Republic of the Philippines

Department of Education
Region XI – Davao Region
Schools Division of Davao City
MAHAYAG NATIONAL HIGH SCHOOL
Purok 1 Barangay Mahayag, Davao City

SELF-LEARNING MODULE DISTRIBUTION AND RETRIEVAL

EVALUATION FORM

Venue: ___________________________________ Date: _________________

Instructions: Please answer each item to how you would honestly and
objectively assess the activity by using 4-point rating scale to indicate the
extent to which you agree or disagree with each statement. Kindly check the
blank space below the appropriate number.

4 3 2 1
Indicators Strongly Agree Disagree Strongly
Agree Disagree

A. Venue
1. The venue was well lighted and
ventilated.
2. The venue was comfortable with
sufficient space for the distribution
and retrieval
3. The venue had sanitary and hygienic
conditions.
4. The venue was accessible convenient.
B. Materials
5. The SLMs objectives were achievable
and in congruence with the MELCS.
6. The SLMs content and exercises
given can be accomplished in the
time duration.
7. The SLMs were adequate and
appropriate.
8. The SLMs were clear and readable.

Address: Purok 1 Barangay Mahayag, Davao City

227-7361
 9. The SLMs were free from errors.
10. The SLMs were complete in pages.
C. Process
10. The process of the distribution
and retrieval were systematic.
11. The process of the distribution
and retrieval were logical.
12. The process of the distribution
and retrieval were clearly stated and
comprehensible.
13. The process of the distribution
and retrieval were clear and posted in
a strategic area.
14. The distribution and retrieval
schedule were announce ahead of
time.
15. The distribution and retrieval
schedule were disseminated
appropriately and in multi-way.
16. The health protocols were given
high regards during the distribution
and retrieval of SLMs.
D. Personnel
17. The distribution and retrieval
personnel were courteous and polite.
18. The distribution and retrieval
personnel were efficient.
19. The distribution and retrieval
personnel were responsive to the
needs of the recipient.

________________________________
Evaluator

Address: Purok 1 Barangay Mahayag, Davao City

227-7361