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Employer / Location Health and Safety Assessment Record

For WBL and Work Experience Programmes

For work experience employers only (WBL employers go to employer


details)
Curriculum Team

Requested by

Placement Start
date

Placement End
date

Learners under 18
Yes/No

Multi site
working Yes/No

Health & Safety assessors to complete pages 1 to 6 for each employer and page 7
(standard 10) for each learner.

Employer Details:
Employers name:

Number of
employees:

Nature of business:
Workplace address:

Main contact:
(Name & Tel
No)
Health and
safety contact:

Learner(s) name(s):
Supervisor(s)
name(s):
Type of work carried
out at workplace
location:
Any Enforcement
action:
(Prosecutions,
Notices)
Yes / No
Employer Liability
Insurance

Health and safety


committee / safety
representation: Yes /
No
Insurer
Policy No
Expiry date

Workplace H&S assessment form


April 2011 Review April 2013
HL Wheatcroft

Page 1 of 9

Employer / Location Health and Safety Assessment Record


For WBL and Work Experience Programmes
Health and Safety Procurement Standard 1:
1

Health and Safety Policy

Is there a written H&S policy statement


mandatory when 5 or more employees)?
Does the policy have an organisation
section detailing the responsibilities for
health and safety (recorded when 5 or more
employees)?
Are arrangements for health and safety
clearly stated (recorded when 5 or more
employees)?
How is the policy communicated to
employees?
Assessment of Standard 1:

C
D

Risk assessment and control

Have risk assessments been carried out and


significant risks identified?
Have the significant findings and details of
any groups identified as being especially at
risk been recorded (mandatory where 5 or
more employees)?
Have control measures been identified and
put in place as a result of the risk
assessments?
Do the risk assessments take into account
young persons, including giving
consideration to their age, inexperience,
immaturity and lack of awareness of risks?
Give details of the risks and control
measures relating to the occupations and
the specific activities carried out in the
workplace.
How are the risks and control measures
explained to employees and others?

C
D

F
G

Yes/N
o

Met
Yes/N
o

Met

Accident, incidents and first aid

Yes/N
o

Have adequate arrangements for first aid


materials been made?
Have adequate arrangements for trained
first aid persons been made?
Are accidents and first aid treatment
rendered recorded?
Are or will all legally reportable accidents,
incidents and ill-health be reported to the
enforcing authority and to Loughborough
College and will they be investigated?
How are the arrangements for accidents,
incidents, ill-health and first aid made
known to all employees?
Assessment of Standard 3:

C
D

Part met

Not met

Evidence / comments

Are risk assessments reviewed eg. In light of


the findings from monitoring activities?
Assessment of Standard 2:

Evidence / comments

Workplace H&S assessment form


April 2011 Review April 2013
HL Wheatcroft

Met

Page 2 of 9

Part met

Not met

Evidence / comments

Part met

Not met

Employer / Location Health and Safety Assessment Record


For WBL and Work Experience Programmes
4
A

B
C

Supervision, training, information and


instruction
Are employees provided with adequate
competent supervision? (Note: where
necessary, suitability checks may be
required for reasons of child protection and
the protection of vulnerable adults)

Is health and safety information, instruction


and training recorded?

How is the effectiveness of health and


safety information, instruction and training
assessed, and is the assessment recorded?
Assessment of Standard 4:

Work equipment and machinery

Is correct machinery and equipment


provided to the appropriate standards?

Is equipment adequately maintained?

Are guards and control measures in place as


determined through risk assessment?

Are safe electrical systems and equipment


provided and maintained?
Assessment of Standard 5:

Personal protective equipment and


clothing
Is PPE/C provided, free of charge, to
employees as determined through risk
assessment?

Is training and information on the safe use


of PPE/C provided to all employees?

Is the proper use and storage of PPE/C


enforced?

Is PPE/C maintained and replaced?

Assessment of Standard 6:
Fire and emergencies

A
B
C
D

Evidence / comments
Supervisors name/s

Is initial health and safety information,


instruction and training given to all new
employees on recruitment?
Is ongoing health and safety information,
instruction and training provided to all
employees?

Yes/N
o

Met
Yes/N
o

Met

Part met
Evidence / comments

Met
Yes/N
o

Part met
Evidence / comments

Page 3 of 9

Not met

Evidence / comments

Yes/N
o

Is there a means of raising the alarm and


fire detection in place?
Are there appropriate means of fighting fire
in place?
Are effective means of escape in place
including unobstructed routes and exits?
Is there a named person(s) for
emergencies?

Workplace H&S assessment form


April 2011 Review April 2013
HL Wheatcroft

Part met

Not met

Not met

Employer / Location Health and Safety Assessment Record


For WBL and Work Experience Programmes
E

Is fire-fighting equipment, preventive


measures and emergency arrangements
maintained, including through tests and
practise drills?
Is a fire log/record book kept?
Assessment of Standard 7:

Workplace H&S assessment form


April 2011 Review April 2013
HL Wheatcroft

Met

Page 4 of 9

Part met

Not met

Employer / Location Health and Safety Assessment Record


For WBL and Work Experience Programmes
8

Safe and healthy working environment

Are premises (structure, fabric, fixtures and


fittings) safe and healthy (suitable,
maintained and kept clean)?

Is the working environment (temperature,


lighting, space, ventilation, noise) an
appropriate safe and healthy one?

Are welfare facilities (toilets, washing,


drinking, eating, changing) provided as
appropriate and maintained?

How is exposure to hazards from physical,


chemical and biological agents adequatrly
controlled?
Assessment of Standard 8:

9
A

B
C
D
E
F
G
H

General health and safety


management
How does the employer consult and
communicate with employees and allow
them to participate in health and safety?

Yes/N
o

Evidence / comments

Met

Part met

Yes/No

Not met

Evidence / comments

Does the employer provide medical /


health screening as appropriate and any
required medical / health surveillance?
Does the employer have access to
competent health and safety advice and
assistance?
Does the employer review health and
safety annually?
Does the employer display the necessary
signs and notices?
Has an OSR1 / F9 been completed and
sent to the enforcing authority?
Is employers liability insurance current
and other insurance in place as
appropriate to the business undertaking?
How does the employer assess, review
and update employees capabilities?

Insurer informed of learners? YES / NO / N/A

Working on other persons premises


I
Will the learner / apprentice be working
on sites other than those controled by the
employer
J
If the other persons premises are
domestic, how will you manage the H&S
K
L

If the other persons premises are


commercial and at multiple locations how
will you manage the employers H&
If the premises are commercial and your
employer is on placement or fixed term
how will you manage the H&S
Assessment of Standard 9:

Workplace H&S assessment form


April 2011 Review April 2013
HL Wheatcroft

Met

Page 5 of 9

Part met

Not met

Employer / Location Health and Safety Assessment Record


For WBL and Work Experience Programmes

Action Plan
Ref

Action required

Workplace H&S assessment form


April 2011 Review April 2013
HL Wheatcroft

Page
By who

Page 6 of 9

Target
date

Completed
(signed of)

of

Employer / Location Health and Safety Assessment Record


For WBL and Work Experience Programmes

Assessment Outcome:
Recommendation:

Accept

Risk Band
Organisational
Risk
Level

Risk category:

Low
Medium
High

Accept with action plan

Reject

Highest Occupational Risk Level


Low
Medium
High
Low
Low
Medium
Low
Medium
High
Unsatisfactory until Improvements Made
High

Medium

Low

The Employer or their representative:

(Please sign to agree that this is an accurate record of the assessment and action plan)
Print name:

Signature

Job title

Date:

Loughborough College representative


Assessment and action plan undertaken by:
Print name:

Signature

Job title

Date:

H&S qualification

Quality assured by:


Name:

Job title:

Date:

Other (please specify):

Date of next
assessment:

Assessment type:
Initial assessment

Re-assessment

Standard 10
Workplace H&S assessment form
April 2011 Review April 2013
HL Wheatcroft

Page 7 of 9

Employer / Location Health and Safety Assessment Record


For WBL and Work Experience Programmes
Learners name:
Employers name and
learners work
location(s):
1
0
A
B
C
D

Management of learners / young


persons /vulnerable adults health
and safety
Type of placement - employed status
(apprenticeship, TtG) work experience
Main occupation of the organisation
Area and type of work the learner /
apprentice will be occupied in
Age group

Yes/N
o

Evidence / comments

Pre 16

16-18

19-24

25+

Is the learner / apprentice classified as


vulnerable by age or other disclosure?
If the answer to E is yes complete the following:
F
Disclosures: (give details of any disclosures
that are relevant to their safety whilst at
work)
G
H

Summary of agreed tasks (refer to other


documents where applicable)
Has the employer assessed the risks to the
learner / young person taking into account
their age, inexperience, immaturity and
lack of awareness of risks?
Have the assessments taken into account
any other special needs or circumstances
including any learning difficulty, disability
and/or medical/health condition?
Has the employer put in place control
measures for learner / young person as a
result of the assessments and have they
informed the learner and their
supervisor(s)?
Detail any necessary prohibitions and
restrictions identified by the risk
assessments that apply to the
learner/young person.
Assessment of Standard 10:

Met

Part met

Action Plan
Ref

Action required

By who

Action
Date

Page
of
Completed
(signed of)

Plan

Prepared by:

Signe
d

Agreed by:

Signe

Workplace H&S assessment form


April 2011 Review April 2013
HL Wheatcroft

Target
date

Not met

Page 8 of 9

Employer / Location Health and Safety Assessment Record


For WBL and Work Experience Programmes
d
Review
dates:

Workplace H&S assessment form


April 2011 Review April 2013
HL Wheatcroft

Page 9 of 9

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