Vocational Placement

Student Acknowledgement Form

STUDENT DETAILS
Qualification Code and Name

HLT54121 Diploma of Nursing

Given Name/s Surname Student No
Balwinder Kaur
474106301
Parent/Guardian’s Name Parent / Guardian Phone
(If the student is under the age of eighteen (18) and is in the care/control of a parent or guardian)

TAFE QUEENSLAND DETAILS

Legal Name ABN

TAFE Queensland 72 898 805 093

Contact Person and Position Phone

0428278406
Jenny Taylor-Gray-VP Officer
Email Address
Jennifer.Taylor-Gray@tafeqld.edu.au

PLACEMENT DETAILS
Placement Provider Name
Logan Hospital

Placement Provider Address

Loganlea rd Meadowbrook 4131

Name of Supervisor Supervisor’s Phone

Placement Start Date Placement End Date Shifts / Times

30-10-2023
Click or tap to enter a date. 26-11-2023
Click or tap to enter a date. As negotiated with Placement Provider

Other Information

Placement Days Total Hours Required

☐ Mon ☐ Tues ☐ Wed ☐ Thurs ☐ Fri ☐ Sat ☐ Sun 160 hours

PRIVACY STATEMENT: TAFE Queensland is collecting personal information on this form for the purposes of arranging and managing vocational placement
arrangements for students of TAFE Queensland. In accordance with the Information Privacy Act 2009 (Qld), personal information will only be accessed and used by staff
employed by TAFE Queensland and the nominated Placement Provider/s for this purpose. Personal Information may also be given to the Queensland Government
Insurance Fund and WorkCover Queensland for the purpose of managing insurance coverage. Personal information will not be provided to any other person or agency
unless you have provided TAFE Queensland with permission or disclosure is otherwise permitted or required by law. Personal information will be stored securely. If you
wish to access or correct any of your information, discuss how it has been managed or have a concern or complaint about the way the information has been collected,
used, stored, or disclosed, please contact the TAFE Queensland Privacy Officer at privacy@tafeqld.edu.au.

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 Vocational Placement
Student Acknowledgement Form
TAFE QUEENSLAND DECLARATION
As the authorised TAFE Queensland representative, I am satisfied that this workplace/facility can provide or arrange
to provide to this student, the facilities, range of work, supervision and training required to undertake their vocational
placement.
Signed for and on behalf of TAFE Queensland by its duly authorised representative:

Name:
Signature:
Date: Click or tap to enter a date.

STUDENT DECLARATION
I have:
 read the information contained within the Vocational Placement Student Information Guide and the Work Placement
Student Logbook and understand the requirements of vocational placement and my responsibilities; and
 provided documentary evidence (as and where applicable) to TAFE Queensland of the following (prior to going on
placement): a valid Blue Card, criminal history check (AFP certificate), Evidence of all mandatory vaccinations, Current
First Aid certificate including up to date CPR and completed any mandatory pre-placement eLearning / documentation.
I understand that I must:
 ensure the safety of staff and clients within the workplace/facility by following appropriate legislation, direction and
demonstrating an appropriate level of knowledge and skills in my position as a student;
 demonstrate professional behaviour (inappropriate behaviour may result in suspension from the placement and if the
allegation is proven, termination of the agreement);
 maintain in the strictest confidence any information to which I have access to any client, staff member, other members of
this organisation or other organisation for which I have contact;
 attend the vocational placement opportunity provided and adhere to the placement person’s requirements;
 record my work hours and complete all assessable activities and ensure these are signed off by my supervisor; and
 satisfactorily complete the required hours of vocational placement and that I will be required to complete and if required
make up any lost hours at another time, prior to end of study date or participate in an alternative vocational placement (in
full) to cover any outstanding hours.
 advise TAFE Queensland prior to commencement of the placement period of any pre-existing conflict of interest /
perceived conflict of interest regarding my placement, such as familiarity with staff or clients of the Placement Provider or
any developing conflict of interest / perceived conflict of interest situations during placement.
I understand and accept that a Placement Provider may refuse my vocational placement as a result of information disclosed in my
criminal history check.
I accept that I am required to be ‘fit for practice’ and adhere to any COVID-19 requirements. I need to advise the Vocational
Placement Coordinator/Officer (in advance) if I have a diagnosed medical/mental health condition, or feel I am suffering from an
undiagnosed condition which may impact on my performance or the safety of staff and/or clients whilst on vocational placement.
NOTE: Failure to advise TAFE Queensland of an issue affecting my fitness to practice (including criminal history, pregnancy etc.)
prior to commencing placement or upon any changes to my fitness to practice may result in my removal from placement and I may
subsequently be deemed ‘unsatisfactory’ for the associated units of competency linked to my vocational placement.

Student
Balwinder Kaur Parent /
Guardian
Signature:
Signature:

Date: Click or tap to3-10-2023

enter a date. Date: Click or tap to enter a date.

122 FM B v4.1 (08/09/2022) © TAFE Queensland Page 2 of 2

This form is a controlled document and becomes uncontrolled when downloaded or reproduced