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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 Student signature Date Qualification Code and Title CPC30211 Certificate III in Carpentry Unit Code and Title CPCCCM2008B – Erect and dismantle restricted height scaffolding 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 student’s file with the evidence

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Document Title: Student final assessment submission evidence
Document Subtitle: CPCCCM2008B – Erect and dismantle restricted height scaffolding
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: 41310CRICOS NO: 03556FRTO Address: Level 7, Wentworth Street Parramatta NSW 2150RTO suburb: Parramatta NSW 2150Copyright:Universal Training SolutionsDeveloped 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

Contents STUDENT DETAILS 4 Declarations 5 Submission evidence 7 ASSESSMENT TASK 1 KNOWLEDGE QUESTIONNAIRE 7 RECORD OF ASSESSMENT TASK 1 KNOWLEDGE QUESTIONS 25 SUBMISSION EVIDENCE – ASSESSMENT TASK 2 PROJECT 27 ANSWER SHEET 27 RECORD OF ASSESSMENT TASK 2 PROJECT 51 SUBMISSION EVIDENCE – ASSESSMENT TASK 3 SIMULATED PRACTICAL AND/OR WORKPLACE OBSERVATION 53 Appendix 1 Planning and Preparation Record Sheet 53 Appendix 2 Quality requirements 55 Appendix 3 Safety checklist 57 Appendix 4 Tool List & Condition requirement 63 Appendix 5 Faults report 64 Appendix 6 Material List 65 Appendix 7 Scaffold Inspection Log 66 APPENDIX 8 – ASSESSOR OBSERVATION CHECKLIST 70 ASSESSOR OBSERVATION CHECKLIST – CRITERION 1 71 ASSESSOR OBSERVATION CHECKLIST – CRITERION 2 73 ASSESSOR OBSERVATION CHECKLIST – CRITERION 3 76 ASSESSOR OBSERVATION CHECKLIST – CRITERION 4 78 ASSESSOR OBSERVATION CHECKLIST – CRITERION 5 80 RECORD OF ASSESSMENT TASK 3 SIMULATED PRACTICAL AND/OR WORKPLACE OBSERVATION 82

STUDENT DETAILSPlease complete this declaration with the student
Unit of competency:Unit CodeCPCCCM2008BUnit TitleErect and dismantle restricted height scaffolding
Trainer/Assessor Name:
Student Name:
Student ID:
Time AllocationRefer 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

TaskDeclaration:SignatureDate
Task 1 Knowledge QuestionnaireI confirm that I have read and understood the instructions, my responsibilities, and requirements for this assessment
Task 2 projectI confirm that I have read and understood the instructions, my responsibilities, and requirements for this assessment
Task 3 Simulated Practical and/or workplace observationI 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 SignatureDate____/____/____
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 SignatureDate____/____/____

Submission evidence

ASSESSMENT TASK 1 KNOWLEDGE QUESTIONNAIRE
QQuestionsSNS
1Confirming 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?
2List 4 Australian Standards that apply to restricted height scaffolding.
3Does the supplier of prefabricated scaffolding need to provide written information about the system?
4In relation to scaffolding, who has obligations for Workplace Safety under the Occupational Health and Safety Act?
5A SWMS must be prepared for high risk construction work before the work starts. What 4 components must the SWMS include?
6What PPE must you wear when using a hazardous substance? How would you determine this?
7Outline 6 points you should consider before you attempt any lifting or handling operation.
8What are the minimum clearance requirements when erecting scaffolding near powerlines? Write your answer on the diagram in the green spaces provided.
9How can a scaffold built alongside a road be protected from traffic damage? You must list 4 examples
10What tools are required to erect scaffolding? List 5.
11How can you check the accuracy of a spirit level? Give 3 examples.
12How would you determine the type and number of scaffold components you require?
13Provide a brief description of the following footing components.
ComponentDescription
Sole board
Screw jack
Caster
14Provide a brief description of the following framing components.
ComponentDescription
Frame
Standard
Brace
Face brace
Tube
Coupler
Ledger
Transom
Joining pin
15Why might a project have an environmental plan?
16Modular systems are simpler and faster to set up than other types of scaffold. Which trades are they most commonly used by? List 4.
17List the 3 most common trades which use a mobile scaffold.
18What are the maximum loads for bays?
19Describe each of the access and egress factors to be considered consider when designing a scaffold system to be used on site.
FactorDescription
Vehicle access
Storage
Safety
Job site
20Label the components of the framed scaffolding. Use the list of words below.
HandrailPlatformSole board
Toe boardGuardrail postBrace
Base plateMid-railFrame
21Would you mix components of two prefabricated systems in one scaffold without a supplier’s or engineer’s consent? If scaffolding is to be modified or altered, where is the scheduling documented?
22List the steps for erecting a scaffold in the correct order.
StepProcedure
Check that the base is square by measuring the diagonals. Adjust if necessary.
A gate panel will be needed at the ladder.
Check that you have all the parts and equipment as per your scaffolding plan, and that nothing has changed on site since you drew up your plan that might affect it.
If you’re working on a firm, stable surface that doesn’t require sole boards, such as concrete, the first components to be positioned are the base plates, which often come with screw jacks attached.
When the erection process is complete, carry out a full inspection of the scaffold, paying particular attention to connections between components.
Securely lash the ladder to the tubes. If space is tight, the ladder can be positioned against the end of the scaffold and tied off to one of the standards.
Fit edge protection to the exposed sides of the platform (those that won’t be connected to the next bay).
Attach braces to both frames, making sure that they lock over the pins correctly.
Continue the same process for the remaining bays.
Place the first boards that will form the working platform on top of the frames. Check that the platform is level. The rest of the platforms will follow the first one, so if the first one is not level, the others won’t be either.
Place a screw jack on the centre of each sole board.
Place the frames on the screw jacks.
Erect the second bay in the same way as the first. Check and adjust for level across both bays.
Measure the distance between the screw jacks to ensure the frames can be placed on top of them easily.
Add the remaining boards to complete the working platform, making sure that the maximum gap between the boards is 10 mm.
Put the first sole board down no more than 200 mm away from the working surface and make sure it’s level. Dig the ground out if required. Place the next sole boards on the ground, ensuring they are the correct distance apart (width and length) to support the frame or standards.
Use a spirit level to level the frames by adjusting the screw jacks up or down until the bubble rests in the centre of the lines.
At the best position for access, and according to the plan, attach tubes to the frame at the top and the bottom for the ladder to be tied to. The slope or pitch of the ladder needs to be not less than 1:4. The slope must be no more than 1:6.
23What is the maximum extension on an adjustable base plate?
24What is the minimum width of a scaffold plank?
25What is the minimum width of a heavy duty work platform?
26Scaffolding inspections depend on a number of factors. Describe 3 factors.
27Are gaps allowed between the planks of a working platform?
28What 5 records must be completed during the inspection of an erected scaffold?
29Provide 2 reasons why a scaffolding plan may need to be modified.
30Review the SafeWork Australia Code of Practice for Scaffolding work, Section 6 – Inspection and Maintenance. Outline the 2 key points under Regulation 225.
31If a scaffold component has been damaged during use, what should you do?
32How is scaffolding dismantled, and what are the main safety hazards?
33Outline the clean-up procedure for dismantled scaffolding components.
34What checks need to be carried out on scaffolding components during the dismantling process? List 4.

RECORD OF ASSESSMENT TASK 1 KNOWLEDGE QUESTIONS
To be completed by the assessor
Learner detailsAssessor details
NameName
Unit CodeCPCCCM2008BUnit TitleErect and dismantle restricted height scaffolding
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/CPCCCM2008B. 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 deemedOutcomeDate of outcome
Task 1– Knowledge Questionnaire☐Satisfactory ☐ Not satisfactory
Attempts –
Attempt 1…../……/…….Attempt 2…../……/…….Attempt 3…../.…../…..
Not satisfactory (NS) Outcomes
Question numberRecord 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 handbook for more details on the complaints and appeals process.
Assessor Feedback 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 NameAssessor SignatureDate
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 nameStudent signatureDate

Name of document: Student final assessment submission Version 1 Page 2 of 2

Name of the RTO: Trinity Institute (Australia) RTO No: # 41310 CRICOS: #03556F Document uncontrolled when printed

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