INDIVIDUAL HOME VISITATION AND REMOTE MONITORING TOOL

SY 2020 - 2021
Learner’s Name: Learning
Area:
Grade Level: Date:
Section: Time:
Mode of Monitoring: ( ) Home Visitation
( ) Remote Monitoring:
( ) SMS
( ) Virtual consultation via _____________________________________
( ) Other remote means
(Specify): _________________________________________________

Focus Challenges Encountered Action Taken

1. Module/ LAS
a. Printing quality
(misprint, missing
page/s, blurry
etc.)

b. Part/s of the
lesson not or less
understood

c. Activities failed
or not
accomplished

d. Other related
circumstances

2. Learner

a. Conduct/
Discipline/
Performance

b. Reading/
Numeracy
Ability
 c. Writing ability

d. Comprehension
ability

e. Other difficulties
met

3. Parent/
Guardian
a. Availability of
time

b. Level of
commitment in
guiding the child

c. Difficulties met
with the process
of home
learning
4. Learning
Environment
a. Classroom
Corner

b. Disturbance/s in
the environment

c. Other factors
affecting the
learning
environment

5. Other issues and

concerns

Monitored by: Noted:

_____________________ _____________________
Class Adviser/Teacher School Head