Supervised Professional Practice - Proposed Placement and Consent Form

SUPERVISED PROFESSIONAL PRACTICE - PROPOSED PLACEMENT AND CONSENT FORM

This form must be completed by a student at the pre-placement interview with the placement agency and returned to the Supervised Professional Practice Coordinators before the student may commence the placement via email – or in person. This form ensures that a student is covered by insurance and that the proposed placement arrangements meet required Social Work Field Education standards.Once this form has been received and approved by a SPP Coordinator; a confirmation email will be issued to the student and agency representative or Social Work Educator, advising that the placement can commence and providing details of the allocated University Contact (Liaison) and External Social Work Educator (if applicable).

This form must be returned to the University as soon as possible after your pre-placement meeting or your placement will not be confirmed and will not proceed.All sections must be completed in full. Scan and upload to InPlace

Student Details: / Student ID:
Student Surname: / First Name:
Phone (day): / Mobile:
Student Email: / @student.monash.edu
Course:
(please select) / ☐ BSW / ☐ BSW(Hons) / ☐ BA/BSW / ☐ BA/BSW(Hons)
☐ MSWQ / ☐ MSW / ☐ BHSc/BSW / ☐BHSc/BSW(Hons)
Unit Code: / ☐ SWK3180 / ☐SWK4560 / ☐ SWM5103 / ☐ SWM5108
Current Employer: / Position:

Details of Proposed Placement (Agency to complete):

Agency:
Contact Person:
Email:
Street Address:
Suburb: / State: / Postcode:
Postal Address: / Phone: / ( )
STUDENT PLACEMENTS CONSIST OF 500 HOURS OF SUPERVISED PROFESSIONAL PRACTICE FIELDWORK
Start Date: / Days per Week (please circle): / 3 / 4 / 5
Day 15 Date: / Day 35 Date: / Finish Date:

Social Work Qualified Supervisor* (Agency to complete)

Will on-site Social Work supervision be provided? / ☐ YES ☐ NO

If YES, please complete the following information:*See next page for role description

(Whether provided by the placement agency or by Monash; these details can be completed at a later date if the Supervisor has not yet been appointed/advised)

First Name: / Surname:
Email: / Phone: / ( )
Social work qualifications:
Name of Institution: / GraduationYr:

Task supervisor* (Agency to complete)

If different from Social Work Supervisor: *See next page for role description

Name: / Surname:
Email: / Phone: / ( )
Role Descriptions:
The Social Work Supervisor (or Field Educator), is a qualified Social Worker who is eligible for accreditation with the AASW and whoprovides 1.5 hours of supervision per student for each five days of placement. The aim ofsupervision is to connect social work theory to practice. If a Social Work Supervisor is not available at the placement agency, Monash will arrange an external supervisor.
The Task Supervisor is the person supervising the student’s daily activities at their placement organization. They may or may not be a Social Worker, and they may or may not be the same person as the Social Work Supervisor.

Learning Aims (Agency to complete):

Field of Practice for this placement:

This placement will include involvement in (please tick):

☐ Case Work ☐Research ☐Policy☐Community Development

Briefly outline your Social Work learning aims and tasks to be achieved on placement, as discussed with the placement agency:

Details of Previous Placement:

If this is your final Placement, please complete the following details about your first Placement:

Agency:
Field of Practice for your first placement:
Is this placement field of practice different to your first placement? / ☐ YES ☐ NO
Did you have on-site Social Work supervision for your first placement? (please select) / ☐ YES ☐ NO

Proposed Offer Form to be signed:

Placements may not commence until students have met the faculty’s mandatory requirements as outlined in Moodle, and the signed placement offer and consent forms are returned to the Field Education Office.

Student / Social Work Educator / Agency Representative
(if different from SWE or SWE not available) / Date

QUESTIONS ABOUT THIS FORM

In person to: / Email: / Contact Monash Supervised Professional Practice
Your Unit Coordinator / / Phone / +61 3 9903 1042
Department of Social Work / Email /
Monash University / Web /
Level 4, Building C, Room 4.01
Caulfield Campus
PROFESSIONAL PRACTICE CONSENT FORM

Placement Agency: ______

Start and End Dates of Placement: ______- ______

If part-time, indicate how many days: 3 / 4 / 5 (please circle)

Having agreed to undertake my Supervised Professional Practice placement within the above agency, I acknowledge that I understand and fully accept the following:

The agency is not part of Monash University, but has accepted me as a field Placement student at the University’s request, to allow me to gain experience in the normal day-to-day operations of the agency.
While undertaking my field Placement, I will adhere to the rules, regulations and by-laws of the agency, and will accept and comply with the Agency’s procedures and the direction of its staff.
Any unresolved complaint by the agency about my actions or standard of conduct during my placement will be referred, as soon as practicable, to the Supervised Professional PracticeAcademic Director. The University will investigate the agency’s complaint under its applicable statutes and regulations (including the Discipline Statute) and may, if appropriate, terminate my placement.
The agency has a duty to ensure the safety and wellbeing of its clients, staff and members of the public on its premises. If actions of mine prevent or impede the performance of that duty, and immediate notification of the University is impossible, the agency may act at once to remove me from its premises, or refuse me admission (as the case may be). The agency will notify the University of any such action as soon as practicable. The University will investigate the matter as an alleged breach of discipline or act of misconduct under the Discipline Statute, or take such other action as is appropriate under the statutes and regulations.
I have read and understand the Australian Association of Social Workers Code of Ethics.
I have read and understood the University’s ‘Personal Conduct and Professional Behaviour on Placement’ requirements as outlined in the MNHS Clinical/Fieldwork Placement Handbook.
I have read and understood the University’s ‘Student and Staff Placements OHS Guidelines.’

Name______Student ID______

Sign______Date______

QUESTIONS ABOUT THIS FORM

Incomplete or unsigned forms cannot be accepted