FIELD INSTRUCTION I EVALUATION FORM

FIRST SEMESTER, SY 2022-2023

Name of Student: Marl Angelo Espenida

Name of Agency Placement: MSWDO

Address of Agency: Dolores Quezon

Instruction: Using a five-point scale, evaluate the field instruction student using the
following equivalent:
5 - Very adequate knowledge gained, appropriate skills demonstrated and proper attitude
displayed without much supervision
4 - Adequate knowledge gained, appropriate skills demonstrated and proper working
habits with less supervision
3 - Sufficient knowledge gained, enough skills demonstrated and shows interest in
improvement
2 - Minimal knowledge gained, limited skills demonstrated and shows interest in
improvement
1 - Little knowledge gained, little skills demonstrated and shows no interest in
improvement

Please DON’T fill in gray-shaded boxes

PARTICULARS PR SR AFS SFI

R R

III. Quantitative

7. Performance of assigned task 5 5 5 5

8. Number of hours earned in field practice 5 5 5 5

9. Number of cases handled 5 5 5 5

10. Preparation of records

5.1 client’s records 5 5 5 5

5.2 student’s process recordings 5 5 5 5

5.3 preparation and submission of records/reports

5.1 regular reports 5 5 5 5

 PARTICULARS PR SR AFS SFI
R R

5.2 self-evaluation reports 5 5 5 5

5.3. other assigned reports 5 5 5 5

12. attendance at conferences, meetings, case 5 5 5 5

presentation
IV. Qualitative

A. Work Habits/Traits

7. Punctuality and regularity in:

1.1 Work attendance 5 5 5 5

1.2 Submitting Requirements 5 4 5 5

1.3 Attending conferences/supervisory sessions 5 5 5 5

8. Observance of rules and regulations relating to FI

2.1. In school 5 5 5 5

2.2. In the agency 5 5 5 5

2.3. In the field 5 5 5 5

9. Positive working relationship with:

3.1. Clients 5 5 5 5

3.2. Colleagues 5 5 5 5

3.3. other agency staff 5 5 5 5

3.4. agency supervisor 5 5 5 5

10. Resourcefulness / initiative 5 5 5 5

11. Willingness to accept responsibility 5 5 5 5

12. Tactfulness 5 5 5 5

B. Knowledge
 PARTICULARS PR SR AFS SFI
R R

10. Course objectives 5 5 5 5

11. The agency, its mission, functions, goals and 5 5 5 5

objectives
12. Social work values, philosophy, goals, methods, 5 5 5 5
skills, techniques, tools. etc.
13. Principles of the helping relationship 5 5 5 5

14. Helping relationship 5 5 5 5

15. Models of intervention 5 4 5 5

16. Social realities / issues affecting agency and 5 5 5 5

client systems
17. Documentation 5 5 4 4

18. Evaluation 4 5 5 4

C. Skills

6. Ability to function within the agency setting 5 5 5 5

7. Ability to use the helping process

2.1. Identifying and eliciting sufficient information 5 5 5 5

for understanding client’s problem/situation
2.2. drawing client’s feelings 5 5 4 4

2.3. empathizing with client 5 5 5 5

2.4. establishing rapport and engaging client into a 5 5 5 4

relationship
2.5. using differential diagnosis 5 4 5 5

2.6. ability to analyze the client in his/her/their 5 5 5 5

situation by identifying the factors that
contributed to it
2.7. ability to identify the strengths and weaknesses 5 5 5 5
of the client that either contribute to or hinder the
solution to the problem
2.8. ability to prepare an intervention plan with the 5 5 5 5
client
2.9. skills in structuring 5 5 5 5
 PARTICULARS PR SR AFS SFI
R R

2.10. ability to use various techniques 5 4 4 5

2.11. ability to mobilize the agency/community 5 4 4 5

human resources
2.12. ability to evaluate clients in his/her/their 5 5 5 5

2.13. situation and process 5 5 5 5

2.14. ability to terminate a helping relationship 5 4 4 5

8. Ability to identify the issues and realities that 5 5 5 5

affect client’s situation
9. Ability to document the necessary process and 5 5 5 5
situation
10. Ability to evaluate self in one’s professional 5 5 5 5
development
D. Conscious Use of Self

4. Attitude towards self

1.1. demonstration of conscious and disciplined use 5 5 5 5

of self
1.2. identification with the ethics and values of the 5 5 5 5
profession
1.3. recognition and use of role as learner 5 5 4 4

1.4. acceptance of one’s limitations and the need to 5 5 5 5

change
5. Attitude towards work and tasks

2.1. Organizing, ranking and planning work 5 5 5 5

2.2. Appreciation and recognition of the meaning 5 5 5 5

and significance of work done
2.3. Carrying appointments 5 5 5 5

2.4. Functioning cooperatively with professionals 5 5 5 4

and paraprofessionals
2.5. adopting and adjusting to work situations 5 5 5 5

2.6. sensitivity to other’s needs and feelings 5 5 5 5

 PARTICULARS PR SR AFS SFI
R R

6. Attitude towards supervisor

3.1. Recognition of supervisor’s role and authority 5 5 5 5

3.2. recognition of and respect of supervisor’s 5 5 5 5

abilities and limitations
TOTAL 303 297 219 299

Legend: PR – Peer Rating, AFSR - Agency Field Supervisor

Rating, SR – Student self Rating, AFS – SFIR – School Field
Instruction Rating

Where:

5 - 96 -
100
Computation: 61 items:
4 - 91 - 95
Peer rating
Score: 244 3 - 86 - 90
61 x .20 = .8
Self rating: 2 - 81 - 85
305 1 - 75 - 80
61 x .20 = 1
AFIR
255
61 x .30 = 1.25

SFIR
260
61 x .30 = 1.27

Add: .8+1+1.25+1.27 = 4.32

MIDTERM GRADE
 Add: 0.99 + 0.97 + 1.07 + 1.47= 4.5

= 4.5

MARL ANGELO ESPENIDA CAMILLE A. ITCHON

Field Instruction Student Peer
Signature over printed name Signature over printed name

Date: 02/20/23 Date: 02/20/23

CIPRIANA A. MONTIERRO FLORDELISA N. ESCULTURA

Agency Field Supervisor School Field Instructor
Signature over printed name Signature over printed name

Date: 02/20/23 Date: 02/20/23