Task

Declaration:

Signature

Date

Task 1 Knowledge Questionnaire

I confirm that I have read and understood the instructions, my responsibilities and requirements for this assessment

Task 2 project

I confirm that I have read and understood the instructions, my responsibilities and requirements for this assessment

Task 3 Simulated Practical and/or workplace observation

I confirm that I have read and understood the instructions, my responsibilities and requirements for this assessment

Assessor declaration

The assessor is to complete this declaration with the student.

I have acknowledged the underpinning knowledge and skills may be assessed on or off the job.

?Yes

?No

I confirm that I am a qualified workplace assessor and will be conducting the assessment for this unit and student

?Yes

?No

Have all aspects of the student agreement been explained and understood?

?Yes

?No

Does the student understand they have three attempts to complete each task satisfactorily? If after the third attempt the student is deemed ‘Not Yet Competent’, they will be required to do further training before reattempting this unit.

?Yes

?No

I have explained the requirements for reasonable adjustment as a result of workplace constraints

?Yes

?No

I confirm that I have explained and confirmed all of the above items with the student.

Assessor Signature

Date

____/____/____

Student declaration

Agreement by the student: Please sign below to demonstrate that you understand what is required of you in relation to this assessment.

Do you have any special needs or considerations to be made for this assessment? If yes, what are they?

?Yes

?No

Do you understand your rights to appeal the decisions made in an assessment?

?Yes

?No

I understand I have three attempts to complete each task satisfactorily. If after the third attempt I am deemed ‘Not Yet Competent’, I will be required to do further training before reattempting this unit

?Yes

?No

Reasonable adjustment: If you require any adjustments to accommodate a need in order to complete this assessment, please talk to your assessor. Arrangements will be put in place to ensure a fair and flexible approach is undertaken for this assessment. Please note that the range or nature of the adjustment will ensure that the outcomes of the unit are not compromised.

?Yes

?No

I agree to comply with all rules, regulations, policies and procedures provided as part of the simulated environment.

?Yes

?No

I give permission for the RTO to use my assignment at the workplace for assessment moderation / validation purposes.

?Yes

?No

I confirm that I have read and understood my responsibilities and requirements for assessment.

Student Signature

Date

____/____/____

SUBMISSION EVIDENCE ASSESSMENT TASK 1 KNOWLEDGE QUESTIONNAIRE

Q

Questions

S

NS

1

Define ‘working at heights’.

2

An employer or self-employed person must not perform high risk construction work if there is a risk to the health or safety of any person arising from the work unless: (tick one of the following)

A SWMS has been prepared before the work commences

A SWMS is being prepared as the work is being conducted

A SWMS is prepared after the work has been completed

None of the above

3

Other than a worker falling, list 4 risks of working at heights.

4

The location of any work that’s going to be carried out at height should be identified during the planning stage of a task or project. Where can you find information about where you will be working? List 3 sources.

5

Before work commences, the employer or person who has control of a workplace and employees should ensure that there is safe access to and egress from the work area. What should this include? List 3 things.

6

How can you eliminated or reduce the risk of tools and materials falling from heights? Give 4 examples.

7

List 6 fall prevention devices.

8

Define the following terms.

Term

Meaning

Fall injury prevention system

Anchorage

9

Explain the difference between a static restraint system and a travel restraint system.

Static restraint system

Travel restraint system

10

Name 2 types of falls arrest systems.

11

What is the diagram below of?

12

Write 4 key points on the use of a fall injury prevention system.

13

Which of the below diagrams show an unacceptable use of a restraint system? Explain why.

A ?

B ?

C ?

14

Safety equipment is installed to reduce the risks of an existing site hazard like working at heights, but what other hazards must you consider? Give 2 examples.

15

True or false. There are significant legal penalties if an accident occurs and it’s found that the safety equipment was incorrectly installed.

16

Detail 6 safe work practices to follow when conducting work from a ladder.

17

No matter what safety equipment you’re using, you must: (tick those that are applicable)

Remove safety equipment briefly for convenience

Adjust it as necessary (using recommended standards and safe work practices) if something changes

Change the type of equipment or add new equipment as necessary if the job changes

Leave scaffolding and edge protection in place at all times

Use it according to the manufacturer’s specifications, regulations, codes of practice and Australian Standards

All of the above

18

Write 5 safety tips for leaving the elevated work area.

RECORD OF ASSESSMENT TASK 1 KNOWLEDGE QUESTIONS

To be completed by the assessor

Learner details

Assessor details

Name

Name

Unit Code

CPCCCM2010B

Unit Title

Work safely from heights

Record of assessment results (please tick appropriate box).

ASSESSORS NOTE: Before making a final judgement on this assessment task, you must determine if the student is able to satisfactorily apply and perform the following criteria. Review the performance criteria by clicking on the link https://training.gov.au/Training/Details/CPCCCM2010B. Marking should be in line with the model answers required as the performance criteria (PCs) is underpinned by this assessment task. All questions must be deemed satisfactory to achieve a satisfactory outcome for this task. If a NS is provided for any section or questions relating to this task, then the task outcome should be treated as NS and the reassessment process should be applied. If a NS (not satisfactory) outcome is applied then you must inform the student in detail as to “why” this outcome was provided. Record your reasons in the section labelled “Not satisfactory (NS) outcomes”. See below for recording appropriate information

Assessment activity - The learner has completed all the assessments requirements for this unit of competency and has been deemed

Outcome

Date of outcome

Task 1– Knowledge Questionnaire

?Satisfactory ? Not satisfactory

Attempts -

Attempt 1

…../……/…….

Attempt 2

…../……/…….

Attempt 3

…../.…../…..

Not satisfactory (NS) Outcomes

Question number

Record in detail the reason for the NS outcome applied

Appeals – refer to the complaints and appeals policy and procedure

If you receive a Not Satisfactory assessment result you have the right to appeal. You have three assessment attempts. After the third attempt arrangements for payment will be made for reassessment purposes. Refer to your student hand book for more details on the complaints and appeals process.

Assessor Feedback to learner:

The assessor must write full feedback to the learner that is constructive and not generic

Reasonable Adjustment

(if applicable) explain why reasonable adjustment has been applied and the tasks it was applied to

Assessor Intervention

(if applicable) - did you need to assist the student in this assessment. If so please explain:

Assessor Name

Assessor Signature

Date

Student declaration - I hereby certify that this assessment is my own work, based on my personal study and/or research. I have acknowledged all material and resources used in the presentation of this assessment whether they are books, articles, reports, internet searched or any other document or personal communication. I also certify that the assessment has not previously been submitted for assessment in any other subject or any other time in the same subject and that I have not copied in part or whole or otherwise plagiarised the work of other learning and/or other persons. I confirm that I understand that I must complete this assessment on my own. I confirm that I will not cheat or plagiarise, or copy from another student during the completion of this assessment.

Student name

Student signature

Date