Republic of the Philippines

Department of Education
Region VIII – Eastern Visayas
Schools Division of Calbayog City
CABATUAN NATIONAL HIGH SCHOOL
SENIOR HIGH SCHOOL DEPARTMENT
SCHOOL ID: 303647
P-2, Brgy. Cabatuan, Oquendo District, Calbayog City, 6710 Western Samar

GENERAL ACADEMIC STRAND

WORK IMMERSION EVALUATION FORM
Rating Scale

1 – Unsatisfactory or Poor Performance – Performance does not meet the required standard. Major
improvements needed.
2 – Needs Improvement – Work improvement plan was needed to bring performance to a satisfactory
level
3 – Fair Performance – Performance partially meets the required standard. Less than satisfactory, could
be doing better.
4– Good or Average Performance – Performance has met the required standard. Can perform duties
with minimal supervision.
5 – Very Good or Outstanding Performance - Performance exceeds the required standard.

Please rate the Student’s overall practicum performance according to the rating scale below.

A. JOB SKILL/COMPETENCY Rating

1. Competent in required job skills and knowledge
2. Exhibits ability to lean and apply new skills and keeps abreast
of current developments in field
Total
B. TEAM WORK
1. Consistently works with others to accomplish goals and tasks
2. Willingness to work with team members to improve team
collaboration on a continuous basis
Total
C. COMMUNICATION
1. Actively listens to supervisor and/or co - worker
2. Comprehends written and oral information
3. Consistently delivers accurate information both written and orally
4. Reliably provides feedback as required, both internally and
externally
Total
D. ATTENDANCE & PUNCTUALITY
1. Is punctual on a regular basis
2. Maintains a good attendance
3. Informs supervisor in a timely manner when absenteeism and
lateness may occur
Total
E. PRODUCTIVITY/RESILIENCE
1. Consistently delivers quality results
2. Ability to multi task
3. Time management is effective and efficient
4. Efficiently informs supervisor of any challenges or barriers relevant
to given task or assignment
Total
F. ATTITUDE
1. Make a positive contribution to morale
2. Accepts constructive criticism positively
 Total
G. PROFESSIONALISM
1. Respects those in authority
2. Follows all policies and procedures when issues and conflicts may
arise
3. Physical and appearance is conducive with the work environment
and placement rules

Overall Rating

COMMENTS AND RECOMMENDATIONS

Comments by Trainee:
(Please confirm that you agree with the Supervisor’s Assessment or indicate any areas of disagreement which may
remain)

Supervisor’s Comments

TRAINEE ACKNOWLEDGEMENT: I have reviewed all pages of this document and have discussed the contents with
my supervisor. My signature means that I have been advised of and fully understand my performance status.

___________________________ ________________________________
Trainee’s Signature On-Site Supervisor’s Signature
Signature Over Printed Name Signature Over Printed Name

Date: ______________________ Date: ___________________________

Company Stamp: _____________________

MARCHIE M. GABUMPA DR. VIRGINIA A. MILLARES, PHD

Work Immersion Teacher Principal I
Signature Over Printed Name Signature Over Printed Name

Date: __________________ Date: __________________