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Republic of the Philippines

Department of Education
CARAGA ADMINISTRATIVE REGION
Division of Surigao City
Caraga regional science high shool
Brgy. San Juan, Surigao City

ANECDOTAL RECORD

Name of Student: ___________________________________ Date: __________________


Age: __________ Sex: _____________ Grade & Section: __________________________
Date of Observation: ____________ Time Started: ___________ Time Ended: ___________

A. Description of Events:
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________

B. Action Taken:
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________

C. Recommendation:
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________

Observed by:

____________________________
Signature over printed name
Republic of the Philippines
Department of Education
CARAGA ADMINISTRATIVE REGION
Division of Surigao City
Caraga regional science high shool
Brgy. San Juan, Surigao City

ANECDOTAL REPORT

Student Observed: ________________________________________________________________________

Observer: _________________________________________________________________________________

Date: ______________________ Time: ____________________Place: ___________________________

Context: What was happening immediately before the behavior occurred?

___________________________________________________________________________________

___________________________________________________________________________________

Behavior: What behavior was manifested?

____________________________________________________________________________________

____________________________________________________________________________________

Effect: How did observe/others respond/react to the manifested behavior?

____________________________________________________________________________________

____________________________________________________________________________________

Outcome: How did person observed react/respond to others?

____________________________________________________________________________________

____________________________________________________________________________________

Recommendation:

____________________________________________________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________
Republic of the Philippines
Department of Education
CARAGA ADMINISTRATIVE REGION
Division of Surigao City
Caraga regional science high shool
Brgy. San Juan, Surigao City

OBSERVATION CHECKLIST

Date: ___________________________________ Place: _____________________________

Name of Observed Student: ________________________ Grade & Section: ____________

Name of Observer: ________________________________ Position: __________________

Period of Observation: From: ________________________ To: ______________________

Reasons for Observation: _____________________________________________________

___________________________________________________________________________

________ Active ________ Dependent on Others

________ Assertive ________ Deceitful

________ Resourceful ________ Careless

________ Conscientious ________ Cooperative

________ Initiating ________ Bullying

________ Creative ________ Unreliable

________ Rude ________ Honest

________ Impatient ________ Law-abiding

________ Domineering ________ Productive

________ Time-wasting ________ Confident

________ Self-centered ________ Aloof

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