Vocational Placement & Risk Assessment Form

This form is for students undertaking a vocational placement inside Australia as part of a Faculty approved subject for credit.

The content of this form will be used to complete the Vocational Placement Letter Agreement which is the formal agreement between the Host Organisation and the University of Melbourne MPF1327. Information collected on this form will be stored securely and only used or released in accordance with the University’s Privacy Policy.

The student must complete this form with the assistance of the Host Organisation at least 4 weeks before the placement commences. Students cannot enrol themselves in an internship subject and will not be enrolled until all required paperwork is completed and returned.

If you have any questions regarding this form, please email design-internship@unimelb.edu.au.

Internship details

Please select your internship subject *

Which course are you studying? *

Is this internship paid? *

Section A: Student information and placement details

A1: Your Details

Name * Please enter your full name.

Student number *

University email address *

Mobile phone number *

Address *

Emergency contact details

Emergency contact name *

Relationship to you *

Emergency contact number *

Email address *

A2: Details of internship/placement

Name of Host Organisation *

Address of Host Organisation *

Address of internship Include this if where the internship will take place is different to the address of the Host Organisation.

Host Supervisor’s Name *

Host Supervisor’s Position * e.g. Manager

Host Supervisor’s contact number *

Host Supervisor’s email address *

Anticipated start date * Please enter as dd-mm-yyyy.

Anticipated completion date * Please enter as dd-mm-yyyy.

Contact hours Please enter the likely contact hours during internship as hours per week.

Activities to be undertaken while on placement, as agreed with the above named Organisation *

A3: Maintaining communication with the Faculty internship supervisor

How you will maintain regular contact with the subject/internship coordinator during your placement? The site host supervisor will monitor your progress and will be your primary contact point if there are any concerns/ problems. The Faculty internship supervisor is responsible for monitoring your overall progress, responding to concerns raised during placement as well as marking assessment pieces. You must provide progress reports to your Faculty internship supervisor. e.g. Brief weekly email updates.

Section B: Internship Placement Risk Assessment

It is recommended that you inform the University of any physical or medical conditions which may affect your comfort or safety or the safety of others during the activity or placement. Provision of this information is not mandatory, but is designed to assist in the event of an accident or emergency. Medical information shared with the University of Melbourne is subject to the Information Privacy Act 2000, Health Records Act 2001, Equal Opportunity Act 1995, Equal Opportunity Policy (MPF1241) and the University’s Privacy Policy (MPF1104). For more information refer to the University's Privacy website.

The University reserves the right to deny participation in any of the activities where your physical or medical condition may affect your safe participation.

B1: Consider your Fitness for Participation in the Activity

Do you have any medical or physical condition which could affect your safe participation in the activity you are undertaking? *

Are you taking any medication that an ambulance or doctor should know about if you were to be incapacitated? *

Consent: I consent to this information being passed to the host organisation for the purposes of assessing the safety of my participation in this event *

Yes, I give my consent

B2: Location

How will you minimise the risks relating to your internship location? Please answer every question.

For each location risk, we have listed examples of control measures. Please note this is not a comprehensive list.

Weather/Outdoor work * Use protective clothing, particularly covering the head. Head coverings should be wide brimmed hats rather than caps;
Wear sunglasses (UV protective safety glasses) for eye protection;
Use protective lotions on exposed parts of the body;
Arrange work patterns that maximize work in shady areas;
Avoid heavy work during the hottest part of the day;
Use personal water canteens;
Drink 250 ml of water every half-hour;
Safety glasses are worn when performing activities which require them or have the potential to cause eye damage.

Bushfire, flood or natural disaster * Regularly check on local conditions and hazards with local Fire Authorities or land managers cfa.vic.gov.au, delwp.vic.gov.au.

Remoteness * Be familiar with emergency and first aid protocols of the host organization;
Do not take unnecessary risk with your personal safety;
Ensure that you are familiar with all available communication tools in the remove or isolated location, eg. mobile phones, satellite phones, two-way radios etc.

Rough terrain and outdoors * Wear sturdy footwear and long leg clothing; do not approach wildlife;
Be prepared for weather conditions; consider supplying sunscreen;
Carry sufficient drinking water where necessary.

Cultural issues * Be aware of possible cultural respect requirements of your fieldwork location and tasks;
Note your right to decline to participate in placement tasks and activities, and ability to discuss this with your academic supervisor.

Close proximity to roads/noise/other hazardous situations * Ensure that appropriate personal protective equipment is used (e.g. high visibility vest, hearing protection, protective clothing, protective shoes, safety glasses, hard hats).

Security Threat/Emergency situation * Follow the directions of your supervisor at the Host Organisation and/or other staff with designated OHS responsibilities (eg. first aiders, safety officers etc);
Report all emergency situations by using the University’s incident report form.

Are there any other locational risks relating to your internship location? *

B3: Placement and Task-Related Hazards

The University of Melbourne is committed to ensuring the safety of all students. Please consider the possible task-related hazards associated with your placement.

For each placement hazard, we have listed examples of control measures. Please note this is not a comprehensive list.

Office work *
As far as reasonably practicable, ensure that your workstation is ergonomically set up.

Utilise the Keyboard Workstation Assessment checklist to undertake a self-assessment of your workstation.

Biological Exposure *
Ensure training is received when exposed or handling biological material;
Use suitable personal protective equipment such as eye protection, latex gloves, masks or gowns;
Ensure universal health precautions are taken (e.g. wash hands and use disinfectants).

Mental stress and graphic images * Note your right to decline to participate in placement tasks and activities, and ability to discuss this with your academic supervisor.

Bushwalking * Wear sturdy footwear and long leg clothing; do not approach wildlife;
if in snake territory, stomp and make loud noises while walking;
be prepared for weather conditions; consider supplying sunscreen;
carry sufficient drinking water where necessary.

Operating Equipment * Refer to the University’s Manual Handling and Ergonomics Policy http://safety.unimelb.edu.au/safety-topics/manual-tasks
Ensure that you have received on-the-job training in the correct use of mechanical plant, equipment or tools
Follow the safe operating procedures for the mechanical plant, equipment or tools;
Utilise personal protective equipment while using the mechanical plant, equipment or tools as applicable (eg. gloves, eye protection etc);
If you are unsure of any part of the task, discuss with your supervisor at the Host Organisation. Do not feel pressured to do something that you are uncomfortable doing.

Manual Handling * Refer to the University’s Manual Handling and Ergonomics Policy http://safety.unimelb.edu.au/safety-topics/manual-tasks/
Adopt correct manual handling techniques while undertaking physical work tasks;
Assess the risk of undertaking the manual handling or physical work tasks;
If you believe that you are not capable of undertaking the manual handling or physical work task, discuss with the supervisor at the Host Organisation. Do not feel pressured to do something that you are uncomfortable doing.

4WD/Off road * Ensure vehicle is roadworthy;
Ensure you have a current drivers licence;
Ensure you have adequate off road safety equipment, spare drinking water, communication devices in case of emergency.

Are there any other hazards relating to the nature of your internship? *

Section C: Student Declaration

Prior to undertaking activities off campus for an internship placement I will ensure that I have:

Enrolled, completed all course requirements, and with enough points left in my degree/subject loading to undertake the internship placement.
An understanding of the skills and standards required.
Advised my subject coordinator if I am under the age of 18 years.
Provided Emergency Contact Details to the University as requested.

In undertaking the placement, I understand that I have duties and responsibilities to abide by the policies and procedures of the University, Responsible Conduct of Students Procedure (MPF1061). I shall be responsible for:

the reasonable care for my own health and safety and that of other personnel who may be affected by my conduct;
cooperating with others in relation to actions taken by the Host Organisation and University to comply with Environmental Health and Safety legislation;
not wilfully placing at risk the health or safety of any personnel;
not wilfully or recklessly interfering or misusing anything provided in the interest of health and safety or welfare of any personnel;
undertaking tasks in accordance with relevant standard operating procedures or work instructions;
wearing correct personal protective equipment specified in standard operating procedures or working instructions;
seeking supervision and guidance from the relevant supervisor for all new or modified work procedures;
using the Host Organisation and University procedures to report hazards and incidents;
where required, participating in health and safety consultative arrangements, including meetings;
where required, participating in health and safety information, training and induction procedures;
following the Host Organisation and University procedures for emergencies.

In undertaking the placement I agree to the following:

If interviews (such as client/research/project interviews) are required to be conducted for the purposes of fulfilling the placement, all information imparted is to be used only for that task and will not be released or allowed to be used in any other manner.
Immediately upon the information no longer being required for my course requirements (i.e. once I have completed the placement and assessment) I will destroy all notes and data in my possession which may identify any individual interviewed during the placement unless these are to be held in confidentiality by the host.
I will conduct myself in such a manner that is respectful and courteous to the placement entity.
I will advise my internship coordinator of any changes to my participation in the internship placement, and recognise that it is my responsibility to ensure I have completed all subject and course requirements associated with this internship placement.

I understand that all medical information shared with the University of Melbourne (the University) will be treated confidentially and is subject to the Information Privacy Act 2000 (Vic) or Health Records Act 2001 (Vic). It is recommended that I inform the University of any physical or medical conditions which may affect my comfort or safety or the safety of others during the activity or placement.

I reserve the right to decline to attend the placement or research program for any reason, or to leave the host location at any time if I feel that my personal safety or wellbeing is at risk. I also understand that the University reserves the right to exclude any student from participation in the placement or research program for reasons which the University believes are justified.

If I have any other concerns, discomfort or uncertainty relating to the placement or research program at any time, I will contact my University academic supervisor as soon as possible. I accept the above terms and conditions and understand the information I have been given.

Declaration

Signature * Sign this declaration by typing your full name.