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DOST TNA Form 01 Application for Technology Needs Assessment
DOST application form for technology assessment needs
Your Browser Doesn't Support Canvas. Showing the Text Content of the PDF Instead: DOST TNA Form 01
APPLICATION FOR TECHNOLOGY NEEDS ASSESSMENT
Name of Enterprise:
Contact Person:
Position in the Enterprise:
Office Address:
Tel. No.
Fax No.
E-mail Address:
Factory Address:
Tel. No.
Fax No.
E-mail Address:
Website:
GENERAL AGREEMENTS:
1.
The applicant shall, at the earliest opportunity, make available to the DOST Regional Office No.
___ (DOST ___) all information (manuals, procedures, etc.) required to establish the technology
status of the selected core business functions and management systems;
2.
If DOST ____ is not satisfied that all the requirements for business registration are complied
with, it shall inform the applicant of the observed deficiencies before starting the assessment;
3.
When the required inputs to the assessment are already supplied by the applicant, including
Attachment A, the DOST ____ will assess the firm through the core business functions and
management systems, whichever is applicable, to identify technology needs and verify
compliance to standards vis-à-vis existing practices;
4.
When the DOST ____ has completed the technology assessment, a report will be prepared on
the results of the assessment with accompanying recommendations and opportunities for
improvement. The report prepared will define the scope of activities, functions, management
practices and locations assessed. The applicant shall not claim or otherwise imply that the
report applies to other locations, product or activities not covered by the report;
5.
The applicant agrees that the report will not be used until permission has been granted by the
DOST ____;
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6.
The applicant agrees that the receipt or acknowledgment of the report ends the assessment
stage; any technical assistance ensuing from the recommendations of the report will be viewed
as a separate project.
UNDERTAKING
I agree to undertake and observe the above General Agreements as stipulated by the Department
of Science and Technology Regional Office No. ____.
___________________________________
Signature over Printed Name
_________________________________
Position in the Enterprise
_________________________________
Date
SETUP Guidelines – Annex B-11 - DOST TNA Form 01
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Attachment A
Enterprise Profile
Name of Enterprise
Production Site/Location
Business Permit No.
Year Registered
Brief Enterprise Background
Year enterprise was established:
Type of Organization:
Initial
capitalization:
Single proprietorship
Cooperative
Partnership
Corporation
Profit
Non-profit
Enterprise Registration No.
Year Registered
Classification according to capital (PhP)
Present
capitalization
Micro (less than 1.5 M)
Small (1.5 – 15 M)
Medium (15 – 100 M)
Classification according to employment (number of employees)
Micro (1 – 9)
Small (10 – 99)
Medium (100 – 199)
Number of Employees:
Direct Workers
M:___
F:___
Production
M:___
F:___
Non-production
M:___
F:___
Indirect/Contract Workers
M:___
F:___
Total
M:___
F:___
Business Activity:
Food processing (please specify specific commodity)
Furniture (please specify specific commodity)
Gifts, decors, handicrafts (please specify commodity)
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Metals and engineering (please specify specific commodity)
Agriculture/Marine/Aquaculture (please specify specific commodity)
Others, please specify
1. Specific product or service the enterprise offers its customers:
2. Reasons why assistance is being sought:
3. Have you consulted any other individual/organization for any assistance?
If Yes, which company/ agency?
Please specify the type of assistance sought
If No, why not?
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Organizational Structure
4. Enterprise’s plan for the next 5 years?
Next 10 years?
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5. Current agreements and alliances undertaken
BENCHMARK INFORMATION
Production and Supply Chain
Raw Material
Raw Material
Source
Unit Cost (P)
Volume Used/Year
Volume of
Production/Year
Unit Cost of
Production (P)
Annual Cost of
Production (P)
Production
Product
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Existing Functional Production Equipment
Type of Equipment
Specifications
Capacity
Production Problems and Concerns
Production Waste Management System
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Production Plan
Plant Lay-Out
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Process Flow
Inventory System
Maintenance Program
cGMP/HACCP Activities
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Supplies/Purchasing System
Marketing
Marketing Plan
Market Outlets and Number
Promotional Strategies
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Market Competitors
Packaging
o Nutrition Evaluation
o Bar Code
o Product Label
o Expiry Date
Finance
Cash Flow or other related documents
Source(s) of capital/credit
Accounting System
Human Resources
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Hiring and Criteria
Incentives to Employees
Training and Development
Safety Measures Practiced
Other Employee Welfare
Other Concerns
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Prepared by:
Validated by:
Printed Name and Signature of
Owner/Chair/Representative
Printed Name and Signature of PSTD
Date
Date
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