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CHCCCS040 Support Independence and Wellbeing Work Vereification Report © 2023 Coast Wide Training Solutions | CHCCCS040 Work Verification Report V1.0 1 CHCCCS040 Support Independence and Wellbeing (Release 1) Work Verification Report Student Name: Program: Date: Assessor Name: Workplace: Supervisor Details Supervisor Name: Relationship to Student: Experience: Years Location of Observation: Date of Observation: Length of Observation: Minutes/Hours Contact Phone: Contact Email: Do you understand your role in this Work Verification process? ☐Yes☐NoAre you willing to be contacted for further verification of the statements/s contained within this report? ☐Yes☐NoIf the answer to any of the questions above is No, please contact the Assessor. Student Signature: Date: Supervisor Signature: Date: SAMPLE

CHCCCS040 Support Independence and Wellbeing Work Vereification Report © 2023 Coast Wide Training Solutions | CHCCCS040 Work Verification Report V1.0 2 Disclaimer This pack contains information that is correct at the time of printing. Changes to legislation and/or training products may impact on the currency of information included. The training provider reserves the right to vary and update information without notice. Readers are advised to seek any changed information and/or updates from the training provider. This pack has been prepared as a tool to assess a student’s level of understanding and achievement toward the requirements of the unit of competency. All students must read, understand, and follow the instructions, responding to the tasks as outlined in this pack. © 2023 Copyright Coast Wide Training Solutions: ABN: 3776 4517 692. This document is protected by copyright laws. It was designed and developed by Coast Wide Training Solutions and remains the sole property of Coast Wide Training Solutions. This document may not be reproduced in any way without the prior written authorisation of Coast Wide Training Solutions. This document was originally developed by Coast Wide Training Solutions but may now be altered from the original form. Coast Wide Training Solutions does not accept any liability for these resources and tools, the content and/or any reliance thereon. Any queries can be directed to: Coast Wide Training Solutions ABN: 3776 4517 692 1/45 Black Hill Road Black Hill, NSW, 2322 PH: 0425 353 277 E: jodie@coastwidetraining.com.au www.coastwidetraining.com.au Version Control Version: Date: Details of Changes: 1.0 February 2023 Initial release SAMPLE

CHCCCS040 Support Independence and Wellbeing Work Vereification Report © 2023 Coast Wide Training Solutions | CHCCCS040 Work Verification Report V1.0 3 Contents Work Verification Report ................................................................................................ 1 Supervisor Details ......................................................................................................... 1 Contents .............................................................................................................................. 3 Supervisor Reporting Instructions ...................................................................................... 4 Assessment Requirements .................................................................................................. 6 Task 1. Supporting Independence and Wellbeing ......................................................... 7 Task 2. Record of Hours Timesheet ............................................................................. 11 Supervisor Report – Support independence and wellbeing ............................................. 14 Supervisor Declaration ...................................................................................................... 16 Student Declaration ........................................................................................................... 16 ASSESSOR ONLY - Verification of Supervisor Observations ........................................... 17 SAMPLE

CHCCCS040 Support Independence and Wellbeing Work Vereification Report © 2023 Coast Wide Training Solutions | CHCCCS040 Work Verification Report V1.0 4 Supervisor Reporting Instructions Due to the nature of vocational learning, the assessment of the practical skills of this unit of competency cannot be entirely conducted by the assessor. To ensure the integrity of the assessment and that the student is authentically acquiring the skills required by the unit, we require a Third-Party to observe the student’s performance and verify their skills acquired. Involving a workplace supervisor as a third party in the collection of evidence allows assessors to gather authentic and valid evidence of the student’s performance outside of the classroom. The purpose of this verification report is for you to verify and record the student’s progress towards achievement of competencies. It contains a record of all the competencies required for this assessment and must be acknowledged by the you, the third-party, by the student and the assessor. Details of competencies in which the student must perform, and you must acknowledge are listed on the following pages. This Workplace Verification Report: • Identifies tasks that the student will need to undertake. • Details the instructions that you, the third party, will need to follow. • Allows you to record your observations of the student and additional comments. • Allows the assessor to validate your feedback and add their own comments. • Is an important record of the student’s achievements and must be completed in full and returned to the student on completion of the assessment. • Provides additional evidence to support the competencies required for this qualification to be achieved. You must complete all the sections in this report after observing the student throughout the task requirements. Complete each section and indicate your opinion of if the student demonstrated the skills described by adding comments and feedback. Responsibilities Students are responsible for: • Providing this Verification Report to you, the Third-Party. • Ensuring this Verification Report is completed by you before submitting it to the assessor. The workplace supervisor is responsible for: • Facilitating the practical activities. • Observing the performance of the student. • Reviewing and monitoring their performance by indicating your observations on the student’s performance and providing feedback to the assessor. • Discussing your observations and feedback with the assessor. SAMPLE

CHCCCS040 Support Independence and Wellbeing Work Verification Report © 2023 Coast Wide Training Solutions | CHCCCS040 Work Verification Report V1.0 7 Task 1. Supporting Independence and Wellbeing 1.1, 1.3, 1.4, 1.5, 2.1, 2.2, 2.3, 2.4, 2.5, 3.1, 3.2, 3.3, 3.4, 3.5, 3.6, 4.1, 4.2, 4.3, 4.4, 4.5, 4.7, 4.8, 4.9, P1, P2, K4, K5, K6, K7, K9, K10, K11, K16, K17, K18 Use the table below to work closely with your Supervisor to promote and enhance the independence and wellbeing of three (3) different people. You will need to ensure the well-being and safety of the clients you are working with so ensure you have read and understood each person’s Individualised Care Plan before undertaking this task. Record comments about your experience. Setting: ☐ Home Setting ☐ Community Care Setting ☐ Aged Care Facility ☐ Disability Care Facility Criteria Person 1 Person 2 Person 3 Take into consideration the person’s individual needs and preferences, stage of life, development and strengths when engaging in support activities while considering potential risks. Comment – Date ___/___/___ Comment – Date ___/___/___ Comment – Date ___/___/___ Use positive and supportive communication to show respect and to promote self-esteem and confidence. Comment – Date ___/___/___ Comment – Date ___/___/___ Comment – Date ___/___/___ SAMPLE

CHCCCS040 Support Independence and Wellbeing Work Verification Report © 2023 Coast Wide Training Solutions | CHCCCS040 Work Verification Report V1.0 11 Task 2. Record of Hours Timesheet P2 You are required to complete 120 hours of direct client support to successfully complete CHCCCS040 Support independence and wellbeing. Use this table to record your hours and have your workplace supervisor sign off to confirm completion. Do not record any break times. An example of how to record your hours has been provided, please ensure you record a brief description of the duties you performed on each shift. Date Time Started Time Finished Hours Worked Student Signature Supervisor Name Supervisor Signature Main duties performed 2/2/2022 8:30am 4:30pm 6.5 RWaslh Marion Day M.Day Travel training Assist client in leisure activity Personal care SAMPLE

CHCCCS040 Support Independence and Wellbeing Work Vereification Report © 2023 Coast Wide Training Solutions | CHCCCS040 Work Verification Report V1.0 17 ASSESSOR ONLY - Verification of Supervisor Observations Contact the student’s workplace supervisor and discuss the student’s performance to confirm satisfactory skills demonstration. During your discussion, consider the actions for which the Supervisor must have observed: Discuss the student’s performance with the Supervisor and record your discussion notes in the table below. Student Name: Supervisor Name: Have the supervisor observations been carried out correctly and successfully? ☐ Yes ☐ No Has the supervisor covered all relevant criteria in their observations? ☐ Yes ☐ No Has the student demonstrated the required skills? ☐ Yes ☐ No Review Comments Assessor Comments and Feedback on Supervisor Observations Supervisor Interview Date of Contact: Time of Contact: Contact Duration: Assessor Interview Comments: Outcome: ☐ Evidence Satisfactory ☐ Evidence NOT Satisfactory Improvements Required: If evidence not satisfactory, date of Reassessment: Assessor Name: Date: Assessor Sign: End of Work Verification Report SAMPLE