Use these DOE forms to ensure Workers’ Comp coverage for students participating in internships off campus.
Interim rules ACT 242 07-15-05 update 04-22-08
Appendix 1 Approval form
Appendix II work site checklist template
Appendix III (Agreement of Expectation)
NEW (3/15/2016): fillable PDF format: Fillable Appendix III Revised Agreement of Expectation for HI Work-Based Learning Experience
Appendix IV training plan
Student Injury Notication Procedures
REVISED on 4/21/2015: Memo 21April2015
Appendix III Agreement of Expectation for HI Work-Based Learning Experience
Appendix III Agreement of Expectation for Hawaii Work-Based Learning Experience (Word format)
At the conclusion of the 60-hour internship, the teacher-sponsor can collect these documents from student as evidence for awarding the ½ credit in Work-based Learning (TGG1500). Other documents (e.g., employer evaluation) can also be included in the packet.
reflection journal template