the Department’s The Workplace Learning Guide for Employers also applies to the provision of on site overnight accommodation. See also the Additional Information for Employers at: https://www.det.nsw.edu.au/vetinschools/worklearn/additional_information_employers.html

The Department, as an agency responsible for the care and welfare of students in schools and TAFE NSW institutes, has a charter to protect the young people in its care from all forms of abuse. In order to formalise the accommodation conditions, please sign and return the undertaking below with the attached Working With Children Check – Declaration for Volunteers and Contractors (Appendix 5) signed by a trusted and responsible employee or the employer/manager volunteering to oversee the student during the overnight accommodation. Proof of Identity that meets the 100-point check (Appendix 6) needs to be supplied to the student’s school or TAFE NSW Institute.

We trust you will enjoy hosting the student at your site and anticipate that the student will benefit greatly from the experience of undertaking workplace learning with your enterprise.

Host employer or manager undertaking to provide accommodation for the student(s)

·  In support of the commitment of the NSW Department of Education and Communities to provide a safe environment for students, I agree to provide appropriate accommodation for the student during the placement.

·  The type of accommodation is ______

·  I am not aware of anything in the background of any staff member at this accommodation that would preclude our hosting the student during this placement.

·  I undertake to provide safe and secure accommodation for the student and to do my utmost to ensure that the student is not exposed to harm.

·  All employees at the accommodation have read/been informed of this essential undertaking.

·  Optional comment:______

Host employer/manager name: ______Date: ______

Host employer/manager signature: ______Relationship to student: ______

Undertaking by the supervisor of the student in the overnight accommodation

·  I understand that the NSW Department of Education and Communities requires me, as the student’s supervisor during the overnight accommodation, to complete a Working With Children Check - Declaration for Volunteers and Contractors (Appendix 5) and to provide Proof of Identity that meets the 100–point check (Appendix 6).

·  The Declaration and certified Proof of Identity is attached and a copy of each lodged with my employer/manager. Overnight, I will be located ______

·  Will there be other employees or visitors at the overnight accommodation? Yes/ No

·  Am I satisfied that the student will be safe in the company of the other employees or visitors? Yes / No

·  Optional comment or overleaf re student’s safety: ______

Supervisor name: ______Date: ______

Supervisor signature: ______No. years as employer/ with the employer: ______

Form A2: Accommodation on-site provided by host employer October 2013