Work Appraisal Form 1

Republic of the Philippines
DEPARTMENT OF EDUCATION
Region VII-Central Visayas
DIVISION OF LAPU-LAPU CITY
ASIAN LEARNING CENTER SENIOR HIGH SCHOOL
WORK IMMERSION PERFORMANCE APPRAISAL
School Year ______________
Student’s Name :___________________________ Strand :___________________
Partner Institution :___________________________
Address :___________________________ Contact No. ________________
Work Immersion Supervisor:____________________ Position :________________
Training Period :___________ to ________________ 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.
4 Very Satisfactory Performance fully met 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 meets 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.
COMPETENCIES 5 4 3 2 1
A.TEAM WORK
1. Consistently works with others to accomplish goals and tasks.
2. Treats all team members in a respectful and courteous manner.
3. Actively participates in activities and assigned tasks required.
4.Willing to work with team members to improve team collaboration on a continuous
basis.
5.Considers the feedback and views of team members when completing an assigned task.
Total Score/5
COMPETENCIES 5 4 3 2 1
B.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.
Total Score/4
C.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.
Total Score/3
D.PRODUCTIVITY/RESILIENCE 5 4 3 2 1
1. Consistently produces quality results.

2. Meets deadlines and manages time well.
3. Can do multi-tasking.
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.
Total Score/6
E.INITIATIVE/PROACTIVITY 5 4 3 2 1
1. Completes assignments with minimum supervision.
2. Completes tasks independently and consistently.
3. Seeks support as the need arises.
4. Recognizes and takes immediate action to effectively address problems and
opportunities.
5. Engages in continuous learning
6. Contributes new ideas and shares skills to improve the department/organization.
Total Score/6
F.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 judgment in handling routine problems.
Total Score/3
G.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 the workplace.
4. Displays high level of performance at all times.
Total Score/4
H.ATTITUDE 5 4 3 2 1
1. Offers assistance willingly.
2. Shows a positive work attitude.
3. Shows sensitivity to and consideration for other’s feelings.
4. Accepts criticism positively.
5. Shows pride in work.
Total Score/5
I.PROFESSIONALISM 5 4 3 2 1
1. Respects persons in authority.
2. Uses all tools, equipment and facilities responsibly.
3. Follows all policies and procedures when issues and conflict arises.
4. Physical appearance conforms with the workplace and placement
rules.
Total Score/4 Total Weighted
Average:
OVER-ALL RATING
SUMMARY OF RATINGS Transmutation Table
WEIGHTED
CRITERIA Computed Weighted Equivalent
AVERAGE
Average Grade
A.Team work
4.20 – 5.00 98
B.Communication
3.40 – 4.19 95
C.Attendance & Punctuality
2.60 – 3.39 90
D.Productivity/Resilience
1.80 – 2.59 85
E.Initiative/Proactivity
1.00 – 1.79 80
F.Judgment/Decision Making
G.Dependability/Reliability
H.Attitude
I.Professionalism
Over-All Weighted Average
Equivalent Grade
______________________________ ______________________________
Student’s signature above Printed Name Work Immersion Supervisor’s Signature
Above Printed Name

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Republic of the Philippines

C.ATTENDANCE AND PUNCTUALITY 5 4 3 2 1

1. Consistently produces quality results.

SUMMARY OF RATINGS Transmutation Table

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