Student placement risk assessment - University of Wolverhampton

Appendix CStudent Placement - Personal Data RecordFor completion prior to the commencement of any work based learning activityName of student;………………………………………………………………………………Student number…………………………………………………………………………………Location of placement:…………………………………………………………………………Duration of placement (with start and end dates)……………………………………………Placement contact: name and telephone number………………………………………………Student home address and telephone number:………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………This section is for use in an emergency only:Next of kin home address and telephone number:………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………Signed(student)…………………………………………………………………………………………Date………………………………………………