APPENDIX 1

GC3 The Health and Safety Practical Application

Candidate and coure pro!ider declaration"
#or co$pletion %y the candidate"
I declare that the work submitted for this practical application assessment ie. the completed observation sheets
and the report to management, is my own work. I recognise that contravention of this statement constitutes
malpractice and may result in my being subject to the penalties set out in the NEBO! "alpractice policy.
Name #$rint% &&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&
ignature &&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&
'ate &&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&
#or co$pletion %y a coure pro!ider repreentati!e &e' internal practical aeor("
I declare that the work marked is identical to that received from the candidate. I recognise that contravention of
this statement constitutes malpractice and may result in my being subject to the penalties set out in the NEBO!
"alpractice policy.
Name #$rint% &&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&
ignature &&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&
'ate &&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&
#or co$pletion %y the coure pro!ider) internal practical aeor"
I declare that I have marked this work and am both (ualified and approved by NEBO! to do so. I recognise
that contravention of this statement constitutes malpractice and may result in my being subject to the penalties
set out in the NEBO! "alpractice policy.
Name #$rint% &&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&
ignature &&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&
'ate &&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&
N*" Thi declaration $ut %e co$pleted in full+ u%$itted and retained ,ith the
candidate) cript- If thi declaration i not u%$itted the candidate) reult $ay %e
declared !oid-