Appendix I – Field Placement Contract Form

Student Name: ________________________________________

I understand and agree to the following:

• I am required to attend 32 hours of placement weekly (Tuesday–Friday) over 14 weeks during Summer 2025) (448 hours). A final grade will not be submitted until I have completed all required hours.

1. Any absence from my field placement must be reported with as much notice as possible to my Agency Field Supervisor (AFS) and College Field Supervisor (CFS). Unreported or repeated absences may result in termination or failure. I understand it is my responsibility to follow the agency’s absence policy.

2. I must report any harassment, serious problems, or major concerns immediately to my CFS and, if appropriate, my AFS.

3. I am required to observe all agency and Centennial College policies, including the Program and Work Code of Ethics, dress code, professionalism, punctuality, and preparedness.

4. Initiating or maintaining contact with clients outside of placement is prohibited unless I have signed permission from my CFS. I must also notify supervisors of prior contact with the agency, staff, or clients.

5. My grade is assigned by the CFS, in consultation with the AFS and myself, based on the evaluation breakdown in the Field Manual. Midterm and final evaluations assess Social Service Worker core competencies.

6. I am responsible for complying with Field Placement Policies outlined in the Field Manual.

7. I must inform my CFS if the placement does not provide learning opportunities in accordance with Field Placement guidelines, or if I have other concerns.

Signatures:

Agency Name: __________________________________________
Contact Information:

• Telephone: ___________________ Ext. _______

• Email: __________________________

Appendix J – Student Declaration of Understanding

WSIB or Private Insurance Coverage – Students on Unpaid Work Placements

Student Coverage While On Placement:

• Ontario students are eligible for WSIB coverage during unpaid placements required by their program of study.

• Private insurance is provided by MTCU if the placement occurs outside Ontario or with an employer not covered under WSIB.

Declaration:
I understand that WSIB or private insurance coverage is provided through MTCU during my unpaid work placement. I will report any work-related accident or illness to my Placement Employer immediately. The Placement Employer must submit an Accident/Illness Report to my College Placement Coordinator within 24 hours.

I acknowledge my responsibility to Occupational Health and Safety. I will not work in unsafe conditions and will report hazards to my Placement Employer Supervisor and College Placement Coordinator.

Signatures:

Student to retain a photocopy for personal files and upload to e-Centennial course shell.

• Original to Centennial College

• Copy to Placement Employer

• Copy to Student

Appendix K – Letter to Placement Employers Regarding WSIB

Process:

• MTCU has streamlined WSIB coverage for students in approved Ontario college programs.

• The Postsecondary Student Unpaid Work Placement Workplace Insurance Claim Form replaces the previous WEPA Form.

• Forms only need to be completed when submitting a claim for an on-the-job injury/disease.

Declaration:
By signing, the Placement Employer confirms commitment to immediately report workplace injuries or disease to Centennial College.

Distribution:

• Original: Centennial College

• Copy: Placement Employer