How to complete a student risk assessment information formThis information has been gathered to assist teaching and support staff to assess any additional risk in addition to standard risk assessments used in their area for the student named below and to help with understanding the specific needs of the student whilst they are in their care.

This form should be completed with the student. You may also include parent/carer where appropriate

Student Name: A Student Student Number: 123543 Date of meeting: --/--/----

Reason risk assessment will be required: This form can be used to collate information on a student’s medical condition, disability or for behaviour issues. (Specific medical conditions will only be stated if student is in agreement)

Key points:-This section should contain information on how the illness, disability or behaviour directly impacts on the student’s ability to learn and therefore may require adjustments to risk assessments.

For example: - The student may suffer side effects from medication which may require adjustments, or may be effected by light, colour or sound.

Some of these key points may not be an affect all of the time or impact on all activities. Symptoms and/or indicator:

This section concentrates on signs that may indicate to others that action needs to be taken before the situation begins to escalate. Basically warning signs.

For example:- an epileptic may start to withdraw from the group just before a seizure. Students with behaviour issues may display a tic or start to use particular language as a sign of building frustration.

Agreed Action Plan

This explains how the situation will be managed. People with long term medical conditions don’t necessarily want an ambulance called every time. Listen to how the student wishes to be helped to manage their condition.

For behavioural issues, de-escalation, anger management strategies should be discussed and agreed.

Additional information

This section should contain further actions/controls if the situation develops beyond the controls agreed in the action plan.

For example:- a seizure continues longer than normal or the medication doesn’t act as quickly as expected. What will the next stage involve? Do parents need to be contacted etc..

Behaviour issues should follow college procedures, which would include calling for assistance where applicable.

Please note that staff have the right and duty to override this assessment if they feel the controls are no longer appropriate.

Medication:(if disclosed) Placement (review the risk assessment and complete this section once placement request has been made by

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student)

What information does the employer need to be able to fully support the student during their placement? What additional support or access needs are required by employer or college?Student to consent to sharing the information ( sign below)

The employer has been notified by: (name of staff member) Date: Email / Phone

Declaration

Student’s Signature:

College Staff Signature:

Date:

Review Date:

Delete as appropriate

I understand the nature of the concern(s) raised by the college, and the possible impact that this may have upon my own fitness to study.

I understand that if I am unable or unwilling to carry out the agreed action points (above), the college will consider taking appropriate actions.

I give consent for the College to inform my placement employer of my medical or support needs.

Whilst I understand that the college has a duty of care to support me, ultimately I am responsible for my own health and wellbeing, and it is my responsibility to be fit to study

Does the student require an ‘Emitag’?If yes please ensure one is issued and completed. YES NO

Completed by:

DateDoes the student require a Personal Emergency Evacuation Plan (PEEP)?These are assessments for students who have reduced mobility and would have problems evacuating the buildings in an emergency.

YES NOCompleted by:

Date

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