Title Page

  • Candidate

  • Assessor

  • IQA

  • Date and Time

  • Scenario

  • Location
  • INSTRUCTIONS
    1. " pass at Level 1", " Marginal Fail Level 2", "Significant Fail Level 3" or "Professional Discussion" on the questions provided below.
    2. Add Photos in "Image" and Comments in "Note" for the items needed.
    3. Add a Corrective Measure by tapping on "Action", then provide a description, assign to a member, set priority, and due date.
    4. Complete the audit by providing a digital signature.
    5. Share your report by exporting as PDF, Word, Excel or Web Link.

Marking Criteria for Assessor please tick to indicate you understand the criteria as the assessor

  • Indicate "Pass" for a competent performance for the criteria

  • Indicate "Pass Level 1" for a pass with prompts for questions needed to confirm understanding

  • Indicate "Review Level 1" for a Marginal Fail, where a lack of understanding or knowledge is shown on a non safety critical issue or command skill

  • Indicate "Review Level 2" for a significant Fail where a lack of understanding or knowledge is shown on a safety critical issue or command skill

Before carrying out Assessment Confirm:

  • Room is safe and fit for purpose and candidate has been fully briefed and is happy for the assessment to begin

  • Has the Video and Audio been checked and is ready to record if applicable?

  • All supporting materials are available in the room for the candidate?

  • All Role players have been briefed and understand the scenario

Performance indicators for this level are Based upon NOS WM7 OR CAP 699 AWM6: Candidate must demonstrate that they ;

  • P1. Collect and confirm information to the known and anticipated risks to people property and the environment

  • P2. Review information relevant to the known and anticipated risks to people, property and environment (6.1) ( Identify the significant findings of the risk assessment process)

  • P3. Determine initial action against available resources including their limitations and capabilities through application of the Decision control process Ensure the action plan meets the known and anticipated needs of the incident

  • P4. Develop objectives through a comprehensive assessment of the risks, DRA and Tactical mode understood and communicated

  • P5. Apply a command structure as appropriate to the needs of an operational incident

  • P6. Identify the significant findings of the risk assessment process

  • P7. Implement risk control measures. clarifies the position in regards to analytical risk assessment

  • P8. Monitor the situation, plan and actions at regular intervals and adjust as appropriate

  • P9. Record relevant risk control measures

  • P10. Maintain ongoing communication on planned actions to those involved in implementation

  • P11. Deploy appropriate resources to meet the needs of the incident

  • P12. Instigate measures to hand over control of an incident to an appropriate person, agency or authority

  • P13. Manage the preservation of potential evidence identified at the incident

  • P14. Secure the availability of resources for further deployment at the earliest opportunity

  • P15. Identify contingency measures in the event of an unplanned or uncontrolled event or escalation

  • P16. Take action to minimise any unresolved hazards and associated risks within operational constraints

  • P17. Conduct a post incident debrief

  • P18 Measure performance against agreed standards relevant to defined roles

  • P19. Identify opportunities to improve future personal, team and organisation performance

  • P20. Record the review process

  • Do you have any questions for the candidate based on their performance, please record the questions asked and answer in notes

Completion

  • Outcome

  • Candidate Feedback – Assessor record outcome and feedback given here.

  • IQA Feedback to Assessor

  • Candidate Signature

  • Assessor Signature

  • IQA Signature

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.