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ASSESSMENT INSTRUMENT

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Excavation Supervision Programme (2021) Page 1
EXCAVATION SUPERVISION

ASSESSMENT INSTRUMENT

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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
18 Email

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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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ASSESSMENT QUESTIONS

Answer the following multiple choice questions

Question 1 (SO 1, AC 1, AC 2, AC 3)
I. Identify the roles and responsibilities of the employer and employee in terms of the
Occupational Health and Safety Act. Discuss in the context of excavation health and safety.
(8)
II. Describe the safety provisions that are contained in the following employment regulations;
 Labour relations Act
(5)
 Basic conditions of employment
(5)
 What are the consequences to the employer, employee and the community for not
adhering to excavation health and safety standards?
(5)

Question 2 (SO 2, AC 2, AC 3, AC 4)
I. Describe general procedures that a company can implement to avoid accidents at an
excavation site. (5)
II. Describe emergency procedures that can be followed in the event of an accident at an
excavation site. (4)
III. Identify and describe post-accident procedures that must be followed at an excavation site.
(4)

Question 3 (SO 3, AC 2, AC 3)

I. Identify and describe methods of supporting deep and shallow excavations. (4)

II. Besides the methods identified above, what other alternative methods can be used to
support excavations (2)

Question 4 (SO 3, AC 4)
Identify and describe methods of preventing obstacles from falling into excavated work areas.
(4)

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Question 5 (SO 4, AC 3)
Identify the consequences of not wearing correctly PPE at an excavation work area
(2)

Question 6 (SO 4, AC 4)
Describe the consequences of unsafe working practices. (4)

Question 7 (SO 2, AC 1)
Study the picture below. Explain why the excavation shown in the picture is regarded as too
dangerous. (2)

INCLUDEPICTURE "http://www.elcosh.org/record/document/1972/image_1.jpg" \* MERGEFORMATINET


INCLUDEPICTURE "http://www.elcosh.org/record/document/1972/image_1.jpg" \* MERGEFORMATINET
INCLUDEPICTURE "http://www.elcosh.org/record/document/1972/image_1.jpg" \* MERGEFORMATINET

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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


Certificate number:

Date issued

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Excavation Supervision Programme (2021) Page 10

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