Republic of the Philippines

Department of Education
Region III – Central Luzon
TARLAC CITY SCHOOLS DIVISION
TIBAG HIGH SCHOOL
(Formerly Maliwalo National High School – Annex)
Tibag, Tarlac City
S.Y. 2019 - 2020
WORK IMMERSION EVALUATION FORM

Name of Student: _______________________________________

Track/Strand: __________________________________________
Place of Immersion/Department: ___________________________
Date/Period of Immersion: ________________________________

Please evaluate the student based on the indicated behavioral statements using the Alwa Rare 0-
Som
scale; ys etim ly Not
Obs es Obs Obs
2-Sometimes Observed(SO) erve Obs erve erve
1-Rarely Observed(RO) 3-Always Observed(AO) d erve d d
(AO) d (RO) (NO)
0-Not Observed (NO) (SO)
Behavior Statements

COMMUNICATION
Communicates in a respectful manner.
Writes in a clear and concise manner.
Actively listens to other to ensure a full understanding of what they are saying.
RELATIONSHIP BUILDING
Maintains good working relationship to achieve objectives.
Works collaboratively with others to achieve goals and objectives.
Encourages other to work collaboratively.
Respects and acknowledges the contributions of others.
Deals with difficult situations quickly and effectively.
ETHICS AND PROFFESIONALISM
Acts in a respectful manner to others regardless of gender ,age ,race, ability, sexual
orientation, culture or religious beliefs.
Maintains professional standards of ethics and integrity.
Respects privacy and confidentiality of others.
Leads by example to demonstrate respectful behavior for the workplace.
Dresses properly and appropriately ; observes proper grooming.
Observes punctuality and regularity.
CREATIVITY AND INNOVATION
Demonstrates creativity when dealing with problems and identifying solution.
Displays adaptability and flexibility.
Manifest thoroughness and precise attention to details; usually comes up with
suggestions to problems.
SELF MANAGEMENT
Recognized need for assistance and requests help.
Prioritizes work respects timeliness when completing tasks.
Pursues learning and development opportunities.
Recognizes barriers to work productivity and takes action to minimize these barriers.
Leads by example.
Manages resistance to change.
CORE VALUES
Maka-Diyos
Expresses one’s spiritual beliefs while respecting the spiritual beliefs of others.
Shows adherence to ethical principles by upholding truth.
Maka-tao
Is sensitive to individual, social and cultural differences.
Demonstrates contribution toward solidarity.
Maka-kalikasan
Cares the environment and utilizes resources wisely, judiciously, and economically.
Maka-Bansa
Demonstrates pride in being a Filipino; exercises the rights and responsibilities of a
Filipino citizen.
Demonstrates appropriate behavior in carrying out activities in the school,
community and country.

Comments/Remarks:____________________________________________________________________
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Evaluated by: Date Accomplished

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Signature Above Printed Name