No.BO.8.4.3.

2-V3 Borang Umpan Balik Magang dari Industri

23 Maret 2020

Tahun 20__

A. Student
Name :
Student ID :
Study Program :
Company/Institution :

B. Overall Comments
1. Overall comments for the intern:
_________________________________________________________________________
________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________

2. Overall comments for Politeknik Negeri Batam :

_________________________________________________________________________
_________________________________________________________________________
______________________________________________________________________________________________________________
____________________________________

3. Does the student’s internship performance meet the requirement for being new employee in
your company/institution?
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________

4. Does your company intend to recruit the intern immediately after he/she finished their
internship?
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________

C. Evaluation Parameter
1. Final grade for student based on overall internship process (range 1 – 100):

2. Please put tick () in the appropriate column in the following table based on the rubric provided in the
subsequent table
No Parameters Feedback
 No.BO.8.4.3.2-V3 Borang Umpan Balik Magang dari Industri
23 Maret 2020

Excelent Good Fair Poor

4 3 2 1
1 Ethics
2 Core competency skills
3 Foreign language proficiency
4 Information technology literacy
5 Comunication skill
6 Teamwork
7 Personal development

Rubric

Parameters Excellent Good Fair Poor

(76-100) (51-75) (26-50) (0-25)
Ethics Attitude and Attitude and Attitude and Demontrates bad
behavior can be set behavior meet the behavior are attitude and
as role model for standard ethics and acceptable, and do behavior, and has
others, personality able to peform good not have negative negative impact on
that meets personality impact for the the organization
professional ethics organization

Core competency skills Able to demonstrate Able to demonstrate Able to demonstrate Failed to
exceptional core core competencies sufficient core demonstrate core
competencies and well, however has competencies, but competencies as
provide value added not contributed to still need significant required in the
for the organization provide value added improvement field
for the organization
Foreign language Able to communicate Able to communicate Able to Unable to
proficiency both orally and in both orally and in communicate both communicate both
writing using one of writing using one of orally and in writing orally and in
foreign languages foreign languages using one of foreign writing using one
fluently in moderately language mixed with of foreign language
accordance with best a local language
practices
Information  technology Able to recognize, Quickly adapt with Do not find Unable to use
literacy access, evaluate, the information him/herself in information
synthesize, and use technology in the trouble with the technology in the
information organization information organization
technology technology in the
application to organization
improve job
performance
Comunication skill Able to effectively Able to understand There is no Unable to
deliver ideas to and deliver ideas to misunderstanding understand others
others both orally others both orally when delivering and and fail to deliver
and in writing, and in writing receiving ideas ideas
actively listen in to/from coworker
conversation, give
and receive critical
feedback and speak
in public.
Teamwork Able to lead a Able to provide Able to provide Gives negative
teamwork, achieve evidence in evidence in effects to the team
the goals, receive collaborating with collaborating with
support from the other team member, other team
team member, and accomplish assigned members,
resolve conflict works, and accomplish assigned
contribute to the work
team

Personal development Willing to learn new Willing to learn new Does not show Does not show
 No.BO.8.4.3.2-V3 Borang Umpan Balik Magang dari Industri
23 Maret 2020

things, take an things with a slight resistance to learn signs of

initiative to improve supervision new things, however willingness and
themselves needs to be initiative to learn
encouraged new things

Batam, 20….
Supervisor
Department

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