Newcastle University Health and Safety Checklist
Name of Placement Host:
Address of Placement Host:
Telephone:
Email:
Health and Safety Contact Name and Position:
Short description of the type of work experience the student will be undertaking:
Do you have a written health and safety policy?
Please provide a copy of the policy
Yes
No
Do you have a policy regarding health and safety for people working in
your undertaking including use of vehicles, plant and equipment?
Yes
No
Will you provide all necessary health and safety training for the
placement student?
Yes
No
a. Health and Safety Executive
Yes
No
b. Local Authority Environmental Health Department
Yes
No
Yes
No
a. Is Employer and Public Liability Insurance held?
Yes
No
b. Will your insurance cover any liabilities incurred by a placement
student as a result of his/her duties as an employee
Yes
No
Yes
No
Yes
No
Yes
No
Is the organisation registered with:
c. If outside the UK an equivalent agency (please name)
___________________________________________
Insurance:
Risk assessment:
a. Have you carried out a risk assessment of your work practices
to identify any potential risk to your employees or others?
b. Are the risk assessments kept under regular review?
c. Are the results of risk assessments implemented
Accidents and incidents
a. Is there a formal procedure for report and recording accidents
and incidents? Please provide details?
Yes
No
b. Have you procedures to be followed in the event of serious and
imminent danger to people at work in your undertaking
Yes
No
c. Will you report to the University all recorded accidents
involving placement students
Yes
No
Yes
No
d. Will you report to the University any sickness involving
placement students which may be attributable to work?
The above statements are true to the best of my knowledge:
Name:
Signature:
Date:
Please return this questionnaire to:
[School nominated contact]
School of
Newcastle University
Newcastle upon Tyne
NE1 7RU