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support@yourlicence.com.au

Personal details (complete fully)

Candidate’s details

Name:

Phone number:

Email:

Organisation:

Assessment date:

Site location:

Task details (tick applicable boxes)High Risk Work type(s)

I last carried out the selected operations:

in the last 6 months 6 - 12 months ago over 12 months ago

PO BOX 146, Riddells Creek VIC 3431

Elevating Work Platform Scissor Lift

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Instructions for completing this Assessment To be eligible for Verification of Competency (VOC) you must hold a Licence,

Qualification Card, Competency Certificate, or Ticket for the specific High Risk

Work or Plant operator tasks. This must have been obtained in a manner

acceptable to the OHS Regulator in the state or territory in which it was issued.

A copy of this, along with other supporting documents must be provided to Your Licence P/L (see "Supporting Documents needed" at the bottom of this page for more information).

Each section of this document is for an element of the national industry

competency standard related to the efficient and safe conduct of your work.

Topics covered in this self-assessment include planning and preparing for High Risk Work, pre-operational checks, carrying out work operations competently and safely, relocating plant and equipment, post-operational checks, maintenance and cleaning up.

Please go through each section of the document very carefully, and complete

the details fully. This record is a legal document and must be signed, dated,

and returned to the RTO as per the rules applicable to the VET training system.

You are completing a Self Assessment of your skills and knowledge:-

Self Assessment is designed to help you identify the extent of your experience

and determine how close a match this is to the national unit of competency.

Supporting Documents needed:

If you have not already provided copies of the following documents, they

MUST be uploaded to our website or submitted with this self-assessment:

High Risk Work Licence or competency ticket relevant to your work.

Any two of: Passport, Drivers Licence, or Medicare Card.

support@yourlicence.com.au PO BOX 146, Riddells Creek VIC 3431

Passport-style profile photo of yourself for your VOC card. Youmust not be wearing a hat or glasses in this photo.

You can scan, photocopy or take a photo of these documents and upload them using the "Upload my Documents" button or Upload Tracker of your online VOC pack or send them along with this self-assessment as certified copies in the mail.7KHVH�FRSLHV�PXVW�EH�LQ�)8//�&2/285�DQG�RI�D�KLJK�TXDOLW\�UHVROXWLRQ�

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support@yourlicence.com.au PO BOX 146, Riddells Creek VIC 3431

Upon�completion of tKLV�process (including theory assessment, practical self-assessment and reference/declaration document),you will be able to download an Interim Certificate of Completion

from your emails. Dependent upon the procedures on your worksite, this certificate can be used to replace or support any

required competency test.

Your Statement of Attainment and VOC card will then be sent to you by mail from our affiliate Registered Training Organisation.

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Self Assessment Check each item and mark with Yes, No or Not applicable to my job (if provided).

Note: Some items may not be relevant to the equipment, tasks or sites where you have worked. If this is the case, mark these as "Not applicable to my job" rather than "No".

Element 1 - Plan and prepare for High Risk Work

I consider that I can competently and safely inspect the area where I will be working and identify hazards -

Yes No

I can check for other people, vehicles and plant in the area

I can check for dangerous materials such as chemicals

I can check for overhead services and power lines

I can check ground/floor conditions and suitability (eg. moisture, stability, condition)

I can check for holes and slopes

I can check that there is sufficient lighting

I can check for buildings and structures (eg. overhead conveyors, service pipes)

I can check for obstructions in the work area

I can check for bad weather conditions (eg. winds, lightning or rain)

I can plan a safe path to and from the work area (for myself and equipment)

I can identify safe positions for parts and tools to be stored for use

4support@yourlicence.com.au PO BOX 146, Riddells Creek VIC 3431

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I consider that I can competently and safely -

Yes No

Choose the correct equipment and tools for the job

Ensure that the weight of operators, equipment and tools does not exceed the rated capacity of the platform

Make sure equipment is stable, correctly secured and safe

Yes No Not applicable to my job

I can competently and safely set up pedestrian or traffic control if needed

Element 2 - Conduct pre-start checks

I consider that I can competently and safely do routine checks on all equipment before I use it -

Yes No

I can check that there is enough fuel or battery charge

I can check the engine and transmission oil levels

I can check the hydraulic oil level

I can check the condition of wheels and tyres

I can check the inflation of tyres

I can check the power steering fluid level

I can check the battery's water

I can check the coolant level

5support@yourlicence.com.au PO BOX 146, Riddells Creek VIC 3431

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For diesel units:

Yes No Not applicable to my job

I can check the air filter indicator

I consider that I can competently and safely do a visual check on the plant -

Yes No

I can walk around the plant and look for damage

I can check under the plant for coolant or oil leaks

I can check the roll-over guard rails or pot hole guards

I can check for loose fittings and hose couplings

I can check the boom or scissor sections for damage

I can check that any attachments are fitted properly and in good condition

I can check the safety lock out device or locking straps for wear and serviceablilty

I can check hoses, fittings and rams for leaks

I can check for adequate lubrication

I can check that the base and basket controls are clean and readable

I can check signs and decals are present and legible

I can check that SWL and wind speed limits are clearly marked and readable

I can check a harness and lanyard for wear and serviceability

I can check that warning devices and beepers are working correctly

6support@yourlicence.com.au PO BOX 146, Riddells Creek VIC 3431

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