FORM 4.

SELF-ASSESSMENT CHECKLIST

INSTRUCTION: This Self-Check Instrument will give your trainer a

data that is essential in designing a Training Plan for
you. Please check the appropriate box of your answer to
each of the questions below.

CAN I?... YES NO

BASIC COMPETENCIES
1. Participate in workplace communication /
1.1 Obtain and convey workplace information /
1.2 Complete relevant work-related /
documents

1.3 Participate in workplace meeting and /

discussion
2. Work in team environment /
2.1 Describe team role and scope /

2.2 Identify own role and responsibility within /

team

2.3 Work as a team member

3. Practice career professionalism /

3.1 Integrate personal objectives with /
organizational goals
3.2 Set and meet work priorities /
3.3 Maintain professional growth and /
development
4. Practice occupational health and safety procedures /
4.1 Identify hazards and risks /
 4.2 Evaluate hazards and risks /
4.3 Control hazards and risks

4.4 Maintain occupational health and safety /

awareness
COMMON COMPETENCIES/

1. Apply safety measures in farm operations /

1.1 Determine areas of concern for safety /
measures

1.2 Apply appropriate safety measures /

1.3 Safekeep/dispose of tools, materials and /
outfit
2. Use farm tools and equipment /
2.1 Select and use farm tools /

2.2 Select and operate farm equipment /

2.3 Perform preventive maintenance

3. Perform estimation and calculation /

3.1 Perform estimation /
3.2 Perform basic workplace calculation /

4. Process Farm wastes /

4.1 Collect farm wastes /
4.2 Identify and segregate wastes /

4.3 Treat and process farm wastes /

4.4 /

CORE COMPETENCIES

1. Maintain housing, farm implements and /

surrounding areas.
1.1 Prepare for farm maintenance activities /
1.2 Maintain farm and housing facilities /
1.3 Apply bio-security measures /
1.4 Perform work to completion

2. Provide Forage /
2.1 Prepare area for forage plantation /

2.2 Plant forage species /

2.3 . Maintain forage plants /

2.4 Produce silage /

2.5 Perform work to completion

3. Perform breeding of Ruminants /
3.1 Prepare animal stocks /
3.2 Breed ruminants
/
3.3 Carry-out monitoring activities

3.4 Feed animals

3.5 Apply basic health care

3.6 Perform post-breeding activities

4. Raise dairy animals /

4.1 Handle dairy animals /
4.2 Rear calves and kids /
4.3 Rear dairy-breeder animals

4.4 Complete the operations

5. Raise meat type animals. /

5.1 Provide assistance in management of meat /
type animals

5.2 Feed animals /

5.3 Apply basic health care

5.4 Perform work to completion

 FORM 4.2

DETERMINING AND VALIDATING

TRAINEES CURRENT COMPETENCY/IES

Identify Current Competencies acquired related to Job/Occupation

and Indicate
Proof of Evidence

Current competencies Proof of Evidence

Perform nursery operations Certificate of employment as
NURSERY Farm worker in Aggies
Farm

Prepare salads and dressings

Certificate of employment as
assistant cook in CDO Sports
and country club

Certificate of training in
Preparing salads and dressings
 FORM 4.3

COMPARING AND CROSS MATCHING OF COMPETENCIES

Current Required Units of Training

Competencies Competency/Learning Gaps/Requirements
Outcomes
Perform nursery Perform nursery
operations operations
Prepare salads and Prepare salads and
dressings dressings
Prepare stocks, sauces Prepare stocks, sauces
and soups and soups
Wwww wwww

Ggg Ggg
 FORM 4.4

TRAINEES TRAINING REQUIREMENT

Module Title/Module
Gaps Duration (hours)
of Instruction

Prepare stocks, sauces Preparing stocks, sauces

and soups and soups
 TRAINING PLAN

Qualification: Animal Production (Ruminants) NC II

Trainees’ Facilities/
Training Mode of Assessment Date and
Training Staff Tools and Venue
Activity/Task Training Arrangement Time
Requirements Equipment

MAINTAIN Hands-on ALEN B. Equipment TESDA- Written September

1. Checking the
HOUSING, LABOR- Grass cutter KNAS 4,5 and 6
problems in Lectures/ Examination
FARM School Sprayer Animal 2023
farm and discussion Oral
IMPLEMENTS Trainer Emergency Producti
surrounding
AND SWBL- lights on( Rum evaluation
area 8:00 AM
SURROUNDIN DTS/DTP Weighing inants)
according Demonstratio to 12 NN/
G AREAS scale NC II
enterprises n
workstat 1:00 PM to
and DENR Tools
ion with 5:00 PM
standards. Pliers
2. Maintaining questions
equipment, Mr. Stewart Hammer Bolo
Leif Rosabal and scythe
tools and Shovel,
materials Municipal The VIP
Hayfork,
according to Agriculture Hotel
Wheel
Occupational Officer barrow, Saw
Safety and Plumbing
Health tools
Standards
(OSHS). Supplies Lime
Detergents
Disinfectants
Hygiene
supplies
Fertilizers
Fuels/lubrica
nts Brooms
Dustpan
Pail
Fire
extinguisher
Garden hose
Nails
Facilities
House
Feeder
Waterer
Feedlot pens
Maternity pen
Kidding/lamb
ing pen, Calf
hutches, Stud
pen for
bulls ,Milking
barn/parlor
with
appropriate
ventilation,
Storage room
for feeds and
supplies,
Laborers
quarter, Silo,
hay barn,
 Manure barn

Prepared by: Approved:

 FORM 4.2-1.1

REQUIRED TRAINING FACILITIES FOR WORK-BASED TRAINING

Trainees’ Training Training Activity/Task Tools Equipment Materials Facilities

Requirements
1. Checking the problems in
MAINTAIN Pliers, Grass cutter Lime House
farm and surrounding area
HOUSING, FARM Sprayer
according enterprises and Hammer Detergents Feeder
IMPLEMENTS AND Emergency lights
DENR standards. Disinfectants Waterer
Bolo and Weighing scale
SURROUNDING 2. Maintaining equipment, Hygiene Feedlot pens
scythe
AREAS tools and materials supplies Maternity pen
according to Occupational Shovel, Fertilizers Kidding/lambin
Safety and Health Hayfork, Fuels/lubricant g pen
Standards (OSHS). Wheel barrow s Brooms Calf hutches
Saw Dustpan Pail Stud pen for
Fire bulls
Plumbing extinguisher Milking
tools Garden hose barn/parlor
Nails with appropriate
ventilation
Storage room for
feeds and
supplies
Laborers
quarter Silo,
hay barn
Manure barn
Machinery shed
Farm office
Water and
power supplies
Working corral
with chute
Disposal area of
dead carcasses
 TRAINEE PROGRESS SHEET

Name : Janiel C. De La Pena Trainer : Anna Luna C. LLubit

Animal Production( Ruminants Nominal

Qualification : : 306 hours
) NC II Duration

Training Adjectival Numerical Student’ Instructor’s

Units of Competency Date Started Date Finished
Duration Grade Grade s Initial Initial

Prepare the dining room JUNE 11, JUNE 29, Competent 85 KBT MVA
/restaurant area for service 120 hours 2020 2020

Welcome guests and take July 2, 2020 August 4, Competent 90 KBT MVA
food and beverage orders 160 2020

Promote food and beverage KBT MVA

products 24

Provide food and beverage KBT MVA

services to guests 80

Provide room service KBT MVA

Receive and handle guest

concerns
 TRAINEE PROGRESS SHEET

Name : Trainer :

Nominal
Qualification : :
Duration

Units of Competency and Training Date Date Adjectival Numerical Student’s Instructor’s
Module Titles Duration Started Finished Grade Grade Initial Initial

1 Prepare the dining JUNE JUNE competent 85 MYL MVA

room /restaurant area for 11, 29, 2020
service 120 hours 2020

LOs

2
 Units of Competency and Training Date Date Adjectival Numerical Student’s Instructor’s
Module Titles Duration Started Finished Grade Grade Initial Initial

Total Average:

Note: The student and the instructor must have a copy of this form. The Numerical Grade will indicate the level of competence of the
trainee. The Adjectival Grade describes the skills competence of the trainee (competent /not competent)
 CLASS PROGRESS CHART

Qualification : Date Started :

Target Date
Trainer : :
to Finish

SAMPLE

Unit of Competency/Module Title

Receive Operate Provide

Provide club
Students and computerized accommodation
Conduct night audit reception Provide porter service
Name process reservations reception
services
reservation systems services

R1 O1 O2 O3 P1 P2 P3 P4 C1 C2 C3 PC1 PC2 PC3 PP1 PP2 PP3 PP4

Agbu, Jay X X X x X
Carl A.

Alguzar, X X X X X X
Marjun T.

Abarrientos X X X X X X
, Tiffany B

Almonia, X X X X X X X X x x x
Juvie T.
O1-Access,
Legends: R1- P1- Prepare C1- Monitor financial PC1- Provide PP1- Review reports
Perform create, transactions to
guest arrival information on on daily guest
 download
correct in accordance ensure accuracy of the club arrival and request
and retrieve
procedure with industry records services and for major guests
in receiving bookings for procedure process movement
and reservation C2- Prepare complete memberships
handling status routine records and
reservations P2- Welcome reports PP2- Handle guest
O2- Prepare and register PC2- Assist luggage on arrival
accurate guests C3- Provide feedback guest on and departure
reservation accordingly to appropriate membership
reports concern/office application-
PP3- Mark and
O3- Send and P3- Organize store luggage
receive guest PC3- Monitor accurately and
reservation departure guest entry to properly according
communications club according to to establishment
according to enterprise procedures and
established P4- Prepare procedures safety
standards accurately the requirements
registration
report
PP4- Respond to
request for bell
desk services
promptly
 CLASS PROGRESS CHART

Qualification : Date Started :

Target Date
Trainer : :
to Finish

Unit of Competency/Module Title

Students
Name

Legends:
 PERFORMANCE CRITERIA CHECKLIST
MONITORING WORK-BASED TRAINING

Trainee’s Name: _____ ____________ Date : _____________________

CRITERIA YES NO
RECEIVE AND HANDLE GUEST CONCERNS

1.

2.
a.

b.

c.

3.

4.
a.

b.

c. Operation of food processing equipment is

managed to achieve planned outcomes
d.

Comments/Suggestions:

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

Trainer’s Signature: ________________________ Date : _____________________

 TRAINING SESSION EVALUATION FORM
INSTRUCTIONS:
This post-training evaluation instrument is intended to measure how
satisfactorily your trainer has done his job during the whole duration of your
training. Please give your honest rating by checking on the corresponding cell of
your response. Your answers will be treated with utmost confidentiality.

TRAINERS/INSTRUCTORS Poor/ Fair/ Good/ Very Outsta

Unsatis Satisfa Adequa Good/ nding
factory ctory te Very
Name of Trainer: Satisfa
MELODY V. ACENAS ctory
1 5
2 3
4
1. Orients trainees about
CBT, the use of CBLM
and the evaluation
system
2. Discusses clearly the unit
of competencies and
outcomes to be attained
at the start of every
module
3. Exhibits mastery of the
subject/course he/she is
teaching
4. Motivates and elicits
active participation from
the students or trainees
5. Keeps records of
evidence/s of competency
attainment of each
student/trainees
6. Instill value of safety and
orderliness in the
classrooms and
workshops
7. Instills the value of
teamwork and positive
work values
8. Instills good grooming
and hygiene
9. Instills value of time
10. Quality of voice while
teaching
11. Clarity of
language/dialect used in
teaching
12. Provides extra
attention to trainees and
students with specific
learning needs
13. Attends classes
regularly and promptly
14. Shows energy and
enthusiasm while
teaching
15. Maximizes use of
training supplies and
materials
16. Dresses appropriately

17. Shows empathy

18. Demonstrates self-

control
 This post-training evaluation instrument is intended to measure how
satisfactorily your trainer prepared and facilitated your training. Please give your
honest rating by checking on the corresponding cell of your response. Your
answers will be treated with utmost confidentiality.

PREPARATION Poor/ Fair/ Good/ Very Outstan

Unsatis Satisfa Adequa Good/ ding
factory ctory te Very
Satisfa
ctory
1 2 3
4 5
1. Workshop layout
conforms with the
components of a CBT
workshop
2. Number of CBLM is
sufficient
3. Objectives of every
training session is well
explained
4. Expected
activities/outputs are
clarified
DESIGN AND DELIVERY Poor/ Fair/ Good/ Very Outsta
Unsatis Satisfa Adequa Good/ nding
factory ctory te Very
Satisfa
ctory
1 2 3
4 5
1. Course contents are
sufficient to attain
objectives
2. CBLM are logically
organized and presented
3. Information Sheet are
comprehensive in
providing the required
knowledge
4. Examples, illustrations
and demonstrations help
you learn
5. Practice exercises like
Task/Job Sheets are
sufficient to learn
required skills
6. Valuable knowledge are
learned through the
contents of the course
7. Training Methodologies
are effective
8. Assessment Methods and
evaluation system are
suitable for the trainees
and the competency
9. Recording of
achievements and
competencies acquired is
prompt and
comprehensive
10. Feedback about the
performance of learners
are given immediately
TRAINING Poor/ Fair/ Good/ Very Outsta
FACILITIES/RESOURCES Unsatis Satisfa Adequa Good/ nding
factory ctory te Very
Satisfa
ctory
1 2 3
4 5
1. Training Resources are
adequate
2. Training Venue is
conducive and
appropriate
3. Equipment, Supplies, and
Materials are Sufficient
4. Equipment, Supplies and
Materials are suitable and
appropriate
5. Promptness in providing
Supplies and Materials
 SUPPORT STAFF Poor/ Fair/ Good/ Very Outsta
Unsatis Satisfa Adequa Good/ nding
factory ctory te Very
Satisfa
ctory
1 2 3
4 5

1. Support Staff are

accommodating

Comments/Suggestions:

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________
1. Self Evaluation

The trainer shall design a self-evaluation questionnaire that he/she

shall answer after the conduct of the training. This shall serve as a
checklist of what he/she must do. A short sample is given below.

During the session, did I? Yes No

1. Establish an atmosphere of trust?

2. Encourage participation of the

trainees?
3. Assist the trainees when they needed
assistance?
4. Consider the feedback of trainees?

5. Remain aware of non verbal

communication?
6. Praise effort?

7. Summarize key points?

8. Vary activities and tasks to aid

attainment of competency?
9. Provide opportunities for practice?

10. Achieve the learning objectives?

Sample questions that the trainer could answer:

1. Were there any parts of the session which did not run as expected? Why?

2. Did any unexpected problem arise? Did I deal with them correctly?
3. Were the session outcomes achieved? If not, why?
4. Should anything be changed for the next training sessions?
 SELF-CHECK 4.3-2

Instructions: Answer the following questions briefly and responsively.

1. Why is Training Evaluation important?

2. What are the ways in evaluating training?

3. How can you encourage feedback from the trainees?

4. Why is there a need to summarize trainees progress chart/report?

 The Supervised Industry Training or On the Job Training Evaluation Form
below is a sample evaluation for to evaluate the implementation of SIT and OJT. It
is recommended that this evaluation form be used and improved so that
appropriate areas to be evaluated are covered.

SUPERVISED INDUSTRY TRAINING OR ON THE JOB TRAINING

EVALUATION FORM

Dear Trainees:
The following questionnaire is designed to evaluate the effectiveness of the
Supervised Industry Training (SIT) or On the Job Training (OJT) you had with the
Industry Partners of (your institution). Please check ( ) the appropriate box
corresponding to your rating for each question asked. The results of this
evaluation shall serve as a basis for improving the design and management of the
SIT in SICAT to maximize the benefits of the said Program. Thank you for your
cooperation.
Legend:
5 – Outstanding
4 – Very Good/ Very Satisfactory
3 – Good/Adequate
2 – Fair/ Satisfactory
1 – Poor/Unsatisfactory
NA – not applicable

Item Question Ratings

No.

INSTITUTIONAL EVALUATION 1 2 3 4 5 NA

Has (your institution) conducted an

orientation about the SIT/OJT program,
1
the requirements and preparations
needed and its expectations?

Has (your institution) the provided the

necessary assistance such as referrals or
2
recommendations in finding the company
for your OJT?

Has (your institution) showed

coordination with the Industry partner in
3
the design and supervision of your
SIT/OJT?

4 Has your in-school training adequate to

undertake Industry partner assignment
 and its challenges?

Has (your institution) monitored your

5
progress in the Industry?

Has the supervision been effective in

6 achieving your OJT objectives and
providing feedbacks when necessary?

Did (your institution) conduct assessment

7 of your SIT/OJT program upon
completion?

Were you provided with the results of the

8 Industry and (your institution)’s
assessment of your OJT?

Comments/Suggestions:
Item Question Ratings
No.

INDUSTRY PARTNER EVALUATION 1 2 3 4 5 NA

Was the Industry partner appropriate for

1 your type of training required and/or
desired?

Has the industry partner designed the

2 training to meet your objectives and
expectations?

Has the industry partner showed

3 coordination with (your institution) in the
design and supervision of the SIT/OJT?

Has the Industry Partner and its staff

4 welcomed you and treated you with
respect and understanding?

Has the industry partner facilitated the

training, including the provision of the
5 necessary resources such as facilities and
equipment needed to achieve your OJT
objectives?

Has the Industry Partner assigned a

6 supervisor to oversee your work or
training?

Was the supervisor effective in

7 supervising you through regular meetings,
consultations and advise?

Has the training provided you with the

necessary technical and administrative
8
exposure of real world problems and
practices?

Has the training program allowed you to

9 develop self-confidence, self motivation
and positive attitude towards work?

Has the experience improved your

10
personal skills and human relations?

11 Are you satisfied with your training in the

 Industry?

Comments/Suggestions:

Signature: _____________________________
Printed Name: __________________________ Qualification: _______________________
Host Industry Partner __________________ Supervisor: ________________________
Period of Training: _____________________ Instructor: ___________________________
 RATER B
A

PREPARATION Poor/ Fair/ Good/ Very Outstan

Unsatis Satisfa Adequa Good/ ding
factory ctory te Very
Satisfa
ctory
1 2 3
4 5
1. Workshop layout X
conforms with the
components of a CBT
workshop
2. Number of CBLM is X
sufficient
3. Objectives of every X
training session is well
explained
4. Expected X
activities/outputs are
clarified

PREPARATION Poor/ Fair/ Good/ Very Outstand

Unsatisf Satisfac Adequat Good/ ing
actory tory e Very
Satisfac
tory
1 2 3
4 5
1. Workshop layout X
conforms with the
components of a CBT
workshop
2. Number of CBLM is X
sufficient
3. Objectives of every X
training session is well
explained
4. Expected X
activities/outputs are
clarified
 RATER CRatings
Average

PREPARATION Poor/ Fair/ Good/ Very Outstan-

Unsatis- Satisfac Adequate Good/ ding
factory -tory Very
Satisfac
-tory
1 2
3 4 5
1. Workshop layout X
conforms with the
components of a CBT
workshop
2. Number of CBLM is X
sufficient
3. Objectives of every X
training session is well
explained
4. Expected X
activities/outputs are
clarified

PREPARATION Average
1. Workshop layout 4
conforms with the
components of a CBT
workshop
2. Number of CBLM is 4
sufficient
3. Objectives of every 4
training session is well
explained
4. Expected 4.33
activities/outputs are
clarified

TOTAL AVERAGE – 4.0825

 Range:

0.00 - 1.49 = Poor/Unsatisfactory

1.50 - 2.49 = Fair/ Adequate

2.50 - 3.49 = Good/Satisfactory

3.50 - 4.49 = Very Good/Very Satisfactory

4.50 - 5.0 = Outstanding

General Interpretation

___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

Recommendation:

___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________