Republic of the Philippines

Department of Education
Division of Oriental Mindoro
Aurelio Arago Memorial National High School

Work Immersion Evaluation Form

Student’s Name: _____________________________________________ Strand: ____________________
Partner Institution: _____________________________________________________________________
Training Period: ____________ to ___________________ Total Number of Hours Rendered: _________
Directions: For each behavioral item listed within the competency bands, with 5 being the most and 1 is the least,
please check the evaluation most suited.
5 Outstanding Perform exceeds the required standard
4 Very Satisfactory Performance fully met the job requirements.
Was able to perform what was expected of a person in his/her position.
3 Satisfactory Performance has met the required standard.
Can perform duties with minimal supervision.
2 Fair Performance partially met the required standard.
Less than satisfactory could be doing better.
1 Needs Improvement Performance does not meet the required standard.
Major improvements needed.
NA Not Applicable Performance indicator is not relevant to the job.

PERFORMANCE APPRAISAL
ATTENDANCE 5 4 3 2 1
Is punctual in a regular basis.
Maintains good attendance.
Informs supervisor in a timely manner when absenteeism and tardiness may occur.
WORK ETHICS
Shows a positive work attitude.
Shows sensitivity to and consideration for other’s feelings.
Accepts criticism positively.
Respects persons in authority.
Uses all tools, equipment and facilities responsibly.
Physical appearance conforms with the workplace rules and regulations.
HANDS-ON
Consistently produces quality results.
Meets deadlines and manages time well.
Can do multitasking.
Can work under pressure and delivers the required task.
Effective and efficient in time management.
Efficiently informs supervisor of any challenge or hindrance related to given task or
assignment.
TECHNICAL ASSISTANCE
Analyzes problems effectively.
Has the ability to make creative and effective solutions to problems.
Demonstrates good judgments in handling routine problems.
Follows all policies and procedures when issues and conflict arises.
Recognizes and takes immediate action to effectively address problems and opportunities
TOTAL POINTS ________________ Transmuted Grade: _____________

WRITTENWORK APPRAISAL
NARRATIVE REPORT 5 4 3 2 1
Good organization; points are logically ordered; sharp sense of beginning and end.
Ideas are expressed clearly.
Well-typed and neat bound with a cover.
The content and idea of a report focuses only on the activities done during the immersion period.
The narrative report is submitted on the given time.
PICTORIAL REPORT
The report is creatively presented.
Appropriate caption in each pictures are evident.
The report covers only the activities covers during the immersion period.
Neatness of the report is evident.
The pictorial report is submitted on the given time.
DIARY
Diary entries have appropriate details and show variety and clarity.
Student writes clearly; the message of each entry is clear.
Information in logical, interesting, and in a sequence which the reader can follow
Diary entries are submitted everyday.
TOTAL POINTS ________________ Transmuted Grade: _____________
________________________________ ______________________________
Signature of Student Signature of Immersion Supervisor
 TRANSMUTATION TABLE

PERFORMANCE APPRAISAL

100 100
97-99 99
94-96 98
91-93 97
88-90 96 WRITTEN APPRAISAL
85-87 95
81-84 94 75 100
78-80 93 72-74 98
75-77 92 69-71 96
71-74 90 66-68 94
68-70 88 63-65 92
65-67 86 60-62 90
61-64 84 57-59 88
58-60 82 54-56 86
55-57 80 51-53 84
51-54 78 48-50 82
48-50 75 45-47 80
45-47 73 41-44 78
41-44 72 38-40 76
38-40 71 35-37 75
35-47 70 31-34 73
31-34 69 28-30 72
28-30 68 25-27 70
25-27 67 21-24 68
21-24 66 18-20 66
18-20 65 15-17 65
11-14 64
15-17 64
8-10 63
11-14 62
5-7 62
8-10 62
2- 4 61
5-7 61 1 60
1-4 60
0 0