Sample Data Gathering Instrument for Trainee’s Characteristics

in Electrical Installation and Maintenance

Name: _______________________________________
Please answer the following instrument according to the characteristics
described below. Encircle the letter of your choice that best describes you as a
learner. Blank spaces are provided for some data that need your response.
Characteristics of learners

Language, literacy Average grade in: Average grade in:

and numeracy English Math
(LL&N)
a. 95 and above a. 95 and above
b.
b 90 to 94 b.
b 90 to 94
c. 85 to 89 c. 85 to 89
d. 80 to 84 d. 80 to 84
a. 75 to 79 e. 75 to 79

Cultural and Ethnicity/culture:

language a. Bisaya
background
b. Igorot
c. Ibanag
d. Waray
e. Muslim
f Bicolano
f.
g. Others( please specify)_____________

Education & Highest Educational Attainment:

general a.
a High School Level
knowledge
b. Elementary Graduate
c. Elementary Undergraduate
d. High School Graduate
e. ALS Graduate

Date Developed: Document No. 00

Data Gathering Issued by:
(Your school
Instrument for
logo here)
Trainee’s Developed by: SFIST Page 1 of 4
Characteristics
Revision # 01
 Characteristics of learners
f. College Level
g. College Graduate
h. Master’s Degree
i. Others:__________
Sex a. Male
b. Female
Age Your age: _____
b
Physical ability 1. Disabilities(if any)_____________________
2. Existing Health Conditions (Existing illness if
any)
a
a. None
b. Asthma
c. Heart disease
d. Anemia
e. Hypertension
f. Diabetes
g. Others(please specify) ___________________

Previous Electrical Installation and Maintenance NC II

experience with Certificates
the topic a. Plan and prepare work
b. Install electrical protective devices Sew and
assemble garment parts
c. Install lighting fixture and auxiliary outlet.
d. Notify completion of work.
e. None
ef.
Number of years as a Electrician__0____

Previous List down trainings related to EIM NC II

learning _Certificate of Employment_
experience ___________________________
___________________________
National Certificates acquired and NC level
Training Level
completed ___ Electrical Installation and

Date Developed: Document No. 00

Data Gathering Issued by:
(Your school
Instrument for
logo here)
Trainee’s Developed by: SFIST Page 2 of 4
Characteristics
Revision # 01
 Characteristics of learners
Maintenance NC II__________

Special courses Other courses related to Electrical Installation

and Maintenance
a. Electrical Technology
b. Electrical Engineering
c. Units in education
d. Master’s degree units in education
e. Registered Master Electrician
f. Others (please specify)
_____N/A____________________

Learning styles a.
a Visual - The visual learner takes mental
pictures of information given, so in order for
this kind of learner to retain information, oral
or written, presentations of new information
must contain diagrams and drawings,
preferably in color. The visual learner can't
concentrate with a lot of activity around him
and will focus better and learn faster in a
quiet study environment.

bb. Kinesthetic - described as the students in the

classroom, who have problems sitting still
and who often bounce their legs while
tapping their fingers on the desks. They are
often referred to as hyperactive students with
concentration issues.

cc. Auditory- a learner who has the ability to

remember speeches and lectures in detail but
has a hard time with written text. Having to
read long texts is pointless and will not be
retained by the auditory learner unless it is
read aloud.
d. Activist - Learns by having a go
e.
e Reflector - Learns most from activities where
they can watch, listen and then review what
has happened.

Date Developed: Document No. 00

Data Gathering Issued by:
(Your school
Instrument for
logo here)
Trainee’s Developed by: SFIST Page 3 of 4
Characteristics
Revision # 01
 Characteristics of learners

f. Theorist - Learns most when ideas are linked

to existing theories and concepts.
g. Pragmatist - Learns most from learning
activities that are directly relevant to their
a
situation.
Other needs a.
Financially challenged
b. Working student
c. Solo parent
d. Out of School Youth
e. Members of Micro Enterprise(MSME)
f. Others (please specify)
___________________________

Date Developed: Document No. 00

Data Gathering Issued by:
(Your school
Instrument for
logo here)
Trainee’s Developed by: SFIST Page 4 of 4
Characteristics
Revision # 01