Republic of the Philippines

Department of Education
Division of City Schools
National Capital Region
QUEZON CITY SCIENCE HIGH SCHOOL
(Regional Science High School for NCR)
Golden Acres Road Corner Misamis St.Bago Bantay Quezon City
Tele Fax 352-59-57

LIST OF TASKS / ACTIVITIES TO BE DONE DURING WORK IMMERSION

Track: Academic Strand: Science & Technology, Engineering, and Mathematics Specialization: _______
Partner Agency: ________________________ Division/Department: ______________________

COMPETENCIES TASKS / ACTIVITIES TIME ALLOTMENT ACTUAL SCHEDULE REMARKS

Students shall not be given other activities outside of those previously agreed upon, which are anchored on
the stated competencies.

Certified true and correct:

Student’s Signature over Printed Name Parent’s Signature over Printed Name

Work Immersion Teacher’s Signature Partner Institution Supervisor’s Signature

over Printed Name over Printed Name
 Republic of the Philippines
Department of Education
Division of City Schools
National Capital Region
QUEZON CITY SCIENCE HIGH SCHOOL
(Regional Science High School for NCR)
Golden Acres Road Corner Misamis St.Bago Bantay Quezon City
Tele Fax 352-59-57

WORK IMMERSION EVALUATION FORM

NOTE: Please rate the Student’s overall performance for the duration of the work immersion according to the rating scale below.
Their rating in the WORK IMMERSION will constitute40% of their Final Grade. Work Immersion is also is a requirement for
graduation.

1 Did not meet expectations. Significant performance improvement urgently needed.

2 Met minimum expectations. Work improvement plan was needed to bring performance to a satisfactory level.
3 Met expectations with few exceptions. Improvements in performance needed in one or more elements.
4 Fully met expectations. Performance was what was expected of a person in his/her position.
5 Exceeded expectations. Student performance was impressive, exceeded what is normally expected in this position.
NA Not Applicable

Criteria/Rating 1 2 3 4 5
Professionalism (30%)
The student…
1. Arrives at the work immersion venue at the time agreed upon
2. Reports to work immersion regularly
3. Performs tasks without much supervision
4. Practices self-discipline in his / her work
5. Demonstrates dedication and commitment to the tasks assigned to him/her
Work Habits Rating (Raw Score / Perfect Score X 100 X .3)
Performance of Tasks (40%)
The student…
1. Demonstrates the ability to manipulate materials / tools / equipment needed on
the job
2. Handles the details of the work assigned to him / her
3. Shows flexibility (whenever the need arises) in the process of performing
his / her task
4. Manifests thoroughness and precise attention to details
5. Understands the connection between his / her task to previous, intervening
and subsequent tasks
6. Comes up with sound suggestions to problems
7. Shows special aptitude in doing neat, accurate work beyond the required
amount
Work Skills Total/Average (Raw Score / Perfect Score X 100 X .4)
Social Skills (30%)
The student…
1. Shows tact in dealing with different people he /she comes in contact with

2. Shows respect and courtesy in dealing with peers and superiors

3. Willingly helps others (whenever necessary) in the performance of their
4. tasks
Is capable of learning from and listening to co-workers
5. Shows appreciation and gratitude for any form of assistance granted to him /
6. her by others
Shows poise, self-confidence and is always well – groomed
7. Shows emotional maturity
Social Skills Total/Average (Raw Score / Perfect Score X 100 X .3)
Over All Total / Average Rating (Work Habits + Work Skills + Social Skills)

Student’s Practicum
Name ___________________________________________ Grade &Date:___________
Supervisor’s Signature over Printed Name:__________________ Section: ____________________
Evaluator’s Name: _______________________________________ Position: ____________________________
Practicum
Evaluator’s Student’s
Signature: Signature over Printed Name: ____________________
____________________________________ Date: ___________
Date of Evaluation: __________________
INSTRUCTIONS:
1. Print only the first two pages of this file.
2. Present the form, enclosed in a long folder, along with the list of
tasks and activities to the Partner Institution Supervisor or the
person in charge of you in the Partner Agency/Institution.
3. You will either be provided with a filled out List of Tasks and
Activities OR you will be asked to fill it out according to what
you will be asked to accomplish during the work immersion
period. Read the SAMPLE template below to help you
understand the purpose of the first form.
 Republic of the Philippines
Department of Education
Division of City Schools
National Capital Region
QUEZON CITY SCIENCE HIGH SCHOOL
(Regional Science High School for NCR)
Golden Acres Road Corner Misamis St.Bago Bantay Quezon City
Tele Fax 352-59-57

LIST OF TASKS / ACTIVITIES TO BE DONE DURING WORK IMMERSION

(SAMPLE)

Track: Academic Strand: Science & Technology, Engineering, and Mathematics Specialization: Science
Partner Agency: Far Eastern University Division/Department: College of Sciences /
Medical Technology

Note: Actual competencies for the specialization/department where learners are assigned must be provided by the
partner institution. Items 1-6 are projected samples for Medical Technology.
COMPETENCIES TASKS / ACTIVITIES TIME ACTUAL REMARKS
ALLOTMENT SCHEDULE
Upon completion of the work
immersion, the student will:

1. Identify and describe the Prepare a written narrative 16 hours January 15-
procedure and services on one’s observations on 16, 2018
provided by medical the services and procedure
technologists. in a laboratory.

Create a flow chart to

describe the procedure
followed.
2. Show familiarity with the Name the tools and 16 hours January 17-
tools and equipment used equipment found in a 18, 2018
in a medical laboratory. medical laboratory.

3. Collect samples, prepare
specimen for analysis, and
determine the acceptability
of sample within
guidelines.
4. Perform tests on blood and
bodily fluids according to
standard methods and
techniques.
5. Perform routine
maintenance on medical
laboratory tools and
equipment following
established procedures.
*Create a portfolio of
learning and task
accomplishment.
Collect, process, and 16 hours January 19 &
analyze patient specimen. 22, 2108
*Create a portfolio of
learning and task
accomplishment.
Test patient blood or bodily 16 hours January 23-
fluids sing manual and 24, 2018
automated means.
*Create a portfolio of
learning and task
accomplishment.
Disinfect and organize 16 hours January 25-
laboratory equipment. 26, 2018
*Create a portfolio of
learning and task
accomplishment.

6. Perform accurately data Gather, process, and *within the January 15-
gathering, processing, and encode data in the duration of the 26, 2018
encoding into the computer system. work immersion
computer system.

7. Communicates clearly in Prepare a written narrative

spoken and written on one’s observations in the
services and procedure in a
 English. laboratory.

8. Complies with rules set by Follow rules and

the partner institution and regulations.
the school.

9. Demonstrates Come to the work

professionalism by coming immersion venue on time
to the work immersion wearing attire prescribed by
venue on time. the institution.

10. Demonstrates team work Participate actively by

and collaboration skills contributing to group
with other senior high discussions/tasks.
school students.

Students shall not be given other activities outside of those previously agreed upon, which are anchored on
the stated competencies.

Certified true and correct:

Student’s Signature over Printed Name Parent’s Signature over Printed Name

Work Immersion Teacher’s Signature Partner Institution Supervisor’s Signature

over Printed Name over Printed Name