WORK PLACEMENT PROVIDER. As the work placement provider, I: • certify that Work Health and Safety practices, procedures and systems are in place and developed and implemented in line with the Work Health and Safety Act 2012 (Cth) • am aware of my obligations under the Fair Work Act 2009 and undertake to comply with the provisions of that legislation • agree to accept this student on work placement and to plan and conduct an appropriate program in a non- discriminatory and harassment free environment in line with the Equal Opportunity Act 1984 • will notify the school in the case of student illness, accident, inappropriate behaviour, or any absence • give assurance that the workplace is suitable for the student to undertake work placement and that all staff engaging with the student will report, as required, any issues or concern to ensure children and young people are kept safe from harm in accordance with the Children and Young People (Safety) Act 2017 • understand the student will not be used to replace a paid or striking worker or participate in industrial disputes • understand the student will be visited or telephoned by a school representative during the placement • acknowledge that the student will be directly supervised by persons who are suitably qualified/and or experienced and competent at the relevant task the student is undertaking during this placement and will only be engaged in tasks that are appropriate for their maturity, skills and qualification level and will support their identified learning goal • understand that the information provided on this form is for the administration of workplace learning only • agree, subject to the requirements of the South Australian Government Information Privacy Principles 1989 (re-issued 16 September 2013), that this information is not to be used for any other purpose. Workplace key contact name: Signature: Date:
