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Assessor's Application Form - ASSESSOR REGISTRATION FORM

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									Level 3 Qualifications in Diabetic Retinopathy Screening

ASSESSOR REGISTRATION FORM
If you would like to register as an assessor for the Qualifications in Diabetic Retinopathy Screening please print and
complete this form.
By submitting your details you agree to us keeping your information on our database for our use and the
use of the English National Screening Programme for Diabetic Retinopathy. Your details will not be submitted
to any other organisation or company without your permission. Records are stored online with the
Data Protection Act 1998 and requests to see your information should be submitted in writing to the
DRS Team.


PLEASE PRINT ALL DETAILS

First Name:                                                   Surname:

Job Title:

Contact Address:




Contact No:                                         Email (please print):

Name(s) of Candidate(s) to be assessed:




Please indicate your preferred method of Assessor Induction (compulsory)

Online Induction                           Attend Assessor Induction Day


If you wish to attend an induction day please contact the DRS Qualifications Team.


Have you included your Curriculum Vitae                          Yes               No

Please post or email your CV this is essential to demonstrate occupational competence


Please state which units you will be assessing (please see enclosed sheet):

Unit 1  Unit 2  Unit 3  Unit 4                Unit 5      Unit 6      Unit 7       Unit 8      Unit 9 


Please sign below to show that you are committed to supporting this candidate in completing
this qualification.


Signature:
Date:


Please return this application form to: DRS Qualifications Office,
Sandford Education Centre, Keynsham Road, Cheltenham, Glos. GL53 7PX
Level 3 Qualifications in Diabetic Retinopathy Screening


 Role and Responsibility of Assessors

 The primary key role of Assessors is to assess Candidates’ performance and/or
 related knowledge in a range of tasks to ensure that the competence/knowledge
 demonstrated meets the requirements of the standards.

  Assessors will, therefore,

  1.     Workplace Assessors must be occupationally competent in the areas of
         expertise that they will be assessing in this qualification
  2.     Be expected to refresh their expertise by being involved in continuous
         professional development activities
  3.     They will observe record and provide constructive feedback.
  4.     Completion of Unit:
         Assessor must be satisfied that Candidate’s evidence is to the required
         standards before completing and signing
  5.     Assessor guidance will be provided but evidence of relevant assessor
         qualifications will be an advantage

 Appropriate assessors for each unit are as follows:

 Unit 1 - Experienced clinical lead, public health consultant
 Unit 2 - Diabetologist, diabetes specialist nurse
 Unit 3 - Ophthalmologist, optometrist, ophthalmic trained nurse
 Unit 4 - Ophthalmologist, optometrist, ophthalmic trained nurse
 Unit 5 - Ophthalmologist, optometrist, ophthalmic trained nurse
 Unit 6 - Ophthalmic photographers, experienced photographers in retinopathy
 screening
 Unit 7 - Ophthalmologist, senior diabetic retinopathy grader
 Unit 8 - Ophthalmologist, senior diabetic retinopathy grader
 Unit 9 - Senior administrator from a screening programme

 In addition, anyone who has achieved a unit will then be able to become an
 assessor for that unit, further to a decision made by the employer.

 This list is a guide only. The DRS Team will ask for a copy of the assessor’s CV in
 order to ensure that they have the relevant qualification and /or experience to act
 as an assessor for an individual unit.


 Who should NOT be an assessor?

 Anyone who wishes to, or will need to, complete the unit/s in the future e.g. if
 holding the qualification might be a requirement for increased pay or for regulation
 purposes. They should not act as an assessor until they have completed the unit
 themselves.

								
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