INTERN’s PERFORMANCE APPRAISAL FORM

STUDENT NAME: _______________________________________ COURSE/MAJOR ______________________

Cooperating Agency: __________________________________________________________________________

Address: ________________________________________________ Contact No.__________________________

Evaluator: _______________________________________________ Position: ____________________________

Training Period: ______________ to ___________________ Total Hours Rendered: _____________________

Directions. Using the scale below, please encircle the rating that best describe the competencies of the intern.

5 Outstanding (O) Performance exceeds the required standard.

4 Very Satisfactory )VS) Performance fully met the training requirements. The intern performed what was expected of him/her.

3 Satisfactory (S) Performance has met the required standards, the intern performed duties with minimal supervision.

2 Fair (F) Performance partially meets the required standard, observed to be less than satisfactory, a lot could be done better.

1 Needs Improvement (NI) Performance does not meet the required standard. Major improvement may be needed.

0 Not applicable N/A Performance indicator is not relevant to the training.

COMPETENCIES O VS S F NI N/A
5 4 3 2 1 0

TEAM WORK

1. Consistently works with others to accomplish goals and tasks. 5 4 3 2 1 0

2. Treats all team members in respectful and courteous manner. 5 4 3 2 1 0

3. Actively participates in activities and assigned tasks. 5 4 3 2 1 0

4. Willingly works with team members to continuously improve team 5 4 3 2 1 0

collaboration

5. Considers feedbacks and views of team members when completing 5 4 3 2 1 0

assigned tasks.

COMMUNICATION

6. Listens conscientiously to supervisor and co-workers 5 4 3 2 1 0

7. Comprehends written and oral information 5 4 3 2 1 0

8. Consistently delivers accurate information 5 4 3 2 1 0

9. Reliably provides feedback as required, both internally and externally 5 4 3 2 1 0

ATTENDANCE & PUNCTUALITY

10. Is consistently punctual 5 4 3 2 1 0

11. Maintains good attendance and participation 5 4 3 2 1 0

12. Informs supervisor promptly if absent or late 5 4 3 2 1 0

PRODUCTIVITY/RESILIENCE

13. Consistently delivers quality results 5 4 3 2 1 0

14. Meets deadlines and manages time well 5 4 3 2 1 0

15. Works around problems and obstacles in a stressful situation in 5 4 3 2 1 0

order to achieve required tasks

16. Time management is effective and efficient 5 4 3 2 1 0

17. Informs supervisor of any challenges or barriers that transpire in tasks 5 4 3 2 1 0

INITIATIVE/PROACTIVITY

18. Completes assignments with minimal supervision 5 4 3 2 1 0

19. Successfully completes tasks independently and accurately 5 4 3 2 1 0

20. Seeks additional support when necessary 5 4 3 2 1 0

21. Recognizes and takes appropriate action to effectively address 5 4 3 2 1 0

problems

22. Engages in continuous learning 5 4 3 2 1 0

23. Contributes new ideas and seek ways to improve the organization or 5 4 3 2 1 0
work place

JUDGEMENT/ DECISION-MAKING
24. Analyzes problems effectively 5 4 3 2 1 0

25. Demonstrates the ability to make creative and effective solutions to 5 4 3 2 1 0

problems

26. Demonstrates good judgement in handling routine problems 5 4 3 2 1 0

DEPENDABILITY/RELIABILITY

27. Ably follows through and meet required deadlines 5 4 3 2 1 0

29. Is personally accountable for his/her actions 5 4 3 2 1 0

29. Adapts effectively to changes in the work environment 5 4 3 2 1 0

30. Displays a consistent level of high performance 5 4 3 2 1 0

ATTITUDE

31. Willingly offers assistance when needed 5 4 3 2 1 0

32. Makes positive contribution to the organization’s morale 5 4 3 2 1 0

33. Shows sensitivity to and consideration for other’s feeling 5 4 3 2 1 0

34. Accepts constructive criticism positively 5 4 3 2 1 0

35. Shows pride in performing tasks 5 4 3 2 1 0

PROFESSIONALISM

36. Respects those in authority 5 4 3 2 1 0

37. Responsibly uses tools, equipment and machines 5 4 3 2 1 0

38. Follows all policies and procedures when issues and conflicts arise 5 4 3 2 1 0

39. Sticks with policies and procedures as issues and conflicts arise 5 4 3 2 1 0

40. Physical appearance is appropriate with the work environment and 5 4 3 2 1 0

placement rules.

Total Score /Equivalent rating

Raw score Equivalent rating Verbal interpretation

180 – 200 97 - 100 Outstanding

160 –180 94 - 96 Excellent

141 - 160 91 - 93 Excellent

121 – 140 88 – 90 Very Good

101 – 120 85 - 87 Good

81 - 100 82 - 84 Fair

61 – 80 79 - 81 Fair

41 - 60 76 - 78 Passed

21 - 40 75 Passed

0-20 74 Conditional Passed

Remarks/Comments/ Suggestions:

_______________________________________________________________________________________________________________________________________________________________________

_____________________

Evaluator’s Signature: _________________________________________ Date: _______________________

BulSU-OP-OSI-16F7

Revision 0