University Code of Practice
Placement Learning (QH:K9)
Annexe 2b - Placement Provider Risk Profiling Form
To apply for placement provider approval this form must be completed by the placement coordinator of the relevant department or school, signed by the relevant head of department/school
(or equivalent) and submitted to the relevant Faculty Dean (or nominee) for approval. Placement
providers deemed to be ‘High Risk’ upon completion of this form must be approved by the Dean;
they must not be delegated to a nominee.
As the level of risk may vary between departments in larger organisations, please complete a
separate annexe 2b form for each physical location and/or service (in the case of organisations
such as councils).
Placement provider name:
Placement provider address:
Placement contact name:
Contact phone number:
Contact email address:
1. General control measures
Yes / No
Additional comments
Does the placement provider
have a written Health and
Safety policy?
Does the placement provider
have a Health and Safety
advisor?
2. Risk assessment and
further specific actions
necessary
Risk profile
Action necessary?
Action completed
(High, Medium
or Low)
Travel and transportation
factors – Risks related to
travel to reach the placement.
Location and/or regional
factors – Risks related to
crime, civil disorder, remote
working, limited medical
services, difficult
communication.
Placement Learning
Learning Enhancement and Academic Practice
Version 1 00 – Oct 14
QH:K9
Annexe 2b:1
General/environmental
health factors – Risks
associated with regional/local
health risks (e.g. mandatory
health protection measures).
Insurance limitations –
Placement provider does not
have adequate insurance to
cover students on placement.
3. Conclusions
Yes / No
Action Necessary?
Action Completed
Is a site safety visit required
before placement is
approved?
Are the risks tolerable such
that the placement provider
can be approved?
Prepared by: [placement co-ordinator]
Date:
Have the above actions being completed? Yes / No
Department:
Head of Department: [print name]
Signed:
Date:
If provider is ‘High Risk’ the Dean must sign below.
I (print name:
Signed:
) approve this placement provider.
Date:
Once completed and approved by the relevant Faculty Dean (or nominee), this form must
be returned to the placement co-ordinator of the relevant department or school and copied
to Learning Enhancement and Academic Practice (LEAP) at placements@hull.ac.uk
LEAP will record the details of the placement provider on the database.
This document is available in alternative formats from Learning Enhancement and
Academic Practice
Placement Learning
Learning Enhancement and Academic Practice
Version 1 00 – Oct 14
QH:K9
Annexe 2b:2