Forms

On the following page the assessment contract that is to be agreed upon by the learner and assessor, is set out. The procedure to follow after the assessment, should the learner be unsatisfied with the outcome of the assessment, is set out below.

In order to prevent any unsatisfactory outcomes, the assessment environment will be set up in such a way that it resembles a real-life situation as closely as possible in order to allow for an accurate and fair assessment of the learner’s capabilities.

I (learner name, surname and ID number as stated on page 1) declare that the assessment plan has been agreed upon by me and the assessor as stated in the assessment plan. I take upon myself to familiarise myself with the contract policies, relevant standards, assessment procedures and appeals procedures, as it has been explained to me by the relevant assessor/facilitator/ representative of the training and assessment provider. I agree that all processes have been explained to me relating to: learner support structures, handling of assessment records, credit transfers, and that provider records are in place.

3.1.3 Confidentiality:
All information related to this Portfolio of Evidence and assessment will be treated as confidential, to ensure that the information and results are used solely for the record keeping and internal process related to assessment, moderation and certification.

3.1.4 Assessment and moderation policy:
The learner and the assessor must use the information on page 2 to familiarise themselves with the relevant standards, assessment and moderation procedures. The assessment will be conducted by an approved assessor.

3.1.5 Appeals procedure:
The learner and assessor must use the information on page 2 to familiarise themselves with the appeals procedure. An appeals form may be obtained from the training provider on request.

3.1.6 Re-assessment:
All learners are entitled to be re-assessed in line with the training provider’s assessment policy. Reassessment decisions may incorporate past assessment results.

3.1.7 Certification:
Additional administrative and identification documentation is required for successful certification. This is a legally binding document in its entirety. All pages must be completed and present. Any additional evidence/pages must be declared in the declaration of authenticity. Signatures on the feedback and evaluation of assessment forms are acceptance of the entire document.

3.1.8 Learner declaration of authenticity:
I (learner name, surname and ID number as stated on the Learner Condensed Curriculum Vitae) declare that the evidence submitted for assessment purposes is my own work. No tippex or pencil may be used in this document, and all changes must be signed by all parties involved.

3.1.9 Fraudulent declaration and agreement by the applicant
I understand and agree that it is considered fraud if I, with a fraudulent purpose, provided false or misleading information or evidence in any circumstances that requires me to provide information, evidence or give notice to another person.

The above-mentioned evidence or information may be in the form of, but is not limited to
a. Gravity Training certificates
b. Any Gravity Group Holdings companies’ certificates
c. Accreditation or professional body certificate like the IRATA, Services SETA or MERSeta
d. Other Training provider certificates,

I understand and agree that if any information or evidence provided by me is found false or misleading by the Certification Administrator the penalties may include but is not limited to
a. My candidature may be rejected at any time and relevant training certificates will be withdrawn and or
b. Relevant course fees paid will be forfeit and or.
c. Be reported to the relevant accreditation body or training provider and or
d. I will be suspended from receiving future training from any of the Gravity Group Holdings companies for a duration of 5 years or.
e. Be liable to pay a fee of twice the course fee for the particular certificate in question.

I hereby declare that I am aware that I can appeal against the above penalties and evidence of forgery against my name, and that Gravity Training Forgery Committee will then investigate the validity of the supporting evidence of during my appeal. Any decisions made by the committee during the appeal will be final.
I hereby declare that I have not forged or intend to forge any Gravity Training or other official documents and that all information or evidence supplied by me, to the best of my knowledge, is correct.

I (name, surname and ID number as stated on the Learner Condensed Curriculum Vitae) (signed below) declare that the assessment plan and all parts of it have been explained to me and that I understand and agree to all parts thereof.

Instructions: Serves as a guide for training and assists the facilitator in the evaluation of a learner’s performance before assessment, as well as the learner’s readiness for the actual assessment.

US229994
Specific Outcome 1 Perform a risk assessment of the worksite where work is to be done at height.
Specific Outcome 2 Demonstrate knowledge of fall arrest rescue equipment and advanced fall arrest rescue techniques.
Specific Outcome 3 Develop a fall protection plan and fall arrest plan.
Specific Outcome 4 Manage safety of personnel working at heights.

Motivation for assessment
Learner request for assessment:
This is to declare that I (name, surname and ID number as stated on the Learner Condensed Curriculum Vitae) have completed the required training and formative assessment according to the Relevant Standards agreed upon. I would like to request to be assessed.
Facilitator recommendation for assessment:
This is to declare that the learner (above mentioned) has completed training and formative assessment according to the Relevant Standards as agreed upon in the assessment plan and contract.

Facilitator to identify which (if any) Specific Outcomes were NOT achieved by the learner DURING TRAINING: