Work Immersion2 Logbook - Pnhs 1 2

Republic of the Philippines
Department of Education
Region XII
Division of South Cotabato
East District
POLOMOLOK NATIONAL HIGH SCHOOL
Barangay Cannery, Polomolok, South Cotabato
STUDENT
WORK
IMMERSION
LOGBOOK (Simplified)
Name of student
School
Immersion venue
Region XII
East District
TABLE OF CONTENTS
Page
Introduction to Student Work Immersion Logbook 3
PART I – Supporting Documents 4
1.1 Student Profile and Contact Information 4

1.2 Employer and School Contact Information 5
1.3. Student Learning Agreement 6
1.4 Indemnity Form 7
1.5 Personal Learning Plan 8
PART 2 – Program Activities 9
2.1 Preparation Checklist for Work Immersion

Placement 10
2.2 Workplace Induction Checklist 11
2.3 Daily Journal (Journal 1 – 10) 12
2.4 Student Evaluation of Work Immersion 22
PART 3 – Employer Evaluation and Certificate 23
3.1 Employer Evaluation of Student Performance 23

3.2 Employer Certificate to Confirm Students Work
Experience Provided 24
Region XII
East District
INTRODUCTION:
To achieve the goals of K to 12 Basic Education Program, Work
immersion has been incorporated into the curriculum as a requirement for graduation.
Generally, this aims to acquaint the learners formally to a real life workplace
environment. This will help explore between the knowledge and skills acquire in the
school with those needed in the real working situations.
Specifically, this enables the students to demonstrate the broad role and
importance of their earned skills and knowledge in the workplace. This will serve also
as a foundation to prepare the learners for working efficiently and effectively..
Furthermore, through this program, the students can be ready for their big step
in working and be comfortable with the work-related conditions in line with their
specialization. They will experience the social interaction in work environment that
would help them as they graduate and face the real life.
The Student Immersion Logbook is divided into three (3) parts:
PART ONE:
This includes information on your profile, your host employer and your school. It also
contains learning agreement and indemnity form that you will sign to be part of this
immersion program.
PART TWO:
Includes information on the roles of your school, your employer and yourself
during immersion placement. It also contains your preparation checklist for work
immersion placement, daily journal and evaluate your work immersion.
PART THREE:
Includes two sections which need to be completes by your host employer at
the end of your work immersion placement. You need to make sure that both sections
in this part are completed before you leave the workplace.
(3)
Region XII
East District
PART ONE
1.1 STUDENT PROFILE AND CONTACT INFORMATION:
Full Name
Surname First Name Middle Name
Learner’s Ref. Number
Grade and Section
Name of School Polomolok National High School
Student’s Contact Number
Home Address
E-mail Address
Father’s Name
Occupation
Name of Parent or
Mother’s Maiden
Guardian
Name
Occupation
Contact No. of Parent
Track and Strand
Why I chose to study this

(Track and Strand)
My future goals
What I hope to learn

during my work
immersion?
Previous immersion I have

had.
(4)
Region XII
East District
1.2 EMPLOYER AND SCHOOL CONTACT INFORMATION:
Employer Contact Information:
Name of Employer
Address of
Employer
E-mail Address
Employer Phone
No.
Main Employer Name

Contact Person
Designation Contact No.
Second Employer Name

Contact Person
Designation Contact No.
School Contact Information
Polomolok National High School

Name of School
Barangay Cannery Site, Polomolok, South Cotabato

Address of the School
E-mail Address
School Phone Number

Name MURDY F. BAUTISTA, PhD.Ed.
School Principal
Contact Number
Name LIZA A. SABA
Class Adviser
Contact Number
Name JEFFERSON V. PABLO
Immersion Teacher
Contact Number 09387322820
Name KENNETH A. JOCSON
SHS Coordinator/
Immersion Coordinator Contact Number 09124815471
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Region XII
East District
1.3 STUDENT LEARNING AGREEMENT
Congratulations you have been selected to participate in the work immersion

This is a wonderful opportunity for you to learn about your chosen occupation and to
improve your employment prospects.
You will be assigned at __________________________________________________

(Name of Employer)
for ____ days, from _______________________ to ______________________.
You need to remember that you are now an ambassador for your school. Your
behavior in your workplace needs to be professional. During your work placement you
need to comply with your school’s code of conduct as well as the rules of your host
employer. Any problem or discipline matters that may arise will be managed by your
school.
During your work placement, you will be required to:
• Adhere to the work hours required by the employer.

• Follow the instructions of the workplace representative responsible for you.
• Comply with safety and other rules in the workplace. This include following the
dress code and wearing the required personal protective equipment.
• Be punctual.
• Maintain professional behavior at all times.
• Take responsibility for making your workplace experience valuable.
• Complete the activities in your workplace.
• Ensure that your host employer completes and signs off the required sections in
your logbook.
When you return to the school, you will be required to:
• Hand in your fully completed logbook.

• Give feedback on your immersion.
I hereby agree that I will be responsible for adhering to the requirements outlined above
Student School Employer
Name
Signature
Date
(6)
Region XII
East District
1.4 INDEMNITY FORM

(To be completed by Parent / Guardian)
I/We ____________________________________________ the parent /

( Full name and surname)
guardian of the student, hereby indemnify____________________________________,

(name of the temporary host employer)
its employees and its agents against any claims of any nature whatsoever which may
be brought against them by the student,____________________________________

(full name and surname of the student)
or any third party or other person claiming on behalf of the student arising out of the
student’s untoward incidents or injury or loss of damage to the student’s property as a
result of entering into and remaining on _____________________________________

(name of temporary host employer)
premises, whether the claim is based on _____________________________________

(name of temporary host employer)
negligence of any of its employees or agents for which they may be liable .
____________________________________________
(Guardian’s / Parent’s Name and Signature)
_____________________________________________
(Relationship to the Student)
_____________________________________________
(Date)
(7)
Region XII
East District
1.5 PERSONAL LEARNING PLAN

(To be signed by the students, teachers and employers)
My work Immersion Program journey begins with me and setting my personal

learning goals. Together with my work Immersion Coordinator and Instructors, I’ve
identified the following competencies I aim to strengthen:
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
Together with my Work placement Officer (Supervisor), I’ve identified the

following skills I am to practice and/or develop further:
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
Through this Work Immersion, I wish to learn more about:
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
Student School Employer
Name
Signature
Date
(8)
Region XII
East District
PART TWO: PROGRAM ACTIVITIES

The Roles of the School, Partners and Students during Placement
The success of the Work Immersion Placement depends on each

stakeholder in the process understanding and carrying their roles effectively.
The School roles are to:
• Ensure that the work immersion placement provided to students, are

appropriate.
• Ensure that the students are adequately supervised by their host employer.
• Monitor the placement of students to endure that they are going according to
plan and to address any problems encountered.
The Partners Roles are to:
• Provide students with experience that is appropriate to their track and strand.
• Manage and supervise the students on a day-today basis. This includes
assigning students to one or more company employees who will: oversee their
daily workplace activities, assist them in working through their student logbooks
and support them with other any arrangements made with the school.
• Ensure that the company employees who work with the students are
adequately briefed about the work immersion requirements, including the
logbook. They need to know what to expose the students to and what practical
tasks to give them while they are in the workplace. In addition, they need to
know how to supervise and work with the students in a manner that makes their
learning experience valuable.
• Induct and orient students to the business, its rules and regulations (especially
those concerning health and safety), and its various departments and how
these are concerned.
• Report any problems experienced during the placements to the relevant school
representative as soon as possible.
The Students Roles are to:
• Report on time each day and engage in the activities arranged for them.
• Take responsibility for making work immersion placement a meaningful and
successful experience. This includes showing initiative asking questions and
engaging with workplace employees.
• Speak to the employer representative responsible for them and contact their
school representative as soon as possible if they have problem.
• Obtain the information they need to complete their logbook through observing,
asking questions and engaging to work activities. They also need to ensure that
employer representatives sign and complete the required section in their
logbook.
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Region XII
East District
2.1 Preparation Checklist for Work Immersion Placement

This checklist contains a summary of all the tasks you need to complete for
your work immersion placement. Some of these tasks must be completed before the
start of your work placement, while others during and after. Use the checklist to help
you track of what you have done and what still you need to do by ticking off each tasks
after you have completed it.
THINGS TO DO BEFORE THE START OF YOUR WORK Tick
IMMERSION PLACEMENT when
done
Give your parent/guardian the letter from your school about your
1
work immersion placement (letter to be provided by your school )
2 Fill in the ‘student profile’ form. (Part 1 / 1.1)
3 Fill in the ‘employer and school contact information form. (Part 1/1.2)
Complete the “learning agreement” (Part 1/1.3). Ensure that it is
signed by the school representative, an employer representative and
4 yourself.
Complete the “indemnity form” (Part 1/1.4). If you are under 18 years
5 old, this needs to be signed by your parent or guardian. And if you’re
18 and above, you need to sign it.
With the help of a Teacher, fill the student Personal Learning Plan”
6 (Part 1/1.5). You, your Teacher, and your employer need to sign the
completed Personal Learning Plan.
7 Make transport arrangements to get to your host employer.
Find out what personal protective equipment (PPE) your host
8 employer requires and make sure you have them.
Ensure you bring the logbook with you to the workplace to complete
9
the daily journal for each day of your placement (Part 2/2.3)
COMPLETION OF LOGBOOK DURING AND AFTER YOUR WORK
IMMERSION PLACEMENT
Complete the “work induction checklist” (Part 2/2.2) on the first day of
10
your work immersion placement.
During your work immersion placement, fill in your daily journal (Part
11. 2/2.3) Ask the person who supervised you each day to sign your
journal.
12. After your placement, evaluate your experience. (Part 2/2.4)
COMPLETION OF EMPLOYER SECTIONS AT THE END OF YOUR
PLACEMENT. BUT BEFORE YOU LEAVE THE WORKPLACE
. Ask your workplace supervisor to complete the evaluation on you.
13
(Part 3/3.1)
. Ask your workplace supervisor to complete the certificate about
14
your placement (Part 3/3.2)
PROVIDE FEEDBACK ON YOUR WORK IMMERSION AFTER
PLACEMENT
Share your experience in the workplace with your school and other
15.
learners.
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Region XII
East District
2.2 Workplace Induction Checklist
Please tick off the items in the checklist below once you have completed. You
also need to fill in the additional information required. This checklist should be
completed on the first day of your placement.
I T E M S Tick
1. I have the name and address of my host employer.

2. 2. I have the name and contact number of the person in the workplace who
is responsible for me during my placement.
3. Name of my supervisor:
Contact number of my supervisor:
3.I know who I will be reporting to on a day-to-day basis in the workplace.
Day When / Date To whom I will report daily?
One
Two
Three
Four
Five
Six
Seven
Eight
Nine
Ten
4. I have been introduced to the I will be working with.
5. I know the rules of my host employer.
6. I know what my host employer expects of me while I am in the workplace.
Things they expect of me include:
a)
b)
c)
d)
e)
7. I know what time I need to be at work daily and when lunch time is. These
are as follows:
Work Hours:
Lunch Time:
8. I have been given a tour of workplace premises and will be able to find my
way around.
9. If I have a problem during my placement I know what to do.
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Region XII
East District
2.3 DAILY JOURNAL
Journal: Day One
Date Time In Time Out No. of Hours

/ /
Tasks you did New knowledge and/or skills you learned
1 1
2 2
3 3
4 4
5 5
To be completed by the Supervisor at the workplace responsible for the student for
the day.
Supervisor’s Comment/s:
Student’s Name: Supervisor’s Name:

School: Polomolok National High School Job Title:
Signature: Signature:
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Region XII
East District
Journal: Day Two

/ /
1 1
2 2
3 3
4 4
5 5
the day.

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Region XII
East District
Journal: Day Three

/ /
1 1
2 2
3 3
4 4
5 5
the day.

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Region XII
East District
Journal: Day Four

/ /
1 1
2 2
3 3
4 4
5 5
the day.

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Region XII
East District
Journal: Day Five

/ /
1 1
2 2
3 3
4 4
5 5
the day.

(16)
Region XII
East District
Journal: Day Six

/ /
1 1
2 2
3 3
4 4
5 5
the day.

(17)
Region XII
East District
Journal: Day Seven

/ /
1
1
2
2
3
3
4
4
5
5
the day.

(18)
Region XII
East District
Journal: Day Eight

/ /
1 1
2 2
3 3
4 4
5 5
the day.

(19)
Region XII
East District
Journal: Day Nine

/ /
1 1
2 2
3 3
4 4
5 5
the day.

(20)
Region XII
East District
Journal: Day Ten

/ /
1 1
2 2
3 3
4 4
5 5
the day.

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Region XII
East District
2.4 STUDENT’S EVALUATION OF WORK IMMERSION

Answer the questions that follow about your workplace experience.
1. Did you feel adequately prepared by your school for your work immersion
placement? Explain your answer. For instance, did you have information about
the employer hosting you? Did you know what would be required of you and
how to complete your logbook?
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
2. Was your immersion relevant to what you have learned in the Track and Strand
at school? If yes, give few examples of how it related to this.
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
____________________________________________________________________
3. Rate and comment on the value of your work immersion.
Not at all Not that useful Fairly useful Very useful Extremely
useful (2) (3) (4) useful (5)
(1)
Give reasons for your rating.

_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
What did you find most valuable about your work immersion?
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
What did you find least valuable about your work immersion?
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
4. How do you think your work immersion could have been improved?
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
5. Other comments:
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
(22)
Region XII
East District
Part Three : EMPLOYER EVALUATION AND CERTIFICATE

3.1 Employer Evaluation of Student Performance
Name of Learner:
________________________ _____________________ ____________________
Last Name First Name Middle Name
1. Rating of students. Encircle the number that best applies in each case where:
1 = very poor 2 = poor 3 = fair 4 = good 5 = very good
NO ITEMS BEING RATED RATING

1 Knowledge of technical field. The student displayed
knowledge of his/her technical field appropriate to his / her 1 2 3 4 5
level of study.
2 Practical competence. The student was effectively
carryout tasks at a level appropriate to his / her level of 1 2 3 4 5
training.
3 Ability to learn. The student was able to easily learn new
1 2 3 4 5
things.
4 Interest in work. The student ask questions and showed
1 2 3 4 5
an interest in the work.
5 Takes initiative. The student looked for work to do and
1 2 3 4 5
acted voluntarily.
6 Communication skills. The student was able to make her/
himself adequately understood and could follow spoken 1 2 3 4 5
and written instructions.
7 Punctuality. The student arrived at work on time and kept
1 2 3 4 5
time.
8 Housekeeping and tidiness. The student displayed the
correct attitude to housekeeping activities and willingly 1 2 3 4 5
engaged in this.
9 Safety. The student understood and followed safety work
1 2 3 4 5
practices
10 Attitude and cooperation. The student showed
willingness and a good attitude and was able to get along 1 2 3 4 5
with others.
Sub-Total
Final Score
2. Overall comments on the student’s performance.
_____________________________________________________________________
_____________________________________________________________________
3. Does the student display the qualities you would look for in an employee?
Please explain.
_____________________________________________________________________
____________________________________________________________________
Name Job Title Signature
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Region XII
East District
GUIDELINES FOR WORK IMMERSION PROGRAM
(COMPILATION OF RELEVANT PROVISIONS FROM THE REPUBLIC

ACTS, DEPARTMENT ORDERS AND ADVISORIES)
I. CONCEPT OF IMMERSION:
Work immersion is that part of the Senior High School (SHS) Curriculum
consisting of 80 hours of hands-on experience or work simulation which the
grades 11 and 12 students will undergo to expose them to the actual
workplace setting and enrich the competencies provided by the school under
the supervision of the School Head and the designated personnel of the
Partner. The 80 hours may be scheduled for no more 8 cumulative or
consecutive hours per day. All Technical – Vocational Institutions (TVIs)
offering Senior High School shall also be governed by the DepEd guidelines on
the 80-hour work immersion. All applicable safety guidelines of TESDA and
DOLE relevant to the basic education shall apply.
Work Immersion shall not be considered as employment arrangement by

only to serve the K-12 Program purpose of exposing the students to the
actual workplace setting and augment the competencies provided by the
school. (Ref. Labor Advisory No. 8, s. 2016, para II)
II. CONDITIONS FOR WORK IMMERSION OF STUDENTS IN THE

WORKPLACES.
The following conditions shall be observed for the protection of SHS

students undergoing work immersion.
1. The work immersion shall be allowed only between 8:00 o’clock in the
morning and 5:00 o’clock in the afternoon;
2. Work immersion for students below 15 years old and with permission
from their parent or guardian, shall be longer than 4 hours in any given
day.
3. SHS Students regardless of age shall not be allowed for work
immersion in industries and activities considered as hazardous in
accordance with DOLE Department Order No. 149, s. 2016, and:
Work immersion shall in no case result in the replacement of or diminution of
benefits of the workers in the partner enterprise / company. (Ref. Labor
Advisory No. 8, s. 2016, para III)
III. HAZARDOUS WORKS AND ACTIVITIES
Work and activities under the following INDUSTRIAL and OCCUPATIONAL

classifications which would subject the child to the conditions provided under
Section 2 of DOLE Department Order No. 149, s. 2016, are declared
hazardous to persons below 18 years of age.
a. Industrial Classifications – refers to the classification of industries

under the 2009 Philippine Standard Industrial Classification published
by the National Statistical Coordination Board. (Ref. DOLE Department
Order No. 149, s. 2016, Sec. 4)
1. Mining and Quarrying – These include the extraction of minerals
occurring naturally as solids (coal and ores), liquids (petroleum0 or
gases (natural gas0. Extraction can be achieved by different
methods such as underground or surface mining, well operation
and seabed mining.
2. Construction – This includes general construction and specialized
construction activities for buildings (such as dwellings, office
buildings, stores farm buildings and other public and utility
buildings0 and civil engineering works (such as motorways, streets,
bridges, tunnels railways, airfields, harbours and other water
projects, irrigation systems, sewerage systems, industrial facilities,
pipelines and electric lines, sports facilities). It includes new works,
repairs, additions and alterations, the erection of prefabricated
buildings or structures on the site and also construction of a
temporary nature.
3. Transportation and Storage – These include the provision of
passenger or freight transport , whether scheduled or not, by rail,
road, water or air and associated activities such as terminal and
parking facilities, cargo handling and storage. Also included are the
renting of transport equipment with driver or operator, and the
postal and courier activities.
4. Water Supply ; Sewerage, Waste Management and Remediation
Activities – These include activities related to the management of
various forms of waste, such as solid or non-solid industrial or
household waste, as well as contaminated site.
5. Forestry and Logging – These include the production of round wood
for the forest-based manufacturing industries as well as the
extraction and gathering of wild-growing non-wood forest products.
6. Fishing and Aquaculture – These include capture fishery and
aquaculture, covering the use of fishery resources from marine,
brackish or fresh water environments, with the goal of capturing or
gathering fish, crustaceans, mollusks and other marine organisms
and products.
7. Hunting, Trapping and Related Service Activities – These include
hunting and trapping on a commercial basis, taking of animals (dead
or alive) for food, fur, skin, or for use in research, in zoos or as pets
or production of fur skins, reptiles, or bird skins from hunting or
trapping activities.
8. Security and Investigation – These include security-related services
such as security and detective services; guard and patrol services; or
picking up or delivering money, receipts or other valuable items
with personnel and equipment to protect such properties while in
transit.
9. Manufacturing of alcoholic beverages, tobacco, pyrotechnics,
rubber and plastic products, chemicals and chemical products, basic
metals and weapons and ammunitions.
b. Occupational Classifications – refers to the classification of
occupations under the 2012 Philippine Standard Occupational
Classification published by the National Statistical Coordination Board.
1. Farmers and other Plant Growers
- Preparatory activities
- Tending activities
- Harvesting activities
- Post harvesting activities
2. Animal Producers
- Rearing activities
- Harvesting activities
- Post-harvesting activities
- Work in slaughterhouse or abattoirs
3. Physical Science, Life Science, and health Associate Professionals
- Operating radiation emitting machines
- Processing human/animal body fluids
- Child as human sample in experiments
4. Sales and Services Elementary Occupations
- Use of dangerous power tools
- Exposures to hazardous materials
- Exposure to extreme environments
- Exposure to verbal or physical abuse
- Lifting of heavy loads
- Selling of items prohibited to minors
- Delivery service-related tasks
5. Personal and Protective service Workers
- Travel related tasks in dangerous activities
- Personal care of sick persons and adults
- Housekeeping-related tasks
- Restaurant service-related tasks
- Preparing and serving alcoholic beverages
- Exposure to sexual abuse Funeral services
6. Customer Service Clerks
- Sales and technical support services
- Work in gambling facilities
7. Craft and Trade Workers
- Operation of high power machinery
- Lifting heavy loads
- Exposure to hazardous materials and environments
- Tasks related to textile and garment
Region XII
East District
LIST OF TASKS / ACTIVITIES TO BE DONE DURING IMMERSION
Name of Student Grade & Sec.

Name of School Polomolok National High School Immersion Site
Track Strand/Specialization
Duration of WI 80 hours. Target Course-College
School Partnership
KENNETH A. JOCSON Contact No. 09124815471
Focal Person
WI Teacher Contact No.
Time Actual Expected

Competencies Tasks / Activities
Allotment Schedule Output
NOTE: Students shall not be given other activities outside of those previously agreed upon,
which are anchored on the stated competencies.
CERTIFIED CORRECT:
__________________________________ ___________________________________
Student’s Signature Over Printed Name Parent’s Signature Over printed Name
_________________________________ ____________________________________
Work Immersion Teacher Over Printed Industry Supervisor’s Signature Over Printed
Name Name
Region XII
East District
LIST OF TASKS / ACTIVITIES TO BE DONE DURING IMMERSION

Name of Student Grade & Sec.
Name of School Immersion Site
Track ACADEMIC Strand/Specialization HUMSS
Duration of WI 80 hours. Target Course-College
School Partnership
KENNETH A. JOCSON Contact No. 09124815471
Focal Person
WI Teacher JEFFERSON V. PABLO Contact No. 09387322820
Time Actual Expected

Competencies Tasks / Activities Allotment Schedule Output
COMMON COMPETENCIES
* Inspect/clean tools and work area.
* Store/arrange tools and shop equipment
1.Perform Shop * Dispose waste/used lubricant. 4 hours
Maintenance *report damaged tools/equipment
2.Perform * Select measuring instrument.
Mensuration and *Carryout measurement and calculation 6 hours
Calculation *Maintain measuring instrument
*Identify and assess manual
specification.
*Interpret manuals. 6 hours
3.Read, Interpret, *Apply information in manual.
and Apply, *Store manuals.
*Adjust contact point clearance.
*Perform ignition wiring installation.
*Adjust ignition timing.
*Repair non-electronic ignition system.
4. Apply * Identify appropriate sealant/adhesive.
Appropriate * Prepare surface for sealant/adhesive. 6 hours
Sealant/Adhesive. *Apply sealant/adhesive evenly.
*Store/Dispose of sealant/adhesive.
5. Use and Apply * Identify types of lubricants/coolants.
Lubricant/Coolant * Use and apply lubricants/coolants. 4 hours
*Perform housekeeping activities.
6. Move and * Prepare vehicle for driving.
Position Vehicle * Move and position vehicle. 2 hours
CORE COMPETENCIES.
1.Service *Test automotive battery.
Automotive * Remove and replace batteries..
Battery * Service and charge battery. 4 hours
* Jump start vehicle.
2. Test and Repair *Test electrical system.
Wiring/Lighting * Repair electrical system.
system *Test/Repair starting system.
3. Service Ignition * Check ignition system.
System * Perform spark test.
* Check ignition coil resistance
* Check ballast resistor. 11 hours
* Adjust contact point resistance
*Perform ignition wiring installation.
* Adjust ignition timing.
* Repair non-electronic ignition system.
*Check/adjust valve clearance.
*Inspect/test spark plug.
*Check/replace fuel filter and air cleaner.
* Inspect/replace contact
points/condenser.
4. Perform Gas
* Adjust engine idle speed and mixture. 9 hours
Engine Tune-up.
* Test/adjust dwell angle and ignition
setting.
* Check advance mechanism and adjust
ignition timing.
* Conduct compression test.
*Install the injection pump following the
5. Perform Diesel correct timing. 5 hours
Engine Tune-up * Bleeding injection fuel pump.
* conduct compression testing.
* Check fluid and lines.
* Inspect brake system.
*Check/change manual transmission and
differential gear oil.
6. Perform Under
* Inspect/replace power steering fluid.
Chassis
* Check/refill automatic transmission
Preventive
fluid.
Maintenance.
* Inspect/bleed air tank.
* Check tires and tires pressure.
* Check under chassis body parts bolts
and nuts.
NOTE: Students shall not be given other activities outside of those previously agreed upon,
which are anchored on the stated competencies.
CERTIFIED CORRECT:
__________________________________ ___________________________________
Student’s Signature Over Printed Name Parent’s Signature Over printed Name
_________________________________ ____________________________________
Work Immersion Teacher Over Printed Industry Supervisor’s Signature Over Printed
Name Name
Region XII
East District
READINESS ASSESSMENT CHECKLIST
No I T E M S Yes No / None
1 Do you have a copy of DepEd Order No. 30. S. 2017?

and DepEd Order No. 39, s. 2018
2 Have you organized School Technical Working Group (STWG)
3 Have you identified the following:
a. School Partnership Focal Person?
b. Work Immersion Teacher?
c. Work Immersion Partner Institution Supervisor?
(one per Workplace immersion Venue)
4 Have you discussed the duties and responsibilities of the following:
a. School Partnership Focal Person?
b. Work Immersion Teacher?
c. Work Immersion Partner Institution Supervisor?
(one per Workplace immersion Venue
5 Have you conducted an orientation with the parents and students?
6 Do the Parental Consent forms of all students have been signed?
7 Have you appropriated amount for the expected Immersion Expenses
8 Do all your students that will undergo immersion have been
insured?
9 Have you identified your Work Immersion Delivery Model?
10. Have you conducted a Work Immersion Partnership Forum?
11. Do your MOA has been approved by the Schools Division
Superintendent?
12 Do your leaners has undergone touring (a day before the actual
Work Immersion, for familiarization purposes.)
NOTE: If all the items has been complied, then YOU ARE READY TO START
YOUR WORK IMMERSION ACTIVITIES.
CHECKED BY:
AGNES L. CAJUCOM
Senior High School Coordinator
APPROVED:
MURDY F. BAUTISTA, PhD.Ed

School Principal II
Region XII
East District
References:
1. DepEd Order No. 30, s. 20 17, dated June 5, 2017.
Guidelines for Work Immersion
2. DepEd Order No. 39, s. 2018
3. Labor Advisory No. 8, s. 2016, para III, dated 30 June 2016

“ Protection for SHS Students on K to 12 work Immersion Program”
4. Labor Advisory No. 9, s. 2017, dated 14 July 2017

“Guidance to Host Establishments in Ensuring Safe Workplaces for SHS
Students under Work immersion Program”
5. DOLE – Department Order No. 149, s. 2016

“Guidelines in Assessing and Determining Hazardous Work in the Employment
of Persons Below 18 Years of Age”
6. TESDA Training Regulations
7. Mindanao Times, dated 24 September 2018

“K – 12 Work Immersion Program of SHS Students”
8. Policy Guidelines on SHS Work Immersion

By: JOSE S. SANDOVAL, Division Chief, Employment Service Policy and
Regulation Division, Bureau of Local Employment , DOLE
9. Republic Act No. 9231 – “An Act Providing for the Elimination of the Worst
Forms of Child Labor and Affording Stronger Protection for the Working Child
otherwise known as “Special protection of Children Against Child Abuse,
Exploitation, and Discrimination Act”
Region XII
East District
Contents:
A. Readiness Assessment Checklist
B. Guidelines for Work Immersion

Program.
C. List of Tasks / Activities to be

Done during Immersion.
D. Immersion Logbook
E. Memorandum of Agreement
(MOA)
F. Work Immersion Monitoring and

Evaluation Tool

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Introduction to Student Work Immersion Logbook 3

PART I – Supporting Documents 4

1.1 Student Profile and Contact Information 4

PART 2 – Program Activities 9

2.1 Preparation Checklist for Work Immersion

PART 3 – Employer Evaluation and Certificate 23

3.1 Employer Evaluation of Student Performance 23

school with those needed in the real working situations.

as a foundation to prepare the learners for working efficiently and effectively..

The Student Immersion Logbook is divided into three (3) parts:

Track and Strand

Why I chose to study this

What I hope to learn

Previous immersion I have

1.2 EMPLOYER AND SCHOOL CONTACT INFORMATION:

Employer Contact Information:

Main Employer Name

Second Employer Name

School Contact Information

Polomolok National High School

Barangay Cannery Site, Polomolok, South Cotabato

School Phone Number

1.3 STUDENT LEARNING AGREEMENT

Congratulations you have been selected to participate in the work immersion

You will be assigned at __________________________________________________

During your work placement, you will be required to:

• Adhere to the work hours required by the employer.

When you return to the school, you will be required to:

• Hand in your fully completed logbook.

Student School Employer

1.4 INDEMNITY FORM

I/We ____________________________________________ the parent /

guardian of the student, hereby indemnify____________________________________,

be brought against them by the student,____________________________________

student’s untoward incidents or injury or loss of damage to the student’s property as a

result of entering into and remaining on _____________________________________

premises, whether the claim is based on _____________________________________

1.5 PERSONAL LEARNING PLAN

My work Immersion Program journey begins with me and setting my personal

Together with my Work placement Officer (Supervisor), I’ve identified the

Through this Work Immersion, I wish to learn more about:

Student School Employer

PART TWO: PROGRAM ACTIVITIES

The success of the Work Immersion Placement depends on each

The School roles are to:

• Ensure that the work immersion placement provided to students, are

The Partners Roles are to:

The Students Roles are to:

2.1 Preparation Checklist for Work Immersion Placement

2.2 Workplace Induction Checklist

1. I have the name and address of my host employer.

2.3 DAILY JOURNAL

Journal: Day One

Date Time In Time Out No. of Hours

Tasks you did New knowledge and/or skills you learned

Student’s Name: Supervisor’s Name:

Journal: Day Two

Date Time In Time Out No. of Hours

Tasks you did New knowledge and/or skills you learned

Student’s Name: Supervisor’s Name:

Journal: Day Three

Date Time In Time Out No. of Hours