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SST FORM/LI.01 SCHOOL OF SCIENCE AND TECHNOLOGY UNIVERSITY MALAYSIA SABAH LATIHAN INDUSTRI / INDUSTRIAL TRAINING Resume / Curriculum Vitae [Your Name] [IC Number] [Race][GENDER][NATIONALITY] [Street Address], [City, ST ZIP Code] [Phone/HP/HOME] [e-mail] SEEKING INDUSTRIAL TRAINING PERSONAL [AGE] [MARITAL STATUS] [IC NUMBER/MATRICS NUMBER] [INTERESTS/HOBBIES] ACADEMIC QUALIFICATIONS UNIVERSITI MALAYSIA SABAH 2002-2005 BSc (PROGRAM) [CGPA FOR SEMESTER 1, 2004/5] [MAJOR COURSES TAKEN SO FAR] STPM/MATRICULATION/DIPLOMA RESULT 1997-1998 [STATE YOUR RESULT] SPM 1996-1997 [STATE YOUR BM RESULT] WORKING EXPERIENCES POSITION, COMPANY, DURATION RESEARCH EXPERIENCES LIST YOUR FINAL YEAR PROJECT LIST YOUR SUPERVISOR & CONTACTS (PHONE, EMAIL) AWARDS DEAN’S LIST OR OTHER SELECTED AWARDS FROM UNIVERSITY/SECONDARY SCHOOL CUCURRICULUM ACTIVITIES STATE TYPE OF ACTIVITIES TAKEN ACCORDING TO CHRONOLOGICAL ORDER. LANGUAGE PROFICIENCY SPOKEN WRITTEN COMPUTER SKILLS STATE YOUR COMPUTING SKILLS LABORATORY SKILLS STATE YOUR LABORATORY SKILLS IF ANY, DELETE THIS IF NOT RELEVANT 1 Your recent passport size colour photo.

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SST FORM/LI.01SCHOOL OF SCIENCE AND TECHNOLOGY

UNIVERSITY MALAYSIA SABAHLATIHAN INDUSTRI / INDUSTRIAL TRAINING

Resume / Curriculum Vitae

[Your Name][IC Number][Race][GENDER][NATIONALITY][Street Address], [City, ST ZIP Code][Phone/HP/HOME][e-mail]

SEEKING INDUSTRIAL TRAININGPERSONAL

[AGE] [MARITAL STATUS] [IC NUMBER/MATRICS NUMBER] [INTERESTS/HOBBIES]

ACADEMIC QUALIFICATIONSUNIVERSITI MALAYSIA SABAH 2002-2005BSc (PROGRAM)[CGPA FOR SEMESTER 1, 2004/5][MAJOR COURSES TAKEN SO FAR]STPM/MATRICULATION/DIPLOMA RESULT 1997-1998[STATE YOUR RESULT]SPM 1996-1997[STATE YOUR BM RESULT]

WORKING EXPERIENCES POSITION, COMPANY, DURATION

RESEARCH EXPERIENCES

LIST YOUR FINAL YEAR PROJECT LIST YOUR SUPERVISOR & CONTACTS (PHONE, EMAIL)

AWARDS DEAN’S LIST OR OTHER SELECTED AWARDS FROM UNIVERSITY/SECONDARY SCHOOL

CUCURRICULUM ACTIVITIES

STATE TYPE OF ACTIVITIES TAKEN ACCORDING TO CHRONOLOGICAL ORDER.

LANGUAGE PROFICIENCY SPOKEN WRITTEN

COMPUTER SKILLS STATE YOUR COMPUTING SKILLS

LABORATORY SKILLS STATE YOUR LABORATORY SKILLS IF ANY, DELETE THIS IF NOT RELEVANT

SST FORM/LI.02

1

Your recent passport size colour photo.

SCHOOL OF SCIENCE AND TECHNOLOGYUNIVERSITY MALAYSIA SABAH

INDUSTRIAL TRAININGSenarai Semak Permohonan

(Application Check Lists)

Nama : _______________________No. Pelajar : _______________________ Program : ______________________________No. Telefon (h/p): ______________________ Tarikh: _________________________________

A. Dokumen Permohonan. Tandakan (√) pada petak yang berkenaan

Bil. Perkara Ada Tiada1. CV / Resume (Borang LI.01)2. Salinan keputusan terkini3. Borang LI.034. Sampul surat bersetem

B. Senarai Nama Organisasi Yang Dipohon

Bil. Nama dan Alamat PerhubunganJawapan

(diterima/ditolak)

Pilihan Pelajar (√)

1. Nama organisasi:Alamat:

No. Telefon : No. Fax:2. Nama organisasi:

Alamat:

No. Telefon: No. Fax:3. Nama organisasi:

Alamat:

No. Telefon: No. Fax:4. Nama organisasi:

Alamat:

No. Telefon: No. Fax:5. Nama organisasi:

Alamat:

No. Telefon: No. Fax:

C. Ulasan Penyelaras LI

Disemak dan dipersetujui pada (tarikh)

Tandatangan dan Cop

::

:

SST FORM/LI.03

2

SCHOOL OF SCIENCE AND TECHNOLOGYUNIVERSITY MALAYSIA SABAH

LATIHAN INDUSTRI / INDUSTRIAL TRAINING

Borang Maklumbalas Organisasi - PermohonanOrganization Reply Form - Application

Industrial Training CoordinatorSchool of Science & Technology,Universiti Malaysia Sabah, Jalan UMS, 88400 Kota Kinabalu, Sabah.[Fax: +6 088-435324; E-mail: [email protected] / [email protected]]

Date: _____________________

Dear Sir,

APPLICATION FOR INDUSTRIAL TRAINING

On behalf of the Department / Organization / Company, we *agree / disagree to accept the student below from your school for Industrial Training in our Department / Organization / Company:

Name :Matric No. :Programme* : Aquaculture Conservation Biology

Biotechnology GeologyEnvironmental Sciences Mathematics with EconomicsIndustrial Chemistry Mathematics with Computer

GraphicsMarine Sciences Plant TechnologyPhysics with Electronics

Thank you.

Yours sincerely,

______________________________ __________________________ (Signature) (Official Stamp)

Name :

Position :

Organization (name and full address) :

Phone No: ______________________ Fax: ____________________ E-mail: _________________

3

* Mohon Dapat Mengisikan Bahagian Ini Jika Pihak Tuan/Puan Bersetuju Menerima Pada Bahagian Di Atas

* Please Fill Up This Form Together With Section above If You Agree

1. JANGKA MASA KERJA (Duration of attachment) :__________________ HINGGA (until ) ___________________

2. BILANGAN PELAJAR YANG DITERIMA (No. of student accepted): _____________________

3. CADANGAN PENYELIA INDUSTRI (iaitu pegawai yang akan menyelia dan mengawasi pelajar berkenaan) PROPOSED INDUSTRIAL SUPERVISOR (ie. the officer that will supervise and monitor the student):

A. NAMA (Name) : ________________________________________________________ JAWATAN (Position) : ______________________________________________________

B. NAMA (Name) : ________________________________________________________JAWATAN (Position) : ______________________________________________________

4. CADANGAN JENIS KERJA / BIDANG KERJA PELAJAR:TYPE OF WORK PROPOSED / STUDENTS FIELD WORK:

5. JUMLAH JAM KERJA SEHARI (Total working hour per day) : __________________6. BILANGAN HARI KERJA (No. of working days) :_________________________7. BILANGAN HARI CUTI (jika ada) {No. of leave (if any)} : ____________________8. TARIKH MELAPOR DIRI (Date of report duty) : __________________________9. DOKUMEN YANG PERLU DIBAWA (Document to bring along) :

10. ELAUN HARIAN (jika ada) / DAILY ALLOWANCE (if any) : ADA (Provided) / TIADA (None)11. KEDIAMAN (Hostel) : ADA (Provided) / TIADA (None)12. PENGANGKUTAN / TRANSPORTATION : ADA (Provided) / TIADA(None)13. LAIN-LAIN KEMUDAHAN, Sila nyatakan:

OTHERS HOSPITALITY, please state:

14. KETERANGAN LAIN (Others) :

4

SST FORM/LI.04SCHOOL OF SCIENCE AND TECHNOLOGY

UNIVERSITY MALAYSIA SABAHINDUSTRIAL TRAINING

Maklumat Peribadi Pelajar(Student Personal Details)

NAME : ___________________________________________________________________________

STUDENT No. : ____________________ NRIC / PASSPORT : ______________________________

DATE OF BIRTH : _________________ PLACE OF BIRTH :___________________________________

PROGRAMME : ______________________________________________________________________

HOME ADDRESS : ___________________________________________________________________

__________________________________________________________________________________

PHONE NO.: ________________________ (H) ___________________________________(MOBILE)

E-MAIL : __________________________________ LATEST CGPA : _______________________

ADDRESS DURING INDUSTRIAL TRAINING :

__________________________________________________________________________________

__________________________________________________________________________________

PHONE NO. DURING INDUSTRIAL TRAINING : ____________________________________________

INDUSTRIAL TRAINING’S ADDRESS :

__________________________________________________________________________________

__________________________________________________________________________________

PHONE NO. : ____________________________ FAX NO. : __________________________________

ACADEMIC SUPERVISOR : ____________________________________________________________

INDUSTRIAL SUPERVISOR : ___________________________________________________________

POSITION OF INDUSTRIAL SUPERVISOR: ________________________________________________

DURATION OF INDUSTRIAL TRAINING : _____________________ TO _______________________

ELAUN OR SALARY: RM _______________ PER MONTH / 10 WEEKS

SST FORM/LI.05a

5

Passport Size Photo

SCHOOL OF SCIENCE AND TECHNOLOGYUNIVERSITY MALAYSIA SABAH

LATIHAN INDUSTRI / INDUSTRIAL TRAINING

Laporan 1: Borang Lapor Diri Latihan IndustriReport 1: Industrial Training Report Duty Form

Catatan / NotesBorang ini hendaklah diisi dengan lengkap dan dihantar oleh pelajar ke alamat seperti di bawah (7 hari dari tarikh lapor diri).Pelajar juga dikehendaki mengupload borang ini kedalam LI portal bagi tujuan pengesahan.Completed form has to be send to the corresponding address within 7 days from the report duty by the students.Students also required to upload this form to the LI portal for the verification purpose.

Diisi oleh Pelajar (To be filled by student)

Nama / Name : ______________________ ___ No. Pelajar / Matric No. : _________________

Program / Programme: ______________________________________________________________

Nama Penyelia LI / Industrial Supervisor :________________________________________________

Alamat Organisasi LI / Address :______________________________________________________

_________________________________________________ No. Tel. Rumah: ___________________

No. Tel Bimbit / Mobile Phone No.: ____ ________________ E-mail : _ __ ____________________

Tandatangan Pelajar/ Signature: ______ ________________ Tarikh/ Date : _______ ___________

** Sila lampirkan bersama pelan lokasi kedudukan tempat Latihan Industri dijalankan.

Diisi oleh Penyelia Latihan Industri:To be filled by the Industrial Training Supervisor:

Dengan ini disahkan bahawa pelajar bernama diatas telah pun melapor diri untuk menjalani Latihan Industri bermula pada tarikh ______________________

Yang benar,

_________________________ ______________________ _____________________ (Tandatangan) (Cop Jabatan) (Tarikh)

No. Telefon : ___________________________ Fax : ______________________

Sila kembalikan borang ini ke : Industrial Training CoordinatorPlease return this form to: School of Science & Technology,

Universiti Malaysia Sabah, Jalan UMS, 88400 Kota Kinabalu, Sabah.Tel : +6-088-320321; Fax : +6-088-435324[E-mail: [email protected] / [email protected]]

SST FORM/LI.05b

6

SCHOOL OF SCIENCE AND TECHNOLOGYUNIVERSITY MALAYSIA SABAH

LATIHAN INDUSTRI / INDUSTRIAL TRAINING

Laporan 2: Borang Laporan Kemajuan Minggu Pertama hingga ke-7Report 2: Progress Reports Form Weeks 1 to 7

Catatan /Notes:Pelajar dikehendaki melengkapkan borang ini sebelum diserahkan kepada organisasi untuk pengesahan. Pastikan borang ini dilampirkan dalam Laporan Penuh Latihan Industri. A complete form has to submit to the organization for the verification purpose. Please be ensure that this form have to be attached in the Full Report of Industrial Training.

Nama / Name : ____________________________________________________________________ No. Pelajar / Matric No. : ______________________ Program / Programme: ____ _________

Week

Work Performed

1

2

3

4

5

7

6

7

Tandatangan Pelajar : _______________________________ Tarikh : ______________________Student Signature Date

Nama Penyelia : _____________________________________ Jawatan : ______________________Name of Supervisor Position

_____________________ ____ _________________ ____ _____________________ Tandatangan Penyelia (Supervisor sign) Cop Jabatan (Official stamp) Tarikh (Date)

SST FORM/LI.05c

8

SCHOOL OF SCIENCE AND TECHNOLOGYUNIVERSITY MALAYSIA SABAH

LATIHAN INDUSTRI / INDUSTRIAL TRAINING

Laporan 3: Borang Pelepasan Laporan Latihan IndustriReport 3: Industrial Training Report Clearance

Catatan /Notes :Borang ini hendaklah diserahkan kepada Organisasi untuk kebenaran pelepasan laporan. Borang yang telah disahkan hendaklah dilampirkan bersama dalam Laporan Penuh. Satu salinan Laporan Penuh hendaklah diserahkan kepada organisasi.This form must be submitted to the organization for clearance. A verify complete form should be attached in the Full Report. One copy of full report should be given to the Organization.

Nama / Name : ______ ______________________________________________________ No. Pelajar / Matric No. : _____________________ Program / Programme : ___________________ Tarikh Latihan Industri / Date : dari (from) _________________ hingga (until) __________________

Nama dan alamat Organisasi di mana Latihan Industri dijalankan: Name and Industry address:____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Tandatangan Pelajar : _______________________________ Tarikh : ______________________Student Signature Date

Kebenaran Pelepasan Laporan daripada Penyelia :Authorization Report Clearance by the Supervisor

Nama Penyelia : _____________________________________ Jawatan : ______________________Name of Supervisor Position

_____________________ ____ _________________ ____ _____________________ Tandatangan Penyelia (Supervisor sign) Cop Jabatan (Official stamp) Tarikh (Date)

9

SST FORM/LI.05dSCHOOL OF SCIENCE AND TECHNOLOGY

UNIVERSITY MALAYSIA SABAHLATIHAN INDUSTRI / INDUSTRIAL TRAINING

Laporan 4: Borang Laporan Kemajuan Minggu ke-8 hingga 10Report 4: Progress Reports Form Weeks 8 to 10

Catatan / Notes : Pelajar dikehendaki melengkapkan dan menghantar borang ini ke alamat di bawah pada minggu ke-10 Latihan Industri. Student require to complete and send the form to the corresponding address by week 10 th of the Industrial Training.

Nama / Name : ____________________________________________________________________ No. Pelajar / Matric No. : _________________ Program / Programme: ______ ______________

Week

Work Performed

8

9

10

Tandatangan Pelajar : _______________________________ Tarikh : ______________________Student Signature Date

Nama Penyelia : _____________________________________ Jawatan : ______________________Name of Supervisor Position

_____________________ ____ _________________ ____ _____________________ Tandatangan Penyelia (Supervisor sign) Cop Jabatan (Official stamp) Tarikh (Date)

Sila kembalikan borang ini ke : Industrial Training CoordinatorPlease return this form to: School of Science & Technology,

10

Universiti Malaysia Sabah, Jalan UMS, 88400 Kota Kinabalu, Sabah.Tel : +6-088-320321; Fax : +6-088-435324[E-mail: [email protected] / [email protected]]

SST FORM/LI.06SCHOOL OF SCIENCE AND TECHNOLOGY

UNIVERSITY MALAYSIA SABAHLATIHAN INDUSTRI / INDUSTRIAL TRAINING

Laporan Penyelia Industri (Penilaian Prestasi Pelajar Minggu Pertama hingga ke-7)

Industrial Supervisor Report( Assessment of Student Performance Form for Weeks 1 to 7)

Catatan (Notes):

a. Borang ini hendaklah diisi oleh Penyelia Industri apabila pelajar tamat latihan.(This form must be filled up by the Industrial Supervisor once the student has completed his/her training)

b. Sila poskan atau fakskan terus borang yang telah lengkap diisi ke alamat di bawah pada minggu Ke - 8 dalam tempoh latihan. (Please post or fax the completed form directly to the address below on the 8th weeks of the training).

Industrial Training Coordinator School of Science & Technology,

Universiti Malaysia Sabah, Jalan UMS, 88400 Kota Kinabalu, Sabah.Tel : +6-088-320321; Fax : +6-088-435324

[E-mail: [email protected] / [email protected]]

BAHAGIAN A (PART A) :

1. NAMA PELAJAR (Student Name) : ___________________________________________________

2. NO. PELAJAR (Student No.) : _______________________

3. PROGRAM PENGAJIAN (Program of Study) : ___________________________________________

4. JANGKAMASA LATIHAN (Training Duration) (dd/mm/yy): daripada (from) _____/_____/_________; sehingga (until) _____/_____/_________

5. NAMA PENYELIA INDUSTRI (Industrial Supervisor Name) : _______________________________________________________________________________

6. JAWATAN PENYELIA (Supervisor Position) : ___________________________________________

7. ALAMAT INDUSTRI (Industry Address) : ____________________________________________________________________________________________________________________________________________________________________________________________________________

8. NO. TEL : ______________________________ NO.FAX : ______________________________

11

9. E-mail : ________________________________

BAHAGIAN B / PART B

PENILAIAN PELAJAR / Student Evaluation:

ASPEK PENILAIAN (Aspects to Evaluated) SKOR (Score)*

a. Tata tertib kerja / disiplin / kekemasan :Work Manner / discipline / tidiness

(Very Good) 5 — 4 — 3 — 2 —1 (Not Satisfactory)

b. Kecekapan kerja :Work efficiency

(Very Good) 5 — 4 — 3 — 2 —1 (Not Satisfactory)

c. Kerjasama semasa latihan :Cooperativeness during the training

(Very Good) 5 — 4 — 3 — 2 —1 (Not Satisfactory)

d. Mutu kerja :Quality of work performed

(Very Good) 5 — 4 — 3 — 2 —1 (Not Satisfactory)

e. Kerajinan dan kehadiran :Diligence & attendance

(Very Good) 5 — 4 — 3 — 2 —1 (Not Satisfactory)

f. Ketepatan masa :Punctuality

(Very Good) 5 — 4 — 3 — 2 —1 (Not Satisfactory)

g. Pengetahuan saintifik dan teknikal :Scientific and technical knowledge

(Very Good) 5 — 4 — 3 — 2 —1 (Not Satisfactory)

h. Keupayaan menerima pengetahuan dan arahan :Ability to accept instruction and absorb knowledge

(Very Good) 5 — 4 — 3 — 2 —1 (Not Satisfactory)

i. Sifat tanggungjawab :Responsibilties

(Very Good) 5 — 4 — 3 — 2 —1 (Not Satisfactory)

j. Dayausaha dan tahap minat kepada kerja : Initiative and level of work interest

(Very Good) 5 — 4 — 3 — 2 —1 (Not Satisfactory)

k. Kebolehan menjalankan kerja tanpa penyeliaan :Ability to work independently

(Very Good) 5 — 4 — 3 — 2 —1 (Not Satisfactory)

l. Kejujuran :Trustworthness

(Very Good) 5 — 4 — 3 — 2 —1 (Not Satisfactory)

m. Hubungan dengan kakitangan dan majikan : Relationship with co-workers and officers

(Very Good) 5 — 4 — 3 — 2 —1 (Not Satisfactory)

n. Kemahiran Komunikasi :Communication skill

(Very Good) 5 — 4 — 3 — 2 —1 (Not Satisfactory)

o. Kepimpinan dan kebolehan untuk membuat keputusan :Leadership and ability to make decision

(Very Good) 5 — 4 — 3 — 2 —1 (Not Satisfactory)

p. Kreativiti dan inovasi :Creativity and innovation

(Very Good) 5 — 4 — 3 — 2 —1 (Not Satisfactory)

JUMLAH (TOTAL) /80* Bulatkan yang berkenan / Please cycle the necessary.

Panduan (Guideline) : 5 - AMAT BAIK (VERY GOOD) 4 - BAIK (GOOD) 3 - MEMUASKAN (SATISFACTORY) 2 - KURANG MEMUASKAN (LESS SATISFACTORY) 1 - TIDAK MEMUASKAN (NOT SATISFACTORY)

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BAHAGIAN C ( PART C) :

*KOMEN PENYELIA INDUSTRI / Industrial Supervisor Comments

a. PADA PENDAPAT TUAN / PUAN, ADAKAH PELAJAR MEMPUNYAI LATAR BELAKANG YANG MENCUKUPI BAGI MEMBOLEHKAN MEREKA MENDAPAT MANFAAT DARIPADA LATIHAN INDUSTRI INI? In your opinion, does the student have enough background that enables her/him to gain benefit from this industrial training?

b. SILA SENARAIKAN ASPEK LATIHAN YANG TELAH DIDEDAHKAN KEPADA PELAJAR SEPANJANG TEMPOH LATIHAN INDUSTRI INI. Please list major aspects of training which the students has been exposed to during this industrial training.

c. SILA BERI ULASAN ATAU CADANGAN TERHADAP LATIHAN YANG DILAKSANAKAN YANG PERLU DIBAIKI ATAU DITAMBAH OLEH PIHAK UNIVERSITI MALAYSIA SABAH. Please give comments or suggestions for further improvement on the present industrial training as practiced by UMS.

d. LAIN-LAIN KOMEN SECARA KESELURUHAN. Other comments in general.

_____________________________ _____________________________Tandatangan (Signature) Cop Rasmi (Official Stamp)

13

Tarikh (Date) : ___________________

SST FORM/LI.07SCHOOL OF SCIENCE AND TECHNOLOGY

UNIVERSITY MALAYSIA SABAHLATIHAN INDUSTRI / INDUSTRIAL TRAINING

Borang Penilaian Laporan Latihan IndustriAssessment Form of Student Industrial Training Report

Catatan :1. Borang ini hendaklah diisi oleh Penyelia Akademik setelah laporan industri dibaca.2. Hantar borang yang lengkap kepada Penyelaras LI dalam masa yang ditetapkan.

NAMA PELAJAR : ____________________________________________

NO. PELAJAR : ____________________________________________

PROGRAM : ____________________________________________

PENILAIAN LAPORAN INDUSTRI

BIL. PERKARA PERATUSAN PENILAIAN

PERATUSAN AGIHAN

1Format, Ejaan dan Bahasa(Adakah ia mengikuti format laporan LI SST, ejaan betul dan bahasa lancar)

5

2Susunan Teks(Adakah ia teratur, mudah difahami dan ada kesinambungan)

5

3Sokongan illustrasi(Adakah rajah, peta, jadual, graf, foto, skesta, carta dan sebagainya; cukup, jelas memadai, dan releven)

5

4

Isi kandungan(Adakah laporan yang ditulis menyampaikan dengan tepat/jelas mengenai aktiviti-aktiviti Latihan Industri yang dijalankan; telah mengaplikasikan prinsip-prinsip sains yang berkaitan; dan telah manampilkan kualiti kesarjanaan akademik)

15

5Rumusan(Adakah analisis yang diberikan sejajar dengan aktiviti LI yang dijalankan serta laporan yang telah ditulis)

5

6Rujukan(Adakah senarai rujukan disertakan, lengkap dan ditulis dengan betul)

5

JUMLAH KESELURUHAN 40

_____________________________ _____________________________Tandatangan (Signature) Cop Rasmi (Official Stamp)Nama (Name) : _____________________________________________________________________Tarikh (Date) : ___________________

14

SST FORM/LI.08 SCHOOL OF SCIENCE AND TECHNOLOGY

UNIVERSITY MALAYSIA SABAHINDUSTRIAL TRAINING

Laporan Lawatan Industri (Penilaian Prestasi Pelajar)(Visiting Industry Report – Assessment of Student Performance)

Catatan (Notes):

Borang yang lengkap diisi oleh Pensyarah hendaklah dihantar kepada Penyelaras Kursus Latihan Industri dalam Program yang berkenaan sejurus selepas lawatan. Pastikan salinan dibuat bagi tujuan penyediaan laporan lawatan kepada Pejabat Dekan.(Complete form filled up by the Lecturer should be submitted directly to the respective Programme Coordinator of Industrial Training Course just after the visit. Please do a copy of this report as a guidance of report preparation to the Dean Office)

BAHAGIAN A (PART A) : MAKLUMAT PELAJAR ( STUDENT INFORMATION )

1. NAMA PELAJAR (Student Name) : ___________________________________________________

2. NO. PELAJAR (Student No.) : _______________________

3. PROGRAM PENGAJIAN (Program of Study) : ___________________________________________

4. TARIKH LAWATAN (Date of Visit) (dd/mm/yy): _____/_____/__________

5. NAMA PENYELIA INDUSTRI DAN JAWATAN (Industrial Supervisor Name & Position): ______________________________________________________________________________________________________________________________________________________________

6. ALAMAT INDUSTRI (Industry Address) :______________________________________________

______________________________________________________________________________________________________________________________________________________________

7. BENTUK PERNIAGAAN (Nature of Business) :

_________________________________________________________________________________________________________________________

8. NO. TEL : ______________________________ NO.FAX : ______________________________

9. E-mail : ________________________________

15

BAHAGIAN B (PART B) :

10. PENILAIAN TERHADAP PELAJAR BERDASARKAN KOMUNIKASI DENGAN PENYELIA INDUSTRI DAN PELAJAR SEMASA LAWATAN (Evaluation of student performance based on Industrial Supervisor and Student account communicated during the visit)

ASPEK PENILAIAN (Aspects to Evaluated) SKOR (Score)

a. Kualiti dan kelengkapan buku log pelajar (Quality and completeness of student log sheet)

(Very Good) 5 — 4 — 3 — 2 —1 (Not Satisfactory)

b. Tatatertib kerja / disiplin / kekemasan (Work Manner / discipline / tidiness) (Very Good) 5 — 4 — 3 — 2 —1 (Not

Satisfactory)c. Kecekapan kerja (Work efficiency) (Very Good) 5 — 4 — 3 — 2 —1 (Not

Satisfactory)d. Kerjasama semasa latihan

(Cooperativeness) (Very Good) 5 — 4 — 3 — 2 —1 (Not Satisfactory)

e. Kerajinan dan kehadiran (Diligence & attendance) (Very Good) 5 — 4 — 3 — 2 —1 (Not

Satisfactory)f. Ketepatan masa (Punctuality) (Very Good) 5 — 4 — 3 — 2 —1 (Not

Satisfactory)g. Pengetahuan saintifik dan teknikal

(Scientific and technical knowledge) (Very Good) 5 — 4 — 3 — 2 —1 (Not Satisfactory)

h. Keupayaan menerima pengetahuan dan arahan (Ability to accept instruction and absorb knowledge)

(Very Good) 5 — 4 — 3 — 2 —1 (Not Satisfactory)

i. Sifat tanggungjawab (Responsibilties) (Very Good) 5 — 4 — 3 — 2 —1 (Not Satisfactory)

j. Dayausaha dan tahap minat kepada kerja (Initiative and level of work interest) (Very Good) 5 — 4 — 3 — 2 —1 (Not

Satisfactory)k. Kebolehan menjalankan kerja tanpa

penyeliaan (Ability to work independently)

(Very Good) 5 — 4 — 3 — 2 —1 (Not Satisfactory)

l. Hubungan dengan kakitangan dan majikan (Relationship with co-workers and officers)

(Very Good) 5 — 4 — 3 — 2 —1 (Not Satisfactory)

m. Kemahiran Komunikasi (Communication skill) (Very Good) 5 — 4 — 3 — 2 —1 (Not

Satisfactory)n. Kreativiti dan inovasi (Creativity and

innovation)(Very Good) 5 — 4 — 3 — 2 —1 (Not

Satisfactory)JUMLAH (Total) /70

Panduan (Guideline) : 5 - AMAT BAIK (VERY GOOD) 4 - BAIK (GOOD) 3 - MEMUASKAN (SATISFACTORY) 2 - KURANG MEMUASKAN (LESS SATISFACTORY) 1 - TIDAK MEMUASKAN (NOT SATISFACTORY)

16

BAHAGIAN C ( PART C) :

11. KOMEN PENSAYARAH PELAWAT (Visiting Advisor Comments)

a. NYATAKAN KOMEN PELAJAR SEPANJANG MENJALANI LATIHAN INDUSTRI (Please state student comment rises throughout Industrial Training)

b. NYATAKAN APA-APA KOMEN DARIPADA ORGANISASI ATAU PENYELIA INDUSTRI (Please state any remarks from the Industrial Supervisor or Organization representatives)

c. KOMEN UMUM: (KESIHATAN/KESELAMATAN DAN LAIN-LAIN ISU)(General remarks: (health/safety and miscellaneous issues).

_____________________________ _____________________________Tandatangan (Signature) Cop Rasmi (Official Stamp)

Nama (Name) : ____________________________________________

Tarikh (Date) : ___________________ 17

18