APPENDICES

SAMPLE DATA GATHERING INSTRUMENT
FOR TRAINEE’S CHARACTERISTICS
Name: ____________________________ Date: ______________
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.
CHARACTERISTCS 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. Bisaya
background
b. Muslim
c. Bla’an
d. Ilonggo
e. Ilocano
f. T’boli
g. Others( please specify)_____________
Education & Highest Educational Attainment:

general a. Junior High School Level
knowledge
b. Senior High School Level
c. High School Graduate
Document No. TSOX-MPDC –

Date Developed: DRV01-0001
MARCH 2024 Issued by:
APPENDIC TESDA SOCCSKSARGEN Page 146
ES Developed by: MANPOWER of 161
JAN COLIN DEVVELOPMENT
RAMISCAL CENTER
Revision # 00
d. Diploma Graduate
e. College Level
f. College Graduate
g. with units in Master’s degree
h. Masteral Graduate
i. With units in Doctoral Level
j. Doctoral Graduate
Sex a. Male
b. Female
Age Your age: _____
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) ___________________
Number of years as a competency trainer
Previous
______
experience with
the topic
Previous List down trainings related to your

learning qualification
experience ___________________________
___________________________
___________________________
National Certificates acquired and NC level

Training Level
___________________________
completed
___________________________
Special courses Other courses related to your qualification

a. Units in education

APPENDICE TESDA Page 147
S Developed by: SOCCSKSARGEN of 165
JAN COLIN J. MANPOWER
RAMISCAL DEVVELOPMENT
CENTER
Revision # 00
b. Master’s degree units in education
c. Others(please specify)
_________________________
Learning styles a. Visual - The visual learner takes mental

pictures of information given, so in order
for this kind of learner to retain
information, oral or written, presentations
of new information must contain diagrams
and drawings, preferably in color. The
visual learner can't concentrate with a lot
of activity around him and will focus better
and learn faster in a quiet study
environment.
b. Kinesthetic - described as the students in
the classroom, who have problems sitting
still and who often bounce their legs while
tapping their fingers on the desks. They are
often referred to as hyperactive students
with concentration issues.
c. Auditory- a learner who has the ability to
remember speeches and lectures in detail
but has a hard time with written text.
Having to read long texts is pointless and
will not be retained by the auditory learner
unless it is read aloud.
d. Activist - Learns by having a go
e. Reflector - Learns most from activities
where they can watch, listen and then
review what has happened.
f. Theorist - Learns most when ideas are
linked to existing theories and concepts.
g. Pragmatist - Learns most from learning
activities that are directly relevant to their
situation.
Other needs a. Financially challenged
b. Working student
c. Solo parent
d. Others (please specify)
___________________________

CENTER
Revision # 00
FORM 1.1 SELF-ASSESSMENT CHECK
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
CAN I…? YES NO
UC1: PARTICIPATE IN WORKPLACE COMMUNICATION
1.1 Obtain and convey workplace information 
1.2 Participate in workplace meetings and discussions 
1.3 Complete relevant work-related documents 
UC2: WORK IN TEAM ENVIRONMENT
2.1 Describe team role and scope 
2.2 Identify own role and responsibility within team 
2.3 Work as a team member 
UC3: PRACTICE CAREER PROFESSIONALISM
3.1 Integrate personal objectives with organizational goals 
3.2 Set and meet work priorities 

CENTER
Revision # 00
3.3 Maintain professional growth and development 
UC4: PRACTICE OCCUPATIONAL HEALTH AND SAFETY

PROCEDURES
4.1 Identify hazards and risks 
4.2 Evaluate hazards and risks 
4.3 Control hazards and risks 
4.4 Maintain OHS awareness 
COMMON COMPETENCIES
CAN I…? YES NO
UC1: APPLY QUALITY STANDARDS
1.1 Assess quality of received materials 
1.2 Assess own work 
1.3 Engage in quality improvement 
UC2: PERFORM COMPUTER OPERATIONS
2.1 Plan and prepare for task to be taken undertaken 
2.2 Input data into computer 
2.3Access information using computer 
2.4 Produce output/ data using computer system 
2.5 Use basic functions of a www-browser to locate 

information
2.6 Maintain computer equipment and systems 
UC3: PERFORM MENSURATION AND CALCULATION
3.1 Select measuring instruments 

CENTER
Revision # 00
3.2 Carry out measurements and calculation 
3.3.Maintain measuring instruments 
UC4: PREPARE AND INTERPRET TECHNICAL DRAWING
4.1 Identify different kinds of technical drawings 
4.2 Interpret technical drawing 
4.3 Prepare/make changes to electrical/electronic 

schematics and drawings
4.4 Store technical drawings and equipment /instruments 
UC5. USE HAND TOOLS
5.1 Plan and prepare for tasks to be undertaken 
5.2 Prepare hand tools 
5.3 Use appropriate hand tools and test equipment 3.1. 

Tools are used according to tasks undertaken 3
5.4 Maintain hand tools 
UC6. TERMINATE AND CONNECT ELECTRICAL WIRING AND

ELECTRONIC CIRCUITS
6 1 Plan and prepare for termination/connection of 

electrical wiring/electronics circuits
6.2 Terminate/connect electrical wiring/electronic circuits 
6.3 Test termination/ connections of electrical 

wiring/electronics circuits
UC7. TEST ELECTRONIC COMPONENTS
7.1 Determine criteria for testing electronics components 
7.2 Plan an approach for component testing 
7.3 Test components 

CENTER
Revision # 00
7. 4 Evaluate the testing process 
CORE COMPETENCIES
UC1: INSTALL AND CONFIGURE COMPUTER SYSTEMS
1.1 Assemble computer hardware 
1.2 Prepare installer 
1.3 Install operating system and drivers for peripherals/ 

devices
1.4 Install application software 
1.5 Conduct testing and documentation 
UC2: SET-UP COMPUTER NETWORKS
2.1 Install network cables 
2.2 Set network configuration 
2.3 Set router/Wi-Fi/ wireless access point/repeater 

configuration
2.4 Inspect and test the configured computer networks 
UC3: SET-UP COMPUTER SERVERS
3.1 Set-up user access 
3.2 Configure network services 2.1 
3.3 Perform testing, documentation and predeployment 

procedures
UC4 Maintain and Repair Computer Systems and Networks
4.1 Plan and prepare for maintenance and repair 
4.2 Maintain computer systems and networks 
4.3 Diagnose faults of computer systems and networks 

CENTER
Revision # 00
4.4 Rectify/correct defects in computer systems and 
networks
4.5 Inspect and test the computer systems and networks 
Note: In making the Self-Check for your Qualification, all

required competencies should be specified. It is
therefore required of a Trainer to be well- versed of the
CBC or TR of the program qualification he is teaching.

CENTER
Revision # 00
FORM 1.2 EVIDENCES/PROOF OF
CURRENT COMPETENCIES
Form 1.2: Evidence of Current Competencies acquired related to

Job/Occupation
Current competencies Proof/Evidence Means of validating
BASIC COMPETENCIES
UC1: PARTICIPATE IN Certificate of Oral interview

WORKPLACE Employment
Written Examination
COMMUNICATION
Cert of Training
Submitted copy of
TOR Authenticated TOR
1.1 Obtain and convey workplace

information
1.2 Participate in workplace

meetings and discussions
1.3 Complete relevant work-

related documents
UC2: WORK IN TEAM Certificate of Oral interview

ENVIRONMENT UNIT CODE Employment
Written Examination
Cert of Training
Submitted copy of
2.1 Describe team role and scope
2.2 Identify own role and

responsibility within team
2.3 Work as a team member
UC3: PRACTICE CAREER Certificate of Oral interview

PROFESSIONALISM

CENTER
Revision # 00
Employment Written Examination
Cert of Training Submitted copy of

Authenticated TOR
TOR
3.1 Integrate personal objectives

with organizational goals
3.2 Set and meet work priorities
3.3 Maintain professional growth

and development
UC4: PRACTICE Certificate of Oral interview

OCCUPATIONAL HEALTH AND Recognition
Written Examination
SAFETY
Cert of Training
Portfolio
Certificate of
Employment
4.1 Identify hazards and risks
4.2 Evaluate hazards and risks
4.3 Control hazards and risks
4.4 Maintain OHS awareness
COMMON COMPETENCIES
UC1: APPLY QUALITY Certificate of Oral interview

STANDARDS achievement
Submitted copy of
Cert of training Portfolio
1.1 Assess quality of received

materials
1.2 Assess own work

CENTER
Revision # 00
1.3 Engage in quality
improvement
UC2 PERFORM COMPUTER Certificate of Oral interview

OPERATIONS Recognition
Submitted copy of
Cert of Training Portfolio
2.1 Plan and prepare for task to

be taken undertaken
2.2 Input data into computer
2.3 Access information using

computer
2.4 Produce output/ data using

computer system
2.5 Use basic functions of a

www-browser to locate
information
2.6 Maintain computer

equipment and systems
UC3: PERFORM Certificate of Oral interview

MENSURATION AND Recognition
Submitted copy of
CALCULATION
3.1 Select measuring instruments
3.2 Carry out measurements and

calculation
3.3 Maintain measuring

instruments
UC4: PREPARE AND Certificate of Oral interview

CENTER
Revision # 00
INTERPRET TECHNICAL Recognition Submitted copy of
DRAWING Authenticated TOR
TOR
Portfolio
Cert of Training
4.1 Identify different kinds of

technical drawings
4.2 Interpret technical drawing
4.3 Prepare/make changes to

electrical/electronic schematics
and drawings
4.4 Store technical drawings and

equipment /instruments
UC5. USE HAND TOOLS Certificate of Oral interview

Recognition
Submitted copy of
5.1 Plan and prepare for tasks to

be undertaken
5.2 Prepare hand tools
5.3 Use appropriate hand tools

and test equipment
5.4 Maintain hand tools
UC6. TERMINATE AND Certificate of Oral interview

CONNECT ELECTRICAL Recognition
WIRING AND Submitted copy of
ELECTRONICS CIRCUIT TOR Authenticated TOR

CENTER
Revision # 00
6.1 Plan and prepare for
termination/connection of
electrical
6.2 Terminate/connect
electrical wiring/electronic
circuits
6.3 Test termination/

connections of electrical
UC7. TEST ELECTRONIC Certificate of Oral interview

COMPONENTS Recognition
Submitted copy of
7.1 Determine criteria

for testing
electronics
components
7.2 Plan an approach

for component
testing
7.3 Test components
7.4 Evaluate the testing

process

CENTER
Revision # 00
IDENTIFYING TRAINING GAPS
From the accomplished Self-Assessment Check (Form 1.1) and the

evidences of current competencies (Form 1.2), the Trainer will be able to
identify what the training needs of the prospective trainee are.
Form 1.3 Summary of Current Competencies versus Required

Competencies
Required Units of Current Training

Competency/Learning Competencies Gaps/Requirements
Outcomes based on CBC
BASIC COMPETENCIES
UC1: PARTICIPATE IN WORKPLACE COMMUNICATION
1.1 Obtain and 1.1 Obtain and

convey convey
workplace workplace
information information
1.2 Participate in 1.2 Participate in

workplace workplace
meetings and meetings and
discussions discussions
1.3 Complete 1.3 Complete

relevant work relevant work
related related

CENTER
Revision # 00
documents documents
UC2: WORK IN TEAM ENVIRONMENT
2.1 Describe team role 2.1 Describe team role

and scope and scope
2.2 Identify own role and 2.2 Identify own role

responsibility within and
team responsibility within
team
2.3 Work as a team 2.3 Work as a team

member member
UC3: PRACTICE CAREER PROFESSIONALISM
3.1 Integrate personal 3.1 Integrate

objectives with personal objectives
organizational goals with organizational
goals
3.2 Set and meet work 3.2 Set and meet

priorities work priorities
3.3 Maintain professional 3.3 Maintain

growth and development professional growth
and development
UC4: PRACTICE OCCUPATIONAL HEALTH AND SAFETY

PROCEDURES
4.1 Identify hazards and 4.1 Identify hazards

risks and risks
4.2 Evaluate hazards and 4.2 Evaluate

risks hazards and risks

CENTER
Revision # 00
4.3 Control hazards and 4.3 Control hazards
risks and risks
4.4 Maintain OHS 4.4 Maintain OHS

awareness awareness
Required Units of Current Training

Competency/Learning Competencies Gaps/Requirements
Outcomes based on CBC
COMMON COMPETENCIES
UC1: APPLY QUALITY STANDARDS
1.1 Assess quality of 1.1 Assess quality

received materials of received
materials
1.2 Assess own work 1.2 Assess own

work
1.3 Engage in quality 1.3 Engage in

improvement quality
improvement
UC2: PERFORM COMPUTER OPERATIONS
2.1 Plan and prepare for 2.1 Plan and prepare for
task to be taken task to be taken
undertaken undertaken
2.2 Input data into 2.2 Input data into

computer computer
2.3 Access information 2.3 Access information

using computer using computer
2.4 Produce output/ data 2.4 Produce output/ data

using computer system using computer system
2.5 Use basic functions of 2.5 Use basic functions

a www-browser to of
locate information a www-browser to

CENTER
Revision # 00
locate information
2.6 Maintain computer 2.6 Maintain computer

equipment and equipment and
systems systems
UC3: PERFORM MENSURATION AND CALCULATION
3.1 Select measuring instruments 3.1 Select measuring

instruments
3.2 Carry out measurements and 3.2 Carry out

calculation measurements and
calculation
3.3 Maintain measuring 3.3 Maintain measuring

instruments instruments
UC4: PREPARE AND INTERPRET TECHNICAL DRAWING
4.1 Identify different kinds 4.1 Identify different

of kinds of
technical drawings technical drawings
4.2 Interpret technical 4.2 Interpret

drawing technical drawing
4.3 Prepare/make changes 4.3 Prepare/make

to changes to
electrical/electronic electrical/electronic
schematics schematics
and drawings and drawings
4.4 Store technical 4.4 Store technical

drawings and drawings and
equipment /instruments equipment
/instruments
UC5. USE HAND TOOLS
5.1 Plan and prepare for 5.1 Plan and

tasks to be undertaken prepare for tasks to
be undertaken

CENTER
Revision # 00
5.2 Prepare hand tools 5.2 Prepare hand
tools
5.3 Use appropriate hand 5.3 Use appropriate

tools hand tools
and test equipment and test equipment
5.4 Maintain hand tools 5.4 Maintain hand

tools
UC6. TERMINATE AND CONNECT ELECTRICAL WIRING AND

ELECTRONICS CIRCUIT
6.1 Plan and prepare for 6.1 Plan and

termination/connection of prepare for
electrical termination/
wiring/electronics circuits connection of
electrical
6.2 Terminate/connect 6.2 Store/arrange

electrical wiring/electronic tools and shop
circuits equipment
6.3 Test termination/ 6.3 Dispose

connections of electrical wastes/used
wiring/electronics circuits lubricants
UC7. TEST ELECTRONIC Current Training

COMPONENTS Competencies Gaps/Requirements
7.1 Determine criteria 7.1 Determine criteria

for testing for testing
electronics electronics
components components
7.2 Plan an approach 7.2 Plan an approach

for component for component
testing testing

CENTER
Revision # 00
7.3 Test components 7.3 Test components
7.4Evaluate the testing 7.4Evaluate the testing

process process
CORE COMPETENCIES
UC1: INSTALL AND CONFIGURE COMPUTER SYSTEMS
1.1 Assemble computer 1.1 Assemble

hardware computer
hardware
1.2 Prepare installer 1.2 Prepare installer
1.3 Install operating 1.3Install operating

system and drivers system and drivers
for peripherals/ for peripherals/
devices devices
1.4 Install application 1.4 Install

software application
software
1.5 Conduct testing and 1.5 Conduct testing

documentation and
documentation
UC2: SET-UP COMPUTER NETWORKS
2.1 Install network 2.1 Install network

cables cables
2.2 Set network 2.2 Set network

configuration configuration
2.3 Set router/Wi-Fi/ 2.3 Set router/Wi-Fi/

wireless access wireless access
point/repeater point/repeater
configuration configuration
2.4 Inspect and test 2.4 Inspect and test

the configured the configured
computer computer

CENTER
Revision # 00
networks networks
3.1 Set-up user access 3.1 Set-up user access
3.2 Configure network services 3.2 Configure network

services
3.3 Perform testing, 3.3 Perform testing,

documentation and pre- documentation and pre-
deployment procedures deployment procedures
UC4: MAINTAIN AND REPAIR COMPUTER SYSTEMS AND

NETWORKS
4.1 Plan and prepare for 4.1 Plan and prepare for
maintenance and repair maintenance and repair
4.2 Maintain computer 4.2 Maintain computer

systems and networks systems and networks
4.3 Diagnose faults of q

computer systems and
networks
4.4 Rectify/correct defects 4.4 Rectify/correct

in computer systems defects
and networks in computer systems
and networks
4.5 Inspect and test the 4.5 Inspect and test the
computer systems and computer systems and
networks networks

CENTER
Revision # 00
FORM NO. 1.4: TRAINING NEEDS
Using Form No.1.4, convert the Training Gaps into a Training Needs/
Requirements. Refer to the CBC in identifying the Module Title or Unit of
Competency of the training needs identified.
Training Needs Module Title/Module of

Instruction
(Learning Outcomes)
UC1: INSTALL AND CONFIGURE

CENTER
Revision # 00
COMPUTER SYSTEMS INSTALLING AND
CONFIGURING
LO1 Assemble computer COMPUTER SYSTEMS
hardware
LO2 Prepare installer
LO3 Install operating system and drivers

for peripherals/ devices
LO4 Install application software
LO5 Conduct testing and documentation
UC2: SET-UP COMPUTER NETWORKS SETTING-UP COMPUTER

NETWORKING
LO1 Install network
Cables
LO2 Set network

configuration
LO3 Set router/Wi-Fi/ wireless access
point/repeater configuration
LO4 Inspect and test the configured
computernetworks
LO1 Set-up user access SETTING-UP COMPUTER

SERVERS
LO2 Configure network services
LO3 Perform testing, documentation and pre-

deployment procedures
UC4: MAINTAIN AND REPAIR
COMPUTER SYSTEMS AND
NETWORKS
LO1 Plan and prepare for maintenance and repair
MAINTAINING AND
LO2 Maintain computer systems and networks
REPAIRING COMPUTER
LO3 Diagnose faults of computer systems and

CENTER
Revision # 00
networks SYSTEMS AND
LO4 Rectify/correct defects In computer systems NETWORKS
and networks
LO5 Rectify/correct defects In computer systems
and networks

CENTER
Revision # 00

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SAMPLE DATA GATHERING INSTRUMENT

FOR TRAINEE’S CHARACTERISTICS

Name: ____________________________ Date: ______________

Please answer the following instrument according to the

Language, Average grade in: Average grade in:

Cultural and Ethnicity/culture:

Education & Highest Educational Attainment:

Document No. TSOX-MPDC –

Physical ability 1. Disabilities(if any)_____________________

Previous List down trainings related to your

National Certificates acquired and NC level

Special courses Other courses related to your qualification

Document No. TSOX-MPDC –

Learning styles a. Visual - The visual learner takes mental

Document No. TSOX-MPDC –

INSTRUCTIONS: This Self-Check Instrument will give the trainer

UC1: PARTICIPATE IN WORKPLACE COMMUNICATION

1.1 Obtain and convey workplace information 

1.2 Participate in workplace meetings and discussions 

1.3 Complete relevant work-related documents 

UC2: WORK IN TEAM ENVIRONMENT

2.1 Describe team role and scope 

2.2 Identify own role and responsibility within team 

2.3 Work as a team member 

UC3: PRACTICE CAREER PROFESSIONALISM

3.1 Integrate personal objectives with organizational goals 

3.2 Set and meet work priorities 

Document No. TSOX-MPDC –

UC4: PRACTICE OCCUPATIONAL HEALTH AND SAFETY

4.1 Identify hazards and risks 

4.2 Evaluate hazards and risks 

4.3 Control hazards and risks 

4.4 Maintain OHS awareness 

UC1: APPLY QUALITY STANDARDS

1.1 Assess quality of received materials 

1.2 Assess own work 

1.3 Engage in quality improvement 

UC2: PERFORM COMPUTER OPERATIONS

2.1 Plan and prepare for task to be taken undertaken 

2.2 Input data into computer 

2.3Access information using computer 

2.4 Produce output/ data using computer system 

2.5 Use basic functions of a www-browser to locate 

2.6 Maintain computer equipment and systems 

UC3: PERFORM MENSURATION AND CALCULATION

3.1 Select measuring instruments 

Document No. TSOX-MPDC –

3.3.Maintain measuring instruments 

UC4: PREPARE AND INTERPRET TECHNICAL DRAWING

4.1 Identify different kinds of technical drawings 

4.2 Interpret technical drawing 

4.3 Prepare/make changes to electrical/electronic 

4.4 Store technical drawings and equipment /instruments 

UC5. USE HAND TOOLS

5.1 Plan and prepare for tasks to be undertaken 

5.2 Prepare hand tools 

5.3 Use appropriate hand tools and test equipment 3.1. 

5.4 Maintain hand tools 

UC6. TERMINATE AND CONNECT ELECTRICAL WIRING AND

6 1 Plan and prepare for termination/connection of 

6.2 Terminate/connect electrical wiring/electronic circuits 

6.3 Test termination/ connections of electrical 

UC7. TEST ELECTRONIC COMPONENTS

7.1 Determine criteria for testing electronics components 

Name: ______________ Date: