WORK IMMERSION CHECKLIST

Name: ____________________________________ Strand: _______________________

Establishment assigned: ______________________Inclusive dates: ________________

Requirements: (to be submitted in a long white folder with plastic cover)

___ Resume
___ Application letter
___ Barangay Clearance
___ Medical Certificate
___ Insurance
___ Performance Appraisal Form
___ Observation form (for those who will be assigned at the classroom)
___ Vaccination card – photocopy
___ Parent’s consent
___Task and Activities done during immersion form

Immersion Proper:

___ Daily Time Record (5copies)

___ Daily narrative on the activities performed with photos and captions
___ Certificate of Appearance signed by the supervisor (5copies)
___ Performance Appraisal Form
___ Observation form (for those who are assigned at the classroom)
___ Task and Activities done during immersion form

Post Immersion: (to be compiled in one white long folder with plastic cover)

___ Daily Time Record (5copies duly signed by the supervisor)

___ Certificate of Appearance signed by the supervisor (5copies)
___ Performance Appraisal Form
___ Observation form (for those who are assigned at the classroom)
___ Daily narrative with photos and captions
___ updated resume
___ reflection paper
___ Certificate of Completion
___ Parent’s consent
___ Task and Activities done during immersion form
 TASKS AND ACTIVITIES TO BE DONE DURING WORK IMMERSION

Name of Student: Chealsey Mae G. Angob Grade and Section: 12 - STEM

School: Magallanes National High Immersion Site: DOST Region XIII
School Office (Butuan City)
Track: Academic Track Strand/Specialization: STEM
Duration of Work: March 6, 2023 – March 17, 2023 (10 days)

School Immersion Focal Sheena Gay E. Canja Contact Number: 09106788248

Person:
Work Immersion Teacher: Rosalyn Ann B. Duran Contact Number: 093016663238

LIST OF TASKS/ACTIVITIES
Competencies Tasks/Activities Time Allotment Actual Schedule Remarks
SalikLakbay 8 hrs. & 41 mins. March 6 (DAY 1), 8 Completed
Documentation hours
SalikLakbay 8 hrs. & 35 mins. March 7 (DAY 2), 8 Completed
Documentation hours
SalikLakbay 8 hrs. & 29 mins. March 8 (DAY 3), 8 Completed
Documentation hours
SalikLakbay 8 hrs. & 40 mins. March 9 (DAY 4), 8 Completed
Documentation hours
SalikLakbay 8 hrs. & 32 mins. March 10 (DAY 5), 8 Completed
Documentation hours
SalikLakbay 8 hrs. & 39 mins. March 13 (DAY 6), 8 Completed
Documentation hours
SalikLakbay 8 hrs. & 19 mins. March 14 (DAY 7), 8 Completed
Documentation hours
SalikLakbay 8 hrs. & 30 mins. March 15 (DAY 8), 8 Completed
Documentation hours
SalikLakbay 8 hrs. & 35 mins. March 16 (DAY 9), 8 Completed
Documentation hours
SalikLakbay 8 hrs. & 34 mins. March 17 (DAY 10) Completed
Documentation 8 hours

Students shall not be given other activities outside of those previously agreed upon, which are
anchored on the above stated competencies.

Certified true and correct:

______CHEALSEY MAE G. ANGOB______ MAXAND REY B. ANGOB_____

Student’s Name in Print and Signature Parent’s Name in Print and Signature

______ROSALYN ANN B. DURAN______ ______________________________

Work Immersion Teacher’s Signature over printed name Industry Supervisor’s Signature over printed name