Learner’s Name: _______________________________ Grade/Section: _____________ Date of Birth: __________________ Age: ________ Sex: [ ] Male [ ] Female Address: _______________________________________________________________ Parent/Guardian: _________________________ Contact No.: ___________________
Purpose: To document significant incidents (positive or negative) regarding a learner's behavior, character, or performance for guidance, intervention, or recognition. Sample Template (Text version – copy to MS Word) Republic of the Philippines Department of Education Region [___] Schools Division of [___] [Name of School] ANECDOTAL RECORD
INCIDENT REPORT
Quiz paper marked accordingly; conference with Leo and his parent via phone.
Recognized during class morning assembly; recorded for Good Manners and Right Conduct (GMRC) portfolio. sample deped anecdotal record form download
Nominate for “Honesty Award” end of quarter. If you need an actual downloadable file (Word/PDF), search: “DepEd Anecdotal Record Form PDF download” – or ask your school’s DRRM/guidance coordinator for the official regional template.
Seat reassignment; remind all students of exam rules. Example Completed Entry (Positive Incident) | Date of Incident | Time | Place | Observer | Signature | |----------------|------|-------|----------|------------| | Sept. 15, 2024 | 10:00 AM | Canteen | Mr. A. Cruz | signed | Nominate for “Honesty Award” end of quarter
During a Math quiz, Leo was seen looking at his classmate’s answer sheet twice. When confronted, he initially denied it but later admitted.
Maria found a wallet with ₱500 and an ID. She immediately returned it to the owner, a Grade 3 pupil, without being asked. Example Completed Entry (Positive Incident) | Date of
| Date of Incident | Time | Place | Name of Observer/Teacher | Signature | |-----------------|------|-------|-------------------------|------------| | | | | | |
Type of Incident: [ ] Positive (e.g., honesty, leadership, kindness) [ ] Negative (e.g., bullying, cheating, disrespect)
