Assessment Cover Sheet

Assessment Cover Sheet
Student’s Name:
Student No:
Address:
Email:
Contact Phone:
Course/Module/Unit of competency:
Name of assessment item:
Teacher’s Name:
Due date:
Declaration:
I certify that the attached assessment item is my own original work and it does not involve plagiarism. To the best of my
knowledge no part of this task has been copied from any other student’s work or from any source except where
referenced.
I am aware that Federation Training will impose penalties for plagiarism and unauthorised collusion with other students
(for additional detail refer to the Federation Training Plagiarism Policy on the Institute website)
Date:
Student Signature:
Assessment record
STAFF USE ONLY
Assessor’s comments:
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
Result: (Resubmit necessary) Yes / No
Signature (Assessor):
_________________________
Date: ________________
Results Codes
For individual assessment tasks in a Unit, at every level
to Advanced Diploma:
Satisfactory
S
Not yet Satisfactory
NYS
For overall assessment for unit
Competent
CM
Date: 26 June 2014
Not Yet Competent
Certificate IV, Diploma & Advanced Diploma:
Distinction
Credit
Pass
Not graded
DI
CR
PA
CNG
NYC
Document No. TL 009 Form 1
Page 1 of 2
Assessment Submission Checklist
Note: Your assessment will not be accepted unless all details are complete.
☐ All assessment tasks have been completed.
☐ All sources of other people’s contributions to this assessment are properly referenced in accordance
with the Federation Training Plagiarism Policy.
☐ The assessment is typed where this is a requirement (typically Certificate IV and Diploma only)
☐ All of the non-shaded areas of this assessment cover sheet have been completed.
☐ This cover sheet is stapled to the assessment or accompanies an electronic file
☐ If submitting a paper copy, the work is stapled and has been placed in an A4 ‘manilla’ folder, envelope
or plastic pocket.
☐ A back-up copy of this assessment (photocopy or digital) has been kept.
Student to complete details in this section. Staff member will sign and date then detach and return as a record for the
student.
 ……………………………………………………………………………………………………………….………………………………………….
Receipt
Student's name:
Student No:
Course/Module/Unit of competency:
Name of assessment item:
STAFF TO COMPLETE PRIOR TO DETACHING
Teachers Name: ___________________________ Due date: ____________ Date Received:
Received by: _________________________
Date: 26 June 2014
__________
Signature: ________________________________________
Document No. TL 009 Form 1
Page 2 of 2