Republic of the Philippines

Department of Education
REGION I
SCHOOLS DIVISION OF ILOCOS SUR
SAN JUAN DISTRICT
SOLOTSOLOT NATIONAL HIGH SCHOOL

Learner’s Name:
Immersion Industry:
Immersion Supervisor:
WORK IMMERSION EVALUATION FORM

Directions: Kindly rate the Work Immersion Trainee/Student’s performance according to the
rating scale below. Please a check (/) mark on the space that corresponds to your given
rating.

5 Outstanding (O) Trainee/Student’s performance was 90-100

impressive and outstanding. It exceeded that
performance on the trainee/student on the
tasks and/or activities assigned to him/her
4 Very Satisfactory Trainee/Student’s performance satisfied the 85-89
(VS) expectations of the industry supervisor
concerning the tasks/activities assigned to
him/her
3 Satisfactory (S) Trainees/Student’s performance satisfied the 80-84
expectations of the industry supervisor
concerning the tasks/activities assigned to
him/her. But, one or two areas still had to be
improved.
2 Fairly Satisfactory Work performance was okay, but there were 75-79
(FS) lots of areas that have to be given attention
to at least satisfy the target competencies.
1 Failed (F) Did not Meet Expectations 74 below

The work immersion trainee/student…

Work Habit Formation 5 4 3 2 1
1 Always come on time
2 Comes to work regularly and religiously
3 Show passion. Commitment and dedication
4 Performs tasks/activities independently
5 Demonstrates self-discipline, self-accountability and flexibility
6 Observes appropriate ethical behavior and/or attitude
7 Prioritizes and observes safety-conscious actions
8 Demonstrates honesty and dependability
Score

Address: Solotsolot, San Juan, Ilocos Sur “DREAM BIG, WORK HARD, SOAR HIGH”
Mobile No.: 09173184572
DepEd Tayo-Solotsolot National High School
 Republic of the Philippines
Department of Education
REGION I
SCHOOLS DIVISION OF ILOCOS SUR
SAN JUAN DISTRICT
SOLOTSOLOT NATIONAL HIGH SCHOOL

Work Skills and Competence 5 4 3 2 1

1 Handles details of the given tasks/activities
2 Provides relevant feedback to the management or supervisor
3 Performs the tasks based on the job/work description
4 Suggest solutions to problems
5 Can troubleshoot immediate concerns and issues by providing
solutions to problem
6 Can manipulate the tools and/or equipment in the workplace
concerning the assigned tasks recorded to his/her
specialization.
Score

Interpersonal and Human Relations Skills 5 4 3 2 1

1 Show respect in dealing with clients and industry supervisor
2 In properly groomed and well-poised
3 Accepts suggestions from industry supervisor, co-workers and
co-trainee in improving work performance
4 Demonstrates appropriate eye contact, gestures and language
in dealing with others in various situations
5 Demonstrates emotional maturity and stability.
Score

Comments:

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Signature overprinted name of WI Supervisor

Date:

Address: Solotsolot, San Juan, Ilocos Sur “DREAM BIG, WORK HARD, SOAR HIGH”
Mobile No.: 09173184572
DepEd Tayo-Solotsolot National High School