Republic of the Philippines

Department of Education
Region 02 (Cagayan Valley)
SCHOOLS DIVISION OFFICE OF ISABELA
Alibagu, City of Ilagan, Isabela 3300

District: _________________________________________________
School: __________________________________________________

Year 1
First Quarter Second Quarter
Module 1 Module 2 Module 3 Module 4

Identify Identify Identify

Identify Instructional Date of Formal Instructional Instructional Date of Formal
Instructional
Name of Newly-hired Teacher Supervision Classroom Remarks Supervision Supervision Classroom Remarks
Supervision
Employed / Date Employed / Observation Employed / Employed / Observation
Date Date Date

7
 8
9
10

Prepared by: Noted by: Approved:

___________________________________________ ______________________________________ _________________________________

(Signature over printed name of School Head) (Signature over printed name of PSDS/PIC) Schools Division Superintendent
 Third Quarter Fourth Quarter
Module 5 Module 6

Identify Identify Identify Date of

Instructional Instructional Date of Formal Instructional Evaluation of
Supervision Supervision Classroom Remarks Supervision Newly-hired
Employed / Employed / Observation Employed / Teacher
Date Date Date
_________________________
Division Superintendent
Republic of the Philippines
Department of Education
Region 02 (Cagayan Valley)
SCHOOLS DIVISION OFFICE OF ISABELA
Alibagu, City of Ilagan, Isabela 3300

District: _________________________________________________
School: __________________________________________________

Year 2
First Quarter Second Quarter Third Quarter

Identify Identify
Identify Date of Formal Instructional Date of Formal Instructional
Instructional
Name of Newly-hired Teacher Classroom Remarks Supervision Classroom Remarks Supervision
Supervision Observation Employed / Observation Employed /
Employed / Date Date Date

8
 9
10

Prepared by: Noted by: Approved:

___________________________________________ ___________________________________ ______________________________________

(Signature over printed name of School Head) (Signature over printed name of PSDS/PIC) Schools Division Superintendent
Third Quarter Fourth Quarter

Identify Date of
Date of Formal Instructional Evaluation of
Classroom Remarks Supervision Newly-hired
Observation Employed / Teacher
Date
Republic of the Philippines
Department of Education
Region 02 (Cagayan Valley)
SCHOOLS DIVISION OFFICE OF ISABELA
Alibagu, City of Ilagan, Isabela 3300

District: _________________________________________________
School: __________________________________________________

Year 3
First Quarter Second Quarter Third Quarter

Identify
Identify Date of Formal Instructional Date of Formal Date of
Instructional
Name of Newly-hired Teacher Classroom Remarks Supervision Classroom Remarks Completion of
Supervision Observation Employed / Observation the Program
Employed / Date Date

8
 9
10

Prepared by: Noted by: Approved:

___________________________________________ ___________________________________ ______________________________________

(Signature over printed name of School Head) (Signature over printed name of PSDS/PIC) Schools Division Superintendent