APPENDICES AQUA - Copy

SAMPLE DATA GATHERING INSTRUMENT
FOR TRAINEE’S CHARACTERISTICS
Name: ____________________________ Date: ______________
Please answer the following instrument according to the

characteristics described below. Encircle the letter of your choice that best
describes you as a learner. Blank spaces are provided for some data that
need your response.
CHARACTERISTCS OF LEARNERS
Language, Average grade in: Average grade in:

literacy and
English Math
numeracy (LL&N)
a. 95 and above a. 95 and above
b. 90 to 94 b. 90 to 94
c. 85 to 89 c. 85 to 89
d. 80 to 84 d. 80 to 84
a. 75 to 79 e. 75 to 79
Cultural and Ethnicity/culture:

language a. Bisaya
background
b. Muslim
c. Bla’an
d. Ilonggo
e. Ilocano
f. T’boli
g. Others( please specify)_____________
Education & Highest Educational Attainment:

general a. Junior High School Level
knowledge
b. Senior High School Level
c. High School Graduate
d. Diploma Graduate
Document No. OAP-NCII-01

Date Developed:
Issued by:
MARCH 2024
SAINT MARGARETH Page 146
APPENDIC Developed by: TVETCInc.
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ES GABRIEL L.
BALBUENA Revision # 00
e. College Level
f. College Graduate
g. with units in Master’s degree
h. Masteral Graduate
i. With units in Doctoral Level
j. Doctoral Graduate
Sex a. Male
b. Female
Age Your age: _____
Physical ability 1. Disabilities(if any)_____________________

2. Existing Health Conditions (Existing illness
if any)
a. None
b. Asthma
c. Heart disease
d. Anemia
e. Hypertension
f. Diabetes
g. Others(please specify) ___________________
Number of years as a competency trainer
Previous
______
experience with
the topic
Previous List down trainings related to your

learning qualification
experience ___________________________
___________________________
___________________________
National Certificates acquired and NC level

Training Level
___________________________
completed
___________________________
Special courses Other courses related to your qualification

a. Units in education
b. Master’s degree units in education
c. Others (please specify)
_________________________

Date Developed:
MARCH 2024 Issued by:
APPENDICE SAINT MARGARETH Page 147
S Developed by: TVETCInc.
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GABRIEL L.
Learning styles a. Visual - The visual learner takes mental
pictures of information given, so in order
for this kind of learner to retain
information, oral or written, presentations
of new information must contain diagrams
and drawings, preferably in color. The
visual learner can't concentrate with a lot
of activity around him and will focus better
and learn faster in a quiet study
environment.
b. Kinesthetic - described as the students in
the classroom, who have problems sitting
still and who often bounce their legs while
tapping their fingers on the desks. They are
often referred to as hyperactive students
with concentration issues.
c. Auditory- a learner who has the ability to
remember speeches and lectures in detail
but has a hard time with written text.
Having to read long texts is pointless and
will not be retained by the auditory learner
unless it is read aloud.
d. Activist - Learns by having a go
e. Reflector - Learns most from activities
where they can watch, listen and then
review what has happened.
f. Theorist - Learns most when ideas are
linked to existing theories and concepts.
g. Pragmatist - Learns most from learning
activities that are directly relevant to their
situation.
Other needs a. Financially challenged
b. Working student
c. Solo parent
d. Others (please specify)
___________________________

Date Developed:
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GABRIEL L.
FORM 1.1 SELF-ASSESSMENT CHECK
INSTRUCTIONS: This Self-Check Instrument will give the trainer necessary

data or information which is essential in planning training sessions. Please
check the appropriate box of your answer to the questions below.
BASIC COMPETENCIES
CAN I…? YES NO
UC1: PARTICIPATE IN WORKPLACE COMMUNICATION
1.1 Obtain and convey workplace information 
1.2 Participate in workplace meetings and discussions 
1.3 Complete relevant work-related documents 
UC2: 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 
UC3: 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 
UC4: 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 OHS awareness 
COMMON COMPETENCIES

Date Developed:
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CAN I…? YES NO
UC 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 tools, materials and outfit 
UC2: USE FARM TOOLS AND EQUIPMENTS
2.1 Select and use farm tools 
2.2 Select and operate farm equipment 
2.3 Perform preventive maintenance 
UC3: PERFORM ESTIMATION AND CALCULATIONS
3.1 Perform estimation 
3.2 Perform basic workplace calculation 
UC4: DEVELOP AND UPDATE INDUSTRY KNOWLEDGE
4.1 Seek information on the industry 
4.2 Update industry knowledge 
UC5: PERFORM RECORD KEEPING
5.1 Carry out inventory activities 
5.2 Maintain production record 
5.3 Prepare financial records 
CORE COMPETENCIES
CAN I…? YES NO
UC1: RAISE ORGANIC CHICKEN
1.1 Select healthy stocks and suitable housing 
1.2 Set-up cage equipment 

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1.3 Feed chicken 
1.4 Grow and harvest chicken 
UC2: PRODUCE ORGANIC VEGETABLES
2.1 Establish nursery 
2.2 Plant seedlings 
2.3 Perform plant care and management 
2.4 Perform harvest and post-harvest activities 
UC3: PRODUCE ORGANIC FERTILIZER
3.1 Prepare composting area and raw materials 
3.2 Compost and harvest fertilizer 
UC4: PRODUCE ORGANIC CONCOCTIONS AND EXTRACTS
4.1 Prepare for the production of various 

concoctions
4.2 Process concoctions 
4.3 Package concoctions 
Note: In making the Self-Check for your Qualification, all

required competencies should be specified. It is
therefore required of a Trainer to be well- versed of the
CBC or TR of the program qualification he is teaching.

Date Developed:
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FORM 1.2 EVIDENCES/PROOF OF
CURRENT COMPETENCIES
Form 1.2: Evidence of Current Competencies acquired related to

Job/Occupation
Current competencies Proof/Evidence Means of validating
BASIC COMPETENCIES
UC1: PARTICIPATE IN Certificate of Oral interview

WORKPLACE Employment
Written Examination
COMMUNICATION
Cert of Training
Submitted copy of
TOR Authenticated TOR
1.1 Obtain and convey workplace

information
1.2 Participate in workplace

meetings and discussions
1.3 Complete relevant work-

related documents
UC2: WORK IN TEAM Certificate of Oral interview

ENVIRONMENT Employment
Written Examination
Cert of Training
Submitted copy of
2.1 Describe team role and scope
2.2 Identify own role and

responsibility within team
2.3 Work as a team member
UC3: PRACTICE CAREER Certificate of Oral interview

PROFESSIONALISM Employment
Written Examination

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Cert of Training Submitted copy of
Authenticated TOR
TOR
3.1 Integrate personal objectives

with organizational goals
3.2 Set and meet work priorities
3.3 Maintain professional growth

and development
UC4: PRACTICE Certificate of Oral interview

OCCUPATIONAL HEALTH AND Recognition
Written Examination
SAFETY
Cert of Training
Portfolio
Certificate of
Employment
4.1 Identify hazards and risks
4.2 Evaluate hazards and risks
4.3 Control hazards and risks
4.4 Maintain OHS awareness
COMMON COMPETENCIES
UC1: APPLY SAFETY Certificate of Oral interview

MEASURES IN FARM achievement
Submitted copy of
OPERATIONS
Cert of training Portfolio
1.1 areas of concern for safety

measures
1.2 Apply appropriate safety

measures
1.3 Safekeep/dispose tools,

materials and outfit

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UC2: USE FARM TOOLS AND Certificate of Oral interview
EQUIPMENT Recognition
Submitted copy of
Cert of Training Portfolio
2.1 Select and use farm tools
2.2 Select and operate farm

equipment
2.3 Perform preventive

maintenance
UC3: PERFORM ESTIMATION Certificate of Oral interview

AND BASIC CALCULATION Recognition
Submitted copy of
3.1 Perform estimation
3.2 Perform basic workplace

calculation
UC4: DEVELOP AND UPDATE Certificate of Oral interview

INDUSTRY KNOWLEDGE Recognition
Submitted copy of
4.1 Seek information on the

industry
4.2 Update industry knowledge
UC5: PERFORM RECORD Certificate of Oral interview

KEEPING Recognition
Submitted copy of

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5.1 Carry out inventory activities
5.2 Maintain production record
5.3 Prepare financial records
IDENTIFYING TRAINING GAPS
From the accomplished Self-Assessment Check (Form 1.1) and the

evidences of current competencies (Form 1.2), the Trainer will be able to
identify what the training needs of the prospective trainee are.
Form 1.3 Summary of Current Competencies versus Required

Competencies
Required Units of Current Training

Competency/Learning Competencies Gaps/Requirements
Outcomes based on CBC
BASIC COMPETENCIES
UC1: PARTICIPATE IN WORKPLACE COMMUNICATION
1.1 Obtain and 1.1 Obtain and

convey convey
workplace workplace
information information

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1.2 Participate in 1.2 Participate in
workplace workplace
meetings and meetings and
discussions discussions
1.3 Complete 1.3 Complete

relevant work relevant work
related related
documents documents
UC2: WORK IN TEAM ENVIRONMENT
2.1 Describe team role and 2.1 Describe team

scope role and scope
2.2 Identify own role and 2.2 Identify own

responsibility within team role and
responsibility within
team
2.3 Work as a team 2.3 Work as a team

member member
UC3: PRACTICE CAREER PROFESSIONALISM
3.1 Integrate personal 3.1 Integrate

objectives with personal objectives
organizational goals with organizational
goals
3.2 Set and meet work 3.2 Set and meet

priorities work priorities
3.3 Maintain professional 3.3 Maintain

growth and development professional growth
and development
UC4: PRACTICE OCCUPATIONAL HEALTH AND SAFETY

PROCEDURES

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4.1 Identify hazards and 4.1 Identify hazards
risks and risks
4.2 Evaluate hazards and 4.2 Evaluate

risks hazards and risks
4.3 Control hazards and 4.3 Control hazards

risks and risks
4.4 Maintain OHS 4.4 Maintain OHS

awareness awareness

COMMON COMPETENCIES
UC1: APPLY SAFETY MEASURES IN FARM OPERATIONS
1.1 Select and use farm 1.1 Select and use

tools farm tools
1.2 Apply appropriate 1.2 Apply

safety measures appropriate safety
measures
1.3 Safekeep/dispose tools, 1.3

materials and outfit Safekeep/dispose
tools, materials and
outfit
UC2: USE FARM TOOLS AND EQUIPMENTS
2.1 Select and use farm 2.1 Select and use

tools farm tools
2.2 Select and operate farm 2.2 Select and

equipment operate farm
equipment
2.3 Perform preventive 2.3 Perform

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maintenance preventive
maintenance
UC3: PERFORM ESTIMATION AND BASIC CALCULATION
3.1 Perform estimation 3.1 Perform

estimation
3.2 Perform basic 3.2 Perform basic

workplace calculation workplace
calculation
UC4: DEVELOP AND UPDATE INDUSTRY KNOWLEDGE
4.1 Seek information on 4.1 Seek

the industry information on the
industry
4.2 Update industry 4.2 Update industry

knowledge knowledge
UC5: PERFORM RECORD KEEPING
5.1 Carry out inventory 5.1 Carry out

activities inventory activities
5.2 Maintain production 5.2 Maintain

record production record
5.3 Prepare financial 5.3 Prepare

records financial records

CORE COMPETENCIES
1.1 Select healthy stocks 1.1 Select healthy

and suitable housing stocks and suitable
housing

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GABRIEL L.
1.2 Set-up cage equipment 1.2 Set-up cage equipment
1.3 Feed chicken 1.3 Feed chicken
1.4 Grow and harvest chicken 1.4 Grow and harvest

chicken
2.1 Establish nursery 2.1 Establish nursery
2.2 Plant seedlings 2.2 Plant seedlings
2.3 Perform plant care and 2.3 Perform plant care and
management management
2.4 Perform harvest and post-harvest 2.4 Perform harvest and

activities post-harvest activities
3.1 Prepare composting area and 3.1 Prepare composting

raw materials area and raw materials
3.2 Compost and harvest fertilizer 3.2 Compost and harvest

fertilizer
UC4: PRODUCE ORGANIC CONCOCTIONS AND EXTRACTS
4.1 Prepare for the production of 4.1 Prepare for the

various production of various
concoctions concoctions
4.2 Process concoctions 4.2 Process concoctions
4.3 Package concoctions 4.3 Package concoctions
FORM NO. 1.4: TRAINING NEEDS
Using Form No.1.4, convert the Training Gaps into a Training Needs/
Requirements. Refer to the CBC in identifying the Module Title or Unit of
Competency of the training needs identified.

Date Developed:
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Training Needs Module Title/Module of
Instruction
(Learning Outcomes)
1.1 Select healthy stocks and suitable

housing
1.2 Set-up cage equipment RAISING ORGANIC

CHICKEN
1.3 Feed chicken
1.4 Grow and harvest chicken
2.1 Establish nursery

PRODUCING ORGANIC
2.2 Plant seedlings VEGETABLES
2.3 Perform plant care and management
2.4 Perform harvest and post-harvest activities

PRODUCING ORGANIC
3.1 Prepare composting area and raw materials FERTILIZER
3.2 Compost and harvest fertilizer
UC4: PRODUCE ORGANIC CONCOCTIONS

AND EXTRACTS PRODUCING ORGANIC
CONCOCTIONS AND
4.1 Prepare for the production of various EXTRACTS
concoctions
4.2 Process concoctions
4.3 Package concoctions

Date Developed:
of 165
GABRIEL L.

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SAMPLE DATA GATHERING INSTRUMENT

FOR TRAINEE’S CHARACTERISTICS

Name: ____________________________ Date: ______________

Please answer the following instrument according to the

Language, Average grade in: Average grade in:

Cultural and Ethnicity/culture:

Education & Highest Educational Attainment:

Document No. OAP-NCII-01

Physical ability 1. Disabilities(if any)_____________________

Previous List down trainings related to your

National Certificates acquired and NC level

Special courses Other courses related to your qualification

Document No. OAP-NCII-01

Document No. OAP-NCII-01

INSTRUCTIONS: This Self-Check Instrument will give the trainer necessary

CAN I…? YES NO

UC1: PARTICIPATE IN WORKPLACE COMMUNICATION

1.1 Obtain and convey workplace information 

1.2 Participate in workplace meetings and discussions 

1.3 Complete relevant work-related documents 

UC2: 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 

UC3: 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 

UC4: PRACTICE OCCUPATIONAL HEALTH AND SAFETY

4.1 Identify hazards and risks 

4.2 Evaluate hazards and risks 

4.3 Control hazards and risks 

4.4 Maintain OHS awareness 

Document No. OAP-NCII-01

UC 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 tools, materials and outfit 

UC2: USE FARM TOOLS AND EQUIPMENTS

2.1 Select and use farm tools 

2.2 Select and operate farm equipment 

2.3 Perform preventive maintenance 

UC3: PERFORM ESTIMATION AND CALCULATIONS

3.1 Perform estimation 

3.2 Perform basic workplace calculation 

UC4: DEVELOP AND UPDATE INDUSTRY KNOWLEDGE

4.1 Seek information on the industry 

4.2 Update industry knowledge 

UC5: PERFORM RECORD KEEPING

5.1 Carry out inventory activities 

5.2 Maintain production record 

5.3 Prepare financial records 

CAN I…? YES NO

UC1: RAISE ORGANIC CHICKEN

1.1 Select healthy stocks and suitable housing 

1.2 Set-up cage equipment 

Document No. OAP-NCII-01

1.4 Grow and harvest chicken 

UC2: PRODUCE ORGANIC VEGETABLES

2.1 Establish nursery 

2.2 Plant seedlings 

2.3 Perform plant care and management 

2.4 Perform harvest and post-harvest activities 

UC3: PRODUCE ORGANIC FERTILIZER

Name: ______________ Date: