GFS Placement - Host Agreement

GFS Placement - Host Agreement

To be completed by host BEFORE scholar starts a placement where scholar intends to do "hands-on" work.
Name of Scholar to be hosted*

First NameLast Name
Placement provider:*
Name of Host organisation
Placement provider address*

Street Address

Street Address Line 2

CityState and country

Post codeCountry
Contact person*

First NameLast Name
Job title of contact person*
Email address*
example@example.com
Phone Number*

Country CodeArea CodePhone Number
Placement start date*

DayMonthYear
Please enter an approximate date if not confirmed
Placement end date*

DayMonthYear
Please enter an approximate date if not confirmed
Location of placement*
Hours of work*
Tasks/activities the scholar will undertake*
Safety precautions to be observed by scholar*
Name of supervisor*

First NameLast Name
Level of supervision to be provided*

ContinuousFrequentOccasionalMinimal

	Comments
What is the size of your organisation? (number of employees)
Following a report of a workplace injury, have you reviewed your safety procedures and consulted with your workers?
Have you conducted an operational risk assessment to identify the hazards, risks and safety controls?
Do you record near miss incidents and investigate the potential causes?
Do you have a system of leading safety indicators to report on the safety culture of the organisation?
Have you identified the most common causes of injury in your workplace?
Will the global footprints scholar be working in these areas where there are high rates of injuries?
If so, what are the proposed safety controls to manage the risks and potential injuries?
Have you conducted a review of your organisation injury rates as compared to your industry injury rates?
Does your organisation have a code of conduct to guide workers in appropriate workplace behaviours to stop bullying, harassment and sexual harassment?

Agreement
THE HOST AGREES TO:
1. Complete and return this Placement Agreement prior to commencement of the placement
2. Provide BBM with a certificate of currency of their public liability insurance prior to commencement of the placement - please upload a copy or send by email - see details at the end of this form
3. Inform the Scholar of any particular safety requirements of the workplace
4. Provide the scholar with all relevant policy and procedure documents
5. Conduct an induction of the worker into the safety systems and the physical workplace and retain a record of the induction
6. Provide the scholar with a hard copy of the safe work procedures relevant to the work tasks they will be undertaking
7. Provide the scholar with the required personal protection equipment (PPE) for their work tasks
8. Provide the scholar with a person who can be contacted 24/7 in case of an emergency during their placement
9. Provide the Scholar with appropriate supervision throughout their work experience placement
10. Comply with BBM’s behaviour policy and code of conduct (linked below)
11. Notify BBM of any accident involving the Scholar or any actions undertaken, and damages to property involving the Scholar during the work experience placement
12. Notify BBM of any unexplained absences by the Scholar during the work experience placement
13. Treat the scholar with respect at all times
GENERAL TERMS AND CONDITIONS:
1. the Scholar is responsible for all costs associated with attending the placement including insurance, accommodation and travelling to and from the placement. These costs are expected to be covered by the Scholar’s Scholarship Grant
2. the placement may be terminated at any time by either the Host or the Scholar by providing two days’ notice of termination.
Signed*

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On behalf of the host organisation*

First NameLast Name
Date*

MonthDayYear
Date
Please upload any supporting documents here

Cancelof
Should be Empty:

	Yes	No	Comments - If no, what action is required?
a system for managing work health and safety
an induction process to induct new workers into the safety systems of the organisation, relevant to the workplace and a record retained of the completed induction
a process of written safe work procedures which are provided to workers for their review, understanding and adoption
a safety process of workers conducting a Job Safety Analysis or similar risk assessment, where the work task is not covered by a safe work procedure
information about the nature of work, including any health and safety risks for the work
information about the work environment where the workers will carry out the work
a system to manage potential hazards e.g. dangerous machinery, hazardous manual tasks, psychosocial hazards, working remotely or in isolation
a system of work to ensure that plant and equipment used at the workplace are safe, fit for use, and appropriately maintained
a system to verify that workers have the necessary qualifications, licences, skills and training to carry out work safely
adequate arrangements in place to provide supervision to workers
a system to ensure workplace incidents and injuries are reported, investigated and actions taken to prevent a reoccurrence
documented information about the way you manage safety
an appointed senior manager who is responsible for making sure safety is adequately managed

GFS Placement - Host Agreement

Host Organisation (PCBU) Work Health and Safety Checklist

Section 1. Managing Safety

Section 2. The Organisation

Agreement