Republic of the Philippines
Department of Education
CARAGA Region
Division of Agusan del Sur
NUEVA GRACIA NATIONAL HIGH SCHOOL
Nueva Gracia, Loreto, Agusan del Sur
School ID. 317427
Anecdotal Record
Student Name: ___________________________
Date: ___________________________
Time: ___________________________
Observer's Name: ___________________________
Incident/Observation: (Briefly describe what happened. Include specific details
about the behavior, interaction, or situation.)
Context: (Describe the setting or circumstances in which the incident occurred.
Include any relevant background information.)
Student’s Reaction:(Detail the student’s response or behavior during the incident.
How did they react to the situation or to others involved?)
Impact on Learning/Behavior:(Discuss how this incident affects the student’s
learning, behavior, or interactions with others. Note any changes in their usual patterns
or performance.)
Follow-Up Actions: (Describe any actions taken as a result of this observation.
Include any plans for further observation, interventions, or communication with
parents/guardians.)
Additional Notes:(Include any other relevant information that may help in
understanding the student’s needs or progress.)
Observer’s Signature: ___________________________
Date: ___________________________
