Learner Details
Name
Placement name
About Me
Hints and Tips

When filling out this section on this form consider-:
What do you like about this industry?  Does this industry help you to get to where you want to be in the future?
Your dreams and Aspirations,
Think about the whole qualification including Maths and English and how it will benefit you in your life at work and at home
How it will help with your teamwork, confidence, skills & knowledge

 
Please write a statement on why you have chosen the industry you are working in
What are your strengths and how do they relate to your job role
What are your Hobbies, interests or achievements
Comments
Self Assessment
Which of the following best describes you?
Friendly
Extravert
Introvert
Confident
Aggressive
Shy
Chatty
Happy
Loud
Quiet
Lack Confidence
Moody
Write a statement about yourself using at least one of the words you have chosen best to describe you.
Learner Health and Safety
Management of learner's / young person's health and safety 
Are you aware of the placements health and safety risks
Comments
Have you seen and discussed the placement risk assessments taking into account young person risks, any other special needs or circumstances including any disability and/or medical/health condition
Comments
Are you aware of any control measures as a result of the risk assessments?
Comments
Do you understand of the control measures of these hazards?
Comments
Do you have supervision ? and do you have a designated person to take overall responsibility for you?
Comments
Have you been provided with an induction and ongoing information, instruction and training ?
Comments
Are you provided, free of charge, any necessary personal protective equipment and clothing (as determined by the risk assessment) and ensure its proper and effective use?
Comments
Who is responsible for Health and Safety within your work place?
Comments
Where is the Accident book and First aid kit kept?
Comments
Where is the Health and Safety Law poster displayed
Comments
Are you aware of the Terms British values & safe-learner?
Comments
 
 
Signatures
Printed Name Signature Date Options
Apprentice Obtain Signature
Training Provider Obtain Signature