Information to the Student:-

Please have this form completed by your Manager or Supervisor within your workplace. Only they can complete this form. Once this form has been 100% completed log back in at

From there click on your profile (top right of page) and select upload. Upload this form so we can check you off. Once we have this form 100% completed and you have successfully completed the online course your certificate will be available for you to download 24/7 within your profile.

1.You can scan the form and uploaded it when prompted.

  1. You can scan or take a photo from your smart phone and email it to
  2. You can post the form to :- Level 14, 333 Collins Street Melbourne 3000

Third Party Checklist

Candidate’s Full Name
Candidate’s Email
Candidate’s Student ID etc AQT001 / AQT
Manager or Supervisor’sFull Name
Unit of Competence
(Code and Title) / SITXFSA001 – Use hygienic practices for food safety
Date of Assessment
Location
Tasks to be simulated if not witnessed over time: / Yes / No
  1. Does the learner follow organisational hygiene procedures?

  1. Does the learner promptly report unsafe practices that breach hygiene procedures?

  1. Does the learner identify food hazards that may affect the health and safety of customers, colleagues and self?

  1. Does the learner remove or minimise the hygiene hazard and report to appropriate person for follow up?

  1. Does the learner report any personal health issues likely to cause a hygiene risk?

  1. Does the learner report incidents of food contamination resulting from personal health issues?

  1. Does the learner cease participation in food handling activities where a health issue may cause food contamination?

  1. Does the learner maintain clean clothes, wear required personal protective clothing and only use organisation-approved bandages and dressings?

  1. Does the learner prevent food contamination from clothing and other items worn?

  1. Does the learner prevent unnecessary direct contact with ready to eat food?

  1. Does the learner avoid unhygienic personal contact with food or food contact surfaces?

  1. Does the learner avoid unhygienic cleaning practices that may cause food-borne illnesses?

  1. Does the learner wash hands at appropriate times and follow hand washing procedures consistently?

  1. Does the learner wash hands using appropriate facilities?

The candidate’s performance was: / Not Satisfactory / Satisfactory
Further comments:
Candidate’s Signature
Manager’s or Supervisor’s
Signature

Third Party Evidence

Confidential Information
Name of Candidate:-
RTO:- AQT RTO # 41598
Unit(s) of Competence:- SITXFSA101 – Use hygienic practices for food safety

As part of the assessment for the units of competency, we are seeking evidence to support a judgment about the candidate’s competence. As part of the evidence of competence we are seeking reports from the supervisor and other people who work closely with the candidate.

Name of the Manager or Supervisor:
Workplace:
Address:
Phone:
Email:
Web address:

Do you understand which evidence/tasks the candidate hasYesNo

provided/performed that you are required to comment on?

Has it been explained the purpose of the candidatesYes No

assessment?

Are you aware that the candidate will see a copy of this form?Yes No

Are you willing to be contacted should further verification of thisYes No

statement be required?

What is your relationship to the candidate?
How long have you worked with the person being assessed?
How closely do you work with the candidate in the area being assessed?
What is your technical experience and/or qualification (s) in the area being assessed? (Include any assessment or training qualifications.)

Does the candidate:

Perform tasks to the industry standards?Yes No

Managed job tasks effectively?Yes No

Implement safe working practices?Yes No

Solve problems on the job?Yes No

Work well with others?Yes No

Add that to new tasks?Yes No

With unusual or non-routine situations?Yes No

Overall do you believe the candidate conforms to the standard required by the unit of competency on a consistent basis?
Identify any training needs for the candidate: