Republic of the Philippines

Department of Education
Region XI
White Lamp School Inc.
Apokon, Tagum City

FORM 1.1 SELF-ASSESSMENT CHECKLIST

INSTRUCTIONS: This Self-Check Instrument will give the trainer necessary data or information
which is essential in planning training sessions. Please check the appropriate
box of your answer to the questions below.

BASIC COMPETENCIES ( Refer to 21st century NC II and NC

III)

CAN I…? YES NO

1. PARTICIPATE IN WORKPLACE COMMUNICATION /

 Obtain and convey workplace information /

 Perform duties following workplace instructions /

 Complete relevant workrelated documents /

2. WORK IN A TEAM ENVIRONMENT

 Describe team role and scope /

 Identify one’s role and responsibility within a team /

 Work as a team member /

3.

COMMON COMPETENCIES (Refer to your TR )

CAN I…? YES NO

1.
COMMON COMPETENCIES (Refer to your TR )

CAN I…? YES NO

2.

3.



CORE COMPETENCIES ( Refer to your TR )
CAN I…? YES NO

1. Provide care and support to infants/toddlers

 Comfort infants and toddlers? /

 Bathe and dress infants and toddlers? /

 Feed infants and toddlers? /

 Put infants and toddlers to sleep? /

 Enhance social, physical, intellectual, creative and /

emotional activities of infants and toddlers?
2. PROVIDE CARE AND SUPPORT TO CHILDREN

 Instill personal hygiene practices to children? /

 Bathe and dress children? /

 Feed children? /

3. Foster social, intellectual, creative and emotional

development of children
 Foster children’s independence and autonomy? /

 Encourage children to express their feelings, ideas /

and needs?
 Stimulate children’s awareness and creativity? /

 Foster children’s self esteem and development of self /

concept?
4. Foster the physical development of children
 Enhance physical activities of children? /
 Create opportunities for children to develop a wider /
range of physical development?
 Provide experience to support physical development /
of children?
5. PROVIDE CARE AND SERVICES TO ELDERLY
 Establish and maintain an appropriate relationship /
with the elderly?
 Provide appropriate support to the elderly? /

/
 Provide assistance with elderly’s personal care
needs?
 Provide assistance with the elderly’s personal care /
needs?
6. PROVIDE CARE AND SUPPORT TO PEOPLE WITH SPECIAL
NEEDS

 Establish and maintain appropriate relationship with /

people with special needs?
 Provide appropriate support to people with special /
needs?
 Assist in maintaining well being of people with special /
needs?
 Assist people with special needs to identify and meet /
their needs?
 Assist people with special needs in maintaining an /
environment that enables maximum independent
living?
7. MAINTAIN A HEALTHY AND SAFE ENVIRONMENT

 Maintain a clean and hygienic environment? /

 Provide a safe environment? /
 Supervise the safety of clients? /
8. RESPOND TO EMERGENCY
 Implement procedures for infection control and /
prevention?
 Recognize and respond to signs of potential illness? /
 Respond to emergencies and accidents? /
 Administer medication within guidelines? /
 Respond to threats and situations of danger? /
9. CLEAN LIVING ROOM, DINING ROOM, BEDROOMS, TOILETS,
BATHROOMS AND KITCHEN

 Clean surfaces and floors? /

 Clean furnishing and fixtures? /
 Make up beds and cots? /
 Clean toilet and bathroom? /
 Sanitize rooms? /
 Maintain clean room environment? /
 Clean kitchen? /
10. WASH AND IRON CLOTHES, LINEN AND FABRIC
 Check and sort clothes, linens and fabrics? /
 Remove stains? /
 Prepare washing equipment and supplies? /
  Perform laundry? /
 Dry clothes, linen and fabric? /

 Iron clothes, linens and fabrics? /

11. PREPARE HOT AND COLD MEALS/FOOD

 Prepare ingredients according to recipes? /

 Cook meals and dishes according to recipes? /

 Present cooked dishes? /

 Prepare sauces, dressings and garnishes? /

 Prepare Appetizers? /

 Prepare desserts and salads? /

 Prepare sandwiches? /

 Store excess foods and ingredients? /

 Convert unconsumed cooked food? /

Reported by: Noted by:

KRISTIN C. NARRA MIRAFLOR P. EGIRON

Trainer School Directress

 Republic of the Philippines

Department of Education
Region XI
White Lamp School Inc.
Apokon, Tagum City

Evidences/Proof of Current Competencies

Form 1.2: Evidence of Current Competencies acquired related to

Job/Occupation ( Caregiving NCII)

Current competencies (Core) Proof/Evidence Means of validating

2. PROVIDE CARE AND Certification of Submitted

SUPPORT TO CHILDREN related training certification of related
training

3. FOSTER SOCIAL, Certification of Submitted

INTELLECTUAL, CREATIVE related training certification of related
AND EMOTIONAL training
DEVELOPMENT OF
CHILDREN

4. FOSTER THE PHYSICAL Certification of Submitted

DEVELOPMENT OF related training certification of related
CHILDREN training

5. PROVIDE CARE AND Certification of Submitted

SUPPORT TO ELDERLY related training certification of related
training

6 . PROVIDE CARE AND Certification of Submitted

SUPPORT TO PEOPLE WITH related training certification of related
SPECIAL NEEDS
training
7. MAINTAIN A HEALTHY Certification of Submitted
AND SAFE ENVIRONMENT related training certification of related
training

8. RESPOND TO Certification of Submitted

EMERGENCY related training certification of related
training

9. CLEAN Certification of Submitted

LIVINGROOM,DINING related training certification of related
ROOM, BEDROOMS, training
TOILETS, BATHROOMS
AND KITCHEN

10.WASH AND IRON Certification of Submitted

CLOTHES, LINEN AND related training certification of related
FABRIC training

11.PREPARE HOT AND Certification of Submitted

COLD related training certification of related
MEALS/FOOD training

Reported by: Noted by:

KRISTIN C. NARRA MIRAFLOR P. EGIRON

Trainer School Directress

 Republic of the Philippines
Department of Education
Region XI
White Lamp School Inc.
Apokon, Tagum City

Form 1.3 Comparing and Cross Matching

Required Units of Current Training Gaps/

Competency/Learning Competencies Requirements
Outcomes based on CBC
(core)
1. Provide care and support to infants/toddlers

 Comfort infants and  Comfort

toddlers. infants and
toddlers.
 Bathe and dress  Bathe and
infants and dress infants
toddlers and toddlers

 Feed infants and  Feed

toddlers infants and
toddlers
 Put infants and  Put infants
toddlers to sleep and toddlers
to sleep

 Enhance social, Enhance 

physical, social,
intellectual, creative physical,
and emotional intellectual
activities of infants , creative
and toddlers and
emotional
activities of
infants and
toddlers
2. PROVIDE CARE AND SUPPORT TO CHILDREN

 Instill personal hygiene  Instill personal

practices to children hygiene
practices to
children
 Bathe and dress  Bathe and
children dress children
  Feed children  Feed children

3. Foster social, intellectual, creative and emotional

development of children
 Foster children’s  Foster
independence and children’s
autonomy independence
and autonomy
 Encourage children to  Encourage
express their feelings, children to
ideas and needs express their
feelings, ideas
and needs
 Stimulate children’s  Stimulate
awareness and children’s
creativity awareness and
creativity
 Foster children’s self  Foster
esteem and children’s self
development of self esteem and
concept development of
self concept
4. Foster the physical development of children
 Enhance physical  Enhance
activities of physical
children activities of
children
 Create  Create
opportunities for opportunities
children to develop for children to
a wider range of develop a wider
physical range of
development physical
development
 Provide experience  Provide
to support physical experience to
development of support
children physical
development of
children
5. PROVIDE CARE AND SERVICES TO ELDERLY
 Establish and  Establish and
maintain an maintain an
appropriate appropriate
relationship with relationship
the elderly with the
elderly
  Provide appropriate  Provide
support to the appropriate
elderly support to
the elderly
 Provide assistance  Provide
with elderly’s assistance
personal care needs with elderly’s
personal care
needs
 Provide assistance  Provide
with the elderly’s assistance
personal care needs with the
elderly’s
personal care
needs
6. PROVIDE CARE AND SUPPORT TO PEOPLE WITH SPECIAL
NEEDS
 Establish and  Establish and
maintain maintain
appropriate appropriate
relationship with relationship with
people with special people with
needs special needs
 Provide appropriate  Provide
support to people appropriate
with special needs support to
people with
special needs
 Assist in  Assist in
maintaining well maintaining well
being of people with being of people
special needs with special
needs
 Assist people with  Assist people
special needs to with special
identify and meet needs to identify
their needs and meet their
needs
 Assist people with  Assist people
special needs in with special
maintaining an needs in
environment that maintaining an
enables maximum environment
independent living that enables
maximum
independent
living
7. MAINTAIN A HEALTHY AND SAFE ENVIRONMENT
 Maintain a clean  Maintain a clean
and hygienic and hygienic
environment environment
 Provide a safe  Provide a safe
environment environment
 Supervise the safety  Supervise the
of clients safety of clients
8. RESPOND TO EMERGENCY
 Implement  Implement
procedures for procedures for
infection control infection control
and prevention and prevention
 Recognize and  Recognize and
respond to signs of respond to signs
potential illness of potential
illness
 Respond to  Respond to
emergencies and emergencies and
accidents accidents
 Administer  Administer
medication within medication
guidelines within
guidelines
 Respond to threats  Respond to
and situations of threats and
danger situations of
danger

9. CLEAN LIVING ROOM, DINING ROOM, BEDROOMS, TOILETS,

BATHROOMS AND KITCHEN

 Clean surfaces and  Clean

floors surfaces
and floors
 Clean  Clean
furnishing and furnishin
fixtures g and
fixtures
 Make up beds  Make up
and cots beds and
cots
 Clean toilet  Clean
and bathroom toilet and
 bathroom
 Sanitize rooms  Sanitize
rooms
 Maintain clean  Maintain
room clean
environment room
environm
ent
 Clean kitchen  Clean
kitchen
10. WASH AND IRON CLOTHES, LINEN AND FABRIC
 Check and  Check and
sort clothes, sort
linens and clothes,
fabrics linens and
fabrics
 Remove stains  Remove
stains
 Prepare  Prepare
washing washing
equipment equipment
and and
supplies supplies
 Perform  Perform
laundry laundry
 Dry clothes,  Dry
linen and clothes,
fabric linen and
fabric
 Iron clothes,  Iron
linens and clothes,
fabrics linens and
fabrics
11. PREPARE HOT AND COLD MEALS/FOOD
 Prepare  Prepare
ingredients ingredients
according to according
recipes to recipes
 Cook meals and  Cook
dishes according meals and
to recipes dishes
according
to recipes
 Present cooked  Present
cooked
 dishes dishes
 Prepare sauces,  Prepare
dressings and sauces,
garnishes dressings
and
garnishes
 Prepare  Prepare
Appetizers Appetizers
 Prepare desserts  Prepare
and salads desserts
and salads
 Prepare  Prepare
sandwiches sandwiche
s
 Store excess  Store
foods and excess
ingredients foods and
ingredients
 Convert  Convert
unconsumed unconsum
cooked food ed cooked
food

Reported by: Noted by:

KRISTIN C. NARRA MIRAFLOR P. EGIRON

Trainer School Directress

 Republic of the Philippines
Department of Education
Region XI
White Lamp School Inc.
Apokon, Tagum City

Form 1.4 Training Needs

Training Needs Module

Title/Module of
(Learning Outcomes) No. of Hours
Instruction
UC1. PROVIDE CARE AND
SUPPORT TO INFANTS
AND TODDLERS

LO1. Comfort infants and

toddlers
LO2. Bathe and dress
infants and toddlers 46 hours
PROVIDING CARE
LO3. Feed infants and AND SUPPORT TO
toddlers INFANTS AND
TODDLERS
LO4. Put infants and
toddlers to sleep
LO5. Enhance social,
physical, intellectual,
creative and emotional
activities of infants and
toddlers.

Reported by: Noted by:

KRISTIN C. NARRA MIRAFLOR P. EGIRON

Trainer School Directress