Region XII

DIVISION OF SULTAN KUDARAT

ISULAN NATIONAL HIGH SCHOOL
SENIOR HIGH SCHOOL
Isulan, Sultan Kudarat

Work Immersion Program:

STUDENT’S PERFORMANCE APPRAISAL FORM
Student’s Name:
Partner Institution Supervisor:
Partner Institution:
Period Under Review:

Rating Scale:
1- Unsatisfactory or Poor Performance. Performance does not meet the required standard. Major
improvement needed.
2- Fair Performance. Performance partially meets the required standard. Less than satisfactory could
be doing better.
3- Good or Average Performance. Performance has met the required standard. Can perform duties
with minimal supervision.
4- Very Good or Outstanding Performance. Performance exceeds the required standards.

Instruction: For each behavioral item listed within the competency bands, please select the
evaluation most suited.
A. Teamwork Target Actual
Rating Rating
1. Consistently work with others to accomplish goals and tasks. 4
2. Treats all team members in a respectful courteous manner. 4
3. Actively participates in activities and assigned task as required. 4
4. Willingly works with team members to improve team collaboration on a 4
continuous basis.
TOTAL
B. Communication
1. Actively listens to supervisor and/or co-worker. 4
2. Comprehends written and oral information. 4
3. Consistently delivers accurate information both written and oral. 4
4. Reliably provides feedback as required, both internal and external. 4

TOTAL
C. Attendance and Punctuality
1. Is punctual on regular basis. 4
2. Maintain a good attendance. 4
3. Inform supervisor in a timely manner when absent. 4
TOTAL
D. Productivity
1. Consistently delivers quality results. 4
2. Has the ability to meet deadlines and manages time effectively and 4
efficiently.
3. Has the ability to multi-task. 4
4. Has the ability to work around problems and obstacle in a stressful situation 4
in order to achieve the required task.
5. Efficiently inform supervisor of any challenges or barriers relevant to given 4
task or assignment.
TOTAL
E. Initiative
1. Has the ability to complete assignment without the need of prompting from 4
the supervisor and others.
 2. Successfully completes tasks independently and consistently. 4
3. Seeks additional support necessary and engages in continuous learning. 4
4. Recognizes and takes appropriate action effectively address problems and 4
opportunities.
TOTAL
F. Judgement/Decision Making
1. Analyzes problems effectively. 4
2. Demonstrates the ability to make creative and effective solutions to 4
problems.
TOTAL
G. Dependability/Reliability
1. Has the ability to follow through and meet required deadlines. 4
2. Is personally accountable for his/her environment. 4
3. Adapt effectively to change in the work environment. 4
4. Displays a consistent level of high performance. 4
TOTAL
H. Attitude
1. Offers assistance willingly. 4
2. Makes positive contribution. 4
3. Shows sensitively to and consideration to other’s feeling. 4
4. Accepts constructive criticism positively. 4
5. Shows pride in work. 4
TOTAL
I. Professionalism
1. Respect those in authority. 4
2. Uses all tools, equipment and machine responsibly. 4
3. Follows all policies and procedures when issues and conflicts may arise. 4
4. Shows conductive physical appearance in work environment and placement 4
rules.
TOTAL
Accumulated Points : (140) TOTAL Average

Comments and Recommendation:

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Signature Over Printed Name
(Partner Institution Supervisor)