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INDUSTRIAL PLACEMENT VISIT REPORT AND INTERIM ASSESSMENT

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					       INDUSTRIAL PLACEMENT VISIT REPORT FORM

                                            AND

                            INTERIM ASSESSMENT




Name of Student:                              ____________________________________

Programme:                                    ____________________________________

Date of Visit:                                ____________________________________

Name of Employer/Organisation:                ____________________________________

                                              ____________________________________

Placement Commencement Date:                  ____________________________________

Anticipated Completion Date:                  ____________________________________




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Student Details

Name:
Contact Address:




Telephone Number:
Visiting Tutor Name:                                           Date:

Placement Details

 Name of Organisation:
 Address:



 Telephone Number:                             Fax Number:


Further Placements - please give brief details if this has not already been notified

 Job Title:
 Job Description:




 Salary & Benefits:                                                    No of Placements:




Important Dates



Project/Report required by




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                              INTERVIEW WITH STUDENT

Jobs/Tasks/Responsibilities




Perception and Overview of Business




Likely Link with Future Career



Health and Safety Awareness



Training Courses/Special Training During Placement




Queries/Problems




Placement Project/Report - Title & Synopsis (must be agreed with Placement Tutor)




Any Other Comments




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                            INTERVIEW WITH EMPLOYER

 Student’s Progress




 Problems/queries




 Any Other Comments




                                 INTERIM ASSESSMENT

Please score the student’s performance during his/her placement by ticking the appropriate
box for each category as Distinction, Merit, Pass or Fail as defined below:

Distinction   Consistently performs to a standard above that required for the job role
Merit         Performs tasks to a high standard
Pass          Generally performs tasks to an adequate standard
Fail          Does not meet the requirements for the job role

                                                                Distinction          Merit            Pass              Fail
 Time keeping
 Acceptance of Instructions
 Quality of Work
 General Employability
 Overall Employer Assessment



Employer/Supervisor Signature:         ..........................................................................................

Student Signature:                     ..........................................................................................

Visiting Officer Signature:            ..........................................................................................


                      Please ensure this form is returned to the Placement Tutor




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