GONZAGA EAST AND WEST DISTRICTS

JANUARY to DECEMBER 2016 INSTRUCTIONAL SUPERVISORY REPORT

Name of School:

Name of School Head:

1. Instructional Supervision
Date

Name of Teacher Observed

Subject

Form 178/NCBTS
Rating

Signature

Name of
Proponent

Remarks

Signature

Type of Evaluation Tool

Prepared/edited

Name of
Teacher

Remarks

Signature

Topics

Observation

Remarks

Signature

Name of Pupils

School
Initiated
Intervention

Remarks

Signature (pupil &

teacher)

2. Instructional Materials
Date

Name of Supplementary
Instructional Materials
designed

3. Evaluation Tools
Date

4. LAC Sessions
Date

5. Remedial Instruction
Date

Note: This is an example please accomplish in 3 copies in long bond paper following the format.
You can use additional sheets. Deadline: Saturday January 7, 2017.