SAMAR STATE UNIVERSITY

Arteche Blvd., Catbalogan City Philippines, 6700

Office of the Director / Student Internship Program

SSU-SIP-FR-007
04-Feb-2019 Rev. 1

Name of Student: ______________________________________Curriculum:_____________________

Major:______________________________Name of Firm:____________________________________
Address of Firm: ____________________________________________________________________

INTERNSHIP EVALUATION PROGRESS REPORT

TO THE EMPLOYER: Please put one (1) check mark opposite the phrase which best describes
accurately the student learner in each category. Add all the weights to come
up with a weighted sum (WS) and indicate its equivalent rating (ER).

ABILITY TO FOLLOW INSTRUCTIONS PUBLIC RELATIONS

5 use initiative in interpreting and 5 extremely tactful and understanding in

following dealing with customers &
superiors.
4 usually follow instructions with no
difficulty.
3 follow instructions with some difficulty
dealing with people & superiors.
2 needs repeated detailed instruction
1 always needs repeated instructions
Instructions.
4 usually poised, courteous & tactful in
dealing with people & superiors.
3 tries to please customers & superiors.
2 sometimes lack poise and self-
centered
1 indifferent to others & superiors

JUDGEMENT DEPENDABILITY

5 Exceptionally matured in decision 5 meets all obligations unfailingly without

making supervision
4 above average in decision making 4 meet obligations with very little
supervision.
3 usually makes the right decision 3 meets obligations under careful
supervision
2 sometimes use bad judgment. 2 sometimes fails in obligations even under
careful supervision
1 Definitely not interested to learn 1 frequently undependable
.
ATTITUDE TOWARDS WORK EXPENSE CONSCIOUSNESS

5 take a keen interest in the training and 5 extremely careful in using materials and
takes initiative to learn. equipment.
4 shows interest in training and has 4 use good judgment in using materials &
desire to learn. equipment.
3 have some interest in training. 3 take average care in using materials and
equipment.
2 shows little interest or enthusiasm for 2 careless about equipment & materials.
the training.
1 definitely not interested to learn. 1 frequently careless in using equipment and
materials.

Telephone No. +6355 251 2139 | Fax: +6355 543 8394 | Website: www.ssu.edu.ph | Contact us: info@ssu.edu.ph | Follow us on @ssucatbalogan | Page 1 of 3
 SAMAR STATE UNIVERSITY
Arteche Blvd., Catbalogan City Philippines, 6700
Office of the Director / Student Internship Program

SSU-SIP-FR-007
04-Feb-2019 Rev. 1

ATTENDANCE AND PUNCTUALITY JOB SKILLS

5 never absent or late without good 5 possess the essential skills and related
cause. information.
4 seldom absent or late without good 4 have above average command of the
cause. Essential skills & related
3 occasionally absent or late. information.
3 have an acceptable command of the
2 frequently absent or late skills and information.
2 lacks in essential skills and related
1 very irregular in attendance information
1 mostly unsatisfactory in the essential
skills and related information.

COOPERATION WORK AREA

5 always cooperate eagerly and 5 keeps work area exceptionally neat and
cheerfully. efficiently organized.
4 usually cooperate eagerly and 4 takes pride in appearance and
cheerfully. arrangement of work area.
3 cooperate willingly when asked. 3 follow good housekeeping.

2 cooperates reluctantly 2 allow work areas to become disorganized

and untidy.
1 unwillingly to accept and cooperate 1 always allows work areas to become
untidy and disorderly.
OBSERVANCE OF RULES QUALITY OF WORK

5 always observes company rules 5 have aptitude for doing neat, accurate
and exceeding the requirements.
4 seldom disregards company rules 4 do more than the required amount of
neat and accurate work.
3 observe some of the company rules. 3 does more than the amount of
acceptable amounts of work
2 frequently neglects company rules 2 do less than the required amount of
satisfactory work.
1 very careless and neglectful of 1 always does unsatisfactory amount of
company rules. work.

Weighted Sum (WS) _________________

Equivalent Rating (ER) _______________

REMARKS: _____________________________________________________________________________

Rated by:
_____________________________________
Name and Signature of On-Site Supervisor
APPROVED:__________________________________
Name/Head of the Agency/Company

Telephone No. +6355 251 2139 | Fax: +6355 543 8394 | Website: www.ssu.edu.ph | Contact us: info@ssu.edu.ph | Follow us on @ssucatbalogan | Page 2 of 3
 SAMAR STATE UNIVERSITY
Arteche Blvd., Catbalogan City Philippines, 6700
Office of the Director / Student Internship Program

SSU-SIP-FR-007
04-Feb-2019 Rev. 2

RATING SCALE

WS ER WS ER WS ER WS ER WS ER
59- 60 = 95 53- 54 = 90 47- 48 = 85 42- 41 = 80 35- 36 = 75
58 = 94 52 = 89 46 = 84 40 = 79 34 = 74
57 = 93 51 = 88 45 = 83 39 = 78 33 = 73
56 = 92 50 = 87 44 = 82 38 = 77 32 = 72
55 = 91 49 = 86 43 = 81 37 = 76 31 = 71

WS ER WS ER WS ER WS ER WS ER
29- 30 = 70 23- 24 = 64 17- 18 = 59 11- 12 = 55 1-2 = 50
28 = 69 22 = 63 16 = 58 9-10 = 54
27 = 68 21 = 62 15 = 57 7-8 = 53
26 = 67 20 = 61 14 = 56 5-6 = 52
25 = 66 19 = 60 13 = 55 3-4 = 51

Note:

The Office would like to request that this rating be put in a sealed envelope before handing to
student. The Program Internship Coordinator will open the sealed envelope during the student
exit assessment for final evaluation and verification.

Telephone No. +6355 251 2139 | Fax: +6355 543 8394 | Website: www.ssu.edu.ph | Contact us: info@ssu.edu.ph | Follow us on @ssucatbalogan | Page 3 of 3
 SAMAR STATE UNIVERSITY
Arteche Blvd., Catbalogan City Philippines, 6700
Office of the Director / Student Internship Program
SSU-SIP-FR-008
04-Feb-2019 Rev. 1

INTERNSHIP PERFORMANCE ASSESSMENT

To the Employer/rater: This survey form is intended to evaluate performance of SSU

students undergoing Internship in your company. The said assessment will be used
solely as a toll for curriculum planning, to produce better students. The result of this
assessment will not alter the training that you have given to the trainee in your company. The
company and the rater’s identity will be kept confidential.

Name of trainee (optional) ________________________________________________________

Name of Firm (optional) _________________________________________________________
Address of the Firm (optional) _____________________________________________________
Name of the immediate supervisor/rater (optional) _____________________________________
Designation of the rater: _________________________________________________________
Age of rater: _______ Years of experience of rater: _______

OJT PERFORMANCE ASSESSMENT NO Lowest - Highest YES

Personal Attitude 1 2 3 4 5
Communicates well with his superiors
Communicates well with his colleagues
Behaves well with his superiors
Behaves well with his colleagues
Follows instruction given by his supervisors
Consistently polite to clients/customers
Keeps working place clean
Tools are kept in order
Working Attitude
Easily accepts assigned work
Willing to learn new things to enhance skills
Works with endurance and little interruptions
Not discourage from mistakes
Handles machinery/equipment carefully
Uses materials efficiently
Punctual and observes working schedule
Quality of Work
Carries out task independently
Can handle difficult task
Works precisely even with little supervision
Very few to no mistakes

Telephone No. +6355 251 2139 | Fax: +6355 543 8394 | Website: www.ssu.edu.ph | Contact us: info@ssu.edu.ph | Follow us on @ssucatbalogan | Page 1 of 3
 SAMAR STATE UNIVERSITY
Arteche Blvd., Catbalogan City Philippines, 6700
Office of the Director / Student Internship Program
SSU-SIP-FR-008
04-Feb-2019 Rev. 1

NO Lowest - Highest YES

Quality of Work
1 2 3 4 5
Can recognize mistakes
Can recognize level of quality of work
Submit required reports on time
Quantity of work
Completes simple task faster by 30% compared to
normal workers
Quantity of simple work performed exceeded by 30%
Target quantity of difficult task completed on time
Job Skills
Possess necessary skills for the job
Possess essential information associated to work
Can learn new skills fast
Skills are better than other OJT
Skills are comparable to professional workers

General Impression (answer only if the

company has OJT from other schools).
Much The Much
Compared to trainees from other schools, how Lower Better
lower same Better
are trainees in terms of their
Personality traits
Work attitude
Quality of work performed
Quantity of work performed
Job skills

1. On average how many students trainees is accepted in your company/year? _________

2. How many trainees from SSU have been accepted into the company? ________
3. Since when are you accepting OJT from SSU? ___________
4. All in all, how many SSU-OJTs have been accepted in the company? _________
5. What other benefits were given to the student trainees?
[ ] none [ ] allowance [ ] accommodation [ ] food [ ] free transportation
[ ] assigned staff that trains the student on OJT [ ] others ___________________
6. Is the company willing to accept trainees next year? [ ] Yes [ ] No
7. (if answer to #6 is no) What is/are the reason(s) why you will not accept trainees from SSU?
(you can select one or more)
[ ] miss match between trainees skills and company needs [ ] poor trainees quality
[ ] do not have enough staff to handle trainees [ ] poor SSU-and company relation
[ ] the company is not anymore open for OJT. [ ] negative impression to SSU trainee [ ]
other, please specify __________________________________________
8. What needs to be enhanced so that our trainees will meet your expectation?
[ ] personal attitude [ ] work attitude [ ] communication skills [ ] job skills

Telephone No. +6355 251 2139 | Fax: +6355 543 8394 | Website: www.ssu.edu.ph | Contact us: info@ssu.edu.ph | Follow us on @ssucatbalogan | Page 2 of 3
 SAMAR STATE UNIVERSITY
Arteche Blvd., Catbalogan City Philippines, 6700
Office of the Director / Student Internship Program
SSU-SIP-FR-008
04-Feb-2019 Rev. 1

9. What improvements you can suggest to build good SSU-your company relation.
[ ] SSU OJT coordinator site visit(s) [ ] formalized linkage through MOA
[ ] other please specify; ___________________________________________________
10. Can you suggest other company where our students can have their OJTs’?
[ ] yes if answer is yes, we will appreciate it a lot if you can provide us the name, address
and contact information of the company _____________________________________________
__________________________________________________________________________
[ ] no, because _____________________________________________________________

Note to the supervisor respondent:

Thank you for filing-up this questionnaire, your cooperation will help us a lot in improving
Student Internship Training program. We would like to request that this questionnaire be
answered only when the trainee is near completion or have completed already the number of
training hours.

Furthermore, we would like to request you to place the filled-up questionnaire inside the provided
white envelope and seal it before handing it to the student trainee or e-mail it to
sip@ssu.edu.ph as scanned document in pdf or jpeg format.

Respectfully yours;

GIL O. AMOYAN, Ph.D.

Director, Student Internship Program

Telephone No. +6355 251 2139 | Fax: +6355 543 8394 | Website: www.ssu.edu.ph | Contact us: info@ssu.edu.ph | Follow us on @ssucatbalogan | Page 3 of 3