I am interested in the:
BITSAFE TRAIN-THE-TRAINER COURSE
Date: 10 – 12 October 2017
Location: Cape Town
This form is to be completed by all candidatesinterested to attend the three (3) day BitSafe ‘Train-the-trainer’ course. Please ensure that the completed form is returned to us via fax on 021 5312606 or email it to .
Each delegate must bring along their own laptop for use during the course
Surname______
First name/s ______
Identity number______
Company______
VAT No:______
Job title______
Postal address______
______
______
Work address______
______
______
Email______
Telephone number (w)______
Fax number______
Cell number______
Jacket size (S/M/L/XL/2XL/3XL)______
Co. Order Number:______
Employment status: Permanent□Consultant (Self Employed)
Fax completed form to Lorraine on 021 5312606 or email to
QUESTION 1: Work place experience
Outline your practical or hands-on experience relating to:
- The manufacture of bituminous products
ActivityNone GoodExcellent
Hotmix asphalt □ □ □
Coldmix asphalt □ □ □
Penetration bitumen □ □ □
Cutback bitumen □ □ □
Bitumen emulsion □ □ □
Bitumen rubber □ □ □
Polymer modified binders □ □ □
other
- The application of bituminous products
ActivityNoneGoodExcellent
Asphalt paving and compaction □ □ □
Asphalt milling □ □ □
Spraying binders □ □ □
Chip spreading and rolling □ □ □
Slurry sealing □ □ □
Foam bitumen stabilisation □ □ □
Emulsion stabilisation □ □ □
Crack sealing □ □ □
Patching □ □ □
other
- The handling of bituminous binders ie penetration, cutback, emulsion and modified binders.
ActivityYes No
Heating □ □
Pumping □ □
Loading□ □
Offloading □ □
Sampling□ □
Testing □ □
Transporting□ □
Mixing or blending□ □
Spraying□ □
Drumming□ □
- Health and Safety in the workplace and on site
Activity
______
- Application and use of PPE, First Aid, Fire fighting equipment
______
QUESTION 2: Training experience
a. What experience have you had in the presentation of training material?
Type of courseLevel of learner ______
b. Outline your experience with regard to:
(1) The organisation, administration and record keeping of training interventions.
______
(2) Assessment and evaluation of learners.
______
(3) Design and development of training materials
______
______
QUESTION 3: Communications skills
a. What is your preferred language of instruction? ______
b. Rate your language ability in:
(1) English to
Speak______
Read______
Write______
(2) 2nd language ______to
Speak______
Read______
Write______
c. How would you best describe your particular training style?
______
QUESTION 4: Qualifications and courses attended
a. Have you ever attended a Presentation Skills Workshop?
Yes□No□
If “Yes,” which course did you attend and when?
______
QUESTION 5: Reference
Provide the names of at least ONE referee who can provide a reference with respect to your training ability and course presentation.
Referee 1:Name:______
Position:______
Organisation:______
Contact details:______