Student Assessment Agreement Make sure you read through the assessments in this booklet before you fill out and sign the agreement below. If there is anything that you are unsure of, consult your assessor prior to signing this agreement. Have you read the assessment requirements for this unit? Yes No Do you understand the requirements of the assessments for this unit? Yes No Do you agree to the way in which you are being assessed? Yes No Do you have any specific needs that should be considered? Yes No If so, explain these in the space below. Do you understand your rights to re-assessment? Yes No Do you understand your right to appeal the decisions made in an assessment? Yes No Student name Student number Qualification Code and Title CPC30211: Certificate III in and Title CPCCCA2003A – Erect and dismantle formwork for footings and slabs on ground Assessor name Assessor signature Date Assessment Task Cover Sheet Student Declaration To be filled out and submitted with assessment responses I declare that this task is all my own work and I have not cheated or plagiarised the work or colluded with any other student(s). I understand that if I If I am found to have plagiarised, cheated or colluded, action will be taken against me according to the process explained to me. I have correctly referenced all resources and reference texts throughout these assessment tasks. Student name Student ID number Student signature Date Assessor declaration I hereby certify that this student has been assessed by me and that the assessment has been carried out according to the required assessment procedures. Assessor name Assessor signature Date Assessment outcome S NS DNS Resubmission Y N Feedback Student result response My performance in this assessment task has been discussed and explained to me. I would like to appeal this assessment decision. Student signature Date A copy of this page must be supplied to the office and kept in the students file with the evidence
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Document Title: Student final assessment submission evidence
Document Subtitle: CPCCCA2003A – Erect and dismantle formwork for footings and slabs on ground
Disclaimer:
This work is under copyright and permission is not given to make copies for hire or resale to third parties to use the document for their own or commercial use.
Universal Training Solutions does not give warranty or accept any legal liability in relation to the content of this work.
Licenced to:
RTO Name: Trinity Institute (Australia)
RTO NO: 41310
CRICOS NO: 03556F
RTO Address: Level 7 16-18 Wentworth
St Parramatta NSW 2150
Copyright:
Universal Training Solutions
Developed by:
Universal Training Solutions and validated by Trinity Institute (Australia)
Acknowledgement:
Thanks to Universal Training Solutions and Trinity Institute (Australia) staff for their consultation and development work.
Version:
Trinity Institute (Australia) V1
STUDENT DETAILS
Please complete this declaration with the student
Unit of competency:
Unit Code
Unit Title
Trainer/Assessor Name:
Student Name:
Student ID:
Time Allocation
Refer to Training Plan
Due date:
Refer to you student program guide (training plan). Please insert the due date as confirmed by your assessor below:
Due Date: /. /.
Declarations
Task
Declaration:
Signature
Date
Task 1 Knowledge Questionnaire
I confirm that I have read and understood the instructions, my responsibilities and requirements for this assessment
Task 2 project
I confirm that I have read and understood the instructions, my responsibilities and requirements for this assessment
Task 3 Simulated Practical and/or workplace observation
I confirm that I have read and understood the instructions, my responsibilities and requirements for this assessment
Assessor declaration
The assessor is to complete this declaration with the student.
I have acknowledged the underpinning knowledge and skills may be assessed on or off the job.
Yes
No
I confirm that I am a qualified workplace assessor and will be conducting the assessment for this unit and student
Yes
No
Have all aspects of the student agreement been explained and understood?
Yes
No
Does the student understand they have three attempts to complete each task satisfactorily? If after the third attempt the student is deemed Not Yet Competent, they will be required to do further training before reattempting this unit.
Yes
No
I have explained the requirements for reasonable adjustment as a result of workplace constraints
Yes
No
I confirm that I have explained and confirmed all of the above items with the student.
Assessor Signature
Date
____/____/____
Student declaration
Agreement by the student: Please sign below to demonstrate that you understand what is required of you in relation to this assessment.
Do you have any special needs or considerations to be made for this assessment? If yes, what are they?
Yes
No
Do you understand your rights to appeal the decisions made in an assessment?
Yes
No
I understand I have three attempts to complete each task satisfactorily. If after the third attempt I am deemed Not Yet Competent, I will be required to do further training before reattempting this unit
Yes
No
Reasonable adjustment: If you require any adjustments to accommodate a need in order to complete this assessment, please talk to your assessor. Arrangements will be put in place to ensure a fair and flexible approach is undertaken for this assessment. Please note that the range or nature of the adjustment will ensure that the outcomes of the unit are not compromised.
Yes
No
I agree to comply with all rules, regulations, policies and procedures provided as part of the simulated environment.
Yes
No
I give permission for the RTO to use my assignment at the workplace for assessment moderation / validation purposes.
Yes
No
I confirm that I have read and understood my responsibilities and requirements for assessment.
Student Signature
Date
____/____/____
Submission evidence
ASSESSMENT TASK 1 KNOWLEDGE QUESTIONNAIRE
Q
Questions
S
NS
1
What is the name of the Australian Standard relevant to formwork construction?
2
Refer to the SDS and TDA for Fosroc Form Release Agent, to complete questions 2, 3, 4, 5, 7 and 11.
SDS: http://www.parchem.com.au/public/pdfs/data-sheets/Form-Release-Agent-SDS.pdf
TDS:
www.parchem.com.au/public/pdfs/data-sheets/Form-Release-Agent-TDS.pdf
How is the product applied?
3
Describe the first aid measures if your skin gets in contact with the product.
4
How should large spills be cleaned?
5
What are the product storage requirements?
6
List 5 hazards associated with the erection, alteration and/or dismantling of formwork on ground.
7
List the PPE to be worn when handling the product
8
A residential site has been cleared and construction works are about to commence. What safety signage should be placed at the entrance to the site? Provide an example of each of the different categories of safety signage.
Building setout at property
Category of safety signage
Example
Mandatory signs
Prohibition signs
Warning signs
Danger signs
9
What are the pre-operational checks you should conduct prior to using a circular saw? Outline 6.
10
You are setting up the formwork for a 3 m x 2 m driveway. You are using 100 mm x 50 mm timbers for the formwork side rails and are driving wooden stakes at no more than 1.2 m apart. You will place extra stakes at every joint in the rails and at corners. The timber comes in 3.6 m lengths.
Calculate how many lengths of timber and how many wooden stakes you will need.
11
What is the application rate for a porous form surface?
12
You are directing a crane operator to unload formwork components and timber stacks. How would you tell the crane operator to hoist the load? Draw the signal you would use.
13
Provide 5 examples of release agents.
14
List 7 termite resistant materials.
15
Formwork components and forms are usually designed for re-use, either on the same project or on others. How can you contribute to the economic operation of the job? Give 4 examples.
16
List 8 materials/products in building and construction which have the potential to pollute stormwater systems.
17
What details should be included in formwork drawings? List 5.
18
What is formwork? Explain its purpose.
19
What materials are used in formwork construction? Give 7 examples.
20
Briefly describe the process to erect, strip, clean and stack simple formwork for a small garden shed concrete slab.
Erect
Strip
Clean and stack
21
Place the following steps in the correct order to build formwork for a slab.
Drive pegs into ground
Install braces
Mark height on pegs
Nail form boards to pegs
Trim pegs to height
22
What is block-outs?
23
Why are release agents applied to the surface of formwork? Provide 4 reasons.
24
What is the order of for removing formwork? List 3 steps in the correct order.
25
Outline 4 important factors to consider when storing forms, to ensure they can be reused on another project.
26
What are the specific care requirements for steel formwork components?
27
Detail 5 tasks that must be completed before leaving the site at the end of the day.
28
Provide 3 control measures to minimise the generation of contaminated stormwater.
29
Confirming the scope of works to be carried out is an essential requirement before commencing any project. Where could you find relevant instructions and information regarding work information? List 10 sources.
RECORD OF ASSESSMENT TASK 1 KNOWLEDGE QUESTIONS
To be completed by the assessor
Learner details
Assessor details
Name
Name
Unit Code
CPCCCA2003A
Unit Title
Erect and dismantle formwork for footings and slabs on ground
Record of assessment results (please tick appropriate box).
ASSESSORS NOTE: Before making a final judgement on this assessment task, you must determine if the student is able to satisfactorily apply and perform the following criteria. Review the performance criteria by clicking on the link https://training.gov.au/Training/Details/CPCCCA2003A. Marking should be in line with the model answers required as the performance criteria (PCs) is underpinned by this assessment task. All questions must be deemed satisfactory to achieve a satisfactory outcome for this task. If a NS is provided for any section or questions relating to this task, then the task outcome should be treated as NS and the reassessment process should be applied. If a NS (not satisfactory) outcome is applied then you must inform the student in detail as to why this outcome was provided. Record your reasons in the section labelled Not satisfactory (NS) outcomes. See below for recording appropriate information
Assessment activity – The learner has completed all the assessments requirements for this unit of competency and has been deemed
Outcome
Date of outcome
Task 1 Knowledge Questionnaire
Satisfactory Not satisfactory
Attempts –
Attempt 1
..//.
Attempt 2
..//.
Attempt 3
../…/..
Not satisfactory (NS) Outcomes
Question number
Record in detail the reason for the NS outcome applied
Appeals refer to the complaints and appeals policy and procedure
If you receive a Not Satisfactory assessment result you have the right to appeal. You have three assessment attempts. After the third attempt arrangements for payment will be made for reassessment purposes. Refer to your student hand book for more details on the complaints and appeals process.
to learner:
The assessor must write full feedback to the learner that is constructive and not generic
Reasonable Adjustment
(if applicable) explain why reasonable adjustment has been applied and the tasks it was applied to
Assessor Intervention
(if applicable) – did you need to assist the student in this assessment. If so please explain:
Assessor Name
Assessor Signature
Date
Student declaration – I hereby certify that this assessment is my own work, based on my personal study and/or research. I have acknowledged all material and resources used in the presentation of this assessment whether they are books, articles, reports, internet searched or any other document or personal communication. I also certify that the assessment has not previously been submitted for assessment in any other subject or any other time in the same subject and that I have not copied in part or whole or otherwise plagiarised the work of other learning and/or other persons. I confirm that I understand that I must complete this assessment on my own. I confirm that I will not cheat or plagiarise or copy from another student during the completion of this assessment.
Student name
Student signatur
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