Republic of the Philippines

Department of Education
REGION III
SCHOOLS DIVISION OF SAN JOSE DEL MONTE CITY
SAN JOSE DEL MONTE NATIONAL TRADE SCHOOL
Brgy. Fatima V, City of San Jose del Monte, Bulacan

Name: ________________________________ Department: _____________________

Inclusive Dates When Teacher
Spent 2 Hours Outside School Premises: ______________________________________

Magna Carta for Public School Teachers

(RA 4670 & DepEd Memorandum291, s. 2008)
Teaching – Related Activities and Ancillary Duties Done Outside the School Premises

CHECKLIST FORM

 Making lesson plans

 Designing instructional materials
 Preparing assessment and evaluation tools
 Checking and recording learners’ outputs
 Conducting research/ innovations
 Attending/ participating in seminars/ workshops
 Facilitating the conduct of counseling/ mentoring/ coaching sessions
 Conducting home visits/ consultation and conference with parents
 Meeting with various key stakeholders
 Participating in the maintenance and improvement of school facilities
 Others. Please specify: _________________________________________

Note: This checklist form must be duly accomplished by the teacher and must be attached to the submitted DTR.

Prepared: Checked:

RICARDO P.GUANZON
Teacher Master Teacher II

Received: Approved:

SOCORRO D. PILI WILMA M. AQUINO

Administrative Officer Principal IV