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Republic of the Philippines

Department of Education
Region VI Western Visayas
Divison of Sagay City
Himoga-an Baybay Integrated School

GUIDANCE AND COUNSELING SERVICES
CONFIDENTIAL
ANECDOTAL REPORT

Person Observed: _______________________________________ Age: _________Sex: _______________
Grade and Section: __________________________________ School: ________________________________
Date: _________________________ Time: ______________ Place: ____________________

Context What was happening before the behaviour occurred?

Behavior What behaviour was manifested?

Effect How did the witness/es respond/react to the manifested behaviour?

Outcome How did person being observed react/respond to the witness/es?

Recommendation What are your recommendations to help the person being observed for his or her
welfare?

______________________________________
Signature over Printed Name of Observer

______________________________________
Designation/Position/Title