FM-AA-INT-13
Rev. 0
03-Oct-2017
INTERNSHIP EVALUATION FORM
PANGASINAN STATE UNIVERSITY
Binmaley Campus
This form is to be completed by the host company or a designated supervisor. This form shall be completed and submitted to the office of Campus
Internship Coordinator and Internship / Practicum Subject Instructor upon completion of _____ training hours.
NAME OF STUDENT-INTERN
NAME OF COMPANY / FIRM /
AGENCY
COMPANY ADDRESS
DATE STARTED DATE ENDED
INSTRUCTIONS: Evaluate Student-Intern fairly and honestly based on his/her performance considering their time in the trade. Rate all 8 competencies
below. There are criteria under each competency. Please rate by encircling the appropriate number that best describes the extent of the performance of
the Student- Intern.
COMPETENCY CRITERIA RATING REMARKS
Grasps new ideas quickly, can readily apply knowledge to new
5
situations, flexible problem solver
Learns quickly, applies past experiences 4
Usually understands instructions; usually has good judgment
A. ABILITY TO LEARN (10%) 3
and reasoning
Slow to grasp concepts, sometimes does not remember
2
important facts and procedures
Does not easily understand; needs repeated instructions on the
1
same tasks.
Possesses a positive perspective; always upbeat and ready to
work; a pleasure to work with; always reports to work ahead of 5
time without any absences and tardiness
Accepts all work assignments; rarely complains; communicates
well with superiors and coworkers; observes regularity and 4
punctuality in attendance
B. WORK ATTITUDE (15%) Takes setback in strides; pleasant and cooperative in most
situations; reports to work on time with minimal absences or 3
tardiness.
Complains that many things are unfair, a whiner; reports to
2
work but sometimes tardy and absent.
Continually gripes about work assignments; disturbs others;
1
uncooperative; temperamental; frequent absences or tardiness.
Always polite; careful not to offend anyone, maintains proper
5
composure; makes special efforts to be helpful.
Mostly polite and helpful; recognizes importance of human
4
relationships; rarely losses temper.
Observes common courtesy but doesn't always recognize
C. CONDUCT (10%) 3
opportunities and/or need to be polite or helpful.
Harasses others; occasionally rude, foul language; not
2
sensitive to others.
Rude; ill mannered; uses obscene language; poor control of
1
emotions; disrespectful to others.
Curiosity goes beyond immediate job procedures; eager to
5
learn more; works hard.
Good knowledge of most procedures; anticipates next steps;
4
goes beyond expectations and prepares ahead.
Asks questions; has adequate degree of knowledge; does
D. MOTIVATION/INITIATIVE 3
routine tasks without prompting; ready with tools.
(10%)
Does what is told; sometimes anticipates parts of the job; does
2
no more than what is required; seems uninterested at times.
Never anticipates requirements of any job or procedure; always
wants or has to be told what to do; lacks initiatives, needs 1
prodding.
Work is very accurate; work meets or exceeds standards; takes
5
pride in his/her work.
Does good work; careful; makes very few mistakes; uses good
4
judgment.
E. QUALITY AND ACCURACY Work usually meets standard or expectations; needs some
OF WORK (20%) 3
extra supervision.
Aims just to get by; careless; some job need to be reworked 2
Makes frequent mistakes; wastes materials; lacks mechanical
1
ability; needs constant supervision.
COMPETENCY CRITERIA RATING REMARKS
Highly productive; fast and accurate; when finished with
5
assigned tasks finds others task to advance the job.
F. QUANTITY OF WORK (10%) Plans work well; works efficient; gets expected work on time. 4
Does fair share; looks busy but after finishing a task usually 3
FM-AA-INT-13
Rev. 0
03-Oct-2017
doesn’t look for other tasks that need to be done.
Does less than expected; does just enough to get by; requires
2
additional oversight.
Doesn’t plans work; slow; procedures very little; wastes time;
1
continually visiting with others which slows down the work.
Always places safety first; helps others to be safe; does not
5
take chances which might endangered self and others.
Observes safety precautions; uses correct tools and wears
4
appropriate safety apparel.
G. SAFETY PRACTICES (15%) Usually follows most safety procedures; usually does the job in
3
safe manner.
Careless, takes shortcuts which can create safety hazards. 2
A hazard to self and others; potential for putting self and others
1
at risk because of risky and unsafe attitude.
Clothes ideal for work; Appearance and hygiene would be
5
acceptable to costumers and co-trainees/personnel.
Arrives at work with clothes clean; showered and clean; clothes
4
are proper, protective and safe.
H. APPEARANCE/HYGIENE Clothes usually clean and appropriate for job; grooming
3
(10%) acceptable
Poorly groomed; hair disheveled; clothing barely job
2
appropriate and unkempt.
Generally not presentable: clothes dirty and not appropriate for
1
the job; looks shabby; unclean; smells bad at times.
OJT GRADE
= Total Points (A + B + C + D + E + F + G+H x 10) / 50 x 50 + 50
Please discuss strengths & weaknesses with the student trainee to encourage and motivate improve performance.
NOTE: When you terminate a student-trainee for any reason, please check the items below.
The Internship Practicum was terminated:
_____ due “only” for lack of work” _____ too much absences and tardiness
_____ violation of Company Rules _____ disrespectful to co-trainee or personnel
_____ unfavorable work habits and practices _____ does not demonstrate interest and desire to learn
_____ altercation on the job _____ other(s), please specify ____________________
___________________________________
_____ We would be pleased to employ thisPrinted
Student-Trainee in the future
Name and Signature of Person Completing this Form
_____ He/She needs to improve his/her performance.
Date: __________________ ___________________________________
Signature of Student-Intern
Date: ____________________
APPROVED:
___________________________________
Training Supervisor
