Pre-enrolment form

Pre-enrolment form

Please fill out the pre-enrolment form below
Student Name*

First NameMiddle NameLast Name
Date of birth*

DayMonthYear
Course you are enrolled in*
USI Number
Assessment Enrolment Number
Note - this is not the number that starts with HRWL. (not required for work safely at heights, confined spaces or elevating work platform)
Phone Number*
Please enter a valid phone number.Format: 0000 000 000.
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState

Post code
Language, Literacy and Numeracy Pre-Training Activity

Activity information

North Coast Training Company recognise that reading, writing, listening, speaking and understanding mathematical concepts and processes are skills required for work and are therefore an important component of training.

As part of the pre-training review process, you are required to complete a language, literacy and numeracy (LLN) activity which will be used to assess your LLN ability to undertake the course. If you have a LLN concern that may affect your training program, we encourage you to raise the matter directly with a member of our administration team or your trainer prior to the commencement of training.

The results of this activity will be used by the training organisation to determine any specific assistance you may require during your training.

Information for the student

The following questions and information must be completed on your own. If your assessment results do not meet the Language, Literacy and Numeracy requirement to gain entry to the course with which you plan to enroll in, a representative from North Coast Training Company will speak to you about any assistance that you may be able to access.

Please complete the questions below.
Is English the main language you speak at home?*

YesNo
If No, what language do you mainly speak?

Please fill out the following:*

Rows	Excellent	Very Good	Good	Poor	None
How would you rate yourself for general learning?
How would you rate yourself for English reading?
How would you rate yourself for English language?
How would you rate yourself for English writing?
How would you rate yourself for oral communication?
How would you rate yourself for English numeracy?

Do you consider yourself to have a disability?*

YesNo
Select any that may apply to you:

HearingVisionIntellectualLearningMental illnessAcquired brain impairmentMedicalOther

I can...*

Rows	Yes	No
Ask routine questions to obtain information
Understand short messages and communicate the information to others
Give simple instructions to others on a familiar topic
Follow simple oral instructions
Use appropriate body language (e.g. smiling, nodding, making eye contact) while having a conversation
Ask complex questions to get the appropriate information
Communicate with others to resolve minor conflicts, such as customer complaints
Express my opinions and ideas clearly and concisely
Train or give instructions to a co-worker
Follow complex oral instructions to complete a task
Understand signs
Fill in a timesheet
Count and check change when shopping
Send a text message
Use the internet to get information like telephone numbers
Fill in a leave form
Read a staff memo
Use a computer to email
Use a calculator
Read a newspaper
Follow instructions given in the workplace
Read a plan or diagram
Read and understand a Material Safety Data Sheet
Use an equipment manual
Complete a logbook
Write an incident report

Reading

Read the following paragraph and answer the questions below.

“The New South Wales Work Health and Safety Act came into operation on 1 January 2012. A primary role of this legislation is to ensure that those responsible for operating plant/equipment are legally responsible for the health and safety of fellow workers and visitors as a result of their operation”
1. When did the New South Wales Health and Safety Act come into operation? *
2. What is the primary role of the legislation*
3. What are the people operating plant/equipment responsible for?*
In a short response (no less than 20 words), please provide an explanation on the benefits of undertaking training*

0/0

Numeracy*

Rows	Answer
1. 1 + 2 =
2. 10 - 6 =
3. 3 x 7 =
4. 10 ÷ 2 =

What is half of 10?*
If training starts at 8:00am and the time is currently 7:45am, how long until training starts?*
If I have $67 to share between 5 people, how much would each person get?*
What is the square root of 25?*
What is 27cm in mm?*
Thank you for completing the LLN pre-enrolment form

We will be in touch if we require any further information.
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Pre-enrolment form

Thank you for completing the LLN pre-enrolment form