Our Lady of the Pillar College-Cauayan
Cauayan City, Isabela
College of Nursing and Midwifery
PEER EVALUATION FORM
Write the name of your group members in the numbered boxes. Then assign yourself a value of each
listed attribute. Finally, do the same for each of your group members and total all of the values
3- Strongly agree 2- Agree 1- Disagree
GROUP/ SECTION: GROUP 1- BSN 1 B DATE/ROTATION: FEB 27, MARCH 5,12 & 19
NAME OF MEMBER: SORIBEN, LEANNA B. Yourself 3 2 1
Was dependable in attending group meetings
Willingly accepted assigned tasks.
Contributed positively to group discussions.
Completed work on time or made alternative arrangements.
Help others with their work when needed.
Did work accurately and completely.
Work well with other group members
Overall was a valuable member of the team
ATTITUDE
Instructions. On a scale of 1 to 5, rate each of the following student behaviors:
5 4 3 2 1
Maintains punctuality and Attends online discussions/meetings with
sufficient preparation and Notifies faculty in a timely manner if he/she will
be absent or late
Attends online discussions/meetings with sufficient preparation
Demonstrate willingness to learn and accepts constructive criticism
Maintains professional appearance
Seeks assistance appropriately from instructor, peers, and other
professionals
Manages time effectively to complete clinical assignments.
Modifies behaviors promptly based on faculty input and self-evaluation
Reflective journal entries demonstrates thoughtful considerations for care
of client
Participates appropriately in clinical conferences
(Rating Code: 1 = never; 2 = fair; 3 = Sometimes; 4 = usually 5 = Always; NA = Not Applicable)
Our Lady of the Pillar College-Cauayan
Cauayan City, Isabela
College of Nursing and Midwifery
PEER EVALUATION FORM
Write the name of your group members in the numbered boxes. Then assign yourself a value of each
listed attribute. Finally, do the same for each of your group members and total all of the values
3- Strongly agree 2- Agree 1- Disagree
GROUP/ SECTION: GROUP 1- BSN 1 B DATE/ROTATION: FEB 27, MARCH 5,12 & 19
NAME OF MEMBER: CALUMAYAN, ARLYN M. Yourself 3 2 1
Was dependable in attending group meetings
Willingly accepted assigned tasks.
Contributed positively to group discussions.
Completed work on time or made alternative arrangements.
Help others with their work when needed.
Did work accurately and completely.
Work well with other group members
Overall was a valuable member of the team
ATTITUDE
Instructions. On a scale of 1 to 5, rate each of the following student behaviors:
5 4 3 2 1
Maintains punctuality and Attends online discussions/meetings with
sufficient preparation and Notifies faculty in a timely manner if he/she will
be absent or late
Attends online discussions/meetings with sufficient preparation
Demonstrate willingness to learn and accepts constructive criticism
Maintains professional appearance
Seeks assistance appropriately from instructor, peers, and other
professionals
Manages time effectively to complete clinical assignments.
Modifies behaviors promptly based on faculty input and self-evaluation
Reflective journal entries demonstrates thoughtful considerations for care
of client
Participates appropriately in clinical conferences
(Rating Code: 1 = never; 2 = fair; 3 = Sometimes; 4 = usually 5 = Always; NA = Not Applicable)
Our Lady of the Pillar College-Cauayan
Cauayan City, Isabela
College of Nursing and Midwifery
PEER EVALUATION FORM
Write the name of your group members in the numbered boxes. Then assign yourself a value of each
listed attribute. Finally, do the same for each of your group members and total all of the values
3- Strongly agree 2- Agree 1- Disagree
GROUP/ SECTION: GROUP 1- BSN 1 B DATE/ROTATION: FEB 27, MARCH 5,12 & 19
NAME OF MEMBER: ARELLANO, ARIANNE G. Yourself 3 2 1
Was dependable in attending group meetings
Willingly accepted assigned tasks.
Contributed positively to group discussions.
Completed work on time or made alternative arrangements.
Help others with their work when needed.
Did work accurately and completely.
Work well with other group members
Overall was a valuable member of the team
ATTITUDE
Instructions. On a scale of 1 to 5, rate each of the following student behaviors:
5 4 3 2 1
Maintains punctuality and Attends online discussions/meetings with
sufficient preparation and Notifies faculty in a timely manner if he/she will
be absent or late
Attends online discussions/meetings with sufficient preparation
Demonstrate willingness to learn and accepts constructive criticism
Maintains professional appearance
Seeks assistance appropriately from instructor, peers, and other
professionals
Manages time effectively to complete clinical assignments.
Modifies behaviors promptly based on faculty input and self-evaluation
Reflective journal entries demonstrates thoughtful considerations for care
of client
Participates appropriately in clinical conferences
(Rating Code: 1 = never; 2 = fair; 3 = Sometimes; 4 = usually 5 = Always; NA = Not Applicable)
Our Lady of the Pillar College-Cauayan
Cauayan City, Isabela
College of Nursing and Midwifery
PEER EVALUATION FORM
Write the name of your group members in the numbered boxes. Then assign yourself a value of each
listed attribute. Finally, do the same for each of your group members and total all of the values
3- Strongly agree 2- Agree 1- Disagree
GROUP/ SECTION: GROUP 1- BSN 1 B DATE/ROTATION: FEB 27, MARCH 5,12 & 19
NAME OF MEMBER: MANALANG, CAREZZ LYNNE Yourself 3 2 1
Was dependable in attending group meetings
Willingly accepted assigned tasks.
Contributed positively to group discussions.
Completed work on time or made alternative arrangements.
Help others with their work when needed.
Did work accurately and completely.
Work well with other group members
Overall was a valuable member of the team
ATTITUDE
Instructions. On a scale of 1 to 5, rate each of the following student behaviors:
5 4 3 2 1
Maintains punctuality and Attends online discussions/meetings with
sufficient preparation and Notifies faculty in a timely manner if he/she will
be absent or late
Attends online discussions/meetings with sufficient preparation
Demonstrate willingness to learn and accepts constructive criticism
Maintains professional appearance
Seeks assistance appropriately from instructor, peers, and other
professionals
Manages time effectively to complete clinical assignments.
Modifies behaviors promptly based on faculty input and self-evaluation
Reflective journal entries demonstrates thoughtful considerations for care
of client
Participates appropriately in clinical conferences
(Rating Code: 1 = never; 2 = fair; 3 = Sometimes; 4 = usually 5 = Always; NA = Not Applicable)
Our Lady of the Pillar College-Cauayan
Cauayan City, Isabela
College of Nursing and Midwifery
PEER EVALUATION FORM
Write the name of your group members in the numbered boxes. Then assign yourself a value of each
listed attribute. Finally, do the same for each of your group members and total all of the values
3- Strongly agree 2- Agree 1- Disagree
GROUP/ SECTION: GROUP 1- BSN 1 B DATE/ROTATION: FEB 27, MARCH 5,12 & 19
NAME OF MEMBER: BASILIO, EL GION Yourself 3 2 1
Was dependable in attending group meetings
Willingly accepted assigned tasks.
Contributed positively to group discussions.
Completed work on time or made alternative arrangements.
Help others with their work when needed.
Did work accurately and completely.
Work well with other group members
Overall was a valuable member of the team
ATTITUDE
Instructions. On a scale of 1 to 5, rate each of the following student behaviors:
5 4 3 2 1
Maintains punctuality and Attends online discussions/meetings with
sufficient preparation and Notifies faculty in a timely manner if he/she will
be absent or late
Attends online discussions/meetings with sufficient preparation
Demonstrate willingness to learn and accepts constructive criticism
Maintains professional appearance
Seeks assistance appropriately from instructor, peers, and other
professionals
Manages time effectively to complete clinical assignments.
Modifies behaviors promptly based on faculty input and self-evaluation
Reflective journal entries demonstrates thoughtful considerations for care
of client
Participates appropriately in clinical conferences
(Rating Code: 1 = never; 2 = fair; 3 = Sometimes; 4 = usually 5 = Always; NA = Not Applicable)
Our Lady of the Pillar College-Cauayan
Cauayan City, Isabela
College of Nursing and Midwifery
PEER EVALUATION FORM
Write the name of your group members in the numbered boxes. Then assign yourself a value of each
listed attribute. Finally, do the same for each of your group members and total all of the values
3- Strongly agree 2- Agree 1- Disagree
GROUP/ SECTION: GROUP 1- BSN 1 B DATE/ROTATION: FEB 27, MARCH 5,12 & 19
NAME OF MEMBER: COLOMA, NICHOLE CATE Yourself 3 2 1
Was dependable in attending group meetings
Willingly accepted assigned tasks.
Contributed positively to group discussions.
Completed work on time or made alternative arrangements.
Help others with their work when needed.
Did work accurately and completely.
Work well with other group members
Overall was a valuable member of the team
ATTITUDE
Instructions. On a scale of 1 to 5, rate each of the following student behaviors:
5 4 3 2 1
Maintains punctuality and Attends online discussions/meetings with
sufficient preparation and Notifies faculty in a timely manner if he/she will
be absent or late
Attends online discussions/meetings with sufficient preparation
Demonstrate willingness to learn and accepts constructive criticism
Maintains professional appearance
Seeks assistance appropriately from instructor, peers, and other
professionals
Manages time effectively to complete clinical assignments.
Modifies behaviors promptly based on faculty input and self-evaluation
Reflective journal entries demonstrates thoughtful considerations for care
of client
Participates appropriately in clinical conferences
(Rating Code: 1 = never; 2 = fair; 3 = Sometimes; 4 = usually 5 = Always; NA = Not Applicable)
Our Lady of the Pillar College-Cauayan
Cauayan City, Isabela
College of Nursing and Midwifery
PEER EVALUATION FORM
Write the name of your group members in the numbered boxes. Then assign yourself a value of each
listed attribute. Finally, do the same for each of your group members and total all of the values
3- Strongly agree 2- Agree 1- Disagree
GROUP/ SECTION: GROUP 1- BSN 1 B DATE/ROTATION: FEB 27, MARCH 5,12 & 19
NAME OF MEMBER: ORLANDA, MIKAELA FAITH Yourself 3 2 1
Was dependable in attending group meetings
Willingly accepted assigned tasks.
Contributed positively to group discussions.
Completed work on time or made alternative arrangements.
Help others with their work when needed.
Did work accurately and completely.
Work well with other group members
Overall was a valuable member of the team
ATTITUDE
Instructions. On a scale of 1 to 5, rate each of the following student behaviors:
5 4 3 2 1
Maintains punctuality and Attends online discussions/meetings with
sufficient preparation and Notifies faculty in a timely manner if he/she will
be absent or late
Attends online discussions/meetings with sufficient preparation
Demonstrate willingness to learn and accepts constructive criticism
Maintains professional appearance
Seeks assistance appropriately from instructor, peers, and other
professionals
Manages time effectively to complete clinical assignments.
Modifies behaviors promptly based on faculty input and self-evaluation
Reflective journal entries demonstrates thoughtful considerations for care
of client
Participates appropriately in clinical conferences
(Rating Code: 1 = never; 2 = fair; 3 = Sometimes; 4 = usually 5 = Always; NA = Not Applicable)
Our Lady of the Pillar College-Cauayan
Cauayan City, Isabela
College of Nursing and Midwifery
PEER EVALUATION FORM
Write the name of your group members in the numbered boxes. Then assign yourself a value of each
listed attribute. Finally, do the same for each of your group members and total all of the values
3- Strongly agree 2- Agree 1- Disagree
GROUP/ SECTION: GROUP 1- BSN 1 B DATE/ROTATION: FEB 27, MARCH 5,12 & 19
NAME OF MEMBER: CABAUATAN, FRANCHESCA Yourself 3 2 1
Was dependable in attending group meetings
Willingly accepted assigned tasks.
Contributed positively to group discussions.
Completed work on time or made alternative arrangements.
Help others with their work when needed.
Did work accurately and completely.
Work well with other group members
Overall was a valuable member of the team
ATTITUDE
Instructions. On a scale of 1 to 5, rate each of the following student behaviors:
5 4 3 2 1
Maintains punctuality and Attends online discussions/meetings with
sufficient preparation and Notifies faculty in a timely manner if he/she will
be absent or late
Attends online discussions/meetings with sufficient preparation
Demonstrate willingness to learn and accepts constructive criticism
Maintains professional appearance
Seeks assistance appropriately from instructor, peers, and other
professionals
Manages time effectively to complete clinical assignments.
Modifies behaviors promptly based on faculty input and self-evaluation
Reflective journal entries demonstrates thoughtful considerations for care
of client
Participates appropriately in clinical conferences
(Rating Code: 1 = never; 2 = fair; 3 = Sometimes; 4 = usually 5 = Always; NA = Not Applicable)
Our Lady of the Pillar College-Cauayan
Cauayan City, Isabela
College of Nursing and Midwifery
PEER EVALUATION FORM
Write the name of your group members in the numbered boxes. Then assign yourself a value of each
listed attribute. Finally, do the same for each of your group members and total all of the values
3- Strongly agree 2- Agree 1- Disagree
GROUP/ SECTION: GROUP 1- BSN 1 B DATE/ROTATION: FEB 27, MARCH 5,12 & 19
NAME OF MEMBER: CACHO, GLIEZELE Yourself 3 2 1
Was dependable in attending group meetings
Willingly accepted assigned tasks.
Contributed positively to group discussions.
Completed work on time or made alternative arrangements.
Help others with their work when needed.
Did work accurately and completely.
Work well with other group members
Overall was a valuable member of the team
ATTITUDE
Instructions. On a scale of 1 to 5, rate each of the following student behaviors:
5 4 3 2 1
Maintains punctuality and Attends online discussions/meetings with
sufficient preparation and Notifies faculty in a timely manner if he/she will
be absent or late
Attends online discussions/meetings with sufficient preparation
Demonstrate willingness to learn and accepts constructive criticism
Maintains professional appearance
Seeks assistance appropriately from instructor, peers, and other
professionals
Manages time effectively to complete clinical assignments.
Modifies behaviors promptly based on faculty input and self-evaluation
Reflective journal entries demonstrates thoughtful considerations for care
of client
Participates appropriately in clinical conferences
(Rating Code: 1 = never; 2 = fair; 3 = Sometimes; 4 = usually 5 = Always; NA = Not Applicable)
Our Lady of the Pillar College-Cauayan
Cauayan City, Isabela
College of Nursing and Midwifery
PEER EVALUATION FORM
Write the name of your group members in the numbered boxes. Then assign yourself a value of each
listed attribute. Finally, do the same for each of your group members and total all of the values
3- Strongly agree 2- Agree 1- Disagree
GROUP/ SECTION: GROUP 1- BSN 1 B DATE/ROTATION: FEB 27, MARCH 5,12 & 19
NAME OF MEMBER: DRES, JEWELL IVHON Yourself 3 2 1
Was dependable in attending group meetings
Willingly accepted assigned tasks.
Contributed positively to group discussions.
Completed work on time or made alternative arrangements.
Help others with their work when needed.
Did work accurately and completely.
Work well with other group members
Overall was a valuable member of the team
ATTITUDE
Instructions. On a scale of 1 to 5, rate each of the following student behaviors:
5 4 3 2 1
Maintains punctuality and Attends online discussions/meetings with
sufficient preparation and Notifies faculty in a timely manner if he/she will
be absent or late
Attends online discussions/meetings with sufficient preparation
Demonstrate willingness to learn and accepts constructive criticism
Maintains professional appearance
Seeks assistance appropriately from instructor, peers, and other
professionals
Manages time effectively to complete clinical assignments.
Modifies behaviors promptly based on faculty input and self-evaluation
Reflective journal entries demonstrates thoughtful considerations for care
of client
Participates appropriately in clinical conferences
(Rating Code: 1 = never; 2 = fair; 3 = Sometimes; 4 = usually 5 = Always; NA = Not Applicable)
Our Lady of the Pillar College-Cauayan
Cauayan City, Isabela
College of Nursing and Midwifery
PEER EVALUATION FORM
Write the name of your group members in the numbered boxes. Then assign yourself a value of each
listed attribute. Finally, do the same for each of your group members and total all of the values
3- Strongly agree 2- Agree 1- Disagree
GROUP/ SECTION: GROUP 1- BSN 1 B DATE/ROTATION: FEB 27, MARCH 5,12 & 19
NAME OF MEMBER: BACANI, JURIEL MARINI Yourself 3 2 1
Was dependable in attending group meetings
Willingly accepted assigned tasks.
Contributed positively to group discussions.
Completed work on time or made alternative arrangements.
Help others with their work when needed.
Did work accurately and completely.
Work well with other group members
Overall was a valuable member of the team
ATTITUDE
Instructions. On a scale of 1 to 5, rate each of the following student behaviors:
5 4 3 2 1
Maintains punctuality and Attends online discussions/meetings with
sufficient preparation and Notifies faculty in a timely manner if he/she will
be absent or late
Attends online discussions/meetings with sufficient preparation
Demonstrate willingness to learn and accepts constructive criticism
Maintains professional appearance
Seeks assistance appropriately from instructor, peers, and other
professionals
Manages time effectively to complete clinical assignments.
Modifies behaviors promptly based on faculty input and self-evaluation
Reflective journal entries demonstrates thoughtful considerations for care
of client
Participates appropriately in clinical conferences
(Rating Code: 1 = never; 2 = fair; 3 = Sometimes; 4 = usually 5 = Always; NA = Not Applicable)
Our Lady of the Pillar College-Cauayan
Cauayan City, Isabela
College of Nursing and Midwifery
PEER EVALUATION FORM
Write the name of your group members in the numbered boxes. Then assign yourself a value of each
listed attribute. Finally, do the same for each of your group members and total all of the values
3- Strongly agree 2- Agree 1- Disagree
GROUP/ SECTION: GROUP 1- BSN 1 B DATE/ROTATION: FEB 27, MARCH 5,12 & 19
NAME OF MEMBER: ALAVAZO, QUEENS ANGEL Yourself 3 2 1
Was dependable in attending group meetings
Willingly accepted assigned tasks.
Contributed positively to group discussions.
Completed work on time or made alternative arrangements.
Help others with their work when needed.
Did work accurately and completely.
Work well with other group members
Overall was a valuable member of the team
ATTITUDE
Instructions. On a scale of 1 to 5, rate each of the following student behaviors:
5 4 3 2 1
Maintains punctuality and Attends online discussions/meetings with
sufficient preparation and Notifies faculty in a timely manner if he/she will
be absent or late
Attends online discussions/meetings with sufficient preparation
Demonstrate willingness to learn and accepts constructive criticism
Maintains professional appearance
Seeks assistance appropriately from instructor, peers, and other
professionals
Manages time effectively to complete clinical assignments.
Modifies behaviors promptly based on faculty input and self-evaluation
Reflective journal entries demonstrates thoughtful considerations for care
of client
Participates appropriately in clinical conferences
(Rating Code: 1 = never; 2 = fair; 3 = Sometimes; 4 = usually 5 = Always; NA = Not Applicable)
