Structured Workplace Learning Arrangement Form (Page 2 of 2) in pdf

STUDENT AGREEMENT

agree to take part in this Structured Workplace Learning Arrangement and to:

carry out all reasonable and lawful directions of the Employer and perform my work to the best of my ability;

comply with all reasonable workplace rules and requirements governing safety and behaviour;

attend at the workplace on each day at the agreed time;

inform both the Employer and the Structured Workplace Learning Coordinator as soon as possible if I am unable to attend work;

promptly inform the Employer of any accident, injury or incident that may occur;

dress appropriately for the workplace;

agree that no payment will be made to me if the placement is with a Commonwealth Department or a body established under a Commonwealth

Act;

give my consent to donating back payment where the placement is with an organisation engaged wholly or mainly in an educational, charitable

or community welfare service not conducted for profit and where I have determined that the whole of my payment will be donated back to the

organisation.

Students aged 18 years and over:

I agree to inform the Employer of any necessary medical information, including details of any known medical condition which may affect me and

any medication or treatment which may be relevant.

I understand that I am responsible for my transport to and from the workplace.

I understand that the Principal will determine whether or not I will undertake Structured Workplace Learning. I acknowledge that prior to

commencing the placement under this Arrangement, I will be undertaking occupational health and safety training that is part of my Accredited

Course of Study (VET students), or I will complete the occupational health and safety program required by the Department of Education and Early

Childhood Development (non-VET students).

Student’s signature

Date

PARENT/GUARDIAN AGREEMENT AND CONSENT (Not required if the student is aged 18 years or over)

consent to my child taking part in this Structured Workplace Learning Arrangement and I:

agree that he or she will be subject to the direction and control of the Employer and nominated Supervisor(s);

understand that all reasonable care for the health and safety of my child will be taken by the Employer and nominated Supervisor(s);

expect my child to comply with all reasonable workplace rules and requirements governing safety and behaviour;

understand that I am responsible for my child’s transport to and from the workplace;

agree that no payment will be made to my child if the placement is with a Commonwealth Department or a body established under a

Commonwealth Act;

give my consent to my child donating back payment where the placement is with an organisation engaged wholly or mainly in an educational,

charitable or community welfare service not conducted for profit and where my child has determined that the whole of his or her payment will be

donated back to the organisation;

understand that I will be notified as soon as possible in the event of illness of or accident to my child, but where it is impracticable to communicate

with me I authorise the person in charge at the workplace of the employer to consent to my child receiving such medical and surgical treatment

(including the administration of an anaesthesia) as may be deemed necessary by a legally qualified medical practitioner, and administer such

first-aid as is judged to be reasonably necessary;

attach details of any known medical condition which may affect my child, and any medication or treatment which may be relevant;

give my consent to the release of any necessary health information in relation to my child by the Principal to the Employer, for which the Principal

is aware of and may disclose pursuant to the Health Records Act 2001 (Vic).

I understand that the Principal will determine whether or not my child will undertake Structured Workplace Learning.

Signature

Parent or

Guardian

Date

WORKSAFE INSURANCE AND PUBLIC LIABILITY INSURANCE

The Student is covered for WorkSafe Insurance by the Department of Education and Early Childhood Development (State of Victoria). The Student is

covered by public liability insurance in accordance with Ministerial Order 55 – Structured Workplace Learning Arrangements, for the arrangement

taken out by the party indicated below (Principal to tick the appropriate box):

Department of Education and Early Childhood Development

Non-Government school

Employer

NOTE: PUBLIC LIABILITY INSURANCE

Public liability insurance of at least $10 million cover per event must be held or taken out, prior to the Student commencing Structured Workplace

Learning under the Arrangement:

when an Arrangement is entered into by a Principal of a Government School in respect of a Government School student, by the Department of

Education and Early Childhood Development with the insured being the Student and the Employer.

ii.

when an Arrangement is entered into by a Principal of a Non-Government School in respect of a Non-Government School student – either:

by that School, with the insured being the School and the Student; or

by the Employer, with the insured being the Employer and the Student, if the Principal of that School has advised the Employer at

least four (4) weeks prior to the Student commencing Structured Workplace Learning that the School does not have public liability

insurance as set out above.

PRINCIPAL CONSENT

Principal of

enter into an Arrangement for the above named Student of this school to be engaged for the purpose of Structured Workplace Learning by the

Employer named above in accordance with the provisions of the Education and Training Reform Act 2006 and Ministerial Order 55 – Structured

Workplace Learning Arrangements, and on the basis of the information provided above and the employer’s acknowledgements. I confirm that I

have informed the Employer as to whether this school holds public liability insurance. I will ensure that the above mentioned student is

undertaking occupational health and safety training that is part of their Accredited Course of Study, or has completed the occupational health and

safety program required by the Department of Education and Early Childhood Development prior to commencing the placement under this

Arrangement.

Principal’s signature

Date

Structured Workplace Learning Arrangement Form Page 2

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