ABN
Yes
No
Student #
Phone
Campus
Email
Phone
Will this placement be paid?
LB5520 Professional Experience
(Self-Sourced)
JCU Work Integrated Learning (WIL) Program
College of Business, Law & Governance
S
tudent Name
Course
Emergency Contact
Relationship to You
Host Organisation
Street Address
Supervisor Name
Supervisor Job Title
Nominated Study Period
PROJECT DESCRIPTION
Workplace Supervisor to provide an outline of proposed project/role
Additional information or requirements:
CRICOS Provider Code: 00117J
SP1 2020
Townsville
Master of Business Administration (MBA)
CONDITIONS OF PLACEMENT
James Cook University (JCU) offers a Work Integrated Learning (WIL) Program which is designed as
a pathway for students to acquire industry experience and enhance graduate employability.
In order to proceed with the offer of a student placement, please review the conditions of placement
outlined below and acknowledge acceptance with your signature:
the workplace complies with the Work Health and Safety Act 2011 (or equivalent)
the workplace will provide a minimum 130 hours of relevant and productive work to the student
the workplace will provide the student with an induction, suitable workspace and access to required resources
the nominated workplace supervisor will provide adequate supervision to the student for the duration of
the placement
the nominated workplace supervisor will participate in a placement plan meeting with the student and a
JCU placement representative prior to the student commencing their placement to discuss the role and
learning outcomes
JCU and the placement provider organisation will enter into a standard Student Placement
Agreement, sample can be obtained prior by emailing legal.wil@jcu.edu.au
the nominated workplace supervisor agrees to provide required feedback to JCU on the
student’s performance, and agrees to submit required reporting within one week of it being requested.
Signed by Workplace Supervisor
Full name
Date
Full name
Date
Signed by the Student
click to sign
signature
click to edit
click to sign
signature
click to edit
HEALTH AND SAFETY
Please indicate the nature of the environment in which the placement student will be exposed to:
Office Laboratory Workshop
Hospital / Clinic Educational
Institution Factory
Other
Supervisor at placement provider responsible for monitoring the health and safety of the student:
Name: Role Title:
Phone: Email:
The person nominated above is required to complete the following checklist.
The Placement Host is aware that all accidents / injuries involving placement students must
be report
ed to JCU through the Placement Coordinator within 24 hours of occurrence?
The workplace of the Placement Provider is covered by a workplace health and safety management system that
is certified by a recognised independent authority.
No further information is required.
The workplace of the Placement Provider is not covered by a workplace health and safety management system
that is certified by a recognised independent authority.
Further information is requested below.
1. Has the Placement Provider developed and kept current emergency procedures for
potential emergencies which may occur in the workplace which provides for emergency
response, evacuation and medical treatment?
2. Does the placement student have access to adequate first aid and qualified first aiders?
3. Are hazards which may cause injury to placement students and other workers identified
and documented so as to provide this information to placement students?
4. Are all hazards eliminated or if that is not reasonably practicable, controlled to minimise
the risk and documented so as to provide this information to placement students?
5. Are the controls and the conditions at the workplace monitored and improved to ensure
health and safety?
6. Does the Placement Provider maintain and provide safe plant, substances and structures
and ensure that they are used safely, handled and stored without risk to
health and safety?
7. Does the Placement Provider have a process for consulting and communicating with all
workers on work health and safety matters and enabling all employees and placement
students to report work health and safety hazards and incidents?
8. Does the workplace have sufficient staffing resources to provide appropriate supervision
that students on a placement are likely to require?
9. Can the workplace provide adequate and maintained facilities (e.g. dining, amenities,
storage, change rooms, showers) to the student over the course of the placement which
includes safe access to the facilities?
10. Will placement students undertake an induction / orientation program which includes
information requested in Items 3 - 11?
11. Does the Placement Provider have process and policies to mange bullying, sexual
harassment and sexual assault?
Yes
No
Yes
No
N/A
TO BE COMPLETED BY JCU PLACEMENT COORDINATOR
Name of Placement Coordinator assessing this form
Discipline
Based on the health and safety information provided in the checklist, the Placement Provider has been
assessed as:
Suitable for student placement
Unsuitable for student placement
Signature
Date
SUBMISSION INSTRUCTIONS
Email completed form to legal.wil@jcu.edu.au
click to sign
signature
click to edit
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