Student Name: Email:
Proposed Placement Host: Host Contact Information (including named supervisor):
Proposed Placement Dates:
Description of placement (job title, project objectives, etc.):
Placement Approved by Host (i.e., application accepted) Yes/No
Newcastle University School/Institute Office number
Personal tutor/supervisor name and email
Placement coordinator name and email
University Security: +44 (0) 191 208 6817 (24 hours a day)
Travel and Health Insurance
Your nominated emergency contact
Newcastle University Insurance: +44 (0) 191 208 3913 insurance@ncl.ac.uk
For emergency claims, contact Chubb Assistance:
Telephone: +44 (0) 207 895 3364
Policy number: 64811698
Include any details of additional insurance (for routine health requirements, additional travel or housing insurance).
Nominate a person whom we may contact if necessary (e.g. mother, father, spouse, partner)
Name:
Relationship:

Accommodation while on placement
Emergency and medical services at placement destination
British Embassy
Complete only if you are travelling overseas
Travel Itinerary
Complete only if you are travelling overseas
Telephone:
Email:
Give the full address of your intended accommodation while on placement. If you do not yet know where you will be staying, provide a sense of your intended accommodation (e.g. rented flat, hostel, staying with family, etc.)
Insert details and telephone numbers of local emergency and medical services.
Ambulance:
Police:
Fire Service:
Local GP/Medical facility:
Other:
Insert name and contact number of the nearest British Embassy to your placement destination.
Name:
Contact Number:
Give details of your itinerary from leaving to returning home, including stopovers and holiday plans. If you have not yet booked your travel, outline your anticipated travel plans.
Control
Measures
(Not all of the hazards and control measures listed below will be relevant to your placement, and there may be others that you need to include. Add and delete as you consider appropriate.)
Hazard 1
Risks
Communication
Risk to student if your academic unit or personal tutor/supervisor cannot contact you in case of emergency or with important information.

I will check my Newcastle email account regularly. If there will be any time when I will not be able to access it regularly, I will let the
School/Institute know in advance.

I will respond to weekly attendance monitoring emails.

I will provide the academic unit and my placement supervisor with my mobile telephone number (including any new number if my placement is

Hazard 2
Risks
Control
Measures
Hazard 3
Risks
Control
Measures
Hazard 4
Control
Measures
Hazard 5 overseas).
 I will use the emergency numbers given above when necessary.
 I will inform my placement supervisor and the academic unit promptly of any incidents or problems that arise while on placement (i.e. illness, accident, assault, etc.)
Add any additional control measures that you will take that are specific to your placement.
Accommodation
Risk to student of theft and exposure to aggressive behaviour. Risk of ill health due to unsafe living conditions.
 I will use reputable accommodation and follow FCO and Newcastle guidance.
 I will use available secure storage facilities for valuable items.
 I will familiarise myself with emergency evacuation procedures and routes of evacuation upon arrival at my accommodation.

I will confirm accommodation security is in place as necessary.

I will take out any necessary accommodation insurance.
Add any additional control measures that you will take that are specific to your placement.
Dealing with people and cultural differences
Risk to students and members of the public of causing offence and confrontation. Risk of legal action and physical injuries.

I will do adequate research in preparation for my placement. I will plan travel routes in commonly used areas and avoid areas of concern. I will use maps and other travel documents.

I will be aware of crowded areas, opportunistic theft and cultural sensitivity.

I will carry an adequate sum of money for the day but keep the amount to a minimum.

If confronted, I will hand over whatever items the aggressors request and report the incident to police.

I will ascertain the security in place at the host institution and remain vigilant at all times.
Add any additional control measures that you will take that are specific to your placement.
Workplace or Laboratory Risks

I will receive a Health and Safety briefing and any necessary safety training during my first week of placement activity.

I will complete and sign a Health and Safety agreement with my placement supervisor in my induction meeting.
Travel and Transport

Risks
Control
Measures
Hazard 6
Risks
Control
Measures
Risks to students and public of road/air accident causing risk of theft, injury, and fatality.

If going overseas, I will check and adhere to FCO travel advice.

I will use the safest possible transport available.

If going overseas, I will register with the FCO LOCATE service.

I will use reputable taxi companies which must be fitted with seatbelts.

I will keep my luggage close and monitored at all times. I will only store my luggage in appropriately locked facilities.

If going overseas, I will take electronic copies or photocopies of my passport and any other documents.
 I will check the FCO website frequently and will not be travelling to or through any areas advised against.
Add below any additional control measures that are specific to your placement.
Location and/or Regional Factors
Risks may include extreme weather conditions, wild life, physical threats, natural disasters, and/or civil disorder.

I will not travel alone.
 I will not travel in high risk areas.
 I will not work alone.
 I will observe local advice.
Add below any additional measures that are specific to your placement.
I have outlined above the details of my intended placement activity as well as the controls that
I will put in place to avoid risks. I confirm that I have answered every question honestly and thoroughly, and that I will keep my School/Institute informed of any changes.
Student Signature: Date:
I confirm that the placement as outlined above is at the appropriate level and provides opportunities for the student to fulfil the learning outcomes of the programme/module. I also confirm that the risk assessment has been completed and that the necessary controls are in place to avoid risks.
Staff Signature: Date: