INDUSTRIAL PRACTICE ACTIVITY RECORD

Name :
Student ID :

Company Name :
Company Address :
Company Phone No. :
Supervisor :
Mentor :
 Student Biography

Picture

Student Name :
Student ID :
Place, Date of Birth :
Home Address :
Phone Number :
Cellphone no. :

Acknowledged by:

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Head of Industrial Engineering Department
 WORK PLAN (Gantt Chart)

Write your tentative project management in its simple form which may include activities, timeline,
resources, and contingency plan.
INTERNSHIP ACTIVITY RECORD (COMPANY)

Date Clock In Clock Out Supervisor

Activity
No (DD/MM/YY) (HH:MM) (HH:MM) Signature

   

     

     

   
 Date Clock In Clock Out Supervisor
Activity
No (DD/MM/YY) (HH:MM) (HH:MM) Signature

   

   

     

     

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 Date Clock In Clock Out Supervisor
Activity
No (DD/MM/YY) (HH:MM) (HH:MM) Signature

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 Date Clock In Clock Out Supervisor
Activity
No (DD/MM/YY) (HH:MM) (HH:MM) Signature

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 Date Clock In Clock Out Supervisor
Activity
No (DD/MM/YY) (HH:MM) (HH:MM) Signature

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*add more row if needed
 INTERNSHIP ACTIVITY RECORD (MENTOR)

Date Supervisor
Activity
No (DD/MM/YY) Signature

   

   

 
 Date Supervisor
Activity
No (DD/MM/YY) Signature

   

   

10

 
*add more row if needed
 NOTE
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Please put a note on this sheet as record for department if student is unable to finish the
industrial practice