ASSESSMENT SUMMARY / COVER SHEET

This form is to be completed by the assessor and used as a final record of student competency.
All student submissions including any associated checklists are to be attached to this cover sheet before placing on the
students file.
Student results are not to be entered into the Student Management Database unless all relevant paperwork is completed
and attached to this form.

Student Name: Roshan Maharjan

Student ID No: CBC190926

Completion Date: 29/4/21

Unit Code: SITHCCC018

Unit Title: Prepare food to meet special dietary

Result
Please attach the following documentation to this form S = Satisfactory
NS = Not Satisfactory
NA = Not Assessed
Reassessment
S = Satisfactory
NS = Not Satisfactory
NA = Not Assessed

Assessment 1  Practical Observation S | NS | NA S | NS | NA

 Multiple Choice - Knowledge

Assessment 2 Test S | NS | NA S | NS | NA

Assessment 3  Work Book – Short Answer S | NS | NA S | NS | NA

Final Assessment Result for this unit C / NYC

Assessor Comments and Feedback to student:

_________________________________________________________________________________________
_________________________________________________________________________________________
_____________________________________________________________

Student Declaration: I declare that this assessment is my own work based on Assessor Declaration: I declare that I have conducted a fair, valid,
personal study and research and not plagiarised or copied from another student’s
reliable and flexible assessment with this student. I have provided
work or source.
appropriate feedback and advised the student of their result.
I am also aware of my appeal rights.

Name: ___Roshan
Maharjan_________________________ Name _________________________

Signature: _____Roshan_______________________ Signature: ____________________________

Date: ___29_/____4_/____21_ Date: ____/_____/_____

Entered into Student Management Database  ________________

Date Initials
Administrative use only

CBC / Assessment Cover Sheet / v2.0 / Updated October 2017

RTO 41297 | CRICOS 03444C