ASSESSMENT INSTRUMENT

NAME OF LEARNER: ________________________________________________

ID NUMBER: ________________________________________________________

NAME OF COMPANY: _______________________________________________

DATE_________________________________________________________________

pg. 1

LEARNER GUIDE
 FIRE FIGHTING LEVEL 2

ASSESSMENT INSTRUMENT

pg. 2
LEARNER REGISTRATION AND SAQA CODING FORM

No Field Description Information

Personal Details
1 Learner Surname As per your ID document

2 Full Names As per your ID document

3 Learner Title Mr, Ms, Mrs, Dr, Prof.

4 ID Number RSA ID. If not, Complete

next line
5 Alternative ID Only complete if no RSA
ID available.
Indicate type of
alternative ID
6 Date of Birth Insert date of birth
7 Gender Male – M, Female – F,
Other – O
8 Equity Black African – BA,
Black Indian Asian – BI,
Black Coloured – BC,
White – W, Other – O
(specify)
9 Socio Economic Status Employed, unemployed,
student
10 Disability Status None, hearing / sight /
speech / movement,
other (specify)
11 Geographic Area List geographic area that
you live in, i.e. Gauteng,
Kwa Zulu Natal, Eastern
Cape, Western Cape,
Northern Cape,
Limpopo, Polokwane,
Free State, North West,
Mpumalanga, Northern
Province, Outside SA
Contact Details
12 Physical Address State physical address

13 Postal Address State PO Box, or

address where mail is
received Postal Code:
14 Home Phone Number One of the following
contact details (number
12 – 16 is mandatory to
complete
15 Business Phone
Number
16 Cell Phone Number
17 Fax Number

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18 Email
Educational Details
19 Highest Education Overview of
qualifications completed

20 Current Occupation State current or last

occupation, if
unemployed.
21 Experience Overview of experience
in years and fields /
areas
22 Years in Occupation State years in last
occupation
Programme Details
23 Name of Learning Full name of
Programme programme, i.e. National
Certificate in …
24 Registration Number of NLRD number
Programme
25 NQF Level of State NQF Level
programme
26 Type of learning Qualification,
programme learnership, skills
programme, learning
programme
Unit Standard Details
27 Unit Standards

Alternative ID type Equity code Nationality code Citizen/residence

status
521 SAQA member ID BA Black: African U Unspecified SEY Seychelles U Unknown
527 Passport No BC Black : Coloured SA South African ZAI Zaire SA South Africa
529 Driver’s licence BI Black : Indian / Asian SDC SADC except SA ROA rest of Africa O Other
531 Temporary ID no U Unknown (i.e. Nam to ZAI) EUR European D Dual (SA plus
533 None WH White NAM Namibia countries other)
535 Unknown BOT Botswana AIS Asian countries
537 Student no ZIM Zimbabwe NOR North American
538 Work permit no ANG Angola countries Gender Code
539 Employee no MOZ Mozambique SOU Central & South
540 Birth certificate no LES Lesotho American countries M Male
541 Human Sciences SWA Swaziland AUS Australia & New F Female
Research Council register MAL Malawi Zealand
no ZAM Zambia OOC Other and rest
561 ETQA record no MAU Mauritius of Oceania
TAN Tanzania NOT N/A: Institution

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ETD PRACTITIONER DETAILS

Unit
Standard:

Course:

Facilitator /Assessor Details

Name

Branch Registration No:

Contact email:
Details Phone: Fax:

Moderator Details

Name

Branch

Contact email: Registration No:

Details Phone: Fax:

Assessor’s declaration:

I hereby declare that I have prepared the candidate for assessment, the candidate was consulted
and all stakeholders have been informed and the workplace is prepared to ensure valid and fair
assessment.

Assessor Name Signature

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PORTFOLIO BUILDING GUIDELINES

Your Portfolio of Evidence (PoE) contains the evidence needed to declare you competent and to
award credits towards the award of this qualification to you. Evidence should be authentic and
reflect both your knowledge of the subject and your ability to apply this knowledge in the
workplace. Thus, evidence of day to day activities supporting the specific outcomes addressed by
this learning programme should complement the theoretical learning you attended and were
assessed on. There are FIVE key steps in creating a portfolio that will reflect your competence.

Plan Your Portfolio

Plan and document the sequence, graphics and layout of your portfolio. This will assist you in
following a logical sequence, which makes the Portfolio also much more user friendly and
understandable for the assessor. It will also reflect your professional approach and attitude
towards the subject matter, your work and your life. Impact and appearance always contribute to or
affect your chances of being taken seriously and declared competent!

Gather The Evidence

An evidence checklist has been provided (Section 4) to tell you what evidence needs to be
gathered for assessment purposes. However, there are four broad categories of evidence that you
should include:
 Knowledge evidence (your knowledge questionnaire).

 Direct performance evidence (actual samples of your work or records of activities captured
on audio or video tape).

 Indirect performance evidence (documentary records of your performance e.g. appraisals,

photographs, testimonials, self-assessments, customer ratings etc.).

 Supplementary evidence (to confirm the authenticity of your evidence).

Evaluate Your Evidence

Once you have collected your evidence, evaluate each piece by ensuring that it is:
 Valid (relevant to the unit standard/s being assessed).
 Authentic (clearly your own work).

 Current (not more than 2 years old).

 Sufficient (adequate to prove your competence against all of the assessment criteria and
range statements in the unit standard/s).

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INSTRUCTIONS TO LEARNER

 You must complete the classroom activities whilst facilitation is taking place. The facilitator
may stop at regular intervals to give you time to complete the activities.
 Please complete all work in blue or black pen. The assessor will not assess the evidence if
completed in pencil.
 You are not allowed to copy from another learner. Any plagiarism committed will be viewed
in a serious light and disciplinary action may be taken against you. Your work must be
authentic i.e. your own work. Group work is allowed in certain activities but your answers
must be your own original work after discussions in the group.
 Please do not use any correction fluid i.e. tippex. Rather cross your work out and write next
to your mistakes.
 The proficiency level required for each unit standard in the cluster is 50% per specific
outcome per unit standard. If you are deemed Not Yet Competent in a unit standard, you
will only be required to redo (remediate those sections in that unit standard.
 Any remediation must be submitted within the specified time frame after you gave received
feedback
 Answer all questions

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FORMATIVE ASSESSMENT
SECTION A
Answer the following questions

Question 1 (SO 2, AC 1, AC 2, AC 3, AC 4; SO 3, SO 4)

Study the table below which shows five classes of fire and corresponding suitable fire extinguisher
to put of that class of fire. Fill in the gaps left on the table in line with the discussion stated in the
statement above. [5]

CLASSES OF FIRE TYPES OF FIRE

A
---------------------------------------------------------------------------------------
---------------------------------------------------------------------------------------
---------------------------------------------------------------------------------------
-----------

B Gasoline, oil, paint, and other flammable liquids

C ---------------------------------------------------------------------------------------
---------------------------------------------------------------------------------------
---------------------------------------------------------------------------------------
------------------------------------------------------------------------------

D Combustible metals and combustible metal alloys

K ---------------------------------------------------------------------------------------
---------------------------------------------------------------------------------------
---------------------------------------------------------------------------------------
---------------------------------------------------------------------------------------
----------------

Question 2 (SO 2, AC 1, AC 2, AC 3, AC 4; SO 3, SO 4)

Tick the box with the correct answer

i). Wood, plastic, and paper are classified as:

A Class A
B Class B
C Class C
D Class D

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ii). Which type of fire extinguisher do you use to fight an electrical fire if a carbon dioxide
extinguisher is unavailable

A Water
B Wet chemical
C Foam
D Dry chemical powder

iii). If there is a black coloured band above the fire extinguisher; what does the colour of the band
tell you?

A that this extinguisher is a wet chemical fire extinguisher

B that this extinguisher is a carbon dioxide extinguisher
C that this extinguisher is broken and should not be used
D that this extinguishercontains flammable materials

iv). The acronym for proper use of a fire extinguisher is:

A PAST
B PASS
C PULL
D PULSE

Question 3 (SO 2, AC 1, AC 2, AC 3, AC 4)
The diagram below is a fre triangle. Label the diagram below to show the three ingredients
needed to start a fire in the chemistry of fire

(3)

pg. 9
Question 4 (SO 2, AC 1, AC 2, AC 3, AC 4; SO 2)

The diagrams below show methods of fire spread. Complete the fire transmission methods shown
on diagrams a, b, and c on the provded spaces.
a)___________________________

b) ______________________________

c) _______________________________

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Question 5 (SO 3, AC1, AC 2, AC 3, AC4)

Thandi has just been appointed the fire officer for Chris Hani Foundation. Her key responsibilities
include fighting the fire as a first responder, evacuation and alerting the fire department where
necessary. Thandi did not receive any formal training in fire management. To this end, she is not
sure which fire fighting and safety equipment she needs to discharge her responsibilities. Thandi
heard you attended a basic fire fighting training and she approached you to help her to identify fire
fighting and safety equipment that she must have.

a). List 5 fire fighting equipment that Thandi must have. (5)
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

b). Name five personal protective equipment that Thandi’s first responders should use in case of
fire. (5)
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

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Question 6 (SO 4, AC 1, AC 2, AC 3, AC 4; EEK)
Are the following statements true or false when preventing the risk of fire caused by arson? Mark
the box which has the correct answer.

i). Keep the number of entry points to the minimum compatible with safe means of escape in case
of fire
True False

ii). Vetting new employees is not a requirement on methods to prevent arson fire.
True False

iii). Fixed and portable fire fighting equipment must be regularly maintained and protected against
sabotage attempts.
True False

Question 6 (SO 1, AC 1, AC 2, AC 3, AC 4, SO 4)

PASS is a general procedure of dealing with a controllable fire in the workplace if you are a fire
fighter to extinguish a minor fire with an extinguisher. Complete the gaps below.

P______________________________________________________

A______________________________________________________

S______________________________________________________

S______________________________________________________

(4)

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SUMMATIVE (TECHNICAL) ASSESSMENT

Instructions

• You are required to carry out the following tasks in the presence of your assessor.
• Attempt all tasks

Task 1 (SO4, AC 4, SO 5, AC 4, SO 6, AC 1, AC 2, AC 3, AC 4)
Assume you have been tasked with the responsibility of monitoring a fire at the building as you
await the arrival of the fire brigade. Identify key things that you must take note of when preparing a
status report on the
fire.___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
(5)

Task 2 (SO 2, SO 3, AC 1, AC 2)

You are required to extinguish a fire started by your assessor using the most appropriate fire
extinguisher. You must demonstrate ability to;
 Identify the class of the fire
 Select the most appropriate fire extinguisher
 Operate the fire extinguisher
 Contain/extinguish the fire

Task 3 (SO 5)
After extinguishing the fire in task 1, your assessor shall light another fire. Now; role play the
process of
 Alerting the fire brigade using a phone,
 retreating from a fire and
 Handover procedures upon the arrival of the fire brigade.

Note:
 your assessor must be present
 Select a class member to act as your fire brigade

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TASK: Extinguish incipient fire with appropriate fire extinguisher.
Resources Fire extinguishers (different classes); fire ; dummy phone or Cellphone;
fire department (any candidate or volunteer); assessors specifications (if
any)
PERFORMANCE OUTCOME:
The candidate, while at the scene of a small fire shall be able
 to select an appropriate fire extinguisher, and to properly extinguish the fire.
 Report a fire to the fire department or superior body
 Retreat from a fire
 Perform correct handover procedures.
Name of candidate: ID Number:

Name of assessor: Assessor Reg Number:

CONDITIONS:
Given a selection of fire extinguishers, a small Class A fire, and in full protective equipment, the
candidate shall demonstrate the ability to:
No: Task steps Met Did not meet Comments
requirements requirements
1 Correctly identify the class of fire

2 Select an extinguisher suitable for

class of fire

3 Properly activate the extinguisher

4 Test operation of the extinguisher

by a brief discharge of agent

5 Approach to an effective distance

for discharge of the selected
extinguisher (Water 30-40
ft.maximum, AFFF 25-
ft.maximum, Dry chemical 20-
ft.maximum)
6 Discharge extinguishing agent on
the base of the fire and sweep
over the fire area
7 Demonstrate ability to alert the
fire department

8 Demonstrate ability to carry out

retreating procedures

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9 Demonstrate handing over
procedures
Signing off I confirm that I have carried out the Practical Test in accordance with unit
standard 12484 that the candidate has:

Achieved not achieved

Candidate signature:_____________________________

Assessor’s signature _____________________________

Date:
Assessors comment

pg. 15
 FACILITATOR/ASSESSOR
INDIVIDUAL LEARNER TRAINING REPORT
(SHORT COURSES)
Facilitator/assessor signature
Name & surnames:

Course Title:

Client Name: NQF

Levels:
Name of Learner

What challenges did the learner experience?

Actions taken to address the challenges

General comments / suggestions

ASSESSOR FEEDBACK TO LEARNER

Facilitator/ assessor
C NYC comments
Multiple choice

Practical task

Overall Assessment Result

Office use only

pg. 16
Certificate number:

Date issued

pg. 17