If you have forgotten please go to (https://www.usi.gov.au/faqs/find-your-usi) or create a new USI if you don’t have one (https://www.usi.gov.au/your-usi/create-usi)

Learner questionnaire

It is the learners responsibility to ensure that this area is read and understood prior in commencing any training and that any answers that are denoted “yes” must also be verbally discussed with the trainer prior to any training beginning. Should any of these conditions change throughout the course duration, the learner must inform the trainer immediately.

RTO statistics

The following questions are asked of learners as statistical data collection only. They will in no way effect your learning, assessment or experience as a learner.




Learner Declaration

1. I understand I will be provided feedback throughout the course and will only be notified if I am not yet competent.
2. I have read and understood all of the Royal Life Saving Society Western Australia policies, procedures and terms of enrolment, available: https://www.royallifesavingwa.com.au/programs/vocational-training/rto-policies
3. I give permission for my statement of attainment / award to be sent to a third party such as an employer.
4. I give permission for photos and video taken during the course to be used by Royal Life Saving for marketing and promotional purposes.

(Please strike-out if you do not give permission)

Learner Declaration & Final Competency Sign-Off Sheet

Elements & Performance Criteria

1. Respond to an emergency situation 1.1 Recognise an emergency situation 1.2 Identify, assess and manage immediate hazards to health and safety of self and others 1.3 Assess the casualty and recognise the need for first aid response 1.4 Assess the situation and seek assistance from emergency response services 2. Apply appropriate first aid procedures 2.1 Perform cardiopulmonary resuscitation (CPR) in accordance with Australian Resuscitation Council (ARC) guidelines 2.2 Provide first aid in accordance with established first aid principles 2.3 Display respectful behaviour towards casualty 2.4 Obtain consent from casualty where possible 2.5 Use available resources and equipment to make the casualty as comfortable as possible 2.6 Operate first aid equipment according to manufacturer’s instructions 2.7 Monitor the casualty’s condition and respond in accordance with first aid principles 3. Communicate details of the incident 3.1 Accurately convey incident details to emergency response services 3.2 Report details of incident to workplace supervisor as appropriate 3.3 Maintain confidentiality of records and information in line with statutory and/or organisational policies 4. Evaluate the incident and own performance 4.1 Recognise the possible psychological impacts on self and other rescuers involved in critical incidents 4.2 Participate in debriefing to address individual needs

Training Location
Assesment Instrument Result Date
1 Knowledge Assessment
2 Adult CPR unconscious and breathing
3 2 person CPR and AED
4 Infant CPR
5 Bleeding control
6 Envenomation
7 Shock
8 Respiratory distress
9 Choking
10 Allergic reaction and anaphylaxis
11 Fractures and sprains
12 Simex #1
13 Simex #2
Final Result

Learner Declaration & Final Competency Sign-Off Sheet

Learner declaration and feedback acknowledgement

1. I have had a copy of the unit/s of competency related to this assessment made available to me. 2. The purpose and consequences of the assessments have been explained to me. 3. I understand I am responsible for keeping a copy of all submitted assessment work in the event that the original is lost or misplaced. 4. I have had the opportunity to discuss any special needs I may have. 5. I am aware that plagiarism is not permitted and that if I am requested to re-submit an assessment due to plagiarism I will be required to pay a fee. 6. I understand I am responsible for keeping a copy of all submitted assessment work in the event that the original is lost or misplaced. 7. I was adequately prepared to undertake the assessments. 8. I understand my right of appeal under the Complaints and Appeals Policy and Procedure. I acknowledge that I have been advised of my final result of:

Trainer Use Only