Page 1 of 1 AV form Guide (Ropes Course) SISOCRP404A VER 1.1 01 Sep 2018 © Copyright PACI Pty Ltd

ASSESSMENT VERIFICATION GUIDE high elements UNIT: SISOCRP302A

Please send this document together with all individual AVETMISS questionnaires from your course.

Student full name:

Student address: Birthdate:

Student Declaration: I understand the competency standards for this qualification level and have successfully achieved all performance criteria

and/or related learning outcomes without prompting or assistance from others. I am adequately prepared to independently apply knowledge and

skills related to this qualification level at sites and under conditions similar to those in which I was assessed. I realise that additional training and

experience is required for participation in specialised activities at height involving new and/or unfamiliar equipment. I am aware that I am

‘competent at time of assessment’ and may need to update or refresh my knowledge and skills after long periods of inactivity. My signature on this

verification form is my personal guarantee that I accept and agree with the assessment decision made by my assessor. I agree to abide by the

Professional Association of Climbing Instructors’ standard safe work practices and/or safe practices for training at height.

Student signature: __________________________________________ Date: _____________________

ASSESSMENT INFORMATION (to be completed by assessor):

Assessor name: PACI No. : Assessment date:

Training organisation:

SCOPE (indicate the range of endorsements that apply – only check boxes that reflect the outcomes of the assessment)

1. ASSESSMENT CONDITIONS 5. SITE SETUP 10. BELAY SKILLS assessed on the job with real clients visual checks of poles, cabling and elements arresting falls promptly & without prior warningassessed with assigned role-playing clients setting up belay ropes on high elements: assessed in using the following belay devices:assessed with employer supplied PPE using draw cord to pull main rope tubular self-locking [] single brake [] double brake assessed with own PPE reverse procedure to replace draw cord munter hitch (improvised system)

2. CONTEXT OF ASSESSMENT / SITE CAPABILITY belay ropes are oriented correctly with belay technique: existing (permanent) site – poles and cables respect to overhead cables 4 step method 5 step method temporary site (trees) with temporary cabling selected high elements are known and routine control measures to avoid uncontrolled uplifting elements using belay from a fixed position for the Guide conducting the activity of belay person in the event of client fall elements using mobile ground belay setting up and securing portable ladders 11. RESCUE SKILLS elements using self-belay (double lanyard) 6. MOBILITY AT HEIGHT Client rescue skills:competent to operate a flying fox (zip line): climbing vertical poles using U staples + lanyard response to client hair entrapment: existing permanently installed system transfer from pole to horizontal cable break rope tension using ascender device secure and stable dual attachment lateral mobility along horizontal cables response to frightened frozen client:

3. PPE & EQUIPMENT maintaining 1 point of continuous contact lower client to ground issuing and fitting PPE to clients using double lanyard to move through elements accompanied (assisted) descent with client checking and ensuring PPE is appropriate and 7. CONTROL AND SUPERVISION response to derailed or jammed flying fox device fit for purpose client control maintained in group context competent to coordinate emergency response checking PPE & equipment conforms to use of team belays to involve clients in activity: Staff rescue skills: relevant standards primary belayer + backup belayers rescuing staff member from pole top position using a double lanyard to climb poles: social atmosphere maintained rescuing staff member from mid-span of cable commercial double lanyard (eg EN355) portable ladder to reach first U staples on poles rescuing without the assistance of the ‘patient’ improvised double lanyard (unequal legs) 8. BELAY ROPE CONNECTIVITY using a micro-hauler device to lift & transfer

4. RISK MANAGEMENT SKILLS accurately and consistently tying own knots rescue skills performed alone and unaided assessing hazards & risks associated with assessed in achieving secure and stable belay 12. HOUSE-KEEPING SKILLS planned activities on high elements rope attachment to client harness: managing PPE & equipment to avoid creatingdeveloping an activity plan (SWMS) direct rope to harness tie-in (eg Figure 8) trip and snag hazardsimplementing control measures to achieve dual clip-in system maintaining a tidy workspaceand maintain acceptable risk levels combination clip-in + tie-in system 13. AUTONOMY selecting elements suited to client abilities 9. DEMONSTRATION OF SKILLS assistance is readily available if requireddelivering pre-activity safety briefings skills clearly and accurately demonstrated carrying out safety checks of self & clients (ABCDE)following industry standards and codes verbal explanations clear & easy to understand competent to setup and conduct activities whichcomplying with PACI protocols all clients have clear view of demonstration are well known and routine

Scope of training: Universal – any site Site-specifc: Request to issue a qualification: Please issue this student with an electronic qualification

Please issue this student with a hard copy (printed) qualification + physical photo ID card

ASSESSOR STATEMENT: I certify that this person has reached a proficiency level acceptable to industry and has successfully achieved all

performance criteria and/or related learning outcomes without requiring my direct assistance, guidance or intervention. I further certify that the assessment

was conducted as specified in the most current PACI training materials and in compliance with PACI standards & procedures. I further certify that my assessment activities were in compliance with the assessment guidelines of the SIS10 training package including unit SISOCRP302A and in accordance with

the national principles for assessment. My signature appearing herein is my personal guarantee that I am a qualified and experienced assessor with

relevant technical competencies for the level that was assessed. I further acknowledge and accept that PACI will conduct quality assurance monitoring on my performance and I may be held accountable for my professional conduct in my capacity as a qualified assessor. I understand that fraud is a criminal

offence and I intend this statement to be legally binding.

Assessor signature _______________________________________________ Date:

PACI office use only

AV Serial No.

DD/MM/YYYY

(conduct a high ropes session)

Name of ropes course used in assessment:

Assessor use only