Republic of the Philippines

DEPARTMENT OF EDUCATION
Region IV-A CALABARZON

DIVISION OF RIZAL

SAN RAFAEL ELEMENTARY SCHOOL

HONEY JIANE B. BAUTISTA TEACHER I
Name of Teacher Position

Appraisal Form #1: Checklist on Classroom Management

SECOND QUARTER

Most of the Time

All the time

Sometimes

Not at All
Rarely

RATING
Item

10 8 6 4 2

1 Calls learners by name (with the help of memory, IDs,

name tags or seat plan ) ü 10
Implements procedures in group work ( evidence of
2 instituted break-out procedures for peer work or group
work) ü 10

Implements discipline in letting students enter inside

3 (after flag ceremony, recess, activity outside the
classroom, etc) and making them take exit from the
classroom ü 8
Implements procedures in the distribution of materials
4 and collection, turning in, and handing back checked
learners’ work ü 8

Employs a facilitated and purposive checking of

5
attendance (finds out who are absent/cutting classes
and why and make a follow up) ü 6

Implements proactive discipline plan (e.g. detects

6 inappropriate behavior and intervenes, calls the
learners’ attention, deal with disruption appropriately
to avoid arguments) ü 10
Uses efficient routines in starting and ending class
7
periods ü 8

8 Implements specified work formats (themes, exercise

notebooks, experiment notebooks, projects, etc.) ü 8
9 Provides authentic rewards and incentives
(appropriate praises, facial expression, gestures) ü 8
10 Reminds students of important schedules and
assignment efficiently ü 2
Manages time appropriately (engaged time on task—
11 arrives and leaves classroom on time and stays in the
classroom or activity area for the whole period)
ü 4
12 Movement in the classroom (moves around, divides
attention equally among students) ü 8
Gives clear directions (e.g. giving appropriate
13
examples or non-examples) ü 8
Gives clear directions (e.g. giving appropriate
14
examples or non-examples)
ü 8
Uses of appropriate non-verbal communication
15 (observes entire class and scans frequently,
signals/gestures) ü 10
Overall Rating 7.73
Description of Rating
8.5 - 10 Outstanding
6.5 - 8. 49 Very Satisfactory
4.5 - 6.49 Satisfactory
2.5 - 4. 49 Unsatisfactory
2.0 - 2. 49 Poor
 Republic of the Philippines

DEPARTMENT OF EDUCATION
Region IV-A CALABARZON
DIVISION OF RIZAL
SAN RAFAEL ELEMENTARY SCHOOL
HONEY JIANE B. BAUTISTA TEACHER I
Name of Teacher Position
Appraisal Form #2: Classroom Management - Ensuring and Maintaining Clean,
Conducive, Secure, and Ebnergy-Saving Environment
SECOND QUARTER

Most of the Time

All the time

Sometimes

Not at All
Rarely

RATING
Item

10 8 6 4 2

1 Electric fans/air-conditioned units are turned off when

not in use and when not necessary (when there is
fresh air, during recess time, lunchtime, and dismissal) ü 8
Lights are turned off when not in use and when not
2 necessary (when there is enough sunlight, during
recess time, lunchtime, and dismissal)
ü 10

3 Water faucets are turned off when not in use and after
dismissal ü 8
4 Classroom is open before the first session starts. ü 10
Classroom is locked when nobody is inside and after
5
dismissal of the last session for the day/night.
ü 8

6 Classroom has broom/s, dust pan, and garbage

containers. ü 6
7 Classroom has updated display boards. ü 6
Classroom has updated bulletin boards (Absences,
8
reminders, best work) ü 8
9 Learners do not throw their garbage anywhere.
ü 8
10 Learners segregate their trash.
ü 8

Homeroom PTA helps in performing minor

11 repairs/improvement of classroom and its
furniture/equipment. ü 6
Homeroom PTA helps in performing minor painting
12
works for the classroom and its furniture. ü 6

OVERALL RATING (TOTAL RATING ÷ 12 X 100) 7.67

Description of Rating
8.5 - 10 Outstanding
6.5 - 8. 49 Very Satisfactory
4.5 - 6.49 Satisfactory
2.5 - 4. 49 Unsatisfactory
2.0 - 2. 49 Poor
 Republic of the Philippines

DEPARTMENT OF EDUCATION
Region IV-A CALABARZON

DIVISION OF RIZAL
SAN RAFAEL ELEMENTARY SCHOOL
HONEY JIANE B. BAUTISTA TEACHER I
Name of Teacher Position
Appraisal Form #3: Checklist for Record Management
SECOND QUARTER

Some times
All the time

Most of the

Not at All
Rarely
Time

RATING
ITEM

10 8 6 4 2

1 Class record/s 10
ü
2 School Form 1 6
ü
3 School Form 2 ü 6

4 School Form 3 ü 6

5 Subject Grade Sheets 8

ü
6 Consolidated Grade Sheets 6
ü
7 Form 137 Permanent Records /SF 10 6
ü
8 Form 138 Report Card 6
ü
Keeps(monthly)/
9 submits(monthly /quarterly) List of Top Ten for a Grading Period 6
ü
up-to-date reports
10 School Form 5 (for the fourth quarter of SY) 6
ü
11 Anecdotal Records 6
ü
12 Lesson Plans 10
ü
13 Nutritional Status (For the 1st and 4th quarter of SY) 6
ü
14 Phil-IRI (For the 1 and 4 quarter of SY)
st th
ü 6

15 Test Results (per subject per section) ü 8

16 Guidance Notebook ü 6

17 Other reports required 8

ü
18 Class record/s
ü 10
19 School Form 1
ü 6

20 School Form 2 6
ü
21 School Form 3
ü 6

22 Subject Grade Sheets 6

ü
23 Consolidated Grade Sheets
ü 6
24 Form 137 Permanent Records /SF 10
ü 6
Accomplishes neat,
25 accurate, and complete Form 138 Report Card
reports personally ü 6
26 List of Top Ten for a Grading Period
ü 6
27 School Form 5 (for the fourth quarter of SY)
ü 6
28 Anecdotal Records
ü 6
29 Lesson Plans
ü 10
30 Nutritional Status (For the 1st and 4th quarter of SY)
ü ü 6
31 Phil-IRI (For the 1st and 4th quarter of SY)
ü ü 6
32 Test Results (per subject per section)
ü 6
33 Guidance Notebook ü 6
34 Other reports required ü 6
OVERALL RATING (TOTAL RATING ÷ 34 X 100)
6.65

Description of Rating
8.5 - 10 Outstanding
6.5 - 8. 49 Very Satisfactory
4.5 - 6.49 Satisfactory
2.5 - 4. 49 Unsatisfactory
2.0 - 2. 49 Poor
 Republic of the Philippines

DEPARTMENT OF EDUCATION
Region IV-A CALABARZON

DIVISION OF RIZAL
SAN RAFAEL ELEMENTARY SCHOOL
HONEY JIANE B. BAUTISTA TEACHER I
Name of Teacher Position
Appraisal Form #4: Checklist for Reviewing Lesson Plans
SECOND QUARTER
OBSERVED
ITEM REMARKS
YES NO
OBJECTIVES
1 Writes objectives clearly for students ü
2 Writes objectives in behavioral terms ü
Objectives are SMART (Specific, Measurable, Attainable,
3
Result-oriented, Time-bounded) ü
Objectives manifest psychomotor, cognitive and affective
4
domains of learning ü
SUBJECT MATTER
Based on CG/PSSLC Budget of Work (Expectation: On
6
time) ü
7 Reflects the use of references and IMs ü
PROCEDURES

The strategy used is suitable in developing the

8
lesson/subject matter. ü
Preparatory activity/ies employed effectively prepares or
motivates learners for the lesson (e.g. drill such phonics
9 drill, review, checking of assignment, unlocking of
difficulties, motivation such as a song, poem, anecdote,
mini-story, picture, game, trivia or motivating question) ü
Activities for the development of the lesson are

10 · well-organized ü
11 · objective-oriented ü
12 · meaningful to learners ü
Activities for the development of the lesson provide
opportunities for learners to ü
13 · develop higher order thinking skills (HOTS) ü
14 · make generalizations/conclusions ü
15 · apply knowledge and skills learned ü
EVALUATION

16 Directions are brief and concise ü

17 Items are aligned with the lesson objectives ü
18 Items are skill-based ü
ASSIGNMENT

19 Provide clear directions ü

Provides opportunities to enhance knowledge and skills

20
learned or prepares the learners for the next lesson
ü
 Republic of the Philippines

DEPARTMENT OF EDUCATION
Region IV-A CALABARZON

DIVISION OF RIZAL
SAN RAFAEL ELEMENTARY SCHOOL
HONEY JIANE B. BAUTISTA TEACHER I
NAME OF TEACHER POSITION

Appraisal Form #5: Checklist for Teacher/Class Observation

SECOND QUARTER
OBSERVED
ITEM
YES NO
INITIAL FOCUS

1 States objectives of the session clearly to students

ü

Gains attention of students (Punctuality, Good

2 Grooming, Posture, Classroom Presence, well-
prepared with all lesson paraphernalia)
ü
CONTENT EMPHASIS AND/OR LINKING

Stresses the importance/significance/essence of the

3
topic
ü
Links lesson to learners’ backgrounds and life
4 experiences, past learning including those in other
subject areas, and future learning ü

Points out similarities and differences of the previous

5
of the topic to the new one
ü
COMPREHENSIBLE INPUT

Uses speech appropriate for learners’ proficiency

5 level (slower rate, enunciation, simple sentence
structure for beginners) ü

6 Explain academic tasks clearly

ü

Use a variety of techniques to make content

7 concepts clear (e.g. modeling, visuals, hands-on
activities, demonstrations, gestures, body language)
ü
STRATEGIES
 Provide ample opportunities for students to use
strategies (e.g., problem solving, predicting,
8
organizing, summarizing, categorizing, evaluating,
self-monitoring).
ü
Use scaffolding techniques consistently (providing
the right amount of support to move students from
9
one level of understanding to a higher level)
throughout lesson.
ü
Use a variety of question types including those that
promote higher-order thinking skills throughout the
10
lesson (e.g., literal, analytical, and interpretive
questions). ü
INTERACTION

Provide frequent opportunities for interactions and

11 discussion between teacher/learner and among
learners, and encourage elaborated responses. ü

Use group configurations that support language and

12 content objectives of the lesson. Provide sufficient
wait time for student response consistently.
ü
Give ample opportunities for students to clarify key
13
concepts
ü
PRACTICE/APPLICATION

Provide hands-on materials and/or manipulatives for

14
students to practice using new content knowledge.
ü
Provide activities for students to apply content and
15
language knowledge in the classroom.
ü
EMPHASIS/REVIEW/ASSESSMENT

16 Give comprehensive review of key vocabularies.

ü
Give a comprehensive review of key content
17
concepts, skills, values, and attitudes.
ü

Provide feedback to learners regularly on their

18
output (e.g. language, content, work)
ü
 Conduct assessments of learner comprehension
based on learning objectives (e.g. spot checking,
19
group response, individual work, peer work and/or
group work)
ü
 Republic of the Philippines

ARTMENT OF EDUCATION
Region IV-A CALABARZON

DIVISION OF RIZAL
RAFAEL ELEMENTARY SCHOOL
TEACHER I
POSITION

m #5: Checklist for Teacher/Class Observation

SECOND QUARTER
REMARKS