Practical Assessment Learner Name Learner Email(Required) Assessor Name Assessor Email(Required) Centre Name Assessment Location Assessment Start Time Hours : Minutes AM PM AM/PM Assessment End Time Hours : Minutes AM PM AM/PM Assessment Date DD slash MM slash YYYY Grading Criteria • If one major fault is given the learner will automatically fail. • If 6 or more minor faults are given the learner fails. • A learner is entitled to one resit on the same day for either theory and/or practical. • A resit can be taken on a different day within a 4-week period. • Assessment ratio 1:1Assessment Criteria ObservedRisk assessment carried out Pass Fail PPE CHECKSHard hat in good condition and worn as needed Pass Fail Eye protection in good condition and worn as needed Pass Fail Gloves in good condition and worn as needed Pass Fail High visibility clothing in good condition and worn as needed Pass Fail Protective clothing in good condition and worn as needed Pass Fail Clothing suitable for inclement weather in good condition and worn as needed Pass Fail Safety boots in good condition and worn as needed Pass Fail Suitable hearing protection (if required) in good condition and worn as needed Pass Fail All PPE present and used correctly Pass Fail Equipment Checks - GDUEquipment in date Pass Fail Calibration Pass Fail Recognise the types of gases checked Pass Fail Battery checks complete Pass Fail Operation Pass Fail Set to Zero Pass Fail Audio on/off Pass Fail Equipment Checks - GeneralLifting bar Pass Fail Lifting keys Pass Fail Manhole cover lifter Pass Fail Rolling bar Pass Fail Water pump checked Pass Fail Water test kit in satisfactory condition Pass Fail Signage and guarding around the working area.Sandbags used (if appropriate) Pass Fail Worksite safely & adequately guarded Pass Fail Removing & Replacing a CoverInitial gas test done Pass Fail Key and roller were used correctly Pass Fail Site guarded adequately Pass Fail Check for the keys Pass Fail Able to break the seal and lift the lid correctly Pass Fail Used good kinetic lifting technique Pass Fail Seating cleaned before cover replacement Pass Fail The cover was replaced safely and correctly Pass Fail Gas TestingGDU checked – bleeps as per manufacturer spec Pass Fail Gas tested at water level and or bottom Pass Fail Gas test at duct entries Pass Fail Carriageway cover removal and replacementSite guarded adequately Pass Fail Initial gas test performed Pass Fail Cover raised using roller if required and pulled clear and stored safely Pass Fail Cleaned seating before replacement of the cover Pass Fail Mechanical /hydraulic lifter parts checked Pass Fail Assembled lifter correctly Pass Fail Lifter operation checked Pass Fail Identified cover and any security fittings Pass Fail Correct keys identified and used Pass Fail Able to break seal correctly Pass Fail Able to replace cover safely and correctly Pass Fail Able to disassemble mechanical/hydraulic lifter Pass Fail Water Test – SimulationTested for discolouration Pass Fail Tested for the unpleasant smell Pass Fail Test for suspended solids in cloudy water Pass Fail Outflow water monitored ensuring no silt or solids are being discharged in line with requirements Pass Fail Pump was lowered and used correctly avoiding disturbing any silt Pass Fail Able to discharge water correctly Pass Fail Environmental conditions met/understood Pass Fail Feedback to the learnerLearner ResultsPASS (5 or less Minor Faults) FAIL (6 or More Minor Faults or 1 Major Fault) Date DD slash MM slash YYYY Legal Consent(Required) I agree to the terms and conditions.Consumer Disclosure Regarding Conducting Business Electronically, Signing Documents Electronically, and Receiving Electronic Notices and Disclosures Please read the information below, carefully, as it concerns your rights. eSignatures are an efficient way to execute an agreement with the same legal force and effect of a handwritten or “wet ink” signature. By signing this document you are agreeing that you have reviewed this Consumer Disclosure and consent and intend to transact business electronically; to use electronic signatures instead of wet ink signatures and paper documents, and to receive notices and disclosures electronically. You are not required to sign documents electronically or to receive notices and disclosures electronically. If you prefer not to transact business electronically, you may request paper copies from the “sending party” and withdraw your consent at any time, as described below. Scope of Consent By utilizing this Service, you agree to receive electronic signature documents with all related and identified documents, notices, and disclosures provided during your relationship with the “sending party.” You may withdraw your consent, at any time, by following the procedures outlined below. 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In order to withdraw consent you must notify the “sending party” that you wish to withdraw your consent to transact business electronically and to provide your future documents, notices, and disclosures in paper format. If at any time, after withdrawing your consent you choose to use our electronic signature system your use of this Service will, once again, evidence your consent to receive documents, notices, and disclosures, electronically. You may withdraw your consent to receive electronic notices and disclosures or execute an electronic signature by following the procedures described below. Withdrawing your consent, requesting a paper copy, or updating your contact information You always have the ability to download and print any documents sent to you through our electronic signature system. To withdraw your consent to conduct business electronically, sign documents electronically, and receive documents, notices, or disclosures electronically, please contact the “sending party” directly; by telephone, by email (sent to the “sending party” with any of the topics outlined below stated in the subject line of your email) or by postal mail to their mailing address specified to receive such notices. “Withdrawal of Consent To Transact Business Electronically” To allow the “sending party” to identify and facilitate your withdrawal of consent to transact business electronically, please provide your name, email address, the date on which you are withdrawing your consent, your telephone number and mailing address. “Requesting A Paper Copy” To allow the “sending party” to identify you to provide a paper copy of the document requiring your signature, the notice, or disclosure, please provide the sending party with your name, email address, mailing address, telephone number, and name of the document of which you are requesting a paper copy . “Update Your Contact Information” To allow the “sending party” to identify you in order to update your contact information, please provide them with your name, email address, mailing address, and telephone number. The “sending party” will inform you of any fees related to costs for printing and mailing paper copies or your withdrawal consent to transact business electronically.Learner Declaration. I confirm that I have completed the assessment set out by the assessor. I confirm that Smart Awards can use the data for the purpose of producing a certificate. I understand that I can withdraw my consent at any time.Learner Name Learner signatureWaiting for another signerDate DD slash MM slash YYYY Assessor Declaration. I confirm that the learner has been assessed in line with the assessment strategy. Assessor Name Assessor signatureDate DD slash MM slash YYYY Internal Quality Assurer declaration I confirm that the evidence has been sampled to the centres sampling strategy and meets the required standard. IQA Name IQA Email(Required) IQA SignatureWaiting for another signerDate DD slash MM slash YYYY Internal Quality Assurer declaration I confirm that the evidence has been sampled to the centres sampling strategy and meets the required standard. EQA Name EQA Email(Required) EQA SignatureWaiting for another signerDate DD slash MM slash YYYY Assessment Overview: The assessment will be conducted in a controlled environment that simulates real-world conditions. The candidate will be required to perform a series of tasks related to risk assessment, equipment checks, cover removal and replacement, gas testing, and water testing. The candidate's competence in adhering to safety protocols, identifying hazards, and responding to environmental conditions will be evaluated. Layout of Assessment: Risk Assessment: Verify if a risk assessment has been carried out. Ensure that all major hazards have been identified. Check if adequate control measures have been put in place. PPE Checks: The candidate will be provided with a designated area containing various PPE items. The assessor will observe the candidate as they inspect and put on the required PPE. The candidate will explain the purpose of each PPE item and its proper usage. Equipment Checks - Gas Detection Unit (GDU): A GDU will be set up, and the candidate will be asked to perform checks. The assessor will assess the candidate's ability to calibrate the GDU, recognize gas types, and perform various operational checks. Equipment Checks - General: Different equipment items will be laid out, and the candidate will be asked to inspect them. The candidate will demonstrate their familiarity with the equipment, checking for proper condition and functionality. Worksite Safety and Signage: A mock worksite area will be set up with appropriate safety measures and guarding. The candidate will identify safety measures and explain the purpose of signage and guarding. Removing & Replacing a Cover: A manhole cover setup will be provided for this task. The candidate will perform the steps required to safely remove and replace a cover. The assessor will evaluate the candidate's adherence to safety protocols and proper technique. Gas Testing Station: The candidate will be provided with a gas testing setup, including simulated gas sources. The candidate will demonstrate the correct use of the GDU for gas testing at different levels and locations. Carriageway Cover Removal and Replacement Station: (In particular order) A carriageway cover setup with a lifter will be provided. The candidate will perform the steps required to remove and replace the cover using the lifter. The assessor will evaluate the candidate's procedure, technique, and understanding of security fittings. Water Test - Simulation: (Must be completed with removal and replacement of a cover) A water testing setup will be provided, including water with simulated conditions. The candidate will conduct water tests and demonstrate proper use of the water pump. The assessor will assess the candidate's ability to identify water quality issues and perform correct testing. If no water present this can be supported by assessor questioning, Demonstration is still to be in place Assessment Criteria Station: At each station, the assessor will use a standardized assessment rubric to evaluate the candidate's performance based on criteria related to PPE usage, equipment checks, safety protocols, technique, and understanding of procedures. Feedback and Evaluation: After completing all stations, the assessor will provide feedback to the candidate, highlighting strengths and areas for improvement based on their performance. The overall assessment will be evaluated against the established criteria.
