School of Education
Professional Experience
Safety in Practice Agreement
School of Education students undertaking professional experience (PE) placement/s
must submit a completed Safety in Practice Agreement annually.
Personal Information Statement
Your personal information is collected by the School of Education on behalf of the
University of Tasmania (UTAS) for the primary purpose of establishing your capacity to
participate safely in PE placements. Your personal information will only be used for the
primary purpose for which it is collected and disclosed only to the following persons or
Employees of the University who require this information to carry out their duties; and
PE placement providers for implementation of reasonable adjustments
UTAS will ensure that your personal information is not used for another purpose or
disclosed to third parties without your consent, unless such a disclosure is required or
permitted by law. Personal information will be managed in accordance with the Personal
Information Protection Act, and the UTAS Privacy Policy. You also have the right to access
your personal information held by the University in accordance with the Right to Information
Act (Tas).
Safety in Practice Disclosure
UTAS is committed to continuously improving the management and standards of work,
health and safety and in so doing we strive to protect the health and safety of our students
and other people in the community with whom students interact as part of their study.
In accordance with UTAS Health and Safety Policy and Professional Experience
Placement Policy, all students required to undertake PE placements as part of their degree
are required to establish and maintain their medical, physical and psychological capacity to
practice safely.
You are therefore, required to declare your capacity to meet the Professional
Experience Mandatory Functional Requirements.
Declaring a medical, physical and /or psychological condition will not automatically exclude
you from undertaking PE placement. UTAS is committed to anti-discrimination practices
and will provide reasonable adjustments to enable students to participate in PE
placements as long as safety requirements or teacher registration requirements are not
Where University of Tasmania staff have reason to believe that a student does not have
the capacity to meet one or more of the Mandatory Function requirements, staff from the
School of Education will discuss this with the student and, if necessary, the student may be
required to undertake relevant assessment prior to confirming the student's eligibility for a
Professional Experience Placement and any relevant conditions or support associated with
the placement.
Professional Experience Placement Mandatory Functional Requirements
Capacity to read and write to enable the student to:
Prepare written documentation relevant to the educational context
Accurately record observations and reflections
Assist learners with their reading and writing
Capacity to undertake critical thinking and reflective analysis to:
Critically self-evaluate and reflect upon own practice, feelings and beliefs and
the consequences of these for individuals and groups within the placement
setting and within the wider community
Critically evaluate and reflect upon 'learners' development and learning
Capacity to communicate to enable the student to:
Accept instruction and professional feedback
Clarify obligations regarding teaching practice
Resolve conflict and negotiate with the placement community
Communicate with learners in a professional manner in order to sustain a
positive and safe learning environment
Psychological capacity to:
Interact with the placement community in a caring and respectful manner
Remain emotionally calm in all situations
Model behaviour appropriate to the professional and the educational context
Physical capacity to:
Use technical equipment, which includes having the dexterity to handle and
operate equipment
Physically manage essential equipment and materials
Maintain adequate mobility and/or agility in order to effectively carry out
teaching responsibilities
Safety in Practice Declaration
Date of Birth: / / Student ID:
Residential Address:
Phone Home: Mobile:
University Email:
Course/Unit code:
Period of Agreement: November 1st , 2021 December 31
, 2022
Clearance to Work with Vulnerable People
I have applied for a Registration to Work with Vulnerable People (for
Tasmanian students) or relevant equivalent/s (for interstate/overseas
students) and TRB Student Good Character Determination (excludes those
enrolled in ESH102) and will upload these to InPlace as requested.
Learning Requirements
I will read and familiarise myself with the learning requirements for my PE
placement/s in regard to the PE Expectations and the PE Assessment
Professional Experience Guidelines
I have read and agree to comply with the Professional Experience Guidelines.
Health and Safety Policy
I have read and understood the UTAS Health and Safety Policy and I will
disclose any existing health issue (disability, impairment or condition), which
may detrimentally affect my capacity to safely undertake my PE placement,
immediately to the Coordinator, Professional Experience and undertake a
Health Assessment if required
Safety in Practice Disclosure
Do you have any permanent, episodic or temporary health condition/s or impairment/s,
including visual or auditory processing (learning disability)?
N.B. Minor treated and stable conditions (e.g. Asthma, hyper/hypothyroidism, stomach
reflux) do not need to be disclosed.
Yes No
Do you take any medication (prescribed or non-prescribed) or other substances that may
affect your judgment, mental alertness and/or coordination (e.g. medication labelled with a
warning sticker alerting the user not to drive a motor vehicle or operate machinery)?
Yes No
Have you experienced seizures, fits, convulsions, epilepsy, recurrent fainting, significant
visual or hearing impairment (which is unable to be corrected with devices, such as glasses
or hearing aids), sleep disorders, sleep apnoea, narcolepsy or diabetes within the last 5
Yes No
Do you have any other known medical conditions, physical conditions, psychological issues
or medication requirements which may impair your capacity to safely undertake PE
Yes No
After reading the Professional Experience Mandatory Functional Requirements (page
2), do you have any concerns about your capacity to safely undertake your PE Placement/
Do you have a Learning Access Plan (LAP)?
Yes No
If you have answered YES to any of the questions above please take the Health
Assessment form to your Medical Practitioner for completion, then scan and submit the
Form via InPlace.
Declaring a medical, physical and/or psychological condition will not automatically exclude
you from undertaking PE placement. UTAS is committed to anti-discrimination practices
and will provide reasonable adjustments to enable students to participate in PE
placements as long as safety requirements or teacher registration requirements are not
Confidentiality Agreement
In relation to my PE placement, I agree to:
Maintain confidentiality of information, including students, staff
and workplace procedures.
Ensure the anonymity of students when documenting reflections
or any other documentation produced as part of my PE
Sign a workplace specific Confidentiality Agreement if required
by the education provider
Signature of Student:
Student Declaration:
I have read and understood the policies and guidelines outlined in this agreement,
and any additional information provided by the Coordinator, Professional Experience,
and I am aware of the requirements of the PE placement. The special conditions
relating to this/these have been explained to me and I have agreed to meet them. I
consent to information from this form, any previous PEs and academic progress
being used in discussions with potential placement providers.
I agree to advise the Coordinator, Professional Experience immediately of any
change to my circumstances which are likely to impact upon my ability to practice
safely throughout the period of my study.
I understand that where I have not disclosed any medical, physical or psychological
condition but am considered by University staff not to have demonstrated the
capacity to meet the Professional Experience Mandatory Functional Requirements or
the Inherent Requirements of the School of Education, staff from the School of
Education will discuss this with me and if necessary, refer me for a relevant
assessment - prior to being considered for a Professional Experience Placement.
I have truthfully completed all details relating to my PE requirements.