University of Santo Tomas

Chemical Engineering Industry Immersion Program

Dear Sir/Madam:

We sincerely appreciate your commitment to the formation of our students. Thank you for providing them the
opportunity to learn on-the-job under your supervision. Please take time to answer this evaluation form for the
student whose name appears below. The total rating will be the basis of 50% of the student’s final grade in ChE500
(Industry Immersion) course which is a requirement in the Chemical Engineering Program. After your evaluation,
please put this two-page sheet in a sealed envelope before handing it to the student for submission to the
Immersion Monitors.

Thank you.

Yours truly,

The Chemical Engineering (ChE) Immersion Monitors/Advisers

Student Information (to be filled out by the student)

Family Name Given Name Middle Name

Mobile Number/s Email Address Immersion Monitor

Permanent Home Address (Number, Street, Barangay/District) Home City/Municipality Home Province

Supervisor/Evaluator Information (to be filled out by the evaluator/supervisor)

Name of Immersion Program Supervisor/Evaluator Position/Designation Contact Number/s

Company Name

Company Address (Number, Street, Barangay/District) City/Municipality Province

Apprentice/Intern Immersion Evaluation (to be rated by the evaluator/supervisor)

Family Name Given Name Middle Initial

Student Name

To the evaluator: Circle the number for each of the ten (10) categories which best indicates your rating for this
apprentice. Write each encircled number of choice on the blank after each corresponding category.

ATTENDANCE (Includes absences and tardiness)

1 2 3 4 5 Rating
Seldom reliable; Occasionally late; Attendance record
Rarely late or Never late or
excessive absences; attendance not good; may be late
absent absent
late often very good on occasions

DEPENDABILITY (On the job performance)

1 2 3 4 5 Rating
Unreliable; usually Very seldom late;
Steady worker; Trustworthy and
Loafs on job; slow to late; needs can be depended
usually reliable on reliable; always
get started constant upon being
the job available
supervision available

ISES Page 1 of 2
ATTITUDE

1 2 3 4 5 Rating
Gripes about work Wastes time; gets Usually applies self Accepts all work High interest in
assignments; moody; indifferent well; usually assignments; job; good person
disturbs others to work interested in job works to improve to work with

INITIATIVE

1 2 3 4 5 Rating
Looks for work to
Needs prodding; Does routine task Self starter; works
No ambition; does do; invites
usually waits for without prompting; most problems on
very little on own responsibility;
directions goes ahead well own
hard worker
INTEREST

1 2 3 4 5 Rating
Apprenticeship Does a good job;
Could care less; no Learns normally; High interest;
just a job; little desires to get
interest; dislikes shows normal always digging in;
desire; does not ahead; looks to
job; indifferent interest learns all he can
attempt to learn learn
COOPERATION AND CONDUCT (Ability to work with others)

1 2 3 4 5 Rating
Uncooperative; Usually cooperative; Good disposition;
Cannot get along Goes out of way
causes friction; liked by most others like to work
with some people; to help others;
behaviour others on the job; with; very
unconcerned well-liked
unacceptable mannerly cooperative
SAFETY AND SAFE PRACTICES

1 2 3 4 5 Rating
Hazard to Observes most
Careless; takes Observes all safety Exceptional safe
self/others; has to safety rules; usually
unnecessary rules; uses correct practices; takes
be warned about does job in safe
chances tools and apparel no chances
safe practices manner
ADAPTABILITY (Ability to learn)

1 2 3 4 5 Rating
Needs repeated Progressing at a Learns quickly;
Learns slowly; Good memory;
instruction on each normal rate; uses good
frequently very alert; grasps
job; very slow usually has good judgment; applies
misunderstands new ideas quickly
learner judgement experience well
QUALITY AND ACCURACY OF WORK

1 2 3 4 5 Rating
Spoils work; work Not careful Produces good work Uses good Takes pride in
must be continually enough; tries to most of the time; judgment; very few work; very
checked; does not get by; jobs have work usually errors; does good accurate; does an
think things out to be reworked passes work excellent job
QUANTITY OF WORK

1 2 3 4 5 Rating
Highly
Plans work poorly; Does less than is Usually does work Makes use of any
productive; fast
slow; produces very expected; tries to on time; does a fair idle time; plans
and accurate;
little just get by share; keeps busy work well
hard worker
Evaluator (Signature over printed name) Date Evaluated Sum of Ratings

/50
Remarks ___________________________________________________________________________________________________________
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Chemical Engineering Industry Immersion (ChE500) of the University of Santo Tomas.
Prepared by the 2012 ChE Immersion Monitors taken from www.noecaiec.org.