"*" indicates required fields Your DetailsName* First Last Email* Assessment Information & CriteriaAssessment Tasks Practical Demonstration Unit Codes & Title RIIWHS204E Work Safely at Heights Context & Conditions of Assessment This assessment is to provide evidence of the Student’s ability to Work Safely at Heights on at least two occasions. The Student’s individual observation checklist will be used to record the Student’s performance for this practical assessment. Prior to assessment Trainers are to read through the Student assessment instructions located at the back of the Student Manual to ensure the Student is well prepared for the assessment process. Other documents that must be read in conjunction with this assessment tool are located in the course folder and include: Training and Assessment Strategy Assessor Assessment Instructions Session Plan Student Manual Relevant documentation that supports this assessment Trainers are to provide support and guidance to Students who do not feel ready to be assessed in these units. Resources For Assessment Safe Work Method Statement iPads Rescue Equipment and first aid kit Signs and Barricades PPE Safety Harnesses Fall Protection Systems Safety helmets Gloves Learner DeclarationLearner Declaration*Links: Course Details Online Assessment Information Complaints and Appeals Policy I have been advised of the physical requirements to undertake the practical component of this unit of competency I have been fully advised of the assessment process and have been instructed on the level of performance required by me for successful completion of this assessment component I have been advised of the Candidate support services and reasonable adjustment that is available to me if needed I have been made aware of how to appeal against an assessment decision I have been made aware of the complaints policy and procedure I declare that I am fully prepared to undertake this practical assessment Learner Signature*By signing below, you confirm the above Learner Declaration.Date* DD slash MM slash YYYY ASSESSOR USE ONLYPart 1. Participate in Pre-Start MeetingActively participates in to the pre-start meeting ✓ Satisfactory ✘ Not yet satisfactory Assessor comment: Why not yet satisfactory?*Part 2. Complete a Safe Work Method StatementActively participates in the completing the Safe Work Method StatementIdentifying: • appropriate PPE • working conditions • where to find appropriate information (Codes of practice; Policies and procedures) • Environmental controls • Equipment for safe method of moving work tools to the work area • Hazards associated with job steps • Control measures to reduce the risk ✓ Satisfactory ✘ Not yet satisfactory Determines the following rescues to be included in the emergency plan• Fall from heights • Suspended harness • Medical emergency ✓ Satisfactory ✘ Not yet satisfactory Identifies necessary emergency equipment• Safety harness • Attachment point • Ladder • First aid kit ✓ Satisfactory ✘ Not yet satisfactory Signs off on Permit ✓ Satisfactory ✘ Not yet satisfactory Assessor comment: Why not yet satisfactory?*Part 3. Pre-Start checksInspects the components of the safety harness• Webbing • Fall Indicators • D-Rings • Buckles and Adjusters o Sewing ✓ Satisfactory ✘ Not yet satisfactory Submits safety harness pre-inspection report on the iPad ✓ Satisfactory ✘ Not yet satisfactory Selects and wears the appropriate PPE• Safety helmet • Gloves ✓ Satisfactory ✘ Not yet satisfactory Checks access from ground to work area and confirms• Stability of surface • The working area is uncluttered • Access and exit to area is safe • Hand grip areas where hand grip may be lost ✓ Satisfactory ✘ Not yet satisfactory Inspects perimeter protection equipment is in place• Kickboards on platform • Safety gates secure ✓ Satisfactory ✘ Not yet satisfactory Installs signs and barricades ✓ Satisfactory ✘ Not yet satisfactory Assessor comment: Why not yet satisfactory?*Part 4. Practical Demonstration 1 - Student manoeuvres from the ground to each level of the height simulator and demonstrates the following:TASK 1 - Dons the safety harness and checks safe fitting• Checks harness is adjusted correctly • Checks fitting of harness leg straps • Attaches pole strap and adjusts where required • Checks anchoring of fall protection • Does not begin work until assessor has confirmed all safety checks are complete ✓ Satisfactory ✘ Not yet satisfactory Locates tools and materials to prevent the risk of falling ✓ Satisfactory ✘ Not yet satisfactory Climbs the vertical rung ladder from the ground to the top platform• Maintains 3 points of contact (2 feet / 1 hand or 1 foot / 2 hands) • Uses ladder to attach to restraint lanyard • Transfers to top of tower while remaining attached (100% Hook-up) ✓ Satisfactory ✘ Not yet satisfactory Demonstrates different techniques of falls arrest such as• Self-retracting lifelines • Twin leg lanyard • Vertical rail systems ✓ Satisfactory ✘ Not yet satisfactory Moves across the top platform• Ensures safety gates are secure ✓ Satisfactory ✘ Not yet satisfactory Climbs down the vertical rung ladder from the top platform to the middle platform using identified techniques ✓ Satisfactory ✘ Not yet satisfactory Moves across the middle platform using identified anchor point and techniques ✓ Satisfactory ✘ Not yet satisfactory Climbs down the step through ladder from the middle platform to the ground using the self-retracting lifeline ✓ Satisfactory ✘ Not yet satisfactory Assessor comment: Why not yet satisfactory?*Part 5. Complete a Take 5Monitors risk and checks safety of falls protection• Completes a TAKE 5 ✓ Satisfactory ✘ Not yet satisfactory Assessor comment: Why not yet satisfactory?*Part 6. Practical Demonstration 2 - During the demonstration, the studentTASK 2 - Checks service dates on all equipment• Keeps infant in a neutral position ✓ Satisfactory ✘ Not yet satisfactory Climbs ladder attached to self-retracting line ✓ Satisfactory ✘ Not yet satisfactory Stops half way up ladder ✓ Satisfactory ✘ Not yet satisfactory Locate and adjust pole strap around ladder ✓ Satisfactory ✘ Not yet satisfactory Attach pole strap to side D-Rings on harness ✓ Satisfactory ✘ Not yet satisfactory Take weight on pole strap while still attached to self-retracting line ✓ Satisfactory ✘ Not yet satisfactory Disconnect pole strap ✓ Satisfactory ✘ Not yet satisfactory Climb down ladder to ground level using self-retracting line ✓ Satisfactory ✘ Not yet satisfactory Assessor comment: Why not yet satisfactory?*Part 7. Completes end of shift requirementsInspects safety harnesses, clean-up work site and submits post- harness inspection and end of shift report on iPad ✓ Satisfactory ✘ Not yet satisfactory Assessor comment: Why not yet satisfactory?*ASSESSOR DECLARATIONLearner Declaration* I declare that I have observed the candidate perform the practical components for these units of competency and the Assessment task has been conducted as per Maxwell Training’s assessment Instructions and procedures I have provided appropriate verbal feedback to the candidate. Overall outcome of resultsRIIWHS204E Work Safely at Heights ✓ Satisfactory ✘ Not yet satisfactory During the Practical Demonstration, did the student:Communicate in a clear and concise manner ✓ Satisfactory ✘ Not yet satisfactory Follow procedures for working safely at heights ✓ Satisfactory ✘ Not yet satisfactory Contribute to the goals of the team ✓ Satisfactory ✘ Not yet satisfactory Took initiative to solve problems ✓ Satisfactory ✘ Not yet satisfactory Managed a number of tasks within the job environment ✓ Satisfactory ✘ Not yet satisfactory Worked well individually and displayed a good attitude overall ✓ Satisfactory ✘ Not yet satisfactory Assessor Comments (optional)Assessor Name & SignatureAssesor Name* First Last Assessor Signature*
