Form 215-1

1. Procedures associated with the approval of work experience programs are presented in the Guide to Education - Junior and Senior High School Handbooks and require that this form be completed by a school offering or intending to offer a Work Experience Program and signed by the Superintendent of Schools or Designate. This signature attests that the Division's Work Experience Program has been approved by the local Board of Education.

Form 215-1


September 20011
OFF-CAMPUS EDUCATION
WORKSITE APPROVAL FORM

School:	School Year:
Address:	School Code:
	Phone Number:
	Fax Number:
Work Experience Coordinator:

PROGRAM TYPE(S) (please write in right column)

1) Work Experience 15/25/35 2) Workplace Readiness/Practicum 3) Work Experience with Cadets/Canadian Forces (Reserves)

^{(Please indicate appropriate W.E. Level)}
4) Special Project Credits 5) RAP 6) Work Study 7) Green Certificate 8) Career Internship

Description of Stations:

Name of Business/Firm	Student's Supervisor in Business (Name & Phone Number)	Name(s) of Student Enrolled	Student Duties	Program Type (choose # from list above)





Name of Business or Firm	Student's Supervisor in Business	Name of Student Enrolled	Student Duties	Program Type (choose # from list above)

1. Procedures associated with the approval of work experience programs are presented in the Guide to Education - Junior and Senior High School Handbooks and require that this form be completed by a school offering or intending to offer a Work Experience Program and signed by the Superintendent of Schools or Designate. This signature attests that the Division's Work Experience Program has been approved by the local Board of Education.
2.	It is understood by the school and the employer that students registered in the Work Experience/Study program:

2.1 will not replace regular employees;

2.2
will be protected by the Workers' Compensation Act upon acceptance of this application by ________________ School;

2.3 students who work days or hours before or after the hours as specified for the Work Experience program:

2.3.1
are not covered for Workers' Compensation by the Department of Education and
2.3.2
shall be paid at a rate not less than the applicable minimum wage;

2.4 a work station/work site, the specific off-campus location at which the student is involved in off-campus learning activities (Work Experience/Study, Internship, RAP, etc.), requires inspection and annual approval by the principal. After a incident or injury the workstation requires a subsequent inspection before re-approval. (Reference: Off-Campus Education Guide, HAA.AR);

2.5 students and parents signing the Work Experience Agreement are considered to have signed the WCB Deeming order for Workers’ Compensation coverage.


3.	It is understood by all parties that the work site/station will be acceptable in terms of the Employment Standards Code, Canada Department of Labour Legislation, Occupational Health and Safety Act, Workplace Hazardous Materials Information System, local standards and other legislated requirements.

4.	I affirm that parental or guardian approval will be obtained on the student's behalf and that a student-employer contract will be signed by both parties and the parents/guardians of under-age students, and that this contract will be on file at the school attended by the student, before the student is placed at the work station.




Principal/Teacher Coordinator _________________________________ Date: _______________________



Superintendent or Designate: __________________________________ Date: _______________________