Sample Data Gathering Instrument for Trainee’s

Characteristics
Please answer the following instrument according to the
characteristics described below. Encircle the letter of your choice that
best describes you as a learner. Blank spaces are provided for some
data that need your response.
Name:__________________________ Address:_______________________
Contact No.:______________
Characteristics of learners

Language, Average grade in: Average grade in:

literacy and English Math
numeracy
(LL&N) a. 95 and above a. 95 and above
b. 90 to 94 b. 90 to 94
c. 85 to 89 c. 85 to 89
d. 80 to 84 d. 80 to 84
a. 75 to 79 e. 75 to 79

Cultural and Ethnicity/culture:

language a. Ifugao
background
b. Ilocano
c. Ibanag
d. Gaddang
e. Muslim
f. Ibaloy
g. Others( please specify)__Itawes__

Education & Highest Educational Attainment:

general a. Elementary Graduate
knowledge
b. High School Level
c. High School Graduate
d. College Level
e. College Graduate
f. with units in Master’s degree
g. Masteral Graduate
h. With units in Doctoral Level
i. Doctoral Graduate
 Characteristics of learners
Sex a. Male
b. Female
Age Your age: 22
Physical ability 1. Disabilities(if any)_____________________
2. Existing Health Conditions (Existing
illness if any)
a. None
b. Asthma
c. Heart disease
d. Anemia
e. Hypertension
f. Diabetes
g. Others(please specify)
___________________

Previous RMO Certificates

experience a. RMO certified
with the topic b. RMO graduate
c. RMO trainer
d. RMO lead trainer
Number of years as a competency trainer
______

Previous List down trainings related to RMO NCII

learning ___________________________
experience ___________________________
___________________________
National Certificates acquired and NC
Training Level
completed level
RICE MACHINERY OPERATIONS NCII

Special Other courses related to RMO

courses ________________________