Republic of the Philippines CAVITE STATE UNIVERSITY

CAVITE VIEJO CAMPUS

Pulo, Dalahican, Cavite City Tel. (046) 431-35-70; (046) 431-35-80

PRACTICUM EVALUATION SHEET

Janine S. Monderas Female Name of Trainee: ________________________________ Sex: _____________ Single Civil Status: _________ Program Pursued: _______________ Inclusive Period of Training: From To May 18, 2011 June 9, 2011 Name of Establishment/Company: City Government, City Health Office, Cavite _____________________________________________ City Hall Samonte Park, Cavite City City Address of Establishment: ___________________________________________________ 4100 Name of the owner of the Establishment: ________________________________________ Name of Evaluator: Arnold C. Mendoza, MD , Teresita R. Desquitado PHN III, Ma. Lourdes A. Del Prado PART I. GENERAL AND PERSONAL CHARACTERISTICS INSTRUCTION: Please indicate the rating on the blanks opposite the items of the column that the trainee deserves. Attached are specific indicators to guide you in rating the trainees. Rating Scale Outstanding (Always or 100% of the time) Very satisfactory (Often or 75% of the time) Satisfactory (Occasional or 50% of the time) Failure (Seldom or 25% of the time) Poor (Never or 0% of the time) 1. 2. 3. 4. 5. 6. 7. 8. Organizes his assigned task Utilizes time effectively. Willing to accept suggestion Cooperates and participates with other Observes punctuality Observes discipline and respect.. Shows initiative and dependability. Expresses himself and be understood . Average rating for Part I 1 2 3 4 5

1.00 ____________ 1.00 ____________ 1.00 ____________ 2.00 ____________ 1.00 ____________ 1.00 ____________ 2.00 ____________ 1.00 ____________ 1.25 _________________

To the Evaluators: Please be guided with the specific locations below. Manifestation of all items each indicators means and outstanding performance or a rating of 1, while manifestation of two items 2 and one item 3. In the event that the trainee show occasional manifestation or did not show any of the listed items within the duration of the practicum, a rating of 4 and 5 shall be given, respectively. SPECIFIC INDICATORS PART II. GENERAL ABLILITY AND PERSONAL CHARACTERISTICAS 1. Organizes his assigned task a. Works according to plan b. Executes plan systematically c. Applies rules, policies, guideline in performing the job 2. Utilizes time effectively a. Completes job before the deadline b. Accomplishes greater number and quality of work within a given period of time c. Does not waste time doing unimportant things 3. Willing to accept suggestions and criticism a. Willing to perform assigned task b. Accepts criticism and suggestion positively c. Shows willingness to learn more 4. Cooperates and participates with others a. Maintain harmonious relationship with supervisor and other staff b. Gives allowance to the shortcomings of others c. Offers help or assistance to fellow trainees and other staff 5. Observes punctuality a. Comes and leaves office on time b. Submits report/assignment/requirement on time c. Performs the job on designated time 6. Observes discipline and respect a. Follows rules and regulations of the center/office b. Considers/appreciates others suggestion c. Shows respect to supervisor/in-charge and fellow trainees 7. Shows initiative and dependability a. Works without being told b. Works with minimum supervision c. Makes practical suggestion for doing things 8. Expresses himself and be understood a. Asks question to supervisor/in-charge whenever necessary b. Brings out his opinion especially when asked c. Explain things when needed

PART III. TECHNICAL KNOWLEDGE AND PRACTICAL SKILLS INSTRUCTION: Please indicate the score on the blanks opposite the items that best describe the technical knowledge and practical skills of the trainee using the following scales: Outstanding Very Satisfactory Satisfactory Fair Poor 1 2 3 4 5

ACTIVITIES

Ability to follow Instruction and apply knowledge/skills learned developed during the training

Quality of work

Ability to Handle and Use tools/ equipment

TOTAL

AVERAGE

1.Types all necessary office documents/paper works and records for submission to the different departments in the city hall. 2.Encoding and submission via email of Immediate and weekly notifiable diseases reports using the Philippine Integrated Disease Surveillance and Response programming system to Provincial Health Office and Regional Health Office. 3.Encoding and submission of data using the Electronic Field Health Service Information System to Provincial Health Office, Regional Health Office and Department of Health (National Office) and eFHSIS website.

1.00

Outstanding

1.00

2.00

1.00

1.00

Outstanding

1.00

2.00

1.00

2.00

Very Satisfactory

1.00

3.00

1.50

4.Fixing minor printing problem and searching and downloading of forms and documents in eFHSIS website: www.efhsis.doh.gov.ph . 5.Dispense medicines prescribed by the doctors to indigent persons and encoding of the RIV-Voucher, medicine and medical supplies coming from DOH-Region-IV Office,Calabarzon. 6.Encoding and submission of reports of DOH program Ligtas Sa Tigdas Ang Pinas to the Provincial and Regional Offices.

1.00

Outstanding

2.00

3.00

1.50

1.00

Outstanding

1.00

2.00

1.00

1.00

Outstanding

1.00

2.00

1.00

7.Records all reports of the City Health Office

1.00

Outstanding

1.00

1.00

1.00

Total Average rating for Part II PART IV. COMMENTS/SUGGESTIONS

1.00 _________________ 1.00 _________________

_____________________________________________________________________________ NONE _____________________________________________________________________________ _____________________________________________________________________________ ___________________________________________________________________________ Rated by: _________________________ TEREISTA R. DESQUITADO
Public Health Nurse III

_____________________________ MA. LOURDES A. DEL PRADO

Administrative Assistant II

___________________________ ARNOLD C. MENDOZA, MD Medical Officer V OIC-City Health Office

PRACTICUM TRAINING PROGRAM City Health Office, City hall, Cavite City FIRM/OFFICE: _______________________________________________________________ SUPERVISOR/OFFICER-IN-CHARGE: ARNOLD C. MENDOZA, MD, TERESITA R. DESQUITADO, PHNIII MA. LOURDES A. DEL PRADO, ADMIN.ASST.II SUMMARY OF ACTIVITIES TOOLS/EQP. USED Computer

DATE
1.

NATURE OF ACTIVITY
Types all necessary office documents/paper works and records for submission to the different departments in the city hall. Encoding and submission via email of Immediate and weekly notifiable diseases reports using the Philippine Integrated Disease Surveillance and Response programming system to Provincial Health Office and Regional Health Office. Encoding and submission of data using the Electronic Field Health Service Information System to Provincial Health Office, Regional Health Office and Department of Health (National Office) and eFHSIS website. Fixing minor printing problem and searching and downloading of forms and documents in eFHSIS website: www.efhsis.doh.gov.ph. Dispense medicines prescribed by the doctors to indigent persons and encoding of the RIV-Voucher, medicine and medical supplies coming from DOHRegion-IV Office,Calabarzon. Encoding and submission of reports of DOH program Ligtas Sa Tigdas Ang Pinas to the Provincial and Regional Offices. Records all reports of the City Health Office

REMARKS none

04-18-11 to 05-27-11

2.

3.

4. 5.

6.
7.

Prepared by: JANINE

Trainee

Noted: ___________________________ ARNOLD C. MENDOZA, MD Medical Officer V ________________________________ TERESITA R. DESQUITADO, RN Public Health Nurse III

OIC-City Health Office