ࡱ> DFC nbjbj++ V4AA MDD$888P$,8/j|T4LZ(,KJrH|4b0/jrr /D :    Health & Safety Assessment of Student Supervision The ҹ޸þ has a responsibility under Health & Safety legislation to provide task supervision (not to be confused with academic supervision) for both undergraduate and postgraduate students to the extent necessary to ensure that they are able to perform their work safely. This guidance considers both categories of student. Most of it is directed towards postgraduate students since the work of undergraduates is usually controlled by the protocols forming the practical side of their course work. This is a specimen form that is referred to in Section 12 for Undergraduate and postgraduate students. It may be adapted, amended to suit the specific needs of the department involved. Note: It is to be used to address the supervisory considerations only. Full Risk Assessments are shown in Document 3. (Please complete in BLOCK CAPITALS) Students Surname: ______________________ First Name: _________________ Supervisor Name: _____________________Room No: __________ Tel. No: _____ Alternate Supervisor Name:______________ Room No:___________ Tel No: ______ Start of work date: ________ Place of work (Tick Box):  FORMCHECKBOX  UCC. Other  FORMCHECKBOX  (If other, state where) _____________________ Note: If 'other' ticked and stated -DO NOT CONTINUE WITH THE REST OF THIS FORM JUST RETURN AS REQUESTED OVERLEAF Term of Assessment (tick box): Yearly  FORMCHECKBOX  Other  FORMCHECKBOX  (please specify term) ______________ Description of work (or programme of work): This form requires you to give a brief statement about intended work, its potential hazards and the appropriate precautions to be taken. This is for the normal daily work, specific pieces of which may be the subject of special requirements for manual handling, chemicals, personal protection or VDSE. Year: _____________________________________________________________________________________________________________________________________________________________________________________________________________________ Hazards: _____________________________________________________________________________________________________________________________________________________________________________________________________________________ Agreed precautions, control measures & personal protective equipment (PPE) required: _____________________________________________________________________________________________________________________________________________________________________________________________________________________ Will the named student be required to work outside of normal working hours? (Tick box) Yes  FORMCHECKBOX  No  FORMCHECKBOX  If Yes please refer to Section 15.0 Organising for Atypical Working Times Why complete this form? - Assessment of Student Supervision - Health & Safety Aspects In the event of an accident occurring involving the named student (or a student undertaking work subject to a group assessment) a copy of the relevant completed Student Supervision -Health & Safety Assessment form must be submitted with the Accident Report Form to the ҹ޸þ Safety Office. Heads of Research & Teaching must be able to demonstrate compliance under Section 12 of the UCC Departmental Safety Statement requirements. Assessments must be reviewed annually or immediately following an accident/unsafe incident occurring. Completed forms must be kept (in a readily retrievable form) for the duration of the course on which the named person(s) is studying. Further advice on completing the form should be sought from the member of staff nominated by the Department Head to advise on this subject. (Senior Technicians). The use of this particular form is required by the school to meet the requirements of responsibilities of Supervisors towards Postgraduate and Undergraduate Students. This completed form does not constitute a full risk assessment as required under the Management of Health & Safety Regulations, or other regulations, such as, the Chemical Regulations, Manual Handling Regulations, etc., nor is it directly concerned with academic supervision. Use must be made of existing ҹ޸þ arrangements for specific aspects of control, e.g. Outside normal hours for working procedure etc. you may need to discuss such aspects with your Safety Co-ordinator. The form may also be used to formalise arrangements for group work, e.g. undergraduate practicals, where there is a shared approach warranting a standard assessment to be made for the whole group. Group assessments must be reviewed before the start off the academic year to which they apply. Risk Category for Supervision (tick box appropriate):  FORMCHECKBOX  Category A - Work must not be started without the direct supervision by one of the supervisors named overleaf  FORMCHECKBOX  Category B - Work must not be started without the advice and approval by one of the supervisors named overleaf PRIVATE "TYPE=PICT;ALT=top of page"  FORMCHECKBOX  Category C While the work entails risks requiring careful attention to the safety related aspects of it, the student has been adequately trained and has demonstrated competence and therefore the work may proceed.  FORMCHECKBOX  Category D - The risk is insignificant and carry no special supervision is necessary. Signatures must be obtained: Supervisor: _________________________________________Date:________ Alternate Supervisor:_________________________________ Date: ________ Student: ___________________________________________Date: ______ PLEASE RETURN TO: ___________________________________ (Insert Name)     DEPARTMENT SAFETY STATEMENT DOCUMENT : Appendices APPENDIX VII - Specimen Assessment Form for Student Supervision Rev.1 Date: Dec 05 PAGE  PAGE 1 of  NUMPAGES 2 Common\Appendix\VII DOCUMENT : Appendices APPENDIX VII - Specimen Assessment Form for Student Supervision (Cont.) 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