Northern Territory Student Placement Agreement - current

STUDENT PLACEMENT FORM

To be completed by the Education Provider Placement Coordinator in consultation with the relevant NT Health Placement Coordinator. Return completed form to the NT

Health Placement Coordinator.

Student(s) name(s): Attach additional pages as required Student contact details:

Education Provider Placement Coordinator:

Education Provider Placement Coordinator contact details:

NT Health Placement Coordinator:

NT Health Placement Coordinator contact details:

Course:

Discipline:

Year Level:

Commencement Date:

End Date:

Applicable DOH policies and

procedures: See Attachment 1

1. I have made the Student(s) aware of the terms and conditions under which Student Placements are conducted.

2. I have provided the Student(s) with access to the:

a. Northern Territory Public Sector Principles and Code of Conduct;

b. DOH Privacy Policy; and

c. DOH policies and procedures specified above.

3. I declare that I have sighted and, if required, can provide copies of the following documentation in relation to the Student(s):

a. proof of identity;

b. an up to date Immunisation Record;

c. a Criminal History Check issued not more than 6 months prior to the Commencement Date;

d. a current Clearance Notice under the Care and Protection of Children Act e. (NT); and

f. a Deed of Undertaking signed by the student and duly witnessed.

Education Provider Placement Coordinator Date

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Attachment 1: Policies and Procedures

 Northern Territory Public Sector Principles

 Code of Conduct

 Information Act (NT)

 NT Information Privacy Principles

 Criminal History Check

 Working with children clearance (Territory Ochre Card)

 Aboriginal Land Rights (Northern Territory) Act

 Aboriginal Land and Permits

 Conducting research in the Northern Territory

 Human Research Ethics Committee

 NT Health Student Placements

 Work Health and Safety (National Uniform Legislation) ACT 2011

 Work Health and Safety (National Uniform Legislation) Regulations

 Appropriate Workplace Behaviour

 NT Worksafe Workers guide to dealing with workplace bullying

 NT Public Sector Employment and Management Act and Regulations

 NHMRC Australian Guidelines for the Prevention and Control of Infection in Healthcare (2019)

 Australian Immunisation Handbook

These documents are available to NT Health staff only on the Policy Guideline Centre:

If you require access to these please contact the NT Health Placement Coordinator.

 NT Health Worker Immunisation against Specified Vaccine Preventable Diseases Policy

 Guidelines for the Control of Tuberculosis in the Northern Territory; 5th Edition

 Additional Precautions NT Hospitals Guideline

 Appropriate Workplace Behaviour Policy

 Manual Handling Checklist with Remedial Action Plan

 Work Health and Safety Policy

 Personal Presentation NT Health Policy

 Staff Identification Policy

 Smoke Free Policy

 Emergency Procedures and Fire and Smoke (Code Red) Procedures are venue dependent.

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