Jose Rizal Memorial State University

Main Campus, Dapitan City

COLLEGE OF ENGINEERING

OJT/PRACTICUM STATUS REPORT

Name of Student: Host Company:
Course/Program: Company Name:
College : Contact Person/Supervisor:
Practicum Adviser Contact/Office Number:
OJT/Practicum Covered Total Number of Hours Covered:
Date Activity Learning’s Problems/Observations Plan of Action
Week 1
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Week 2
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Week 3 __________________________________ _____________________ _____________________ _____________________
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Week 4 __________________________________ _____________________ _____________________ _____________________
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Prepared by: _________________________________ Received by: ________________________________
Student’s Signature over Printed Name Instructor/OJT Supervisor
Date: ____________________________
NOTE: Print this form in multiple copies for your future/succeeding use, NOT valid without the signature of the Supervisor