North York Campus

1000 - 211 Consumers Rd.

ON M2J 4G8
Brampton Campus
Capstone Project Agreement Form 111 - 44 Peel Centre Dr.
ON L6T 4B5

Between Cambrian at Hanson and (Student name)__________________________________________________________.

The parties agree to a capstone project for the student in accordance with the capstone project policy in this document.

The capstone project will start on _____________________ and end on _____________________ unless it is mutually
agreed to end at an earlier date.

STUDENT DETAILS

Student Name: HID:

Program: AID:

Email: Tel:

CAPSTONE PROJECT DETAILS

Supervisor/Instructor Name:

Email: Job title:

Company name: Company website:

Ekene Chiedozie, Placement Coordinator Laura Logiacco, Placement Coordinator

Brampton Campus NorthYork Campus
Email: ekene.chiedozie@hansoncollege.com Email: laura.logiacco@hansoncollege.com
Cell: 416-874-2055 Cell: 416-874-2036
Jeevan Singh, Job Development Coordinator
Ontario Campuses
Email: jeevan.singh@hansoncollege.com
Cell: 416-874-2057

ATTESTATION:
I (student name) _____________________________________ certify that I have read the policy below, and agree to
adhere by the defined terms and conditions.

Student Signature: ______________________________ Date: ______________________________

For College Use Only:

Placement Coordinator: __________________________ Date: ______________________________

Signature: ____________________________

Page 1 of 2
 Capstone Project Policy

1. Notice of Injury
The Work Site Organization will, if a student is injured, immediately report the occurrence of injury to Hanson College. If
you are injured or contract a disease while an Unpaid Work Placement while enrolled in an Approved Program at
Cambrian at Hanson, Hanson College will disclose your personal information relating to the Unpaid Work Placement
and (WSIB) claim (or ACE-INA claim if your placement is with a firm that is not required to carry WSIB coverage) to the
Ministry of Colleges and Universities.

2. Duration of the Capstone Project

The Student agrees to perform those duties as assigned by the project supervisor on the days and during the hours
indicated:
Hours: 40 hours per week (280 hours - 7 weeks in total) or at such other times in writing, as may be agreed by the
project supervisor, Cambrian at Hanson and the student.
3. Supervision
The Student agrees to be under the direct supervision of the project supervisor and the supervisor agrees to monitor
the student during the project.

4. Transportation
The parties agree that the Student is solely responsible for transportation cost associated with moving between the
home and project workspace (if applicable).
5. Evaluation
The project supervisor will evaluate the student’s performance and provide support where necessary. Students must
achieve a pass grade from the project to graduate from the program.
6. Insurance
As a Student Trainee performing unpaid work in Ontario with an Ontario Placement Employer while enrolled in
and as part of an Approved Program with Cambrian at Hanson, you are eligible to make a claim for Benefits in the
event of an injury or disease incurred while in an Unpaid Work Placement.
7. Minimum Age
The Student is 18 years of age or older at the date of this Agreement.

8. Reference
In this Agreement a reference to Cambrian at Hanson includes employees or representatives acting within the scope
of their employment.
9. Confidentiality
All parties agree to maintain in the strictest confidence, information that comes to their knowledge during the project.

10. Attendance
The Student must join the correct capstone course on Schoology. It is mandatory to attend classes, participate, and
contribute to project activities.

11. Student Duties

The Student agrees to perform project tasks assigned by the project supervisor. The Student agrees to comply with
08 23 17E F
Hanson’s rules and all applicable safety regulations.

Page 2 of 2
 North York Campus
1000 - 211 Consumers Rd.
ON M2J 4G8
Brampton Campus
111 - 44 Peel Centre Dr.
ON L6T 4B5

To: Placement Employers

Process for Workplace Safety and Insurance Board coverage

The Ministry of Colleges and Universities has implemented a new streamlined process for students
enrolled in an approved Ontario college program that requires them to complete unpaid work
placements.

The Workplace Education Placement Agreement (WEPA) Form has been replaced by the Postsecondary
Student Unpaid Work Placement Workplace Insurance Claim Form. Placement Employers and Training
Agencies (colleges) are not required to complete and sign the online Postsecondary Student Unpaid
Work Placement Workplace Insurance Claim Form for each student completing an unpaid work
placement in order to be eligible for WSIB coverage or Private Insurance (for non-WSIB firm members,
or out of province, or out of country unpaid placements). Instead, this form only needs to be completed
when submitting a claim resulting from an on-the-job injury/disease. Please note that colleges will
be required to enter their MCU-issued Firm Number in order to complete the online claim form.

The new form has been posted on the Ministry’s public website at:

http://www.forms.ssb.gov.on.ca/mbs/ssb/forms/ssbforms.nsf/FormDetail?OpenForm&ACT=RDR&TA
B=PROFILE&SRCH=&ENV=WWE&TIT=1352&NO=022-13-1352E

Please note that all WSIB procedures must be followed in the event of an injury/disease. Colleges will
keep the signed original of the placement letter on file and ensure that Placement Employers have a copy.

Declaration
By signature of an authorized representative here under we confirm our commitment to immediately
report any workplace injuries or disease to the student’s college.

Employer’s Signature: __________________________________ Job Title: ______________________

Name of Organization: __________________________________ Date: _________________________

Student’s Name: _______________________________________ Hanson ID: ____________________

Student's Program: ____________________________________________

Distribution
A copy with the original signature is to be returned to the Placement/Co-op Coordinator at Hanson and a
copy is to be kept by the placement employer.

Page 1 of 1
 North York Campus
1000 - 211 Consumers Rd.
ON M2J 4G8
Brampton Campus
111 - 44 Peel Centre Dr.
ON L6T 4B5

Student Declaration of Understanding WSIB Coverage on Unpaid Placement

Student coverage while on placement

The government of Ontario, through the Ministry of Colleges and Universities (MCU) reimburses WSIB for
the cost of benefits it pays to Student Trainees enrolled in an approved program at a Training Agency
(college). Ontario students are eligible for Workplace Safety Insurance Board (WSIB) coverage while
on unpaid work placements as required by their program of study. MCU also provides Private
insurance to students should their unpaid placement required by their program of study take place with an
employer who is not covered under the Workplace Safety and Insurance Act.

Furthermore, MCU provides limited private insurance coverage for students in Ontario publicly supported

postsecondary programs whose unpaid work placements are arranged by their postsecondary institution to

take place outside of Ontario (international and other Canadian jurisdictions). In the event of the

student completing a capstone project with the college; the designated campus co-op/placement

coordinator is selected as the 'employer' contact for WSIB related administration.

Declaration

I have read and understand that WSIB or private insurance coverage will be provided through the Ministry of

Colleges and Universities while on an unpaid work placement as arranged by the college as a requirement

of my program of study.

I understand the implications and have had any questions answered to my satisfaction.

Student name (print): ____________________________

Student HID: ____________________________ AID: _______________________

Program and Semester: ___________________________________________ and ____________

________________________________________ ________________________
Date
Student Signature

Page 1 of 1
 North York Campus
1000 - 211 Consumers Rd.
ON M2J 4G8
Brampton Campus
111 - 44 Peel Centre Dr.
ON L6T 4B5
Student Health and Safety Pre-Capstone Project Checklist
Student Information
Student Name (Last Name, First Name) Student HID

Course Name Course Code

Capstone Project Employer Capstone Project Employer Address

Project Start Date (dd/mm/yyyy) Project End Date (dd/mm/yyyy) Remote Work Address

Health and Safety Considerations

General Yes No N/A Comment

Are you at risk of contracting a transmissible
disease (Covid-19) at your residence as compared
to other public settings?
I can participate in meetings via telephone or a
virtual platform
Ergonomic Considerations Yes No N/A Comment
Does the workspace provide the ability to set up
a workstation with ergonomic considerations?
• Your desk, chair, and other accessories should be
comfortable and supportive, similar to that in the office
• Your workspace should permit you to position
the keyboard at the right height (wrists in a
neutral position)
• Lighting is properly arranged; there should not be
reflections on or glare from the computer monitor
Source: ccohs.ca/oshanswers/ergonomics

I can schedule regular breaks

Fire Protection Yes No N/A Comment

Are carbon monoxide and smoke detectors
in place and functional?
Electrical Safety Yes No N/A Comment
Extension/power cords are in good condition and
not plugged in end-to-end to make a longer cord

Cords and cables do not pose a tripping hazard

Outlets are grounded and not overloaded

There is sufficient ventilation for electrical equipment

Please complete this form electronically, and submit via email.

Page 1 of 2
Health and Safety Considerations (continued)

Emergency Procedures Yes No N/A Comment

I am aware of the College’s accident/injury reporting
procedures (read clause 1 of the capstone agreement form)

Are there any safety or security concerns?

A periodic contact schedule has been established

(if working alone)

There are adequate first aid supplies

I can maintain all Public Health recommendations

under the current pandemic

Signature

By signing below, I confirm that the above items are in place or not applicable
at the remote work location indicated in this form.

Signature Date (dd/mm/yyyy)

Please complete this form electronically

Page 2 of 2
 North York Campus
1000 - 211 Consumers Rd.
ON M2J 4G8
Brampton Campus
111 - 44 Peel Centre Dr.
Novel Coronavirus(COVID-19): Informed ON 46T 4B5
Student Consent
This consent must be read in full and signed by the student opting to
continue with co-op, or placement.

Personal Information
Student Name (Last Name, First Name) Student HID:

Academic Program Host Institution/Employer for Clinical, Internship, or Placement

As part of several of its academic programs, Hanson College provides applied learning at businesses, and other
community agencies/sites by partnering with those other organizations. As part of that applied learning environment,
students may be exposed to a greater risk of the Coronavirus (COVID-19). Hanson places the health and safety of our
students at the forefront and is, therefore, neither insisting nor recommending that students continue with co-op or
placement at organizations still accepting students.
1. At this time, Hanson is allowing students to continue in a co-op or placement for students who choose
to do so and where the co-op or placement site is able to support accordingly.

2. Students who choose to continue with co-op or placement acknowledge that they fully understand the potential
health risk of doing so.

3. The student acknowledges and condones that he or she has read all parts of this agreement and fully understands
its terms.

4. The Student has read the employer's Covid-19 vaccination policies and agrees to follow the regulations.
Student Consent

Signature Date Student Address

Print Name

Student Signature

Please complete this form electronically

Page 1 of 1
ATTACH/UPLOAD YOUR VALID WORK PERMIT