EFFECTIVITY:

DOST TNA Form 04

Department of Science and Report No

Technology Page No.
Audit Date(s)

TECHNOLOGY NEEDS ASSESSMENT (TNA) REPORT

COMPANY:

ADDRESS:

SCOPE OF ASSESSMENT*

* Scope of TNA is based on Technology Assessment Plan (TAP)

SUMMARY OF ASSESSMENT

Reported by __________________________Signature ____________________Date _____________

Name of TNA Team Leader

Attested by ___________________________Signature ____________________Date _____________

Name of ARD

SETUP Guidelines – Annex B-12 - DOST TNA Form 04 Page 1 of 2

 EFFECTIVITY:
DOST TNA Form 04

Department of Science and Report No

Technology Page No.
Audit Date(s)

BACKGROUND:

METHODOLOGY

SUMMARY OF FINDINGS

 .
 .


Process/ Existing Proposed S&T Proposed S&T intervention Impact Expected

Practice/Problem Intervention related equipment / skills
upgrading

RECOMMENDATIONS:

TNA Team Composition:

Team Leader: __________________
Members: __________________
__________________

Reported by __________________________Signature ____________________Date _____________

Name of TNA Team Leader

Attested by ___________________________Signature ____________________Date _____________

Name of ARD

SETUP Guidelines – Annex B-12 - DOST TNA Form 04 Page 2 of 2