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 and Average grade in: Average grade in:

numeracy (LL&N) English Math
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
a. 75 to 79 e. 75 to 79
Cultural and language Ethnicity/culture:
background a. Ifugao
b. Igorot
c. Ibanag
d. Gaddang
e. Muslim
f. Ibaloy
g. Others( please specify)_____________
Education & general Highest Educational Attainment:
knowledge a. High School Level
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: _____

Physical ability 1. Disabilities(if any)_____________________

2. Existing Health Conditions (Existing illness if any)
a. None
b. Asthma
c. Heart disease
d. Anemia
e. Hypertension
 f. Diabetes
g. Others(please specify) ___________________
Previous experience with TM Certificates
the topic a. TQ certified
b. TM graduate
c. TM trainer
d. TM lead trainer
Number of years as a competency trainer ______
Previous learning List down trainings related to TM
experience ___________________________
___________________________
___________________________
Training Level completed National Certificates acquired and NC level
___________________________
___________________________
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 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.

2.
Evidences/Proof of Current Competencies(Sample)

Form 1.2: Evidence of Current Competencies acquired related to Job/Occupation

Current competencies Proof/Evidence Means of validating

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 Competencies Training

Competency/Learning Outcomes Gaps/Requirements
based on CBC
1.

Required Units of Current Competencies Training

Competency/Learning Outcomes Gaps/Requirements
based on CBC
2.

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)
1.

2.

3.

4.

5.
 In template form, the session plan will look like this.
SESSION PLAN
Sector :
Qualification Title :
Unit of Competency :
Module Title :
Learning Outcomes:
A. INTRODUCTION

B. LEARNING ACTIVITIES

LO 1:

Learning Content Methods Presentation Practice Feedback Resources Time

LO 2:

C. ASSESSMENT PLAN
 Written Test
 Performance Test
D. TEACHER’S SELF-REFLECTION OF THE SESSION
(Qualification Title)
COMPETENCY-BASED LEARNING MATERIALS

List of Competencies

No. Unit of Competency Module Title Code

1.
2.
3.
4.
5.
6.
MODULE CONTENT

UNIT OF COMPETENCY
MODULE TITLE

MODULE DESCRIPTOR:

NOMINAL DURATION:

LEARNING OUTCOMES:
At the end of this module you MUST be able to:
1.
2.
3.
4.

ASSESSMENT CRITERIA:
1.
2.
3.
4.
5.
6.
LEARNING OUTCOME NO. 4
(LO Title)

Contents:
1.
2.
3.
4.
5.
Assessment Criteria
1.
2.
3.
4.

Conditions
The participants will have access to:
1.
2.
3.
Assessment Method:
1.
2.
3.
Learning Experiences
Learning Outcome 1
(LO TITLE)

Learning Activities Special Instructions

Information Sheet _______
(Title)

Learning Objectives:
After reading this INFORMATION SHEET, YOU MUST be able to:
1.
2.

(Introductory Paragraph)

(Body)
Self- Check ______

(Type of Test) : (Instruction)

ANSWER KEY ____

1.
2.
3.
4.
TASK SHEET _____

Title:

Performance Objective: Given (condition), ,you should be able to (performance) following (standard).

Supplies/Materials :

Equipment :

Steps/Procedure:
1.
2.
3.
4.

Assessment Method:
Performance Criteria Checklist ______

CRITERIA
YES NO
Did you….
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
JOB SHEET _____

Title:

Performance Objective: Given (condition), ,you should be able to (performance) following (standard).

Supplies/Materials :

Equipment :

Steps/Procedure:
5.
6.
7.
8.

Assessment Method:
Performance Criteria Checklist ______

CRITERIA
YES NO
Did you….
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
Evidence Plan

Competency standard:
Unit of competency:
Ways in which evidence will be collected: De
Obs
[tick the column] mo
erv Thi
nstr
atio rd
atio Por
n& part Wri
n& tfoli
Que y tten
Que o
stio Rep
stio
nin ort
nin
g
The evidence must show that the trainee… g
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










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NOTE: *Critical aspects of competency
 TABLE OF SPECIFICATION

Objectives/Content # of items/
Knowledge Comprehension Application
area/Topics % of test

TOTAL
Performance Test

Specific Instruction for the Candidate

Qualification
Unit of Competency
General Instruction:
Specific Instruction:
QUESTIONING TOOL
Satisfactory
Questions to probe the candidate’s underpinning knowledge response

Extension/Reflection Questions Yes No

1.  
2.  
3.  
4.  
Safety Questions
5.  
6.  
7.  
8.  
Contingency Questions
9.  
10.  
11.  
12.  
Job Role/Environment Questions  
13.  
14.  
15.  
16.  
Rules and Regulations  
17.  
18.  
19.  
20.  
The candidate’s underpinning knowledge was:  Satisfactory  Not Satisfactory
Templates for Inventory of Training Resources
Resources for presenting instruction
 Print Resources As per TR As per Remarks
Inventory

 Non Print Resources As per TR As per Remarks

Inventory

Resources for Skills practice of Competency #1 ______________________________

 Supplies and Materials As per TR As per Remarks
Inventory

 Tools As per TR As per Remarks

Inventory

 Equipment As per TR As per Remarks

Inventory

Note: In the remarks section, remarks may include for repair, for replenishment, for reproduction, for
maintenance etc.