ASSESSMENT VERIFICATION (For SRO03 Canyoning Courses Only) (Complete and Mail to PACI Within 5 Days) Outdoor – Natural Cliffs (Multi Pitch)

ASSESSMENT VERIFICATION (for SRO03 Canyoning courses only) (Complete and mail to PACI within 5 days) Outdoor – Natural cliffs (multi pitch)

Serial No. PART 1: TO BE COMPLETED BY STUDENT (please ‘print’ clearly in ink)

______First Name Second name Last (family) name

______Postal Address City State Post Code Date of Birth ____ / ____ / ____ Sex: M [ ] F [ ]

Student Statement: I understand the competency standards for this qualification level and have successfully achieved all performance criteria and/or related learning outcomes without prompting or assistance from others. I am adequately prepared to independently apply knowledge and skills related to this qualification level in areas and under conditions similar to those in which I was assessed. I realise that additional training and experience is required for participation in specialised activities at height involving new and/or unfamiliar equipment. I am aware that I am ‘competent at time of assessment’ and may need to update or refresh my knowledge and skills after long periods of inactivity. My signature on this verification form is my personal guarantee that I accept and agree with the assessment decision made by my assessor. I agree to abide by the Professional Association of Climbing Instructors’ standard safe climbing and abseiling practices and/or safe practices for working at height.

Student Signature: ______Date: ______

PART 2: ASSESSMENT INFORMATION (TO BE COMPLETED BY ASSESSOR ONLY)

Canyoning (multi-pitch)______Name of PACI course (specify if RPL or Upgrade) Assessment Date Assessor Name (full legal name) PACI No. (eg L-007) Name of your training organisation

Occupational stream: Recreational canyoner (multi-pitch)

Endorsements: (mark with an ‘X’ all that apply within outdoor recreation canyoning context only): This section tells us about the context and environment in which the assessment took place. Note: Speculation or assumptions about student competence is not permitted.

1. ENVIRONMENT 4. ANCHOR SYSTEMS 6. ABSEILING SKILLS a. [ ] able to access the following canyons: a. [ ] limited to pre-existing fixed anchors only a. [X] capable of multi-pitch applications [ ] able to enter dry canyons b. [ ] able to achieve no single point of failure [ ] limited to obvious ledges & anchors [ ] able to enter wet canyons c. [ ] able to use removable protection devices [ ] able to build & use hanging belays [ ] able to enter canyons with vertical [ ] wired nuts [ ] cams [ ] hexes b. [X] able to descend consecutive pitches access only d. [ ] able to use natural anchors (eg trees) in a linked sequence b. [ ] able to apply skills in remote canyons e. [ ] able to accurately align anchor system for c. [ ] able to descend with double ropes c. [ ] able to operate in canyon environments intended descent point d. [ ] able to increase friction to slow descent requiring wetsuits f. [ ] able to install permanent bolts in rock e. [ ] capable of abseiling with heavy backpack 2. KNOTS [ ] drive in [ ] expansion [ ] glue in f. [ ] able to descend using a munter hitch a. [ ] able to tie own knots to build anchor system g. [ ] able to use slings to configure an anchor g. [ ] able to use a leg wrap to hold position b. [ ] able to achieve knot symmetry & stability 5. RETRIEVABLE ABSEIL h. [ ] able to tie-off device to hold position c. [ ] able to tie the following knot categories: a. [ ] able to select a suitable descent point i. [ ] capable of using descending devices: [ ] end line knots (eg ABoK #1047) b. [ ] able to setup a retrievable abseil system [ ] circular [ ] planular [ ] tubular [ ] mid line knots (eg ABoK #1085) c. [ ] able to use improvised anchors (tape slings) [ ] in-line [ ] auto-locking [ ] joining knots (eg ABoK #1415) d. [ ] able to join 2 abseil ropes together j. [ ] able to use a backup self belay system [ ] sliding friction knots (eg ABoK #1763) using an appropriate joining knot [ ] rigged above device [ ] load control hitches (eg ABoK #1195) e. [ ] able to identify correct rope to pull [ ] rigged below device d. [ ] able to select optimum knot for application f. [ ] able to avoid line twists and rope jams k. [ ] able to abseil by head lamp (night) 3. AUTONOMY g. [ ] able to successfully retrieve rope from 7. VERTICAL MOBILITY SKILLS a. [ ] capable of working alone and unaided below a. [ ] able to climb a rope using slide & grip b. [ ] able to work as part of a canyoning team h. [ ] able to avoid retrieval failure by conducting hitches test pull before last person descends [ ] single rope only [ ] double ropes

Scope of training: [ ] Able to transfer knowledge & skills in new and/or unfamiliar canyons [ ] Site specific ______(specify site)

Qualifications: [ ] Please issue this student with a statement of attainment (for all original training to achieve competency at this qualification level) [ ] Please issue this student with a statement of currency (for refresher / skills maintenance programs)

ASSESSOR STATEMENT: I certify that this person has reached a proficiency level acceptable to industry and has successfully achieved all performance criteria and/or related learning outcomes without requiring my direct assistance, guidance or intervention. I further certify that the assessment was conducted as specified in the most current PACI training materials and in compliance with PACI standards & procedures. I further certify that my assessment activities were in compliance with the relevant ANTA endorsed training package and/or curriculum and in accordance with the national principles for assessment. My signature appearing herein is my personal guarantee that I am a qualified and experienced assessor with relevant technical competencies for the level that was assessed. I further acknowledge and accept that PACI will conduct quality assurance monitoring on my performance and I may be held accountable for my professional conduct in my capacity as a qualified assessor. I understand that fraud is a criminal offence and I intend this statement to be legally binding.

Assessor signature ______Date ______