Unit Assessment and
Quality Assurance Declaration
Please complete form in block letters please photocopy as necessary
Qualification & Level ___________________________________________________________
Unit No. & Title ________________________________________________________________
I confirm that the evidence listed for this unit is authentic and a true representation of my own work.
Candidate Name ______________________________________________________________
Candidate Enrolment Number ___________________________________________________
Candidate Signature ______________________________________ Date ____________
I confirm that this candidate has achieved all the requirements of this unit with the evidence listed.
Assessment was conducted under the specified conditions and context, and is valid, authentic, reliable.
Assessor Name ______________________________________________________________
Assessor Signature _______________________________________ Date ____________
Name of Countersigning Assessor ________________________________________________
Counter Signature (if relevant) _______________________________ Date ____________
Internal Quality Assurance Declaration
I have internally quality assured the assessment work on this unit in the following ways (please tick)
Sampling candidate and assessment evidence
Observation of assessment practice
Discussion with candidate
Other – please state
I confirm that the candidate’s work meets the standards specified for this unit and may be presented for
external quality assurance and/or certification.
Internal Quality Assurer Name ___________________________________________________
Internal Quality Assurer Signature ____________________________ Date ____________
Name of Countersigning IQA ____________________________________________________
Counter signature _________________________________________ Date ___________
ATS Form Q4 01/5/11