Other Name. Country of Birth Are you an Australian Resident Y N

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1 Course Enrolment Form Workplace Safe Working Emergency at Response Heights Warden RIIOHS204D PUAWER005B and PUAWER008B Unique Student Identification Number You must have a USI to complete the enrolment Apply now at RPL Are you applying for Recognition of Prior Learning? If yes please see your Instructor. Y N First Name Other Name Surname Gender M F Residential Address Number Title (Mr / Mrs /Miss /etc.) Street Date of Birth Suburb Postal Address State Post Code Number Street Suburb Home Phone Address State Mobile Post Code Country of Birth Are you an Australian Resident Y N Are you Aboriginal / Torres Straight Islander Y N Do you speak any language other than English Y N If yes which language do you speak How well do you speak English Very Well Well Not Well Not at All Will you require assistance Y N Have you successfully completed any of the following qualifications Certificate 1 Diploma Level Are you currently at School Y N Certificate 2 Advanced Diploma or Degree Certificate 3 Bachelor degree or Higher If yes what year are you in Yr Certificate 4 Other Education What is the highest level of school that you completed Yr What Year did you leave School Do you consider yourself to have a disability Y N Do you require assistance with your disability Y N If you require assistance what assistance is required Please indicate your current employment status Participants Employment Details Employer Part time employee Not Employed - Not seeking employment Self Employed Casual employee Unemployed - Seeking full time work Full Time Employed Employed - Unpaid family business Unemployed - Seeking part time work Employer Business Name Address Employer Contact Employer Contact Number **** Please sign the reverse of this form to complete the enrolment process **** Enrolment and Assessment - Warden V1.0.docx Page 1 of 12

2 Privacy Policy EMS collects personal information from participants to facilitate efficient service provision and meet AVETMISS requirements only. The details below are required as part of the Australian Government Regulatory Requirement for Registered Training Organisations. If you fail to complete all details your enrolment will be invalid and you will be contacted to complete the details prior to your enrolment and any subsequent certification being issued. EMS ensures privacy in the following ways. Information is only collected with the knowledge and consent of individuals. Information is only ever used for the purposes that it is collected and is never sold, distributed or shared to third parties except where required by law or other regulation. EMS ensures that the demographic and other statistical information is not linked to and personal information that can be used to disclose the identity of an individual. The information on this form will be used by EMS, The department of Education and Training (DET) and the National Centre for Vocational Education Research (NCVER) and/or other authorised organisations for the purpose of general student administration, identification, communication, State and National reporting, program monitoring and evaluation. Information provided will be held securely and disposed of securely when no longer needed. You may access, correct or amend your personal details by contacting EMS. Participant Declaration By signing below I agree to the terms and conditions as outlined in the Participant Agreement. A copy of this is available on ems.edu.au. Your instructor will also have a copy you are able to view at your training. Pre Course Study (Where Applicable) Where pre course study is required I declare that all work submitted is my own completed solely by me without assistance. Participant Declaration and Release Disability, Cultural or Impairments. I have discussed with my trainer any disabilities, cultural matters or impairments that may effect my ability to complete this course. I am aware that EMS will make adjustments to the program where ever possible so long as it is not a safety issue to enable you to complete the course. Release note I give permission for EMS to discuss my training progress and results with my employer or other appropriate persons as required by EMS. I give permission for EMS to record evidence of my participation and assessment, in written, verbal and visual (including photographic and video) formats. I also give full ownership of such material to EMS. I acknowledge that I have read the above and understand the information provided. I confirm that this information provided by me is true and correct at the time of completion. PARTICIPANT TO SIGN HERE Participant to Sign Date By signing you acknowledge that you agree to the above Enrolment and Assessment - Warden V1.0.docx Page 2 of 12

3 Assessment Task 1 Emergency Risk Assessment Group Activity To complete this assessment, you will be required to participate in an emergency planning risk assessment. Discuss within your group the possible emergencies that could occur and list the most appropriate prevention and response strategies for each emergency, in addition to the resources that would be required to manage it effectively. Each participant must complete the table below and identify at least 4 different types of emergency. Emergency What emergency could occur in your workplace? Prevention What could you do to prevent the emergency? Response How would you respond if the emergency occurred? (Brief description) Resources What resources would you use whilst responding to this emergency? Fire in the Kitchen Never leave cooking unattended. Ensure Extinguishers are suitable and available. Extinguish if possible. If unable to extinguish, close doors and evacuate all occupants to the assembly point Fire Extinguisher, Fire Hose, Fire Blanket, Evacuation Alarm, Warden ID Vest Enrolment and Assessment - Warden V1.0.docx Page 3 of 12

4 Assessment Task 2 Act as part of an Emergency Control Organisation Warden To complete this assessment, you will be required to respond to an incident, as identified by the Assessor and act in the role of Warden. The incident may be related to any of the following emergencies: Fire, Bomb Threat, Suspicious Package, Chemical Spill, Gas Leak, Flooding, Structural Damage, Wires Down, Power Failure, Armed Hold Up and Explosion. The assessment will be carried out as follows: 1. The Assessor will notify the occupants of the incident and then observe how the candidates act in the role of a Warden. 2. Each candidate must demonstrate the ability to safely respond to the specific emergency and evacuate occupants in a safe and effective manner. 3. Each candidate must successfully take part in two different emergency simulations. 4. The emergency be may be repeated and/or changed as many times is necessary to ensure that all candidates are assessed to a satisfactory level. 5. Although this exercise will be conducted in a group, participants will be individually assessed as per the following criteria and must achieve competency in order to be awarded the unit of competency. Exercise 1 Competencies required for successful completion: Identify the type of incident and the immediate threat. Take charge and remove persons from danger. Don the appropriate identification and gather required equipment. Consider further development of the incident. Alert other occupants, the ECO and Emergency Services. Consideration must be given to persons with special needs such as cultural and linguistic differences. Contain the incident as required for the type of incident. (e.g. fire, bomb, gas leak, etc). Identify the need to evacuate. Evacuate the area by directing persons to the nearest safe exit and towards the Assembly Point. Consider alternate evacuation routes (if required). Assist occupants as required. Arrange for First Aid for injured occupants at the Assembly Point. Maintain communication with the Chief Warden and provide updates regularly. Conduct a final inspection following a logical search pattern and communicate the results to the Chief Warden. Attend a role call / head count at the Assembly Point and report to the Chief Warden. Assessor Comments List the emergency that the candidate responded to: Tick if the candidate has completed the exercise satisfactorily meeting the key competencies listed on the left hand side. Other comments: Exercise 2 Competencies required for successful completion: Identify the type of incident and the immediate threat. Take charge and remove persons from danger. Don the appropriate identification and gather required equipment. Consider further development of the incident. Alert other occupants, the ECO and Emergency Services. Consideration must be given to persons with special needs such as cultural and linguistic differences. Contain the incident as required for the type of incident. (e.g. fire, bomb, gas leak, etc). Identify the need to evacuate. Evacuate the area by directing persons to the nearest safe exit and towards the Assembly Point. Consider alternate evacuation routes (if required). Assist occupants as required. Arrange for First Aid for injured occupants at the Assembly Point. Maintain communication with the Chief Warden and provide updates regularly. Conduct a final inspection following a logical search pattern and communicate the results to the Chief Warden. Attend a role call / head count at the Assembly Point and report to the Chief Warden. Assessor Comments List the emergency that the candidate responded to: Tick if the candidate has completed the exercise satisfactorily meeting the key competencies listed on the left hand side. Other comments: Enrolment and Assessment - Warden V1.0.docx Page 4 of 12

5 Assessment Task 3 Confine a Small Workplace Emergency The aim of this assessment is to assess the candidate in their ability to manage a small work place emergency. You will be asked to practically confine a small workplace emergency relevant to your work place (e.g. fire, spill, medical, wires down, broken pipe, gas leak or electrical hazard) using equipment that is generally available at your site. The emergency must be related to your work place and the equipment used must also be available for demonstration during the session. Safe working practices must be demonstrated at all times when using any equipment. Each participant must demonstrate the ability to safely respond and practically operate the equipment required to contain the emergency. Competencies Required for Successful Completion: The emergency is identified and any additional hazards noted. (Dependant on the emergency this may be smoke from a fire, spills running towards drains, potential electricity hazard, potential for flooding, further medical issues, etc.) Initial response procedures are implemented (RACE) o Persons are removed from danger o The alarm is raised o Containment procedures are implemented (Must be consistent with type of emergency e.g. Extinguish, stop leaks, close doors, erect barriers, etc.) o Evacuation is considered and implemented, if required. Assessor Comments List the emergency that the candidate responded to: Tick if the candidate has completed the exercise satisfactorily meeting the key competencies listed on the left hand side. Other comments: Equipment is selected and obtained to deal with the emergency. The equipment must be suitable for the simulated emergency (e.g. the correct Fire Extinguisher, Spill Kit, Barrier Tape, Warning Signs, Buckets, Towels or other equipment suitable for managing the particular emergency.) The equipment is checked for serviceability prior to use. Depending on the equipment obtained, any pre operation checks that should be done must be completed e.g. testing a fire extinguisher. Actions required to stop or contain the emergency using the equipment are implemented in a timely manner using the equipment available. The equipment must be used as per the manufacturers recommendations and in line with safe working procedures. Safe work procedures are followed when using equipment. The equipment must be operated in a safe manner and all PPE required must be used such as dust masks, gloves etc. Equipment is stowed or replaced as per workplace requirements. The equipment used must be serviced and maintained as per the requirements of the site e.g. Extinguishers must be refilled and not placed back on the wall. Spills Kits must be replenished and barriers and signs rolled up and packed away. Enrolment and Assessment - Warden V1.0.docx Page 5 of 12

6 Assessment Task 4 Short Answer and Multiple Choice Questions Candidates are to complete the following questions by answering each question in the space provided. Question 1 Write the correct ECO member position title in front position descriptions listed below: Chief Warden / Deputy Chief Warden / Area Warden / Warden a. Assumes overall control of the site. b. Is responsible for coordinating the emergency procedures in an area within the site. c. Contains the emergency and / or evacuates occupants. d. Coordinates the assembly point and accounts for evacuees. Question 2 List the colour of the helmets worn by each of the ECO positions listed below: Area Warden Chief Warden Warden Deputy Chief Warden First Aid Officer Question 3 List 2 ways in which you could raise an alarm if an emergency incident occurred in your area? Question 4 Define each of the initial response procedures for the acronym RACE: R A C E Enrolment and Assessment - Warden V1.0.docx Page 6 of 12

7 Question 5 What is the emergency signal to evacuate in your workplace? Question 6 List 4 items of emergency equipment available in your workplace: Question 7 List the actions that you would take if someone reported that there were persons unaccounted for after an evacuation had occurred: Question 8 Where would I find the steps to follow in the event of an emergency occurring on site? A. In the Emergency Planning Cupboard B. In the Emergency Procedure Manual C. Under the Reception Desk D. On the MSDS Sheet Question 9 How would you find the nearest exit in an emergency? A. Follow the green exit signs B. By looking at the evacuation plans located throughout the building C. Following the direction from a Warden D. All of the above Question List 3 possible means of communication that could be used to communicate during an emergency within your workplace: Enrolment and Assessment - Warden V1.0.docx Page 7 of 12

8 Question 11 As per Australian Standard AS , how often should the ECO members receive training? A. 6 Months B. 3 Months C. 1 Month D. 1 Year Question 12 Where is the emergency assembly point located for the building that you usually work in? Question 13 What document would you prepare for a person who would require assistance during an emergency or evacuation? A. A Near Miss Report B. A Personal Emergency Evacuation Plan (PEEP) C. A Safe Work Method Statement D. A Bundy Card Question 14 For the two emergencies listed below, state the special considerations that you would take when evacuating for each emergency (Note: Consider doors/windows). Fire Bomb Threat Question 15 When evacuating the building a roll call is carried out at which of the following locations? A. At the entrance to the building B. At the assembly point C. Under the stairs D. In your area prior to evacuating Question 16 What is the average rate that a fire will spread? On average the fire triples every 60 seconds On average the fire triples every 2 minutes On average the fire doubles every 30 seconds On average the fire doubles every 5 minutes Enrolment and Assessment - Warden V1.0.docx Page 8 of 12

9 Question 17 What would you do if during an evacuation you came across an occupant who refused to comply with the evacuation order? A. Do nothing B. Reiterate the need to evacuate, take note of their location and inform the Chief Warden C. Call the Police D. Ring the persons Manager Question 18 In an emergency situation where would I expect to find the Chief Warden? A. The Assembly Point B. The Emergency Control Point C. The Fire Door D. At the entrance to the building Question 19 Extinguishers should be inspected by trained service personnel every A. 4 months B. 6 months C. 12 months D. 2 weeks Question 20 Once you have completed evacuating your area, what would you do? A. Report the area status to the Emergency Services B. Call for emergency assistance C. Report the area status to the Chief Warden D. Leave the site Question 21 List 3 factors that would affect the progress or spread of a fire in a fire emergency? Question 22 A visitor on your site has been injured. What would your actions be? Enrolment and Assessment - Warden V1.0.docx Page 9 of 12

10 Question 23 A. 2m B. 3m What clearance must be left under a sprinkler head so that it will operate effectively in the event of a fire? C. 500mm D. 1m Question 24 In the event of a gas leak or chemical spill it is important to evacuate occupants A. Up hill and down wind from the incident B. Down hill and up wind from the incident C. Up wind and up hill from the incident D. Down hill and down wind from the incident Question 25 A common issue effecting a Fire Door effectiveness is A. The Fire Doors being propped open B. The Fire Doors being left closed C. The Fire Doors installed being the wrong type D. The Fire Doors being painted the wrong colour Question 26 What is the role of the Assembly Point Coordinator (Muster Warden)? A. To move people from the danger to the assembly point B. To coordinate the activities at the assembly point and conduct the role call / head count C. To combat the emergency D. Operating emergency equipment in the event of a fire Question 27 What incident below requires all persons to cease the use of portable radios and mobile phones? A. Fire incidents B. Medical Emergencies C. Structural Collapse D. Bomb Threats Question 28 What number would you dial to contact emergency services? A. 000 B. 123 C. 111 D Enrolment and Assessment - Warden V1.0.docx Page 10 of 12

11 Question 29 Define the 3 methods of extinguishment by joining the boxes Cooling Removing the Fuel from the Fire Smothering Removing the Heat from the Fire Starvation Removing the Oxygen from the Fire Question 30 In a multi storey building with a fire on the middle floor the priority in an evacuation would be The fire floor and all the floors above prior to the rest of the building The fire floor, two floors above and one floor below then the rest of the building All floors except the fire floor as it may be too dangerous All floors at the same time as everyone is equally important Mark on Theory Assessment Mark on Theory Re-Assessment (Where required) / 30 / 30 Competent Not Yet Competent Enrolment and Assessment - Warden V1.0.docx Page 11 of 12

12 Assessment Findings Candidate Feedback (Optional) Candidate Response (Mandatory where written feedback is given) Candidate signature (Mandatory where written feedback is given) Overall Findings Theory Assessment Satisfactory Unsatisfactory Practical Assessments Satisfactory Unsatisfactory As a result of the assessment process I have found the participant to be: Competent Not Yet Competent I, in my capacity as the nominated assessor declare by signing below that: I have sighted the participants legal proof of identity I have conducted a fair and reasonable, both summative and formative assessment of the participant as per the requirements of the applicable training packages and associated assessment materials. I have conducted assessment in accordance with the training package and the training and assessment guidelines. The course was delivered in accordance with the training and assessment strategy and other guidelines provided by EMS. I have provided the participant with appropriate feedback on their performance during assessment and have provided feedback to the participant as to the results of their assessment tasks. Assessor Name: Signed by Assessor: Date: Enrolment and Assessment - Warden V1.0.docx Page 12 of 12