FORM 1.

1 SELF-ASSESSMENT CHECK

INSTRUCTIONS: This Self-Check Instrument will give the trainer necessary

data or information which is essential in planning training
sessions. Please check the appropriate box of your answer
to the questions below.
CORE COMPETENCIES
CAN I…? YES NO
1. PROVIDE CARE AND SUPPORT TO INFANTS AND TODDLERS
Comfort infants and toddlers /
Bathe and dress infants and toddlers /
Feed infants and toddlers /
Put infants and toddlers to sleep /
Enhance social, physical, intellectual, creative and /
emotional activities of infants and toddlers
2. PROVIDE CARE AND SUPPORT TO CHILDREN
Instill personal hygiene practices to children /
Bathe and dress children /
Feed children /
3. FOSTER THE SOCIAL, INTELLECTUAL, CREATIVE AND EMOTIONAL
DEVELOPMENT OF CHILDREN
Foster children’s independence and autonomy /
Encourage children to express their feelings, ideas and /
needs
Stimulate children’s awareness and creativity /
Foster children’s self-esteem and development of self- /
concept
4. FOSTER PHYSICAL DEVELOPMENT OF CHILDREN
Enhance physical activities of children /
Create opportunities for children to develop a wider range of /
physical development
Provide experience to support physical development of /
children
5. PROVIDE CARE AND SERVICES TO ELDERLY
Establish and maintain an appropriate relationship with the /
elderly
Provide appropriate support to the elderly /
 Provide assistance with elderly’s personal care needs /
6. PROVIDE CARE AND SUPPORT TO PEOPLE WITH SPECIAL
NEEDS

Establish and maintain appropriate relationship with people /

with special needs
Provide appropriate support to people with special needs /
Assist in maintaining well-being of people with special /
needs.
Assist people with special needs to identify and meet their /
needs
Assist people with special needs in maintaining an /
environment that enables maximum independent living
7. MAINTAIN A HEALTHY AND SAFE ENVIRONMENT
Maintain a clean and hygienic environment /
Provide a safe environment /
Supervise the safety of clients /
8. RESPOND TO EMERGENCY
Implement procedures for infection control and prevention /
Recognize and respond to signs of potential illness /
Respond to emergencies and accidents /
Administer medication within guidelines /
Respond to threats and situations of danger /
9. CLEAN LIVING ROOM, DINING ROOM, BEDROOMS, TOILETS,
BATHROOMS AND KITCHEN
Clean surfaces and floors /
Clean furnishing and fixtures /
Make up beds and cots /
Sanitize rooms /
Maintain clean room environment /
Clean kitchen /
10. WASH AND IRON CLOTHES, LINEN AND FABRIC
. Check and sort clothes, linens and fabrics /
Remove stains /
Prepare washing equipment and supplies /
Perform laundry /
 Dry clothes, linen and fabric /
Iron clothes, linens and fabrics /
11. PREPARE HOT AND COLD MEALS/FOOD
Prepare ingredients according to recipes /
Cook meals and dishes according to recipes /
Present cooked dishes /
Prepare sauces, dressings and garnishes /
Prepare Appetizers /
Prepare desserts and salads /
Prepare sandwiches /
Store excess foods and ingredients /
Convert unconsumed cooked food /

Note: In making the Self-Check for your Qualification, all required

competencies should be specified. It is therefore required of a Trainer to be
well- versed of the CBC or TR of the program qualification he is teaching.
 Evidences/Proof of Current Competencies (Sample)

Form 1.2: Evidence of Current Competencies acquired related to

Job/Occupation

Current
Proof/Evidence Means of validating
competencies
Instill personal hygiene Certificate of Employment Authenticated Certificates
practices to children
Bathe and dress Certificate of Employment Authenticated Certificates
children
Feed children Certificate of Employment Authenticated Certificates
Establish and maintain Certificate of Employment Authenticated Certificates
an appropriate
relationship with the
elderly
Provide appropriate Certificate of Employment Authenticated Certificates
support to the elderly
Provide assistance with Certificate of Employment Authenticated Certificates
elderly’s personal care
needs
Maintain a clean and Certificate of Employment Authenticated Certificates
hygienic environment
Provide a safe Certificate of Employment Authenticated Certificates
environment
Supervise the safety Certificate of Employment Authenticated Certificates
of clients
. Check and sort Certificate of Employment Authenticated Certificates
clothes, linens and
fabrics
Remove stains Certificate of Employment Authenticated Certificates
Prepare washing Certificate of Employment Authenticated Certificates
equipment and
supplies
Perform laundry Certificate of Employment Authenticated Certificates
Dry clothes, linen and Certificate of Employment Authenticated Certificates
fabric
Iron clothes, linens Certificate of Employment Authenticated Certificates
and fabrics
Prepare ingredients Certificate of Employment Authenticated Certificates
according to recipes
Cook meals and Certificate of Employment Authenticated Certificates
dishes according to
recipes
Present cooked dishes Certificate of Employment Authenticated Certificates
Prepare sauces, Certificate of Employment Authenticated Certificates
dressings and
garnishes
Prepare Appetizers Certificate of Employment Authenticated Certificates
Prepare desserts and Certificate of Employment Authenticated Certificates
salads
Prepare sandwiches Certificate of Employment Authenticated Certificates
Store excess foods Certificate of Employment Authenticated Certificates
and ingredients
Convert unconsumed Certificate of Employment Authenticated Certificates
cooked food
 Identifying Training Gaps

From the accomplished Self-Assessment Check (Form 1.1) and the

evidences of current competencies (Form 1.2), the Trainer will be able to
identify what the training needs of the prospective trainee are.

Form 1.3 Summary of Current Competencies Versus Required

Competencies (Sample)

Required Units of Current Training

Competency/Learning
Outcomes based on CBC
1. PROVIDE CARE AND SUPPORT TO INFANTS AND TODDLERS
Comfort infants and toddlers
Bathe and dress infants
and toddlers
Feed infants and toddlers
Put infants and toddlers to
sleep
Enhance social, physical,
intellectual, creative and
emotional activities of
infants and toddlers
2. PROVIDE CARE AND SUPPORT TO CHILDREN
Instill personal hygiene
practices to children
Bathe and dress children
Feed children
3. FOSTER THE SOCIAL, INTELLECTUAL, CREATIVE AND EMOTIONAL
DEVELOPMENT OF CHILDREN
Foster children’s
independence and
autonomy
Encourage children to
express their feelings, ideas
and needs
Competencies Gaps/Requirements
Comfort infants and
toddlers
Bathe and dress infants
and toddlers
Feed infants and toddlers
Put infants and toddlers
to sleep
Enhance social, physical,
intellectual, creative and
emotional activities of
infants and toddlers
Instill personal
hygiene
practices to
children
Bathe and dress
children
Feed children
Foster children’s
independence and
autonomy
Encourage children to
express their feelings,
ideas and needs
Stimulate children’s awareness Stimulate children’s
and creativity awareness and creativity
Foster children’s self- Foster children’s self-
esteem and development of esteem and development
self-concept of self-concept
4. FOSTER PHYSICAL DEVELOPMENT OF CHILDREN
Enhance physical activities Enhance physical
of children activities of
children
Create opportunities for Create
children to develop a opportunities
wider range of physical for children to
development develop a wider
range of
physical
development
Provide experience to Provide experience
support physical to support
development of children physical
development of
children
5. PROVIDE CARE AND SERVICES TO ELDERL
Establish and maintain an Establish and
appropriate relationship maintain an
with the elderly appropriate
relationship with
the elderly
Provide appropriate support Provide
to the elderly appropriate
support to the
elderly
Provide assistance with Provide
elderly’s personal care assistance with
needs elderly’s personal
care needs
Provide assistance with the Provide
elderly’s personal care assistance with
needs the elderly’s
personal care
needs

6. PROVIDE CARE AND SUPPORT TO PEOPLE WITH SPECIAL NEEDS

Establish and maintain Establish and
 appropriate relationship maintain
with people with special appropriate
needs relationship with
people with
special needs
Provide appropriate Provide
support to people with appropriate
special needs support to
people with
special needs
Assist in maintaining well Assist in
being of people with maintaining
special needs. well being of
people with
special needs.
Assist people with special Assist people with
needs to identify and special needs to
meet their needs identify and
meet their
needs
Assist people with special Assist people with
needs in maintaining an special needs in
environment that maintaining an
enables maximum environment
independent living that enables
maximum
independent
living
7. MAINTAIN A HEALTHY AND SAFE ENVIRONMENT
Maintain a clean and Maintain a clean
hygienic environment and hygienic
environment
Provide a safe environment Provide a safe
environment
Supervise the safety of Supervise the
clients safety of clients
8. RESPOND TO EMERGENCY
Implement procedures for Implement
infection control and procedures for
prevention infection control
and prevention
Recognize and respond to Recognize and
signs of potential illness respond to signs
of potential
 illness
. Respond to emergencies Respond to
and accidents emergencies and
accidents
Administer medication Administer
within guidelines medication
within
guidelines
Respond to threats and Respond to threats
situations of danger and situations
of danger
9. CLEAN LIVING ROOM, DINING ROOM, BEDROOMS, TOILETS,
BATHROOMS AND KITCHEN
Clean surfaces and floors Clean surfaces
and floors
Clean furnishing and Clean furnishing
fixtures and fixtures
Make up beds and cots Make up beds
and cots
Clean toilet and bathroom Clean toilet and
bathroom
Sanitize rooms Sanitize rooms
Maintain clean room Maintain clean
environment room
environment
Clean kitchen Clean kitchen
10. WASH AND IRON CLOTHES, LINEN AND FABRIC
Check and sort clothes, Check and sort
linens and fabrics clothes, linens
and fabrics
Remove stains Remove stains
Prepare washing Prepare washing
equipment and supplies equipment and
supplies
Perform laundry Perform laundry
Dry clothes, linen and Dry clothes,
fabric linen and fabric
Iron clothes, linens and Iron clothes,
fabrics linens and
fabrics
11. PREPARE HOT AND COLD MEALS/FOOD
Prepare ingredients Prepare
according to recipes ingredients
according to
recipes
Cook meals and dishes Cook meals and
according to recipes dishes according
to recipes
Present cooked dishes Present cooked
dishes
Prepare sauces, dressings Prepare sauces,
and garnishes dressings and
garnishes
Prepare Appetizers Prepare
Appetizers
Prepare desserts and Prepare desserts
salads and salads
Prepare sandwiches Prepare
sandwiches
Store excess foods and Store excess
ingredients foods and
ingredients
Convert unconsumed Convert
cooked food unconsumed
cooked food
Using Form No.1.4, convert the Training Gaps into a Training
Needs/Requirements. Refer to the CBC in identifying the Module Title or
Unit of Competency of the training needs identified.

Form No. 1.4: Training Needs (Sample)

Training Needs Module Title/Module of

Instruction
(Learning Outcomes)
Comfort infants and toddlers 1. PROVIDING CARE AND
SUPPORT TO INFANTS
Bathe and dress infants and toddlers
AND TODDLERS
Feed infants and toddlers
Put infants and toddlers to sleep 2. FOSTERING THE
SOCIAL,
Enhance social, physical, intellectual,
INTELLECTUAL,
creative and emotional activities of
CREATIVE AND
infants and toddlers
EMOTIONAL
Foster children’s independence and DEVELOPMENT OF
autonomy CHILDREN
Encourage children to express their
feelings, ideas and needs
Stimulate children’s awareness and
creativity
Foster children’s self-esteem and 3. FOSTERING
development of self-concept PHYSICAL
DEVELOPMENT OF
Enhance physical activities of children
CHILDREN
Create opportunities for children to
develop a wider range of physical
development
Provide experience to support physical
development of children
Establish and maintain appropriate
relationship with people with special needs
Provide appropriate support to people
with special needs
Assist in maintaining well being of 4. PROVIDING CARE
people with special needs AND SUPPORT TO
PEOPLE WITH
Assist people with special needs in
SPECIAL NEEDS
maintaining an environment that
enables maximum independent living 5. RESPONDING TO
EMERGENCY
Implement procedures for infection
 control and prevention
Recognize and respond to signs of potential
illness
Respond to emergencies and accidents
Administer medication within guidelines
Respond to threats and situations of
danger

Prepared By:
PHETTER LEO C. CAJEGAS
Date: November 17,2021
Time: 12:50PM