Oxford Brookes HST Placement Test

Placements Type of Work Experience / Placement * School * Subject Area * Course*

Module Code

Placement Details Role Title * Start Date * Finish Date *

Currencies * Salary Frequency * Salary (and benefits) *

Hours Per Week * Your Responsibilities *

Organisation Organisation Name * Main Switchboard Number *

Placement Address Street * City * County * Country * Post Code *

Company Contact First Name * Last Name * Telephone * Email * Job Title *

Supervisor / Line Manager First Name (If different) Last Name (If different) Phone (If different) Email Address (If different) Job Title (If different)

Fitness to Practice Safeguarding *

Safeguarding Cert Number * Safeguarding Date *

DBS *

DBS Number * DBS Date *

First Aid *

First Aid Cert Number * First Aid Date *

Other Requirements

Your Developmental SMART Targets SMART Target 1 * SMART Target 2 * SMART Target 3 *

For BSc students only Are you aware of the aims and objectives of the Work Experience module? * Are you aware of the Association for Nutrition’s (AfN) core competencies and standards of ethics, conduct and performance? *

Risk Assessment Have you attended all mandatory health & safety/ academic assignment briefing sessions that take place before the start of the placement/internship/WB Learning? * Have you received health & safety information from your placement employer? * Have you reviewed the Module Guide (including the deadlines for each assignment) and the Placement Guide along with emergency contact details on Moodle? * As far as you are aware, how would you rate your travel and transportation risks? * As far as you are aware, how would you rate the location/ regional risks? * As far as you are aware, how would you rate your working environment? * How much of your experience is on-site/ in the office? * As far as you are aware, how would you rate the general health and safety risks associated with work place activities? * How would you rate risks associated with your personal circumstances? * As far as you are aware, how would you rate the insurance risks? * I agree to inform the placement office if I am absent from work for 7 consecutive working days or more (excluding paid annual leave) * If, following commencement, I have any concerns regarding any aspect of my experience, I will contact my Tutor or the office * I will remember to re-enrol for my placement/internship/WB learning via my student record page. * I will contact the module leader or faculty employability office if there are any changes during my placement/internship/WB learning(i.e. address, line manager/ mentor) *