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.

INDUSTRY IMMERSION PERFORMANCE EVALUATION FORM-LUBELCO

 2. Use Personal Protective clothing and Equipment
(PPE) in performing assigned tasks.
3. Use appropriate tools and equipment on the assigned
tasks.
4. Inspect/clean/maintain tools and work area before
and after work.
5. Keep/arrange tools and equipment on their proper
place.
6. Apply accurate measurement in performing tasks.
7. Read and record required measurements according
to LUBELCO’s specification.
8. Perform simple calculations based on the job
requirement.
9. Demonstrate accurate reading measurements.
10. Install new electrical connections.
11. Observe safety procedure in installing electrical
connections.
12. Check installation based on the job requirements.
13. Connect electric meter according to manufacturer’s
specifications.
14. Disconnect electric meter according to
manufacturer’s specifications.
15. Check electrical lines according to the job
requirements following PEC and NEC.
16. Rehabilitate electrical lines according to the job
requirements following PEC and NEC.

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-LUBELCO

INDUSTRY IMMERSION PERFORMANCE EVALUATION FORM-LUBELCO