Workplace Assessment Checklist - Core (v3)

• Document no: 10FP3058, version 3, student name

• Audit Title

• Client / Site

• Position

Course:

• FDF 30111 Certificate III in Food Processing

Unit code(s) and name:

• FDFFS2001A Implement the food safety program and procedures
  FDFFS3001A Monitor the implementation of quality and food safety
  FDFOP2064A Provide and apply workplace information
  FDOHS3001A Contribute to OHS processes
  MSAENV272B Participate in environmentally sustainable work practices

• Provide a brief overview of the Candidates workplace role and responsibilities

  Select Monitoring CCP's Completing Quality Paperwork Checking Product Quality Staff Supervision Monitoring OH&S Requirements Cleaning & Sanitation Basic Routine Maintenance

  • Monitoring CCP's
  • Completing Quality Paperwork
  • Checking Product Quality
  • Staff Supervision
  • Monitoring OH&S Requirements
  • Cleaning & Sanitation
  • Basic Routine Maintenance

• Students are observed a number of times during workplace visits. What tasks was the candidate performing at the time of the observations?

  Select Monitoring CCP's Completing Quality Paperwork Checking Product Quality Staff Supervision Monitoring OH&S Requirements Cleaning & Sanitation Basic Routine Maintenance

  • Monitoring CCP's
  • Completing Quality Paperwork
  • Checking Product Quality
  • Staff Supervision
  • Monitoring OH&S Requirements
  • Cleaning & Sanitation
  • Basic Routine Maintenance

• AQF Level Characteristics:
  *Demonstrate some relevant theoretical knowledge;
  *Apply a range of well-developed skills;
  *Apply known solutions to a variety of predictable problems;
  *Perform processes that require a range of well developed skills where some discretion and judgement is required
  *interpret available information, using discretion and/or judgement
  *Take responsibility for own outputs in work and learning
  *Take limited responsibility for the output of others (where applicable)

Skills Observation and Critical Questions Checklist

Observe the candidate and check understanding through the associated critical questions:

• O.1 Comply with the personal hygiene requirements of the food safety program:

  Select Wearing hygienic clothing correctly Washing and sanitising hands Walking through sanitiser foot baths (where applicable) No unauthorised jewellery or personal items

  • Wearing hygienic clothing correctly
  • Washing and sanitising hands
  • Walking through sanitiser foot baths (where applicable)
  • No unauthorised jewellery or personal items

• Assessor's Comments:

  Select Acceptable demonstration Observed hygiene standards

  • Acceptable demonstration
  • Observed hygiene standards

• Any additional comments:

• Satisfactory?

  Yes

  No

• Date observed:

  Date

• Critical Questions (CQs) Why is it important to ensure you wash your hands, wear hairnets correctly and comply with other GMP requirements?

  Select Prevent contaminating food and equipment Setting a good example to other employees

  • Prevent contaminating food and equipment
  • Setting a good example to other employees

• Assessor's Comments:

  Select Handled product correctly Acceptable practices

  • Handled product correctly
  • Acceptable practices

• Any additional comments:

• Satisfactory?

  Yes

  No

• Date observed:

  Date

• O.2 Select, fit and use personal protective clothing and equipment correctly and ensure others in the work group are doing the same:

  Complies with specific work area PPE requirements

• Assessor's Comments:

  Select PPE worn correctly

  • PPE worn correctly

• Any additional comments:

• Satisfactory?

  Yes

  No

• Date observed:

  Date

• Critical Questions (CQs) Does wearing PPE guarantee your safety? What other preventative measures keep you safe in the workplace?

  Select No PPE is the last resort on the hierarchy of controls Guarding Signage Controlled traffic patters Emergency stop buttons Mechanical aids Non slip flooring Good housekeeping Chemical handling training

  • No
  • PPE is the last resort on the hierarchy of controls
  • Guarding
  • Signage
  • Controlled traffic patters
  • Emergency stop buttons
  • Mechanical aids
  • Non slip flooring
  • Good housekeeping
  • Chemical handling training

• Assessor's Comments:

  Select Acceptable answers

  • Acceptable answers

• Any additional comments:

• Satisfactory?

  Yes

  No

• Date observed:

  Date

• Q.3 Follow all occupational health and safety procedures while conducting duties

  Select Correct manual handling techniques Mechanical aids (where applicable) Use Chemicals Safely Observe signage and guarding Prevent tripping hazards Practice electrical safety Follow lock/tag out procedures Movement complies with food safety program

  • Correct manual handling techniques
  • Mechanical aids (where applicable)
  • Use Chemicals Safely
  • Observe signage and guarding
  • Prevent tripping hazards
  • Practice electrical safety
  • Follow lock/tag out procedures
  • Movement complies with food safety program

• Assessor's Comments:

  Select Acceptable manual handling Demonstrated correct requirements

  • Acceptable manual handling
  • Demonstrated correct requirements

• Any additional comments:

• Satisfactory?

  Yes

  No

• Date observed:

  Date

• Critical Questions (CQs)<br>Can you identify and potential safety and/or environmental hazards in this process/work area? What might go wrong if there were no controls to prevent this from occurring?

  Listed at least 4 controlled environmental hazards

• Assessor's Comments:

  Select Environmental hazards discussed Student has acceptable knowledge

  • Environmental hazards discussed
  • Student has acceptable knowledge

• Any additional comments:

• Satisfactory?

  Yes

  No

• Date observed:

  Date

• Q.4 Monitor the production process for any food safety, quality and OH&S non-conformances:

  Select Watching the process for inconsistencies Inspecting packaging and raw materials Monitoring critical control points OH&S requirements followed

  • Watching the process for inconsistencies
  • Inspecting packaging and raw materials
  • Monitoring critical control points
  • OH&S requirements followed

• Assessor's Comments:

  Select Production monitoring observed Continuos product monitoring No product defects observed

  • Production monitoring observed
  • Continuos product monitoring
  • No product defects observed

• Any additional comments:

• Satisfactory?

  Yes

  No

• Date observed:

  Date

• Critical Questions (CQs) If I was a new employee you were responsible for training, what would you tell me about the food safety and quality requirements for this work area? And what would you tell me about the OH&S requirements for this work area?

  Select Explained the companies GMP policies Demonstrated communication skills Explained company's safe work procedures Explained OH&S requirements

  • Explained the companies GMP policies
  • Demonstrated communication skills
  • Explained company's safe work procedures
  • Explained OH&S requirements

• Assessor's Comments:

  Select Acceptable answers Acceptable procedures demonstrated

  • Acceptable answers
  • Acceptable procedures demonstrated

• Any additional comments:

• Satisfactory?

  Yes

  No

• Date observed:

  Date

• How do you know what the food safety and quality requirements are for your work area?

  Select Documented in the food safety program Signage HACCP documents Induction and training

  • Documented in the food safety program
  • Signage
  • HACCP documents
  • Induction and training

• Assessor's Comments:

  Select SOP's sighted

  • SOP's sighted

• Any additional comments:

• Satisfactory?

  Yes

  No

• Date observed:

  Date

• O.5 Responding to food safety or quality non-conformance and taking the appropriate corrective and preventative action:

  Select Take action to rectify defects Removing defective item from line adjusting equipment to prevent defects notifying appropriate personnel

  • Take action to rectify defects
  • Removing defective item from line
  • adjusting equipment to prevent defects
  • notifying appropriate personnel

• Assessor's Comments:

  Select Adjustments made Acceptable procedures demonstrated Monitoring observed

  • Adjustments made
  • Acceptable procedures demonstrated
  • Monitoring observed

• Any additional comments:

• Satisfactory?

  Yes

  No

• Date observed:

  Date

• Critical Questions (CQs) Who do you report quality and food safety incidents to?

  Select Product supevisor Coordinator Quality Coordinator

  • Product supevisor
  • Coordinator
  • Quality Coordinator

• Assessor's Comments:

  Select Acceptable answers

  • Acceptable answers

• Any additional comments:

• Satisfactory?

  Yes

  No

• Date observed:

  Date

• O.6 Handle food, materials and equipment hygienically to maintain the quality and safety of the product:

  Select Wearing food handling gloves Washing or sanitising hands

  • Wearing food handling gloves
  • Washing or sanitising hands

• Assessor's Comments:

  Select Acceptable answers Acceptable procedures demonstrated

  • Acceptable answers
  • Acceptable procedures demonstrated

• Any additional comments:

• Satisfactory?

  Yes

  No

• Date observed:

  Date

• O.7 Maintain work area and equipment in and orderly and hygienic state, including modelling safe work policies and procedures in own work:

  Select Storing tools in appropriate ares Cleaning as you go

  • Storing tools in appropriate ares
  • Cleaning as you go

• Assessor's Comments:

  Select Demonstrated correct procedures Process observed

  • Demonstrated correct procedures
  • Process observed

• Any additional comments:

• Satisfactory?

  Yes

  No

• Date observed:

  Date

• Critical Questions (CQs) Why is it important to keep the workplace neat and tidy?

  Select Prevent tripping and slipping Minimise contamination A better work environment

  • Prevent tripping and slipping
  • Minimise contamination
  • A better work environment

• Assessor's Comments:

  Select Acceptable answers

  • Acceptable answers

• Any additional comments:

• Satisfactory?

  Yes

  No

• Date observed:

  Date

• O.8 Conduct any required food and safety checks:

  Select Visual inspection Weight check Seal integrity check Temperature check Metal detector check

  • Visual inspection
  • Weight check
  • Seal integrity check
  • Temperature check
  • Metal detector check

• Assessor's Comments:

  Select Continuous monitoring Visual inspection observed

  • Continuous monitoring
  • Visual inspection observed

• Any additional comments:

• Satisfactory?

  Yes

  No

• Date observed:

  Date

• Critical Questions (CQs) What investigations and actions would you take if some laboratory micro test results from products manufactured on your line were out of specification? Why might this be a problem? Describe any incidents that may have occurred in the past. (Problems are highlighted in red)

  Select Inspect equipment for wear and tear Check for dirty areas Additional cleaning Monitor performance of other workers Check for cross-contamination Dead legs in pipework Take samples and submit for testing Product may be contaminated Product may need to be disposed and replaced

  • Inspect equipment for wear and tear
  • Check for dirty areas
  • Additional cleaning
  • Monitor performance of other workers
  • Check for cross-contamination
  • Dead legs in pipework
  • Take samples and submit for testing
  • Product may be contaminated
  • Product may need to be disposed and replaced

• Assessor's Comments:

  Select Checks completed Samples collected Correct procedures demonstrated

  • Checks completed
  • Samples collected
  • Correct procedures demonstrated

• Any additional comments:

• Satisfactory?

  Yes

  No

• Date observed:

  Date

• Describe any OH&S, food safety and quality checks you do or samples you take and explain why this is important.

  Select OH&S checklists Temperate checks pH checks Date code checks Weight checks Samples take at start middle and end Regularly check for safe production of food It is a requirement of regulatory, company and customer

  • OH&S checklists
  • Temperate checks
  • pH checks
  • Date code checks
  • Weight checks
  • Samples take at start middle and end
  • Regularly check for safe production of food
  • It is a requirement of regulatory, company and customer

• Assessor's Comments:

  Select Records maintained Checks completed Acceptable answers

  • Records maintained
  • Checks completed
  • Acceptable answers

• Any additional comments:

• Satisfactory?

  Yes

  No

• Date observed:

  Date

• O.9 Take samples (where relevant).

  Select Take samples with sterile equipment Samples must be clearly labelled and stored

  • Take samples with sterile equipment
  • Samples must be clearly labelled and stored

• Assessor's Comments:

  Select Records maintained Correct procedures followed

  • Records maintained
  • Correct procedures followed

• Any additional comments:

• Satisfactory?

  Yes

  No

• Date observed:

  Date

• O.10 Handle and disposed of out-of-specification or contaminated food, waste and recycled material in accordance with the requirements of the food safety program (within the scope of responsibility).

  Select Waste clearly identified Waste placed in appropriate receptacles Reject or rework is clearly identified

  • Waste clearly identified
  • Waste placed in appropriate receptacles
  • Reject or rework is clearly identified

• Assessor's Comments:

  Select Demonstrated correct procedures Process observed

  • Demonstrated correct procedures
  • Process observed

• Any additional comments:

• Satisfactory?

  Yes

  No

• Date observed:

  Date

• Critical Questions (CQs) Why is product and material traceability important?

  Select Used to identify product in case of recall Helps to investigate potential problems We know which line made the product We know what materials were used

  • Used to identify product in case of recall
  • Helps to investigate potential problems
  • We know which line made the product
  • We know what materials were used

• Assessor's Comments:

  Select Good understanding Acceptable answers

  • Good understanding
  • Acceptable answers

• Any additional comments:

• Satisfactory?

  Yes

  No

• Date observed:

  Date

• What is the process for dealing with product, raw material or packaging that is out of specification?

  Select Depends on company procedure Depends on extent of non-conformance Remove it from the process Quarantine or dispose of product Put a hold label on it

  • Depends on company procedure
  • Depends on extent of non-conformance
  • Remove it from the process
  • Quarantine or dispose of product
  • Put a hold label on it

• Assessor's Comments:

  Select Correct actions discussed

  • Correct actions discussed

• Any additional comments:

• Satisfactory?

  Yes

  No

• Date observed:

  Date

• O.11 Communicate effectively and appropriately with others in the work area to give or receive food safety and quality information and OH&S information.

  Select Ask someone to take a sample etc. Asking for/listening to instructions Giving instruction to other employees Effective use of 2 way communication

  • Ask someone to take a sample etc.
  • Asking for/listening to instructions
  • Giving instruction to other employees
  • Effective use of 2 way communication

• Assessor's Comments:

  Select Good communication Observed acceptable procedures

  • Good communication
  • Observed acceptable procedures

• Any additional comments:

• Satisfactory?

  Yes

  No

• Date observed:

  Date

• Critical Questions (CQs) How would you go about organising a meeting to discuss some food safety and quality issues on your line?

  Select Identify who needs to be there Provide details about the meeting Chair meeting and take minutes Distribute minutes to all attendees

  • Identify who needs to be there
  • Provide details about the meeting
  • Chair meeting and take minutes
  • Distribute minutes to all attendees

• Assessor's Comments:

  Select Discussed requirements in detail Good understanding Acceptable answer

  • Discussed requirements in detail
  • Good understanding
  • Acceptable answer

• Any additional comments:

• Satisfactory?

  Yes

  No

• Date observed:

  Date

• O.12 Use/maintain workplace documentation.

  Select Locate and use an SOP Cleaning procedure Production schedule Product specification MSDS Product instruction or recipe OH&S documentation Safe work procedures Incident reports

  • Locate and use an SOP
  • Cleaning procedure
  • Production schedule
  • Product specification
  • MSDS
  • Product instruction or recipe
  • OH&S documentation
  • Safe work procedures
  • Incident reports

• Assessor's Comments:

  Select SOP located Observed SOP being used SOP's available

  • SOP located
  • Observed SOP being used
  • SOP's available

• Any additional comments:

• Satisfactory?

  Yes

  No

• Date observed:

  Date

• O.13 Record workplace information in the required format.

  Select Entering data from various checks into a computer Filling out incident report forms Enter information for inventory management Data must comply with program requirements Info must be signed or initialled

  • Entering data from various checks into a computer
  • Filling out incident report forms
  • Enter information for inventory management
  • Data must comply with program requirements
  • Info must be signed or initialled

• Assessor's Comments:

  Select Quality records sighted Records maintained Records available

  • Quality records sighted
  • Records maintained
  • Records available

• Any additional comments:

• Satisfactory?

  Yes

  No

• Date observed:

  Date

• Critical Questions (CQs) What is the purpose of keeping records of food safety and quality checks?

  Select As evidence that checks are completed Data can be used for product improvement Regulatory and customer compliance

  • As evidence that checks are completed
  • Data can be used for product improvement
  • Regulatory and customer compliance

• Assessor's Comments:

  Select Good understanding Acceptable answers

  • Good understanding
  • Acceptable answers

• Any additional comments:

• Satisfactory?

  Yes

  No

• Date observed:

  Date

• O.14 Show me where the emergency stop buttons are on the equipment you are working on.

  Identify all e-stops

• Assessor's Comments:

  Select E-stops demonstrated Acceptable procedures

  • E-stops demonstrated
  • Acceptable procedures

• Any additional comments:

• Satisfactory?

  Yes

  No

• Date observed:

  Date

• Critical Questions (CQs) When do you need to use an emergy stop?

  Select When machine needs to be stopped quickly Safety may be compromised Machine may be damaged

  • When machine needs to be stopped quickly
  • Safety may be compromised
  • Machine may be damaged

• Assessor's Comments:

  Select Good understanding Acceptable answers

  • Good understanding
  • Acceptable answers

• Any additional comments:

• Satisfactory?

  Yes

  No

• Date observed:

  Date

• When and why should a lock-out/tag-out process be used?

  Select Before maintenence is performed Before opening electrical cabinets Before removing safety guarding Lockouts are to prevent possible hazards

  • Before maintenence is performed
  • Before opening electrical cabinets
  • Before removing safety guarding
  • Lockouts are to prevent possible hazards

• Assessor's Comments:

  Select Procedure discussed in detail

  • Procedure discussed in detail

• Any additional comments:

• Satisfactory?

  Yes

  No

• Date observed:

  Date

• Who is authorised to perform this procedure in your area?

  Select Authorised personnel in accordance with LOTO

  • Authorised personnel in accordance with LOTO

• Assessor's Comments:

  Select Acceptable answers

  • Acceptable answers

• Any additional comments:

• Satisfactory?

  Yes

  No

• Date observed:

  Date

• What do you do if you see a piece of equipment you need to use has been locked/tagged out?

  Select Depends on level of authority Depends on company procedures Leave it alone Contact person whose name is on it

  • Depends on level of authority
  • Depends on company procedures
  • Leave it alone
  • Contact person whose name is on it

• Depends on the level of authority and company procedures. Leave it alone and contact the person whose name is on the tag and ask them to come and remove it.

  Select Leave equipment alone Notify supervisor Observed correct procedures

  • Leave equipment alone
  • Notify supervisor
  • Observed correct procedures

• Any additional comments:

• Satisfactory?

  Yes

  No

• Date observed:

  Date

• O.15 Work is conducted in accordance with workplace environmental guidelines.

  Select Aware of company guidelines Recycling policy Reusing policy Rework policy Saving water/energy policies Reducing pollution Noise reduction techniques

  • Aware of company guidelines
  • Recycling policy
  • Reusing policy
  • Rework policy
  • Saving water/energy policies
  • Reducing pollution
  • Noise reduction techniques

• Assessor's Comments:

  Select Good knowledge Company procedures followed Observed acceptable procedure

  • Good knowledge
  • Company procedures followed
  • Observed acceptable procedure

• Any additional comments:

• Satisfactory?

  Yes

  No

• Date observed:

  Date

• Critical Questions (CQs) How do you manage waste and rework?

  Select Store in designated locations Keep clean and tidy Waste and rework clearly identified Do not cross-contaminate

  • Store in designated locations
  • Keep clean and tidy
  • Waste and rework clearly identified
  • Do not cross-contaminate

• Assessor's Comments:

  Select Good understanding Acceptable procedures followed

  • Good understanding
  • Acceptable procedures followed

• Any additional comments:

• Satisfactory?

  Yes

  No

• Date observed:

  Date

• What are the company's policies around environmental sustainability and what do you do to follow these?

  Select Aware of environmental guidelines Identify recycling procedure Identify reusing procedure Identify rework procedure Identify saving water and energy procedure

  • Aware of environmental guidelines
  • Identify recycling procedure
  • Identify reusing procedure
  • Identify rework procedure
  • Identify saving water and energy procedure

• Assessor's Comments:

  Select Discussed in detail Observed correct procedure

  • Discussed in detail
  • Observed correct procedure

• Any additional comments:

• Satisfactory?

  Yes

  No

• Date observed:

  Date

• O.16 Cleaning and sanitation procedures where relevant.

  Select Preparing equipment for cleaning Notify relevant personnel of intentions Purging lines Conducting pre-cleaning rinses Operating CIP control panels Cleaning equipment complies with GMP policy Chemicals used safely with PPE Follow appropriate cleaning procedure Correct chemicals used in prescribed doses

  • Preparing equipment for cleaning
  • Notify relevant personnel of intentions
  • Purging lines
  • Conducting pre-cleaning rinses
  • Operating CIP control panels
  • Cleaning equipment complies with GMP policy
  • Chemicals used safely with PPE
  • Follow appropriate cleaning procedure
  • Correct chemicals used in prescribed doses

• Assessor's Comments:

  Select Observed cleaning procedure Records maintained Records available and sighted PPE worn correctly Manual handling acceptable Chemicals handles correctly

  • Observed cleaning procedure
  • Records maintained
  • Records available and sighted
  • PPE worn correctly
  • Manual handling acceptable
  • Chemicals handles correctly

• Any additional comments:

• Satisfactory?

  Yes

  No

• Date observed:

  Date

• Critical Questions (CQs) What do you do if you find any pests or signs of pest infestation in the workplace?

  Select Take immediate action Remove and clean Report to appropriate personnel

  • Take immediate action
  • Remove and clean
  • Report to appropriate personnel

• Assessor's Comments:

  Select Good knowledge Acceptable answers Reported to supervisor

  • Good knowledge
  • Acceptable answers
  • Reported to supervisor

• Any additional comments:

• Satisfactory?

  Yes

  No

• Date observed:

  Date

• O.17 Environmental work practices:

  Select Identifies issues Complies with regulations Reports incidents Follows procedures Minimises resource damage

  • Identifies issues
  • Complies with regulations
  • Reports incidents
  • Follows procedures
  • Minimises resource damage

• Assessor's Comments:

  Select Discussed requirements in detail Observed correct procedures Acceptable answers Records maintained Records accaptable

  • Discussed requirements in detail
  • Observed correct procedures
  • Acceptable answers
  • Records maintained
  • Records accaptable

• Any additional comments:

• Satisfactory?

  Yes

  No

• Date observed:

  Date

• O.18 Carry out calculations and/or estimations:

  Select Addition Subtraction Multiplication Division Estimation

  • Addition
  • Subtraction
  • Multiplication
  • Division
  • Estimation

• Assessor's Comments:

  Select Calculations Completed Acceptable Correct procedures followed

  • Calculations Completed
  • Acceptable
  • Correct procedures followed

• Any additional comments:

• Satisfactory?

  Yes

  No

• Date observed:

  Date

• O.19 Follow emergency procedures in case of a fire.

  Select Knowledge of emergency procedure

  • Knowledge of emergency procedure

• Assessor's Comments:

  Select Procedures decribed Procedures demonstrated Company procedures followed

  • Procedures decribed
  • Procedures demonstrated
  • Company procedures followed

• Any additional comments:

• Satisfactory?

  Yes

  No

• Date observed:

  Date

• Critical Questions (CQs) Describe the emergency signals and alarms that may occur and what to do if you hear them:

  Select Described alarms and signals Described procedures that follow

  • Described alarms and signals
  • Described procedures that follow

• Assessor's Comments:

  Select Alarms discussed Good knowledge demonstrated

  • Alarms discussed
  • Good knowledge demonstrated

• Any additional comments:

• Satisfactory?

  Yes

  No

• Date observed:

  Date

• O.20 Appropriate bandage and dressings.

  Identify appropriate bandages/dressings

• Assessor's Comments:

  Select First aid kit sighted Available stocks in kit Acceptable answers

  • First aid kit sighted
  • Available stocks in kit
  • Acceptable answers

• Any additional comments:

• Satisfactory?

  Yes

  No

• Date observed:

  Date

General Observations - Across Tasks: During the many tasks the student demonstrates, the following should observed across the task.

• Access and use workplace information, including policies and procedures, food safety program etc.

  Select Identify requirements Locate/source Interpret/analyse Apply Share Follow Respond to requests

  • Identify requirements
  • Locate/source
  • Interpret/analyse
  • Apply
  • Share
  • Follow
  • Respond to requests

• Assessor's Comments:

  Select Observed student Acceptable procedures Records sighted and correct Records maintained

  • Observed student
  • Acceptable procedures
  • Records sighted and correct
  • Records maintained

• Any additional comments:

• Satisfactory?

  Yes

  No

• Date observed:

  Date

• Communication:

  Select Listening Clarifying Questioning Seeking advice Reading/writing required level for job

  • Listening
  • Clarifying
  • Questioning
  • Seeking advice
  • Reading/writing required level for job

• Assessor's Comments:

  Select Good communication skills Observed acceptable procedures

  • Good communication skills
  • Observed acceptable procedures

• Any additional comments:

• Satisfactory?

  Yes

  No

• Date observed:

  Date

• Work cooperatively Within a culturally diverse workforce.

  Worked cooperatively with team members

• Assessor's Comments:

  Select Good team member Correct procedures Model employee

  • Good team member
  • Correct procedures
  • Model employee

• Any additional comments:

• Satisfactory?

  Yes

  No

• Date observed:

  Date

• Operates within the parameters of their own work role and responsibilities.

  Tasks performed within level of responsibility

• Assessor's Comments:

  Select Acceptable demonstration Good skills observed

  • Acceptable demonstration
  • Good skills observed

• Assessors comments/feedback (include any actions required to be taken i the event of 'non-satisfactory' for any part of this assessment.

Final Signoff

• From your observations at the time of the assessment, the candidate's performance was:

  Yes

  No

• Assessors Name and Signature:

  Sign

• Date

  Date

• Student's Name and Signature:

  Sign

• Date

  Date