BSc Work Integrated Education (WIE) Assessment Form for Supervisor

Personal Information Collection Statement (PICS)

The University pledges to meet fully, and where possible exceeds internationally recognized standards of personal data privacy protection, in complying with the requirements of the Personal Data (Privacy) Ordinance. The personal data collected in this form will be used for internship-related purposes and viewed by designated staff of The Hong Kong Polytechnic University and student(s) ONLY. Strict confidentiality will be observed and no personal identity will be revealed.

Under the Personal Data (Privacy) Ordinance, you have the right to request access to, and/or correction of your personal data in relation to your assessment of WIE. If you wish to do so, please contact us at wie.lsgi@polyu.edu.hk.

Note: If there is more than one industrial supervisor for the student, the supervisor for most of the placement period should fill this form after taking into other supervisor’s consideration

There are 7 questions in this form.

Part A: Student Information

Student Name:

No. of working hour (hours in total):

Start Date of Training

Format: dd-mm-yyyy

End Date of Training

Format: dd-mm-yyyy

Part B: Student Performance

Rating Standards

1 Very Poor Work performance is inadequate and inferior to the standards of performance.

2 Poor Work performance does not consistently meet the standards of performance.

3 Satisfaction Work performance consistently meets the standards of performance.

4 Good Work performance is consistently above the standard of performance.

5 Excellent Work performance is consistently superior to standards required.

Rating Factors (Definitions)

	1	2	3	4	5
Quality of Work	1	2	3	4	5
Customer Focus	1	2	3	4	5
Teamwork	1	2	3	4	5
Technical & Professional Knowledge	1	2	3	4	5
Self Motivation	1	2	3	4	5
Proactive Communication	1	2	3	4	5
Problem Solving	1	2	3	4	5
Productivity	1	2	3	4	5
Overall Performance	1	2	3	4	5

Employer's/ Supervisor's comments (optional)

Your answer

Part C: Relevance of the work to Land Surveying and Geo-Informatics

Work/training is related to Land Surveying and/or Geo-Informatics

(1:Not related; 5: Very related)

Part D: Employer's / Supervisor's Information

Please complete the following information of employer/ supervisor (compulsory)

Name of Employer/Supervisor:

Position:

Company / Department:

Address:

Telephone:

Email:

1 Very Poor	Work performance is inadequate and inferior to the standards of performance.
2 Poor	Work performance does not consistently meet the standards of performance.
3 Satisfaction	Work performance consistently meets the standards of performance.
4 Good	Work performance is consistently above the standard of performance.
5 Excellent	Work performance is consistently superior to standards required.