ASSESSMENT INSTRUMENT
NAME OF LEARNER: ________________________________________________
ID NUMBER: ________________________________________________________
NAME OF COMPANY: _______________________________________________
DATE_________________________________________________________________
FIRST AID LEVEL 1
ASSESSMENT INSTRUMENT
LEARNER REGISTRATION AND SAQA CODING FORM
No Field Description Information
Personal Details
1 Learner Surname As per your ID document
2 Full Names As per your ID document
3 Learner Title Mr, Ms, Mrs, Dr, Prof.
4 ID Number RSA ID. If not, Complete
next line
5 Alternative ID Only complete if no RSA
ID available.
Indicate type of
alternative ID
6 Date of Birth Insert date of birth
7 Gender Male – M, Female – F,
Other – O
8 Equity Black African – BA,
Black Indian Asian – BI,
Black Coloured – BC,
White – W, Other – O
(specify)
9 Socio Economic Status Employed, unemployed,
student
10 Disability Status None, hearing / sight /
speech / movement,
other (specify)
11 Geographic Area List geographic area that
you live in, i.e. Gauteng,
Kwa Zulu Natal, Eastern
Cape, Western Cape,
Northern Cape,
Limpopo, Polokwane,
Free State, North West,
Mpumalanga, Northern
Province, Outside SA
Contact Details
12 Physical Address State physical address
13 Postal Address State PO Box, or
address where mail is
received Postal Code:
14 Home Phone Number One of the following
contact details (number
12 – 16 is mandatory to
complete
15 Business Phone
Number
16 Cell Phone Number
17 Fax Number
18 Email
Educational Details
19 Highest Education Overview of
qualifications completed
20 Current Occupation State current or last
occupation, if
unemployed.
21 Experience Overview of experience
in years and fields /
areas
22 Years in Occupation State years in last
occupation
Programme Details
23 Name of Learning Full name of
Programme programme, i.e. National
Certificate in …
24 Registration Number of NLRD number
Programme
25 NQF Level of State NQF Level
programme
26 Type of learning Qualification,
programme learnership, skills
programme, learning
programme
Unit Standard Details
27 Unit Standards
Alternative ID type Equity code Nationality code Citizen/residence
status
521 SAQA member ID BA Black: African U Unspecified SEY Seychelles U Unknown
527 Passport No BC Black : Coloured SA South African ZAI Zaire SA South Africa
529 Driver’s licence BI Black : Indian / Asian SDC SADC except SA ROA rest of Africa O Other
531 Temporary ID no U Unknown (i.e. Nam to ZAI) EUR European D Dual (SA plus
533 None WH White NAM Namibia countries other)
535 Unknown BOT Botswana AIS Asian countries
537 Student no ZIM Zimbabwe NOR North American
538 Work permit no ANG Angola countries Gender Code
539 Employee no MOZ Mozambique SOU Central & South
540 Birth certificate no LES Lesotho American countries M Male
541 Human Sciences SWA Swaziland AUS Australia & New F Female
Research Council register MAL Malawi Zealand
no ZAM Zambia OOC Other and rest
561 ETQA record no MAU Mauritius of Oceania
TAN Tanzania NOT N/A: Institution
ETD PRACTITIONER DETAILS
Unit
Standard:
Course:
Facilitator /Assessor Details
Name
Branch Registration No:
Contact email:
Details Phone: Fax:
Moderator Details
Name
Branch
Contact email: Registration No:
Details Phone: Fax:
Assessor’s declaration:
I hereby declare that I have prepared the candidate for assessment, the candidate was
consulted and all stakeholders have been informed and the workplace is prepared to ensure
valid and fair assessment.
Assessor Name Signature
PORTFOLIO BUILDING GUIDELINES
Your Portfolio of Evidence (PoE) contains the evidence needed to declare you competent and
to award credits towards the award of this qualification to you. Evidence should be authentic
and reflect both your knowledge of the subject and your ability to apply this knowledge in the
workplace. Thus, evidence of day to day activities supporting the specific outcomes addressed
by this learning programme should complement the theoretical learning you attended and
were assessed on. There are FIVE key steps in creating a portfolio that will reflect your
competence.
Plan Your Portfolio
Plan and document the sequence, graphics and layout of your portfolio. This will assist you in
following a logical sequence, which makes the Portfolio also much more user friendly and
understandable for the assessor. It will also reflect your professional approach and attitude
towards the subject matter, your work and your life. Impact and appearance always contribute
to or affect your chances of being taken seriously and declared competent!
Gather The Evidence
An evidence checklist has been provided (Section 4) to tell you what evidence needs to be
gathered for assessment purposes. However, there are four broad categories of evidence that
you should include:
• Knowledge evidence (your knowledge questionnaire).
• Direct performance evidence (actual samples of your work or records of activities
captured on audio or video tape).
• Indirect performance evidence (documentary records of your performance e.g.
appraisals, photographs, testimonials, self-assessments, customer ratings etc.).
• Supplementary evidence (to confirm the authenticity of your evidence).
Evaluate Your Evidence
Once you have collected your evidence, evaluate each piece by ensuring that it is:
• Valid (relevant to the unit standard/s being assessed).
• Authentic (clearly your own work).
• Current (not more than 2 years old).
• Sufficient (adequate to prove your competence against all of the assessment criteria
and range statements in the unit standard/s).
INSTRUCTIONS TO LEARNER
• You must complete the classroom activities whilst facilitation is taking place. The
facilitator may stop at regular intervals to give you time to complete the activities.
• Please complete all work in blue or black pen. The assessor will not assess the
evidence if completed in pencil.
• You are not allowed to copy from another learner. Any plagiarism committed will be
viewed in a serious light and disciplinary action may be taken against you. Your work
must be authentic i.e. your own work. Group work is allowed in certain activities but
your answers must be your own original work after discussions in the group.
• Please do not use any correction fluid i.e. tippex. Rather cross your work out and write
next to your mistakes.
• The proficiency level required for each unit standard in the cluster is 50% per specific
outcome per unit standard. If you are deemed Not Yet Competent in a unit standard,
you will only be required to redo (remediate those sections in that unit standard.
• Any remediation must be submitted within the specified time frame after you gave
received feedback
• Answer all questions
FORMATIVE ASSESSMENT
SECTION A
Answer the following questions;
Question 1 (SO 1, AC 1; SO 2, AC 1)
i. State two ways in which a first aider may assist a victim in first aid.
_________________________________________________________________________
_________________________________________________________________________
______________________________________________________________________ (2)
ii. Explain how a first aider may prevent cross- infection between himself or herself and
the casualty during emergency management.
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
________________________________________________________________ (4)
iii. Define first Aid
___________________________________________________________________
___________________________________________________________________
_________________________________________________________________(2)
iv. Anatomy is that branch of science that deals with the structure of the human body.
Name any five systems of the human body that you studied.
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
________________________________________________________________ (5)
v. Physiology study the functions of the human body. State the system that do the
following functions in a human body.
Blood circulation; ______________________________________________
Breathing; __________________________________________________ (2)
Question 2 (SO 1, AC 1, AC 2, AC 3)
a) State the materials and equipment that you can use to improvise for the following first aid
contents in case you got an emergency situation without a first aid box.
*gloves, __________________________________________________________
*gauze, __________________________________________________________
*splints, __________________________________________________________
*slings, ___________________________________________________________
(4)
b) Describe first aid procedures and equipment from a first aid box that you would use for a
fractured leg.
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_______________________________________________________________________ (6)
SECTION A: PRACTICAL ASSESSMENT
Attempt the following tasks
TASK 1 (SO 4, AC 1, AC 2, AC 4, AC 5)
The facilitator or assessor shall give learners manikins for this task. The aim of this task is to
demonstrate how to perform CPR (Cardio- Pulmonary Resuscitation) on a patient using the
checklist below;
CHECKLIST
STEPS DONE/
NOT DONE
1. Check the pulse of the patient by passing your 2 middle fingers on the
Adams apple
2. Ensure the patient is face up, in a horizontal position and on a firm
surface when external chest compressions are performed.
3. Locate the lower margin of the patient’s rib cage on the side next to
the first aider using middle and index fingers.
4. Move the fingers to the rib cage to the notch where the ribs meet the
sternum at the centre of the lower chest. Ensure that these two fingers
cover and protect the Xyphiod.
5. Place the heel of the other hand (which had been used on the
forehead to maintain head position) is placed on the lower half of the
sternum, and just next to the index finger, which is next to the middle
finger that located the notch.
6. Remove the first hand from the notch, placed on top of the hand on
the sternum so that both hands are parallel and directed straight away
from the first aider.
7. Straighten and lock elbows.
8. Position your shoulders directly over the patient’s elbows so that the
thrust for the compression is straight down.
9. Compress ensuring that each compression must “squeeze” the heart
or increase the pressure within the chest so that blood moves through
the body to the brain.
10. Release the pressure to allow the heart and lungs to refill. You must
compress in this manner at a rate of 60 times per minute in one
minute of CPR.
11. Check breathing and pulse after every minute of resuscitation
TASK 2 (SO 3, AC 3; SO 4, AC 1, AC 2, AC 3, AC 4, AC 6)
Your facilitator or assessor shall pair you with another colleague in your class. The aim of
this task is to allow the learner to demonstrate how to treat a wound using a bandage. The
following resources shall be provided;
• Bandages
• Access to clean water.
• Soap
• Soft towel
• Gloves
• Marker
• Cloth
Assumptions and preparatory requirements
• Assume the wound is 2cm deep, 5cm long and 3mm wide and was caused by a
sharp embedded object. Mark the position of the wound with a marker on the left
hand.
• Apply dust around the wound.
Now, role-play the process of treating a patient who has been injured. Use the checklist
below;
CHECKLIST
STEPS DONE/
NOT DONE
1. Wear gloves
2. Stop bleeding by applying direct pressure on the wound using a cloth,
if possible, elevate the injured area. Apply steady direct pressure for 15
minutes.
2. Clean the wound using running water
3. wash the skin around the wound with soap
4. rinse the wound thoroughly using a towel to get rid of any dirt and
soap
5. Apply a clean bandage on the wound.
6. Replace the bandage after 10 minutes
Assume the patient must be referred to a medical doctor. Role-play the referral process. The
assessor shall appoint one a third class member to act as a doctor. The following checklist
must be followed;
CHECKLIST
STEPS DONE/
NOT DONE
1. Introduce yourself and the patient
2. Explain the cause of the injury and the where the wound is.
3. Inform the doctor what you have done as a first aider
4. Tell the doctor any special needs that the patient might
have
5. Inform the doctor of any allergies or other conditions that
you know or have discovered
EVALUATION CHECKLIST
NAME: ………………………………………. DATE:
COMPANY………………………………….. TIME:
ID…………………………………………….. TASK NO: 1; 2
EVALUATION CRITERIONS MET DID NOT MEET COMMENTS OR
REQUIREMENTS REQUIREMENTS ACTION REQUIRED
TASK 1
CARDIO-PULMONARY
RESUSCITATION (CPR)
Ability to check pulse at the
right point
Ability to ensure the patient is
in the right position for CPR
Ability to locate the lower
margin of the patient’s rib
cage
Ability to identify the notch
Ability to position both hands
for CPR
Ability to compress in such a
way that chest pressure
increases.
Ability to release pressure to
allow the heart and lungs to
refill.
Ability to check breathing and
pulse during CPR
TASK 2
MANAGING A WOUND
Use of protective clothing
Ability to demonstrate how to
stop bleeding
Ability to clean the wound
using running water
Ability to wash the skin
around the wound
Ability to improvise first aid
equipment
Ability to provide after
treatment support
GENERAL COMMENTS:
Date…………………….. Time started……………….. Time completed……………….
FACILITATOR NAME FACILITATOR SIGNATURE ASSESSOR ENDORSEMENT
(SIGNATURE)
……………………………… ……………………………………. ………………………………….
