Workplace Assessment Plan and Checklist

• Prepared by

• Conducted on

  Date

• Assessment Type

• Name of Candidate

• Safe System of Work

  Select Safeguarded Fenced Separated Equipment Warning - Permanent Equipment Warning - TOWS Equipment Warning - Human Activated Equipment Warning - Portable Unassisted Lookout Other

  • Safeguarded
  • Fenced
  • Separated
  • Equipment Warning - Permanent
  • Equipment Warning - TOWS
  • Equipment Warning - Human Activated
  • Equipment Warning - Portable
  • Unassisted Lookout
  • Other

• Other SSoW

• Sentinel Card No

• N.I No

• Card Expiry Date

  Date
• Assessment Location
  Address

• Assessment Date & Time

  Date

• Organisation

• Manager’s Name

The assessor must brief and question the candidate on the points below prior to the assessment event, this may be done either face to face or via the telephone. The candidate is to sign the assessment plan confirming their understanding.

• Post Mentoring: The mentor must be present at the assessment and be prepared to undertake the duties being assessed should the assessor deem the candidate ‘not yet competent or not competent' - The logbook must also be endorsed by the mentor to confirm the candidate is ready for their Post Mentoring Assessment

  Yes

  No

  N/A

• Interim: The candidate is aware that a suitable experienced and competent person is available at the time of the assessment who can undertake the duties of the candidate, if the assessor deems the candidate ‘not competent’

  Yes

  No

  N/A

• Does the candidate have any special needs or requirements?

  Yes

  No

• What special requirements/needs does the candidate require?

• Has the candidate been briefed on the Health & Safety, Environmental & Quality Policy’s

  Yes

  No

  N/A

• Assessment results and appeals procedure briefed?

  Yes

  No

  N/A

• The Candidate has been briefed that they must be able to evidence the correct number of endorsed work experience entries (either within their work experience book or sentinel logbook). The workplace assessment is 'open book' - rulebook modules, keypoint cards and other relevant resources may be referred to during the assessment

  Yes

  No

  N/A

• Candidates' comments following agreeing to the assessment plan

• Assessors comments following agreeing to the assessment plan

• Assessment methods agreed (select as applicable)

  Select Observation Questioning Product Documentation

  • Observation
  • Questioning
  • Product
  • Documentation

• Assessors name and signature

  Sign

I, the below signed give permission to copy this documentation as proof of my identity. I also understand giving false information or documentation will result in the certification being trained or assessed in will be revoked. I am also agreeing that the assessor has briefed me on the assessment plan as detailed above and I'm happy with the assessment arrangements.

• Copy of Candidate's identification

  Media

• Candidate name and signature

  Sign
• Location
  Address

I, the Assessor confirm that the acceptable form of identification is a true likeness of the Candidate.

• Assessor's name and signature

  Sign

In compliance with our Equality and Diversity Policy, we are monitoring the provision of training by the company to ensure discrimination on the grounds of sex, sexual orientation, gender reassignment, race, ethnic origin, religion, marital status, age, and disability do not occur. We would be grateful if you would complete and return this form with your application for training or prior to the commencement of the training provided.

• 1. Gender

  Male

  Female

• 2. Preferred Title

  Select Miss Mrs Ms Mr Dr Other

  • Miss
  • Mrs
  • Ms
  • Mr
  • Dr
  • Other

• Other:

• 3. Maritial Status

  Select Married Single Divorced Separated Widowed Other

  • Married
  • Single
  • Divorced
  • Separated
  • Widowed
  • Other

• Other:

• 4. Ethnic Origin

  Select White British White Irish White Other Black/ Black British Asian Asian British Chinese Mixed Other

  • White British
  • White Irish
  • White Other
  • Black/ Black British
  • Asian
  • Asian British
  • Chinese
  • Mixed
  • Other

• Other:

  Select Miss Mrs Ms Mr Dr Other

  • Miss
  • Mrs
  • Ms
  • Mr
  • Dr
  • Other

• 5. Disability. Do you consider yourself to be disabled under the Disability Discrimination Act? (The Disability Discrimination Act (1995) defines disability as “a physical or mental impairment which has a substantial and adverse effect on a person’s ability to carry out day to day activities”.)

  Yes

  No

• If yes, what is the nature of your disability?

• 6. Age Range

  Select 16-24 25-34 35-44 45-54 55-64 65+

  • 16-24
  • 25-34
  • 35-44
  • 45-54
  • 55-64
  • 65+

The information you have provided here will be stored either on paper records or a computer system, for a period not exceeding 7 years, in accordance with the Data Protection Act 2018 (GDPR) and will be used solely to monitor the diversity of Seaton Rail training initiatives and courses regarding Equal Opportunity issues.

• Name & Signature:

  Sign

PRE-ASSESSMENT ADMIN/ DOCUMENT CHECKLIST (COMPLETED BEFORE THE ASSESSMENT)

• NWR Assessment material version number

• Assessment Booking Form

  Yes

  No

  N/A

• Assessment Plan/Pack

  Yes

  No

  N/A

• NWR Assessment Pack

  Yes

  No

  N/A

• Line Blockage Assessment Pack

  Yes

  No

  N/A

• Protection Controller Assessment

  Yes

  No

  N/A

• NWR Question Bank

  Yes

  No

  N/A

• Agreement to Copy I.D

  Yes

  No

  N/A

• Copy of SSoW Pack/ Permit

  Yes

  No

  N/A

• Copy of PICOP Pack or Plan

  Yes

  No

  N/A

• Copy of Sentinel Print Outs

  Yes

  No

  N/A

• SR Non-Library Question Pack

  Yes

  No

  N/A

• Assessment uploaded to NSAR's Skills Backbone

  Yes

  No

  N/A

• Action Plan

  Yes

  No

  N/A

• Other items checked by the assessor - as applicable

• Checks completed by

  Sign

ASSESSMENT CHECKS (TO BE CARRIED OUT BY THE ASSESSOR ON THE DAY OF THE ASSESSMENT)

• Assessor and delegate sentinel swipe in and Candidate sentinel card competency check

  Media

• Copy of log book entries or sentinel logbook

  Media

• Lineside documentation review

  Media

• PPE Site and Safety Critical Equipment available?

• Additional photographic evidence taken?

Further comments/summary on candidate’s performance:

• Further comments/summary on candidate’s performance:

ASSESSMENT OUTCOME

• Outcome:

  Competent

  Not Yet Competent

  Not Competent

• Assessors Signature

  Sign

Assessors record of travel time

• Time left place of rest

  Date

• Time arrived on site

  Date

• Time departed site

  Date

• Time arrived at place of rest

  Date

• Total hours door to door

• ASSESSOR'S DECLARATION OF TRAVEL TIME

  Sign

Post Assessment Checks:

• Assessment Pack Returned and Checked

  Yes

  No

  N/A

• Results notified to Sentinel

  Yes

  No

  N/A

• Results notified to sponsor (External)

  Yes

  No

  N/A

• Results entered on database (Internal)

  Yes

  No

  N/A

• Copy of result notifications on file

  Yes

  No

  N/A

• Check Completed and Pack Ready for Filing

  Yes

  No

  N/A

• Signature

  Sign