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Clin­i­cal Place­ment Request Form

ProMED Tas­ma­nia wel­comes stu­dents from recog­nised edu­ca­tion­al insti­tu­tions to under­take clin­i­cal place­ments with our team. Our place­ments offer hands-on expe­ri­ence across a diverse range of events and envi­ron­ments, giv­ing stu­dents the oppor­tu­ni­ty to apply their learn­ing, devel­op pro­fes­sion­al skills, and work along­side expe­ri­enced clin­i­cians. To request a place­ment, please com­plete the form below. Our team will review your sub­mis­sion and be in touch to dis­cuss avail­abil­i­ty and next steps.

Applicant Information


Emergency Contact


Placement Details

Total number of clinical hours required

e.g. Certificate IV/Diploma/Paramedic/RN

e.g. logbooks/documents/skills etc

Preferred Location/s 

Please describe any previous clinical placements, including type of placement, setting and key experiences


Certificates/Licences

Please confirm that you hold the following certificates/licences. You will be asked to provide proof of these if accepted for placement with ProMED Tasmania. If you do not hold them, you will be required to obtain prior to onboarding.
Registration to Work with Vulnarable Persons Card (Tasmania) 
National Police Check 

Do you hold a current National Police Check (issued within the past 3 years)?

HLTAID009 Provide CPR 

Do you hold a current HLTAID009 Provide CPR certficate (issued within the past 12 months)?

HLTAID011 Provide First Aid 

Do you hold a current HLTAID011 Provide First Aid certficate (issued within the past 12 months)?

Diphtheria, Tetanus, Pertussis (dTpa) 

Do you have a record of dTpa vaccination or booster in the past 10 years?

Hepatitis B 

Do you have a record of Hepatitis B vaccination or confirmatory serology?

Measles, Mumps, Rubella (MMR) 

Do you have a record of MMR vaccination, confirmatory serology, or a birth before 1966?

Varicella (Chickenpox) 

Do you have a record of Varicella vaccination, confirmatory serology, or records of natural immunity to Varicella?

Influenza 

Do you have a record of Influenza vaccination in the past 12 months?


Applicant Placement Agreement

This agreement is made between Pro-Services Tasmania Pty Ltd trading as ProMED Tasmania ("the Organisation") and the person identified as "Full Name" within this form ("the Student"), and outlines the terms and conditions of the placement program, which aims to provide the Student with practical experience aligned to their academic curriculum and professional development requirements.

The placement will commence on the "Preferred Placement Start Date" and conclude on the "Preferred Placement End Date" indicated within this form, during which the Student is expected to fulfil the "Clinical Hours" specified.

ProMED Tasmania agrees to provide a safe and supportive learning environment, assign qualified supervisors to mentor and guide the Student, offer exposure to a range of duties including emergency response, patient care, and administrative tasks, provide feedback on the Student's performance, and ensure compliance with workplace health and safety regulations. In turn, the Student agrees to adhere to all policies, procedures, guidelines, protocols, and regulations; comply with applicable legislation and professional codes of conduct relevant to the placement setting; maintain professional conduct and attire; complete assigned tasks diligently and to the best of their ability; respect the confidentiality of patients, staff, and organisational matters; notify ProMED Tasmania promptly in the case of absence or delay; provide evidence of immunisations, first-aid certification, and other prerequisites; and refrain from undertaking placement or employment with another medical services provider during the term of this placement unless expressly approved in writing by ProMED Tasmania.

The Student confirms they are covered by insurance provided by their educational institution for the duration of the placement, and ProMED Tasmania is not liable for any injury, loss, or damage incurred by the Student during the placement unless caused by the Organisation's negligence.

The placement may be terminated by either party with written notice in the event of a breach of agreement terms, unprofessional or unsafe conduct, or circumstances beyond the control of either party such as natural disasters or organisational changes, and where the Student initiates termination, appropriate notice should be provided (minimum 7 days unless otherwise agreed).

Any disputes arising during the placement will be addressed in a timely and respectful manner through discussion between the Student, the Organisation, and the educational institution.

The Student further agrees to treat all information related to ProMED Tasmania, its staff, and patients as confidential, and to refrain from disclosing any confidential information without prior written consent.

Finally, the Organisation will complete an evaluation report of the Student's performance, which may be shared with the educational institution; the Student may be required to submit reflective logs or case studies as part of their academic requirements, and agrees to participate in feedback sessions and submit any required documentation to their institution.

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