NATIONAL SKILLS PROFILE ASSESSMENT RECORD
Centre name
Centre no
Candidate name
Assessor name
Skill area
Personal Skills
Module no and title
Module 1 Identify your local community
Grade
First
Evidence Record
Evidence must show that you can:
Evidence location
1.
Identify the community/ies that you belong to
2.
Identify others who are part of these communities
3.
Identify four different local community facilities
4.
Identify the purpose of each community facility

Assessment Decision
Assessment method/s used:
Observation
Examination of product/candidate’s work
Questioning of candidate
Assessment of the evidence for
this module confirms:
It is valid
It is authentic
It is sufficient
Feedback to candidate on evidence assessed:
I confirm that the candidate has met the requirements of the Evidence must show you can
statements for this module.
Assessor signature
Date
Candidate signature
Date
NATIONAL SKILLS PROFILE ASSESSMENT RECORD
Centre name
Centre no
Candidate name
Assessor name
Skill area
Personal Skills
Grade
Module no and title
Module 1 Identify individual responsibilities in the community
Second
Evidence Record
Evidence must show that you can:
Evidence location
1.
Identify at least three community responsibilities you have
2.
Identify possible consequences if you fail to carry out each of these
community responsibilities
3.
Identify the positive outcome/s of individuals acting responsibly in the
community
4.
Identify three other ways in which you can make a positive contribution
to your community

Assessment Decision
Assessment method/s used:
Observation
Examination of product/candidate’s work
Questioning of candidate
Assessment of the evidence for
this module confirms:
It is valid
It is authentic
It is sufficient
Feedback to candidate on evidence assessed:
I confirm that the candidate has met the requirements of the Evidence must show you can
statements for this module.
Assessor signature
Date
Candidate signature
Date
NATIONAL SKILLS PROFILE ASSESSMENT RECORD
Centre name
Centre no
Candidate name
Assessor name
Skill area
Personal Skills
Grade
Module no and title
Module 1 Agree and carry out a personal action plan to increase your
contribution to the community
Third
Evidence Record
Evidence must show that you can:
1.
2.
Evidence location
Work with an appropriate person to agree a personal action plan to
increase your contribution to the community that includes:
a)
the community activity that you are going to be involved with
b)
the actions you will take to increase your contribution to the
community
c)
the timescales for carrying out each action
d)
the support you will need
Carry out the actions identified in your action plan

Assessment Decision
Assessment method/s used:
Observation
Examination of product/candidate’s work
Questioning of candidate
Assessment of the evidence for
this module confirms:
It is valid
It is authentic
It is sufficient
Feedback to candidate on evidence assessed:
I confirm that the candidate has met the requirements of the Evidence must show you can
statements for this module.
Assessor signature
Date
Candidate signature
Date
NATIONAL SKILLS PROFILE ASSESSMENT RECORD
Centre name
Centre no
Candidate name
Assessor name
Skill area
Personal Skills
Module no and title
Module 2 Identify daily routine activities
Grade
First
Evidence Record
Evidence must show that you can:
Evidence location
1.
Identify at least five different activities that are part of your daily routine
2.
For three different activities that are part of your daily routine identify:
a)
each activity
b)
the support you need to complete each activity

Assessment Decision
Assessment method/s used:
Observation
Examination of product/candidate’s work
Questioning of candidate
Assessment of the evidence for
this module confirms:
It is valid
It is authentic
It is sufficient
Feedback to candidate on evidence assessed:
I confirm that the candidate has met the requirements of the Evidence must show you can
statements for this module.
Assessor signature
Date
Candidate signature
Date
NATIONAL SKILLS PROFILE ASSESSMENT RECORD
Centre name
Centre no
Candidate name
Assessor name
Skill area
Personal Skills
Grade
Module no and title
Module 2 Identify and carry out weekly routine activities
Second
Evidence Record
Evidence must show that you can:
Evidence location
1.
Identify at least five different activities that are part of your weekly
routine
2.
Identify three of these activities that you could start to take
responsibility for
3.
Take responsibility for carrying out these three activities over a period
of time

Assessment Decision
Assessment method/s used:
Observation
Examination of product/candidate’s work
Questioning of candidate
Assessment of the evidence for
this module confirms:
It is valid
It is authentic
It is sufficient
Feedback to candidate on evidence assessed:
I confirm that the candidate has met the requirements of the Evidence must show you can
statements for this module.
Assessor signature
Date
Candidate signature
Date
NATIONAL SKILLS PROFILE ASSESSMENT RECORD
Centre name
Centre no
Candidate name
Assessor name
Skill area
Personal Skills
Grade
Module no and title
Module 2 Agree and carry out a personal action plan to complete a new
personal goal
Third
Evidence Record
Evidence must show that you can:
1.
2.
Evidence location
Work with an appropriate person to agree a personal action plan for
completing a new personal goal that includes:
a)
the new personal goal you want to achieve
b)
the actions you will take to complete a new personal goal
c)
the timescales for completing each action
d)
the support you will need
Carry out the actions identified in your action plan

Assessment Decision
Assessment method/s used:
Observation
Examination of product/candidate’s work
Questioning of candidate
Assessment of the evidence for
this module confirms:
It is valid
It is authentic
It is sufficient
Feedback to candidate on evidence assessed:
I confirm that the candidate has met the requirements of the Evidence must show you can
statements for this module.
Assessor signature
Date
Candidate signature
Date
NATIONAL SKILLS PROFILE ASSESSMENT RECORD
Centre name
Centre no
Candidate name
Assessor name
Skill area
Personal Skills
Grade
Module no and title
Module 3 Identify healthy lifestyle requirements
First
Evidence Record
Evidence must show that you can:
Evidence location
1.
Identify three factors that contribute to a healthy lifestyle
2.
Identify three different healthy snacks you could eat
3.
Identify three different healthy meals you could eat
4.
Identify three different ways you could exercise
5.
Identify at least one reason why it is important for you to wash and
keep clean

Assessment Decision
Assessment method/s used:
Observation
Examination of product/candidate’s work
Questioning of candidate
Assessment of the evidence for
this module confirms:
It is valid
It is authentic
It is sufficient
Feedback to candidate on evidence assessed:
I confirm that the candidate has met the requirements of the Evidence must show you can
statements for this module.
Assessor signature
Date
Candidate signature
Date
NATIONAL SKILLS PROFILE ASSESSMENT RECORD
Centre name
Centre no
Candidate name
Assessor name
Skill area
Personal Skills
Grade
Module no and title
Module 3 Identify own needs for a healthy lifestyle
Second
Evidence Record
Evidence must show that you can:
Evidence location
1.
Identify the areas of your life which contribute to a healthy lifestyle
2.
Identify areas of your life which do not contribute to a healthy lifestyle
3.
Identify three changes that would make your lifestyle more healthy
4.
Identify the support you will need to make these changes

Assessment Decision
Assessment method/s used:
Observation
Examination of product/candidate’s work
Questioning of candidate
Assessment of the evidence for
this module confirms:
It is valid
It is authentic
It is sufficient
Feedback to candidate on evidence assessed:
I confirm that the candidate has met the requirements of the Evidence must show you can
statements for this module.
Assessor signature
Date
Candidate signature
Date
NATIONAL SKILLS PROFILE ASSESSMENT RECORD
Centre name
Centre no
Candidate name
Assessor name
Skill area
Personal Skills
Grade
Module no and title
Module 3 Agree and carry out a personal action plan for a healthier
lifestyle
Third
Evidence Record
Evidence must show that you can:
1.
2.
Evidence location
Work with an appropriate person to agree a personal action plan for a
healthier lifestyle that includes:
a)
the healthy lifestyle goals you want to achieve
b)
the actions you will take for a healthier lifestyle
c)
the timescales for completing each action
d)
the support you will need
Carry out the actions identified in your action plan

Assessment Decision
Assessment method/s used:
Observation
Examination of product/candidate’s work
Questioning of candidate
Assessment of the evidence for
this module confirms:
It is valid
It is authentic
It is sufficient
Feedback to candidate on evidence assessed:
I confirm that the candidate has met the requirements of the Evidence must show you can
statements for this module.
Assessor signature
Date
Candidate signature
Date
NATIONAL SKILLS PROFILE ASSESSMENT RECORD
Centre name
Centre no
Candidate name
Assessor name
Skill area
Personal Skills
Grade
Module no and title
Module 4 Identify interpersonal skills that contribute to positive
relationships
First
Evidence Record
Evidence must show that you can:
Evidence location
Work with an appropriate person to:
1.
Identify interpersonal skills that contribute to positive relationships
2.
Identify who it is important to develop or maintain positive relationships
with
3.
Identify the possible consequences of negative relationships

Assessment Decision
Assessment method/s used:
Observation
Examination of product/candidate’s work
Questioning of candidate
Assessment of the evidence for
this module confirms:
It is valid
It is authentic
It is sufficient
Feedback to candidate on evidence assessed:
I confirm that the candidate has met the requirements of the Evidence must show you can
statements for this module.
Assessor signature
Date
Candidate signature
Date
NATIONAL SKILLS PROFILE ASSESSMENT RECORD
Centre name
Centre no
Candidate name
Assessor name
Skill area
Personal Skills
Grade
Module no and title
Module 4 Identify strengths and weakness in your interpersonal skills
Second
Evidence Record
Evidence must show that you can:
Evidence location
Work with an appropriate person to:
1.
Identify at least three interpersonal skills which are your strengths
2.
Identify at least three interpersonal skills which could be improved
3.
Identify why you would like to improve those interpersonal skills

Assessment Decision
Assessment method/s used:
Observation
Examination of product/candidate’s work
Questioning of candidate
Assessment of the evidence for
this module confirms:
It is valid
It is authentic
It is sufficient
Feedback to candidate on evidence assessed:
I confirm that the candidate has met the requirements of the Evidence must show you can
statements for this module.
Assessor signature
Date
Candidate signature
Date
NATIONAL SKILLS PROFILE ASSESSMENT RECORD
Centre name
Centre no
Candidate name
Assessor name
Skill area
Personal Skills
Grade
Module no and title
Module 4 Agree and carry out a personal action plan to develop your
interpersonal skills
Third
Evidence Record
Evidence must show that you can:
1.
2.
Evidence location
Work with an appropriate person to agree an individual action plan for
developing your interpersonal skills that includes:
a)
the interpersonal skills that you want to develop
b)
the actions you will take to develop your interpersonal skills
c)
the timescales for reviewing the actions
d)
the support you will need
Carry out the actions identified in your action plan

Assessment Decision
Assessment method/s used:
Observation
Examination of product/candidate’s work
Questioning of candidate
Assessment of the evidence for
this module confirms:
It is valid
It is authentic
It is sufficient
Feedback to candidate on evidence assessed:
I confirm that the candidate has met the requirements of the Evidence must show you can
statements for this module.
Assessor signature
Date
Candidate signature
Date
NATIONAL SKILLS PROFILE ASSESSMENT RECORD
Centre name
Centre no
Candidate name
Assessor name
Skill area
Personal Skills
Grade
Module no and title
Module 5 Identify ways to keep safe in the community
First
Evidence Record
Evidence must show that you can:
Evidence location
1.
Identify at least two activities that you do in the community where you
need to keep safe
2.
For each activity, identify at least one way that you can keep safe
3.
Identify what to do if you feel unsafe in these situations

Assessment Decision
Assessment method/s used:
Observation
Examination of product/candidate’s work
Questioning of candidate
Assessment of the evidence for
this module confirms:
It is valid
It is authentic
It is sufficient
Feedback to candidate on evidence assessed:
I confirm that the candidate has met the requirements of the Evidence must show you can
statements for this module.
Assessor signature
Date
Candidate signature
Date
NATIONAL SKILLS PROFILE ASSESSMENT RECORD
Centre name
Centre no
Candidate name
Assessor name
Skill area
Personal Skills
Grade
Module no and title
Module 5 Improve personal safety in public places and on public
transport
Second
Evidence Record
Evidence must show that you can:
Evidence location
1.
Identify at least three different ways to improve personal safety in
public places
2.
Identify at least three different ways to improve personal safety on
public transport
3.
Identify at least three ways to reduce the risk of becoming the victim of
crime
4.
Identify at least three different strategies for dealing with unsafe
situations in public places

Assessment Decision
Assessment method/s used:
Observation
Examination of product/candidate’s work
Questioning of candidate
Assessment of the evidence for
this module confirms:
It is valid
It is authentic
It is sufficient
Feedback to candidate on evidence assessed:
I confirm that the candidate has met the requirements of the Evidence must show you can
statements for this module.
Assessor signature
Date
Candidate signature
Date
NATIONAL SKILLS PROFILE ASSESSMENT RECORD
Centre name
Centre no
Candidate name
Assessor name
Skill area
Personal Skills
Grade
Module no and title
Module 5 Agree and carry out a personal action plan to improve your
personal safety in the community
Third
Evidence Record
Evidence must show that you can:
1.
Evidence location
Work with an appropriate person to agree a personal action plan to
improve your safety in the community that includes:
a)
the activities where you need to improve your personal safety
b)
the actions you will take improve your safety in the community
2.
Carry out the actions identified in your action plan over a period of time
3.
Identify the safe and unsafe ways of dealing with at least three different
threatening situations

Assessment Decision
Assessment method/s used:
Observation
Examination of product/candidate’s work
Questioning of candidate
Assessment of the evidence for
this module confirms:
It is valid
It is authentic
It is sufficient
Feedback to candidate on evidence assessed:
I confirm that the candidate has met the requirements of the Evidence must show you can
statements for this module.
Assessor signature
Date
Candidate signature
Date