Republic of the Philippines

BULACAN STATE UNIVERSITY

COLLEGE OF ____________________

INTERN’s PERFORMANCE APPRAISAL FORM

STUDENT NAME: _____________________________________________ COURSE/MAJOR ______________________

Cooperating Agency: _____________________________________________________________________________

Address: _____________________________________________________ Contact No.__________________________

Evaluator: ____________________________________________________ Position: ____________________________

Training Period: __________________ to _______________________ Total Hours Rendered: _____________________

Directions. Using the scale below, please encircle the rating that best describe the competencies of the intern.
5 Outstanding (O) Performance exceeds the required standard.

4 Very Satisfactory ) Performance fully met the training requirements. The intern performed what was expected of
VS) him/her.
3 Satisfactory (S) Performance has met the required standards, the intern performed duties with minimal
supervision.
2 Fair (F) Performance partially meets the required standard, observed to be less than satisfactory, a lot
could be done better.
1 Needs Performance does not meet the required standard. Major improvement may be needed.
Improvement (NI)
0 Not applicable Performance indicator is not relevant to the training.
N/A

COMPETENCIES O VS S F NI N/A
TEAM WORK 5 4 3 2 1 0
1. Consistently works with others to accomplish goals and tasks. 5 4 3 2 1 0
2. Treats all team members in respectful and courteous manner. 5 4 3 2 1 0
3. Actively participates in activities and assigned tasks. 5 4 3 2 1 0
4. Willingly works with team members to continuously improve team 5 4 3 2 1 0
collaboration
5. Considers feedbacks and views of team members when completing 5 4 3 2 1 0
assigned tasks.
COMMUNICATION 5 4 3 2 1 0
6. Listens conscientiously to supervisor and co-workers 5 4 3 2 1 0
7. Comprehends written and oral information 5 4 3 2 1 0
8. Consistently delivers accurate information 5 4 3 2 1 0
9. Reliably provides feedback as required, both internally and externally 5 4 3 2 1 0
ATTENDANCE & PUNCTUALITY 5 4 3 2 1 0
10. Is consistently punctual 5 4 3 2 1 0
11. Maintains good attendance and participation 5 4 3 2 1 0
12. Informs supervisor promptly if absent or late 5 4 3 2 1 0
PRODUCTIVITY/RESILIENCE 5 4 3 2 1 0
13. Consistently delivers quality results 5 4 3 2 1 0
14. Meets deadlines and manages time well 5 4 3 2 1 0
15. Works around problems and obstacles in a stressful situation in 5 4 3 2 1 0
order to achieve required tasks
16. Time management is effective and efficient 5 4 3 2 1 0
17. Informs supervisor of any challenges or barriers that transpire in tasks 5 4 3 2 1 0
INITIATIVE/PROACTIVITY 5 4 3 2 1 0
18. Completes assignments with minimal supervision 5 4 3 2 1 0
19. Successfully completes tasks independently and accurately 5 4 3 2 1 0
20. Seeks additional support when necessary 5 4 3 2 1 0
21. Recognizes and takes appropriate action to effectively address 5 4 3 2 1 0
problems
22. Engages in continuous learning 5 4 3 2 1 0
23. Contributes new ideas and seek ways to improve the organization or 5 4 3 2 1 0
work place
JUDGEMENT/ DECISION-MAKING 5 4 3 2 1 0
24. Analyzes problems effectively 5 4 3 2 1 0
25. Demonstrates the ability to make creative and effective solutions to 5 4 3 2 1 0
problems
26. Demonstrates good judgement in handling routine problems 5 4 3 2 1 0
DEPENDABILITY/RELIABILITY 5 4 3 2 1 0
27. Ably follows through and meet required deadlines 5 4 3 2 1 0
29. Is personally accountable for his/her actions 5 4 3 2 1 0
29. Adapts effectively to changes in the work environment 5 4 3 2 1 0
30. Displays a consistent level of high performance 5 4 3 2 1 0
ATTITUDE 5 4 3 2 1 0
31. Willingly offers assistance when needed 5 4 3 2 1 0
32. Makes positive contribution to the organization’s morale 5 4 3 2 1 0
33. Shows sensitivity to and consideration for other’s feeling 5 4 3 2 1 0
34. Accepts constructive criticism positively 5 4 3 2 1 0
35. Shows pride in performing tasks 5 4 3 2 1 0
PROFESSIONALISM 5 4 3 2 1 0
36. Respects those in authority 5 4 3 2 1 0
37. Responsibly uses tools, equipment and machines 5 4 3 2 1 0
38. Follows all policies and procedures when issues and conflicts arise 5 4 3 2 1 0
39. Sticks with policies and procedures as issues and conflicts arise 5 4 3 2 1 0
40. Physical appearance is appropriate with the work environment and 5 4 3 2 1 0
placement rules.

Total Score /Equivalent rating

Raw score Equivalent rating Verbal interpretation

172 – 200 96 – 100 Outstanding
146 – 171 91 - 95 Excellent
120 - 145 86 - 90 Very good
94 – 119 81 - 85 Good
68 – 93 76 - 80 Fair
40 - 67 71 - 75 Conditional

Remarks/Comments/ Suggestions:

__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________

Evaluator’s Signature: _________________________________________ Date: _______________________

BulSU-OP-OSI-16F7
Revision 0