This form is to be completed by the assessor and used a final record of student competency. All student submissions including any associated checklists (outlined below) are to be attached to this cover sheet before placing on the students file. Student results are not to be entered onto the Student Management System unless all relevant paperwork is completed and attached to this form. Student Name Kushal Ghimire Student ID No: Click or tap here to enter text. Folder No. Click or tap here to enter text. Final Completion Date: Assessor Name Rakesh Gudideveni Unit Code/ Title CHCCCS015 Provide individualised support Please attach the following documentation to this form Result Observation Checklist in the Work Placement Assessment Task 1- Record Book (1 assessor observation) Observation & Logbook Work Placement Record Book attached (1 5 / NYS workplace supervisor observation) Assessment Task 2- Written Test Written Test attached S / NYS S = Satisfactory, NYS = Not Yet Satisfactory Final Assessment Result for this unit C / NYC C = Competent: NYC = Not Yet Competent Assessor: I declare that I have conducted a fair, valid, Signature: reliable and flexible assessment with this student, and I have provided appropriate feedback. Date: Student Declaration: I declare that I have been assessed Signature: in this unit, and I have been advised of my result. | also am aware of my appeal rights. I also declare that the work Date: J- submitted is my own, and has not been copied or plagiarised from any person or source