ESPERANCE SHS - VET - Workplace Learning – Forms

FORM A

PARENT/CARER CONSENT FOR WORKPLACE LEARNING (WPL)

Instructions: Please fill in all sections, ensuring all boxes -  - are ticked.

Student’s Name
Workplace / Approved by Parent/Guardian / Date

I have read and I understand the attached information regarding WPL and I understand the nature of the activities proposed. I give consent for my child to participate in this excursion.

I give permission for my child to travel in the private vehicle of a staff member in order to attend interviews in the workplace.

I take responsibility for transporting my child to and from the above workplace.

I give permission for my child to travel in workplace vehicles as part of the requirementsof the workplace during their work placement hours.

I give permission for my child to be unsupervised during work breaks (morning/afternoon tea, lunch).

I give permission for my child to leave the workplace during work breaks.

I give permission for my child’s health details/medical plan to be made available to the employer

I agree to inform the organisers before the scheduled commencement of WPL of any change to my child’s health and fitness, or of any medical conditions relevant to the excursion, so that appropriate supervision may be arranged.

Where it is not practical to communicate with me, I authorise both the school supervisor and the workplace supervisor to consent to my child receiving medical treatment as may be considered necessary.

I am aware that Department of Education insurance does not cover loss or damage of the student’s personal belongings.

I am aware that my child’s work placement is subject to their appropriate behaviour in accordance with the employer’s and school’s policies.

Full Name: ...... (Parent/Guardian)

Signature:...... (Parent/Guardian)

Date: ......

FORM B

STUDENT INFORMATION SHEET

Student’s Name
Date of Birth
Gender / Form:
Address
Student Contact Phone / Name: / Home:
Mobile:
ParentContact Phone / Name: / Home:
Mobile:
Parent Email
Emergency Contact / Name: / Home:
Mobile:
Work:
Medicare Number Reference Number Expiry Date
Name as written on card
Medical Conditions (include Asthma)
Medication Required

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ESPERANCE SHS - VET - Workplace Learning – Forms

FORM C

WORKPLACE INFORMATION

Instructions: Please fill in all sections, ensuring all boxes -  - are ticked.

WORKPLACE NAME
WORKPLACE SUPERVISOR / PH:
STREET ADDRESS
POSTAL ADDRESS
EMAIL
DRESS REQUIREMENTS
SAFETY REQUIREMENTS

General

I have read and understood the advice related to my roles and responsibilities as a Workplace Supervisor (Employer)

Workplace Safety and Induction Check

Comply with Work Health and Safety (WHS) legislation including but not limited to:

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ESPERANCE SHS - VET - Workplace Learning – Forms

Chemicals and harmful substances

Machinery and plant

Electricity
Manual handling

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ESPERANCE SHS - VET - Workplace Learning – Forms

Evacuation plan and muster point

Induction will be provided to students on WorkHealth and Safety (WSH) matters at commencement of placement

General Site Induction will be provided to students

Other health and safety matters ......

Insurance Acknowledgement

I acknowledge that I have received, read and understand the advice detailed in the insurance conditions (page 7 Workplace Learning Information document) relating to insurance conditions and confirm that organisation/business has public liability insurance of $...... for any one occurrence. I have consulted with my insurance broker to determine the appropriate level of Public Liability cover for my business.

 Public Liability Certificate of Currency supplied

Vehicle and Licence Conditions(Applicable where students may be travelling in vehicles as part of their WPL)

I certify that all vehicles and drivers associated with this business are correctly licensed and insured.Registration of vehicles students may travel in are:

Signed:Employer:...... Date: ……………………

WPL Teacher...... Date: ……………………

FORM D

WORKPLACE CONTRACT

Instructions: Please fill in all sections, ensuring all boxes -  - are ticked.

This contract confirms the commitment between the studentand school to fully participate in the program.

Student Agreement

I will attend Workplace Learning at ...... (Workplace)

Day/Week/Term / Start Time / Finish Time

I will undertake Workplace Learning to the best of my ability in accordance with the student responsibilities and behaviour expectations specified by the employer and school.

I will abide by the attendance requirements of Workplace Learning.

I will notify both my employer and the school of my reason for not attending Workplace Learning ASAP.

Name of Student ......

Signature of Student ...... Date ......

School Agreement

Name of WPL Teacher ......

Signature of WPL Teacher ...... Date ......

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