Sample Data Gathering Instrument for Trainee’s

Characteristics
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.

Characteristics of learners

Language, literacy Average grade in: Average grade in:

and numeracy English Math
(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
e. 75 to 79 e. 75 to 79

Cultural and Dialect:

language a. Ilocano
background
b. Pangasinense
c. Kapampangan
d. Tagalog
e. Chabacano
f. Sambal
g. Others( please specify)_____________

Education & Highest Educational Attainment:

general a. High School Level
knowledge
b. High School Graduate
c. College Level
d. College Graduate
e. with units in Master’s degree
f. Masteral Graduate
g. With units in Doctoral Level
h. Doctoral Graduate
Sex a. Male
b. Female
Age Your age: 38
Physical ability 1. Disabilities(if any)_____________________
2. Existing Health Conditions (Existing illness if
 Characteristics of learners

any)
a. None
b. Asthma
c. Heart disease
d. Anemia
e. Hypertension
f. Diabetes
g. Others(please specify) ___________________

Previous TM Certificates
experience with a. TQ certified
the topic b. TM graduate
c. TM trainer
d. TM lead trainer
Number of years as a competency trainer ______

Previous List down trainings related to TM

learning ___________________________
experience ___________________________
___________________________
National Certificates acquired and NC level
Training Level
completed

Special courses Other courses related to TM

a. Units in education
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
 Characteristics of learners

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)
___________________________
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.
CORE COMPETENCIES
CAN I…? YES NO
1. CLEAN AND MAINTAIN KITCHEN PREMISES
LO 1. Clean, sanitize and store equipment 

LO 2. Clean and sanitize premises 

LO 3. Dispose of waste 

2. PREPARE STOCKS, SAUCES AND SOUPS

LO 1. Prepare stocks, glazes and essences required for the 
menu items
LO 2. Prepare soups required for menu items 

LO 3. Prepare sauces required for menu items 

LO 4. Store and reconstitute stocks, sauces and soups 

3. PREPARE APPETIZERS
LO1. Perform Mise’ en place 

LO 2. Prepare a range of appetizers 

LO 3. Present a range of appetizers 

LO 4. Store appetizers 

4. PREPARE SALAD AND DRESSING

LO 1. Perform Mise’ en place 

LO 2. Prepare a variety salads and dressings 

LO 3. Present a variety salads and dressings 

LO 4. Store salads and dressings 

 5. PREPARE SANDWICHES
LO 1. Perform Mise’ en place 

LO 2. Prepare a variety of sandwiches 

LO 3. Present a variety of sandwiches 

LO 4. Store sandwiches 

6. PREPARE MEAT DISHES

LO1.Perform Mise’ en place 

LO2.Cook meat cuts for service 

LO3.Present meat cuts for service 

LO4. Store meat 

7. PREPARE VEGETABLE DISHES

LO1. Perform Mise’ en place 

LO2. Prepare vegetable dishes 

LO3. Present vegetable dishes 

LO4. Store vegetable dishes 

8. PREPARE EGG DISHES

LO1. Perform Mise’ en place 

LO2. Prepare and cook egg dishes 

LO3. Present egg dishes 

LO4. Store egg dishes 

9. PREPARE STARCH DISHES

LO1. Perform Mise’ en place 
LO2. Prepare starch dishes 

LO3. Present starch dishes 

LO4. Store starch dishes 

10. PREPARE POULTRY AND GAME DISHES

LO1. Perform Mise’ en place 

LO2. Cook poultry and game dishes 

LO3. Plate/present poultry and game dishes 

LO4. Store poultry and game 

11. PREPARE SEAFOOD DISHES

LO1. Perform Mise’ en place 

LO2. Handle fish and seafood 

LO3. Cook fish and shellfish 

LO4. Plate/Present fish and seafood 

LO5. Store fish and seafood 

12. PREPARE DESSERTS

LO1. Perform Mise’ en place 

LO2. Prepare desserts and sweet sauces 

LO3. Plate/Present desserts 

LO4. Store desserts 

13. PACKAGE PREPARED FOOD

LO1. Select packaging materials 

LO2. Package food 

Evidences/Proof of Current Competencies (Sample)

Form 1.2: Evidence of Current Competencies acquired related to

Job/Occupation

Current
Proof/Evidence Means of validating
competencies
Clean and Certificate of Employment Interview, Demonstration
maintain kitchen of Skills
Transcript of Records
premises
Prepare stocks, Certificate of Training Interview, Demonstration
sauces and soups of Skills
Transcript of Records
Prepare appetizers Certificate of Competency Interview, Demonstration
of Skills
Transcript of Records
Prepare salads Certificate of Employment Interview, Demonstration
and dressing of Skills, Written Exam
Transcript of Records
Prepare Certificate of Training Interview, Demonstration
sandwiches of Skills
Transcript of Records
Prepare meat Certificate of Competency Interview, Demonstration
dishes of Skills
Transcript of Records
Prepare vegetable Certificate of Employment Interview, Demonstration
dishes of Skills
Transcript of Records
Prepare egg dishes Certificate of Training Interview, Demonstration
of Skills
Transcript of Records
Prepare starch Certificate of Competency Interview, Demonstration
dishes of Skills
Transcript of Records
Prepare poultry Certificate of Employment Interview, Demonstration
and game dishes of Skills
Transcript of Records
Prepare seafood Certificate of Training Interview, Demonstration
dishes of Skills
Transcript of Records
Prepare desserts Certificate of Competency Interview, Demonstration
of Skills
Transcript of Records
Package prepared Certificate of Employment Interview, Demonstration
food of Skills
Transcript of Records
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 (Sample)

Required Units of Current Training

Competency/Learning Competencies Gaps/Requirements
Outcomes based on CBC
1. Clean and maintain kitchen premises
LO 1. Clean, sanitize and LO 1. Clean, sanitize
store equipment and store equipment
LO 2. Clean and sanitize LO 2. Clean and
premises sanitize premises
LO 3. Dispose of waste LO 3. Dispose of
waste
2. Prepare stocks, sauces and soups
LO 1. Prepare stocks, LO 1. Prepare stocks,
glazes and essences glazes and essences
required for the menu required for the menu
items items
LO 2. Prepare soups LO 2. . Prepare soups
required for menu items required for menu
items
LO 3. Prepare sauces LO 3. Prepare sauces
required for menu items required for menu
items
LO 4. Store and LO 4. Store and
reconstitute stocks, sauces reconstitute stocks,
and soups sauces and soups
3. Prepare appetizers
LO 1 Perform Mise’ en LO 1 Perform Mise’
place en place
LO 2. Prepare a range of LO 2. Prepare a range
appetizers of appetizers
LO 3. Present a range of LO 3. Present a range
appetizers of appetizers
LO 4. Store appetizers LO 4. Store
appetizers
4. Prepare salads and dressing
LO 1. Perform Mise’ en
place
LO 2. Prepare a variety
salads and dressings
LO 3. Present a variety
salads and dressings
LO 4. Store salads and
dressings
5. Prepare sandwiches
LO 1. Perform Mise’ en
place
LO 2. Prepare a variety of
sandwiches
LO 3. Present a variety of
sandwiches
LO 4. Store sandwiches
6. Prepare meat dishes
LO1. Perform Mise’ en
place
LO2. Cook meat cuts for
service
LO3. Present meat cuts for
service
LO4. Store meat
7. Prepare vegetable
dishes
LO1. Perform Mise’ en
place
LO2. Prepare vegetable
dishes
LO3. Present vegetable
dishes
LO4. Store vegetable dishes
8. Prepare egg dishes
LO1. Perform Mise’ en
place
LO 1. Perform Mise’
en place
LO 2. Prepare a
variety salads and
dressings
LO 3. Present a
variety salads and
dressings
LO 4. Store salads
and dressings
LO 1. Perform Mise’
en place
LO 2. Prepare a
variety of sandwiches
LO 3. Present a
variety of sandwiches
LO 4. Store
sandwiches
LO1. Perform Mise’
en place
LO2. Cook meat cuts
for service
LO3. Present meat
cuts for service
LO4. Store meat
LO1. Perform Mise’
en place
LO2. Prepare
vegetable dishes
LO3. Present
vegetable dishes
LO4. Store vegetable
dishes
LO1. Perform Mise’
en place
LO2. Prepare and cook egg LO2. Prepare and
dishes cook egg dishes
LO3. Present egg dishes LO3. Present egg
dishes
LO4. Store egg dishes LO4. Store egg dishes
9.Prepare starch dishes
LO1. Perform Mise’ en LO1. Perform Mise’
place en place
LO2. Prepare starch dishes LO2. Prepare starch
dishes
LO3. Present starch dishes LO3. Present starch
dishes
LO4. Store starch dishes LO4. Store starch
dishes
10.Prepare poultry and
game dishes
LO1. Perform Mise’ en LO1. Perform Mise’
place en place
LO2. Cook poultry and LO2. Cook poultry
game dishes and game dishes
LO3. Plate/present poultry LO3. Plate/present
and game dishes poultry and game
dishes
LO4. Store poultry and LO4. Store poultry
game and game
11.Prepare seafood dishes
LO1. Perform Mise’ en LO1. Perform Mise’
place en place
LO2. Handle fish and LO2. Handle fish and
seafoods seafoods
LO3. Cook fish and LO3. Cook fish and
shellfish shellfish
LO4. Plate/present fish and LO4. Plate/present
seafoods fish and seafoods
LO5. Store fish and O5. Store fish and
seafoods seafoods
12.Prepare desserts
LO1. Perform Mise’ en LO1. Perform Mise’
place en place
LO2. Prepare desserts and LO2. Prepare desserts
sweet sauces and sweet sauces
LO3. Plate/present
desserts
LO4. Store desserts
13.Package prepared food
LO1. Select packaging
materials
LO2. Package food
LO3. Plate/present
desserts
LO4. Store desserts
LO1. Select
packaging materials
LO2. Package food

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.

Form No. 1.4: Training Needs (Sample)

Training Needs Module Title/Module of

Instruction
(Learning Outcomes)
Perform Perform Mise’ en place 1. PREPARING STARCH
DISHES
Prepare starch dishes
Present starch dishes
Store starch dishes