Cleon Grant Assessment Templsate

Code: MEMMAH0071A
Code: MEMMAH0081A
Code: MEMMAH0071A
Candidate’s I.D. No.____________________
Assessment Package
Summary Sheet
ATO: JDF TTI Date of assessment _____________________________________
Candidate’s Name: _________________________________________________________________
Workplace/Institution: ___JDF TTI______________________________________________________
Result of Assessment (Tick appropriate box (es): Used for single, clustered or integrated assessment)
Competent Competent Competent
Unit Code(s) _ MEMMAH0071A_____ MEMMAH0081A _______ MEMMAH0071A ____________
Not yet Competent Not yet Competent Not yet Competent
Unit Code(s) _ MEMMAH0071A MEMMAH0081A _________ MEMMAH0071A ______
_________________ ___________________
Assessor’s Checklist Yes No
The correct forms have been used.
All pages relating to the assessment instrument have been completed.
The circles have been checked
All the required supplementary evidence has been provided.
Feedback has been provided to candidate
The summary sheet has been signed by both assessor and candidate
The Critical Employability Skills (CES) have been assessed
Candidate’s Checklist Yes No

I am exposed to the competency standard and other learning resources
Self assessment and planning is completed
I am ready to be assessed
Candidate’s Signature _______________________________________
This section should be signed on completion of assessment
Assessor’s Name: Cleon Grant
Signature: Candidate: Assessor:
For ATO/Office Use Only Recognition of certificate
Data input by: Yes No

Statement of Competency
Signature: ______
issued
Date: ___________________________
Date:
Standards and Assessment Development Unit, NCTVET MEM06 Page 1 of 21

Copyright Ó 2006 National Council on Technical & Vocational Education & Training (NCTVET)
Code: MEMMAH0071A
Code: MEMMAH0081A
Code: MEMMAH0071A
Candidate’s I.D. No.____________________
NB. The ATO must keep this record regarding assessment according to the assessment guidelines

Code: MEMMAH0071A
Code: MEMMAH0081A
Code: MEMMAH0071A
Candidate’s I.D. No.____________________
1. Unit code(s) and title(s) Assessed

_____________________________________________________________________________
________ MEMMAH0071A- MEMMAH0081A - MEMMAH0071A __
_____________________________________________________________________________
_____________________________________________________________________________
2. Tasks/Project Assigned
____________________________________________________________________________
__________ See Attachment _____________________________________________
____________________________________________________________________________
____________________________________________________________________________
The assessor should specify the following:

3. Range of conditions under which the assessment took place (see range statement in unit
standards).
This assessment has been conducted based on the following range of conditions:-
____________________________________________________________________________
_________ As per range statement _________________________________________
____________________________________________________________________________
____________________________________________________________________________
4. Context of Assessment
On the job
Off the job
5. Additional Comments
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________

Unit Code: MEMMAH0071A Title of Unit: Perform manual handling and lifting
Unit Code MEMMAH0081A Unit Title : Perform housekeeping duties
Unit Code MEMMAH0071A Unit Title: Perform manual handling and lifting
Candidate’s I.D. No.____________________
This table is used by the assessor when there is an adjustment in the prescribed assessment tool given.
Record of Reasonable Adjustment

Performance Criteria Evidence Type Reason for New Activity Details Comments Competent Not yet
Adjustment Competent
Assessor’s signature _______________________ Date

Candidate’s I.D. No.____________________
Assessment Procedure
The assessment package consists of two sections, Observation

the administrative section and data collection The assessor should observe the candidate at the
section for the assessor to make a judgment. time of assessment and identify the evidence
required.
The administrative section is made up of the
following sheets: Performance criterion with a circle denotes
 summary Critical Aspect of Evidence as stated in the
 the range of conditions standards and is crucial to a competent
 workplace assessment checklist performance.
 record of reasonable adjustment
Where appropriate, assessment may be negotiated
The data collection section consists of the and agreed on between the assessor and the
following sheets: candidate.
 evidence record
 key competencies Critical Aspect of Evidence
 assessment matrix.
 Demonstrate compliance with OH&S
The summary sheet is used for administrative regulations applicable to workplace operations
purposes to record the result of assessment and and show compliance with quality assurance
the evidence record is used to guide the assessor requirement
in conducting assessment.  Demonstrate safe and effective operational
use of lifting equipment, tools and attachments
The assessor will need to visit the candidate’s and demonstrate safe handling of materials
workplace/institution on at least one occasion prior  Demonstrate correct procedures in manual
to conducting assessment. Workplace advisors handling and demonstrate effective handling
may be consulted when conducting assessment. technique to produce designed outcomes
They should contribute their own knowledge of the  Interactively communicate with others to
candidate’s performance to assist in the ensure safe operations and give particular
completion of the candidate’s assessment. attention to safety and elimination of hazards
To carry out the assessment you will: Context of Assessment

 Observation Where multiple assessors are involved in
 Oral Questioning conducting panel assessment, the strategies used
 Past Performance Records should be agreed on.
 Refer to Training Records
The Accredited Training Organization (ATO) will
Assessment Evidence develop record acceptance procedures for the
Four types of evidence are used to assess this receipt of completed packages.
unit. One or more types are required to assess
each performance criteria and these are written Instructions for Completing Evidence
beside the criteria in the record of evidence.
Record
Question to Candidate
If the candidate demonstrates competency, then
place a check mark () in the circle or box
Oral questions are used to collect evidence about
. If not yet competent, place an (x).
the candidate’s knowledge. The candidate must
answer these without help from other people
although the assessor may assist by clarifying the
questions where necessary.

Candidate’s I.D. No.____________________
N.B. The circle denotes Critical Aspect of

Evidence and the assessor must probe to
ensure that all these are demonstrated in order
to make a judgment of competency.
TASK/PROJECT ASSIGNED
The task(s)/project that were assigned to the

candidate should be documented in the space
provided on page two. All questions and
possible responses, case studies, general
instructions and any other supporting evidence
should be documented and attached to the
assessment package.

Unit Title: Perform manual handling and lifting Unit Code: MEMMAH0071A
Unit Title : Perform housekeeping duties Unit Code MEMMAH0081A
Unit Title: Perform manual handling and lifting Unit Code MEMMAH0071A
Candidate’s I.D. No.____________________
If the candidate demonstrates competency, then place a check mark () in the circle or box . If not yet competent, then place an (x). N.B.
The circle denotes Critical Aspect of Evidence.
Evidence Record
Element Type of Evidence Area of Probing/Scope/Sample Performance Outcomes

Questions
Element 1: Lift materials manually
1.1 Material weight is determined Observation  Ability to use and interpret weight Weight of materials are
correctly utilising most appropriate Questioning Third measuring device. Knowledge of determined correctly using
technique party reports weight measuring device to be the correct measuring
used device
1.2 Lifting techniques are undertaken to Observation,  Knowledge of proper lifting Materials are lifted
safe work standards, standard Practical techniques. Knowledge of correctly without injury to
operating procedures. (Type of Project,questioning standard operating procedures of persons or things
movement, methods of movement, the job
storage condition, height and
position).
Element 2: Move/shift materials

manually
2.1 Appropriate equipment are selected Observation,  Knowledge of the type of Equipment selected are
where required. Practical equipment to be selected suitable for the job
Project,questioning
Candidate’s I.D. No.____________________
Evidence Record

Questions
2.2 Material is placed safely and Observation,  Knowledge of lifting techniques. Materials are placed safely
securely on moving equipment Practical Project Knowledge of safety rules to be and securely on moving
followed when securing materials equipment
on moving equipment
2.3 Material is relocated ensuring Observation,  Ability to relocate materials safely Materials are relocated
safety of personnel and security of Practical Project and securely without injury to safely and securely
material personnel
2.4 Material is unloaded from moving Observation,  Ability to unload materials safely Materials are unloaded
equipment and placed in a safe and Practical Project from moving equipment safely safely and securely
secure manner. and securely
Evidence Record

Questions
Element 1: Follow safe work practices

Candidate’s I.D. No.____________________
Evidence Record

Questions
1.1 Work is carried out safely and in Observation,  Ability to carry out work safely Work is carried out safely
accordance with company policy Practical, and according to company and according to standard
and company procedures and Questioning, Third policies and procedures and procedures.
industry requirements. party Reports industry requirement.
1.2 Housekeeping is undertaken in Observation,  Knowledge of company Good housekeeping

accordance with company Practical, housekeeping procedures procedures are followed
procedures Questioning, Third
party Reports
1.3 Responsibilities and duties of Observation,  Knowledge of employees Employee responsibilities

employees are understood and Questioning, duties and responsibilities. and duties are understood
demonstrated in day-to-day Practical, Third party Ability to follow them on a and adhered to.
actions reports day-to-day basis
1.5 All equipment and safety devices Observation,  Knowledge of Legislative Safety devices and
are used according to legislative Questioning, requirements and equipment are used
requirements and Practical, Third party company/manufacturer’s according to the standard
company/manufacturer's reports procedures/instructions specification.
procedures/instructions.
Candidate’s I.D. No.____________________
Evidence Record

Questions
1.6 Safety signs/symbols are Observation,  Ability to identify safety Jobs are done safely at all
identified and followed as per Questioning, symbols and follow times
instruction Practical, Project instructions
1.7 All manual handling is carried out Observation,  Ability to carry out manual Manual handling is done
in accordance with Industry Questioning, handling according to according to standard
requirements, company Practical, Project standard operational operating procedures
procedures and National procedures
Occupational Health & Safety
guidelines
1.8 Occupational Health & Safety Observation,  Knowledge of Occupational Guidelines are
Commission guidelines Questioning, Health & Safety Commission demonstrated.
demonstrated Practical, Project guidelines.
Element 2: Report workplace hazards
2.1 Workplace hazards identified Observation,  Ability to identify workplace Workplace hazards are
during the course of work are Questioning, hazards. Knowledge of identified and reported to
reported to appropriate person Practical, Project appropriate personnel to the relevant personnel.
according to standard operating whom hazards should be
procedures/factory act. reported.
Candidate’s I.D. No.____________________
Evidence Record

Questions
Element 3: Follow emergency

procedures
3.1 Means of contacting the Observation,  Ability to recognize an Ability to recognize

appropriate personnel and Questioning, accident. Knowledge of accident and knowledge of
emergency services in the event Practical appropriate personnel and appropriate personnel and
of an accident demonstrated. emergency services emergency services
demonstrated
3.2 Emergency and evacuation Observation,  Knowledge of emergency and Emergency and
procedure understood and carried Questioning, evacuation procedure. Ability evacuation procedures are
out when required. Practical to carry out procedures when carried correctly
required
Elements Performance Criteria Yes No Not
Observed
Plan and prepare  OH&S requirements associated with application tasks and
work workplace environment are recognised and adhered to.
 Appropriate personal protective equipment are selected,
correctly fitted and used.
 Quality Assurance requirements associated with company’s
construction operations are recognized and adhered to.
 Tools and equipment for handling materials/goods, non-toxic
waste, selected consistent with job requirements, checked for
serviceability and any faults reported to supervisor.
Correctly manual  Common engineering construction materials are recognized and

handle, sort and selected for sorting and stacking/stockpiling to supervisor’s
stack engineering instructions and/or specifications.
/construction  Handling characteristics of materials are identified and
material appropriate handling techniques applied.
 Specific handling requirements for hazardous materials are
applied.
 Materials are stored, stacked/stockpiled and protected, clear of
traffic ways, so they are easily identified, retrieved and not
damaged.
 Appropriate signage and barricades are erected where
applicable to isolate stored materials from workplace traffic or
access.
 Correct manual handling techniques are used.
Prepare for  Materials are stacked/banded for mechanical handling in

mechanical handling accordance with type of material and plant/equipment to be
of materials used.
 Rigger is assisted with loading, unloading, moving, locating
and/or installing materials.
 Materials are safely handled with assistance of pallet trolley,
forklift or hoist.
Elements Performance Criteria Yes No Not
Observed
Handle and remove  Waste materials are handled correctly and safely according to
waste safely OH&S and requirements of regulatory authorities.
 Hazardous materials are identified for separate handling.
 Non-toxic materials are removed using correct procedures.
 Dust suppression procedures are used to minimize health risk to

work personnel and others.
Clean up  Tools and equipment are cleaned, maintained, and stored.
 Unused materials are safely stacked/stockpiled stored.
 Waste materials are disposed of safely.
 Work area is cleaned and cleared of debris and unwanted

material.
Ensuring the Key Competencies is assessed.
Evidence Guide
Critical Employability Looking for Evidence

Skills
Collecting, analyzing The capacity to sift, sort and retrieve information. This Perform manual handling
and organizing involves accurately organizing and recording and lifting accurately,
information information in prescribed format. safely and according to
standard procedures and
Level 1
requirements
Communicating ideas The ability to present simple ideas and information in Information pertaining to
and information familiar context to expected audience in a drawing, instructions
predetermined context. This should include the use of given and all matters
Level 1
language to communicate clearly set information and relevant to the job are
the verification of accurate and complete understood
communication
Planning and The capacity to follow prescribed guidelines to Activities of the job are
organizing activities organize work activities to achieve predetermined selected and carried out
objectives and to identify, request, use and maintain sequentially so that all
Level 1
assigned resources. This also involves checking objectives of the job are
process and outcome against predetermined criteria met on a timely basis
Working with others The capacity to interact effectively with others in a Ability to work with others
and in teams team including understanding and responding to the and in a team to get the job
needs of a client and working effectively as a member done correctly and on time
Evidence Guide

Skills
Level 1 of a team to complete one’s share of assigned tasks. to standard specification.

This involves the positive use of established rules,
values and attitudes and responding positively to
praise and criticism and seeking consensus about
task to be performed.
Using mathematical The capacity to clarify the objectives of the activities, Perform manual handling
ideas and techniques follow guidelines for selecting ideas and techniques, and lifting accurately
use mathematics ideas to accurately meet using the correct
Level 1
requirements and to ensure that answer makes sense techniques, correct lifting
in context device, correct moving
equipment and correct
weight
Solving problems The capacity to identify desired outcomes and The ability to identify and
processes, follow a given process to completion, solve problems, prevent
Level 1
respond to faults and difficulties using given future ones and perform
instruction and action plans and to check the process the job to the required
and outcomes against specified criteria standard
Evidence Guide

Skills
Using technology The capacity to follow guidelines to select appropriate The ability to recognize
technology, use technology in a variety of ways to and use the most modern
Level 1
meet the needs of routine situations and to achieve technology available to
required outcome. This involves taking into account get the job done safely
the relevant health and safety issues and following and to the specific
established guidelines for the use of technological standard
equipment and materials
Unit Title: Per form manual handling and lifting Unit Code: MEMMAH0071A
Candidate’s I.D. No.____________________
Template 2
Assessment Method Matrix
Summary of evidence sources for the unit of competency

Unit(s): Perform manual handling and lifting Code(s): MEMMAH0071A
For each performance criterion, place a check mark to indicate the type(s) of evidence
Elements & Practical Third Questioning/ Personal Workplace Training Case Projects Testimonials Others
Performance Demon- Party Interview Statement/ Documents Records Studies /
Criteria stration Reports Resume Awards
Element 1 1.1   
1.2.   
Element 2 2.1   
2.2  
2.3  
2.4  
Evidence may include but not limited to the above
Template 3: Self-assessment guide

Candidate’s I.D. No.____________________
SELF-ASSESSMENT GUIDE
Unit: MEMCOR0141A: Follow principles of Occupational Health and Safety
(OH&S) in work environment
MEMMAH0081A: Perform housekeeping duties
MEMMAH0071A: Perform manual handling and lifting
Instructions
 Read each of the questions in the left hand column of the chart.
 Place a tick in the box if you believe that you can perform the tasks described.
 Complete the column on the right hand side by listing any evidence you have to show that you
perform these tasks.
Can I? Evidence suggestions
□ (Place elements of the units in this column )
□ Follow safe work practices

 Practical Observed, Written question,
Oral question
□ Report workplace hazards

Oral question
□ Follow emergency procedures

Oral question
□ Plan and prepare work

Oral question
Correctly manual handle, sort

and stack engineering
□ /construction material Oral question
Candidate’s I.D. No.____________________
Prepare for mechanical handling


□ of materials
Practical Observed, Written question,
Oral question

□ Handle and remove waste safely
Oral question

□ Clean up
Oral question

□ Lift materials manually
Oral question

□ Move/shift materials manually
Oral question
Candidate’s name: Date:
Template 6: Assessment agreement (back of Template 3)
Evidence to be collected:  Practical Observed

Candidate’s I.D. No.____________________
 Written question
Oral question
Candidate to answer questions (yes/no)
 Have the purpose and the consequences of the assessment been explained?
 Have you received copies of the relevant unit(s) of competency?
 Do you understand what evidence is to be collected?
 Have your rights and the appeal system been fully explained?
 Have you discussed any special needs to be considered during assessment?
I agree to undertake assessment in the knowledge that information gathered will only be used for
professional development purposes and can only be accessed by my manager and the ATO.
Candidate
Date:
signature:
Assessor
Date:
signature:
Template 5: Assessment plan
Assessment Plan for Unit(s): ___ MEMMAH0071A- MEMMAH0081A- MEMMAH0071A

Candidate Name / Details: ______________________________________________________________________________
Assessor’s Name / Details: ______________________________________________________________________________
Proposed Date of Assessment:_____________________________________________________________________________
Critical Aspects of the Context Context of this Recommended Assessment Assessment Strategies Used
Unit(s) as specified in the Unit(s) Strategies
Candidate’s I.D. No.____________________
Unit (s) (Tick as appropriate)
 Observation  Observation
demonstrate  Simulation  Simulation
compliance with On the job
Occupational Off the job Off the job  Role Play  Role Play
Health and Safety  Portfolio  Portfolio
regulations  Project  Project
applicable to  Question  Question
workplace (written /oral (written /oral
operations  Other  Other
• demonstrate
application of
organizational
policies and
procedures
including Quality
Assurance
requirements
where applicable.
• carry out correct
procedures prior to
and during work
activities.
• safe and
effective
operational use of
tools, plant and
equipment.
• carry out
appropriate
applications in
accordance with
regulatory and
legislative
requirements
demonstrate
compliance with
Occupational
Health and Safety
regulations and
Industry
guidelines
applicable to
workplace
operations
• indicate
compliance with
organisational
policies and
procedures
including Quality
Assurance
requirements
• carry out correct
Candidate’s I.D. No.____________________
procedures prior to
and during
application of
materials handling
processes
• demonstrate
safe and effective
operational use of
tools and
equipment
• demonstrate
safe application in
the process of
cleaning up
• interactively
communicate with
others to ensure
safe and effective
operations
• demonstrate
compliance with
Occupational
Health and Safety
regulations
applicable to
workplace
operations
• show compliance
with organizational
policies and
procedures
including Quality
Assurance
requirements
• adopt and carry
out correct
procedures prior to
handling materials
• demonstrate
safe and effective
operational use of
lifting equipment,
tools, and
attachments
• demonstrate
correct procedures
in manual handling
• give particular
attention to safety
and elimination of
hazards
• demonstrate
safe handling of
material
Candidate’s I.D. No.____________________
• interactively
communicate with
others to ensure
safe operations
• demonstrate
effective handling
technique to
produce designed
outcome

Cleon Grant Assessment Templsate

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Code: MEMMAH0071A

Candidate’s Name: _________________________________________________________________

Workplace/Institution: ___JDF TTI______________________________________________________

The correct forms have been used.

All pages relating to the assessment instrument have been completed.

The circles have been checked

All the required supplementary evidence has been provided.

Feedback has been provided to candidate

The Critical Employability Skills (CES) have been assessed

Candidate’s Checklist Yes No

Self assessment and planning is completed

Candidate’s Signature _______________________________________

This section should be signed on completion of assessment

Assessor’s Name: Cleon Grant

Signature: Candidate: Assessor:

For ATO/Office Use Only Recognition of certificate

Data input by: Yes No

Standards and Assessment Development Unit, NCTVET MEM06 Page 1 of 21

Standards and Assessment Development Unit, NCTVET MEM06 Page 2 of 21

1. Unit code(s) and title(s) Assessed

The assessor should specify the following:

Standards and Assessment Development Unit, NCTVET MEM06 Page 3 of 21

Record of Reasonable Adjustment

Assessor’s signature _______________________ Date

Standards and Assessment Development Unit, NCTVET MEM06 Page 4 of 21

The assessment package consists of two sections, Observation

To carry out the assessment you will: Context of Assessment

Standards and Assessment Development Unit, NCTVET MEM06 Page 5 of 21

N.B. The circle denotes Critical Aspect of

The task(s)/project that were assigned to the

Standards and Assessment Development Unit, NCTVET MEM06 Page 6 of 21

Candidate’s I.D. No.____________________

Element Type of Evidence Area of Probing/Scope/Sample Performance Outcomes

Element 1: Lift materials manually

Element 2: Move/shift materials

Candidate’s I.D. No.____________________

Element Type of Evidence Area of Probing/Scope/Sample Performance Outcomes

Element Type of Evidence Area of Probing/Scope/Sample Performance Outcomes

Element 1: Follow safe work practices

Candidate’s I.D. No.____________________

Element Type of Evidence Area of Probing/Scope/Sample Performance Outcomes

1.2 Housekeeping is undertaken in Observation,  Knowledge of company Good housekeeping

1.3 Responsibilities and duties of Observation,  Knowledge of employees Employee responsibilities

Candidate’s I.D. No.____________________

Element Type of Evidence Area of Probing/Scope/Sample Performance Outcomes

Element 2: Report workplace hazards

Candidate’s I.D. No.____________________

Element Type of Evidence Area of Probing/Scope/Sample Performance Outcomes

Element 3: Follow emergency

3.1 Means of contacting the Observation,  Ability to recognize an Ability to recognize

Correctly manual  Common engineering construction materials are recognized and

Prepare for  Materials are stacked/banded for mechanical handling in

 Non-toxic materials are removed using correct procedures.

 Dust suppression procedures are used to minimize health risk to

Clean up  Tools and equipment are cleaned, maintained, and stored.

 Unused materials are safely stacked/stockpiled stored.

 Waste materials are disposed of safely.

 Work area is cleaned and cleared of debris and unwanted

Ensuring the Key Competencies is assessed.

Critical Employability Looking for Evidence

Critical Employability Looking for Evidence

Level 1 of a team to complete one’s share of assigned tasks. to standard specification.

Critical Employability Looking for Evidence

Workplace/Institution: _JDF TTI____________________________________________________