Republic of the Philippines

Department of Education
Region VII, Central Visayas
Division of Cebu Province

Kansi National High School

Kansi, Tuburan, Cebu

S.Y. 2023-2024

PERFORMANCE EVALUATION FORM

Inclusive Dates:____________________
NAME OF TRACK &
STUDENT SPECIALIZATION

WORK WORK
IMMERSION IMMERSION
PARTNER PARTNER
INSTITUTION INSTITUTION
SUPERVISOR

For each behavioral item listed within the competency, please rate the student using the
following rating scale below by writing the number that corresponds to the rating.

1- Poor performance, when performance does not meet the required standard. Needs major
improvements.

2- Fair performance, when performance partially meets the required standard.

3- Average performance, when performance has met the required standard. Can perform duties
with minimal supervision.

4- Outstanding performance, when performance exceeds the required standard.

A. TEAMWORK 4 3 2 1
1. Consistently works with others to accomplish goals and tasks.

2. Treats all team members in respectful courteous manner.

3. Actively participates in activities and assigned tasks as 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 competing an

assigned task.

SUB-RATING (Add scores/number of items)

B. COMMUNICATION 4 3 2 1
1. Actively listens to supervisor and/or co-workers.

2. Comprehends written and oral information.

3. Consistently delivers accurate information both written and orally

4. Reliably provides feedback as required, both internally and externally.

SUB-RATING (Add scores/number of items)

C. ATTENDANCE AND PUNCTUALITY 4 3 2 1

1. Is punctual on a regular basis.

2. Maintains a good attendance.

3. Informs supervisor in timely manner when absenteeism and lateness may

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occur.

SUB-RATING (Add scores/number of items)

D. PRODUCTIVITY/ RESILIENCE 4 3 2 1

1. Consistently delivers quality results.

2. Ability to meet deadlines and manages time well.

3. Ability to multi-task.

4. Ability to work around problems and obstacles in a stressful situation in order

to achieve the required task.

5. Time management is effective and efficient.

6. Efficiently informs supervisor of any challenges or barriers relevant to given

task or assignment.

SUB-RATING (Add scores/number of items)

E. INITIATIVE/ PROACTIVE 4 3 2 1

1. Ability to complete assignments without the need for prompting from the
supervisors and / or others.

2. Successfully completes task independently and consistently,.

3. Seek additional support when necessary.

4. Recognizes and takes appropriate action to effectively address problems

and opportunities.

5. Engages in continuous learning.

6. Contributes new ideas and always seeks ways to improve the department/
organization.

SUB-RATING (Add scores/number of items)

F. DEPENDABILITY/ RELIABILITY 4 3 2 1
1. Ability to follow through and meet required deadlines.

2. Is personally accountable for his/her actions.

3. Adapts effectively to changes in the work environment.

4. Displays a consistent level of high performance.

SUB-RATING (Add scores/number of items)

G. ATTITUDE 4 3 2 1
1. Offers assistance willingly.

2. Make positive contribution to morale.

3. Shows sensitivity to and consideration for other feelings.

4. Accepts constructive criticism positively.

5. Show pride in work.

SUB-RATING (Add scores/number of items)

H. PROFESSIONALISM 4 3 2 1
1. Respects those authority.

2. Uses of tools, equipment and machines responsibly.

3. Follows all policies and procedures when issues and conflicts may arise.

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4. Accepts constructive criticism positively.

5. Shows pride in work.

SUB-RATING (Add scores/number of items)

SUMMARY OF RATINGS

A. Teamwork

B. Communication

C. Attendance and Punctuality

D. Productivity/ Resilience

E. Initiative/ Proactive

F. Dependability/ Reliability

G. Attitude

H. Professionalism

FINAL RATING ( Add scores/8)

Supervisor’s Comments:

Student’s/Trainee’s Comments:

________________________ _____________________
Name and Signature of Student Date

______________________ _____________________

Name and Signature of Supervisor Date