SAMPLE

ASSESSMENT
TOOLS
 Skill Provider Technological Institute Inc.

ATTENDANCE SHEET
HILOT WELLNESS MASSAGE NCII

Name of School / Training Center: Skill Provider Technological Institute

Inc.
No. TRAINEE'S NAME SIGNATURE SIGNATURE
AM PM
1. Andres, John B.
2. Carating, Alban S.
3. Domen, Jorelyn O.
4. Eustaquio, Erica B.
5. Floralde, Ciara Mae D.S.
6. Jacinto, Ian Jay D.
7. Robles, Jessica G.
8. Santos, Judy Ann S.
9. Villanueva, Angel J.
10 Yco, Micca Gale R.
.
Trainer: Training Director:

Constancia S.A. Bernardino Laura O. Luna

SignatureOver Printed Name Signature Over Printed Name
 TESDA-SOP-CACO-07-F23

Technical Education and Skills Development Authority

ASSESSMENT AND CERTIFICATION PROGRAM

ATTENDANCE SHEET
Hilot Wellness Massage NCII

Name of Competency Skill Provider Technological Institute

Assessment Center: Assessment Center
Date of Assessment: Feb.12, 2017
No. CANDIDATE’S NAME SIGNATURE ASSESSMENT
RESULTS
1. Andres, John B. Competent
2. Carating, Alban S. Competent
3. Domen, Jorelyn O. Competent
4. Eustaquio, Erica B. Competent
5. Floralde, Ciara Mae D.S. Competent
6. Jacinto, Ian Jay D. Competent
7. Robles, Jessica G. Competent
8. Santos, Judy Ann S. Competent
9. Villanueva, Angel J. Competent
10. Yco, Micca Gale R. Competent
Assessor/s: TESDA Representative:

Constancia S.A. Bernardino

Jovita Advincuala
Signature Over Printed Name
Signature Over Printed Name
Accreditation Number: 1234567890

CAC Manager:

Laura O. Luna
Signature Over Printed Name
Evidence Plan
Competency
Hilot Wellness Massage NC-II
standard:
Unit of
Apply Hilot Wellness Massage Techniques
competency:
Module Title: Applying Hilot Wellness Massage Techniques

Oral Questioning Demonstration with

Written Test
The evidence must show that the trainee…
*Explains Factor which may interfere with the  
effectiveness of the treatment.
*Explains the mode of administration and management 
of the treatment of the client / patient
Requires client/patient to monitor reactions and contact  
practitioner.
*Ensures Consent for treatment 
Drapes client/patient to expose only the part of the body  
being worked on
Provides therapeutic massage according to the treatment 
plan.
Recognizes reaction to treatment and promptly responds if 
necessary.
Explains time, location, and content of future sessions 
clearly to the client/patient.
*Documents Recommendations 

*Applies Therapeutic massage techniques  

Answers client/patient queries with clarity, using the 
appropriate language.
Uses honesty and integrity when explaining treatment 
plans and recommendations to the client/patient.
Uses appropriate interpersonal skills when explaining 
treatment plans and recommendations to the
client/patient.
*Promotes client/patient independence and responsibility 
in treatment wherever possible.
Evaluates progress with the client/patient. 
 Identifies and records effects of previous treatment 

Reviews previous treatment plan. 

*Evaluates need for ongoing and/or additional treatment. 

Negotiates changes to the plan with the client/patient to 

ensure optimal outcomes
NOTE: *Critical aspects of competency
SELF-ASSESSMENT GUIDE
QUALIFICATION Hilot Wellness Massage NCII
UNIT OF APPLY HILOT WELLNESS MASSAGE
COMPETENCY TECHNIQUES
Instruction:
 Read each of the questions in the left-hand column of the chart.
 Place a check in the appropriate box opposite each question to
indicate your answer.
Can I? YES NO
Explain factor which may interfere with the effectiveness of 
the treatment.
Explain the mode of administration and management of 
the treatment of the client / patient
Require client/patient to monitor reactions and contact 
practitioner.
Ensure Consent for treatment 
Drape client/patient to expose only the part of the body 
being worked on
Provide therapeutic massage according to the treatment 
plan.
Recognize reaction to treatment and promptly responds if 
necessary.
Explain time, location, and content of future sessions 
clearly to the client/patient.
Document Recommendations 
Apply Therapeutic massage techniques 
Answer client/patient queries with clarity, using the 
appropriate language.
Use honesty and integrity when explaining treatment plans 
and recommendations to the client/patient.
Use appropriate interpersonal skills when explaining 
treatment plans and recommendations to the
client/patient.
Promote client/patient independence and responsibility in 
treatment wherever possible.
Evaluate progress with the client/patient. 
Identify and records effects of previous treatment 
Review previous treatment plan. 
Evaluate need for ongoing and/or additional treatment. 
Negotiate changes to the plan with the client/patient to 
ensure optimal outcomes
I agree to undertake assessment in the knowledge that information
gathered will only be used for professional development purposes and can
only be accessed by concerned assessment personnel and my
manager/supervisor.
Candidate's Name and Signature: Date:
 Feb.12, 2018

Andreah M. San Agustin

TABLE OF SPECIFICATION

Total Perce
Objectives/Content Knowle Compre Applica
# of ntage
area/Topics dge hension tion
Items of test

Factors which may interfere

with the effectiveness of the X(5%) X(5%) X(5%) 3 15%
treatment
 Monitoring of reactions and
X(5%) X (5%) X(5%) 3 15%
contact practitioner

Proper Draping X(10%) X (5%) X(5%) 4 20%

Therapeutic massage X(25%) X (10%) X(15%) 10 50%

techniques

TOTAL 45% 25% 30% 20 100%

TABLE OF SPECIFICATION

TEST ITEM
DISTRIBUTION
Total
Perce
# of
Objectives/Content area/Topics ntage
Compr Item
Know Applic (%)
ehensi s
ledge ation
on

Factors which may interfere with 1 1 1 3 15%

the effectiveness of the treatment

Monitoring of reactions and

1 1 1 3 15%
contact practitioner

Proper Draping 2 1 1 4 20%

Therapeutic massage techniques 5 2 3 10 50%

TOTAL 9 5 6 20 100%

Hilot Wellness Massage NCII

APPLYING HILOT WELLNESS MASSAGE TECHNIQUES

WRITTEN TEST

NAME: _______________________________ DATE: ___________________

Multiple choice: Encircle the letter of the correct answer.
1. Uses massage for a variety of health-related purposes including.
a) Stress
b) Pain
c) All of the above
2. After the HILOT massage treatment you Will?
a) Take a bath
b) Drink cold water
c) None of the above
3. Contraindication of HILOT massage.
a) Severe pain
b) Back pain
c) Headaches
4. Why is it important to have consent from the client before starting the
HILOT massage treatment?
a) For records and documentation
b) For massage treatment plan
c) Both a and b
5. What is not the type of consent needed in HILOT massage treatment?
a) Treatment plans and goals
b) Know the address of the client
c) Your intentions for the massage
6. What is Consent?
a) Rub and knead (a person or part of the body) with the hands.
b) Your intentions for the massage.
c) The manner in which someone behaves toward or deals with
someone or something.
7. What is draped?
a) Let or make (something) fall vertically.
b) The coverings (sheets/blankets) that are on top of the client
c) The physical structure of a person or an animal, including the
bones, flesh, and organs.
8. Type of draping used in massage treatment.
a) Therapeutic
b) Conservative
c) All of the above
9. This type of draping allows greater access to the muscles.
a) Therapeutic
b) Conservative
c) Draping
10. What is the importance of draping in applying HILOT massage
treatment.
a) To expose only the part of the being worked on.
b) To ease pain.
c) To cover the body of the client when sleeping.
11. The most commonly used massage treatment.
a) Shiatsu Massage
b) Thai Massage
c) Hilot Wellness Massage
12. A strokes of Hilot massage also known as gliding technique.
a) Haplos
b) Hagod
c) Pindot
13. A strokes of Hilot massage also known as kneading technique.
a) Haplos
b) Hagod
c) Piga
14. It rhythmic percussion type of Hilot massage.
a) Pindot
b) Pisil
c) Piga
15. It involves working and acting on the body with pressure.
a) Massage
b) Treatment
c) Swedish Massage
16. In Hilot massage treatment, this equipment is used to check the blood
pressure of the client.
a) Digital clock
b) Thermometer
c) BP Apparatus
17. Massage helps us to?
a) Relieve pain
b) Have good blood circulation
c) All of the above
18. What type of oil is use in Hilot massage treatment.
a) Cooking oil
b) Scented oil
c) Engine oil
19. The PPE for Hilot Massage.
a) Uniform
b) Lab Gown
 c) Scrub Suit
20. This material is use in sanitation in Hilot Massage treatment.
a) Oil
b) Alcohol
c) Lotion

Hilot Wellness Massage NCII

APPLYING HILOT WELLNESS MASSAGE TECHNIQUES
ANSWER KEY TO WRITTEN TEST
 1. C
2. C
3. A
4. C
5. B
6. C
7. B
8. B
9. A
10. A
11. C
12. B
13. A
14. C
15. A
16. C
17. C
18. B
19. C
20. B

Specific Instruction for the Candidate

Qualification Hilot Wellness Massage NCII
Unit of Competency APPLY HILOT WELLNESS MASSAGE
TECHNIQUES
General Instruction:
Given the necessary tools, materials and equipment, you are required to
Implement in accordance with industry accepted standards within 2
hours

Specific Instruction:

1. The assessment shall be based on the unit of competency in the

Training Regulation and the evidence plan and shall focus on the
following evidence gathering methods:
- Demonstration
- Oral Questioning

2. You shall be given 15 minutes to prepare the needed materials, tools

and equipment for the performance of tasks.

3. You shall be required to perform the following tasks for one (3) hour:
 LO 1: Plan the Hilot Wellness Program of Clients
 LO 2: Provide Pre-service to clients
 LO 3: Apply Hilot Wellness massge techniques
 LO 4: Provide Post-advise and Post-service to clients

4. Present your finished product/work to your assessor

5. After the performance of tasks, answer the questions about your

demonstration to be asked by the assessor.

6. You have to answer other questions to probe the underpinning

knowledge about the unit of competency

7. After the oral questioning portion, answer carefully the written test
about the unit of competency. Please write your answer on a
separate sheet of paper to be provided by the assessor.

8. After the assessment, the assessor shall provide you feedback on the
assessment result. The feedback shall indicate whether you are :

- COMPETENT
- NOT YET COMPETENT

Tools, Equipment and Materials

Materials
Bath towels
hand towels
Draw sheets
Pillow (donuts)
Bed sheets
Oil
Alcohol
Bathrobe14
Tools
Thermometer

Massage table:
L = 1.8M
W = 0.8M
H = 0.7M
Sphygmomanometer / stethoscope

Materials:

Assorted Consumables will be provided to you upon request and verified

by the trainer/assessor.

RATING SHEET FOR DEMONSTRATION

Trainee name Andreah M.San Agustin
Trainer name Constancia S.A. Bernardino
Qualification Hilot Wellness Massage NC II
APPLYING HILOT WELLNESS MASSAGE
Module Title
TECHNIQUES
Date of
FEBRUARY 12, 2018
assessment
Time of
8:40 AM 10:30 AM
assessment
Instructions for demonstration
Given the necessary materials, tools and equipment, the trainee
must be able to implement the therapeutic massage treatment in
accordance with industry accepted standards within 2 hours.
MATERIALS & EQUIPMENT:
Oil, Alcohol, BP Apparatus, Thermometer, Massage table

 to show if evidence is
OBSERVATION
demonstrated
During the demonstration of skills, did the
Yes No N/A
trainee:
Explain factor which may interfere with

the effectiveness of the treatment.
Explain the mode of administration and 
management of the treatment of the
client / patient
Require client/patient to monitor 
reactions and contact practitioner.
Ensure Consent for treatment 
Drape client/patient to expose only the 
part of the body being worked on
Provide therapeutic massage according to 
the treatment plan.
Recognize reaction to treatment and 
promptly responds if necessary.
Explain time, location, and content of 
future sessions clearly to the
client/patient.
Document Recommendations 
Apply therapeutic massage techniques 
Answer client/patient queries with clarity, 
using the appropriate language.
Use honesty and integrity when explaining 
treatment plans and recommendations to
the client/patient.
Use appropriate interpersonal skills when 
explaining treatment plans and
recommendations to the client/patient.
Promote client/patient independence and 
responsibility in treatment wherever
possible.
Evaluate progress with the client/patient. 
Identify and records effects of previous 
treatment
Review previous treatment plan. 
Evaluate need for ongoing and/or 
additional treatment.
Negotiate changes to the plan with the 
client/patient to ensure optimal outcomes
The trainee’s demonstration was:
Satisfactory  Not Satisfactory 
Satisfactory
QUESTIONS Response
The trainee should answer the following questions: Yes No
[Extension / Reflection Questions]
1. What would you do if your client has fever but
 
still want to undergo massage treatment?
2. What if you were using oil but run out of it,
 
instead you only have powder and lotion?
[Safety Questions]
1. What safety clothing would you used when
 
performing massage treatment?
2. What would you do if your client/patient
 
experience pain during the treatment?
[Contingency Questions]
1. What precaution must you take when your
client has an allergy with the oil you are going to  
use?
2. What would you do if the client/ patient want to
 
undergo treatment but he/she has skin disease?
[Infrequent Events]
1. What would you do if you accidentally touch the
 
private part of your client?
[Rules and Regulations]
1. What is the regulation that covers clients
 
consent to the treatment?
2. What are the specified procedures or step in
 
accommodating new client/patient?
The trainee’s underpinning knowledge was:
Satisfactory  Not Satisfactory 
Feedback to trainee:

The demonstration is well executed by the trainee and questions are

answered satisfactorily.

The trainee’s overall performance was:

Satisfactory  Not Satisfactory 

Trainee signature: Date:Feb 12, 2018

Trainer signature: Date:Feb 12, 2018

Acceptable answers are:
[Extension / Reflection Questions]
1. Advise the client/patient to ask permission from the doctor if
he/she can undergo massage treatment.
2. Explain to the client/ patient the situation then ask for permission
if you can use alternatives like lotion or powder.
[Safety Questions]
1. Wear Scrub suit as safety clothing for massage treatment.
2. Advise the client to visit his/her doctor.
[Contingency Questions]
1. Ask the client/patient about the type of oil you are going to use. If
he/she has allergy on that oil, then, use alternative types of oil.
2. Explain to him/her clearly why he/she can’t undergo treatment
and advise his/her to ask permission from the doctor.
[Infrequent Events]
1. Ask for forgiveness, then be sure not to happen it again.
[Rules and Regulations]
 1. Ensure clients consent.
a) Be hospitable when talking to new client.
b) Use language according to what they can understand.
c) Ask for the treatment they want to undergo.

COMPETENCY ASSESSMENT RESULTS SUMMARY

Candidate’s Name: Andreah M.San Agustin

Assessor’s Name: Constancia S.A. Bernardino
Title of Qualification/Cluster
Hilot Wellness Massage NCII
of Units of Competency
Skill Provider Technological Institute
AssessmentCenter: Date: Feb 12, 2018
Assesment Center
The performance of the candidate in the following unit(s) of competency
and corresponding methods Satisfactory Not Satisfactory
Unit of Competency Assessment Methods
WORK WITH A HOLISTIC
THERAPEUTIC MASSAGE Demonstration with Oral 
FRAMEWORK Questioning

PERFORM THERAPEUTIC Demonstration with Oral

MASSAGE ASSESSMENT Questioning 
PLAN THERAPEUTIC Demonstration with Oral
MASSAGE TREATMENT Questioning 
IMPLEMENT THE
Demonstration with Oral
THERAPEUTIC MASSAGE 
Questioning
TREATMENT
PERFORM THE REMEDIAL
Demonstration with Oral
THERAPEUTIC MASSAGE 
Questioning
TREATMENT
Note: Satisfactory Performance shall only be given to candidate who demonstrated successfully all the competencies
identified in the above-named Qualification/Cluster of Units of Competency
For submission of For re-assessment (pls.
Recommendation  For issuance of NC/COC

additional documents

specify)
: (Indicate title of COC, if full Specify: _______________
Qualification is not met) ______________________
Massage Therapy NCII
Did the candidate overall performance meet the required evidences/standards?  YES  NO
 OVERALL EVALUATION Competent  Not Yet Competent

General Comments [Strengths/Improvements needed]

Candidate’s signature: Date: Feb 12, 2018
Assessor’s signature: Date: Feb 12, 2018
Assessment Center
Date: Feb 12, 2018
Manager Signature:

CANDIDATE’S COPY (Please present this form when you claim your NC/COC)

COMPETENCY ASSESSMENT RESULTS SUMMARY

Name of Candidate: Andreah M. San Agustin Date: Feb 12, 2018

Skill Provider Technological Institute
Name of Assessment Center: Date: Feb 12, 2018
Assessment Center
Assessment Results: Competent  Not Yet Competent

Recommendation: For issuance of NC/COC  For submission of

additional documents
 For re-assessment (pls.
specify)
(Indicate title of COC, if full Specify:
Qualification is not met)
Massage Therapy NCII

Assessed by: Constancia S.A. Bernardino Attested by: Laura O. Luna

Name and Signature Name and Signature
Date: Feb 12, 2018 Date: Feb 12, 2018

Inventory of Training Resources

Resources for presenting instruction
 Print Resources As per TR As per Remarks
Inventor
y
CBLM 25 for
replenishme
nt
Books 5 for
replenishme
nt
 Non Print Resources As per TR As per Remarks
Inventor
y
Videos 12 for
replenishme
nt
Resources for Skills practice
 Supplies and Materials As per TR As per Remarks
Inventor
y
Bath towels 10 10 for
maintenance
Face towels / hand towels 30 30 for
maintenance
Draw sheets 10 10 for
maintenance
Pillow (donuts) 10 10 for
maintenance
Pillow case 10 10 for
maintenance
Bed sheets 10 10 for
maintenance
Powder 5 5 for
maintenance
Oil 5 5 for
maintenance
Lotion 5 5 for
maintenance
Alcohol 5 5 for
maintenance
Basin 5 5 for
maintenance
bathrobe 10 10 for
maintenance
 Tools As per TR As per Remarks
Inventor
y
Ultraviolet lamp 5 5 for
maintenance
Vibrator 5 5 for
maintenance
Heat packs and immersion baths 5 5 for
Thermometer maintenance
 Equipment As per TR As per Remarks
Inventor
y
Overhead projector 1 1 for
maintenance
White board 1 1 for
maintenance
 Microphone 1 1 for
maintenance
Massage table: 5 5 for
maintenance
L = 1.8M
W = 0.8M
H = 0.7M
Sphygmomanometer / stethoscope 10 10 for
maintenance

Note: In the remarks section, remarks may include for repair, for
replenishment, for reproduction, for maintenance etc.