REPUBLIC OF THE PHILIPPINES

LUBANG VOCATIONAL HIGH SCHOOL

Tangal, Lubang

Name of Student Grade and Section

School Immersion Site

Track Strand/ Specialization

Duration of Work
Immersion

School Partnerships Contact

Focal Person Number

Work Immersion Contact

Teacher Number

INDUSTRY IMMERSION PERFORMANCE EVALUATION FORM

Instructions: This evaluation form is to be accomplished by the immediate supervisor of the trainee and to be returned to
the Work Immersion Teacher. Put a check on the box that describes the trainee most accurately. Get the sum of the value
for all responses and record in the total score section.

COMPETENCIES 5 4 3 2 1
Excellent Good Average Fair Poor
A. Behavior /Attitude
1. Submit him/herself to immediate supervisor.
2. Show or practice respect and honestly within/out of
workplace.
3. Maintain constant level of performance on the assigned
tasks.
4. Use initiative in interpreting and following instructions.
5. Show resourcefulness in going beyond the assigned jobs.
6. Show special attitude for doing neat, accurate beyond
required amount of work.
7. Cooperate eagerly and cheerfully in all activities.
8. Demonstrate working level of skill/knowledge in area of
expertise. Apply professional and technical expertise to
best meet task needs.
9. Demonstrate leadership abilities.
10. Exercise solid listening, written, and oral communication
skills.
B. Attendance and Punctuality
1. Always prompt and regular, and willing to work
overtime.
2. Come/Report to workplace on time.
3. Attend regularly the work schedule.
4. Utilize time allocation for task accomplishment
C. Skills
1. Apply safety practices on the workplace.
2. Use Personal Protective clothing and Equipment (PPE) in
performing assigned tasks.
3. Use appropriate tools and equipment on the assigned
tasks.

INDUSTRY IMMERSION PERFORMANCE EVALUATION FORM-LUBANG DISTRICT HOSPITAL

 4. Inspect/clean/maintain tools and work area before and
after work.
5. Keep/arrange tools and equipment on their proper place.
6. Perform housekeeping activities.
7. Observe proper waste disposal.
8. Apply accurate measurement in performing tasks.
9. Read and record required measurements.
10. Perform simple calculations based on the job requirement.
11. Demonstrate accurate reading measurements.
12. Cut variety of vegetable according to dishes:
a. Pork stew
b. Caldereta
c. Chopsuey
d. Afritada
e. Paksiw na isda
13. Cook dishes following appropriate cooking methods:
a. Pork stew
b. Caldereta
c. Chopsuey
d. Afritada
e. Paksiw na isda
f. Beef steak
g. Pork Adobo
h. Fried fish
i. Rice
14. Cut meats and poultry products according to a given
menu.
15. Set table according to the standards of Lubang District
Hospital.
16. Perform skirting in table preparation.
17. Select packaging appropriate for the preservation of
product freshness and eating characteristics.
18. Serve food selections promptly from service areas.
TOTAL SCORE_______________

Describe the student-trainees areas of strengths:

Describe the student-trainees areas that need improvement:

Other recommendations:

Industry Supervisor’s Signature Position

Industry Supervisor’s Printed Name Date

Name of Industry Address

INDUSTRY IMMERSION PERFORMANCE EVALUATION FORM-LUBANG DISTRICT HOSPITAL

INDUSTRY IMMERSION PERFORMANCE EVALUATION FORM-LUBANG DISTRICT HOSPITAL