NAME OF STUDENT: ______________________________________

STUDENT’S POSITION: ______________________________________

NAME OF COMPANY: ______________________________________
COMPANY IMMERSION SUPERVISOR: ____________________________________
PERIOD COVERED: _______________________________________

PURPOSE:
Your evaluation is requested to guide the work immersion coordinator in determining a fair
grade to be given to the student-trainee assigned in your company. It is also intended to make the
student-trainee aware of his/her strengths and areas of improvement
TIMETABLE:
To enable us to monitor the progress of the student-trainee, it is requested that an evaluation be
done after 120 hours of training and after the completion of his/her assignment in your company
PROCEDURE:
1. It is suggested that the student-trainee’s immediate superior evaluates his/her
performance.
2. The evaluator should accomplish the evaluation form then rate the student as
objectively as possible.
3. After filling in the form, the evaluator should discuss the results of his/her
evaluation with the student-trainee.
4. The accomplishment evaluation form should then be awarded to the immersion
coordinator.
Using the scale below, write the number that corresponds to your trainee on the space provided
on the right-hand side:

5- OUTSTANDING 3- GOOD 1- NEEDS IMPROVEMENT

4- VERY GOOD 2- FAIR

I. WORK ATTITUDES AND HABITS (25 POINTS)

Courtesy in dealing with superiors and peers ___
Patience and diligence in performing assigned tasks ___
Punctuality and regularity in attendance ___
Neatness of the reports submitted on the scheduled time ___
Punctuality in submitting reports to assigned task ___

II. WORK KNOWLEDGE

Technical Knowledge __
Relate the theories to actual experience __
Open to constructive criticism __
Discreet, capable of observing prudent silence __
 III. PERSONALITY AND PERSONAL APPEARANCE
Reports for work neat and well-groomed __
Reports for work in proper attire __
Shows poise and self confidence __
Can easily deal with co-workers __

IV. PROFESSIONAL COMPETENCE (25 POINTS)

Work performance (entire duration of stay) __
Readily understands instructions __
Shares sound suggestions to problems __
Can cope with prescribed ethical standards __
Speaks audibility in well-modulated voice __
TOTAL POINTS: __

________________________________
Evaluator’s Printed Name and Signature

________________________________
Position

________________________________
Date

CONFORME:

______________________________
Ma. Isabel Abear
Immersion Adviser

APPROVED BY:

________________________________________
Dr. Sheba O. Nievares-Cabrera
Director, Health Services/ School Physician