Form 4.1 Self-Assessment Checklist
Form 4.1 Self-Assessment Checklist
Region IV-A
NAME OF INSTITUTION
Institution’s Address
FORM 1.1
SELF-ASSESSMENT CHECKLIST
INSTRUCTION:
This Self-Check Instrument will give your trainer a data that is essential in
designing a Training Plan for you. Please check the appropriate box of your
answer to each of the questions below.
CAN I? . . . . YES NO
BASIC COMPETENCIES
1. Participate in workplace communication
a. Obtain and convey workplace communication
b. Participate in workplace meetings and
discussions
c. Complete relevant work related documents
2. Work in team environment
a. Describe team role and scope
b. Identify own role and responsibility within team
c. Work as a team member
3. Practice career professionalism
a. Integrate personal objectives with
organizational goals
b. Set and meet work priorities
c. Maintain professional growth and development
4. Practice occupational health and safety
a. Identify hazards and risk
b. Evaluate hazards and risk
c. Control hazards and risks
d. Maintain occupational health and safety
awareness
COMMON COMPETENCIES
Required Units of
Training Gaps/
Current Competencies Competency/
Requirement
Learning Outcomes