Placement Host Assessment Form
Placement Host Assessment Form
Kindly fill out the required details below to ensure a comprehensive assessment.
Host Information
Host Name
Company Name
Address
Phone number
Placement Details
Program/Internship Name
Number of Participants
Host Environment Assessment
Is the workplace safe and compliant with relevant health and safety regulations?
Are facilities accessible to all participants, including those with disabilities?
Does the host provide meaningful tasks and opportunities for skill development?
Are appropriate mentorship and guidance provided?
Does the host understand and agree to their role in supporting the placement program?
Does the host comply with legal requirements, such as employment laws and confidentiality?
Strengths
Areas for Improvement
Declaration and Acknowledgment
I hereby certify that the information provided in this assessment is accurate and reflects the conditions and performance of the placement host.
Date:
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