Assessment Moderation Record Form
Record the moderation details, review outcomes, and follow-up actions for an assessment moderation process.
Assessment Details
Assessment Name / Title
*
Moderation Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Moderator Name
*
Assessment Type
*
Please Select
Exam
Quiz
Assignment
Practical
Project
Presentation
Other
Moderation Review
Moderation Sample Reviewed
*
Moderation Outcome
*
Approved
Approved with Changes
Rejected for Review
Overall Quality Rating
*
1
2
3
4
5
Review Criteria
*
Rows
Meets Standard
Needs Attention
Alignment to rubric
1
2
Scoring consistency
3
4
Clarity of instructions
5
6
Fairness and accuracy of assessment content
7
8
Actions and Notes
Required follow-up action items
*
Moderator comments or recommendations
Submit
Should be Empty: