RECOGNITION OF PRIOR LEARNING IN TVET (RPL-TVET) Form 1 Self-Assessment Instrument

Name of Learner-Applicant: Date Applied: _____________

Program Title: Conatact Tracing Level II

INSTRUCTIONS: This Self-Evaluation Instrument will give the RPLET the necessary data or information, which is
essential in the recognition of prior learning of the learner.

1. Please check YES if you think you have experienced this or have knowledge of doing the task/job.
2. Check NO if do not have any experience/know anything about it.
3. If you have checked YES, please write down evidence that you can provide/submit later as required.
4. If you do not have evidence, please check the column “No Evidence to Provide”.
5. Affix your signature below as affirmation of truth to the information declared/presented.

I have actually performed the following Evidence/ Document to be Submitted or No Evidence to

YES NO
task/s. Provided Provide

BASIC AND 21ST CENTURY COMPETENCIES

Module 1.   PARTICIPATING IN WORKPLACE
COMMUNICATION
Learning Outcomes:
1.     Obtain and convey workplace information √
2.     Participate in workplace meetings and
√
discussions
3.     Complete relevant work-related documents √

Module 2: WORKING IN TEAM ENVIRONMENT

Learning Outcomes:
1.     Describe team role and scope √
2.     Identify own role and responsibility within the
√
team
3.     Work as a team member √
Module 3.   SOLVING/ADDRESSING
GENERAL WORKPLACE PROBLEMS
Learning Outcomes:

1. Identify routine problems

2. Look for solutions to routine problems

3. Recommend solutions to problems
Module 4.   DEVELOPING CAREER AND LIFE
DECISIONS
Learning Outcomes:

1. Manage one’s emotions

2. Develop reflective practice

3. Boost self-confidence and develop self-
regulation
Module 5.   CONTRIBUTING TO WORKPLACE
INNOVATION
Learning Outcomes:
 RECOGNITION OF PRIOR LEARNING IN TVET (RPL-TVET) Form 1 Self-Assessment Instrument

1. Identify opportunities to do things better

2. Discuss and develop ideas with others
3. Integrate ideas for change in the workplace
Module 6.   PRESENTING RELEVANT
INFORMATION
Learning Outcomes:
1. Gather data/information
2. Assess gathered data/ information
3. Record
Module 7:and present information
PRACTICING OCCUPATIONAL
HEALTH AND SAFETY POLICIES AND
PROCEDURES
Learning Outcomes:
1. Identify OSH compliance requirements
2. Prepare OSH requirements for compliance
3. Perform tasks in accordance with relevant
Module 8.   EXERCISING
OSH policies and proceduresEFFICIENT AND
EFFECTIVE SUSTAINABLE PRACTICES IN
THE WORKPLACE
Learning Outcomes:
1. Identify the efficiency and effectiveness of
resource
2. utilization
Determine causes of inefficiency and/or
ineffectiveness of resource
3. Convey inefficient utilization
and ineffective
environmental practices
Module 9.   PRACTICING ENTREPRENEURIAL
SKILLS IN THE WORKPLACE
Learning Outcomes:
1. Apply entrepreneurial workplace best practices
2. Communicate entrepreneurial workplace best
practices
3. Implement cost- effective operations
CORE COMPETENCIES
Module 1: PROVIDING CARE AND SUPPORT
TO INFANTS /TODDLERS
Learning Outcomes:
1.  Explain the concepts and principles of caring,
√
growth and development of infants/toddlers
2. Prepare infants / toddlers for taking vital signs,
√ Diploma (BS Nursing)
bathing and dressing
Trancript of Records
3.  Clean, sterilize feeding bottles and prepare Certificate of Employment
√
milk formula (Nurse/National Chrildren's Hospital)
4.  Prepare and introduce adequate nutrition and
√
semi-solid food.
5. Prepare infant / toddlers crib. √
Module 2: PROVIDING CARE AND SUPPORT
TO CHILDREN
Learning Outcomes:
1. Explain the importance of instilling personal
√
hygiene practices to children
2. Maintain children’s paraphernalia √
Diploma (BS Nursing)
3.  Prepare children for taking vital sign, bathing Trancript of Records
√
and dressing Certificate of Employment
4.  Perform after care activities for materials and (Nurse/National Chrildren's Hospital)
√
paraphernalia
5.  Determine nutritional food requirements of
√
children
Module 3: FOSTERING SOCIAL,
INTELLECTUAL, CREATIVE AND EMOTIONAL
DEVELOPMENT OF CHILDREN
Learning Outcomes:
 RECOGNITION OF PRIOR LEARNING IN TVET (RPL-TVET) Form 1 Self-Assessment Instrument

1. Explain the concepts and principles of social, Diploma (BS Nursing)

intellectual, creative and emotional development √ Trancript of Records
of children (3-12 yrs. Old) Certificate of Employment
(Nurse/National Chrildren's Hospital)
Module 4: FOSTERING PHYSICAL
DEVELOPMENT OF CHILDREN
Learning Outcomes:
1.  Explain the concepts and principles of physical
√ Diploma (BS Nursing)
development of children
Trancript of Records
2.  Explain the importance of healthy sleeping Certificate of Employment
√
patterns and practices (Nurse/National Chrildren's Hospital)
3. Perform physical activities √
Module 5: PROVIDING CARE AND SUPPORT
TO ELDERLY
Learning Outcomes:
1.  Explain the concepts and principles of basic
√
nursing care of the elderly
Diploma (BS Nursing)
2.  Identify appropriate physical, emotional, Trancript of Records
√
spiritual and intellectual needs. Certificate of Employment
3. Provide assistance in promoting the (Nurse/National Chrildren's Hospital)
appropriate needs for roles, responsibilities, √
rights, freedom and activities of elderly.
4.  Provide adequate nutrition and elimination
Module 6: PROVIDING CARE AND SUPPORT
TO PEOPLE WITH SPECIAL NEEDS
Learning Outcomes:
1. Identify and explain the needs of people with
√
special needs
2.  Identify personal care and assistance needed
√
for daily living
3. Establish and maintain appropriate relationship √ Diploma (BS Nursing)
Trancript of Records
4.  Provide appropriate support for people with Certificate of Employment
√
special needs (Nurse/National Chrildren's Hospital)
5. Assist in oral and written communication √

6.  Provide adequate nutrition and elimination for

√
people with special needs
Module 7: MAINTAINING A HEALTHY AND
SAFE ENVIRONMENT
Learning Outcomes:
1.  Explain the concepts and principles in
√
maintaining a clean and therapeutic environment
Diploma (BS Nursing)
2.  Explain the procedure in maintaining a clean Trancript of Records
√ Certificate of Employment
and therapeutic environment
(Nurse/National Chrildren's Hospital)
3.  Assist client in implementing a safe and
√
therapeutic environment

Module 8: RESPONDING TO EMERGENCY

Learning Outcomes:
1.  Discuss signs and symptoms of various
√
illnesses and diseases

Diploma (BS Nursing)

 RECOGNITION OF PRIOR LEARNING IN TVET (RPL-TVET) Form 1 Self-Assessment Instrument

2.  Identify and explain appropriate first aid and

√
basic emergency procedure
3.  Explain the procedures in implementing Diploma (BS Nursing)
√
infection control prevention Trancript of Records
4.  Identify the appropriate procedures in Certificate of Employment
√ (Nurse/National Chrildren's Hospital)
medicine administration

5. Identify dangerous, hazardous and threat to

√
safety and well being

6. Perform first aid procedures √

Module 9: CLEANING LIVING ROOM, DINING
ROOM, BEDROOM, TOILET AND BATHROOM
Learning Outcomes:
1.  Explain the principles and proper procedures
in cleaning and polishing (living room, bedroom, √
bathroom, and kitchen)
2.  Clean and sanitize toilet and bathroom √
3. Identify different kinds of cleaning agent √
4.  Make up beds and cots. (open and closed
√
bed)
5.  Maintain a clean environment √
6.  Perform after care activities of materials and
√
equipment
Module 10: WASHING AND IRONING
CLOTHES, LINENS AND FABRICS
Learning Outcomes:
1.  Explain the principles and procedures in
√
washing and ironing clothes
2.  Explain the procedures in operating tools and
√
equipment
3.  Perform laundry √
4.  Iron clothes, linens and fabrics √
5.  Perform after care activities of materials and
√
equipment
Module 11: PREPARING HOT AND COLD
MEALS
Learning Outcomes:
1.  Explain the procedures in preparing hot and
√
cold meals
2.  Prepare hot and cold meals √
3.  Prepare appetizers, sauces, dressings and
√
garnishes
4.  Cook meals and dishes according to recipe/
√
dietary requirements
5.  Set table and serve cooked dishes √
6.  Perform after care activities of materials and
√
equipment
7.  Demonstrate personal good grooming and
√
hygiene
8.  Demonstrate clear and effective
√
communication on the job.
9.  Maintain professionalism at the workplace √
RECOGNITION OF PRIOR LEARNING IN TVET (RPL-TVET) Form 1 Self-Assessment Instrument

I hereby certify to the correctness of the information/details declared above.

Amor Santos De Guzman

(Signature over Printed Name of Learner-Applicant)
RECOGNITION OF PRIOR LEARNING IN TVET (RPL-TVET) Form 1 Self-Assessment Instrument
RECOGNITION OF PRIOR LEARNING IN TVET (RPL-TVET) Form 1 Self-Assessment Instrument
 RECOGNITION OF PRIOR LEARNING IN TVET (RPL-TVET) Form 2 Evaluation on Acceptability of the Evidence Presented/Submitted (Rules of
Evidence)

Name of Learner-Applicant: Application Number:

Qualification/Program Title:
COMPETENCY AREA:
(Please ü appropriate box)
Contact Tracing Level II Date of Application
BASIC COMPETENCIES
COMMON COMPETENCIES
CORE COMPETENCIES

Learner-Applicant Profile: (Please provide all necessary and applicable information)

Year
Educational Level (ü) Degree/Program Completed Graduated/ Name of Provider
Completed
( √ ) College Graduate
( ) College Undergraduate
( ) SHS Graduate or Equivalent
( ) Post-Secondary Graduate
( ) TVET Graduate
Name of Company Length of Type of Employment
Employment (ü) Service
( √ ) With work experience
( ) No work experience (Do not fill-out this portion

INSTRUCTION:
1.  The evaluators shall encode the type of evidence/s presented/submitted by the learner-applicant in column [A]
2.  The evaluators shall put coding for each evidence presented/submitted by the learner-applicant in column [B];
3.  Evaluators shall tick (√) each rule of evidence column [C] upon initial evaluation of the document/evidence presented/submitted by the learner-
applicant;
4. The evaluators shall indicate the RESULT in column [D] if the evidence/s presented is ACCEPTED or NOT ACCEPTED; and
5. Evaluators shall affix signature over printed name and date evaluated, and ensure to attach all the evidence/s used.

DO NOT FILL-OUT THIS PORTION (To be filled out by RPLET)

RECOGNITION OF PRIOR LEARNING
RULES OF EVIDENCE
(Portfolio Evaluation) RESULT
Document No. / ('C) (D)
Evidences
Code of Evidence
(A)
(B) tick (√) if evidence met requirement/s (Indicate ACCEPTED or NOT
ACCEPTED)
Authentic Valid Recent Consistent Current Sufficient

Portfolio Evaluator 1: Portfolio Evaluator 2:

Katrina Amore M. Vinarao Hannie Mae L. Malabad

Signature over printed name Signature over printed name
Date evaluated: _________ Date evaluated:____________
RECOGNITION OF PRIOR LEARNING IN TVET (RPL-TVET) Form 2 Evaluation on Acceptability of the Evidence Presented/Submitted (Rules of
Evidence)
 RECOGNITION OF PRIOR LEARNING IN TVET (RPL-TVET) PORTFOLIO ASSESSMENT INSTRUMENT

Name of Learner-
Applicant:

Training Program Title: Contact Tracing LEvel II

Type of Modules: MODULES FOR CORE COMPETENCIES

BASIC COMPETENCIES
PORTFOLIO EVALUATION:
Document No. / CURRENCY and SUFFICIENCY
Module Title Learning Outcomes Critical Aspects of Competency Code of Tick (√) if evidence met requirement/s or mark (X) if not met
(A) (B) (C) Evidence RESULT
If requirements NOT MET, state the reason/circumstance at the REMARKS column
(E) (G)
(F)
Current REMARKS Sufficient REMARKS S US
1. Plan and prepare for the conduct of case
1. Plan and prepare for the investigation
conduct of case investigation 2. Conduct interview with the patient
3. Close procedure/ interview
2.Conduct interview with the 4. Evaluate Conduct of interview
patient 5. Identify close contacts or personsup
Module 1.  
Conduct Case 3. Close procedure/ interview
Investigation And
Contact Identification 4. Evaluate Conduct of
interview

5. Identify close contacts or

persons

1. Profile close contact

1. Profile close contact 2. Conduct follow-up
Module 2.  
Conduct Profiling of
contacts and follow-
up
2. Conduct follow-up

1 Observes proper infection prevention

1. Observes proper infection control (IPC) protocols
prevention control (IPC)
protocols 2. Coordinate with drivers and health
workers on the transport of patient for referral
2. Coordinate with drivers and
3. Observes proper referral and transfer
health workers on the transport
protocol
of patient for referral
Module 3. Conduct 4. Monitor patient’s condition during
Referral to Health transport2
Facility/Quarantine/ot 3. Observes proper referral and
her relevant agencies transfer protocol

4. Monitor patient’s condition

during transport
 RECOGNITION OF PRIOR LEARNING IN TVET (RPL-TVET) PORTFOLIO ASSESSMENT INSTRUMENT

1. Establish and maintain rapport with the

patient
1. Establish and maintain 2. Assess patient’s health educational needs
rapport with the patient and readiness to learn.
3. Plan and implement an individualized
teaching plan
4. Evaluate the patient’s learning progress
2. Assess patient’s health during and after teaching
educational needs and
readiness to learn.
Module 4.  
Conduct health
education Program
3. Plan and implement an
individualized teaching plan

4. Evaluate the patient’s

learning progress during and
after teaching

1. Demonstrate computer literacy and

1. Demonstrate computer
literacy and data/records data/records management
management 2 . Collate records
3. Prepare reports based on workplace
Module 4.   record system
Conduct health 2. Collate records
education Program

3. Prepare reports based on

workplace record system

1. Monitor close contacts of a specific

1. Monitor close contacts of a case.
specific case 2. Update client’s records
3. Inform immediate supervisor of
specific cases/findings in a timely manner
Module 5.  
Conduct Monitoring 2. Update client’s records
And Surveillance

3. Inform immediate supervisor

of specific cases/findings in a
timely manner

Portfolio Evaluator 1: Portfolio Evaluator 2:

Katrina Amore M. Vinarao Hannie Mae L. Malabad

Signature over printed name Signature over printed name
Date evaluated: _____________ Date evaluated: _____________
 RECOGNITION OF PRIOR LEARNING IN TVET (RPL-TVET) Form 3 Result of Evaluation per Evaluation Modalities Utilized
Name of Learner-Applicant: Amor S. De Guzman
Training Program Title: Caregiving NC II
Type of Modules: MODULES FOR BASIC, COMMON, & CORE COMPETENCIES

PORTFOLIO EVALUATION
RESULT OTHER EVALUATION MODALITIES USED
(D) (E)
(WHEN Portfolio reflect in the appropriate column the result of the
evidence/s is/are FINAL RESULT
evaluation/assessment used
Document No. / UNSATISFACTORY, NOTE: Attach Institutional Assessment instrument used and the PER
Module Title Learning Outcomes Code of proceed with other result of the assessment as evidences LEARNING
(A) (B) Evidence appropriate OUTCOME
assessment method) (F)
(C) Demonstration
Actual Work
Interview Written Test with Oral
Observation
Questioning
S US S US S US S US S US S US
MODULES OF CORE COMPETENCIES
1.  Explain the principles and procedures in washing
and ironing clothes √
Module 10: WASHING 2.  Explain the procedures in operating tools and
√
equipment
AND IRONING
CLOTHES, LINENS
3.  Perform laundry √
AND FABRICS 4.  Iron clothes, linens and fabrics √
5.  Perform after care activities of materials and
equipment √
1.  Explain the procedures in preparing hot and cold
meals √
2.  Prepare hot and cold meals √
3.  Prepare appetizers, sauces, dressings and
garnishes √
4.  Cook meals and dishes according to recipe/
Module 11: dietary requirements √
PREPARING HOT 5.  Set table and serve cooked dishes √
AND COLD MEALS 6.  Perform after care activities of materials and
√
equipment
7.  Demonstrate personal good grooming and
hygiene √
8.  Demonstrate clear and effective communication
on the job. √
9.  Maintain professionalism at the workplace √
PORTOFOLIO EVALUATORS: OTHER ASSESSMENT METHOD EVALUATOR: CONFORME:

Joy Lorena P. Reyes Christine R. Agustin Amor S. De Guzman

Signature over printed name Signature over printed name Signature over printed name
Date evaluated: _____________ Date evaluated: _____________ (Learner’s First Name, Middle Initial, Family Name)
 RECOGNITION OF PRIOR LEARNING IN TVET (RPL-TVET) Form 3 Result of Evaluation per Evaluation Modalities Utilized
@
00-010 SAMPLE 02-011FOR00-010M
RECOGNITION OF PRIOR LEARNING IN TVET (RPL-TVET) Form 3 - Result of Evaluation per Evaluation Modalities Utilized ANNEX - C

Name of Learner-Applicant: JUAN DELA CRUZ

Training Program Title: CAREGIVING NC II
Type of Modules: MODULES FOR BASIC COMPETENCIES

INSTRUCTION:
1. Write in column [A] the Module Title for Basic. Common and Core as appropriate
2. Indicate in column [B} the Learning Outcomes
3.  The evaluators shall indicate the specific Code of the accepted evidence/s that matched the learning outcomes (LOs) in column [C] based on the results of the Portfolio
Assessment;
4.   Evaluators shall accomplish column [D] based on the results of the Portfolio Assessment on Portfolio Assessment Instrument
5.   When portfolio rating is Not Satisfactory in column D, the evaluators shall now use the appropriate assessment method/s as recommended in column [E]
(Interview, Written Test, Demonstration, Actual Work Observation and/or using Third Party Report, etc.). The evaluator shall use its existing Institutional
Assessment instrument and attach the same to serve as evidence;
6.  The evaluators shall indicate the result/s of the other assessment method/s used in the column [E] by ticking the corresponding cell; US if Unsatisfactory and
S if Satisfactory;
7.  The evaluators shall indicate the FINAL RESULTS of all the assessment method/s used in the column [F] by ticking the corresponding cell; US if Unsatisfactory
and S if Satisfactory; and
8.  Evaluators shall affix signature over printed name and date evaluated; ensure to attach all the evidence/s used; let the learner affix his/her signature at the conforme
portion.

PORTFOLIO EVALUATION
RESULT OTHER EVALUATION MODALITIES USED
(D) (E)
(WHEN Portfolio reflect in the appropriate column the result of the
evidence/s is/are evaluation/assessment used FINAL RESULT
UNSATISFACTORY NOTE: Attach Institutional Assessment instrument used and the PER
Document No. / , proceed with result of the assessment as evidences
Module Title Learning Outcomes LEARNING
Code of Evidence other appropriate OUTCOME
(A) (B) assessment
(C) (F)
method) Demonstration
Actual Work
Interview Written Test with Oral
Observation
Questioning

S US S US S US S US S US S US
MODULES OF BASIC COMPETENCIES
1. Obtain and convey
workplace information
√ √
Module 1.  
PARTICIPATE IN 2. Perform duties following
WORKPLACE workplace instruction
√ √
COMMUNICATION
00-010 SAMPLE 02-011FOR00-010M
RECOGNITION OF PRIOR LEARNING IN TVET (RPL-TVET) Form 3 - Result of Evaluation per Evaluation Modalities Utilized ANNEX - C

Module 1.  
PARTICIPATE IN
WORKPLACE
COMMUNICATION 3. Complete relevant work-
related documents
√ √
1. Describe team role and
scope
√ √
Module 2.  
WORK IN TEAM 2. Identify one’s role and
responsibility within team
√ √
ENVIRONMENT
3. Work as a team member √ √
1. Integrate personal objectives with
organizational goals
√ √
Module 3.  
PRACTICE CAREER 2. Set and meet work priorities √ √
PROFESSIONALISM 3. Maintain professional growth and
development
√ √

Module 4.   1. Identify hazards and risks √ √

PRACTICE 2. Evaluate hazards and risks √ √
OCCUPATIONAL
HEALTH AND SAFETY 3. Control hazards and risks √ √
PROCEDURES 4. Maintain OHS awareness √ √
MODULES OF COMMON COMPETENCIES
1. Provide information to the work group
Module 1: about the organization’s infection control √ √
policies and procedures.
IMPLEMENTING AND 2. Integrate the organization’s infection
MONITORING control policy and procedure into work √ √
INFECTION CONTROL practices.
POLICIES AND 3. Monitor infection control performance
PROCEDURES and implement improvements in √ √ √
practices

Module 2: RESPONDING
1.  Plan and respond to emergencies. √ √
EFFECTIVELY TO
DIFFICULT/CHALLENGI
NG BEHAVIOR 2. Report and review incidents. √ √

1. Assess the situation. √ √

Module 3: APPLYING 2. Apply basic first aid techniques. √ √
BASIC FIRST AID
3. Communicate details of the incident. √ √
1. Communicate appropriately with
patients.
√ √
2. Establish and maintain good
Module 4: MAINTAINING
interpersonal relationship with patients.
√ √
HIGH STANDARD OF
PATIENT SERVICES 3. Act in a respectful manner at all times. √ √ √
00-010 SAMPLE 02-011FOR00-010M
RECOGNITION OF PRIOR LEARNING IN TVET (RPL-TVET) Form 3 - Result of Evaluation per Evaluation Modalities Utilized ANNEX - C

Module 4: MAINTAINING
HIGH STANDARD OF
PATIENT SERVICES
4. Evaluate own work to maintain a high
standard of patient service.
√ √ √

1.  Explain the concepts and principles of MODULES OF CORE COMPETENCIES

caring, growth and development of √ √
infants/toddlers
2. Prepare infants / toddlers for taking
Module 1: PROVIDING √ √
vital signs, bathing and dressing
CARE AND SUPPORT 3.  Clean, sterilize feeding bottles and
prepare milk formula
√ √
TO INFANTS 4.  Prepare and introduce adequate
/TODDLERS nutrition and semi-solid food.
√ √
5. Prepare infant / toddlers crib. √ √
1. Explain the importance of instilling
personal hygiene practices to children
√ √

Module 2: PROVIDING
2. Maintain children’s paraphernalia √ √
3.  Prepare children for taking vital sign,
CAREModule
AND SUPPORT
3: bathing and dressing
√ √
TO CHILDREN 4.  Perform after care activities for
√ √
FOSTERING materials and paraphernalia
SOCIAL, 5.  Determine nutritional food
1. Explain
requirementsthe of
concepts
childrenand principles of
√ √
INTELLECTUAL, social, intellectual, creative and
emotional development of children (3-12
√ √
CREATIVE AND 1.  Explain
Module 4:
EMOTIONAL yrs. Old) the concepts and principles of √ √
physical development of children
FOSTERING OF
DEVELOPMENT 2.  Explain the importance of healthy
PHYSICAL √ √
CHILDREN sleeping patterns and practices
DEVELOPMENT OF
CHILDREN 3. Perform physical activities √ √
1.  Explain the concepts and principles of
basic nursing care of the elderly
√ √
2.  Identify appropriate physical,
Module 5: PROVIDING emotional, assistance
3. Provide spiritual andinintellectual
promoting the √ √ √
CARE AND SUPPORT needs.
appropriate needs for roles,
TO ELDERLY responsibilities, rights, freedom and
√ √ √
4.  Provide
activities of adequate
elderly. nutrition and
elimination
√ √
1. Identify and explain the needs of
people with special needs
√ √ √
2.  Identify personal care and assistance
needed for daily living
√ √ √
Module 6: PROVIDING 3. Establish and maintain appropriate
CARE AND SUPPORT relationship
√ √ √
TO PEOPLE WITH 4.  Provide appropriate support for
people with special needs
√ √ √
SPECIAL NEEDS 5. Assist in oral and written
communication
√ √ √
6.  Provide adequate nutrition and
elimination for people with special needs
√ √
1.  Explain the concepts and principles in
Module 7: maintaining a clean and therapeutic √ √
MAINTAINING A environment
2.  Explain the procedure in maintaining a
clean and therapeutic environment
√ √ √
HEALTHY AND SAFE 3.  Assist client in implementing a safe
ENVIRONMENT and therapeutic environment
√ √ √
1.  Discuss signs and symptoms of
various illnesses and diseases
√ √
00-010 SAMPLE 02-011FOR00-010M
RECOGNITION OF PRIOR LEARNING IN TVET (RPL-TVET) Form 3 - Result of Evaluation per Evaluation Modalities Utilized ANNEX - C

2.  Identify and explain appropriate first

aid and basic emergency procedure
√ √
Module 8: 3.  Explain the procedures in
√ √
RESPONDING TO implementing infection control prevention
4.  Identify the appropriate procedures in
EMERGENCY medicine administration
√ √
5. Identify dangerous, hazardous and
threat to safety and well being
√ √
1.  Explain
6. Perform the
first principles and proper
aid procedures √ √
procedures in cleaning and polishing
(living room, bedroom, bathroom, and
√
2.  Clean and sanitize toilet and
Module 9: CLEANING kitchen)
bathroom
√
LIVING ROOM, 3. Identify different kinds of cleaning
agent
√
DINING ROOM, 4.  Make up beds and cots. (open and
BEDROOM, TOILET closed bed) √
AND BATHROOM 5.  Maintain a clean environment √
6.  Perform after care activities of
materials and equipment
√
1.  Explain the principles and procedures
in washing and ironing clothes
√
Module 10: WASHING 2.  Explain the procedures in operating √
AND IRONING tools and equipment
3.  Perform laundry √
CLOTHES, LINENS
AND FABRICS 4.  Iron clothes, linens and fabrics √
5.  Perform after care activities of
materials and equipment
√
1.  Explain the procedures in preparing
hot and cold meals
√
2.  Prepare hot and cold meals √
3.  Prepare appetizers, sauces, dressings
and garnishes
√
4.  Cook meals and dishes according to
Module 11: recipe/ dietary requirements
√
PREPARING HOT 5.  Set table and serve cooked dishes √
AND COLD MEALS 6.  Perform after care activities of
√
materials and equipment
7.  Demonstrate personal good grooming
and hygiene
√
8.  Demonstrate clear and effective
communication on the job.
√
9.  Maintain professionalism at the
workplace
√
FINAL RECOMMENDATION
(tick the appropriate column)
For Proper Training on LOs found
Modules (Basic Competencies) For Issuance of Certificate of Achievement
Not Satisfactory

1. Participate in workplace communication √

2. Work in a team environment √
3. Practice career professionalism √
00-010 SAMPLE 02-011FOR00-010M
RECOGNITION OF PRIOR LEARNING IN TVET (RPL-TVET) Form 3 - Result of Evaluation per Evaluation Modalities Utilized ANNEX - C

4. Practice occupational health and safety procedures √

5. Implement and monitor infection control policies and procedures √
6. Respond effectively to difficult/challenging behavior √
7. Apply basic first aid √
8. Maintain high standard of patient services √
9. Providing care and support to infants/toddlers √
10. Providing care and support to children √
11. Fostering social, intellectual, creative and emotional development of children √
12. Fostering the physical development of children √
13. Providing care and support to elderly √
14. Providing care and support to people with special needs √
15. Maintaining a healthy and safe environment √
16. Responding to emergency √
17. Cleaning living room, dining room, bedrooms, toilet and bathroom √
18. Washing and iron clothes, linen and fabric √
19. Preparing hot and cold meal √
PORTOFOLIO EVALUATORS: OTHER ASSESSMENT METHOD EVALUATOR: CONFORME:

Joy Lorena P. Reyes Christine R. Agustin Amor S. De Guzman

Signature over printed name Signature over printed name Signature over printed name
Date evaluated: _____________ Date evaluated: _____________ (Learner’s First Name, Middle Initial, Family Name)
Date: _____________

Legend:
S - Satisfactory
NS - Not Satisfactory
00-010 SAMPLE 02-011FOR00-010M
RECOGNITION OF PRIOR LEARNING IN TVET (RPL-TVET) Form 3 - Result of Evaluation per Evaluation Modalities Utilized ANNEX - C
 RECOGNITION OF PRIOR LEARNING IN TVET (RPL-TVET) Form 4 Overall Recommendation

Name of Learner-Applicant: Amor Santos De Guzman

Training Program Title: Caregiving NC II

INSTRUCTION:
1. The evaluators shall summarize the result of the evaluation after exhausting all evaluation/assessment methods;
2. The evaluators shall recommend either of the following;
a) Issuance of Certificate of Achievement on Module/s found Satisfactory
b) Proceed to the training proper on LOs found Unsatisfactory
3. Evaluators shall affix signature over printed name and date evaluated and conforme of the learner.

OVERALL RECOMMENDATION

For Issuance of
Certificate of For Proper Training
Modules Basic Competencies Achievement on the on LOs found
Modules found Unsatisfactory
Satisfactory

BASIC COMPETENCIES
Module 1: Participating in Workplace Communication √
Module 2: Working in team environment √
Module 3: Practice career professionalism √
Module 4: Practice occupational health and safety procedures √
COMMON COMPETENCIES
Module 1: Implement and monitor infection control policies and procedures √
Module 2: Respond effectively to difficult/challenging behavior √
Module 3: Apply basic first aid √
Module 4: Maintain high standard of patient services √
CORE COMPETENCIES

Module 1: Providing care and support to infants/toddlers

√

Module 2: Providing care and support to children √

Module 3: Fostering social, intellectual, creative and emotional development √
of children
Module 4: Fostering the physical development of children √
Module 5: Providing care and support to elderly √
Module 6: Providing care and support to people with special needs √
Module 7: Maintaining a healthy and safe environment √
Module 8: Responding to emergency √
Module 9: Cleaning living room, dining room, bedrooms, toilet and bathroom √
Module 10: Washing and iron clothes, linen and fabric √
Module 11: Preparing hot and cold meal √
PORTOFOLIO EVALUATORS: OTHER ASSESSMENT METHOD EVALUATOR:

Joy Lorena P. Reyes Christine R. Agustin Joy Lorena P. Reyes

Signature over printed name Signature over Printed Name Signature over printed name
Date evaluated: __________ Date evaluated:_____________ Date evaluated: _____________

ATTESTED AND APPROVED BY:

Arlene S. Sta. Maria

Signature over printed name
(RPL Committee Chair)
Date: _____________

NOTE: For the basic competencies, we used the CS for basic competencies with 21st century skills National Certificate Level II in this draft instrument
 RECOGNITION OF PRIOR LEARNING IN TVET (RPL-TVET) Form 4 Overall Recommendation

with 21st century skills National Certificate Level II in this draft instrument