HOLY NAME UNIVERSITY

Department of Medical Technology

Janssen Heights, Dampas District, Tagbilaran City, Bohol

MEDICAL TECHNOLOGY INTERNSHIP

EFFICIENCY RATING TOOL
_____SEMESTER; S.Y.__________

NAME OF INTERN :_______________________________ RATING :_____________%

SECTION ASSIGNMENT:_______________________________ INSTITUTION:_____________
DATE OF ROTATION :_______________________________

INSTRUCTION: Kindly put a CHECK () under the column which corresponds to the rating of your choice. Please use
the Rating Scale Table provided below as reference:

RATING SCALE:

RATE DESCRIPTION
4.0 Excellent The intern’s performance is perfect in all aspects.
3.5 Very Good The intern’s performance is almost perfect.
The intern’s performance is not consistently effective and efficient but has
3.0 Good / Above Average
demonstrated very good improvement over a long period of time.
The intern’s performance is not consistently effective and efficient but has
2.5 Average / Passing Grade
demonstrated better improvement over a long period of time.
2.0 Below Average / Fair The intern’s performance is merely satisfactory.
Expected tasks are not performed. Most of the time, the student expresses
1.5 Poor
refusal to perform laboratory procedures.
1.0 Very Poor Expected tasks are not performed at all times.
NA - The student’s performance was not observed, or the student had no opportunity
to perform the test.

AREA RATING
KNOWLEDGE (30%) 1.0 1.5 2.0 2.5 3.0 3.5 4.0 NA
At the end of clinical duties, the intern will:

1. state the principle of the test(s) performed.

2. discuss the principle of operation of the machines
used.
recall the reference values of tests performed.
3.
identify the factors(s) affecting the clinical
4.
laboratory test(s).
5. correlate laboratory test result(s) patients disease
condition.

SKILLS (50%) 1.0 1.5 2.0 2.5 3.0 3.5 4.0 NA

At the end of clinical duties, the intern will:

1. observe aseptic technique throughout the

performance of the clinical laboratory test(s).
2. perform clinical laboratory test(s) with the speed,
accuracy and complies all the requirements.
3. perform clinical laboratory test(s) with confidence
and absence of/ minimum awkwardness.
4. prepare materials and equipment, demonstrates
economy of using materials and performs aftercare.
5. record all results in the logbook/ computer/
notebooks.
 ATTITUDE (20%) 1.0 1.5 2.0 2.5 3.0 3.5 4.0 NA
At the end of clinical duties, the intern will:

1. show punctuality during clinical duties and

examinations all the time.
2. demonstrate respect, courtesy, integrity and
honesty to supervisors, peers and clients all the
time.
3. exhibit initiative and enthusiasm during clinical
duties and performs all required test(s).
4. accept criticisms and comments from superiors,
peers and clients.
5. obey the policies, standards and guidelines of the
hospital institution and the school.

KNOWLEDGE = Average Rating ________ x 0.30 = ____________

SKILLS = Average Rating ________ x 0.50 = ____________
ATTITUDE = Average Rating ________ x 0.20 = ____________

Total Numerical Grade ______/4 x 100 _____________%

REMARKS :________________________________________________________________________
________________________________________________________________________
________________________________________________________________________

____________________________________ ____________________________________
SIGNATURE OVER PRINTED NAME OF STUDENT SIGNATURE OVER PRINTED NAME OF C.I/RMT