Allocated Assessor

By February 1, 2019 Teaching

Allocated Assessor: Contact number Qualification to complete: Sign up Date (Assessor Only):
Title Mr / Mrs / Miss / Ms Home Tel No: Surname: Mobile: Forename: Work Tel No: Home Address Email Address Emergency Contact Postcode Sex Male Female Date of Birth NI Number ULN 0-156210000-81915113665Learner Details
00Learner Details

If learner does not have a ULN, please indicate what type of evidence you have seen to prove ID.

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Passport Driving Licence Exam Certificate National Insurance Card Other
Learner Loans – WPS Learners Only
Has the loan approval been seen? Yes No Has a copy of the learning loan letter been retained? Yes No Has a copy of the learning loan approval been retained? Yes No Loan reference number: Ethnicity and Disability
How would you describe your ethnic origin or personal identity?
We are required to obtain this information to monitor the implementation of your Equality & Diversity Policy in relation to the Equality Act using the Government classification of Ethnicity.

Please indicate ethnicity
English/Welsh/Scottish/Northern Irish/British (31) White and Asian (37) Caribbean (45)
Irish (32) Indian (39) Arab (47) Gypsy or Irish Traveller (33) Pakistani (40) Any other mixed/multiple ethnic background (38) Any Other White Background (34) Bangladeshi (41) Any other Asian Background (43) White and Black Caribbean (35) Chinese (42) Any other Black/African/Caribbean Background (46) White and Black African (36) African (44) Any other ethnic group (98) Not provided (99) All learners need to completed the below. We require this information to ensure that any support you need is available to you.

Please indicate any disabilities, learning difficulties and/or health problem
Visual Impairment (4) Moderate Learning Difficulty (10) Dyslexia (12) Hearing Impairment (5) Other Medical Condition (95) Dyscalculia (13) Disability Affecting Mobility (6) Severe Learning Difficulty (11) NONE Other Physical Disability (93) Social and emotional difficulties (8) Not Provided (99) Mental Health difficulty (9) Other Specific Learning Difficulty (94) Asperger’s Syndrome (15) Temporary Disability After Illness or accident (16) Autism Spectrum Disorder (14) Other Disability (97) Profound Complex Disabilities (7) Other Learning Difficulty (96) Please indicate which of the above is your PRIMARY disability, learning difficulty and/or health problem _______________________
Household situation
Please tick which of the following statement apply (one or more may apply):
No member of the household in which I live (including myself) is employed Lone or Teenage Parent The household that I live in includes only one adult (aged 18 or over) Carer or Care Leaver There are one or more dependent children (aged 0-17 years or 18-24 years if full time student or inactive) in household I confirm that I wish to withhold this information None of these statements apply Prior Qualifications
All learners must provide detail of all prior qualifications and any other form of study below or provide a CV as part of the Enrolment Form. If the learner has no qualifications please state ‘None’. Please continue onto another sheet of paper if required.

Subject
Level of Study Grade Date Achieved
Programme Start Date: Planned End Date: Actual End Date: Achievement Date: Completion Status: Outcome Indicator: Withdrawal Reason: Emergency Contact Detail:
Name: Relationship: Contact details: Functional Skill Initial Assessment Level
Maths Working towards level
English Working towards level
Evidence of Initial Assessment and diagnostics must be printed for our records.

Initial Assessment Discussion
Outline details of proposed Functional/Basic Skills training (this must include the offer to upskill to level 2 English/Maths and justification for where a learner is upskilling by more than one level)
Additional Learning Support Discussion
Details of proposed support for additional learning above and beyond normal arrangements.

-19050254000 Additional Learning Support identified
-1905012763500
Not applicable
How long is the support required for ……………………………………………………………….. months
Please detail the support required:
Detail of Support Required How will this be provided By Who By When
Section 4: Accreditation of Prior Learning (APL)
Record any APL for NVQ units, Functional Skills qualification, Employment Rights and Responsibilities (ERR)or PLTS
Qualification Title and Date on Certificate Concession for APL evidence
Y or N
-20955-698500398145-698500 Yes No
-20955-698500398145-698500 Yes No
-20955-698500398145-698500 Yes No
-20955-698500398145-698500 Yes No
-20955-698500398145-698500 Yes No
-20955-698500398145-698500 Yes No
-20955-698500398145-698500 Yes No
Section 5: Qualification Details
Competence levels need to be identified during initial assessment discussion with learner and mentor / manager.
Title and Units Level QCF Credit Start Date Planned End Date Actual End Date GLH Teaching and Learning Required
How training will be delivered
On the job Off the job 1/2/3 Unit HSC024 – Principles of safeguarding and protection in health and social care Unit HSC025 – The role of the health and social care worker Unit SHC31 – Promote communication in health social care or children’s and young people’s settings Unit SHC32 – Engage in personal development in health social care or children’s and young people’s settings Unit SHC33 – Promote equality and inclusion in health social care or children’s and young people’s settings Unit SHC34 – Principles for implementing duty of care in health social care or children’s and young people’s settings Unit HSC036 – Promote person centred approaches in health and social care
Title and Units QCF Credit Start Date Planned End Date Actual End Date GLH Teaching and Learning Required
On the job Off the job 1/2/3 Unit HSC037 – Promote and implement health and safety in health and social care Unit HSC038 – Promote good practice in handling information in health and social care settings
Unit IC01 – The principles of Infection Prevention and Control
Unit IC02 – Causes and Spread of Infection
Unit HSC2024 – Undertake agreed pressure area care
Unit HSC2028 – Move and position individuals in accordance with their plan of care
Unit SSOP38 – Enable individuals to negotiate environments
Unit LD206 – Principles of supporting an individual to maintain personal hygiene
Unit HSC3029 – Support Individuals With Specific Communication Needs
Unit HSC3045 – Promote positive behaviourJustification for change in programme length (If applicable)
How the programme links to the learner’s career aspirations:
What are the learner relevant experiences and achievement both in and out of their current job role:
9525-105791000
Section 6: Induction & Information, Advice & Guidance
Topics (all should be covered at sign-up) Date Covered Comments (If applicable)
What EDO are and what we do
Completion of ILP/Learning Agreement/Declaration letter
Induction to course
Assessment Methods
Roles and responsibilities
All about your learning aims
Visits, assessments and reviews
Who will be involved with your learning
How your training will be delivered (resources)
Special assessment requirements
Equality and Diversity
Procedure for Safeguarding
Confidentiality, appeals and complaints
Health and Safety
I can confirm that the following learning activity has taken place today on the following unit:
Assessors Signature:
Learners Signature:
19050-106743500
320738516954500I have confirmed a copy of the Edo Learner Handbook for Loans
As a Learner I accept responsibility to complete the agreed actions in my Personal Learning Plan and endeavour to achieve my qualification.

I confirm that I have received an explanation of the Learner Handbook. I can also confirm that I understand the above information and my responsibilities during the period of my loan/course. I give my consent for all information I have given to be kept on a computer database/secure server and forwarded to the Skills Funding Agency and other relevant bodies.
I understand that in the ESFA funding regulations it states that anyone under the age of 24 wanting to complete a 19+ Advanced Learner Loan and they haven’t already completed a Level 3 qualification, may be eligible for the Adult Skills budget Level 3.
I understand this funding regulation and have chosen to take the Advanced Learner Loan option through Enabling Development Opportunities instead because:
……………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………
I also understand that by taking the Advanced Learner Loan option I may not be eligible for the Adult Skills Budget Level 3 in the future.

This programme is part financed by the European Union through the European Social Fund (ESF) to support activities to extend employability opportunities and develop a skilled workforce.

I confirm I am aware that my programme is part financed by the European Union
Learner Name
Learner Signature
Date I confirm behalf of the provider that the information on the Enrolment Form and ILP is correct and, to the best of my knowledge.

Provider Name Provider Signature Date: A copy of this form must be given to the learner.

x

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