Directions: For Each Behavioral Item Listed Within The Competency Bands, With 5 Being The Most and 1 Is

Republic of the Philippines
Region IV-A
WORK IMMERSION PERFORMANCE APPRAISAL

(Work Immersion Venue)

STUDENT’S NAME: ___________________________________________ STRAND:_____________
Partner Institution: _____________________________________________
_____________________ Address: ______________________________ Contact No: ______________
_____________________ Work Immersion Supervisor: ______________________________________
_____________________ Position: ______________________ Training Period: ________________ to
_____________________ Total No. of Hours Rendered: __________________________________
Directions: For each behavioral item listed within the competency bands, with 5 being the most and 1 is
the least, please select the evaluation most suited.
5 Outstanding Performance exceeds the required standard.

Performance fully met job requirements. Was able to perform what
4 Very Satisfactory
was expected of.
Performance has met the required standard. Can perform duties
3 Satisfactory
with minimal supervision.
Performance partially meets required standard. Less than
2 Fair
satisfactory could
1 Needs Improvement Performance does not meet the required standard. Major Improve
NA Not Applicable Performance indicator is nor relevant to the job.
COMPETENCIES 5 4 3 2 1
TEAMWORK
1. Consistently works with other to accomplish goals and tasks
2. Treats all team members in a respectful courteous manner.
3. Actively participates in activities and assigned task required.

4. Willing to work with team members to improve team collaboration
on continuous basis,
5. Considers the feedback and views of team members when
completing an assigned task.
TEAMWORK Total Score /5
Region IV-A

COMPETENCIES 5 4 3 2 1
COMMUNICATION
1. Actively listens to supervisor and/or co-workers.
2. Comprehends written and oral information
3. Consistently delivers accurate information both written and oral.
4. Reliably provides feedback as required both internally and externally
COMMUNICATION Total Score /5
ATTENDANCE AND PUNCTUALITY 5 4 3 2 1
1. Is punctual on a regular basis.

2. Maintains good attendance
3. Informs supervisor in a timely manner when absenteeism and tardiness
may occur.
ATTENDANCE AND PUNCTUALITY Total Score /5
PRODCTIVITY/RESILIENCE 5 4 3 2 1
1. Consistently produce quality results.

2. Meets the deadlines and manages time well.
3. Can do multitasking.
4. Can work under pressure and delivers the required tasks.
5. Effective and efficient in time management.
6. Efficiently informs supervisor of any challenge or hindrance related
to given task or assignment.
PRODCTIVITY/RESILIENCE Total Score /5
INITIATIVE /PROACTIVITY 5 4 3 2 1
1. Completes assignments within minimum supervision

2. Completes tasks independently and consistently
3. Seeks support as need arises
4. Recognizes and takes immediate action to effectively address
problem
5. Engages in continuous learning
6. Contributes new ideas and shares skills to improve the
department/organization
INITIATIVE /PROACTIVITY Total Score /5
Region IV-A

JUDGEMENT/DECISION MAKING 5 4 3 2 1
1. Analyzes problems effectively

2. Has the ability to make creative and effective solutions to problems
3. Demonstrates good judgement in handling routine problems
JUDGEMENT/DECISION MAKING Total Score /5
DEPENDABILITY/RELIABILITY 5 4 3 2 1
1. Has the ability to follow through and meet deadlines.

2. Has commitment for his/her action
3. Can adjust easily to changes in work place
4. Displays high level of performance at all times
DEPENDABILITY/RELIABILITY Total Score /5
ATTITUDE 5 4 3 2 1
1. Offers assistance willingly

2. Shows positive work attitude
3. Shows sensitivity and consideration for other’s feelings
4. Accepts criticism positively
5. Shows pride in word
ATTITUDE Total Score /5
PROFESSIONALISM 5 4 3 2 1
1. Respects person in authority

2. Use all tools, equipment and facilities responsibly
3. Follows all policies and procedures when is use and conflict
arises
4. Physical appearance conforms with the workplace and
placement rules
PROFESSIONALISM Total Score /5
Weighted Equivalent
Average Grade
OVERALL RATING
Region IV-A

SUMMARY OF SCORES
CRITERIA WEIGHTED
AVERAGE
TEAMWORK
COMMUNICATION
ATTENDANCE & PUNCTUALITY
PRODUCTIVITY/RESILIENCE
INITIATIVE/PROACTIVITY
JUDGEMENT/DECISION MAKING
DEPENDABILITY/RELIABILITY
ATTITUDE
PROFESSIONALISM
Over-all Weighted Average
Equivalent Grade
REMARKS: (Comments/Suggestions)
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Student’s Signature: _______________________________ Date: ________________________
Work Immersion Supervisor’s Signature over Printed Name ___________________________________
Transmutation Table
Computed Weighted Average Equivalent Grade
4.20 – 5.00 100
3.40 – 4.19 95
2.60 – 3.39 90
1.80 – 2.59 85
1.00 – 1.79 80

Directions: For Each Behavioral Item Listed Within The Competency Bands, With 5 Being The Most and 1 Is

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Republic of the Philippines

WORK IMMERSION PERFORMANCE APPRAISAL

WORK IMMERSION PERFORMANCE APPRAISAL

5 Outstanding Performance exceeds the required standard.

NA Not Applicable Performance indicator is nor relevant to the job.

1. Consistently works with other to accomplish goals and tasks

2. Treats all team members in a respectful courteous manner.

3. Actively participates in activities and assigned task required.

WORK IMMERSION PERFORMANCE APPRAISAL

ATTENDANCE AND PUNCTUALITY 5 4 3 2 1

1. Is punctual on a regular basis.

1. Consistently produce quality results.

1. Completes assignments within minimum supervision

WORK IMMERSION PERFORMANCE APPRAISAL

1. Analyzes problems effectively

1. Has the ability to follow through and meet deadlines.

1. Offers assistance willingly

1. Respects person in authority

WORK IMMERSION PERFORMANCE APPRAISAL

Student’s Signature: _______________________________ Date: ________________________

Work Immersion Supervisor’s Signature over Printed Name ___________________________________

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Student’s Signature: _______ Date: