Competency Record FormCompetency Record.Competency Form (#6) THIS FORM MUST BE COMPLETED AT THE END OF TRAININGSpeak to your trainer for more informationDetailsFirst NameSurnameDate Of BirthTrainer- Select -Blen Tohianga SimeonReece ChaseCourse- Select -Enter and work in confined spaces - RIIWHS202EWork safely at heights - RIIWHS204ELicence to operate a forklift truck - TLILIC0003Licence to perform dogging - CPCCLDG3001Licence to erect, alter and dismantle scaffolding intermediate level - CPCCLSF3001Licence to erect, alter and dismantle scaffolding advanced level - CPCCLSF4001Licence to erect, alter and dismantle scaffolding basic level - CPCCLSF2001Licence to perform rigging basic level - CPCCLRG3001Licence to perform rigging intermediate level - CPCCLRG3002Gas Test Atmospheres - MSMWHS217Construction White CardLicence to operate a boom-type elevating work platform (11 metres or more) - TLILIC0005Start DateAssessmentLocation Of Assessment 7/15 Vanden Way, Joondalup, 6027 14/2 Gott St, Port Kennedy, 6172Type of assessment RPL Work based Training OtherIf Other please specifyAssessor Comments- Select -Competent in all areasNot yet competentOtherIf Other please specifyActions to be taken: (e.g areas to be retrained and re-assessed)Learner Signature Sign HereSubmit Form