Education and Training Reform Act 2006 – Ministerial Order 55: Structured Workplace Learning Arrangements (Schools)
School Name and Address
Structured Workplace Learning Coordinator
Student Year Level
IN CASE OF AN EMERGENCY, THE EMPLOYER SHOULD CONTACT THE STUDENT’S PARENT OR GUARDIAN AND THE STRUCTURED
WORKPLACE LEARNING COORDINATOR:
Emergency contact (Name and Tel.)
PRIVACY INFORMATION: The information provided on this form is for the administration of Structured Workplace Learning
Arrangements only and is not to be used for any other purpose. Health information will be provided if the Student has a medical
condition or requires medication that may be relevant to their placement. This information must be kept confidential.
WORK PLACEMENT DETAILS
Employer (business) name
Type of industry
Primary activity at workplace
Student’s work location address
Workplace contact person
Activities the student will undertake (if insufficient space, attach separate sheet)
Structured Workplace Learning hours
am / pm, to
am / pm; on
from (commencement date)
to (completion date)
Total number of days
Rate of payment $
per day ($5.00 per day minimum)
EMPLOYER ACKNOWLEDGEMENT (Employer to sign)
[name of individual, or on behalf of the Employer if Employer is an incorporated body] agree that:
1. I understand occupational health and safety legislation and standards relevant to the conduct of my undertaking and will comply with these laws
and standards with respect to the Student as if the Student were my employee.
2. I will identify all hazards relevant to the conduct of my undertaking and will assess and control all related risks. If I have not controlled all related
risks I will inform the school of this fact prior to the Structured Workplace Learning Arrangement commencing.
3. I have read and understood the Department of Education and Early Childhood Development Structured Workplace Learning Guidelines for
Employers. I will ensure that required planning, induction, supervision and safe systems of work are provided for the Student to maintain a safe
and healthy Structured Workplace Learning Arrangement at all times.
4. I will consider and take into account the competency, maturity and physical capabilities of the Student in relation to all activities he or she will
undertake. The Student’s program of activities will be planned and carried out with these considerations in mind.
5. I will nominate a Supervisor (or Supervisors) of the Student who will be responsible for ensuring that my obligations as the Student’s Employer
are carried out.
6. I will provide appropriate information, training, instruction and supervision to the Student in respect of occupational health and safety and will
provide any equipment and/or clothing which is required to comply with my duty of care toward the Student.
7. I will ensure that the Structured Workplace Learning is undertaken in a non-discriminatory and harassment free environment.
8. I will permit access to the workplace and contact with the Student by the Principal or the Structured Workplace Learning Coordinator at any
reasonable time during the Structured Workplace Learning Arrangement.
9. I will ensure that the Structured Workplace Learning Arrangement is not used as a substitute for the employment of employees or the
engagement of contractors and the payment of appropriate wages or fee for services to employees or contractors respectively.
10. I will ensure that the maximum number of students in the workplace does not exceed one Student for every three employees.
11. If I have sought to engage more than the permitted number of Structured Workplace Learning Students, I confirm that direct supervision will be
provided for all Students.
12. Where the Principal has disclosed any necessary health information in relation to the Student I confirm that I will maintain the confidentiality of
that health information and only disclose this information to another party if treatment is required for a known medical condition or in the case of a
13. I will notify the Structured Workplace Learning Coordinator as soon as is possible if the Student is absent, injured or becomes ill in the course of
undertaking the Structured Workplace Learning.
14. I will consult with the Principal if I consider it necessary to terminate the Arrangement before the specified time.
15. I will advise the Principal if the industry to which this Arrangement relates includes potential exposure of the Student to scheduled carcinogenic
substances and/or other hazardous substances as defined in the Occupational Health and Safety Regulations 2007.
I understand and accept the responsibilities set out above. Following the Principal’s review of these details, I understand that he or she will determine
whether or not the Student will undertake the Structured Workplace Learning Arrangement proposed here.